proofreading team. the care and feeding of children a catechism for the use of mothers and children's nurses by l. emmett holt, m.d., ll.d. professor of diseases of children in the college of physicians and surgeons (columbia university) attending physician to the babies' hospital and the foundling hospital, new york fourth edition, revised and enlarged new york and london d. appleton and company copyright, , , , by d. appleton and company [transcriber's note: the text scans did not include a table of contents so the following has been added for the convenience of the reader.] contents i. the care of children bathing genital organs eyes mouth skin clothing napkins nursery airing weight, growth, and development dentition ii. infant feeding nursing weaning artificial feeding selection and care of milk used for infant feeding modification of cow's milk food for healthy infants--the early months food for healthy infants--the later months general rules for guidance in the use of the formulas given addition of other foods to milk overfeeding loss of appetite changes in food required by special symptoms or conditions common mistakes in milk modification and infant feeding preparation of cow's milk at home directions for feeding infants intervals of feeding regularity in feeding sterilized milk modified milk of the milk laboratories peptonized milk feeding during the second year feeding during the third year iii. the diet of older children milk and cream eggs meats and fish vegetables cereals broths and soups bread, crackers, and cakes desserts fruits indigestion in older children general rules to be observed in feeding food formulas iv. miscellaneous bowels sleep exercise cry lifting children temperature nervousness toys kissing convulsions foreign bodies colic earache croup contagious diseases scurvy constipation diarrhoea bad habits vaccination weight charts the care and feeding of children part i the care of children bathing _at what age may a child be given a full tub bath?_ usually when ten days old; it should not be given before the cord has come off. _how should the bath be given?_ it should not be given sooner than one hour after feeding. the room should be warm; if possible there should be an open fire. the head and face should first be washed and dried; then the body should be soaped and the infant placed in the tub with its body well supported by the hand of the nurse. the bath should be given quickly, and the body dried rapidly with a soft towel, but with very little rubbing. _at what temperature should the bath be given?_ for the first few weeks at ° f.; later, during early infancy, at ° f.; after six months, at ° f.; during the second year, from ° to ° f. _with what should the bath be given?_ soft sponges are useful for bathing the body, limbs and scalp. there should be a separate wash-cloth for the face and another for the buttocks. _what are the objections to bath sponges?_ when used frequently, they become very dirty and are liable to cause infection of the eyes, mouth or genital organs. _under what circumstances should the daily tub bath be omitted?_ in the case of very feeble or delicate infants on account of the exposure and fatigue, and in all forms of acute illness except by direction of the physician. in eczema and many other forms of skin disease much harm is often done by bathing with soap and water, or even with water alone. genital organs _how should the genital organs of a female child be cleansed?_ best with fresh absorbent cotton and tepid water, or a solution of boric acid, two teaspoonfuls to the pint. this should be done carefully at least once a day. if any discharge is present, the boric-acid solution should invariably be used twice a day. great care is necessary at all times to prevent infection which often arises from soiled napkins. _how should the genital organs of a male child be cleansed?_ in infancy and early childhood the foreskin should be pushed back at least twice a week while the child is in his bath, and the parts thus exposed washed gently with absorbent cotton and water. if the foreskin is tightly adherent and cannot readily be pushed back, the physician's attention should be called to it. the nurse or mother should not attempt forcible stretching. _when is circumcision advisable?_ usually, when the foreskin is very long and so tight that it cannot be pushed back without force; always, when this condition is accompanied by evidences of local irritation or difficulty in passing water. eyes _how should the eyes of a little baby be cleansed?_ with a piece of soft linen or absorbent cotton and a lukewarm solution of salt or boric acid,--one half of an even teaspoonful to one pint of water. _if pus appears in the eyes, what should be done?_ they should be cleansed every hour with a solution of boric acid (ten grains to one ounce of water). if the lids stick together, a little vaseline from a tube should be rubbed upon them at night. if the trouble is slight, this treatment will control it; if it is severe, a physician should be called immediately, as delay may result in loss of eyesight. mouth _how is an infant's mouth to be cleansed?_ an excellent method is by the use of a swab made by twisting a bit of absorbent cotton upon a wooden toothpick. with this the folds between the gums and lips and cheeks may be gently and carefully cleansed twice a day unless the mouth is sore. it is not necessary after every feeding. the finger of the nurse, often employed, is too large and liable to injure the delicate mucous membrane. _what is sprue?_ it appears on the lips and inside the cheeks like little white threads or flakes. it is also called thrush. in bad cases it may cover the tongue and the whole of the inside of the mouth. _how should a mouth be cleansed when there is sprue?_ it should be washed carefully after every feeding or nursing with a solution of borax or bicarbonate of soda (baking soda), one even teaspoonful to three ounces of water, and four times a day the boric-acid solution mentioned should be used. skin _how should the infant's skin be cared for to prevent chafing?_ first, not too much nor too strong soap should be used; secondly, careful rinsing of the body; thirdly, not too vigorous rubbing, either during or after the bath; fourthly, the use of dusting powder in all the folds of the skin,--under the arms, behind the ears, about the neck, in the groin, etc. this is of the utmost importance in very fat infants. _if the skin is very sensitive and chafing easily produced, what should be done?_ no soap should be used, but bran or salt baths given instead. _how should a bran bath be prepared?_ one pint of wheat bran should be placed in a bag of coarse muslin or cheese-cloth, and this put in the bath water. it should then be squeezed for five minutes until the water resembles a thin porridge. _how should a salt bath be prepared?_ a teacupful of common salt or sea salt should be used to each two gallons of water. _how should the buttocks be cared for?_ this is the most common place for chafing, as the parts are so frequently wet and soiled; hence the utmost pains should be taken that all napkins be removed as soon as they are wet or soiled, and the parts kept scrupulously clean. _if the parts have become chafed, what should be done?_ only bran and salt baths should be used, and in very severe cases even these may have to be omitted for a day or two. the parts may be cleansed with sweet oil and a little absorbent cotton, and the skin kept covered with a dusting powder composed of starch two parts, boric acid one part. _what is prickly heat, and how is it produced?_ it consists of fine red pimples, and is caused by excessive perspiration and the irritation of flannel underclothing. _how should it be treated?_ muslin or linen should be put next to the skin; the entire body should be sponged frequently with equal parts of vinegar and water, and plenty of the starch and boric-acid powder mentioned should be used. clothing _what are the most essential things in the clothing of infants?_ that the chest shall be covered with soft flannel, the limbs well protected but not confined, and the abdomen supported by a broad flannel band, which should be snug but not too tight. it is important that the clothing should fit the body. if it is too tight it interferes with the free movements of the chest in breathing, and by pressing upon the stomach sometimes causes the infant to vomit soon after swallowing its food. if the clothing is too loose it is soon thrown into deep folds or bunches, which cause much discomfort. no pins should be used, but, instead all bands about the body should be basted. the petticoats should be supported by shoulder straps. _how should the infant be held during dressing and undressing?_ nothing is more awkward than to attempt to dress a young baby in a sitting posture. it should lie upon the nurse's lap until quite old enough to sit alone, the clothing being drawn over the child's feet, not slipped over the head. _of what use is the band?_ it protects the abdomen, but its most important use is to support the abdominal walls in very young infants, and in this way to prevent the occurrence of rupture. _how long is this band required?_ the snug flannel band, not usually more than four months. in healthy infants this may then be replaced by the knitted band, which may be worn up to eighteen months. the band is an important article of dress in the case of thin infants whose abdominal organs are not sufficiently protected by fat. with such, or with those prone to diarrhoea, it is often advisable to continue the band until the third year. _what changes are to be made in the clothing of infants in the summer?_ only the thinnest gauze flannel undershirts should be worn, and changes in temperature should be met by changes in the outer garments. the greatest care should be taken that children are not kept too hot in the middle of the day, while extra wraps should be used morning and evening, especially at the seashore or in the mountains. _should older children be allowed to go with their legs bare?_ if strong and well there is no objection to this in very hot weather. in cold weather, however, it is doubtful if any children are benefited by it, particularly in a changeable climate like that of new york. many delicate children are certainly injured by such attempts at hardening. _what sort of underclothing should be worn during cold weather?_ never the heaviest weight, even in winter. four grades are usually sold, the next to the heaviest being thick enough for any child. _do little children require as heavy flannels as older people?_ not as a rule. they usually live in a warm nursery; their circulation is active; and they always perspire easily during their play. when they go out of doors, the addition of coats and leggings renders thick flannels unnecessary. _are not many little children clothed too thinly for the ordinary house?_ very few. the almost invariable mistake made in city homes is that of excessive clothing and too warm rooms. these two things are among the most frequent reasons for their taking cold so easily. napkins _how should napkins be taken care of?_ they should he immediately removed from the nursery when soiled or wet. soiled napkins should be kept in a receptacle with a tight cover, and washed as soon as possible. _should napkins which have been only wet be used a second time without washing?_ it is no doubt better to use only fresh napkins, but there is no serious objection to using them twice unless there is chafing of the skin. clean napkins, changed as soon as wet or soiled, are of much importance in keeping the skin healthy. _what are the important things to be observed in washing napkins?_ soiled napkins should not be allowed to dry, but should receive a rough washing at once; they should then be kept in soak in plain water until a convenient time for washing,--at least once every day,--when they should be washed in hot suds and boiled at least fifteen minutes. afterward they should be very thoroughly rinsed or they may irritate the skin, and ironed without starch or blueing. they should never be used when clamp. nursery _what are the essentials in a good nursery?_ the furnishings should be very simple, and unnecessary hangings and upholstered furniture should be excluded. as large a room as possible should be selected--one that is well ventilated, and always one in which the sun shines at some part of the day, as it should be remembered that an average child spends here at least three fourths of its time during the first year. the nursery should have dark shades at the windows, but no extra hangings or curtains; about the baby's crib nothing but what can be washed should be allowed. the air should be kept as fresh and as pure as possible. there should be no plumbing no drying of napkins or clothes, no cooking of food, and no gas burning at night. a small wax night-light answers every purpose. _how should a nursery be heated?_ best by an open fire; next to this by a franklin stove. the ordinary hot-air furnace of cities has many objections, but it is not so bad as steam heat from a radiator in the room. a gas stove is even worse than this, and should never be used, except, perhaps, for a few minutes during the morning bath. _at what temperature should a nursery be kept during the day?_ best, ° to ° f., measured by a thermometer hanging three feet from the floor. never should the temperature be allowed to go above ° f. _at what temperature during the night?_ during the first two or three months, not below ° f. after three months the temperature may go as low as ° f. after the first year it may be ° or even ° f. _at what age may the window be left open at night?_ usually after the third month, except when the outside temperature is below freezing point. _how often should the nursery be aired?_ at least twice a day--in the morning after the child's bath, and again in the evening before the child is put to bed for the night. this should be done thoroughly, and the child should be removed meanwhile to another apartment. it is well to air the nursery whenever the child is out of the room. _what symptoms are seen in a child who is kept in too hot a room?_ it becomes pale, loses appetite, shows symptoms of indigestion, occasionally vomits, stops gaining in weight, perspires very much, and takes cold easily because of this and also because of the great difference between the indoor and outdoor temperatures. its condition may be such as to lead one to suspect very serious illness. airing _how early may airing indoors he commenced and how long may it be continued?_ airing in the room may be begun, even in cold weather, when the child is one month old, at first for only fifteen minutes at a time. this period may be gradually lengthened by ten or fifteen minutes each day until it is four or five hours. this airing may be continued in almost all kinds of weather. _is there not great danger of a young baby's taking cold when aired in this manner?_ not if the period is at first short and the baby accustomed to it gradually. instead of rendering the child liable to take cold, it is the best means of preventing colds. _how should such an airing be given?_ the child should be dressed with bonnet and light coat as if for the street and placed in its crib or carriage which should stand a few feet from the window all the windows are then thrown wide open, but the doors closed to prevent draughts. screens are unnecessary. _at what age may a child go out of doors?_ in summer, when one week old; in spring and fall, usually at about one month; in winter, when about three months old, on pleasant days, being kept in, the sun and out of the wind. _what are the best hours for airing out of doors?_ in summer and early autumn a child may be out almost any time between seven in the morning and sunset; in winter and early spring, a young child only between or a.m. and p.m., although this depends somewhat upon the climate. in new york and along the atlantic coast the early mornings are apt to be damp and the afternoons raw and cloudy. _on what kind of days should a baby not go out?_ in sharp winds, when the ground is covered with melting snow, and when it is extremely cold. a child under four months old should not usually go out if the thermometer is below freezing point; nor one under eight months old if it is below ° f. _what are the most important things to be attended to when the child is out in its carriage?_ to see that the wind never blows in its face, that its feet are properly covered and warm, and that the sun is never allowed to shine directly into its eyes when the child is either asleep or awake. _of what advantage to the child is going out?_ fresh air is required to renew and purify the blood, and this is just as necessary for health and growth as proper food. _what are the effects produced in infants by fresh air?_ the appetite is improved, the digestion is better, the cheeks become red, and all signs of health are seen. _is there any advantage in having a child take its airing during the first five or six months in the nurse's arms?_ none whatever. a child can be made much more comfortable in a baby carriage, and can be equally well protected against exposure by blankets and the carriage umbrella. _what are the objections to an infant's sleeping out of doors?_ there are no real objections. it is not true that infants take cold more easily when asleep than awake, while it is almost invariably the case that those who sleep out of doors are stronger children and less prone to take cold than others. _what can be done for children who take cold upon the slightest provocation?_ they should be kept in cool rooms, especially when asleep they should not wear such heavy clothing that they are in a perspiration much of the time. every morning the body, particularly the chest and back, should be sponged with cold water ( ° to ° f.). _how should this cold sponge bath be given?_ the child should stand in a tub containing a little warm water, and a large bath sponge filled with cold water should be squeezed two or three times over the body. this should be followed by a vigorous rubbing with a towel until the skin is quite red. this may be used at three years, and often at two years. for infants a little higher temperature ( ° to °) may be used. weight, growth, and development _of what importance is the weight of the child?_ nothing else tells so accurately how well it is thriving. during the first year a record of the weight is almost indispensable; throughout childhood it is of much interest and is the best guide to the physical condition. it will well repay any mother or nurse to keep such a record. _how frequently should a child be weighed?_ every week during the first six months, and at least once in two weeks during the last six months of the first year. during the second year a child should be weighed at least once a month. _how rapidly should an infant gain in weight during the first year?_ there is usually a loss during the first week of from four to eight ounces; after this a healthy child should gain from four to eight ounces a week up to about the sixth month. from six to twelve months the gain is less, usually from two to four ounces a week. _is it to be expected that bottle-fed infants will gain as rapidly as those who are nursed?_ they seldom do so during the first month; after that time under favourable circumstances the gain is usually quite as regular, and during the latter half of the first year it is likely to be more continuous than in a nursing infant, because the latter usually loses weight at the time of weaning. _why do they not gain so rapidly at first?_ it takes a few weeks for the stomach to become accustomed to cow's milk, and until this is accomplished it is necessary to make the milk very weak or the child's digestion will be upset. _for a child of average weight at birth (seven to seven and a half pounds) what should be the weight at the different periods during the first year?_ at three months it should be twelve to thirteen pounds; at six months, fifteen to sixteen pounds; at nine months, seventeen to eighteen pounds; at one year, twenty to twenty-two pounds. at five months a healthy child will usually double its weight, and at twelve months it will nearly treble its weight. _do all healthy infants gain steadily in weight during the first year?_ as a rule they do; yet it is seldom the case that one gains every week for the entire year. with most infants there are from time to time periods of a few weeks in which no gain is made. these are more often seen from the seventh to the tenth month and frequently occur when the child is cutting teeth, sometimes during very hot weather. _is it true that every infant who gains rapidly in weight is thriving normally?_ not invariably. some who are fed upon prepared infant foods increase rapidly in weight but not in strength, nor in their development in other respects. _is the weight of as much value in the second year as a guide to the child's condition?_ after the first year, the gain in weight is seldom continuous; there are many interruptions, some depend on season, and others often occur without apparent cause. _at what age should the fontanel close?_ the average is about eighteen months. it seldom closes earlier than fourteen months, and it should not be open at two years. _at what age should a child hold up its head?_ as a rule during the fourth month, and often during the third month, the head can be held erect when the body is supported. _when does an infant first laugh aloud?_ usually from the third to the fifth month. _when does it begin to reach for toys and handle them?_ usually from the fifth to the seventh month. _at what age should a child be able to sit and to stand alone?_ at seven or eight months a healthy child is usually able to sit erect and support the body. during the ninth and tenth months are usually seen the first attempts to bear the weight upon the feet, and at eleven or twelve months most children can stand with assistance. _when should a child walk alone?_ the first attempts are generally seen in the twelfth or thirteenth month. at fifteen or sixteen months the average child is able to run alone. _what conditions postpone these events?_ prematurity, a very delicate constitution, any severe or prolonged illness, and especially chronic disturbances of digestion making feeding difficult. a common cause of late sitting, standing, or walking is rickets. _should a child be urged to walk?_ never; he is usually quite willing to do so as soon as his muscles and bones are strong enough. none of the contrivances for teaching children to walk are to be advised. _when do children begin to talk?_ generally at one year a child can say "papa" and "mamma" or other single words. at the end of the second year the average child is able to put words together in short sentences. _if at two years the child makes no attempt to speak, what should be suspected?_ either that the child is a deaf-mute or that it is mentally deficient, although this is occasionally seen in children who are only very backward. _table showing the average weight, height, and circumference of head and chest of boys_[ ] at birth weight - / pounds. height - / inches. chest - / " head " one year weight pounds. height inches. chest " head " two years weight - / pounds. height - / inches. chest " head " three years weight pounds. height inches. chest " head - / " four years weight pounds. height inches. chest - / " head - / " five years weight pounds. height - / inches. chest - / " head - / " six years weight pounds. height inches. chest " seven years weight - / pounds. height inches. chest - / " eight years weight - / pounds. height inches. chest - / " nine years weight pounds. height inches. chest . " ten years weight - / pounds. height inches. chest " the above weights are with ordinary house clothes. [ ] weights for the first four years are without clothes. the weight of girls is on the average about one pound less than boys. they are about the same in height. charts showing weight curve for the first year, and from one year to fourteen years are given at the end of this book. dentition _how many teeth are there in the first set?_ twenty. _what is the time of their appearance?_ the two central lower teeth are usually the first to appear, and come from the fifth to the ninth month; next are the four upper central teeth, which come from the eighth to the twelfth month. the other two lower central teeth and the four front double teeth come from the twelfth to the eighteenth month. then follow the four canine teeth, the two upper ones being known as the "eye teeth," and the two lower as the "stomach teeth"; they generally come between the eighteenth and the twenty-fourth month. the four back double teeth, which complete the first set, come between the twenty-fourth and thirtieth month. at one year a child usually has six teeth. at one and a half years, twelve teeth. at two years, sixteen teeth. at two and a half years, twenty teeth. _what are the causes of variation?_ the time of appearance of the teeth varies in different families; in some they come very early, in others much later. the teeth may come late as a result of prolonged illness and also from rickets. _what symptoms are commonly seen with teething?_ in healthy children there is very often fretfulness and poor sleep for two or three nights; there may be loss of appetite, so that only one half the usual amount of food is taken; there is salivation or drooling, and often slight fever; there may be some symptoms of indigestion, such as vomiting or the appearance of undigested food in the stools. in delicate children all these symptoms may be much more severe. _how long do these symptoms last?_ usually only three or four days; but there may be no gain in weight for two or three weeks. _what is the cause of most of the other symptoms attributed to teething?_ nearly all of them come from indigestion due to bad feeding. part ii infant feeding _what is the best infant food?_ mother's milk. _of what is mother's milk composed?_ thirteen parts solids and eighty-seven parts water. _what are the solids?_ fat, sugar, proteids, and salts. _what is the fat?_ the cream. _what is the sugar?_ it is lactose, or milk sugar. _what are the proteids?_ the curd of the milk. _are all these elements necessary?_ yes; we cannot expect to rear a healthy infant unless they are all in his food. _of what use is the fat?_ it is needed for the growth of the bones, the nerves, the fat of the body, and the production of heat. _of what use is the sugar?_ it is needed for the production of heat, and to make fat in the body. _of what use are the proteids?_ they are needed for the growth of the cells of the body, such as those of the blood, the various organs, and the muscles. _of what use are the salts?_ particularly for the growth of bone. _of what use is the water?_ by means of the water the food is kept in a state of minute subdivision or in solution, so that the delicate organs of a young infant can digest it. it is also necessary to enable the body to get rid of its waste. nursing _should all mothers attempt to nurse their children?_ as a rule they should do so, but there are many conditions when they should not. _what are the most important ones?_ if the mother has or has had tuberculosis or any other serious chronic disease, or is herself in very delicate health, she should not try. she is likely soon to fail in nourishing her child, and the attempt may do herself much harm as well as injure the child. _how often should infants be nursed during the first two days of life?_ usually only four or five times daily, since there is very little milk secreted at this time. _when does the milk come in abundance?_ usually on the third day, sometimes not until the fourth or fifth day. _should the infant be fed anything additional during the first two days?_ usually not; if much food were necessary, we may be sure nature would have provided it. water, however, should be given regularly. _how frequently should an infant be nursed during the first week?_ after the third day, every two hours during the day and twice during the night. the frequency during the rest of the first year is given in the following table: ------------------------------------------------------------------ period. nursings in interval night nursings hours. by day. ( p.m. to a.m.). ------------------------------------------------------------------ st and d day hours. days to weeks " weeks to months - / " to months " to months " ------------------------------------------------------------------ _how long should the child be kept at the breast for one nursing?_ not over twenty minutes. _should the child take both breasts at one nursing?_ if the milk is very abundant one breast may be sufficient, otherwise both breasts may be taken. _what are the important things to be attended to in nursing?_ first, regularity; it is just as important as in the case of bottle-feeding. secondly, the nipples should be kept clean by being washed after every nursing. _what should be the diet of a nursing mother?_ she should have a simple but generous diet with plenty of fluids; three regular meals may be given and gruel, milk, or cocoa at bed-time and sometimes between meals. she may take eggs, cereals, most soups, and nearly all vegetables, avoiding sour fruits, salads, pastry, and most desserts. meat should not be taken more than twice daily, and in many cases but once. she should take but little tea or coffee, and ordinarily no wine or beer. _are fruits likely to disturb a nursing infant?_ sour fruits in some cases may do so, but sweet fruits and most cooked fruits are useful. _what else is important in the life of the nursing mother?_ she should lead a simple natural life; should have regular out-of-door exercise, preferably walking or driving, as soon after her confinement as her condition will permit. she should have regular movements from the bowels daily. she should be as free as possible from unnecessary cares and worry; her rest at night should be disturbed as little as possible; she should lie down for at least one hour in the middle of the day. _does the nervous condition of the mother affect the milk?_ very much more than her diet; worry, anxiety, fatigue, loss of sleep, household cares, social dissipation etc., have more than anything else to do with the failure of the modern mother as a nurse. uncontrolled emotions, grief, excitement, fright, passion, may cause milk to disagree with the child; at times they may excite acute illness, and at other times they may cause a sudden and complete disappearance of the milk. _does menstruation affect the milk?_ in nearly all cases the quantity of milk is lessened so that the infant is not satisfied and may gain less in weight or not at all. in many cases the quality of the milk is also affected to such a degree as to cause slight disturbances of digestion, such as restlessness, colic, and perhaps some derangement of the bowels. in a few, attacks of acute indigestion are excited. _is regular menstruation a reason for stopping nursing?_ not invariably; as a rule both functions do not go on together. but if the child is gaining regularly in weight between the periods, nursing may be continued indefinitely, although it may be well to feed the infant wholly or in part during the first day or two that the mother is unwell. _what symptoms indicate that a nursing infant is well nourished?_ the child has a good colour, sleeps for two or three hours after nursing, or, if awake, is quiet, good-natured, and apparently comfortable. it has normal movements of the bowels and gains steadily in weight. _what symptoms indicate that a child who is nursing is not properly nourished?_ it does not gain and may even lose in weight. it no longer exhibits its usual energy and playfulness, but is either listless and indifferent or cross, fretful and irritable, and is apt to sleep poorly. it grows pale and anæmic and its tissues become soft and flabby. when the milk is scanty it will often nurse a long time at the breasts, sometimes three quarters of an hour, before stopping. at other times it may take the breast for a moment only, and then turn away in apparent disgust. _what should be done when such symptoms appear?_ this depends upon the severity of the symptoms and how long they have lasted. if the child has made no gain for three or four weeks, or is losing weight, immediate weaning will probably be necessary; in any case, other food in addition to the breast milk should be given at once. one may begin by alternating the nursing and the bottle-feeding and increase the number of bottle-feedings as may be indicated by the results. _is there any objection to a baby being partly nursed and partly fed?_ none whatever; it is often better from the outset to feed the baby during the night, in order not to disturb the mother's rest. _what symptoms indicate that the mother's milk disagrees with the child?_ the child suffers from almost constant discomfort sleeps; little and then restlessly, cries a great deal, belches gas from the stomach, and passes much by the bowels, or if not passed, the gas accumulates and causes abdominal distention and colicky pain. there may be vomiting, but more often the trouble is intestinal. sometimes the bowels are constipated, but usually the movements are frequent, loose, green, contain mucus and are passed with much gas. _what should be done under these circumstances?_ if the symptoms have persisted for two or three weeks and the child is not gaining in weight, there is little chance of improvement, and the child should be taken from the breast at once. if there is some gain in weight, one may try for a little longer, endeavouring to improve the mother's milk by rest, fresh air, careful diet, etc. however, one should always realize that the trouble is with the milk, not with the child. _what changes should be made if a nursing infant habitually vomits?_ if this occurs soon after nursing, the infant has usually taken too much and the time of nursing should be shortened, or one breast may be given instead of two; the nursing should also be interrupted by occasional rests, so that the milk is not taken too fast. if the vomiting occurs some time after nursing and is repeated, it is a sign of indigestion; often because the milk is too rich in fat. the intervals between nursings should then be lengthened; the breast milk may be diluted by giving one or two tablespoonfuls of plain boiled water, lime-water, or barley-water, five or ten minutes before nursing; the mother should eat less hearty food, especially less meat. _what should be done if the infant has frequent or habitual colic?_ this is usually because the milk is too rich in proteids; the mother should take more out-of-door exercise, eat less meat, and seek to control her emotions; all causes of worry should be removed. _can constipation in a nursing infant be controlled through the mother's milk?_ only to a limited extent. it is important that the mother's bowels be regular and her digestion good. an increase in the meat and milk of her diet is sometimes beneficial. weaning _at what age should the child be weaned from the breast?_ usually weaning should be begun at nine or ten months by substituting one feeding a day for one nursing, later two feedings, and thus gradually the child is to be taken from the breast altogether. _what is the principal reason for weaning earlier?_ the most important one is that the child is not thriving--not gaining in weight and not progressing normally in its development. serious illness of the mother, or pregnancy, may make weaning necessary. _at what age should the weaning be completed?_ generally at one year. in summer it may sometimes be advisable to nurse an infant a little longer rather than wean in warm weather; but even then the dangers of weaning are much less than those of continuing to nurse, as is so often done, after the milk has become very scanty and poor in quality. _when should a child who is weaned from the breast be taught to drink from the cup, and when to take the bottle?_ if weaning is done as early as the eighth or ninth month it is better to give the bottle; if from the tenth to the twelfth month the infant should be taught to drink or be fed with a spoon. _how may some of the difficulties in weaning be overcome?_ by feeding every nursing infant once a day or by giving it water regularly from a feeding-bottle. it then becomes accustomed to the bottle. this is a matter of great convenience during the whole period of nursing when the mother or nurse is from necessity away from the child for a few hours; when more feeding is required at weaning time the child does not object. _when should a child be weaned from the bottle?_ with children who are not ill, weaning from the bottle should invariably be begun at the end of the first year, and after a child is thirteen or fourteen months old the bottle should not be given except at the night feeding. _is there any objection to the child's taking the bottle until it is two or three years old?_ there are no advantages and some serious objections. older children often become so attached to the bottle that only with the greatest difficulty can they be made to give it up. frequently they will refuse all solid food, and will take nothing except from the bottle so long as it is given, and when finally at three or four years, it is taken away, they will not touch milk during the rest of their childhood. the difficulty is here that children form the "bottle habit." this habit is troublesome, unnecessary, and should by all means be prevented. an exclusive diet of milk for children of two or three years often results in anæmia and malnutrition. _how should one train a child to do without the bottle?_ this is usually very easy if it is begun at one year. the milk should be poured into a tiny glass or cup and little by little the child is taught to drink; at first only a small portion of the food is taken in this way, the balance being given from the bottle; but in the course of a few weeks the average infant learns to drink from a cup without difficulty, and all the food can be so given. if the child is two or more years old, the only effective means of weaning from the bottle is through hunger. the bottle should be taken away at once and entirely, and nothing allowed except milk from a cup until the child takes this willingly. sometimes a child will go an entire day without food, occasionally as long as two days, but one should not be alarmed on this account and yield. this is a matter of the child's will and not of his digestion, and when once he has been conquered it is seldom that any further trouble is experienced. as soon as a child has learned to drink his milk from a cup, cereals and other solid foods may gradually be added to the diet. the educational value of such training is not the least important consideration. _can a baby just weaned take cow's milk of the same proportions as one of the same age who has had cow's milk from birth?_ very rarely; to give a baby who has had nothing but the breast from birth, plain cow's milk, or even that milk which a bottle-fed baby of the same age might take, is almost certain to cause indigestion. the change in the food is quite a marked one, and should be made gradually by beginning with a very weak milk and increasing its strength as the baby becomes accustomed to take cow's milk. _what would be the proper proportions for an infant weaned at four or five months?_ about the same as for a healthy bottle-fed infant of two months; the quantity of course should be larger. the food can in most cases be gradually increased so that in two or three weeks the usual strength for the age can be taken. _what would be the proper proportions for an infant weaned at nine or ten months?_ about the same as for a bottle-fed infant at four or five months, to be increased as indicated above. _will not a child lose in weight when placed upon so low a diet?_ very often it will do so for the first week or two, but after that will gain quite regularly; the acute indigestion, however, which generally accompanies the use of stronger milk will, in most cases, cause a greater loss. artificial feeding _what foods contain all the elements present in mother's milk?_ the milk of other animals,--cow's milk being the only one which is available for general use. _is it not possible for infants to thrive upon other foods than those containing fresh milk?_ they may do so for a time, but never permanently. the long-continued use of other foods as the sole diet is attended with great risk. _what are the dangers of such foods?_ frequently scurvy is produced (see page ), often rickets, and in other cases simply a condition of general malnutrition,--the child does not thrive, is pale, and its muscles are soft and flabby. the selection and care of milk used for infant feeding _what are the essential points in milk selected for the feeding of infants?_ that it comes from healthy cows, and that it is clean and fresh. _is it not important to select a rich milk?_ by no means; in fact the very rich milk of highly bred jerseys and alderneys has not been found nearly so satisfactory in infant feeding as that from some other herds, such, for example, as the common "grade cows." _which is the better, milk from one cow or the mixed milk of several cows?_ the mixed, or "herd milk," is usually to be preferred since it varies little from day to day; while that from a single cow may vary considerably. _how fresh is it important that cow's milk should be for the best results in infant feeding?_ this depends very much upon the season, and how carefully milk is handled. as ordinarily handled at the dairy and in the home, milk should not be used for infants in winter after it is forty-eight hours old; in summer not after it is twenty-four hours old, and it may be unsafe in a much shorter time. when handled with especial care milk may be safe for a longer time. _what are the two essentials in handling milk?_ . that it be kept clean and free from contamination. this necessitates that cows, stables, and milkers be clean, and that transportation be in sealed bottles; also that those who handle the milk do not come in contact with any contagious disease. all milk-pails, bottles, cans, and other utensils with which the milk comes in contact should be sterilized shortly before they are used, by steam or boiling water. . that it be cooled immediately after leaving the cows, and kept at as low a temperature as possible; to be efficient this should not be above ° f. milk produced under hygienic conditions and handled with special care is sold in bottles in a number of cities under the name of "certified," "guaranteed," or "inspected" milk. when available such milk should be used for infants. of course the extra care bestowed in its production and transportation increases the cost of the milk, but the best will usually be found in the end to be the cheapest. _how should milk be handled in the home when obtained fresh from the cows?_ that to be used for infants should be strained through a thick layer of absorbent cotton or several thicknesses of cheese-cloth into quart glass jars or milk bottles which should be covered and cooled immediately best by placing the bottles quite up to their necks in ice water or cold spring water, where they should stand for at least half an hour. that required for children who take plain milk may now be poured into half-pint bottles, stopped with cotton, and put in the ice-chest, or the coolest place possible. this first rapid cooling is very important and adds much to the keeping qualities of the milk. milk loses its heat very quickly when cooled in water, but very slowly when it is simply placed in a cold room. after standing four or five hours the top-milk may be removed; after twelve to sixteen hours the cream may be removed. _how should milk be handled when bottled milk is purchased?_ it should be cooled as just described, as its temperature is usually somewhat raised during transportation if it has been bottled at a dairy, the cream or the top-milk may be removed after an hour or so. _how should milk and cream be handled when they are purchased in bulk?_ such milk should never be used for infants when it is possible to obtain bottled milk, as it is much more liable to contamination. both cream and milk should be poured at once into covered vessels and kept in the coolest place possible. the cream and top-milk will seldom rise upon such milk with any satisfactory regularity. _what are the important things to be secured in nursery refrigerators?_ absolute cleanliness is essential; hence the inner portion should be of metal. those made entirely of metal are unsatisfactory as in them the ice melts very quickly. if the ordinary metal refrigerator sold is encased in a wooden box, we have the best form. another easy way of securing the same result is to make for the refrigerator a covering or "cosey" of felt or heavy quilting, which can be easily removed when wet or soiled. the compartments of the refrigerator should be so arranged that the bottles of milk are either in contact with the ice or very near it. the supply of ice should be abundant. often the amount of ice is so small, and the bottles so far away, that the temperature of the milk is never below ° or ° f. to be really effective a refrigerator should have a temperature where the milk is placed of not over ° f. the temperature should be tested with the nursery thermometer from time to time to ascertain what results are being obtained. spoiled milk owing to a faulty refrigerator is to be blamed for many attacks of acute illness among infants. next to the feeding-bottles it is the one thing in the nursery which should receive the closest attention. the modification of cow's milk _can cow's milk be fed to infants without any changes?_ no; for although it contains similar elements to those in mother's milk, they are not identical, and they are not present in the same proportions. _is this a matter of much importance?_ it is of the greatest importance. there are few infants who can digest cow's milk unless it is changed. to change cow's milk so as to make it more nearly resemble mother's milk is called _modifying_ cow's milk. _how is this milk whose proportions have been changed distinguished from the original unchanged milk?_ the changed milk is usually called "modified milk"? the original unchanged milk is known as "plain milk," "whole milk," "straight milk," or is referred to simply as "milk." _what are the principal differences between cow's milk and mother's milk?_ cow's milk has a little more than half as much sugar; it has nearly three times as much proteids and salts; its proteids are different and much more difficult of digestion; its reaction is decidedly acid, that of mother's milk is faintly acid or neutral. _are there any other important things to be considered?_ yes; mother's milk is always fed fresh and is practically sterile. cow's milk is generally kept twenty-four hours and sometimes much longer. it is always to a greater or less degree contaminated by dirt and germs, the number of which increases rapidly ( ) with the age of the milk; ( ) in proportion to amount of the dust or dirt which enters it; ( ) with any increase in the temperature at which the milk is kept. it is just as important for success in infant feeding that these conditions receive attention as that the proportions of the different elements of the milk are right. _how is the acidity of cow's milk overcome?_ by the addition of lime-water or bicarbonate of soda. if lime-water is used, one ounce to twenty ounces of food is generally required; if soda is used, twenty grains to twenty ounces of food. if there is a tendency to constipation the milk of magnesia (phillips's) may be used; from one half to one teaspoonful being added to each twenty ounces of food. _how is the sugar best increased?_ by adding milk sugar to the food; one ounce to each twenty ounces of food will give the proper quantity for the first three or four months. this will make the proportion about the same (between and per cent) as in mother's milk. _how should the sugar be prepared?_ simply dissolved in boiled water; if the solution is not clear, or if there is a deposit after standing, it should be filtered by pouring through a layer of absorbent cotton, half an inch thick, which is placed in an ordinary funnel. _will not cane (granulated) sugar answer as well?_ not as a rule; however, there are many infants who get on very well when cane sugar is used. it has the advantage of being much cheaper. a good grade of milk sugar is somewhat expensive, costing from twenty-five to sixty cents a pound, and cheap samples are apt to contain impurities. _if cane sugar is used, what amount should be added?_ considerably less than of the milk sugar. usually about half the quantity (half an ounce to twenty ounces of food) is as much as most infants can digest if the same quantity is used as of the milk sugar, the food is made unduly sweet, and the sugar is likely to ferment in the stomach and cause colic. _is not the purpose of the sugar to sweeten the food in order to make it palatable?_ not at all; although it does that, its real use is to furnish one of the essential elements needed for the growth of the body, and the one that is required by young infants in the largest quantity. _how do we know that this is so?_ by the fact that in good breast milk the amount of sugar is greater than that of the fat, proteids, and salts combined. _we have seen that cow's milk has nearly three times as much proteids (curd) and salts as mother's milk. how are these to be diminished?_ by diluting the milk. _will it be sufficient to dilute the milk twice (i.e., add two parts of water to one part of milk)?_ not for a very young infant. although this will give about the quantity of proteids present in mother's milk, the proteids of cow's milk are so much more difficult for the infant to digest, that in the beginning it should be diluted five or six times for most infants. _if cow's milk is properly diluted and lime-water and sugar added does it then resemble mother's milk?_ no; the mixture contains too little fat. _what is the easiest way of overcoming this?_ by increasing the fat in the milk before dilution. it may be done by using top-milk or a mixture of milk and cream. _what is top-milk?_ it is the upper layer of milk removed after standing a certain number of hours in a milk bottle, glass jar, or any tall vessel with straight sides. it contains most of the cream and some of the milk just below. the strength of the top-milk is measured by the fat it contains--e.g., a -per-cent milk contains per cent fat; -per-cent milk contains per cent fat, etc. these are the two strengths of top milk most used in infant feeding. _on what does the percentage of fat in top-milk depend?_ . on the length of time the milk has stood. . on the manner in which the top-milk is removed. . on the number of ounces removed. . on the richness of the milk used. unless these are known it is impossible to say even approximately how strong in fat the top-milk is. _when and how should top-milk be removed?_ if milk fresh from the cow, or before the cream has risen, is put into bottles and rapidly cooled, the top-milk may be removed in as short a time as four hours. in the case of bottled milk it makes little difference if it stands a longer time, even until the next day. the best means of removing it is by a small cream-dipper[ ] holding one ounce; although it may be taken off by a spoon or siphon. it should not be poured off. [ ] obtained from any of the walker-gordon milk laboratories, from james dougherty, no. west th street, new york, and from many druggists. price, cents. _how can we obtain a -per-cent top-milk with the different kinds of cow's milk?_ from a rather poor milk (containing -- - / per cent fat) by removing the upper eight ounces from a quart, or one fourth. from a good average milk (containing per cent fat) by removing the upper eleven ounces from a quart, or about one third. from a rich jersey milk (containing -- - / per cent fat) by removing the upper sixteen ounces, or one half. _how can we obtain a -per-cent top-milk with the different kinds of cow's milk?_ from a rather poor milk, by removing the upper eleven ounces from a quart, about one third. from a good average milk, by removing the upper sixteen ounces, or one half. from a rich jersey milk, by removing the upper twenty-two ounces, or about two thirds. [illustration: the percentage of fat in the different layers of milk of good average quality.] _what is cream?_ 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. it differs from milk chiefly in containing much more fat. _in what ways is cream now obtained?_ ( ) by skimming, after the milk has stood usually for twenty-four hours? this is known as "gravity cream." ( ) by an apparatus known as a separator; this is known as "centrifugal cream"; most of the cream now sold in cities is of this kind. the richness of any cream is indicated by the amount of fat it contains. the usual gravity cream sold has from to per cent fat. the cream removed from the upper part (one fifth) of a bottle of milk has about per cent fat. the usual centrifugal cream has to per cent fat. the heavy centrifugal cream has to per cent fat. food for healthy infants[ ]--the early months [ ] the directions and formulas given in the following pages are intended only for guidance in feeding children who are not suffering from any special disturbance of digestion; directions for such conditions are given in a later chapter. _what are the most important points to be remembered in modifying cow's milk for feeding during the early months?_ that of the different ingredients of milk the sugar is most easily digested; the fat is next; while the proteids are the most difficult. _what relation should the fat bear to the proteids during this period?_ for most infants with good digestion the best results are obtained when the fat is three times the proteids. however, this is not true of all. there are many healthy infants who are unable to digest this proportion of fat, and who do much better when the fat is made only twice the proteids. _how can one obtain formulas in which the fat is three times the proteids?_ by using for dilution a -per-cent milk (i.e., milk containing per cent fat) which serves as the primary formula from which all the other formulas of this series are derived. in -per-cent milk the fat is just three times the proteids. _how can one get the -per-cent milk?_ ( ) as top-milk, as described on page ; or, ( ) by mixing equal parts of plain milk and ordinary cream (containing about per cent fat); ( ) from any of the milk laboratories it may be ordered directly. _is it better to obtain the -per-cent milk by using a mixture of milk and cream, or as top-milk?_ if one can get milk fresh from the cows, the top-milk is to be preferred on account of freshness. the food can then be made up when the milk is but a few hours old. in cities, if one uses bottled milk, the upper third may also be used. but if one buys milk and cream separately, it is usually more convenient to mix these, as the cream will not rise upon milk a second time with any uniformity. _how can one obtain formulas in which the fat is twice the proteids?_ by using for dilution a -per-cent milk (i.e., milk containing per cent fat) which serves as the primary formula from which all the other formulas of this series are derived. in -per-cent milk the fat is just twice the proteids. _how can one get the -per-cent milk?_ ( ) as top-milk, as described on page ; or, ( ) by mixing three parts of milk and one part of ordinary ( per cent) cream; ( ) from any of the milk laboratories it may be obtained directly. as in the case of -per-cent milk, the top-milk is generally to be preferred to a mixture of milk and cream. _how should the food be prepared during the early months?_ it is convenient in calculation to make up twenty ounces of food at a time. the first step is to obtain the -per-cent milk or the -per-cent milk to be used as the primary formula. then to take the number of ounces of this that are called for in the formula desired. note.--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 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. [ ] if the milk sugar be measured in the milk-dipper, two scant dipperfuls may be calculated as one ounce. if measured in a tablespoon, three even tablespoonfuls may be calculated as one ounce. these formulas written out would be as follows: _first series_ _formulas for the early months from -per-cent milk_ ----------------------------------------------------------- i. ii. iii. iv. v. ----------------------------------------------------------- -per-cent milk oz. oz. oz. oz. oz. milk sugar " " " " " lime-water " " " " " boiled water " " " " " ----------------------------------------------------------- oz. oz. oz. oz. oz. ----------------------------------------------------------- as the milk sugar dissolves in the water the total in each column will be exactly twenty ounces. the food is strengthened by gradually increasing the milk and reducing the water. the approximate composition of these formulas expressed in percentages is as follows: ---------------------------------------- formula. fat. sugar. proteids. ---------------------------------------- i. . . . ii. . . . iii. . . . iv. . . . v. . . . ------------------------------------------ _second series_ _formulas for the early months from -per-cent milk_ ----------------------------------------------------------- i. ii. iii. iv. v. ----------------------------------------------------------- -per-cent milk oz. oz. oz. oz. oz. milk sugar " " " " " lime-water " " " " " boiled water " " " " " ----------------------------------------------------------- oz. oz. oz. oz. oz. ----------------------------------------------------------- the approximate composition of these formulas expressed in percentages is as follows: ---------------------------------------- formula. fat. sugar. proteids. ---------------------------------------- i. . . . ii. . . . iii. . . . iv. . . . v. . . . ------------------------------------------ _how is one to decide whether to use the first or the second series of formulas?_ with a large, strong child, having a good digestion one should use the first series. with a smaller, less vigorous child, whose digestion is not so good, or with one who does not do well upon the first series, the second series should be used. _why is it necessary to make the food so 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. _how rapidly can the food be increased in strength from formula i to ii, from ii to iii, etc.?_ no absolute rule can be given. usually we begin with i on the second day; ii on the fourth day; iii at one week or 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 v by the time it is three or four weeks old. a child with a feeble digestion must go much slower and may not reach v 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 ounces, the increase would be to ½ ounces; from ounces to ½ ounces, etc. at least two or three days should be allowed between each increase in the strength of the food. _what general rule can be given for increasing the food?_ to increase when the infant is not satisfied but is digesting well. _how does an infant show that he is not satisfied?_ he drains the bottle eagerly and cries when it is taken away. he often forms the habit of sucking his fingers immediately after. he begins to fret half an hour or an hour before the next feeding is due. _in the series of formulas given in the table the quantities are mentioned for making only twenty ounces of food. how should it be prepared when more than this quantity is needed?_ it is equally convenient to make up ounces, ounces, ounces, or ounces at a time. to make-- ounces of any formula add one quarter more of each ingredient. " " one half " " " " three quarters " " " " twice as much " " thus ounces of formula i would be obtained by using ½ ounces of milk, ¼ ounces of sugar and lime-water, ¼ ounces of water; ounces of the same would require ounces milk, ½ ounces lime-water and sugar, and ½ ounces water; ounces would require ½ ounces milk, ¾ ounces lime-water and sugar, and ¾ ounces water. the amount of water need not be calculated in any case, but after measuring carefully the other ingredients enough water should be added to bring the total up to the amount required. _how great an increase in the quantity should be made at one time?_ one may make up five ounces additional food; but the first two days only two or three ounces of the additional amount should be given; the next two days, four ounces; after two days more, the five ounces may be given. the increase in the quantity given at a single feeding should not be more than a quarter of an ounce. food for healthy infants--the later months _how long should the fat be as much as three times the proteids?_ this is seldom of advantage longer than three or four months. _what changes should then be made in the milk?_ after formula v of the first series ( ounces of -per-cent milk in ounces of food) has been reached, the fat should be increased very slowly for this proportion ( per cent) is near the limit for most healthy children. the milk should now be strengthened chiefly by raising the percentage of proteids. _how is this accomplished?_ the -per-cent milk and the formulas derived from it should now be discontinued, and those made from -per-cent milk used. _third series_ _formulas for the later months from -per-cent milk_ ----------------------------------------------------------- i. ii. iii. iv. v. ----------------------------------------------------------- -per-cent milk oz. oz. oz. oz. oz. milk sugar " " " / " / " lime-water " " " " " boiled water " " " " " barley gruel " " " " " ----------------------------------------------------------- oz. oz. oz. oz. oz. ----------------------------------------------------------- since the sugar dissolves, the total will be twenty ounces in each column. of any of the formulas, ounces is made by using one quarter more of each ingredient; ounces, by using one half more; ounces, by using three quarters more; ounces, by using twice as much, exactly as described in the first series on page . the approximate composition of these formulas expressed in percentages is as follows: ---------------------------------------- formula. fat. sugar. proteids. ---------------------------------------- i. . . . ii. . . . iii. . . . iv. . . . v. . . . ------------------------------------------ _how should the food be increased during this period?_ beginning with i of this series, which should usually follow v of the first or second series (pages , ), the increase may generally be made in a week or ten days to ii; in about two weeks more to iii; now more slowly to iv and v. when iv or v has been reached, the same formula may sometimes be continued for three or four months with no other change than an increase in the quantity. _in passing from formula v of the first series to formula i of the third series the proportion of fat is at first reduced. is this necessary or important?_ no; it only happens to come so in simplifying the calculation. it may be avoided by taking off at first the upper ounces as top-milk and using ounces of this in a -ounce mixture, in place of formula i; and by using for the next increase the upper ounces as top-milk, taking of this ounces in a -ounce mixture in place of formula ii. then should follow formula iii. _what further addition may be made to the food of the later months?_ usually about the sixth or seventh month, farinaceous food in the form of gruel may be added, this taking the place of part of the water and part of the sugar. _what changes may be made in the food when the infant has reached the age of ten or eleven months?_ the proteids may be still further increased, and the sugar and the lime-water reduced until plain milk is given. _how may this best be done?_ at first one feeding a day of plain milk and barley gruel may be given; later, two feedings; then three feedings, etc. let us suppose an infant to be taking such a modified milk as formula iv or v (page ), six feedings a day. the plain milk diluted only with barley gruel would at first replace one of these feedings; then two, three, four, etc., these changes being made at intervals of about two weeks. the proportions of the milk and barley gruel should at first be about - / ounces milk, - / ounces barley; later, ounces milk, ounces barley; still later, ounces milk, ounces barley, until finally plain milk is given to drink and the cereals given separately with a spoon. this is reached with most infants at fourteen or fifteen months; with many at twelve or thirteen months. other forms of farinaceous food may of course be used in the place of the barley, and in the same proportions. with some infants the addition of a pinch of bicarbonate of soda may be advantageously made to each milk-feeding when the lime-water is omitted, but with most this is unnecessary. if the infant strongly objects to the taste of the milk when the milk sugar has been omitted, a small quantity (one fourth to one half teaspoonful) of granulated sugar may for a time be added to each feeding, then gradually reduced. general rules for guidance in the use of the formulas given it should again be emphasized that these formulas are not intended for sick children nor for those suffering from any marked symptoms of indigestion. for such infants special rules are given later. _what should be the guide in deciding upon a formula with which to begin for a child who is to be artificially fed?_ the age and the weight are of some importance, but the best guide is the condition of the child's digestive organs. one should always begin with a weak formula, particularly, ( ) with an infant previously breast fed; ( ) with one just weaned, as a child who has never had cow's milk must at first have weaker proportions than the age and the weight would seem to indicate; ( ) with infants whose power of digestion is unknown. if the first formula tried is weaker than the child can digest, the food can be strengthened every three or four days until it is found what the child is able to take. on the contrary, if the food is made too strong at first, an attack of indigestion will probably follow. _how should the food be increased in strength?_ the first essential is that it be done very gradually; abruptly increasing the food usually causes a disturbance of digestion. it is never wise to advance more rapidly in strengthening the food than from one formula to the next one in any of the series given; with many infants it is better to make the steps of increase only half as great as those indicated (page ). _how rapidly should the food be increased in quantity?_ the increase should not be more than a quarter of an ounce in each feeding; or from one and a half to two ounces in a day. _when should the food be increased?_ in the early weeks an increase may be necessary every few days; in the later months sometimes the same formula may be continued for two or three months. it is, however, impossible to give a definite rule as to time. one cannot say with any child that an increase is to be made every week or every two weeks. a much better guide are the conditions present. the signs indicating that the food should be increased are, that the infant is not satisfied, not gaining in weight, but is digesting well, i.e., not vomiting, and having good stools. one should not increase the food, however, so long as the child seems perfectly satisfied and is gaining from four to six ounces a week, even though both the quantity and the strength of the food are considerably below the average; nor should the food be increased if the child is gaining from eight to ten ounces a week, even if he seems somewhat hungry. the appetite is not always a safe guide to follow. _how can one know whether the strength or the quantity of the food should be increased?_ in the early weeks it is well first to increase the strength of the food, the next time to increase the quantity, then the strength again, etc. after the fourth or fifth month, the quantity, chiefly, should be increased. _if a slight disturbance or discomfort occurs after the food has been strengthened, is it best to go back to the weaker formula or to persist with the new one?_ symptoms of minor discomfort are seen for a day or two with many infants after an ordinary increase in food; but in most cases an infant soon becomes accustomed to the stronger food and is able to digest it. if, however, the symptoms of disturbance are marked, one should promptly go back to the weaker formula. the next increase should be a smaller one. _should one be disturbed if for the first two or three weeks of artificial feeding the gain in weight is very slight or even if there is none?_ not as a rule. if the infant does not lose weight, is perfectly comfortable, sleeps most of the time, and does not suffer from any symptoms of indigestion, such as colic, vomiting, etc., one may be sure that all is going well and that the infant is becoming used to his new food. as the child's appetite improves and his digestion is stronger, the food may be increased every few days and very soon the gain in weight will come and will then be continuous. if, however, the scales are watched too closely and, because there is only a slight gain in weight or none at all, the food is rapidly increased, an acute disturbance of digestion is pretty certain to follow. _is not constipation likely to occur if the child is on a very weak food?_ it is very often seen and is due simply to the small amount of residue in the intestine. under these circumstances, if the bowels move once every day, one should not be disturbed even when the movements are small and somewhat dry. as the food is gradually strengthened, this constipation soon passes off; while if injections, suppositories, or cathartics are used to produce freer movements, the functions of the bowels are likely to be disturbed. _under what circumstances should the food be reduced?_ whenever the child becomes ill from any cause whatever, or whenever any marked symptoms of indigestion arise. _how may this be done?_ if the disturbance is only a moderate one and the food has been made up for the day, one third may be poured off from the top of each bottle just before it is given, and this quantity of food replaced by the same amount of boiled water. if the disturbance is more severe, the food should be immediately diluted by at least one half and at the same time the quantity given should be reduced. for a severe acute attack of indigestion the regular food should be omitted altogether and only water given until the doctor has been called. _if the food has been reduced for a disturbance of digestion, how should one return to the original formula?_ while the reduction of the food should be immediate and considerable, the increase should be very gradual. after a serious attack of acute indigestion, when beginning with milk again, it should not be made more than one fifth the original strength, and from ten days to two weeks should pass before the child is brought back to his original food, which should be done very gradually. it is surprising how long a time is required with young infants before they completely recover from an attack of acute indigestion, even though it did not seem to be very severe. the second disturbance always comes from a slighter cause than the first one. the addition of other foods to milk _how long should modified milk be continued without the addition of other food?_ this depends upon circumstances; usually, for about six months; but if the infant is thriving satisfactorily the milk may be used alone for ten or eleven months; with some infants who have especial difficulty in digesting cow's milk, it is advisable to begin the use of other food at three or four months or even from the outset. _what is the first thing to be used with milk?_ farinaceous food in some form, usually as a gruel. _how are these gruels made?_ they may be made directly from the grains or from some of the prepared flours (page ). the flours are usually to be preferred as being more simple of preparation. _how should they be used in making the food?_ they should be cooked separately, rather than with the milk; when the food is mixed, they take the place of a portion of the water in the formulas given on pages and . _how much of the gruel should be used?_ if it is prepared as recommended on page , it may make according to circumstances from one sixth to one half the total quantity of food. _which of the farinaceous foods are to be preferred?_ those most used are barley, oatmeal, arrowroot, and farina. there is not much difference in their nutritive value; oatmeal gruel is somewhat more laxative. _what value do these substances possess as infant foods?_ some of the starch is digested and absorbed; but the chief value of gruels is believed to be that when added to milk they render the curd more easily digested by preventing it from coagulating in the stomach in large tough masses. this is certainly true with many infants, but there are others who are not at all benefited, and not a few young infants whose digestion is made distinctly worse by the use of farinaceous food, particularly when employed in considerable quantity. the addition of gruels to milk for all infants is not to be recommended. _what further additions may be made to the diet of healthy infants during the first year?_ beef juice, the white of egg, and orange juice. _how and when may beef juice be used?_ with infants who are strong and thriving satisfactorily it may be begun at ten or eleven months; two teaspoonfuls may be given daily, diluted with the same quantity of water, fifteen minutes before the midday feeding; in two weeks the quantity may be doubled; and in four weeks six teaspoonfuls may be given. the maximum quantity at one year should not be more than two or three tablespoonfuls. with delicate infants who are pale and anæmic, beef juice is more important, and it may often be wisely begun at five or six months in half the quantities mentioned. _when should white of egg be used?_ under the same conditions as beef juice, particularly with infants who have difficulty in digesting the proteins (curd) of milk. at six months half the white of one egg may be given at one time, and soon after this the entire white of one egg. the best in manner of cooking is the "coddled", egg (see page ). _when should orange juice be begun?_ usually about the eleventh or twelfth month; it should be given about one hour before the feeding; two teaspoonfuls at first, then one tablespoonful at a time, and later three or four tablespoonfuls. it is particularly useful when there is constipation. it should always be strained, and care should be taken that it is sweet and fresh. overfeeding _what is meant by overfeeding?_ giving an infant too much food; either too much at one time or too frequently. overfeeding is sometimes practised during the day, but is chiefly done at night. _is not an infant's natural desire for food a proper guide as to the quantity given?_ the appetite of a perfectly normal infant usually is; but overeating is a habit gradually acquired and may continue until twice as much food as is proper is taken in the twenty-four hours. this habit is most frequently seen in infants whose digestion is not quite normal; because of the temporary relief from discomfort experienced by taking food into the stomach, they often appear to be hungry the greater part of the time, especially at night. _what are the causes of overfeeding?_ the most common one is the habit of watching the weight too closely, and the conviction on the part of the mother or nurse that because a child is not so large nor gaining so rapidly as some other infant of the same age, more food or stronger food should be given. _what harm results from overfeeding?_ all food taken in excess of what a child can digest becomes a burden to him. the food lies in the stomach or bowels undigested, ferments, and causes wind and colic. when overfeeding is longer continued, serious disturbances of digestion are soon produced. the infant is restless, fretful, constantly uncomfortable, sleeps badly, and stops gaining and may even lose in weight. such symptoms may lead to the mistaken conclusion that too little food is given, and it is accordingly increased, when it should be diminished. one of the results of long-continued overfeeding is dilatation or stretching of the stomach. _what should guide one as to the quantity of food to be given to any infant??_ ( ) the size of the infant's stomach at the different months; ( ) the amount of milk which the healthy nursing infant gets; ( ) the quantities with which most children do best. the table of quantities and intervals of feeding, on page , gives the average figures derived from these sources. it is seldom wise to go beyond the limits there stated; nor should one insist upon giving any fixed amount if it is clearly more than the child wants or can be made to take except by continued coaxing. loss of appetite _what is to be done when without any other signs of illness a child's appetite gradually fails?_ this is often the result of a long period of overfeeding or the use of milk too rich in fat. if in all other respects the child seems well and simply does not want his food, it should be offered at regular hours, but not more frequently; on no account should he be coaxed, much less forced, to eat, even though he takes only one half or one third the usual quantity. the intervals between feedings should not be shortened but rather lengthened. often, with a child a year old, it is necessary to reduce the number of feedings to four or even three in twenty-four hours. water, however, may be offered at more frequent intervals. the food should be weakened rather than strengthened. no greater mistake can be made than, because so little is taken, coaxing or forcing food at short intervals through fear lest the child may lose weight. the changes in the food required by special symptoms or conditions infants with weak digestion and those suffering from various forms of indigestion have often especial trouble in digesting the fat of milk. to meet the needs of such there is required a series of formulas in which the fat is lower than in those already given. these formulas are obtained from plain milk. _fourth series_ _formulas from plain milk (containing -per-cent fat)_ --------------------------------------------------------- i. ii. iii. iv. v. vi. vii. viii. --------------------------------------------------------- plain milk oz. oz. oz. oz. oz. oz oz. oz. milk sugar " " " " / " / " / " / " lime-water. " " " " " " " " boiled water " " " " " " " " barley gruel " " " " " " " " --------------------------------------------------------- oz. oz. oz. oz. oz. oz. oz. oz. --------------------------------------------------------- when larger quantities than ounces are required they are calculated in the same manner as described on page in speaking of -per-cent milk. the approximate composition of the formulas of the fourth series expressed in percentages is as follows: ---------------------------------------- formula. fat. sugar. proteids. ---------------------------------------- i. . . . ii. . . . iii. . . . iv. . . . v. . . . vi. . . . vii. . . . viii. . . . ---------------------------------------- _why is it that an infant so often vomits some of its food within a few moments after finishing its bottle?_ usually because the quantity is too large. sometimes it is due to the fact that the food is taken too rapidly, from too large a hole in the nipple. it may be due to too tight clothing, or to moving the child about in such a way as to press upon the stomach. _what are the principal causes of, and the changes in the food required by habitual vomiting, regurgitation, or spitting up of small quantities of food between feedings, often repeated many times a day?_ this is always a symptom of gastric indigestion, and a most troublesome one. in such conditions the fat and often the sugar also should be reduced and the lime-water increased. formulas made from rich top-milk or milk and cream are to be avoided. those made from -per-cent milk are less likely to be the cause of trouble than those from -per-cent milk; but if the symptoms are at all severe it is better to use instead of these the formulas of the fourth series derived from plain milk. reduction in the sugar may be made by adding only one half ounce of milk sugar to each twenty ounces of the food; in severe cases the sugar may be omitted altogether. it is often advisable to double the amount of lime-water--i.e., use two ounces to each twenty ounces of food. the malted foods and all other foods containing much sugar usually aggravate the symptoms. the intervals between meals should generally be half an hour longer, and sometimes an hour longer, than when digestion is normal. the quantity given at a feeding should generally be less than with a normal digestion. usually a smaller quantity of a strong food succeeds better than a larger quantity of a weak food. _what are the causes of, and food changes required by a constant and excessive formation of gas in the stomach, leading to distention and pain, or eructations (belching) of gas and often of a sour, watery fluid?_ this is often associated with habitual vomiting, and is due to similar causes, but particularly to the sugar, which should be greatly reduced or omitted entirely. _what changes should be made when there is habitual colic?_ this is generally due to an accumulation of gas in the intestines which forms there because the proteids (curd) of the milk are not digested. they should be reduced by using in the early months a weaker formula--i.e., instead of formula v of the first or second series, iv might be used, or, for a short time, even iii. the proteids may be reduced in the middle period by using weaker formulas if we desire to reduce the proteids without reducing the fat, we may change from the second to the first series. another means of relieving habitual colic is the use of partially peptonized milk (page ); still another the dilution with barley-water instead of plain water. _what change should be made if curds appear in the stools regularly or frequently?_ this is usually associated with habitual colic, and has to be managed exactly like that condition, by the means just described. _how should the milk be modified for chronic constipation?_ the constipation of the first weeks of life has been already referred to (page ); it usually disappears as the food is gradually strengthened in all its proportions. habitual constipation at a later period is difficult to overcome by diet alone. it sometimes depends upon the fact that the proteids are too high, and sometimes that the fat is too low. hence it is more frequent when infants are fed upon plain milk variously diluted (page ), then when -per-cent or -per-cent milk is used, and diluted to a greater degree. but it is not desirable to use a top-milk containing more than ten per cent fat for this purpose, nor is it wise to carry the fat in the food above per cent (i.e., ounces of -per-cent milk, or ounces of -per-cent milk, in a -ounce mixture) or other disturbances of digestion may be produced. in some cases the use, in place of milk sugar, of ordinary brown sugar, in half the quantity, is of assistance; or of some of the malted foods (mellin's food, malted milk, cereal milk) also in the place of milk sugar. the substitution of the milk of magnesia for the lime-water as recommended on page will often be found useful. to infants over nine months old, orange juice may be given. _what special modifications are required during very hot weather?_ during the warm season it is well to make the proportion of fat less than during cold weather. during short periods of excessive heat it should be much less. the fat is reduced by using -per-cent milk in place of -per-cent (i.e., the second instead of the first series of formulas, page ), or plain milk in place of the -per-cent milk in the second and third series (page ). at such times also the usual food should be diluted, and water should be given freely between the feedings. _what changes should be made in the food of a child who, with all the signs of good digestion, gains very little or not at all in weight?_ if the child seems hungry the quantity of food may be increased; but if the child will not readily take any more in quantity the strength may be increased by the use of the next higher formula. one should, however, be extremely careful under these circumstances not to coax or force a child; for this plan is almost certain to cause disturbance of digestion and actual loss in weight. a better policy is that of looking after the other factors in the child's life,--the care, sleep, fresh air, etc., for with these rather than with the food the trouble often lies. _what should be done with infants who in spite of all variations in the milk continue to have symptoms of indigestion and do not thrive?_ except inmates of institutions who form a class by themselves, most infants who receive proper care thrive upon milk if the proportions suited to the digestion are given. still there are some who do not. the nutrition of such is always a matter of difficulty. if a wet-nurse is available the employment of one is the thing most likely to succeed, particularly if the infant is under four or five months old. if the infant is older, or if a wet-nurse cannot be obtained, some of the substitutes for fresh cow's milk may be tried. one of the best is condensed milk, borden's eagle brand, canned, being preferred. this is more likely to agree if the symptoms are chiefly intestinal (colic, flatulence, curds in the stools, constipation or diarrhoea) than if they are chiefly gastric (vomiting, regurgitation, etc.). _how should condensed milk be used?_ for an infant three or four months old with symptoms of indigestion, it should at first be diluted with parts of boiled water, or, sometimes preferably, with barley-water. with improvement in the symptoms the dilution may be made to , to , to , and to , these changes being gradually made. the intervals between feedings and the quantities for one feeding are given on page . _how long should condensed milk be continued?_ in most cases it should be used as the sole food for a few weeks only. afterward, one feeding a day of a weak formula of modified milk (e.g., no. iii or iv of the second series, page ) may be given; later two feedings, and thus gradually the number of milk feedings is increased until the child is taking only modified milk. condensed milk is not to be recommended as a permanent food where good fresh cow's milk can be obtained. _what are the objections to its use?_ it is very low in fat and proteids, and high in sugar. this accounts for its easy digestibility, and also explains why children reared upon it often gain very rapidly in weight, yet have as a rule but little resistance. they are very prone to develop rickets and sometimes scurvy. _are the proprietary infant foods open to the same objections as condensed milk?_ they are. what has been said of condensed milk applies equally well to most of those that are sold in the market as substitutes for milk. _what changes in the food are required by slight indisposition?_ for slight general disturbances such as dentition, colds, sore throats, etc., it is usually sufficient simply to dilute the food. if this is but for two or three feedings, it is most easily done by replacing with boiled water an ounce or two of the food removed from the bottle just before it is given; if for several days, a weaker formula should be used. _what changes should be made for a serious acute illness?_ for such attacks as those of pneumonia, bronchitis measles, etc., attended with fever, the food should be diluted and the fat reduced as described on page . it should be given at regular intervals, rather less frequently than in health. water should be given freely between the feedings. food should not be forced in the early days of an acute illness, since the loss of appetite usually means an inability to digest much food. _what immediate changes should be made in the food when the child is taken with an acute attack of gastric indigestion with repeated vomiting, fever, pain, etc.?_ all milk should be stopped at once, and only boiled water given for ten or twelve hours; afterward barley-water or whey may be tried, but no milk for at least twenty-four hours after the vomiting has ceased. when beginning with modified milk the quantity should be small and the fat low, which may be secured by the use of the fourth series of formulas in the place of the first or second series. the proportion of lime-water may be doubled. _what changes should be made for an attack of intestinal indigestion attended by looseness of the bowels?_ if this is not severe (only two or three passages daily) the fat should be lowered in the manner stated just above, and the milk should be boiled for five minutes. if curds are present in the stools, it may be still further diluted. if the diarrhoeal attack is more severe, and attended by fever and foul-smelling movements of greater frequency, all milk should be stopped immediately and the diet mentioned just above under the head of acute disturbances of the stomach should be employed. _what changes in the food should be made when the child seems to have very little appetite and yet is not ill?_ the number of feedings should be reduced, the interval being lengthened by one hour or even more. no greater mistake can be made than to offer food every hour or two to an infant who is not hungry. such a course only prolongs and aggravates the disturbance. _what other conditions besides the food greatly influence the child's digestion?_ proper clothing, warm feet, regular habits, fresh air, clean bottles, and food given at the proper temperature are all quite as important as the preparation of the food; quiet peaceful surroundings and absence of excitement are also essential to good digestion. common mistakes in milk modification and infant feeding i. in using modifications made from top-milk, much confusion arises from the notion that top-milk is a single definite thing, whereas its composition depends upon a great variety of conditions and, unless all these are known, it is impossible to tell how strong it is. directions for the removal of top-milk should be explicitly followed (see page ), or the results will be very different from those expected. ii. in formulas calling for a certain number of ounces of top-milk of any given strength, the mistake is made of removing only the number of ounces needed for the formula. the proper way is to remove the amount required to secure a top-milk of the desired strength and then to take of this the number of ounces needed in the formula. iii. a rich jersey milk is used as if it were ordinary milk. the formulas given in this book are chiefly calculated on the basis of a good average milk which contains about per cent fat. many persons have the idea that the richer the milk, the more rapidly the child will gain in weight, and hence the superiority of such milk for infant feeding. while it is true that some children taking a very rich milk may, for a time, gain rapidly in weight, yet sooner or later, serious disturbances of digestion are nearly always produced. iv. the food is increased too rapidly, particularly after some disturbance of digestion. if, in an infant three or four months old, an attack of somewhat acute indigestion occurs, the food should seldom be given in full strength before two weeks. the increase in the diet should be made very gradually, the steps being made only one half those indicated in the series of formulas on pages and . otherwise it generally happens that the attack of indigestion is very much prolonged and much loss in weight occurs. v. when symptoms of indigestion occur, the food is not reduced rapidly enough. indigestion usually means that the organs are, for the time, unequal to the work imposed. if the food is immediately reduced by one half, the organs of digestion soon regain their power and the disturbance is short. in every case the amount of reduction should depend upon the degree of the disturbance. preparation of cow's milk at home _what articles are required for the preparation of cow's milk at home?_ feeding-bottles, rubber nipples, an eight-ounce graduated measuring glass, a glass or agate funnel, bottle brush, cotton, alcohol lamp or, better, a bunsen gas burner, a tall quart cup for warming bottles of milk, a pitcher for mixing the food, a wide-mouth bottle for boric acid and one for bicarbonate of soda, and a pasteurizer. later, a double boiler for cooking cereals will be needed. _what bottles are to be preferred?_ a cylindrical graduated bottle with a rather wide neck, so as to admit of easy washing, and one which contains no angles or corners. a single size holding eight ounces is quite sufficient for use during the first year. all complicated bottles are bad, being difficult to clean. one should have as many bottles in use as the child takes meals a day. _how should bottles be cared for?_ as soon as they are emptied they should be rinsed with cold water and allowed to stand filled with water to which a little bicarbonate of soda has been added. before the milk is put into them they should be thoroughly washed with a bottle brush and hot soap-suds and then placed for twenty minutes in boiling water. _what sort of nipples should be used?_ only simple straight nipples which slip over the neck of the bottle. those with a rubber or glass tube are too complicated and very difficult to keep clean. nipples made of black rubber are to be preferred. the hole in the nipple should not be so large that the milk will run in a stream, but just large enough for it to drop rapidly when the bottle with the nipple attached is inverted. _how should nipples be cared for?_ new nipples should be boiled for five minutes; but it is unnecessary to repeat this every day as they soon become so soft as to be almost useless. after using, nipples should be carefully rinsed in cold water and kept in a covered glass containing a solution of borax or boric acid. at least once a day they should be turned wrong side out and thoroughly washed with soap and water. _what sort of cotton should be used?_ the refined non-absorbent cotton is rather better for stoppering bottles, but the ordinary absorbent cotton will answer every purpose. _which is better, the bunsen burner or the alcohol lamp?_ if there is gas in the house, the bunsen burner is greatly to be preferred, being cheaper, simpler, and much safer than the alcohol lamp. if the lamp is used, it should stand upon a table covered with a plate of zinc or tin, or upon a large tin tray. the french pattern of alcohol lamp is the best. _give the directions for preparing the food according to any of the above formulas._ the nurse's hands, bottles, tables, and all utensils should be scrupulously clean. first dissolve the milk sugar in boiling water, filtering if necessary. then add the milk and cream and lime-water, mixing the whole in a pitcher. a sufficient quantity of food for twenty-four hours is always to be prepared at one time. this is then divided into the number of feedings required for the day, each feeding being put in a separate bottle, and the bottle stoppered with cotton. the bottles should then be cooled rapidly by standing, first in tepid then in cold water, and afterward placed in an ice chest. if the milk is to be pasteurized or sterilized, this should precede the cooling. directions for feeding infants _how should the bottle be prepared at feeding time?_ it should be taken from the ice chest, and warmed by standing in warm water which is deep enough to cover the milk in the bottle; it should then be thoroughly shaken and the nipple adjusted; the nurse should see that the hole in the nipple is not too large nor too small. _how may the temperature of the milk be tested?_ never by putting the nipple in the nurse's mouth. before adjusting the nipple, a teaspoonful may be poured from the bottle and tasted, or a few drops may be poured through the nipple upon the inner surface of the wrist, where it should feel quite warm but never hot; or a thermometer may be placed in the water in which the bottle stands. a dairy thermometer should be used, and the temperature of the water should be between ° and ° f. _what is a simple contrivance for keeping the milk warm during feeding?_ a small flannel bag with a draw string may be slipped over the bottle. _in what position should an infant take its bottle?_ for the first two or three months it is better, except at night, when it may be undesirable to take the infant from its crib, that it be held on the nurse's arm during the feeding; later it may lie on its side in the crib provided the bottle is held by the nurse until it has been emptied; otherwise a young infant readily falls into the bad habit of alternately sucking and sleeping, and often will be an hour or more over its bottle. _how much time should be allowed for one feeding?_ never more than twenty minutes. the bottle should then be taken away and not given until the next feeding time. under no circumstances should an infant form the habit of sleeping with the nipple in its mouth. a sleepy infant should be kept awake by gentle shaking until the food is taken, or the bottle should be removed altogether. _should an infant be played with soon after feeding?_ on no account; such a thing frequently causes vomiting and sometimes indigestion. after every feeding the infant should be allowed to lie quietly in its crib, and disturbed as little as possible. intervals of feeding _how often should a baby be fed during the first month?_ every two hours during the day and twice during the night, or ten feedings during the twenty-four hours. _at what age may the interval be made two and a half hours?_ usually at five or six weeks. _when may it be increased to three hours?_ usually at two months. _why should not a child be fed more frequently?_ it takes the stomach nearly two hours to digest a meal at two months, and about two and a half hours at five or six months, and if the meals are too near together the second one is given before the first has been digested and vomiting and indigestion result. the meals should be far enough apart to give the stomach a little time for rest just before each feeding. _schedule for feeding healthy infants during the first year_ ------------------------------------------------------------------- age. interval night no. of quantity quantity between feedings feedings for one for meals, ( p.m. in feeding. hours. by day. to a.m.). hours. --------------------------------------------------------------------- hours. ounces. ounces. d to th day - - / - d and d weeks - / - - th and th weeks - / - - / - th to th week - / - - d to th month - - th to th month - - / - th to th month - - --------------------------------------------------------------------- this schedule gives the averages for healthy children the smaller quantities are those required by small children whose digestion is not very vigorous. the larger quantities are those required by large children with strong digestion; in very few cases will it be advisable to go above these figures. the interval is reckoned from the beginning of one feeding to the beginning of the next one. _when should the interval between the feedings be lengthened?_ when there is gastric indigestion as shown by habitual vomiting or the regurgitation of food long after the bottle is finished; also when the appetite is very poor so that the infant regularly leaves some of its food. _when should the interval between the feedings be shortened?_ this is done much too frequently; it is rarely advisable to feed any infant, except one seriously ill, oftener than the time put down in the schedule. regularity in feeding _how can a baby be taught to be regular in its habits of eating and sleeping?_ by always feeding at regular intervals and putting to sleep at exactly the same time every day and evening. _when should regular training be begun?_ during the first week of life. _should a baby be wakened to be nursed or fed if sleeping quietly?_ yes, for a few days. this will not be required long, for with regular feeding an infant soon wakes regularly for its meal, almost upon the minute. _should regularity in feeding be kept up at night as well as during the day?_ only up to nine or ten o'clock; after that time a baby should be allowed to sleep as long as it will. _at what age may a well baby go without food from p.m. to or a.m.?_ usually at four months, and always at five or six months. night feeding is one of the most frequent causes of wakefulness and disturbed sleep. sterilized milk _what is meant by sterilizing milk?_ heating milk for the purpose of destroying germs. _does all cows milk contain germs?_ yes; even when handled most carefully, milk contains many germs; but when carelessly handled, and in summer, the number is enormous. while most of these are harmless or cause only the souring of milk, others are occasionally present which may produce serious diseases such as typhoid fever, diphtheria scarlet fever, cholera, tuberculosis, and many forms of diarrhoea. _under what circumstances is it necessary to sterilize milk?_ . in warm weather when it cannot be obtained fresh; hence always in cities and towns during the summer. . when one cannot be certain that the cows are healthy, or that the milk has been carefully handled. . when the milk is to be kept for any considerable time (i.e., over twenty-four hours), especially if no ice can be had. . during epidemics of typhoid fever, scarlet fever, diphtheria, or any form of diarrhoeal disease. _what are the two methods of heating milk?_ the first is known as _sterilizing_, in which the milk is heated to ° f. for one hour or one hour and a half; the second is known as _pasteurizing_, in which the milk is heated to ° or ° f. for thirty minutes. a temperature of ° f. continued for thirty minutes is sufficient to kill the germs of the diseases above referred to. _will milk which has been thus treated keep indefinitely?_ no; for although all the living germs may be killed, there are many undeveloped germs, or spores, which are not destroyed, and which soon grow into living germs. milk heated to ° f. for an hour will keep upon ice for two or three weeks; that heated to ° f. for two or three days. _is milk which has been sterilized always a safe food?_ no; for the reason that the milk may be so old, so dirty, and so contaminated before sterilizing that it may be still unfit for food, though it contains no living germs. _is cow's milk rendered more digestible by being heated in this way?_ sterilizing milk does not improve its digestibility but rather the contrary. sterilized milk should be modified for infant feeding in the same way as milk which has not been heated. _is milk in any way injured by heating to ° f. for an hour?_ there is abundant evidence that milk is rendered less digestible by such heating; also that it is more constipating, and that for some children its nutritive properties are interfered with, so that it may cause scurvy; this, however, is not seen unless it is continued as the sole food for a long period. these objections are of so much importance that this plan of heating milk is not to be recommended for general use. _when is it advantageous to heat milk to ° f.?_ for use upon long journeys, such as crossing the ocean. milk should then be heated for one hour upon two successive days, without removing the cotton stoppers from the bottles. _is milk in any way injured by heating to ° f. for thirty minutes?_ this point is not yet definitely settled. such heating does not affect the taste of milk and does not render it more constipating. the unfavourable effects; if there are any, are so slight that they need not deter one from the use of pasteurized milk, even for long periods. the preference, however, should always be given to milk which is so clean and so fresh as not to require any heating. _how should milk be pasteurized?_ a convenient form of apparatus is that known as freeman's pasteurizer[ ]; another is the walker-gordon pasteurizer.[ ] [ ] this can be obtained at west fifty-ninth street, new york, with bottles and full directions; a tin one, at a cost of $ . , and a copper one, which is much more durable, for $ . . [ ] obtained at the same prices from any of the walker-gordon milk laboratories. _how should milk be cooled after pasteurizing?_ always by placing the bottles in cold water, so as to cool them rapidly; never by letting them stand at the temperature of the room, or by placing them, when warm, in an ice box. _why is this precaution necessary?_ cooling in the air or in an ice box requires from two to four hours, and during that time a great many of the undeveloped germs may mature and greatly injure the keeping properties of the milk. in the cold water, milk can be cooled in from ten to twenty minutes if the water is frequently changed, or if ice is added to the water. modified milk of the milk laboratories _what is "modified milk" of the milk laboratories?_ it is milk containing definite proportions of the fat, sugar, proteids, etc., put up usually according to the prescription of a physician, who indicates how much of the different elements he desires. the most reliable are the laboratories of the walker-gordon company, which has branches in many of the large cities of the united states. this is an excellent method of having milk prepared since it can be done with greater care and cleanliness than are possible in most homes. it is besides a great convenience if circumstances make it impossible to prepare the milk properly at home. the laboratory should be used for infant feeding only by one who is somewhat familiar with this method of ordering milk. peptonized milk _what is peptonized milk?_ milk in which the proteids (curd) have been partially digested. _how is this accomplished?_ by the action of a peptonizing powder which is composed of a digestive agent known as the extractum pancreatis and bicarbonate of soda, which is added to the plain or diluted milk. this is sold in tubes or in tablets, and it is the active ingredient of the peptogenic milk powder. _describe the process._ the plain or modified milk is placed in a clean glass jar or bottle, and the peptonizing powder, which is first rubbed up with a tablespoonful of the milk, is added and the bottle shaken. the bottle is then placed in a large pitcher or basin containing water kept at the temperature of about ° f., or as warm as the hand can bear comfortably, and left for ten to twenty minutes if the milk is to be partially peptonized; for two hours if it is to be completely peptonized. _what taste has partially peptonized milk?_ none, if peptonizing is continued for only ten minutes, but at the end of twenty minutes it begins to be bitter, when the process of digestion has gone further. _how is the bitter taste avoided in partially peptonized milk?_ at the end of ten or fifteen minutes the milk may be placed in a saucepan and quickly raised to boiling point; this kills the ferment, so that the milk will not become bitter when warmed a second time. or, the milk may be rapidly cooled by placing the bottles first in cool and then in ice water; in this way the ferment is not destroyed, and the milk may become bitter when warmed for feeding. _should the whole day's supply be peptonized at once, or each bottle separately just before the feeding?_ either plan may be followed. if the former, it is better to raise the milk to boiling point after peptonizing; if the latter, it should not be peptonized more than ten minutes, for it will continue to peptonize while it is being taken by the child. _is not the bitter taste of completely peptonized milk a great obstacle to its use?_ not in the case of young infants; one under four or five months old will usually take it without any objection after two or three feedings; but it cannot often be used for those who are much older. _how much of the peptonizing powder should be used?_ there are required for one pint of plain milk, five grains of the extractum pancreatis and fifteen grains of bicarbonate of soda. this quantity is usually put up in a single tube or tablet. in the formulas previously given, less than this will be required; for the weaker formulas, one half or one third of the powder mentioned will be sufficient for one pint of food. for a single feeding of four ounces, one may use one eighth of a tube with a weak formula, or one sixth of a tube with a stronger formula. _what are the advantages of peptonized milk?_ partially peptonized milk is useful for young infants who have great difficulty in digesting the curd of milk, sometimes even when diluted as already described; completely peptonized milk, during acute attacks of indigestion. _for how long a period may the use of peptonized milk be continued?_ completely peptonized milk may be used for a few days, or at most a few weeks; partially peptonized milk may be used for two or three months, but not indefinitely; it should be left off gradually by shortening the time of peptonizing, and lessening the amount of the powder used. feeding during the second year _how many meals are required during the second year?_ it is usually better to continue five meals throughout the second year. some children will sleep from p.m. to a.m. without waking, but unless there is a feeding at p.m. children are apt to wake very early in the morning. _should each feeding be prepared at the time it is given, or all feedings at one time, as during the first year?_ during the second and third years it is better to prepare the milk for the entire day at one time. if it is to be modified by adding cream, water, etc., it is done as during the first year. later, when only plain milk is used, the quantities needed for the different feedings should be put into one or into two bottles, which then may be pasteurized or not as may be necessary. in this way the different feedings are kept separate, and the day's supply of milk is not disturbed every time the child is fed, as otherwise is unavoidable. the food should be prepared as soon as possible after the daily milk supply is delivered in the morning. _give a proper diet for an average healthy child of twelve months._ . a.m. milk, six to seven ounces; diluted with barley or oat gruel, two to three ounces; after the thirteenth month, taken from a cup. a.m. orange juice, one to two ounces. a.m. milk, two parts; oatmeal or barley gruel, one part; from ten to twelve ounces in all may be allowed; it should be given from a cup. p.m. beef juice, one to two ounces; or, the white of one egg, slightly cooked; later, the entire egg; or, mutton or chicken broth, four to six ounces. milk and gruel in proportions above given, four to six ounces. p.m. same as at a.m. p.m. same as at . a.m., except that the milk may be given from the bottle. _how long may this schedule be followed?_ usually until the fourteenth or fifteenth month. after this time the cereals may be given much thicker and fed from a spoon. _may any other fruit juices be given at this period?_ orange juice is the best; next to this the juice of fresh ripe peaches, red raspberries or strawberries. all these should be strained very carefully through muslin to make sure that the child gets none of the pulp or seeds, either of which may cause serious disturbance. of the orange or peach juice, from one to four tablespoonfuls may be allowed at one time; of the others about half the quantity. the fruit juice is best given one hour before the second feeding. _when should a child be weaned from its bottle?_ most children can and should be taught to take their food from the cup or spoon by the time they are thirteen months old; but it is convenient to give the p.m. feeding from the bottle during the greater part of the second year (see page ). _give a proper diet for an average child from the fourteenth to the eighteenth month._ the bottle should not be given except at night. cereals may now form an important part of the diet. they should be very thoroughly cooked, usually for three hours, and strained. the daily schedule should be about as follows: . a.m. milk, warmed, eight to ten ounces, given from a cup. a.m. fruit juice, one to three ounces. a.m. cereal: one, later two or three, tablespoonfuls of oatmeal hominy or wheaten grits, cooked for at least three hours; upon this from one to two ounces of thin cream, or milk and cream, with plenty of salt, but without sugar. crisp dry toast, one piece; or, unsweetened zwieback; or, one huntley and palmer breakfast biscuit. milk, warmed, six to eight ounces, from a cup. p.m. beef juice, one to two ounces; and one egg (soft boiled, poached or coddled); and boiled rice, one tablespoonful; or, broth (mutton or chicken), four ounces; one or two huntley and palmer breakfast biscuits, or zwieback; and (if most of the teeth are present) rare scraped meat, at first one teaspoonful, gradually increasing to one tablespoonful. p.m. cereal: two tablespoonfuls of farina, cream of wheat, or arrowroot, cooked for at least one half hour, with milk, plenty of salt, but without sugar. milk, warmed, eight to ten ounces, given from a cup. p.m. milk, warmed, eight to ten ounces, which may be given from a bottle. _give a proper diet for an average child from the eighteenth month to the end of the second year._ the same order of meals as for the months just preceding should be followed. for most children milk at p.m. is desirable. there are many, however who sleep regularly from p.m. until a.m. without food; for such the night feeding should, of course, not be insisted upon. the daily schedule should be about as follows: . a.m. milk, warmed, ten to twelve ounces, given from cup. a.m. fruit juice, two to three ounces. a.m. cereals: similar to those given from the fourteenth to the eighteenth month; they need not be strained although they should be cooked and served in the same way. crisp dry bread, zwieback, or huntley and palmer biscuits, without butter. milk, warmed, one cup. p.m. beef juice and one egg; or, broth and meat; care being taken that the meat is always rare and scraped or very finely divided; beefsteak, mutton chop, or roast beef may be given. very stale bread, or two pieces of zwieback. prune pulp or baked apple, one to two tablespoonfuls. water; no milk. p.m. cereal: farina, cream of wheat, or arrowroot, cooked for at least one half hour, with milk, plenty of salt, but without sugar. or, milk toast or stale bread and milk. p.m. if required, ten to twelve ounces of plain milk. _what fruits may be given at this period?_ if the child has a feeble digestion, only the fruit juices previously allowed; strong children may have in addition prune pulp, baked apple, and applesauce. the prune pulp is prepared by stewing the dried prunes without sugar until they are very soft, and removing all the skin by putting the fruit through a strainer; of this from one to two tablespoonfuls may be given at one time. the baked apple should be given without cream, and the applesauce should have very little sugar. _how and when should water be given?_ throughout the second year water should be given freely between the feedings, especially in warm weather; from one to three ounces may be given at one time, either from a spoon, a glass, or a bottle. the water should be boiled daily and then cooled. it should not be allowed to stand in the room, but fresh water should be put into the bottle each time. feeding during the third year _what changes may be made in the diet during the third year?_ the night feeding at p.m. should be omitted. a greater quantity of solid food may be allowed, particularly at the mid-day meal. it is not advisable to begin potato and other vegetables until this age is reached. three regular meals should be given and milk once besides, either between the breakfast and dinner or dinner and supper, whichever is the longer interval. water should be allowed freely between meals. _what would be a proper schedule for an average child during the third year?_ . a.m. cereal: cooked (preferably over night) for three hours, although a somewhat larger variety may be given than during the second year; given as before with milk or thin cream, salt, but very little sugar. warm milk, one glass. a soft egg, poached, boiled or coddled. bread, very stale or dry, one slice, with butter. a.m. warm milk, one cup, with a cracker or piece of very stale bread and butter. p.m. soup, four ounces; or, beef juice, two ounces. meat: chop, steak, roast beef or lamb or chicken. a baked white potato; or, boiled rice. green vegetable: asparagus tips, string beans, peas, spinach; all to be cooked until very soft, and mashed, or preferably put through a sieve; at first, one or two teaspoonfuls. dessert: cooked fruit--baked or stewed apple, stewed prunes. water; no milk. p.m. cereal: farina, cream of wheat, or arrowroot, cooked for at least one half hour, with plenty of salt, but without sugar; or, milk toast; or, bread and milk; or, stale or dry bread and butter and a glass of milk. part iii the diet of older children (fourth to tenth year) throughout this period the largest meal should always be in the middle of the day, and a light supper given, very much like that described for the third year. during the first half of this period, milk may be allowed once either between breakfast and dinner or dinner and supper; no other eating between meals should be permitted, but water should be allowed freely. milk and cream _what part of the diet should milk form during childhood?_ it should form a very important part up to the tenth year; nothing can take its place. there are comparatively few children who cannot take and digest milk if it is properly fed. _why is milk so advantageous?_ because no food that we possess has so high a nutritive value as milk, for the amount of work required of the organs of digestion. it is, therefore, peculiarly adapted to the diet of the child. _what are the essential points in the use of milk?_ it should be clean and fresh, but not too rich. it is a mistake to select for any children the rich milk of a jersey herd and use it as though it were an ordinary milk. for children who have difficulty in digesting milk, it should be somewhat diluted, i.e., one part of water to four parts of milk, or salt or bicarbonate of soda should be added. it is also important not to give milk at meals when fruits, especially sour fruits, are allowed. _how much milk may advantageously be given?_ the average child with good digestion should take from one and one half pints to one quart of milk daily, this including not only what the child drinks but what is served upon cereals and in other ways. it is seldom wise to allow a child to take as much as two quarts daily, as a more mixed diet for most children is better. _to what extent may cream be used?_ older children do not require so large a proportion of fat in their food as do infants, and the use of cream, especially very rich cream, often results in disturbances of digestion. the use of too much or too rich cream is a common cause of the coated tongue, foul breath and pale gray stools, often called "biliousness." _is not cream useful in overcoming the constipation of children?_ with infants it is valuable to a certain point, but with older children only to a limited degree, and if such symptoms as those above described are present, cream should not be given. eggs _to what extent may eggs be used in the diet of this period?_ they form a most valuable food. it is essential that they should be fresh and only slightly cooked, soft boiled, poached or coddled; fried eggs should never be given and all omelets are objectionable. _which is more digestible, the white or yolk of the egg?_ for the great majority of children, the white of the egg. this forms one of the most digestible proteids we possess, and can be used, even in the latter part of the first year, with advantage. _is it not true that eggs often cause "biliousness"?_ very seldom, if fed as above advised. this is an old prejudice but has little basis in fact. _how often may eggs be given?_ most children from four to ten years old will take one egg for breakfast and another for supper for an indefinite period with relish and benefit. there are, however, some few who have a peculiar idiosyncrasy as regards eggs and cannot take them at all. meat and fish _what meats may be given to young children?_ the best are beefsteak, mutton-chop, roast beef, roast lamb, broiled chicken and certain delicate fish, such as shad or bass. _what are the important points to be considered in giving meat to children?_ most meats should be rare and either scraped or very finely divided, as no child can be trusted to chew meat properly. meats are best broiled or roasted, but should not be fried. _how often should meat be given?_ at this period, only once a day, at the mid-day meal. _is not the excessive nervousness of many modern children due to the giving of meat, or at least aggravated by its use?_ there is little ground for such a belief, unless an excessive amount of meat is given. certainly cutting off meat from the diet of nervous children seldom produces any striking benefit. _what meats should be forbidden to young children?_ ham, bacon, sausage, pork, liver, kidney, game and all dried and salted meats, also cod, mackerel and halibut; all of these are best withheld until the child has passed the tenth year. _are not gravies beneficial and nutritious?_ the beef juice, or so-called "platter gravy," from a roast is exceedingly nutritious and desirable, but many of the thickened gravies are much less digestible and are too often given in excess; only a small quantity should be allowed. they should not form an important part of the meal. vegetables _what vegetables may be used at this period?_ white potatoes may be given first. these should preferably be baked or boiled and mashed, but never fried. they should be served with beef juice or with cream rather than with butter. of the green vegetables, the best are peas, spinach, asparagus tips, string beans, stewed celery, young beets, or carrots, and squash. baked sweet potato, turnips, boiled onions and cauliflower, all well cooked, may be given after the sixth or seventh year in moderate amount. the principal trouble in the digestion of vegetables is due to imperfect cooking. it is, in fact, almost impossible to cook them too much; they should also be very finely mashed. they form a valuable addition to the diet after three years, although the amount at first given should be small, one or two teaspoonfuls. they greatly aid in securing regularity of the bowels. because small particles are seen in the stools, it is not to be inferred that they are causing disturbance and should, therefore, be stopped, but only that they should be more thoroughly cooked and more finely divided before being given. _is it safe to use canned vegetables for children?_ many of the best brands of canned vegetables are quite safe and some, such as peas and asparagus, can be used with advantage. they are frequently better than stale green vegetables often sold in the markets. _what vegetables should not be given to young children?_ none of those which are eaten raw, such as celery, radishes, onions, cucumbers, tomatoes or lettuce. certain others, even when well cooked, should not be allowed; as corn, lima beans, cabbage, egg plant. none of these should be given until a child has passed the age of ten years. _are vegetable salads to be given?_ as a rule salads of all kinds should be omitted until a child has passed the tenth year. salads are difficult to digest and a cause of much disturbance in children of all ages. cereals _what are the most important points in selecting and preparing cereals?_ the important things are that they are properly cooked and not used in excess. the ready-to-serve cereals should never be chosen for children, nor should a child, because he is fond of cereals, be allowed to make his entire meal of them, taking two or three saucerfuls at a feeding. many of the partially cooked preparations of oatmeal and wheat are excellent, but should be cooked for a much longer time than is stated upon the package, usually three or four times as long. digestibility is chiefly a matter of proper cooking. most of the grains,--oatmeal, hominy, rice, wheaten grits,--require at least three hours' cooking in a double boiler in order to be easily digested. the prepared flours,--corn starch, arrowroot, barley,--should be cooked at least twenty minutes. i know of no preparation in the modern market which requires no cooking, which is to be recommended for children. _how are cereals to be given?_ usually with milk or a mixture of milk and cream; always with an abundance of salt and with very little or no sugar, one half teaspoonful on a saucerful of cereal should be the limit. cereals should not be served with syrups or butter and sugar. broths and soups _what broths and soups are to be recommended?_ meat broths are generally to be preferred to vegetable broths,--mutton or chicken being usually most liked by children. nearly all plain broths may be given. those thickened with rice, barley or corn starch form a useful variety, especially with the addition of milk. vegetable purees of peas, spinach, celery or asparagus may be used for children over seven years old. tomato soup should not be given to young children. bread, crackers and cakes _what forms of breadstuffs are best suited to young children?_ fresh bread should not be given, but stale bread cut thin and freshly dried in the oven until it is crisp is very useful, also zwieback, the unsweetened being preferred. oatmeal, graham or gluten crackers and the huntley and palmer breakfast biscuits, stale rolls, or corn bread which has been split and toasted or dried till crisp, form a sufficient variety for most children. _what breadstuffs should be forbidden?_ all hot breads, all fresh rolls, all buckwheat and other griddle cakes, all fresh sweet cakes, especially those covered with icing and those containing dried fruits. a stale lady-finger or piece of sponge cake is about as far in the matter of cakes as it is wise to go with children up to seven or eight years old. desserts _what desserts may be given to young children?_ mistakes are more often made here than in any other part of the child's diet. up to six or seven years, only junket, plain rice pudding without raisins, plain custard and, not more than once a week, a small amount of ice cream. _what should be especially forbidden?_ all pies, tarts and pastry of every description, jam, syrups and preserved fruits; nuts, candy and dried fruits. _does "a little" do any harm?_ yes, in that it develops a taste for this sort of food, after which plainer food is taken with less relish. besides the "little" is very apt soon to become a good deal. _does not the child's instinctive craving for sweets indicate his need of them?_ that a child likes or craves sweets is the usual excuse of an indulgent parent. every child likes his own way, but that is no reason why he should not be trained to obedience and self-control; a child's fondness for sweets can hardly be considered a normal instinct. as a matter of fact, supported by everyday experience, no causes are productive of more disorders of digestion than the free indulgence in desserts and sweets by young children. it is a constantly increasing tendency, not easily controlled as a child grows older; and in early childhood, the only safe rule is to give none at all. fruits _are fruits an essential or important part of the diet?_ they are a very important part and should be begun in infancy. they are particularly useful for the effect they have upon the bowels. it is important that they should be selected with care and given with much discretion, especially in cities. in the country where fruit is absolutely fresh, a somewhat greater latitude may be allowed than is given below. _what fruits may safely be given to children up to five years old?_ as a general rule, only cooked fruits and the juices of fresh fruits. _what fruit juices may be used?_ that from sweet oranges is the best, but the fresh juice of grape fruit, peaches, strawberries and raspberries may also be used. _what stewed fruits may be given?_ stewed or baked apples, prunes, pears, peaches and apricots. _what raw fruits are to be particularly avoided with young children?_ the pulp of oranges or grape fruit, also cherries, berries, bananas and pineapple. _what precautions should be emphasized regarding the use of fruits?_ that they should be used with greater care in hot weather and with children who are prone to attacks of intestinal indigestion. _what symptoms indicate that fruits should be avoided?_ a tendency to looseness of the bowels with the discharge of mucus, or frequent attacks of abdominal pain or stomach ache. _is there any special choice of meals at which fruit should be given?_ the fruit juice given early in the morning, upon an empty stomach, works more actively upon the bowels than if it is given later in the day. it is not, as a rule, wise to give cream or milk with sour fruits. usually the fruit is best given at the mid-day meal, as a dessert, at a time when no milk is taken. it is in all cases important that the quantity of fruit should be moderate. _what besides water and milk should a child be allowed to drink and what should be forbidden?_ tea, coffee, wine, beer and cider in all quantities and in all forms should be forbidden to young children below puberty. cocoa which is made very weak, i.e., almost all milk, is often useful as a hot drink. lemonade, soda-water, etc., should if possible be deferred until the tenth year. a free indulgence in things of this kind should never be permitted with children of seven or eight years. indigestion in older children _what are the different ways in which indigestion shows itself in children?_ first, in acute disturbances which last for a few days only; and, secondly, in chronic disturbances which may continue for weeks or months. _which of the two forms of indigestion is more likely to impair seriously the health of the child?_ chronic indigestion; for since the cause is not recognized it often goes on for months and even years unchecked. _what are the symptoms of acute indigestion?_ these are familiar and easily recognized. they are vomiting, pain, undigested movements from the bowels, often fever and considerable prostration. such attacks are usually traceable to their proper cause, the removal of which is followed by prompt recovery. _what are the common causes of acute indigestion?_ this is frequently due to overeating, to indulgence in some special article of improper food, or to eating heartily when overtired. acute indigestion often marks the beginning of some acute general illness. _how should acute indigestion be managed?_ one should bear in mind that for the time being the digestive organs have stopped work altogether. the important thing, therefore, is to clear out from the intestines all undigested food by some active cathartic, such as castor oil. the stomach has usually emptied itself by vomiting. all food should be stopped for from twelve to thirty-six hours, according to the severity of the attack, only water being given. _at the end of this time is it safe to begin with the former diet?_ no; for such a procedure is almost certain to cause another attack of indigestion. at first only broth, thin gruel, very greatly diluted milk, or whey should be given. the diet may be very slowly but gradually increased as the child's appetite and digestion improve, but in most cases a week or ten days should elapse before the full diet is resumed. _what are the symptoms of chronic indigestion?_ these, although familiar, are not so easily distinguished and are very often attributed to the wrong cause. there are usually general symptoms such as indisposition, disturbed sleep, grinding of the teeth, fretfulness, languor, loss of weight and anæmia. there are besides local symptoms: flatulence, abdominal pain, abdominal distention, constipation, or looseness of the bowels with mucus in the stools, foul breath, coated tongue, loss of appetite, or an abnormal capricious appetite. such symptoms are often wrongly ascribed to intestinal worms. _what are the common causes of chronic indigestion?_ this is generally the result of a bad system of feeding, either the prolonged use of improper food or of improper methods of feeding. examples of bad methods of feeding are, coaxing or forcing to eat, rapid eating with insufficient mastication eating between meals, allowing a child to have his own way in selecting his food, as when he lives largely upon a single article of diet. things to be considered under the head of improper food are, indulgence in sweets, desserts, etc., the use of imperfectly cooked foods, especially cereals and vegetables, and of raw or stale fruits. _is it not true that a diet or a special article of food which does not make a child ill is proof that such a diet or such a food is proper for a child?_ by no means; with many people the only guide in feeding children is that the article in question did not make the children sick, therefore it is allowable. this is a very bad principle. a better one is to adopt such a diet as will nourish the child's body with the least possible tax upon his digestive organs; in other words, to exclude articles which experience has shown to be injurious to most children. _how should chronic indigestion be managed?_ this is a much more difficult matter than the treatment of acute indigestion, for, as it is usually the result of the prolonged use of improper food or of an improper method of feeding, a cure can be accomplished only by a discovery and removal of the cause. _is chronic indigestion curable?_ in the vast majority of cases it is so, but only by faithfully observing for a long period the rules for simple feeding laid down elsewhere. one of the greatest' difficulties in the way of recovery is that parents and nurses are unwilling to follow a restricted diet long enough to secure a complete cure, or to change radically their methods of feeding, but expect the child to recover by simply taking medicine. _for how long a period is it necessary to continue very careful feeding?_ in any case it must be done for several months; with most children for two or three years; with some, throughout childhood, for with them the slightest deviation from established rules is sure to provoke a relapse. _is not medicine useful?_ it is undoubtedly of assistance for the relief of some symptoms, but the essential thing is proper feeding, without which nothing permanent can be accomplished. general rules to be observed in feeding bad habits of eating are readily acquired but difficult to break. young children should not be allowed to play with their food, nor should the habit be formed of amusing or diverting them while eating, because by these means more food is taken. older children should not be permitted to make an entire meal of one thing, no matter how proper this may be. children, who are allowed to have their own way in matters of eating are very likely to be badly trained in other respects; while those who have been properly trained in matters of eating can usually be easily trained to do anything else that is important. learning to eat proper things in a proper way forms therefore a large part of a child's early education. if careful training in these matters is begun at the outset and continued, the results will well repay the time and effort required. whether the child feeds himself or is fed by the nurse, the following rules should be observed: . food at regular hours only; nothing between meals. . plenty of time should be taken. on no account should the child bolt his food. . the child must be taught to chew his food. yet no matter how much pains are taken in this respect, mastication is very imperfectly done by all children; hence up to the seventh year at least, all meats should be very finely cut, all vegetables mashed to a pulp, and all grains cooked very soft. . children should not be continually urged to eat if they are disinclined to do so at their regular hours of feeding, or if the appetite is habitually poor, and under no circumstances should a child be forced to eat. . indigestible food should never be given to tempt the appetite when the ordinary simple food is refused? food should not be allowed between meals because it is refused at meal-time. . one serious objection to allowing young children highly seasoned food, entrees, jellies, pastry, sweets, etc., even in such small amounts as not to upset the digestion, is that children thus indulged soon lose appetite for the simple food which previously was taken with relish. . if there is any important article of a simple diet such as milk, meat, cereals, or vegetables, which a child habitually refuses, this should always be given first at the meal and other food withheld until it is disposed of. children so readily form habits of eating only certain things and refusing others that such an inclination should be checked early. . if an infant refuses its food altogether, or takes less than usual, the food should be examined to see if this is right. then the mouth should be inspected to see if it is sore. if neither of these things is the cause, the food should be taken away and not offered again until the next feeding time comes. . in any acute illness the amount of food should be much reduced and the food made more dilute than usual. if there is fever, no solid food should be given. if the child is already upon a milk diet, this should be diluted, and in some cases partially peptonized. . in very hot weather the same rules hold, to give less food, particularly less solid food, and more water. food formulas _beef juice._--one pound of rare round steak, cut thick, slightly broiled, and the juice pressed out by a lemon-squeezer, or, better, a meat-press. from two to four ounces of juice can generally be obtained. this, seasoned with salt, may be given cold, or warmed by placing the cup which holds it in warm water. it should not be heated sufficiently to coagulate the albumin which is in solution, and which then appears as flakes of meat floating in the fluid. _beef juice by the cold process._--one pound of finely chopped round steak, six ounces of cold water, a pinch of salt; place in a covered jar and stand on ice or in a cold place, five or six hours or overnight. it is well to shake occasionally. this is now strained and all the juice squeezed out by placing the meat in coarse muslin and twisting it very hard. it is then seasoned and fed like the above. beef juice so made is not quite as palatable as that prepared from broiled steak, but it is even more nutritious, and is more economical, as fully twice as much juice, can be obtained from a given quantity of meat. beef juice prepared in either of these ways is greatly to be preferred to the beef extracts sold. _mutton broth._--one pound of finely chopped lean mutton, including some of the bone, one pint cold water, pinch of salt. cook for three hours over a slow fire down to half a pint, adding water if necessary; strain through muslin, and when cold carefully remove the fat, adding more salt if required. it may be fed warm, or cold in the form of a jelly. a very nutritious and delicious broth is made by thickening this with cornstarch or arrowroot, cooking for ten minutes and then adding three ounces of milk, or one ounce and a half of thin cream, to a half pint of broth. _chicken, veal, and beef broths._--these are made and used in precisely the same manner as mutton broth. _meat pulp._--a rare piece of round or sirloin steak, the outer part having been cut away, is scraped or shredded with a knife; one teaspoonful to one tablespoonful may be given, well salted, to a child of eighteen months. scraping is much better than cutting the meat fine. for this on a large scale, as in institutions, a hamburg-steak cutter may be employed. _junket, or curds and whey._--one pint of fresh cow's milk, warmed; pinch of salt; a teaspoonful of granulated sugar; add two teaspoonfuls of fairchild's essence of pepsin, or liquid rennet, or one junket tablet dissolved in water; stir for a moment, and then allow it to stand at the temperature of the room for twenty minutes, or until firmly coagulated; place in the ice box until thoroughly cold. for older children this may be seasoned with grated nutmeg. _whey._--the coagulated milk prepared as above is broken up with a fork and the whey strained off through muslin. it is best given cold. if some stimulant is desired, sherry wine in the proportion of one part to twelve, or brandy one part to twenty-four, may be added. whey is useful in many cases of acute indigestion. _barley jelly from the grains._--three tablespoonfuls of pearl barley; soak overnight, then place this in one quart of fresh water; add pinch of salt, and cook in double boiler steadily for four hours down to one pint, adding water from time to time; strain through muslin. when cold this makes a rather thick jelly. if a thinner gruel (barley water) is desired, one half the quantity of barley should be used. _oat, wheat, or rice jelly._--these are prepared from oatmeal, wheaten grits, and rice grains in the same manner as the barley jelly. _barley jelly from the flour._--either robinson's patent barley or prepared barley flour of the health food company may be used. one rounded tablespoonful of the flour, thoroughly blended with a little cold water, is added, stirring, to one pint of boiling water containing a pinch of salt; cook for twenty minutes in a double boiler, and strain. this makes a jelly of about the consistency of that made from the grains as above. it is essentially the same in composition, and much less trouble to prepare. a thinner gruel (barley water) is made by using half the quantity of flour. when this is to be mixed with milk, it is well to add the milk to the barley gruel before removing from the fire, and stir two or three minutes, or until the milk has nearly reached the boiling point, when it should be removed and bottled. _oat or wheat jelly from the flour._--these are made from the prepared oat flour of the health food company or hubbell's prepared wheat flour. they are used like the barley. _imperial granum._--this is prepared and used in precisely the same way as the barley flour above mentioned, the gruel being mixed with milk before it is removed from the fire. _albumin water._--the white of one fresh egg; half a pint of cold water; pinch of salt; teaspoonful of brandy. this should be shaken thoroughly and fed cold either with a spoon or from a bottle. it is useful in cases of vomiting, and can sometimes be retained by a very irritable stomach. _lime-water._--one heaping teaspoonful of slaked lime; one quart boiled or distilled water; place in a corked bottle and shake thoroughly two or three times during the first hour. the lime should then be allowed to settle, and after twenty-four hours the upper clear fluid carefully poured or siphoned off for use. _dried bread._--either stale or fresh bread may be used; it is cut in thin slices and placed in the oven, with the door open, and quickly dried until it is crisp, but not browned. it is in many respects preferable to crackers for little children. _coddled egg._--a fresh egg, shell on, is placed in boiling water which is immediately after removed from the fire. the egg then cooks slowly in the water, which gradually cools, for seven or eight minutes, when the white should be about the consistency of jelly. for a delicate digestion the white only should be given, with salt; it can be easily separated from the yolk. part iv miscellaneous the bowels _how many movements daily should an infant have during the first few weeks of life?_ usually two or three a day for the first week, and then one or two each day. _how many after a child is a month old?_ a healthy child should have at least one movement each day; many have two and some more than two; but it is the character of the stools rather than their number which is to be taken as the evidence of perfect digestion. _what is the appearance of a healthy movement of a child who is taking nothing but milk?_ it is soft, yellow, and smooth, containing no lumps. _when are the stools dark brown or black?_ while taking bismuth, iron, and sometimes when taking much meat or beef juice; also while taking many of the prepared foods. they may be dark brown or black from blood. this last is a condition which may indicate serious illness. _how may a child be trained to be regular in the action of its bowels?_ by endeavouring to have them move at exactly the same time every day. _at what age may an infant be trained in this way?_ usually by the second month if training is begun early. _what is the best method of training?_ a small chamber, about the size of a pint bowl, is placed between the nurse's knees, and upon this the infant is held, its back being against the nurse's chest and its body firmly supported. this should be done twice a day, after the morning and afternoon feedings, and always at the same hour. at first there may be necessary some local irritation, like that produced by tickling the anus or introducing just inside the rectum a small cone of oiled paper or a piece of soap, as a suggestion of the purpose for which the baby is placed upon the chamber; but in a surprisingly short time the position is all that is required. with most infants, after a few weeks the bowels will move as soon as the infant is placed on the chamber. _what advantage has such training?_ it forms the habit of having the bowels move regularly at the same hour, which is a matter of great importance in infancy and makes regularity in childhood much easier. it also saves the nurse much trouble and labour. sleep _should a child sleep in the same bed with its mother or nurse?_ under no circumstances, if this can possibly be avoided. very young infants have often been smothered by their mothers, by overlying during sleep. if the infant sleeps with the mother, there is always the temptation to frequent nursing at night, which is injurious to both mother and child. older children also should, if possible, have separate beds; many contagious diseases and bad habits are contracted by children sleeping together. _how should an infant's bed be prepared?_ the mattress should be firm but soft, the pillow very thin, and the covering not excessive. a baby should not be allowed to sleep always in the same position, but should be changed from side to side. hair pillows are useful in summer and for children who perspire very much. _how much sleep is natural for a newly born baby?_ a baby with a good digestion and proper food will usually sleep at this period about nine tenths of the time. _how much should a baby sleep at six months?_ about two thirds of the time. _up to what age should an older child take a nap during the day?_ always until four years old, and if possible longer. _at what age may an infant go all night without feeding?_ at five months a child should not be fed or nursed between p.m. and a.m. at two years a child can easily go from p.m. to a.m. without feeding. _how should a baby be put to sleep?_ the room should be darkened and quiet, the child's hunger satisfied, and the child made generally comfortable and laid in its crib while awake. _is rocking necessary?_ by no means. it is a habit easily acquired, but hard to break, and a very useless and sometimes injurious one. the same may be said of sucking a rubber nipple, or "pacifier," and all other devices for putting children to sleep. _what are the principal causes of disturbed sleep?_ as quiet peaceful sleep is a sign of perfect health, disorders of sleep may be produced by almost anything which is wrong with the child. . habitual disturbance of sleep in infants is most frequently associated with the food or feeding. it may be from the discomfort of chronic indigestion due to improper food. in bottle-fed infants it is often the result of overfeeding; in those who are nursed it is often due to hunger. a common cause is frequent night feeding; an infant who is fed three or four times during the night is almost invariably a bad sleeper. . disturbed sleep or sleeplessness may be due to causes purely nervous. such are bad habits acquired by faulty training; as when the nursery is lighted and the child taken from its crib whenever it wakes or cries; or when some of the contrivances for inducing sleep have been used. any excitement or romping play just before bedtime, and fears aroused by pictures or stories, are frequent causes. children who inherit from their parents a nervous constitution are especially likely to suffer thus. . there may be physical discomfort from cold feet, insufficient or too much clothing, or want of fresh air in the sleeping room. . interference with breathing due to obstruction from large tonsils or adenoids. these cause great restlessness and lead a child to assume many different postures during sleep, often lying upon the face or upon the hands and knees. . chronic pains or frequently recurring night pains may be causes of disordered sleep, when a child wakes with a sudden sharp cry. in infants this is most often due to scurvy, sometimes to syphilis. in older children it may be the earliest symptom of disease of the hip or spine. . sleeplessness and disturbed sleep are frequent whenever the general condition falls much below a healthy standard; e.g., in infants who are not thriving and in children suffering from marked anæmia. _how are children who sleep too little, or whose sleep is constantly disturbed, to be treated?_ never by the use of soothing sirups or other medicines. successful treatment consists in the discovery and removal of the cause. _do children ever sleep too much?_ it is doubtful if healthy children ever do. excessive sleep is an important symptom of some diseases of the brain. otherwise it seldom if ever occurs unless soothing sirups or other drugs have been given. exercise _is exercise important for infants?_ it is as necessary for them as for older children. _how is it obtained?_ a young baby gets its exercise by screaming, waving its arms, kicking, etc. the clothing should not be so tight as to make these movements impossible. at least twice a day the infant should be allowed for fifteen or twenty minutes the free use of its limbs by permitting it to lie upon a bed in a warm room, with all clothing except the shirt, stockings, and napkin removed. later, when in short clothes, the baby may be put upon a thick blanket or quilt laid upon the floor, and be allowed to tumble about at will. a nursery fence two feet high, made to surround a mattress, is an excellent device and makes a convenient box stall for the young animal, where it can learn to use both its arms and legs without the danger of injury. only by exercise such as this do the muscles have an opportunity to develop properly. the cry _when is crying useful?_ in the newly born infant the cry expands the lungs, and it is necessary that it should be repeated for a few minutes every day in order to keep them well expanded. _how much crying is normal for a very young baby?_ from fifteen to thirty minutes a day is not too much. _what is the nature of this cry?_ it is loud and strong. infants get red in the face with it; in fact, it is a scream. this is necessary for health. it is the baby's exercise. _when is a cry abnormal?_ when it is too long or too frequent. the abnormal cry is rarely strong, often it is a moaning or a worrying cry, sometimes only a feeble whine. _what are the causes of such crying?_ pain, temper, hunger, illness, and habit. _what is the cry of pain?_ it is usually strong and sharp, but not generally continuous. it is accompanied by contraction of the features, drawing up of the legs, and other symptoms of distress. _what is the cry of hunger?_ it is usually a continuous, fretful cry, rarely strong and lusty. _what is the cry of temper?_ it is loud and strong and accompanied by kicking or stiffening of the body, and is usually violent. _what is the cry of illness?_ there is usually more of fretfulness and moaning than real crying, although crying is excited by very slight causes. _what is the cry of indulgence or from habit?_ this is often heard even in very young infants, who cry to be rocked, to be carried about, sometimes for a light in the room, for a bottle to suck, or for the continuance of any other bad habit which has been acquired. _how can we be sure that a child is crying to be indulged?_ if it stops immediately when it gets what it wants, and cries when it is withdrawn or withheld. _what should be done if a baby cries at night?_ one should get up and see that the child is comfortable--the clothing smooth under the body, the hands and feet warm, and the napkin not wet or soiled. if all these matters are properly adjusted and the child simply crying to be taken up, it should not be further interfered with. if the night cry is habitual some other cause should be sought (see page ). _how is an infant to be managed that cries from temper, habit, or to be indulged?_ it should simply be allowed to "cry it out." this often requires an hour, and in extreme cases, two or three hours. a second struggle will seldom last more than ten or fifteen minutes, and a third will rarely be necessary. such discipline is not to be carried out unless one is sure as to the cause of the habitual crying. _is it likely that rupture will be caused from crying?_ not in young infants if the abdominal band is properly applied, and not after a year under any circumstances. lifting children _how should a young baby be lifted from its bed?_ the right hand should grasp the clothing below the feet, and the left hand should be slipped beneath the infant's body to its head. it is then raised upon the left arm. _what is the advantage of this?_ the entire spine is supported, and no undue pressure is made upon the chest or abdomen, as often happens if the baby is grasped around the body or under the arms. _how should a child old enough to run about be lifted?_ always by placing the hands under the child's arms, and never by the wrists. _what injury may be inflicted by lifting the child by the wrists or hands?_ often serious injury is done to the elbow or shoulder joints. the temperature _what is the normal temperature of an infant?_ the normal temperature varies more than in adults. in the rectum it usually fluctuates between ° and . ° f.; a rectal temperature of . ° f. or of . ° f. is of no importance whatever unless it continues. _where should the temperature of infants and young children be taken?_ the rectum is altogether the best place, and next to this the groin. the rectal temperature is from half a degree to a degree higher than that in the groin. _how long should the thermometer be left in place to take the temperature?_ two minutes in the rectum, and five minutes in the groin. _is the temperature of a young child a good guide as to the severity of its symptoms in illness?_ as a rule it is. a temperature of ° to ° f. commonly means a mild illness, and one of ° f. or over a serious one. the duration of the fever is, however, even more important than the height of the temperature. it should be remembered that in all young children slight causes often produce a high temperature which lasts for a few hours; one should not therefore be unduly alarmed unless the temperature continues high, or is accompanied by other important signs of illness. _is not a high temperature a more serious symptom in a young child than in an adult?_ the opposite is rather the case. young children are extremely sensitive to conditions which produce fever, and the thermometer often gives an exaggerated idea of the severity of the symptoms. a cause which in an adult might produce a temperature of ° f. or ° f., in a young child would very likely be accompanied by a temperature of ° or ° f. nervousness _what are the principal causes of excessive nervousness in infants and young children, and what can be done to prevent this?_ the most important cause is the delicate structure of the brain at this time, and its rapid growth. it grows as much during the first year as during all the rest of life. this requires quiet and peaceful surroundings. infants who are naturally nervous should be left much alone, should see but few people, should be played with very little, and should never be quieted with soothing sirups or the "pacifier." _at what age may playing with babies be begun?_ babies under six months old should never be played with; and the less of it at any time the better for the infant. _what harm is done by playing with very young babies?_ they are made nervous and irritable, sleep badly and suffer from indigestion and in many other respects. _when may young children be played with?_ if at all, in the morning, or after the midday nap; but never just before bedtime. toys _what points should guide one in selecting toys and playthings for an infant?_ the instinct in a baby to put everything into the mouth is so strong that nothing should be given that cannot be safely treated in this way. hence one should choose things which are smooth, those which can be easily washed, and those which cannot be swallowed. one should avoid ( ) toys with sharp points or corners; ( ) those with loose parts that might be detached or broken off and swallowed; ( ) small objects which might be swallowed or pushed into the nose or ear, such as coins, marbles, and safety-pins, also beads and buttons unless strung upon a stout cord; ( ) painted toys; ( ) those covered with hair or wool. infants have often been severely injured by swallowing what they have pulled off from their small toy animals. _what points are to be considered in selecting the toys and playthings of a child over two years old?_ it should be remembered that toys are not merely a source of amusement, but that they have an educational value as well. those are therefore to be preferred the use of which develops the child's imagination, and with which he can be taught to amuse himself. for boys nothing can surpass blocks, toy soldiers, balls, engines, and cars; and for girls, dolls and housekeeping sets. the complicated mechanical toys now so much in vogue give only a momentary pleasure, and as soon as the wonder at their operation has worn off, they have lost interest for the child except that which he gets in breaking them to see how the thing worked. _what important things can be taught children with their toys and how may this be done?_ the imagination may be developed, and children may be trained to habits of neatness, order and regularity and to concentration of mind. to this end toys should be kept in an orderly way upon a shelf in the nursery or in a closet, never piled in a miscellaneous heap in the corner of the room. children should select their toys and play with one thing at a time, which they should be taught to put away in its place before another is given. they should never be allowed to have a dozen things strewn about the room at one time, with none of which they are occupied. kissing _are there any valid objections to kissing infants?_ there are many serious objections. tuberculosis, diphtheria, and many other grave diseases may be communicated in this way. the kissing of infants upon the mouth by other children, by nurses, or by people generally, should under no circumstances be permitted. infants should be kissed, if at all, upon the cheek or forehead, but the less even of this the better. convulsions _what should be done for a child in convulsions before a doctor arrives?_ keep the child perfectly quiet with ice at the head, put the feet in a mustard bath, and roll the entire body in large towels which have been dipped in mustard water (two heaping tablespoonfuls of mustard to one quart of tepid water), and have plenty of hot water and a bath tub at hand, so that the doctor can give a hot bath if he thinks it advisable. _when is a hot bath useful?_ if the convulsions have continued until the pulse is weak, the face very pale, the nails and lips blue, and the feet and hands cold, the hot bath will be useful by bringing blood to the surface and relieving the heart, lungs, and brain. _how should the bath be given?_ the temperature should not be over ° f.; this should always be tested by a thermometer if one can be obtained. without this precaution, in the excitement of the moment, infants have frequently been put into baths so hot that serious and even fatal burns have been produced. if no thermometer is available the nurse may plunge her arm to the elbow into the water. it should feel warm, but not so hot as to be at all uncomfortable. one half a teacupful of powdered mustard added to the bath often adds to its efficacy. foreign bodies _what should be done if a foreign body has been swallowed?_ first, examine the throat with the finger to see if it has lodged there, and if so remove it. if it has passed from the throat it has usually gone into the stomach. _what should be done in this case?_ give the child plenty of dry food, like bread, potato, etc., but under no circumstances either an emetic or cathartic. an infant may have its usual food. _what harm would a cathartic do?_ it is likely to hurry the foreign body too rapidly through the intestine and in this way do harm; otherwise it becomes coated with fecal matter and passes the intestine usually without doing injury. _what should be done if a child gets a foreign body into the ear?_ unless this can easily be removed with the fingers it should not be meddled with, for it is likely to be pushed farther into the ear. the child should be taken to a physician. _what should be done if there is a foreign body in the nose?_ the child should blow his nose strongly while the empty nostril is compressed. unless this removes it a physician should be called. meddlesome interference is always harmful. colic _what are the symptoms of colic?_ there is a strong, hard cry, which comes suddenly and returns every few minutes. with this there is drawing up of the feet, contraction of the muscles of the face, and other signs of pain. the abdomen is usually tense and hard. _what should be done for a baby with colic?_ first, see that the feet are warm. place them against a hot-water bag, or hold them before an open fire; apply a hot flannel to the abdomen, or let the child lie upon its stomach across a hot-water bag. if the colic continues, a half teacupful of warm water containing ten drops of turpentine may be injected into the bowels with a syringe; at the same time the abdomen should be gently rubbed so as to start the wind. if the gas is in the stomach, half of a soda mint tablet may be given in a tablespoonful of very warm water. earache _what are the symptoms of earache?_ the pain is generally severe and accompanied by a sharp scream; the child often puts the hand to the affected ear, or cries whenever it is touched. the pain is likely to be prolonged and continuous. _how should a child with earache be treated?_ the ear should be irrigated with a solution of boric acid (twenty grains to the ounce) as warm as can be borne. dry heat may then be applied in several ways. the ear having been first covered with cotton, a small hot-water bag or one filled with hot salt or bran, may be bound over it with a bandage; or a small butter plate heated in hot water may be used in the same way. the hot-water bag may be held against the ear or the child may lie with his head upon it. the use of such substances as oil and laudanum in the ear is not to be recommended. croup _what are the symptoms of croup?_ there is a hollow, dry, barking cough, with some difficulty in breathing. _when is this likely to come on?_ usually at night. _is simple croup dangerous?_ the ordinary croup of infants is spasmodic croup, and is very rarely dangerous, although the symptoms seem very alarming. _what are the symptoms?_ in a mild attack there is simply noisy breathing, especially on drawing in the breath, with a tight, barking, or croupy cough. in a severe attack the child's breathing is more noisy and becomes difficult. _what is the dangerous form of croup?_ membranous croup, which is the same thing as diphtheria of the larynx. _how does this develop?_ gradually; very rarely does it come on suddenly. _what should be done for a baby who has spasmodic croup?_ the room should be very warm, hot cloths or poultices should be applied over the throat, and either a croup kettle or an ordinary tea-kettle kept boiling in the room. this is more efficacious if the child is placed in a tent made by a raised umbrella with a sheet thrown over it, and the steam introduced beneath the tent. if the symptoms are urgent, ten drops of the sirup of ipecac should be given every fifteen minutes until free vomiting occurs. whenever the symptoms reach a point where breathing becomes difficult, a doctor should be summoned without delay. contagious diseases _what are the first symptoms of measles?_ measles comes on rather gradually with cough, sneezing, watery eyes and nose, much like an ordinary cold in the head. the eruption appears after three or four days, first upon the face and neck as small red spots, and spreads slowly over the body. _is measles a serious disease?_ in infants and during the winter season it is likely to be very serious on account of the danger of bronchitis and pneumonia, which frequently accompany it. in children over four years old it is generally not severe. no child should be voluntarily exposed to this disease, and particularly one who is delicate or prone to disease of the lungs should be protected against it. _when and how is measles contagious?_ measles may readily be conveyed from the very beginning of the catarrh, two or three days before any eruption is present. it is not often carried by healthy persons. its poison does not cling long to a sick room. _what is german measles?_ german measles, or rubella, is a distinct disease and has nothing to do with ordinary measles. it is extremely rare for a child to be much sick with it. there is usually a very extensive eruption which may cover the body, but few other symptoms. _what are the first symptoms of scarlet fever?_ generally it comes suddenly, with vomiting, high fever, and sore throat. the eruption usually appears within twenty-four hours as a red blush, first upon the neck and chest, and spreads rapidly. _when and how is scarlet fever contagious?_ scarlet fever is only slightly contagious for the first one or two days of the attack. it is most contagious at the height of the disease and during desquamation. it may be carried by healthy persons and by the clothing or bedding from the sick room. _how does whooping-cough begin?_ for a week or ten days it cannot be distinguished from an ordinary cold on the chest. then the attacks of coughing gradually become more severe and vomiting may follow. after a severe coughing fit the breath is caught with a peculiar noise known as the "whoop." _how does chicken-pox begin?_ it usually comes out gradually, as widely scattered pimples over the scalp, face, and body, many of which soon become small vesicles, resembling tiny blisters. there is itching and local discomfort but little fever, and the child rarely seems to be very ill. _how does diphtheria begin?_ sometimes suddenly, but usually gradually, with sore throat and swelling of the glands of the neck, with white patches upon the tonsils, or a free discharge which may be bloody, from the nostrils. _how does mumps begin?_ as a swelling upon the jaw, beneath the ear. as it increases it extends forward upon the cheek and backward behind the ear. it affects one or both sides. mumps is not very common in young children, and in them it is usually mild. after twelve or thirteen years it is likely to be more severe. _how long after exposure do the first symptoms appear in the different diseases?_ in scarlet fever in from three to five days, rarely later than a week; in measles in from nine to fourteen days, occasionally as late as twenty days; in whooping-cough in from one to two weeks; in chicken-pox in from fourteen to sixteen days; in german measles in from ten to sixteen days. in diphtheria the time varies much; it may be only one day, and it may be one or two weeks. in mumps it is usually a little less than three weeks, the average being twenty days. _which of these diseases are most contagious?_ measles and chicken-pox are very contagious, and very few children who have not had them can come near a person suffering from either disease without taking it. whooping-cough is almost as contagious as measles, and for young babies even more so. a very close exposure is not necessary in the case of either of these diseases, and whooping-cough can undoubtedly be contracted in the open air. scarlet fever and diphtheria are much less contagious; for both of these a pretty close exposure is necessary. _how long should a child with any of these diseases be kept away from other children?_ with measles, for two weeks after the rash has gone; with scarlet fever, for at least four weeks after the rash has gone, and longer if the peeling is not over or if the ears are running; with whooping-cough, for two months, or so long as the paroxysmal cough continues; with chicken-pox, until all crusts have fallen off, or for about three weeks after the eruption appears; with german measles for one week after the eruption has faded; with diphtheria, at least ten days after the throat is well in a very mild case, and four weeks if the case has been severe; with mumps for one week after the swelling has gone. _what should be done when a child shows the first symptoms of serious illness?_ the child should be put to bed. if it is an infant the food should be diluted to one half the usual strength; if an older child, only fluid food should be given. if the child seems feverish, take the temperature if the bowels are constipated, give a teaspoonful of castor oil; but no other medicine without the doctor's orders. send for the doctor at once, and until he comes carefully exclude all other children from the room. _by what nursery training may the examination and treatment of sick children he made much easier?_ by teaching all children to gargle, to show the throat, to take pills, and by constantly teaching them to regard the doctor as the child's best friend, and his visits as a great treat. on no account should a child be frightened into obedience by threats of what the doctor will do. with care and patience most children may be taught to gargle and take pills at four or five years, and to show the throat willingly at two or three. all these matters should be made a part of the child's education. scurvy _what is scurvy and how is it produced?_ scurvy is a disease of general nutrition, usually caused by the long-continued use of improper food. most of the cases come from the use of the prepared infant's foods sold in the stores, especially when they are given without fresh milk; occasionally the use of condensed milk and of sterilized milk is followed by scurvy; sometimes it is seen when, owing to feeble digestion, it has been necessary to make cow's milk very weak for a long time. _what symptoms are seen in an infant with scurvy?_ at first there is only indefinite and occasional soreness in the legs so that the child cries out when handled. as this soreness becomes more severe the child is often thought to have rheumatism. the gums swell and are of a deep purple colour. there may be bleeding from the gums, nose, bowels, or black-and-blue spots may be seen upon the legs. the ankles and knees may swell. the child grows very pale, loses appetite and weight, and sleeps badly. _what should be done when an infant shows signs of scurvy?_ the diet should at once be changed to fresh milk, properly modified according to the child's digestion, but not sterilized or pasteurized. the juice of a sweet orange should be given, best about an hour before the feeding. at first one or two teaspoonfuls, four or five times a day; later, more may be given if the symptoms are not improved. properly treated an infant with scurvy generally recovers promptly and completely. if not recognised, or untreated, it may cause death. constipation _when it is necessary to move the bowels immediately, what are some of the easiest methods?_ an injection of one tablespoonful of sweet oil may be given, or half a teaspoonful of glycerine in one tablespoonful of water, or a teacupful of tepid soap and water, or a glycerine suppository. none of these should be continued excepting under the physician's directions. _what sort of a syringe is to be preferred for giving an injection to an infant?_ the bulb syringe is the simplest; this consists of an oval bulb of soft rubber and a soft rubber or a hard rubber tip. it holds one or two ounces. _what is the most essential thing in preventing or overcoming constipation?_ the formation of the habit of having the bowels move every day regularly at the same hour, and proper early training (see page ). _what is the best hour?_ in most cases immediately after the first meal in the morning. _what are some simple means by which constipation may be relieved?_ the best are diet, suppositories, and massage. the changes to be made in the milk of constipated infants have been mentioned on page . the addition to the milk of some of the malted foods, such as mellin's food or malted milk, is sometimes useful. for little children the fruit juices are particularly beneficial when given half an hour or more before the first morning feeding, with half a glass of water. for older children the amount of white bread, toast, and potato, should be reduced, and green vegetables oatmeal, and graham bread given, with plenty of fruit twice a day. raw scraped apples are sometimes of more value than any other fruit. the best suppositories for continuous use are probably the gluten suppositories of the health food company. one should be given the first thing in the morning. they act rather slowly, usually in about two hours. in obstinate cases one may also be used at bedtime. glycerine suppositories act more quickly, but are too irritating for regular use. massage consists in rubbing the abdomen, which may be done in one of two ways: beginning at the right groin, the hand is carried up to the ribs, then across to the opposite side, then around to the left groin. the abdomen is stroked gently at first, and afterward deeper pressure used as the child becomes accustomed to it. the second method is by rubbing the deeper parts with a circular movement--the fingers not moving upon the skin--making a series of small circles, beginning at the right groin and following the same course as described above. either method should be employed for six or eight minutes twice a day, at almost any regular time, except soon after a meal. diarrhoea _in case a child is taken with diarrhoea, what should be done?_ with a moderate looseness of the bowels in an older child, solid food should be stopped, and boiled milk given diluted with gruel; the child should be kept perfectly quiet, as walking about always aggravates such a disturbance. if the symptoms are more severe and attended by fever and vomiting, all milk should be stopped at once, and only broth, barley water, or some thin gruel given. some cathartic, usually castor oil, is required with a severe attack. if the patient is an infant, the milk should be diluted and especially should the fat be reduced (see page ). in severe attacks with vomiting or frequent foul stools, all food should be stopped for at least twelve hours and all milk for a longer time, and the bowels freely moved by a cathartic. _why is a cathartic necessary if the movements are already frequent?_ such movements are nearly always due to an irritation in the bowel, set up by the fermenting food which has not been digested. the diarrhoea is nature's effort to get rid of the irritant. nothing to stop the movements should be given until the bowels have been thoroughly cleared by the treatment mentioned. bad habits _what are the most common bad habits of young children?_ sucking, nail-biting, dirt-eating, bed-wetting, and masturbation. _what do children suck?_ most frequently the thumbs or fingers, sometimes the clothing or blanket; often the "pacifier" or rubber nipple. _when is this habit most frequently seen?_ it begins in quite early infancy, and if not broken may last until children are six or seven years old. _is the sucking habit a harmful one?_ when persisted in it may produce a misshapen mouth or fingers. it constantly stimulates the flow of saliva and certainly aggravates disturbances of digestion during which the sucking habit is likely to be practised. it may lead to thrush or other forms of infection of the mouth. it is not necessary as a means of quieting a child, though it may in some degree cover up the consequences of bad feeding or bad training. on no account should the habit of sucking the "pacifier" be allowed as a means of putting children to sleep, or of quieting them while restless from dentition or indigestion. _how is the sucking habit to be controlled?_ one should be sure in the first place that the constant sucking of fingers is not due to hunger from insufficient food. sucking of the hands may often be controlled by wearing mittens or fastening the hands to the sides during sleep. in more obstinate cases it may be necessary to confine the elbow by small pasteboard splints to prevent the child from bending the arm so as to get the hand to the mouth. _when are nail-biting and dirt-eating seen, and how are they to be controlled?_ these habits belong especially to children over three years old. they are seen particularly in those who are excessively nervous or whose general health is below par; sometimes in those who develop serious nervous diseases later in life. children with such tendencies should be closely watched, and every means used to break up these habits early. dirt-eating is a morbid craving which is rarely seen in a normal child. _at what age may a child generally be expected to go without wetting the bed during the night?_ usually at two and a half years, if it is taken up late in the evening. some children acquire control of the bladder at night when two years old, and a few not until three years. after three years habitual bed-wetting is abnormal. _how should a young child addicted to bed-wetting be managed?_ at three or four years of age, punishments are sometimes useful, especially when it seems to depend more upon the child's indifference than anything else. they are of no value in older children, rewards being much more efficacious. in all cases one should give a child plenty of milk and water early in the day, but no fluids after p.m., the supper being always of solid or semi-solid food. the child should be taken up regularly at ten o'clock or thereabouts. it often happens that the formation or continuance of the habit is due to the child being in poor general condition, to some irritation in the urine, or in the genital organs. unless the simple means mentioned are successful the child should be placed under the charge of a physician. _what is masturbation?_ it is the habit of rubbing the genital organs with the hands, with the clothing, against the bed, or rubbing the thighs together. sometimes the child sits upon the floor, crosses its thighs tightly and rocks backward and forward. many of these things are passed over lightly and are regarded for months as simply a "queer trick" of the child. it may be seen at any age, even in those not more than a year old, and in both sexes. _how should such a child be treated?_ masturbation is the most injurious of all the bad habits, and should be broken up just as early as possible. children should especially be watched at the time of going to sleep and on first waking. punishments and mechanical restraint are of little avail except with infants. with older children they usually make matters worse. rewards are much more efficacious. it is of the utmost importance to watch the child closely, to keep his confidence, and by all possible means to teach self-control. some local cause of irritation is often present, which can be removed. medical advice should at once be sought. vaccination _nowadays when small-pox occurs so seldom is it necessary to have every child vaccinated?_ it should by all means be done. it is only by the practice of general vaccination that small-pox is kept down. in countries or in communities where vaccination is neglected, frightful outbreaks of small-pox occur every now and then just as in olden times. _what is the best time for vaccination?_ the time usually selected is from the third to the sixth month. it may be deferred in a very delicate child who is not likely to be exposed to small-pox, or in a child suffering from any form of skin disease. _which is preferable for vaccination, the arm or the leg?_ the part which can be most easily protected and kept at rest is to be chosen. in infants who do not yet walk or creep, the leg is to be preferred? in older children, in most circumstances, the arm. if older children are vaccinated on the leg, they should not be allowed to walk much while the vaccination is active. _when should vaccination be repeated?_ an unsuccessful vaccination proves nothing and should be repeated in two or three weeks. if success fully vaccinated in infancy, a child should invariably be revaccinated before puberty. if exposed or likely to be exposed to small-pox at any time vaccination should be repeated. [illustration: weight chart for the first year; the curved line indicates the average rate of gain.] [illustration: weight chart, one to fourteen years. the upper line indicates the average for boys; the lower (dotted) line that for girls.] transcriber's notes: seven typographical errors have been corrected: page , " " changed to " " (see fig. ) page , " " changed to " " (see fig. ) page , "does" changed to "dose" (give a big dose of castor oil) page , "he" changed to "be" (which should be covered with a single thickness) page , "iself" changed to "itself" (than by the bite itself) page , "dioxid" changed to "dioxide" (harmless substances as water and carbon dioxide) page , "ecezmatous" changed to "eczematous" (to keep the eczematous skin area moist) [illustration] the mother and her child by william s. sadler, m. d. professor of therapeutics, the post-graduate medical school of chicago; director of the chicago institute of physiologic therapeutics; fellow of the american medical association; member of the chicago medical society; the 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. _illustrated_ [illustration] toronto mcclelland, goodchild & stewart chicago: a. c. mcclurg & co. copyright a. c. mcclurg & co. * * * * * published august, * * * * * _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_, . contents * * * * * part i the mother chapter page i the expectant mother ii story of the unborn child iii birthmarks and prenatal influence iv the hygiene of pregnancy v complications of pregnancy vi toxemia and its symptoms vii preparations for the natal day viii the day of labor ix twilight sleep and painless labor x sunrise slumber and nitrous oxid xi the convalescing mother part ii the baby xii baby's early days xiii the nursery xiv why babies cry xv the nursing mother and her babe xvi the bottle-fed baby xvii milk sanitation xviii home modification of milk xix the feeding problem xx baby's bath and toilet xxi baby's clothing xxii fresh air, outings, and sleep xxiii baby hygiene xxiv growth and development part iii the child xxv the sick child xxvi baby's sick room xxvii digestive disorders xxviii contagious diseases xxix respiratory diseases xxx the nervous child xxxi nervous diseases xxxii skin troubles xxxiii deformities and chronic disorders xxxiv accidents and emergencies xxxv diet and nutrition xxxvi caretakers and governesses xxxvii the power of positive suggestions xxxviii play and recreation xxxix the puny child xl teaching truth appendix index illustrations the mother and her child _frontispiece_ figure page steps in early development the "expectant" costume the photophore taking the blood pressure breast binder how to hold the baby making the sleeping blanket in the sleeping blanket homemade ice box heating the bottle a sanitary dairy articles needed for baby's feeding supporting the baby for the bath developmental changes the cooling enema x ray showing tuberculosis of the lung father and mother corn and morning 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: . cessation of menstruation. . changes in the breast. . morning sickness. . 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 to , then, to find the probable day of delivery, we count back three months to september , and then add seven days. this gives us september , 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. | | oct. | | ---------+-------------------------------------------------+------- jan. | | oct. | | nov. =========+=================================================+======= feb. | | nov. | | ---------+-------------------------------------------------+------- feb. | | nov. | | dec. =========+=================================================+======= mar. | | dec. | | ---------+-------------------------------------------------+------- mar. | | dec. | | jan. =========+=================================================+======= april. | | jan. | | ---------+-------------------------------------------------+------- april. | | jan. | | feb. =========+=================================================+======= may. | | feb. | | ---------+-------------------------------------------------+------- may. | | feb. | | mar. =========+=================================================+======= june. | | mar. | | ---------+-------------------------------------------------+------- june. | | mar. | | apr. =========+=================================================+======= july. | | apr. | | ---------+-------------------------------------------------+------- july. | | apr. | | may. =========+=================================================+======= aug. | | may. | | ---------+-------------------------------------------------+------- aug. | | may. | | june. =========+=================================================+======= sept. | | june. | | ---------+-------------------------------------------------+------- sept. | | june. | | july. =========+=================================================+======= oct. | | july. | | ---------+-------------------------------------------------+------- oct. | | july. | | aug. =========+=================================================+======= nov. | | aug. | | ---------+-------------------------------------------------+------- nov. | | aug. | | sept. =========+=================================================+======= dec. | | sept. | | ---------+-------------------------------------------------+------- dec. | | sept. | | 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. ) 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. ). 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. ). 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. 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. ). the blending of the sperm and ovum has been perfect, the division of the original body multitudinous. [illustration: sperm and ovum cell division fetus at six weeks fetus at three months fig. . steps in early development] 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. ). 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. ). 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. [illustration: fig. . 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. ). 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 ( 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: . one teaspoon of milk magnesia. . one tablespoon of lime water. . 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: . patient's name. . address. . this specimen was taken from a twenty-four hour voiding of urine, which began at .... a.m. ...., and ended at .... a.m. .... . 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: . 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. . all sour fruits, and fruit acids: apples, grapes, gooseberries, grape fruit, currants, plums, and tomatoes. . fruit juices, especially from sour fruits: grape juice, lemonade, fruit soup, etc. . all foods high in fat: butter, cream, eggs, eggnog, ripe olives, olive oil, nuts--especially pecans, brazil nuts, and pine nuts. . buttermilk and koumiss. . 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 . 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. . 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: . _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. . _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: . heavy menstrual pains. . backache. . 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. 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. ). 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. [illustration: fig. . the photophore.] 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 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 to millimeters of mercury. pressure above 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: . headache. . dizziness. . blurring of the vision. . swelling of the feet and hands, or puffiness of the face. . diminished urine. . vomiting. . high blood-pressure. . 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: . drink more water or lemonade. . take a mild cathartic. . 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. . a hot colonic flushing (see appendix). . a hot bath followed by the hot blanket pack (see appendix). . one drop of croton oil on a bit of sugar may be placed on the back of the tongue. . 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: . persistent, dull headache. . presence of casts in the urine. . persistent high blood-pressure, with tendency to increase. of course, albumin will probably appear in the urine along with the casts, but it is the continued appearance of the casts that is of more importance as a danger signal. albumin is quite common in the urine of the expectant mother, but casts--long continued--suggest trouble. headache as an indicator of toxemia is of special significance when coupled with the other two cardinal symptoms of eclampsia--urinary casts and increasing high blood-pressure. therefore, the necessity for frequent urinary tests and blood-pressure examinations during the last weeks of pregnancy--especially, if the patient has suffered from headaches and has been running albumin in the urine. [illustration: fig. . taking the blood pressure] 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. ). 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 to 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, 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 mm., and later, possibly to mm. if the pressure goes no higher, we are not alarmed, for we have come to recognize a blood-pressure of 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 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 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 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 or 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 or , 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 $ . to $ . a week can be just as clean as the bed of the $ . 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 $ . to $ . 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 $ . to $ . 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 $ . 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. one large package of sterile gauze ( yards). four rolls of cotton batting. two yards of stout muslin for abdominal binders. two old sheets. twelve old towels or diapers. one yard of strong narrow tape for tying the cord. three short obstetrical gowns for the patient. two pairs of extra long white stockings. four t-binders. other articles needed by physician, nurse, and patient are: fifty bichloride of mercury tablets (plainly marked "_poison_"). four ounces of lysol. two ounces of powdered boric acid. one half ounce of % argyrol. one quart of grain alcohol. one pound jar of surgeon's green soap. one half pound of castile soap. one bottle white vaseline. one drinking tube. one medicine glass. one two-quart fountain syringe. one covered enamel bucket or slop jar. one good sized douche pan. three agateware bowls, holding two quarts each. two agateware pitchers, holding two quarts each. two stiff hand-brushes. one nail file. one pair surgeon's rubber gloves. one and one-half yards rubber sheeting inches wide. two no. rubber catheters. two dozen large safety pins. small package of tooth picks, to be used as applicators. six breast binders (fig. ). six sheets. just before confinement send for one ounce of fluid extract of ergot and an original pint bottle of squibb's chloroform. the preparation of the supplies . _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. . _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. . _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. [illustration: fig. . breast binder] . _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. . _the bobbin._ cut the bobbin or tape into four nine-inch lengths and wrap and mark. . the _tooth picks_ are left in the original package and do not require sterilization. . _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. one pint of liquid albolene. one half ounce of argyrol (mentioned in the mother's list). safety pins of assorted sizes. a powder box containing powder and puff. an old soft blanket in which to receive the child after birth. a soft hair brush. three old towels. small package of sterile gauze squares. scales. diapers. a silk and wool shirt (size no. ). an abdominal band to be sewed on with needle and thread. a pair of silk and wool stockings. a flannel skirt. an outing flannel night dress. a woolen wrapper. 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 ( antiseptic tablets to ½ 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 . 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: . that eighty to ninety per cent of all women who use this method can be carried through a practically painless labor. . 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. . 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. . 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. . 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. . 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. . 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. . 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. . 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. . 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. . 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. . 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. . 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: . 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. . 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. . 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. . 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. . 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. . 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. . 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. . 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. . 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. . 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. . 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: . "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.) . 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. . we know that standard and fresh solutions--as already noted--are absolutely essential for the success of this method. . 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." . 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. . 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. . 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. . 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. . 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. . 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. . 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. . 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. . 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. . 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." . 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. . 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. . 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." . 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 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 , 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: . 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. . 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. . 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. . 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. . 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." . 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. . 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. . under the influence of "gas," patients often appear to "bear down" with increased energy. it certainly does not lessen their cooperation in this respect. . 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. . 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. . 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. . 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 $ . for the first hour and $ . 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: . 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. . 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. . 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. . 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. . 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. . 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. . head raising, body straight and stiffened. . arm raising, well extended. . leg stretching, with knees stretched and toe extended. . 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 ° 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 or 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 to first month to one to six months about six months to one year about one to two years to two to four years to the above table is correct for the inactive normal child. muscular activity, such as crying and sucking, increases the pulse rate from to 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 weeks to during the rest of the first year to one to two years about two to four years about 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. ), 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 to ounces two to five years to ounces five to ten years to 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. 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. [illustration: fig. . how to hold the baby] 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. ). 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 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 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. castile soap. soft wash cloths. soft linen towels. bottle of plain vaseline. boracic acid, oz. iv (saturated solution). olive oil. sterile cotton balls in covered glass jar. safety pins of different sizes. hot water bag with flannel cover. baby scales. drying frames for shirt and stockings. baby's bed since the days of solomon, accidents have occurred where mother and babe have occupied the same bed. not only is there the ever-present danger of smothering the babe, but there are also many other reasons why a baby should have its own bed. the constant tendency to nurse it too often and the possibility of the bed clothing shutting off the fresh air supply, are in and of themselves sufficient reasons for having a separate bed for baby. the first bed is usually a basinet--a wicker basket with high sides--with or without a hood. a suitable washable lining 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. [illustration: fig. . 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. ). 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. ). 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. [illustration: fig. . 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 warm water. a small cup for boracic acid solution. castile soap. a soft wash cloth. several warmed soft towels. a bath thermometer. a medicine dropper for washing baby's eyes. talcum powder. oil or vaseline. sterile cotton. tooth picks. 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 f. from two to six months temperature f. from six to twenty-four months temperature -- 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 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. )--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, to give a full dose of castor oil to clear out the bowel tract. do not jolt or bounce the baby, do not carry him about, and don't walk the floor with him. heat him up inside and outside, warm his clothing and his bedding, and thus bring about relief without sowing seeds for future trouble--the sorrow of a spoiled child. one very quiet little baby was one day brought to the 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 thirsty. he has been given a dirty bottle. his mother has failed properly to cleanse the nipples. his food is not prepared right. his food is too cold. his bowels are constipated. his band is too tight. his clothes are wrinkled. his diaper is wet. he is too hot. he wants fresh air. he is too cold. he is in pain. he is very sick. his throat is sore. his ear aches. he has been rocked, carried, or bounced. he has been given a pacifier. he has had too much excitement. his mother has eaten the wrong food. chapter xv the nursing mother and her babe happy is the mother, and thrice blessed is the babe when he is able to enjoy the supreme benefits of maternal 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:" . regular periodical sucking of the breasts from the day of baby's birth. . systematic applications of alternate hot and cold compresses, followed by massage to the breasts. . three good nourishing meals each day, eaten with merriment and gladness of heart. . a glass of "cream gruel," milk, cocoa, or eggnog at the close of each meal, with a glass just before retiring. . three outings each day in the open air. . 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. . take a daily nap. . you can bank on fretting and stewing over the hot cook stove to decrease your milk. it seldom fails to spoil it. . regular body bathing, with cold friction rubs to the skin. . a happy, carefree mental state. nothing dries up milk so rapidly as worry, grief, or nagging. . 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: . a new pregnancy. . mothers with uncontrollable tempers. . cases of breast abscess. . prolonged illness of the mother with high fever. . wasting diseases such as tuberculosis, bright's disease, heart disease, etc. . maternal syphilis. . 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: . progressive loss in weight. . 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. . 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: . she must be free from tuberculosis and syphilis. . she should be between twenty and thirty years of age. . she should abstain from all stimulants. . 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 -- weeks -- ounces weeks-- months ½-- ounces months-- months -- ounces months-- year -- 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. ). 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. [illustration: fig. . 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. ). 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. [illustration: fig. . 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 . never play with a baby during or right after a meal. . lay the baby on his side when nursing the bottle. . three full hours should intervene between feedings. . don't give the food too hot--it should just be warm. . make the test for warmth on the inner side of your arm. . give a drink of water between each meal if awake. . never save the left-overs for baby. . if possible, give three feedings each day in the cool air, with baby comfortably warm. . do not jump, bounce, pat, or rock baby during or after meals. . never coax baby to take more than he wants, or needs. . no solid foods are given the first year. . 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 % . sugar . proteins . salts . water . ------ % . cow's milk fat % . sugar . proteins . salts . water . ----- % . 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. 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 or above . [illustration: fig. . a sanitary dairy _courtesy of lakewood farm_ _courtesy of lakewood farm_] 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. ). 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 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: . 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. . 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. . 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. ): . as many bottles as there are feedings in one day. . a nipple for each bottle. . waxed paper for each bottle top. . rubber bands for each bottle. . a two-quart pitcher. . a long-handled spoon for stirring the food. . a tablespoon. . a fork. . an eight-ounce, graduated measuring glass. . a bottle of lime water. . a fine-mesh, aluminum strainer. . a square of sterile gauze for straining the food (should be boiled for fifteen minutes with the utensils). . one plate, and later a double boiler ( ). . the sugar. . the milk. . ready for the ice box. . refrigeration. 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. ). 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. 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. [illustration: fig. . articles needed for baby'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. r_{x} whole milk ounces cane sugar level tablespoons boiled water ounces ½ lime water ounces amount at each feeding ounces ½ number of bottles interval between feedings hours 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 ==========+========+=======+=======+=======+========+=======+========+ age | | | | | | | amount | | baby's | whole | cane | wheat | boiled | lime | at | | weight | milk | sugar | flour | water | water | feeding| ----------|--------|-------|-------|-------|--------|-------|--------| | | | level | level | | | | | pounds |ounces | table-| table-| ounces | ounces| ounces | | | | spoon | spoon | | | | ----------|--------|-------|-------|-------|--------|-------|--------| week | ½ | ½ | | | | ½ | | ----------|--------|-------|-------|-------|--------|-------|--------| weeks | ½ | ½ | ½ | | | ½ | | ----------|--------|-------|-------|-------|--------|-------|--------| weeks | ¾ | | | | | ½ | ½ | ----------|--------|-------|-------|-------|--------|-------|--------| weeks | | | | | | | | ----------|--------|-------|-------|-------|--------|-------|--------| months | | | | | ½ | | ½ | ----------|--------|-------|-------|-------|--------|-------|--------| months | | | | ½ | | | ½ | ----------|--------|-------|-------|-------|--------|-------|--------| months | | | ½ | | ½ | ½ | ½ | ----------|--------|-------|-------|-------|--------|-------|--------| months | | | ½ | ½ | ½ | ½ | | ----------|--------|-------|-------|-------|--------|-------|--------| months | | | ½ | ½ | ½ | ½ | | | | | | | | | | ----------|--------|-------|-------|-------|--------|-------|--------| months | | | | ½ | ½ | ½ | | | | | | | | | | ----------|--------|-------|-------|-------|--------|-------|--------| months | | | ½ | | | ½ | ¼ | | | | | | | | | ----------|--------|-------|-------|-------|--------|-------|--------| months | | | | | | | ¾ | | | | | | | | | ----------|--------|-------|-------|-------|--------|-------|--------| months | | | ¾ | | | | | | | | | | | | | ----------|--------|-------|-------|-------|--------|-------|--------| months | | | ½ | | | | | | | | | | | | | ----------|--------|-------|-------|-------|--------|-------|--------| months | | | | | | | | | | | | | | | | | | | | | | | | ----------|--------|-------|-------|-------|--------|-------|--------| months | | | | | | | | | | | | | | | | ----------+--------+-------+-------+-------+--------+-------+--------+ ==========+=========+==========+=========+==========+======== age | number | interval | | soups | total | of | between | fruit | and | daily |feedings | feedings | juices | broths |calories ----------|---------|----------|---------|----------|-------- | | | | | | in | hours | | | | hours | | | | ----------|---------|----------|---------|----------|-------- week | | | | | ----------|---------|----------|---------|----------|-------- weeks | | | | | ----------|---------|----------|---------|----------|-------- weeks | | | | | ----------|---------|----------|---------|----------|-------- weeks | | | | | ----------|---------|----------|---------|----------|-------- months | | | | | ----------|---------|----------|---------|----------|-------- months | | | | | ----------|---------|----------|---------|----------|-------- months | | | | | ----------|---------|----------|---------|----------|-------- months | | ½ | | | ----------|---------|----------|---------|----------|-------- months | | | one | one | | | |teaspoon |tablespoon| ----------|---------|----------|---------|----------|-------- months | | | two | ¼ | | | |teaspoons| cup | ----------|---------|----------|---------|----------|-------- months | | |one-half | ¼ | | | | orange | cup | ----------|---------|----------|---------|----------|-------- months | | | one | ½ | | | | orange | cup | ----------|---------|----------|---------|----------|-------- months | | ½ | one | ¾ | | | | orange | cup | ----------|---------|----------|---------|----------|-------- months | | | one | | | | | orange | cup | ----------|---------|----------|---------|----------|-------- months | | | one | cup | | | | orange | arrowroot| | | | | cracker | ----------|---------|----------|---------|----------|-------- months | | | toast, gravies, baked | | | potato and apple, etc. ----------+---------+----------+---------+----------+-------- note ounce of whole milk equals calories level tablespoon of cane sugar equals calories level tablespoon of milk sugar equals calories level tablespoon of flour equals calories the juice of average orange equals calories cup of average bouillon equals about calories (this table is calculated on the basis of about 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. per cent milk milk sugar ¾ ¾ ¾ ¾ lime water boiled water --- --- --- --- --- --- --- --- --- the approximate composition of these formulas expressed in percentages are as follows: formula fat sugar proteins i . . . ii . . . iii . . . iv . . . v . . . vi . . . vii . . . viii . . . ix . . . 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 ° 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 ( / ) 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. . _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. . _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. . _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. . _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 milk ingredients food food food (horlick's) per cent per cent per cent per cent fat . . . . proteins . . . . cane sugar . ... ... ... dextrose ... ... } . [ ] ... lactose (milk sugar) . ... } } . [ ] maltose } . . ... } dextrins } . . . carbohydrates (soluble) . . . . starch . ... . ... inorganic salts . . . . water . . . . ridge's imperial carnrick's ingredients food granum food per cent per cent per cent fat . . . proteins . . . cane sugar ... ... ... dextrose . . ... lactose (milk sugar) ... ... maltose ... ... dextrins . . ... carbohydrates (soluble) . . . starch . . . inorganic salts . . . water . . . [ ] chiefly lactose. [ ] 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 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, f.; early infancy, f.; after six months, f., cooling down to 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 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 f. when baby is dipped in to be rinsed. the head and face toilet are identical with that described before, and with the baby undressed and wrapped in a warm 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. ). 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. [illustration: fig. . supporting the baby for the bath] 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: . not too much soap--and no strong soap. . careful rinsing of the skin area. . avoid harsh rubbing, but thoroughly dry. . 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 to skirts (flannel) shirts light-weight wool wrappers abdominal bands to diapers (first size) doz. diapers (third size) doz. stockings, pairs booties, pairs nightgowns handling blankets silkaline puffs baby blankets, pair hair or cotton mattress basinet 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. ) 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: . when the weather is excessively hot, take him out only in the early morning and late in the afternoon. . in extremely cold, below zero, weather, let his airing be indoors. . 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. . 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: . _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. . _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. . _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. . _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. . _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. . _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. . _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 . or . f. while the child may be in perfectly good health. the baby's temperature should be taken at the rectum--which should normally register . f. this temperature, as stated above, may register . 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 f. the physician should always be notified and his orders carefully followed. slight causes often produce a high temperature of to 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. ). 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: . the drinking water is boiled or distilled. . the orange is not overripe. . the banana is not underripe or overripe and is not eaten in chunks. . the milk is fresh and pasteurized. . the baby does not eat candy, ice cream, or other forbidden foods. . the baby's bowels move daily. . he does not remain dirty. . he naps daily. . he is protected from dust, flies, flees, and mosquitoes. . 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: . toys with sharp points. . small enough to swallow, or to push into the nose. . covered with hair or wool. . glass that is easily broken. painted toys. . toys that may be taken apart and the small parts swallowed. . paper books that may be chewed or torn. bear in mind that babies are easily amused with such simple toys as: . a half-dozen clothes pins. . an aluminum pan and a spoon. . rubber toys (easily washed). . celluloid dolls, ducks, and other floating toys. . blocks. . 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 years four central incisors years four lateral incisors years four first bicuspids to years four second bicuspids to years four canines to years four second molars to years four third molars to 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 inches. lbs. oz. week " ½ " weeks " ½ " } gained oz. weeks " " } a day; month ½ inches ¾ " } oz. a week months " ¾ " } months " ¼ " } {gained / oz. a day; months " ¾ " } { - / oz. a week. months ½ " " } {double original weight. months " ¼ " } {gained / oz. a day; { - / oz. a week. { months ½ " ¼ " } { months " ¼ " } {gained / in. a month. months ½ " ¾ " } { months " ¾ " } {gained about lb. a month. months ½ " ½ " } { year " ½ " } {treble original weight. years " " } { years " " } {gain in. a year. years ½ " " } double original length. years " " } {gained in. and lbs. } {a year. years " " } {gained in and lbs. years " " } {a year. years " " } {gained in. and lbs. years " " } {a year. years " " } {gained in. and lbs. years " " } {a year. years " " } years " " } years " " } {gained inches and years " " } {about lbs. a year. years " " } general development the accompanying illustration (fig. ), 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. [illustration: fig. . 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 to use cow's milk during the season of the year when the risks of contamination are greatest. if the baby is nursed up to the close of his first year he hardly need be trained to use the bottle, but may take his food from a cup. from one to two months should always be consumed in weaning the baby, unless sudden weaning is necessitated by ill health, as noted elsewhere. the baby should have, if possible, from thirty to forty days to accustom himself to cow's milk exclusively. if the child is weaned slowly there should be no trouble with the breasts, but in the instance of sudden weaning the mother should restrict her liquids, put on a tight breast binder, and for a day or two should take a dose of a saline cathartic, which will assist in taking care of the liquids and thus decrease the secretion of milk. normal bottle weaning if the bottle food is agreeing with the baby he should be allowed to use it up to the end of the first year when he will be given whole milk with possibly the addition of a little lime water. we see no reason why the child should give up his bottle during the second year unless other food is refused--unless he will not accept other food than from his bottle--and if you are convinced that he has formed the "bottle habit," then the milk should be put into a tiny cup or glass, and he should learn to sip it along with his solid foods; but if he takes his other foods without any hesitancy, then we know no reason why he should not take his milk in this comfortable manner from his bottle at least two or three feedings each day. if you desire to wean him from his bottle, serve the first part of it with a spoon from a cup or glass and then give him the remainder in the bottle. the beautiful picture of a big, robust baby lying on his back, knees flexed, both hands holding his beloved bottle still lingers in my mind as one of the pleasant memories of my lad's babyhood days, and at the close of the second year, when the beloved bottle was left behind, i believe i missed something as well as did the lad. i recall no difficulty with his taking the food from a cup. the success of all normal weanings is due entirely to the fact that it is done gradually and slowly, and under no circumstances should it be roughly and abruptly attempted--particularly in case of the bottle feeding. training the bowels and bladder reference is made to this subject in another part of this book--where we went into the detail of keeping the daily record of these physiological occurrences--and it was found that the bowels moved and the bladder was emptied at about the same time each day. any mother, caretaker, or nurse, who will take the time to keep a daily record of the hours of defecation and urination, will observe the time carefully and will catch the child on nearly every occasion before an accident occurs. often as early as four months the bowels will move in an infant's chamber at regular times each day. the nurse or mother places this receptacle in her lap and holds the child gently and carefully upon it. a little later it can be made to sit on a special chair prepared for the purpose, and at eight or nine months by careful training the urination can be controlled, and by the end of the first year the diapers ought to be discontinued. if the child has not learned to control the bladder by the age of two years, medical attention should be called to the fact and remedial measures instituted. baby's speech the baby should begin to talk at one year. he early learns to say "mamma" and "papa," and gradually adds nouns to his vocabulary, so that at eighteen months the normal child should have a vocabulary of one hundred to one hundred and fifty words. as he nears the two-year mark, he has acquired a few simple verbs and he can possibly put three words together, such as, "willie wants drink." pronouns come in late, as we all recall that the young child usually speaks of himself by his own name. children are born mimics. if you talk baby talk to them, they will talk baby talk back. for instance, a well known author told us just the other day that for many years no other name was given to the sewing machine in his house but the word "mafinge," and not until he went to school did he correct the word "bewhind," for in the nursery he learned the line "wagging their tails bewhind them." baby talk is very cunning, and often the adult members of the family pick it up and keep it up for years, and only when they are exposed in public, as one mother was on a suburban platform by her four-year-old lad shouting, "mamma, too-too tain tumin, too-too tain tumin," do they sense their responsibility and realize how difficult it is to form new habits. this poor mother tried in vain to have her little fellow say, as did another little lad two and one-half years old, "mother, the train's coming; let's get on." many words of our beloved language at best are hard to understand; so let us speak correct english to the little folks and they will reward us by speaking good english in return. if at two years the child makes no attempt at speech, suspicions should be aroused concerning mutism or other serious nervous defects. medical advice should be sought. defective speech all guttural tones which may be occasioned by adenoids or enlarged tonsils, all lisping, stuttering, or defective speech of all words should be taken in hand at the very start, as they are usually overcome by constant repetition of the correct manner of speaking the particular word in question. children of defective speech need special training, and should in no way be allowed rapidly to repeat little nursery rhymes, as oftentimes this rapid repetition of rhymes by a child with hereditary nervous defects may occasion stuttering or stammering later on. calisthenics special exercise should not be forced upon young children. physical culture, along with many other things intended for sedentary adults, should never be forced upon little folks who get all of the exercise they need in the many journeys they take building their blocks, sailing their boats, tearing down imaginary houses, making imaginary journeys--from morning until night the little feet are kept busy--never stopping until the sandman comes at sleepy time. do not yourself attempt to stimulate a child who seems backward. consult your physician. you had much better put a child out to grow up in the yard by himself with his sandpile than to force calisthenics or advance physical training upon him. bow legs and walking do not attempt to hasten nature in aiding the child to walk. let him creep, roll, slide, or even hunch along the floor--wait until he pulls himself to his feet and gradually acquires the art of standing alone. if he is overpersuaded to take "those cute little steps" it may result in bow legs, and then--pity on him when he grows up. sometimes flat foot is the result of early urging the child to rest the weight of the body upon the undeveloped arch. a defect in the gait or a pigeon toe is hard to bear later on in life. a certain amount of pigeon-toeing is natural and normal. if the baby is heavy he will not attempt to walk at twelve months. he will very likely wait until fourteen or fifteen months. the lighter-weight children sometimes walk as early as eleven months, but they should all be walking at eighteen months, and if not, it is usually indicative of backward mentality. if the training of the bowels and bladder will replace the diapers with drawers, the baby will attempt to walk sooner than when encumbered with a bunglesome bunch of diaper between the thighs. the little fellow runs alone at sixteen months and thoroughly enjoys it, and the wise mother will pay no attention to the small bumps which are going to come plentifully at this particular time. summary of baby's development he discovers his hands at three or four months. at six months he sits alone, plays with simple objects, grasps for objects, and laughs aloud from the third to the fifth month. he says "goo goo" at four or five months. at one year he should stand with support, listen to a watch tick, follow moving objects, know his mother, play little games, such as rolling a ball, should have trebled his birth weight, and have at least six teeth, and should use three words in short sentences. at eighteen months he should say "mamma" spontaneously, walk and run without support, should have quite a vocabulary, should be able to perform small errands like "pick up the book," and should have twelve to sixteen teeth. at two years he should be interested in pictures, able to talk intelligently, and know where his eyes, nose, mouth, hands, and feet are. at three years, he should enumerate the objects in a picture, tell his surname, and repeat a sentence with six words. in the case of a premature baby or a very delicate child, or as a result of a prolonged illness or a very severe sickness, such as spinal meningitis, the time of these mental and physical developments may all be postponed, while rickets, which will be spoken of later, is often the cause of late sitting, late standing, and late walking. diet after the first year milk is the principal article of diet during the second year. it should be given with regularity at distinct intervals of four meals a day. it may be given from the nursing bottle, unless the child has acquired the bottle habit and refuses to eat anything else but the food from his bottle, in which case it should be given from a cup. beginning with the sixth month, aside from his milk, be it breast milk or bottle milk, he is to be given orange juice once each day as well as the broth from spinach and other vegetables. this is necessary to give the child certain salts which are exceedingly essential to the bottle baby. at the close of the year when he is taking whole milk he should be given arrowroot cracker, strained apple sauce, prune pulp, fig pulp, mashed ripe banana (mashed with a knife), a baked potato with sauce or gravy (avoiding condiments), and a coddled egg. fruit juices may be added to the diet, such as grape, pineapple, peach, and pear juice. later in the second year he may be given stale bread and butter, and for desserts he may have cup custard, slightly sweetened junket, and such fruit desserts as baked apple and baked pear. we do not think it is necessary to give children much meat or meat juices. we appreciate that there is a diversity of opinion upon this subject, but we do not hesitate to say that in the families where meat is little used, the children seem to grow up in the normal manner with sound healthy bodies, sometimes having never tasted it. when meat is used, it should be well cooked to avoid contamination with such parasites as tapeworm and trichina; it should also be well chewed before swallowing, as many of the intestinal disturbances of the older children are due to the swallowing of unmasticated food such as half-chewed banana, chunks of meat, rinds of fruit, and the skins of baked potatoes. let the children's diet be simply planned, well cooked, thoroughly masticated, and above all things have regular meal hours, and no "piecing" between meals; and if the mother begins thus early with her little fellow, she will be rewarded some later day by hearing him say to some well-meaning neighbor, who has just given him a delicious cookie or a bit of candy: "thank you, i will keep it until meal time." children learn one of the greatest lessons of self control in following the teaching that nothing should pass the lips between meals but water or a fruit-ade. children in the second year require four meals a day, one of which is usually only the bottle or a cup of milk. these meals are usually taken at six, ten, two, and six in the evening. oftentimes this early six o'clock meal is just a bottle or cup of milk, as may also be the evening meal. candy now, a word about candy. pure candy is wholesome and nourishing. it is high in calorific value, and children should be allowed to have it if it does not enter the stomach in solutions stronger than ten or fifteen per cent. we can see at a glance that chocolate creams, bonbons, and other soft candies should never be given to children. candies that they can suck, such as fruit tablets, stick candy, sunshine candy, and other hard confections that are pure, and free from mineral colorings and other concoctions such as are commonly used in the cheaper candies, may safely be given at the close of the meals--but never between meals. all such articles as tea, coffee, beer, soft candies, condiments, pastries, and fried foods, should be positively avoided in the case of all children under five and six years of age. the diet from now on will be considered in the chapter "diet and nutrition." part iii the child part iii the child chapter xxv the sick child to the mother who has passed through the experience of bringing the child into the world is usually given that intuitiveness which helps her in caring for that child when it is well and in recognizing certain symptoms when it is sick. the newborn baby brings with him a large responsibility, but as the weeks pass by his care becomes less and less of a nervous strain, as the routine duties, so nearly alike each day of his little life, have made the task comparatively easy; but when the baby gets sick, particularly if he is under one year of age, and it is impossible for him clearly to make known his wants, and being unable to tell where it hurts or how badly it hurts, the average mother is likely to become somewhat panicky; and this confusion of mind often renders her quite unfit successfully to nurse the sick baby. the nurse it is often wise to secure the services of a trained nurse, and if the family purse will allow such services, a good, sincere, capable, practical nurse should be engaged, for her firm kindness will often accomplish much more than the unintentional irritability and anxious solicitude of an overworked and nervous mother. usually the mother not only attempts the care of the sick baby with the long night vigil--often not having the opportunity to take a bath or change her raiment day in and day out--but she often attempts to manage the entire household as well, including the getting of the meals and keeping the house cleaned, and it is not to be wondered at that her nerves become overtaxed and in an unlooked for moment she becomes irritable and cross with the sick child. no matter how low the financial conditions of the family may be, outside help is always essential in cases of severe or long-continued illness of the children. should the mother insist upon caring for the baby herself, then all household duties should be given over to outside help, and as she takes the rôle of the nurse, the same daily outing and sleep that an outside nurse would receive should be hers to enjoy. dr. griffith has so ably detailed the "features of disease" that we can do no better than to quote the following:[a] [a] from griffith's _care of the baby_, copyrighted by w. b. saunders company. position the position assumed in sickness is a matter of importance. a child feverish or in pain is usually very restless even when asleep. when awake it desires constantly to be taken up, put down again, or carried about. sometimes, however, at the beginning of an acute disease it lies heavy and stupid for a long time. in prolonged illnesses and in severe acute disorders the great exhaustion is shown by the child lying upon its back, with its face turned toward the ceiling, in a condition of complete apathy. it may remain like a log, scarcely breathing for days before death takes place. perfect immobility may also be seen in children who are entirely unconscious although not exhausted. a constant tossing off of the covers at night occurs early in rickets, but, of course, is seen in many healthy infants, especially if they are too warmly covered. a baby shows a desire to be propped up with pillows or to sit erect or to be carried in the mother's arms with its head over her shoulder whenever breathing is much interfered with, as in diphtheria of the larynx and in affections of the heart and lungs. the constant assumption of one position or the keeping of one part of the body still, may indicate paralysis. when, however, a cry attends a forcible change of position, it shows that the child was still because movement caused pain. sleeping with the mouth open and the head thrown back often attends chronic enlargement of the tonsils and the presence of adenoid growths in young children, although it may be seen in other affections which make breathing difficult. in inflammation of the brain the head is often drawn far back and held stiffly so. sometimes, too, in this disease the child lies upon one side with the back arched, the knees drawn up, and the arms crossed over the chest. a constant burying of the face in the pillow or in the mother's lap occurs in severe inflammation of the eyes. gestures the gestures are often indicative of disease. babies frequently place the hands near the seat of pain; thus in slight inflammation of the mouth they tend to put the hand in the mouth; in earache to move it to the ear; and in headache to raise it to the head. in headache or in affections of the brain they sometimes pluck at the hair or the ears, although they may often do this when there is no such trouble. picking at the nose or at the opening of the bowel is seen in irritation of the intestine from worms or oftener from other cause. a child with a painful disease of its chest may sometimes place its hand on its abdomen, or a hungry child try to put its fists into its mouth. in approaching convulsions the thumbs are often drawn tightly into the palms of the hands and the toes are stiffly bent or straightened. very young babies, however, tend to do this, although healthy. the alternate doubling up and straightening of the body, with squirming movements, making of fists, kicking, and crying, are indications of colic. this is especially true if the symptoms come on suddenly and disappear as suddenly, perhaps attended by the expulsion of gas from the bowel. skin color the color of the skin is often altered in disease. it is yellow in jaundice, and is bluish, especially over the face, in congenital heart disease. there is a purplish tint around the eyes and mouth, with a prominence of the veins of the face, in weakly children or in those with disordered digestion. a pale circle around the mouth accompanies nausea. the skin frequently acquires an earthy hue in chronic diarrhea, and is pale in any condition in which the blood is impoverished, as in bright's disease, rickets, consumption, or any exhausted state. flushing of the face accompanies fever, but besides this there is often seen a flushing without fever in older children the subjects of chronic disorders of digestion. sudden flushing or paling is sometimes seen in disease of the brain. facial expression the expression of the face varies with the disease. in whooping cough and measles the face is swollen and somewhat flushed, giving the child a heavy, stupid expression. there is also swelling of the face, especially about the eyes, in bright's disease. repeated momentary crossing of the eyes often indicates approaching convulsions. in very severe acute diarrhea it is astonishing with what rapidity the face will become sunken and shriveled, and so covered with deep lines that the baby is almost unrecognizable. the same thing occurs more slowly in the condition commonly known as marasmus. often the face has an expression of distress in the beginning of any serious disease. if the edges of the nostrils move in and out with breathing, we may suspect some difficulty of respiration, such as attends pneumonia. the baby sleeps with its eyes half open in exhausted conditions or when suffering pain. the head the head exhibits certain noteworthy features. excessive perspiration when sleeping is an early symptom of rickets. it must be remembered, however, that any debilitated child may perspire more or less when asleep. both in rickets and in hydrocephalus (water on the brain) the face seems small and the head large, but in the former the head is square and flat on top, while in the latter it is of a somewhat globular shape. the fontanelle is prominent and throbs forcibly in inflammation of the brain, is too large in rickets and hydrocephalus, bulges in the latter affection, and sometimes sinks in conditions with only slight debility. the chest the chest exhibits a heaving movement with a drawing in of the spaces between the ribs in any disease in which breathing is difficult. a chicken-breasted chest is seen in pott's disease of the spine, and to some extent in bad cases of enlargement of the tonsillar tissue; a "violin-shaped" chest in rickets; a bulging of one side in pleurisy with fluid; and a long, narrow chest, with a general flattening of the upper part, in older children predisposed to consumption. the abdomen the abdomen is swollen and hard in colic. it is also much distended with gas in rickets, and is constantly so in chronic indigestion in later childhood. it is usually much sunken in inflammation of the brain or in severe exhausting diarrhea or marasmus. it may be distended with liquid in some cases of dropsy. the cry the study of the cry furnishes one of the most valuable means of learning what ails a baby. a persistent cry may be produced by the intense, constant itching of eczema. the paroxysmal cry, very severe for a time and then ceasing absolutely, is probably due to colic, particularly if accompanied by the distention of the abdomen and the movements of the body already referred to. a frequent, peevish, whining cry is heard in children with general poor health or discomfort. a single shrill scream uttered now and then is often heard in inflammation of the brain. in any disease in which there is difficulty in getting enough air into the lungs, as in pneumonia, the cry is usually very short and the child cries but little, because it cannot hold its breath long enough for it. a nasal cry occurs with cold in the head. a short cry immediately after coughing indicates that the cough hurts the chest. crying when the bowels are moved shows that there is pain at that time. a child of from two to six years, waking at night with violent screaming, is probably suffering from night terrors. in conditions of very great weakness and exhaustion the baby moans feebly, or it may twist its face into the position for crying, but emit no sound at all. this latter is also true in some cases of inflammation of the larynx, while in other cases the cry is hoarse or croupy. crying when anything goes into the mouth makes one suspect some trouble there. if it occurs with swallowing, it is probable that the throat is inflamed. with the act of crying there ought always to be tears in children over three or four months of age. if there are none, serious disease is indicated, and their reappearance is then a good sign. coughing the character of the cough is also instructive. a frequent, loud, nearly painless cough, at first tight and later loose, is heard in bronchitis. a short, tight, suppressed cough, which is followed by a grimace, and, perhaps, by a cry, indicates some inflammation about the chest, often pneumonia. there is a brazen, barking, "croupy" cough in spasmodic croup. in inflammation of the larynx, including true croup, the cough may be hoarse, croupy, or sometimes almost noiseless. the cough of whooping cough is so peculiar that it must be described separately when considering this disease. then there are certain coughs which are purely nervous or dependent upon remote affections. thus the so-called "stomach cough" is caused by some irritation of the stomach or bowels. it is not nearly so frequent as mothers suppose. irritation about the nose or the canal of the ears sometimes induces a cough in a similar way. enlarged tonsils or elongated palate or throat irritation may also produce a cough. the breathing the breathing of a young child, particularly if under one year of age and awake, is always slightly irregular. if it becomes very decidedly so, we suspect disease, particularly of the brain. a combination of long pauses, lasting half a minute or a minute, with breathing which is at first very faint, gradually becomes more and more deep, and then slowly dies away entirely, goes by the name of "cheyne-stokes respiration," and is found in affections of the brain. it is one of the worst of symptoms except in infancy, and even then it is very serious. the rate of respiration is increased in fever in proportion to the height of the temperature. it is increased also by pain in rickets, and especially in some affections of the lungs. sixty respirations a minute are not at all excessive for a child of two years with pneumonia, and the speed is frequently decidedly greater than this. breathing is often very slow in disease of the brain, particularly tubercular meningitis. poisoning by opiates produces the same effect. frequent deep sighing or yawning occurs in affections of the brain, in faintness, or in great exhaustion, and may be a very unfavorable symptom. breathing entirely through the mouth shows that the nose is completely blocked, while snuffling breathing is the result of a partial catarrhal obstruction. a gurgling in the throat not accompanied by cough may indicate that there is mucus in the back part of it, the result of an inflammation, sometimes slight, sometimes serious. "labored" breathing, in which the chest is pulled up with each breath while the muscles of the neck become tense, the pit of the stomach and the spaces between the ribs sink in, and the edges of the nostrils move in and out, is seen in conditions where the natural ease of respiration is greatly interfered with, as in pneumonia, diphtheria of the larynx, asthma, and the like. long-drawn, noisy inspirations and expirations are heard in obstruction of the larynx, as from laryngeal diphtheria or spasmodic croup. the pulse the rate of the pulse is subject to such variations in infants that its examination is of less value than it would otherwise be. in early childhood its observation is of more service, although even then deceptive. slight irregularity is not uncommon. unusual irregularity is an important symptom in affections of the brain or heart. fever produces an increase in the pulse rate, the degree of which depends, as a rule, upon the height of the temperature. slowing of the pulse is a very significant symptom, seen particularly in affections of the brain, and sometimes in bright's disease and jaundice. the temperature the temperature is of all things important to remember in infancy and childhood because fever is easily produced and runs high from slight causes. even slight cold or the presence of constipation or slight disturbances of digestion may in babies sometimes produce a temperature of f. or more. we do not speak of fever unless the elevation reaches f. a temperature of or f. constitutes moderate fever, while that of or f. is high fever, and above f. very high. a temperature of f. is very dangerous, and is usually not recovered from. the danger from fever depends not only upon its height, but upon its duration also. an elevation of f. may be easily borne for a short time, but it becomes alarming if much prolonged. the mouth the tongue of newborn infants is generally whitish and continues to be so until the saliva becomes plentiful. after this we usually find it coated in disturbances of the stomach and bowels and in nearly any disorder accompanied by fever. in scarlet fever the tongue becomes bright red after a few days, and in measles and whooping cough it is often faintly bluish. in the latter affection an ulcer may sometimes be found directly under the tongue, where the thin membrane binds it to the floor of the mouth. in thrush the tongue is covered with white patches like curdled milk. a pale, flabby tongue, marked by the teeth at its edges, indicates debility or impaired digestion. in prolonged or very high fever the tongue grows dry, and in some diseases of the stomach or bowels it may look like raw beef. grinding of the teeth is a frequent symptom in infants in whom dentition has commenced. it generally indicates an irritated nervous system. most often this depends upon some disturbance of digestion; less often upon the presence of worms. the symptom is present during or preceding a convulsion, and may occur, too, in disease of the brain. in some babies it appears to be only a nervous habit. nursing the manner of nursing or swallowing frequently affords important information. a baby whose nose is much obstructed or who has pneumonia can nurse but for a moment, and then has to let the nipple go in order to breathe more satisfactorily. if it gives a few sucks and then drops the nipple with a cry, we must suspect that the mouth is sore and that nursing is painful. if it swallows with a gurgling noise, often stops to cough, and does as little nursing as possible, we suspect that the throat may be sore. the ceasing to nurse at all, in the case of a very sick baby, is an evidence of great weakness or increasing stupor, and is a most unfavorable symptom. the urine urine that is high-colored and stains the diaper, or that shows a thick, reddish cloud after standing, may accompany fever or indigestion. sometimes the urine under these conditions is milky when first passed. in some babies a diet containing beef juice or other highly nitrogenous food will produce the reddish cloud, or even actual, red, sandlike particles. a decidedly yellow stain on the diaper occurs when there is jaundice. a faint reddish stain seldom indicates blood. the amount of urine passed is scanty in fever, in diarrhea, and especially in acute bright's disease. in the latter disease the urine is often of a smoky or even a muddy appearance. the possibility of the occurrence of this symptom after scarlet fever must always be kept in mind, in order that a physician may be summoned very quickly, since it is a serious matter. the stools we find that the passages are often putty-colored in disorders of the liver, frequently bloody or tarry in appearance in bleeding within the bowel, and liable to be black after taking bismuth, charcoal, or iron, and red after krameria, kino, or haematoxylon. infants who are receiving more milk than they can digest constantly have whitish lumps in their stools, or even entirely formed but almost white passages. the presence of a certain amount of greenish coloration of the passages is not infrequent. this is usually an evidence of indigestion, but passages which are yellow when passed and turn to a faint pea green some time later are not an indication of disease. when baby gets sick when baby shows that he is sick, take his temperature as directed elsewhere, cut down the feeding to at least one half, or, if his temperature is around f. give him nothing but rice water or barley water. if he is constipated give him a cleansing enema, and if hot and feverish a sponge bath may be administered. he should then be put into a bed with light covers and wait further orders which the doctor will give on his arrival. give the baby no medicine unless ordered to do so by the physician. known to every physician who undertakes the care of children, is the failure of many well-meaning mothers to call him early. the mother attempts the care of the baby herself, and not until the condition gets beyond her knowledge and wisdom does she seek medical advice. in the early hours of an approaching cold, the beginning of intestinal indigestion, or at the beginning of bronchitis, if the physician can see the child early, prolonged illness may be avoided as well as unnecessary expense and many heart-breaking experiences. feeding the sick baby feeding the sick baby differs somewhat with the character of the individual disease, but in the outset of any and all diseases the intestinal tract should not be overburdened with food. at the approach of any illness, the food should at least be cut down one half; for instance, in the case of a serious acute illness accompanied by fever, not only should the strength of the food be reduced one half, but water should be given plentifully between feedings. it is better never to urge the baby to eat at such times--for the ability to digest food is very much reduced. in cases of acute attacks with much vomiting and fever, all milk should be immediately stopped and rice water or barley water substituted. when vomiting ceases and the fever approaches normal and food is desired, begin with boiled skim milk in small amounts, well diluted with cereal water, and do not approach the normal amount of milk for twenty-four to forty-eight hours. in this way the weak digestive organs are not overtaxed and they gradually resume their usual work of good digestion. when a baby seems to have no appetite for food, lengthen the intervals from three to four or five hours, for feeding when food is not desired usually aggravates disease disturbances. examining sick children and now, above all times, the early seed sowing of teaching the child self-control, teaching him to gargle if he is sufficiently old enough, to open his mouth and allow observation without resistance, brings sure results. the great harm of making the doctor and his medicine a threat to obtain obedience also brings its harvest at this time; for the doctor, of all people, ought to be regarded as the child's best friend. when baby is sick, the doctor is needed, his daily visits must not be resisted, his medicines must not be feared--these and such other matters should be made a part of every child's early education. under no circumstances or conditions should we directly falsify to a child. nothing is accomplished by telling a child it will not hurt when you know that it will hurt, or that the medicine tastes good when you know it is bad-tasting. every physician can recall unnecessary disturbances in the office because a mother has allowed a child to acquire a wrong mental attitude toward the family physician. one mother told her little girl in my office when i wished to make an examination for adenoids which necessitated my putting my finger back of the child's uvula, "now mary, the doctor won't hurt you at all, it will feel nice." i turned to the little girl and said: "mary, it will not feel nice, it really won't hurt you, but it will feel uncomfortable." it was a grave mistake to tell her that it would feel nice. the child resisted, and, while the examination was successfully made, the greatest of tact had to be used in securing the friendship of the child after the examination. it is far better when the throat is to be examined to wrap the child in a shawl or a sheet with his arms placed at his side, and for a member of the family to take him in her lap and hold him securely while the physician quickly makes the observation. and while we appreciate that sickness is not the time to introduce new methods of training, in instances where children have been spoiled, it is far better quietly and firmly to go about the task in a manner that you know can be carried through to a successful finish. treatment of sick children a sick child should be encouraged to lie in his bed much of the time, and the bed should be kept clean and cool. he should never be set up suddenly or laid back quickly. in the case of a broken leg, all rapid movements should be avoided. a simple story or a soothing lullaby, or the giving of a toy, will often divert attention when some painful movement must be made or some disagreeable task performed. both cleanliness of the body and cleanliness of the mouth are exceedingly necessary in sickness. in all instances of disease or indisposition, the mouth must receive daily care, for stomatitis or gangrene of the mouth often follows neglect. a listerine wash in proportion of one to four, or a magnesia wash, or the addition of a few drops of essence of cinnamon to the mouth wash will do much to prevent such conditions, as well as to relieve them. applications of medicine to the throat may be made without resistance if the tactful nurse watches her time. she should slowly introduce the tongue depressor which may be a flat stick or a spoon, when the application of medicine with a camel's-hair brush is quickly made to the rolled-out throat as the child gags, and if the nurse then quickly diverts his attention to some beautiful story or a picture or a new toy, the treatment is soon forgotten. under no circumstances argue with or scold a sick child. get everything ready, if possible behind his back or in another room, and then with plenty of help make the application or the observation without words, always with gentleness and firmness. nursing records whether the nurse be the mother, caretaker, practical or professional nurse, a record should always be kept of the condition of the patient. the temperature should be reported at different periods designated by the physician. the pulse should be recorded, the amount of urine passed and the time it was passed, the number of bowel movements, all feedings and the general well being of the child--whether it is restless or comfortable, sleeping or awake, together with the water that he drinks. the record may be kept, if necessary, on a piece of common letter paper, and should read something like this: march , a. m. temperature ; pulse ; respiration ; morning toilet; took ounces of milk; ounces of barley water; ounce of lime water. a. m. enema given; good bowel movement; mustard paste applied to chest, front and back, and oil-silk jacket applied; drank boiled water, ounces. a. m. took the juice of one orange; temperature ; pulse . noon. very listless and nervous; temperature . has coughed a great deal. gave mustard paste to chest, front and back, and wet-sheet pack. : p. m. temperature . ; ounces of water to drink; looks better. p. m. has slept ½ hours; temperature . ; pulse ; respiration ; ounces of food given ( ounces of milk, ounces of barley water and ounce of lime water). a record like this is a great help to the physician, and such a record may be kept by anyone who can read and write. there are printed record blanks which may be procured from any medical supply house and most drug stores. bad-tasting medicines castor oil has neither a pleasant smell nor taste, and nothing is accomplished by telling the child that it does smell good or taste good. if the patient is old enough to drink from a cup, put in a layer of orange juice and then the castor oil and then another layer of orange juice, and in this way it often can be easily taken. someone has suggested that a piece of ice held in the mouth just before the medicine is taken will often make a bad dose go down without so much forcing. a taste of currant jelly, or a bit of sweet chocolate, or the chewing of a stick of cinnamon is a great adjunct to the administration of bad-tasting medicines. all oily medicines must be kept in a cool place and should always be given in spoons or from medicine glasses that have first been dipped in very cold water. very often the addition of sugar to bad-tasting medicines will in no wise interfere with their action, while it often facilitates the administration of the disagreeable dose. the majority of bad-tasting medicines are now put up in the form of chocolate-flavored candy tablets. temperatures and pulse the normal temperature of a baby is . to f. in the rectum. after shaking the mercury of the thermometer down below the mark it is well lubricated with vaseline and then carefully, gently, pushed into the rectum for about an inch and a half or two inches, and left there for three minutes before removing. mothers should exercise self-control in taking the temperature, for nothing is gained by allowing a panicky fear to seize you should the mercury register higher than you anticipated. notify your physician when the temperature registers above f. the respirations of a child are fairly regular and rhythmic and occur about forty times per minute during the first month of life and about thirty times per minute during the remainder of the year. from one to two years, twenty-six to twenty-eight is the average. breathing is somewhat irregular when the child is awake and may be a bit slower when asleep. before the baby is born the fetal pulse is about . at birth it ranges from to . during the first month the pulse is found to be from to . by the sixth month it gets down to or , and from that on to a year the normal pulse beat of the baby is about . the pulse is influenced very much by exercise and is often increased by crying or nursing or any other excitement. fever children get fever very easily--the digestive disturbance of overeating, constipation, a slight bilious attack--all produce fever which disappears quite as suddenly as it came. the first thing to do under such circumstances is to withhold food, give plenty of water to drink, produce a brisk movement of the bowel by giving a dose of castor oil, give a cleansing enema, and treat the fever as follows: after removing all of the clothes from the child, place him in a warm blanket and then prepare a sponge bath which may be equal parts of alcohol and water; expose one portion of the body at a time and apply the water and alcohol first to one arm and then to the other arm, the chest, one leg, the other leg, the back and then the buttocks. do not dry the part but allow evaporation to take place, and this, accompanied by the cooling of the blood which is brought to the skin by the friction, readily reduces the fever. another procedure which may be employed if the fever registers high is the wet-sheet pack which is administered as follows: three thicknesses of wool blankets are placed on the bed and a sheet as long as the baby and just enough to wrap around him once, is wrung out of cool water and spread over these blankets. with a hot-water bottle to the feet, the child is then laid down in the wet sheet which is now brought in contact with every portion of his body, then the blankets are quickly brought around, and he is allowed to warm up the sheet--which lowers his temperature. another valuable procedure is the cooling enema. water the same temperature as that of the body, is allowed to enter the bowel and is then quickly cooled down to or f.; in this manner much heat is taken out of the body and the fever quickly reduced. (for further treatment of fevers see appendix.) chapter xxvi baby's sick room visitors should never be allowed in the sick room during the height of a disease, and during convalescence not more than one visitor should be allowed at one time, and the visit then should be only two or three minutes in length. the order and the quietness and the system of the sick room should be perfect. visitors and loitering members of the family do no good and they may do much harm to the recuperating nervous system of the child. location of the sick room in these days of high rents, we realize that the greater per cent of our readers are living in apartments and homes just big enough conveniently to care for the family during health, and while it would be pleasant and convenient to have a spare room or an attic chamber that could be used in case of illness, it is the exception rather than the rule that the families to whom sickness comes have these extra apartments. when a contagious or an infectious disease comes to the family, it is of great importance that the sick child be isolated, preferably on another floor, from that used by the immediate family. those living in homes, more than likely can fix up a room on the attic floor for the isolation, and those living in apartments may put the sick child in one end of the apartment, while they inhabit the other end. one family under my observation not long ago had a child stricken with the measles. in the same apartment there lived a puny baby not quite two years old. coming as it did in february, the mother of the child was apprehensive, fearing that measles would leave a severe bronchitis which might mean the death of the already too-delicate baby. she was instructed to move the baby's bed to the sun parlor in the front of the flat, while the boy with the measles was put in the parents' room in the rear end of the flat. a sheet was suspended in the middle of the hall leading from the living-room to the bedrooms. door knobs were disinfected daily, a caretaker was put in charge of the measles patient, the mother very frequently was compelled to go back and administer a treatment, but each time she donned a large apron and completely covered her hair with a towel, she administered the treatment, took off her wrappings, thoroughly washed her face and hands--disinfected them--and returned to her baby in the front part of the house. at night this mother slept on the floor on springs and mattress in the living-room, and to that home the measles came and departed, and the baby did not get them at all, so perfect was the isolation, so vigilant the disinfection, and so scrupulous the care to prevent contamination. so you see from this one instance that it is altogether possible to make isolation complete even on the same floor. but, mind you, the dishes that the lad ate from were all kept in his room. food was brought to the sheet and there the caretaker held her dishes while the cook poured or lifted the food from her clean dishes to the dishes the caretaker brought from the sick room. whether the sick room is in the attic or whether it be the rear end of an apartment, if the principles of contagion and disinfection are understood i believe it is perfectly possible to isolate even scarlet fever without danger to the other members of the family. necessary furnishings for slight indispositions and trifling disorders, it is not necessary to strip the room of its adornment, but it is well to clear off the dresser tops, protect them well with many thicknesses of newspapers covered over by a folded sheet so that alcohol, witch-hazel and other necessaries will not injure the mahogany or oak-top dresser. whenever the children are sick, rob the room of anything that is going to be in your way. in instances of infectious or contagious diseases, take down all silk or wool hangings, replace them by washable curtains or inexpensive ones that can be burned if necessary, and remove valuable paintings and other bric-a-brac that later fumigation will harm or that may gather the dust during the days of illness. just as it is necessary for the man who mines the coal to wear suitable garments, and for the woman who does the scrubbing to dress accordingly, and for the nurse who cares for the case to wear washable clothes--so it is necessary to dress the sick room in garments that are suitable, convenient, and capable of being thoroughly disinfected, fumigated, or even burned if the occasion demands. hence, expensive rugs should be replaced by rag carpets or no rug at all, while unnecessary articles and garments should be removed from closets, etc. remembering that the little fellow is to remain in this room for possibly two weeks or maybe six weeks, let us put up some bright-colored pictures that he will enjoy, bring in some books and magazines by which he may be entertained, secure a few simple toys that will not tax the brain, but serve as a help to pass away the long hours. there are many paper games that may be had, such as transfer pictures, picture puzzles, kindergarten papers, drawing pictures, as well as toys that may be put together to fashion new articles. a whole lot of fun can be gotten out of a bunch of burrs that can be stuck together to make men, animals, houses, etc. scissors and pictures are entertaining as well as paper dolls with their wardrobes. rubber balloons, or a target gun for the boy of six will be a great source of delight to him; as will a doll with a trunk full of clothes for the little girl during her convalescent days. a tactful nurse and a resourceful mother will think of all the rest that we have not mentioned--which will amuse, entertain and keep happy our convalescent children, help them to forget that they are "shut ins." the nursery refrigerator it is wise in instances of the more severe childhood troubles, such as infectious and contagious diseases, to keep as many things in the sick room as possible, and so we remind our reader of the home-made ice box, described elsewhere in this book, in which may be kept the fruit juices and the fruits, as well as the milk and the buttermilk. many medicines, particularly the oily medicines, should be kept in this home-made ice box and five cents worth of ice a day will not only make things taste better, especially during the warm months, but will protect the other members of the family, for the family ice box is a big central station which must be protected against infections and carriers of disease. in connection with the ice box, we are reminded that it would be a great convenience to have a simple contrivance for heating bouillon, milk, or making a piece of toast, which can be readily done with an electric heater, an alcohol stove, or a small apparatus fitting over the gas jet. sick room disinfectants the most important thing which we are going to mention in this division of the chapter is the disinfection of the door knobs. according to the directions on the poison bottle, place an antiseptic tablet into a small amount of water which will make a solution of to of bichlorid of mercury, and several times a day disinfect the door knobs, particularly in the sick end of the house--thoroughly washing and adequately rubbing with a towel moistened in this solution. all stools and urine from the sick one will receive attention as directed by the physician. the stools from a typhoid patient should stand for one-half hour in a chamber covered with a layer of lime. it is not at all necessary to have vessels containing disinfectant substances standing about the room and in the closet. in a room adjoining should be kept all of the dishes used by the sick patient, his tray, half a dozen napkins, knife, fork, spoon, serving dishes, drinking glass, pitcher, etc. all bedding and all linen used by the sick member should be allowed to stand in a solution of disinfectant for several hours when they may be wrung out of the solution, dropped into a bucket and carried to the laundry without any danger to other members of the family. the nurse is not allowed to leave this room in the garments that are worn while caring for the sick. she should have her meals in an adjoining room which is also under strict isolation. the medicine chest the sick room medicine chest should be so placed on the wall that it is outside the reach of the smaller members of the family, for in it should be placed poisons for external use that are capable of producing death if taken internally. bottles that hold these poisons--such as bichlorid of mercury, lysol, carbolic acid, laudanum, paregoric, belladonna, etc.--should be so different from the other bottles in the medicine chest that if one should reach for them with his eyes shut or in the dark he would at once recognize that he had hold of a poison bottle. this is absolutely necessary. it usually means a bit of extra expense, but when we realize what tragedies may be avoided by such slight expense, it must not be considered. bottles may be procured that have been molded with points of glass projecting from the outside which make them rough to the touch, or they may be covered with a wire mesh or with a wicker covering which may easily be told from the other bottles in the case. one woman lost her life because the nurse placed two ounces of carbolic acid in the enema instead of two ounces of saline solution. saline solution is nothing but salt and water, while carbolic acid cost the woman her life, simply because the carbolic acid was not placed in a specialized poison bottle and the attendant could not read the label in the dark. under no circumstances keep from one year to another the remnants of unused medicine of a former sickness, for medicines do not keep well and often lose their strength if kept longer than the physician intended. in this medicine chest should be found the following articles: a glass graduate marked with fluid drachms ( teaspoon), and fluid ounces ( teaspoons). a medicine dropper. absorbent cotton. boric acid. camphorated oil. castor oil. aromatic spirits of ammonia. alcohol. olive oil. epsom salts. soda-mint tablets. vaseline. zinc ointment, together with other medicines the physician orders. ice bag, hot-water bottle and oiled silk. besides these articles, in the nursery--in readiness for emergencies and accidents--should be found the following: gauze bandages of various sizes. sterile gauze. boric acid crystals and powder. mustard. a pocket case of instruments containing scissors, knife, dressing forceps, etc. syrup of ipecac. glycerin. tincture of iodine. package of ordinary baking soda. peroxid of hydrogen. absorbent cotton. needle and thread. lime water. patent medicines aside from the giving of castor oil and the application of vaseline to the nose, or of applying boracic acid to the eyes, no medicine should be administered to the baby without competent medical advice. there are numerous widely advertised nostrums frequently sold as soothing syrups to be used during the teething or during attacks of diarrhea, or cough spasms, croup, or worms, that contain dangerous drugs and should not be given to children. many well-meaning but ignorant mothers are slowly but surely laying the foundations for serious nervous disorders and are often making veritable dope fiends out of their children. patent medicines are dangerous things in the hands of the people; if we are going to give medicines to our little babies let us at least know what we are giving. let some conscientious, scientific physician examine the baby and prescribe for its needs. if urged to use a patent medicine, examine the label carefully, for the federal food and drug act requires the manufacturer of patent medicines to print plainly on the label of the bottle the name and amount of certain dangerous drugs which it may contain. the drugs mentioned in this drug act and which are often used in patent medicine nostrums are, chloral hydrate, cocaine, heroin, chloroform, alpha or beta eucaine, opium, morphin, alcohol, cannabis indica, or any derivative or preparation of any such substance contained therein. there are many other drugs sold on the market containing syrups or flavoring materials which may do harm--which may upset the baby's digestion. mothers avoid patent medicines. consult your physician. never give a baby any sort of medicine to induce sleep. unless babies are sick or spoiled or hungry, they will go to sleep of themselves, and even in the days of a high fever a wet-sheet pack seldom ever fails to put the baby to sleep and can do no harm if properly given. this may be as good a place as any to mention the dosage of castor oil which is as follows: up to three months, / teaspoon. from three to six months, teaspoon. from six to nine months, ½ teaspoons. from nine to twelve months, dessert spoon ( teaspoons). from twelve months on, to tablespoons. after the sickness is over the physician will direct when the disinfectant bath is to be given to the patient previous to his liberation from isolation. the different diseases demand different treatment, but, on the whole, it is about as follows: the day before the boy is to be allowed to go out among the family once more he receives a soap wash, clean sheet and bedding on the bed, and puts on clean garments. the following morning, his head thoroughly shampooed, his nails manicured, a second soap wash is given followed by a weak bichlorid bath ( to , solution) which is followed by an alcohol rub. he is then allowed to go out of the sick room which is now to be thoroughly disinfected and fumigated. after the illness is over, the sick room and the adjoining closets and ante rooms must be thoroughly disinfected or fumigated. if you are located in a city, the health authorities will do this after an infectious or contagious disease. away from such conveniences, use the following method: place two ounces of crystals of permanganate of potash in a pan and have a pint bottle of formalin near by. everything in the room is now exposed, dresser drawers are opened, all bedding, all garments--in fact everything that is in the room--is put in such a position as to be readily exposed to the fumes which are to follow. a line should be stretched across the room over which are thrown the bedding, garments, etc. the cracks of the windows and doors, except the one door of exit, are now sealed up with paper which has been dipped in green soap, and having the paper strips and pan of green soap ready just outside the exit door, the formalin is now poured over the permanganate crystals. fumes will immediately arise and permeate every corner, crack and crevice of the sick room. now quickly make your exit, close the door and seal up key hole and cracks and space under the door with paper dipped in green soap. leave the room for six hours. after this with a well-moistened cloth to the nose, rush in and throw the windows open, hurry out and allow the room to air from twelve to twenty-four hours, after which wash woodwork and painted walls or take paper off and repaper walls; recalcimine ceilings and closets; scrub closet shelves and dresser drawers, bedsteads, and other furniture thoroughly. if the mattress is old throw it away, but if not, sun it for several days following the fumigation. chapter xxvii digestive disorders in this chapter we will consider the diseases which commonly occur during infancy and early childhood relative to digestion and the alimentary tract. irregularity of feeding, feeding between meals, feeding too much at any given time, as well as feeding the wrong kind of food may cause stomach disturbances and intestinal troubles. vomiting in a previous chapter, "the feeding problem," a common stomach disturbance, vomiting, was gone into quite thoroughly, and in passing to other disorders, we wish to remind the mother that vomiting should always be taken seriously. the interval between meals should usually be lengthened, the time spent in feeding shortened, and it is often necessary to withhold all milk and food of any kind for twelve or eighteen hours, giving only boiled, unsweetened water. vomiting frequently ushers in some acute disease, and in remote cases, when it is very persistent, it may indicate inflammation of the brain. complete rest is essential, trotting on the knee, suddenly changing the baby's position, or other quick movements must all be avoided. a physician should see the sick one and determine the cause of the trouble. colic cases of ordinary colic are usually relieved by heat to the abdomen and feet, drinking hot water in which there has been dissolved a pinch of ordinary baking soda, or a portion of a soda mint tablet, or by the use of the photophore, as previously described. the treatment of such ordinary colic need not be given further consideration here because it has been described at length in a former chapter; but we do call the attention of the mother to a more serious form of recurring colic which so often accompanies chronic intestinal indigestion, marasmus, and malnutrition. in most instances the food is radically at fault and should be reduced to a mixture which can more readily be digested and assimilated by the child. often whey mixtures, peptonized foods, or buttermilk may be indicated. the weight of the baby, the age of the baby, and the color of the stools, must all be taken into account in the preparation of this easily digested food. weak mixtures should be given at first and then gradually and carefully the quality may be strengthened until the normal formula is again used for the baby. injections into the bowel of water, to which has been added one level teaspoon of soda to the pint, will often give relief in this form of colic. chronic indigestion while this condition may occur at any time during babyhood days, it often makes its appearance during the last half of the first year and up to the fifth year. it is accompanied by mucus in the stools, chronic flatulence, constipation or diarrhea, or the alternating of the two, restlessness at night, distention of the abdomen ("pot bellied") accompanied by pain, a coated tongue with a fetid breath, and loss of appetite. it is a pitiable picture--the weight is usually reduced and the child gives the appearance of being decidedly undernourished. this condition is usually occasioned by errors in diet, whether it be over-feeding or feeding of the wrong element of food, and, since the diet is usually responsible for the condition, in the line of treatment diet is a prime factor. all fats must be taken from the food, sugars should be avoided, and the amount of starchy foods, such as flour, potatoes and bread, should be greatly reduced. buttermilk, skimmed milk, eggs, green vegetables, and fruit juices should be given. in the older child, if grains are used, they should be well toasted or baked. jaundice it is altogether common and physiological for the newborn baby to pass through a few days of yellow skin which usually clears up in the second or third week, but it should not recur. occasionally this yellow tint deepens, the whites of the eyes are yellow, the urine passed leaves a yellow stain on the diaper, while passages from the bowels are white or clay colored. if the child shows symptoms of ill health other than the yellow tint, it should receive medical attention. older children troubled with jaundice should receive the following treatment: the photophore as described elsewhere should be applied to the liver and abdomen (the liver is on the right side), and this should be followed by the application of what is known as a heating compress, consisting of three layers--a cloth wrung from cold water, a mackintosh, and then two thicknesses of blanket flannel--which are all applied when the skin has been made red by the application of heat. (if the photophore is unavailable, a hot-water bottle may be applied.) the flannel is pinned snugly on the outside as the wet cloth goes next to the skin with the mackintosh between. this should remain on the abdomen for three or four hours, after which the hot application is again made to the liver and abdomen. the administration of broken doses of calomel is sometimes indicated in obstinate cases in connection with these applications of heat to the liver. hot milk or mineral water may be taken with dry toast. in a day or two the color should clear up, the stools should be normal again, and the treatment may be discontinued. worms irritation about the rectum which cannot be otherwise explained is usually suggestive of pinworms. these seatworms or pinworms are very much like little pieces of cotton thread--one-fourth of an inch in length. they grow and thrive in the lower part of the large bowel. simple and effective treatment is as follows: it is well to bathe the parts about the rectum after each bowel movement and often two or three times a day with a weak antiseptic solution. itching may be controlled by the application of a disinfectant ointment, or the local applications of ice may serve the same purpose. after a thorough cleansing of the colon by an injection of lukewarm water containing a teaspoon of borax to the pint in order to remove the mucus, doctor holt suggests that after the discharge of this borated enema, infusions of quassia are very helpful (see appendix). children suffering from roundworms experience a loss of appetite, varying temperature from above normal to subnormal, with colicky pains in the abdomen on coming to the table and beginning to eat. they are pale and listless, or nervous and irritable. roundworms very much resemble earthworms in shape and color. while their home is in the small intestines they often travel to other parts of the body. they have sometimes crawled into the stomach and have been vomited. the only definite symptom of worms is to find the eggs or the worms themselves in the stool. no worm medicine should ever be given by the mouth without being prescribed by a physician. cases are on record where well-meaning mothers have killed their children by giving an over dose of worm medicine. tapeworms sometimes trouble children; their segments are found in the stool, and look like small pieces of tape line. the segments are flat and thin, one-fourth inch to one-half inch in width and three-fourths to one inch in length. they are joined together and often their number is so great the worm is many feet in length. the segments grow smaller and smaller as they approach the neck, the head of the worm being a mere point. as the worm is passing from the child it should never be pulled, as the head is easily broken off, and, on remaining in the bowel, it will grow to a full-sized worm. worms come from the eating of half-cooked meats; they enter the stomach as eggs or tiny worms, and pass out into the small intestines, where they begin to grow. they are a common parasite in the human family and should be suspected in all instances where digestive symptoms are masked or do not yield to treatment. hookworm disease this disease, once seen only in the southern part of the united states, is leaving its former domains as the migrating population is distributing it more or less widely everywhere. sandy soil and country districts are infected by a tiny worm which thrives in polluted soil and enters the body through the skin of the feet. it also gets into the body through the drinking water or from the eating of uncooked vegetables, such as are used in salads. the disease is manifested by "sallow skin, paleness, headache, swollen abdomen and sores on the legs." little swollen places where the worm enters the skin may be seen on the flesh. the condition yields readily to treatment. if a child is discovered scratching his feet (especially in the southern part of this country), he should be taken at once to a physician. disordered stomach at the first symptom of a disordered stomach take all food from the baby and give him rice water prepared by throwing a cupful of well-washed rice into a kettle of boiling water and allowing it to continue to boil for a couple of hours. the water which is strained off is rice water, ready for use after it is cooled. this may be given to the child at the meal hour in the place of his regular food. it should be kept in a glass-covered jar in the ice box. a dose of castor oil, according to the age, should be administered before the feed. the bowels should be washed out and boiled water given freely between the meals of rice water. for a day or two (twenty-four to forty-eight hours), the child should be fed only this rice water, or until the temperature returns to normal and he appears very hungry, at which time milk, which has been boiled for five minutes, may be added to the rice water, first in one-half ounce quantities and gradually increased. each day a little more milk is added until baby is taking his regular food again. many a death and many acute attacks of summer complaint are avoided by the quick use of castor oil, and by withholding food and stopping the use of milk as soon as the child becomes ill. stomatitis or thrush thrush is evidenced by fretfulness or crying on attempting to nurse. on examination of the mouth it is found to be hot and very tender and covered with little white specks which, if looked at under the microscope, appear to be a fungus growth. if scratched off, the mucous membrane bleeds easily. thrush often occurs during a fever or in connection with other diseases, and is often due to neglect and lack of cleanliness about the bottles, nipples, etc. taken in time it is quickly cured. an immediate dose of castor oil or milk of magnesia is indicated, and the use of a mouth wash which will be prescribed by the physician. if neglected, it may become ulcerous or gangrenous, which is a very serious condition. everything pertaining to the feeding, as well as the child's toys, hands, etc., must be kept scrupulously clean. constipation in the chapter, "the feeding problem," constipation in bottle-fed babies was discussed. the bowels should move at least once in twenty-four hours. the passages are frequently very hard and leave the body only after a very great effort of straining. this constipation, often continuing until late childhood, should be corrected in the following manner: in early infancy--as early as the fourth month--prune juice may be given as directed elsewhere, while in later months prune pulp or fig pulp, which has been carefully rubbed through a fine-mesh colander, may be given at meal time. by the time the baby is eleven or twelve months old, strained apple sauce may be given. we deplore the use of the water enema as a regular daily procedure; in its place we suggest the use of the enema of oil or the introduction into the rectum of a gluten suppository or in obstinate cases a glycerine suppository. abdominal massage should be daily administered. with a well-oiled hand, begin on the right abdomen and proceed upward to the lower border of the right ribs and across to the left side and down. this should be repeated many times at a regular hour each day. the mother should select an hour for the bowels to move, preferably after the forenoon feeding, and if the child is too small to sit upon the toilet chair, a gluten suppository may be placed into the rectum before the forenoon feed and some time during the middle of the day the bowel movement will be found in the napkin. for the older child, before a certain meal each day, a well-vaselined piece of cotton may be inserted in the rectum; this often produces a bowel movement immediately after the meal. laxative foods, such as bran, stewed figs, stewed prunes, or a raw apple, should be used faithfully--as repeated medication never corrects the difficulty, but usually prolongs it. to immediately flush out the bowel, a soapsuds enema or a plain water enema may be allowed to flow into the lower colon, or a glycerine suppository inserted into the rectum will quickly bring a bowel movement. these methods are only of temporary value; a regular habit should be formed, if possible, to bring about a natural, normal bowel movement. when necessary to resort to drugs--such remedies as cascara sagrada, milk of magnesia, or syrup of rhubarb, are satisfactory, as well as our old stand-by--castor oil. regular habits must be insisted upon, and if the mother pays attention to regularity at stool in early childhood very little trouble will be met later on in adolescence and adult life. chronic constipation often produces abnormal conditions about the rectum such as fissures, hemorrhoids, or prolapse, which may be of serious import. diarrhea diarrhea is a symptom of an acute illness, or it may be associated with a chronic condition such as chronic intestinal indigestion, tuberculosis of the bowel, or may occur alternately with constipation in colitis. it is the most dangerous of all symptoms that babies develop, and in spite of all the instruction given to mothers at the present time, in spite of all the welfare stations in large cities, and in spite of all the efforts put forth by the commissioner of health, with his corps of visiting nurses--even yet, more babies die of diarrhea each summer than from any other single cause. there are usually just two reasons for diarrhea--uncleanliness and bad milk. during the hot summer days flies multiply greatly and all manner of bacteria and germs grow in warm, moist, shadowy places, so that usually before the milk leaves the dairy farm it is seriously contaminated with disease-producing germs. if the milk is not kept at a temperature of or f. (which is just above the freezing point), these bacteria, particularly the manure germ, grow at such a rate that by the time the milk gets to the infant it is teeming with bacteria, and diarrhea is the sure result. another form of diarrhea is cholera infantum, where the stools soon become watery and colorless. the vomiting is almost incessant and there is high fever. fortunately it is a rare disease, but when once seen it is never forgotten. one beautiful baby weighing nearly thirty pounds was reduced to sixteen within forty-eight hours, and when death came he could hardly be recognized because of the wasting from this most dreaded of infant diseases. another form of diarrhea is seen in an acute inflammatory condition of the intestine itself. the stools contain more or less mucus and blood. the bowel movements, which are very frequent, are accompanied by a great deal of pain and straining. this form is often seen in the more severe types of summer dysentery. we wish to impress upon the reader's mind that these diarrheas may all be avoided if the baby's food is clean and free from germs, if the apple or pear is not only washed, but thoroughly scrubbed before paring during the summer months. if all the bottles, nipples, water, toys, etc., are adequately clean, no summer diarrhea, no dysentery, no other infection due to dirt, will attack the baby. of paramount importance is the pasteurization of milk during the summer months, as mentioned elsewhere. treatment of diarrhea simple diarrhea in the older child of two or three years is treated as follows: take away all solid foods. give a big dose of castor oil, thoroughly wash out the bowel by warm water containing a level teaspoon of salt and a level teaspoon of baking soda to the pint, and put the child to bed in a quiet room. boil all milk for ten minutes and thicken it with flour that has been browned in the oven; feed this to the child at five-hour intervals. after each bowel movement, no matter how often they come, the colon should be washed out with the salt and soda enema as before mentioned. bear in mind that the child is losing liquids, and so, after the bowels have moved, boiled water should be given by mouth, or a cupful of water can often be retained if it is introduced into the rectum slowly under very low pressure. twenty-four or forty hours should clear up a case of simple diarrhea, and on returning to food it should be dry toast and boiled milk. for the younger baby, withhold all milk and give barley water or rice water for the first twenty-four hours, returning to milk very gradually and slowly. for the more severe types, such as the dysentery containing mucus and blood, everything that has been done for the simple diarrhea should be done; the baby should be kept very quiet, while castor oil should be promptly administered. food is withheld and the bowels are carefully irrigated after each movement with the salt and soda solutions. after the bowels have moved from the castor oil, then bismuth subnitrate, which has been dissolved in two ounces of water, should be given--one or two teaspoons every three hours. this will naturally turn the bowel movements dark. under no circumstances should any other medicines be given without the physician's knowledge, as it is at such times as this that many "would-be friends" advise laudanum, paregoric, and other opiates. the skin must be kept warm, and fluids must replace those that have been carried off in the many stools. water may be given by an enema, by water drinking, and in such rare cases as cholera infantum, when water cannot be retained on the stomach, it often becomes necessary to inject it under the skin (hypodermoclysis) so that it may go at once to the wasted tissues and perhaps save the baby's life. give the baby ten days or two weeks to return to normal condition, and under no circumstances hurry the feeding of milk, as a second attack may occur much more readily than the first; may more profoundly overcome the baby and result in death. rupture a protrusion of a loop or portion of intestine through a weakened abdominal muscle--which grows larger when baby cries and smaller when he is lying down in a relaxed condition--is known as rupture or hernia, and is of common occurrence in infancy. it is often seen at the navel and sometimes in the groin as early as the second week. hernia is always dangerous and should never be neglected. the physician will protect the navel by a special support with adhesive plaster which is carefully renewed twice a week, and if worn for several months usually entirely corrects the condition. a comfortable truss made from skeins of white yarn will amply protect a groin hernia. the condition should always be taken seriously and receive immediate treatment. prolapse of the bowel occasionally, as the result of severe straining in constipation, the rectum protrudes sometimes one-half inch, and in rare instances two or three inches. the placing of a young child upon a toilet chair and insisting upon severe straining sometimes results in such a protrusion of the rectum. this may be avoided by the application of vaseline to the rectum or by the use of the gluten or glycerine suppositories which cause the hardened masses to make their way out easily. someone has suggested that if the buttocks are supported by a board placed over the toilet seat with a two-inch opening so that severe straining of the rectal muscles is impossible, the prolapse of the rectum will not recur. the moment the mother observes the slightest protrusion of the rectum she should quickly put it back and have the child lie down and move the bowel in the diaper. very severe cases require a physician's attention, but if prompt and quick measures are taken on the first appearance it may be quickly corrected and serious consequences be avoided. in this connection we might mention a condition which sometimes babies are born with--the absence of the rectal opening. if the baby's bowels do not move for the first two days, surgical interference is more than likely necessary. often the external opening alone is missing. sometimes there is a complete closure or atresia of the lower part of the colon. bleeding from the navel there should be no hemorrhage from the umbilical stump after it has been properly tied, but occasionally a bit of blood is found upon the dressing and a second tying of the cord stump is necessary. the cord drops off in eight or ten days, and the umbilicus that is left may be moist or it may bleed slightly; if such is the case, great care should be exercised in bathing this ulcer that has been left behind. it simply should be touched with alcohol, a bit of boric acid powder applied, and a small piece of sterile gauze be placed over it. in the course of two or three days it will entirely heal. care should always be exercised in washing the umbilicus. extensive hemorrhage from this portion of the body is rare, but it does happen occasionally and is a severe condition which demands surgical attention. if the umbilicus remains moist and foul smelling, general blood poisoning of the infant may easily follow. thorough dusting with boric acid powder, with possibly a little oxide of zinc, will usually effect a cure promptly, but should the condition continue, which it does only in rare instances, the doctor may have to cauterize it. chapter xxviii contagious diseases never under any circumstances knowingly expose a child to any of the so-called "childhood diseases." the old method of "have the child get them as quickly as possible and get over them," has laid the foundation for many chronic disorders later in life. for instance, eye troubles and running ears are often the sequelae of measles; chronic coughs, tuberculosis and bronchitis frequently follow in the wake of whooping cough; heart disorders follow diphtheria, while kidney disease often follows in the course of scarlet fever. catching disease under all circumstances keep the children away from these dangerous childhood diseases. when a contagious disease breaks out in a school and the little fellow has, along with the other pupils, been exposed to it, begin at once systematically to keep the nose and throat very clean with such well-known sprays as the champhor-menthol-albolene spray, which should be used in the nose morning, noon, and night. throat gargles, such as listerine, or equal parts of alcohol and water, help to keep the throat in condition to resist the microbic invasion. during this anxious time of patient waiting the bowels should move every day and the food should be cut down at least a third. in other words, moderate eating and a clean bowel tract go a long way toward keeping a child well and preparing him for an attack of disease. the skin at this time should be kept well bathed and free from the accumulated skin secretions which clog up the sweat glands and otherwise lower the vitality. stuffy, close rooms, where the ventilation is poor, not only harbor disease germs, but also lower the vitality of the child. never take your child into a household where there is any form of sickness, for it may turn out to be a contagious disease--no matter how it began, it must be remembered that many contagious diseases, in their earlier stages, much resemble a simple cold. measles come on rather gradually, and one might suspect that the child was simply suffering from a severe cold in the head. scarlet fever usually begins with a sore throat, while chickenpox has very few initial symptoms; usually the first thing noted is the rash itself. diphtheria begins with a sore throat, while whooping cough begins very insidiously. the most important thing is to keep children away from people who are sick, and if a contagious or infectious disease is prevalent in the neighborhood discourage the mingling of the children in hot, illy ventilated rooms. put a stop to "parties" and all similar gatherings. let the little folks have good books, plenty of toys, in a well-ventilated room, and the more they keep to themselves at this particular time the better they are off. the spread of contagion it is possible to "stamp out" any known disease if only proper cooperation takes place and certain sanitary regulations are maintained. it is within the memory of most of our readers when yellow fever was put to flight and the cause of malaria discovered. we learned to screen our camps and no longer did our soldiers contract the fever; while the simple covering of stagnant pools with oil, together with proper screenage, stopped the ravages of malaria. likewise, many of the woeful tragedies of infant summer diarrhea and dysenteries have been tracked to the so-called "innocent house fly." we have all learned--only recently--that if we move the manure pile once in seven days the hatching of the maggots may be prevented, and so millions, yes trillions, of these carriers of disease may never be born. if there is one sweet morsel above another for this fly pest it is tubercular sputum or feces, and from these feasts they go directly to walk over baby's hands, crawl over his cheek, and wash their feet in his milk. proper screenage will prevent such contamination of food, such opportunities for carrying disease. sunshine, hot water, soap, and fresh air, are the best ordinary every-day disinfectants. it is possible so to conduct the treatment of a contagious or infectious disease that no other member of the family may contract it. a few simple but very important hints are: . door knobs are one of the very greatest avenues of contagion--disinfect them. . cleanse the hands both before and after attending to the sick; first, scrub with stiff brush, soap and water, then dip in alcohol. . an epidemic of sore eyes may be stopped by absolute "hand disinfection" and using separate towels. . do not go visiting when you have a "common cold." . kissing is one of the best ways of spreading many diseases. . in cases of contagious and infectious diseases completely cover all excretions from the body with lime. . country homes would be as healthy as city homes if the privies and stables were screened. . in the country, the well water should be boiled; one infected well may be the cause of the death of a score of beautiful children. incubation periods the incubation period of scarlet fever is from one to seven days. measles, ten to twenty days. whooping cough, from one to two weeks. chicken-pox, fourteen to sixteen days. german measles, seven to twenty-one days. diphtheria, any time from one to twelve days. mumps, from one week to three weeks. of all the diseases, measles and chicken-pox are probably the most contagious. in scarlet fever and diphtheria, close contact is necessary for exposure, while whooping cough can actually be contracted in the open air, young babies being particularly susceptible. typhoid fever typhoid fever is a disease of the small intestine. typhoid germs accumulate in the little lymph nodes of the small intestines and that is the reason why we often have so many hemorrhages from the bowel--actual ulcerations take place--and if an ulcer is situated in the neighborhood of a blood vessel hemorrhage may result. typhoid fever begins rather insidiously with a slight debility and loss of appetite, but if a temperature record is kept the fever will be found to rise from one-half to a degree higher each day. a steady climb in the temperature curve is noted until the end of the first week, when it remains for a week, possibly or f. after one week it begins slowly to decrease and, if all goes well, the early part of the fourth week usually finds the temperature about normal. it is exceedingly important that the child be kept in bed during the entire course of the disease. the bed pan must be used at each bowel movement or urination. _first week treatment._ during this week the child may feel quite well, but he should be kept in bed and sustaining treatments begun--such as wet-sheet packs and cold frictions to the skin (during which time there should always be external heat to the feet). the diet must be full and nourishing, but all pastries and "knicknacks" should be avoided. abundance of fresh fruit that has been well washed before paring, eggs, pasteurized milk, baked potatoes, and toasted bread may be taken at regular periods--with an interval of not less than five hours between meals. the bowels should be opened in the beginning of the disease with a liberal dose of castor oil, after which daily colonic irrigations should be employed. these enemas should be given at least once a day, the temperature being about that of the body, with a smaller terminal enema about five degrees cooler at the close of each bowel cleansing. _second week treatment._ the normal temperature at this time is no longer . , it is . f. this fever is essential to the curative and defensive processes of the body; and while we do not care to have the fever fall below . , at the same time nothing is to be gained by allowing the fever to go up much above . or degrees f. and so, during the second week, while the disease is at its height, we make frequent use of the wet-sheet pack, always remembering that the extremities must be kept warm and never permitting the skin to become blue or mottled while the cold treatment is being administered. since the real disease is localized in the small intestine, we will now describe a very important treatment for the diseased bowel--and one which is also very useful in combating high temperature. _the cooling enema._ the temperature of this enema begins one degree higher than that of the body (supposing the body temperature to be , the temperature of the enema would start at f.). this is allowed to flow into the colon and out again, under low pressure, without disturbing the patient, by means of a glass tube connection (see fig. ). the temperature is quickly brought down to , then to , then to , usually finishing up at or f. the water is allowed to enter the rectum slowly through a soft rubber catheter (not a hard rectal point), and as it comes out it will be noted that the water is very warm, sometimes registering , and it is needless to add that if the water goes in at and comes out at f., much heat has been taken from the body; and so, of all the treatments we have to suggest for typhoid fever, the one just mentioned is possibly the most important. when it is necessary to keep up this enema for an hour or two, the cool water may cramp the bowels, but this may be entirely obviated by applying hot compresses to the abdomen. another treatment of great importance in this second week is the cold abdominal compress. much fever is occasioned in the abdomen because it is the seat of disease, and the much dreaded hemorrhages which often cause the death of the patient are usually avoided by the use of abdominal compresses--wrung out of water at f.--the temperature of ordinary well water--and changed every twenty minutes. [illustration: fig. . the cooling enema] i recall one mother in my dispensary practice who was so poor she could not afford a nurse, her only helper being a son twelve years old. a nurse went to the house twice each day and taught this lad of twelve years to give his mother the cooling colonic irrigation; he was also taught to warm up the abdomen by a hot application and afterwards to apply the cold compresses. the mother made a good recovery. during this second week the diet should be sustaining. it should consist of boiled milk, eggs, fresh fruit and fresh fruit juices, dextrinized grains (hard toast, toasted corn flakes, shredded wheat biscuits, etc.). the mouth should be kept scrupulously clean, for in all the infectious and contagious diseases there is always the possibility of gangrene in the mouth if it is neglected. _third week treatment._ this is the week we look for hemorrhage from the bowel unless the abdomen has been well treated during the second week; and even so, the cool compresses to the abdomen will be continued well into the third week--also the daily or semi-daily enema. the skin is kept in good condition with soap washing and friction baths, and a fairly liberal diet is maintained. during the whole course of the disease the skin is never allowed to get blue or mottled, being quickly restored to the normal red color by the mustard sheet bath, the short hot-blanket pack, or the dry-blanket pack with hot-water bottles. under no circumstances let the child leave the room or his bed for at least another week. mumps infants are rarely affected with mumps. it is a disease of the salivary glands and (as a rule) is usually preceded by pain between the ear and the angle of the jaw, accompanied in a short time by swelling and temperature. it is distinctly contagious even during the incubation period. there is much tenderness on pressure, and chewing is difficult and may be impossible. it usually occurs on the face and only one side may be affected. the bowels should be kept open, the mouth should be kept clean, and the side of the face should be protected by a layer of cotton held in place by bandages. hot fomentations may be applied if the pain is severe. the electric light bulb on an extension cord, that was mentioned in connection with earache, is very comforting in this condition. isolation should be maintained for ten days or two weeks after all symptoms have disappeared. scarlet fever scarlet fever is one of childhood's most dreaded diseases because of, first, its long quarantine; second, its terrible possibilities of contagion; and, third, its sequelae. absolute quarantine is necessary until ten days after the last signs of desquamation have disappeared. this disease is always alarming because of the possibilities of its sequelae--the danger of pneumonia, inflammation of the ears, abscesses of the glands of the neck, and nephritis (inflammation of the kidneys). scarlet fever is highly contagious at any time during its onset and course. among the first symptoms of the disease are sore throat, swollen glands, fever, etc. vomiting on a street car or at the movie may spread the disease to more than one child who might otherwise have escaped. one child who may have only a very light form of the disease may give it to another child in the most severe form. any such group of classic symptoms--vomiting, fever, rapid pulse, and sore throat--should cause any parent immediately to isolate the little sufferer for several days--awaiting the "rash"--which usually puts in its appearance after three or four days of increasing temperature. this rash has an appearance "all of its own," unlike any other. because the fine "meal-like" red points are in such close proximity, the skin assumes a smooth "lobster red" color that is never to be forgotten. after three days of increasing redness, the color begins slowly to fade, and after four or five days of this fading a peculiar peeling takes place, whose scales vary in size from a small fleck to casts of the whole of the soles of the feet and the palms of the hands. during the height of the disease, the throat is very red, the tonsils are not only inflamed, but covered over with white patches, the head aches and the tongue possesses a peculiar coating through which peep the red points of the swollen papillae, presenting the classic "strawberry tongue" of scarlet fever. after ten days the fever disappears and the "real sick" stage of the disease is in the past. each morning of the ten previous days a small dose of epsom salts is usually administered and the itching, which so often accompanies the rash, is relieved by carbolized-water sponge baths. the nose, throat, and ears receive daily care--sprays to the nose and gargles to the throat, as well as special swabbing to the tonsils. the physician in charge of the case will note the urinary findings, guard the heart and kidneys, prevent the spreading of the scales of desquamation by frequent rubbing of the skin with oil, and otherwise work for the future well-being of the patient. measles measles, one of the most common diseases of childhood, is not to be regarded lightly, for very often its sequelae--running ears, weak eyes, and bronchial coughs--may prove very serious and troublesome. tuberculosis of the lungs not infrequently follows in the wake of measles. the early symptoms of measles are so mild that often the child is out of doors, at school, or about his usual play, until the second or third day of the fever. he was supposed merely to be suffering from a simple "cold in the head." on the third or fourth day the patient begins heavy sneezing and wears a stupid expression; and it is then that the mother ascertains that his temperature is perhaps to f. he is put to bed and the next day the rash usually appears. the rash is peculiar to itself, not usually mistaken for anything else, being a purplish red, slightly elevated, flattened papule, about the size of a split pea. the coughing, which is very annoying, usually remains until about the seventh or eighth day--at which time the fever also disappears. the bowels must be kept open; a daily bath be given--in which has been dissolved a small amount of bicarbonate of soda (simple baking soda)--after which an oil rub should be administered. the nose should be frequently sprayed with three per cent camphor-menthol-alboline spray, while the throat is gargled with equal parts of alcohol and water. the feet should be kept warm by external heat, while the physician in charge may order additional attention to the chest, such as a pneumonia jacket, etc. care should be taken to guard against "catching cold," for bronchitis or pneumonia is quite likely to develop in many cases of measles. the eyes should be protected by goggles and the room should be darkened; under no circumstances should the little patient be allowed to read. carelessness in this respect may mean weakened eyesight all the rest of his life. until two weeks after the rash has disappeared, the little fellow should be kept by himself, for the desquamation keeps up almost continuously during this time. the food during the course of the disease is a liquid and soft diet. children should never be allowed to go to a party or gathering with a cold in the head; the mothers of a group of small children will never forget the time that one certain mother allowed her little fellow to attend a party with "simply a cold in the head." he laughed, talked, and sneezed during the afternoon and when he went home the rash appeared that night, while eight of the ten exposed children came down with measles during the next two weeks. chickenpox the incubation period of chickenpox is from ten to seventeen days. it is a mild disease, with a troublesome rash consisting of widely scattered pimples appearing over the scalp, face, and body. these pimples soon became vesicles (small blisters), which in turn quickly become pustular, afterwards drying up with heavy crust formation. severe itching which attends these pustules may be greatly allayed by either the daily carbolic-acid-water bath or a baking-soda bath. the itching must be relieved by proper measures, for if the crust is removed from the top of the blebs by scratching, a scar usually results. the bowels should be kept open, the diet should be soft. rigidly isolate, for chickenpox is highly contagious. smallpox this disease occurs oftenest during the cold season. it spares no one unless vaccinated, attacking children and adults alike. the early symptoms are: headache, pain in the back, high fever, vomiting, and general lassitude. in many respects these resemble the symptoms of the grippe, while on the third day the eruption appears. the pimples are hard and feel like shot under the skin. within a day or two these shotlike pimples have grown and pushed themselves beyond the skin into little conical vesicles which soon turn to pus. by the eighth or ninth day crusts are formed over the vesicle, beginning to fall off about the fifteenth day. patients are quarantined usually eight weeks and when a case of smallpox in the home breaks out everyone in the family should be revaccinated. the strictest isolation is important from the first of the disease. we will not enter into the treatment of smallpox, for medical aid is sought at once and usually the patient is removed to a special isolation hospital. vaccination the history of the change brought about in the philippines since vaccination has been introduced is an argument of itself which ought to convince the most skeptical of the value of vaccination. by all means, every child in a fair degree of health should be vaccinated. it is wise to vaccinate babies before the teething period--from the third to the sixth month. babies with any skin trouble or suffering from malnutrition, but not living in a smallpox district, should be vaccinated during the second year. in young babies, under six months, the leg is the proper place to receive the vaccination. if proper surgical cleanliness is practiced and ample protection is afforded in after dressing, vaccination need not be a taxing process. the child suffers from general lassitude--a little drowsiness with loss of appetite and a small amount of fever--but this passes off in a reasonable length of time, especially if he is not overfed and his bowels are looked after. on the second or third day after vaccination a red papule appears which soon grows larger, and, after five or six days, it becomes filled with a watery fluid. by the tenth day it has the appearance of a pustule about the size of a ten-cent piece, surrounded by a red areola about three inches in diameter. at the end of two weeks the pustule has dried down to a good crust or scab, in another week it falls off, leaving a pitted white scar. if the vaccination does not take, it should be repeated after an interval of two months. diphtheria diphtheria is a disease much dreaded during childhood and adolescence. it may attack any age--even little babies are susceptible. it begins with a general feeling of heavy, drowsy lassitude with a sore throat. white spots appear on the tonsils which may resemble a simple follicular tonsillitis, while in a short time white patches spread over the throat and tonsils. it is not at all uncommon for this membrane to attack the nose, producing a bloody, pustular discharge; and when it does attack the nose, it is none the less contagious and must be regarded just as seriously. a physician is called at once, and, not only to the child, but to the other members of the family, antitoxin is immediately administered. the disease runs a regular course and its most dangerous complication is the membrane which forms in the larynx and threatens to suffocate the child unless prompt intubation is performed--the slipping of a silver tube in the larynx to prevent suffocation and death. the early use of antitoxin greatly lessens all these serious complications. care must be exercised to prevent sudden heart failure; and this is done by raising the child to an upright position with the utmost care; while you insist upon him lying quietly upon his back or his side, long after the disease has left his throat. while the throat or nose is the seat of disease, the toxins from these most dreaded diphtheritic microbes spread through the lymph channels and the blood vessels to the heart itself--so weakening that organ that it sometimes suddenly fails, or becomes more or less crippled for life. these serious results are to be prevented by the science of good nursing and the prompt use of antitoxin. in these days the "schick test" may be administered for the purpose of ascertaining whether one is susceptible to contracting diphtheria. a physician is always in charge of diphtheria, and he will supply directions for the bowels, the diet, and the sprays for the nose and throat, and the general well-being of the suffering child. isolation and quarantine should continue for two weeks, and in bad cases three weeks, after the membrane has disappeared from the throat. whooping cough a child suffering from a continuous cough, particularly if it is accompanied by a whoop or a condition which is so often seen in children who cough--not able to stop--should not be taken to church, nor to the movies, nor allowed to go to school; neither should he be allowed to leave his own yard. the average duration of the disease is usually six weeks. the child should have an abundance of fresh air, should spend much of his time out of doors, and while in the house should avoid dust of every kind; at night he should not be exposed to drafts. call the physician early in the case and he may attempt to thwart the progress of the disease by certain administrations of vaccine medication. in very bad cases, where a young child cannot catch his breath and gets blue in the face--which, fortunately, is uncommon--he should be slapped in the face with a towel wet in cold water; or, he may be lifted into a tub of warm water, then quickly in cold water, then back into the warm, etc. hygienic measures should prevail, such as keeping the bowels open, the skin clean, and the use of the usual throat gargles and nasal sprays. do not be misguided by the old-time thought that whooping cough must run its course; for, if medical aid is promptly secured, the disease may often be cut short and the severe paroxysms greatly lessened. eye infections not long ago while in north dakota near canada, we took a trip one day just over the border to visit several villages of russian peasants. we found the boys and girls of nearly the entire village suffering from trachoma--a dangerous, infectious disease of the eyes which spreads alarmingly from one child to another. we saw the disease in all of its varying degrees among the children. some of them had swollen, reddened lids. a discharge of pus was coming from the eyes of others, and they could not look toward a light or the sun. this disease is spread in a hundred different ways--through the common use of wash basins, towels, handkerchiefs, tools, toys, door knobs, gates, etc., and that is the reason why these isolated villages of foreign people who could neither read nor write the english language were nearly all so sorely afflicted. the ordinary condition of "catching cold in the eye" ("pink eye") is just as infectious as the trachoma which we have mentioned, although it is more of an acute disorder and nothing like so serious. in all such cases a physician is to be called immediately, isolate the patient, and give strict attention to carrying out the doctor's orders. another form of inflammation of the eye which was mentioned in a previous chapter, is the inflammation of the eye of the newborn. in most civilized districts at the present, especially where the cases are attended by a physician, the eyes of all newborn babies are treated with either argyrol or silver nitrate. just as soon as defective sight is discovered in the child the eyes should be examined at once and proper glasses fitted. while the glimmer and shimmer of moving pictures may seriously interfere with the child's vision, on the other hand, this very thing often discovers the defect in the eyesight earlier than it would otherwise be found out. running ears inflammation of the ears was fully covered in our discussion of adenoids and tonsils, but we would like to add at this time that under no circumstances should a running ear be regarded lightly. a chronic mastoiditis (inflammation of the middle ear) often follows measles, scarlet fever, adenoid infection, and inflammation of the tonsils. the attention of a specialist should be called to it and his instructions most carefully carried out; for, when we have a sudden stopping of the discharge from the ear with high fever and pain behind the ear, sometimes an operation is imperative or the child may be lost. chapter xxix respiratory diseases next to digestive disturbances, babies suffer more frequently from respiratory disorders--colds, bronchitis, and pneumonia. in fact, during very early infancy, pneumonia heads the list of infant deaths, only to be displaced a few months later by that most dreaded summer disease--diarrhea. little tiny babies are so helpless--they are so dependent upon their seniors for life itself--that our responsibility is indeed great. we should put forth our best endeavor to avoid and prevent common colds. among all the common maladies that afflict the human race "colds" probably head the list; and, in the case of babies and the younger children, the common colds often go on into coughs, croup, bronchitis, and even pneumonia. why babies catch cold . someone has brought the infection to him. . somebody coughed in his face. . germ-laden hands have handled the baby. . he has drunk from an "infected" glass. . there was not enough moisture in the air. . somebody wiped his face with an infected towel. . baby was allowed to play on the cold floor. . baby's lowered vitality could not stand the combined strain of overeating and clogged up bowels. . baby was kissed in the mouth by a "cold-germ" carrier. . baby was dressed too warmly--and then taken out. . somebody carelessly breathed in baby's face. . he slept in a stuffy room. . his extremities got chilled. . baby has adenoids or diseased tonsils. babies should not be allowed to sit or play on cold, drafty floors. they may play on mother's bed whose open side is protected with high-back chairs, or they may play in their own bed whose raised sides are sheltered by blankets. it is possible for a mother so to disinfect her hands, and so garb herself with clean, washable garments, that, although she may be suffering from an acute cold, she may continue to care for her baby and the baby need not contract the cold. coryza--cold in the head this most annoying ailment, a cold in the head, is particularly hard on babies because the obstruction of the nasal passages not only makes breathing difficult, but renders nursing well-nigh impossible. the throat end of the eustachium tube (the ear tube) is found in the upper and back part of the throat, just behind the nose. the infection of the cold extends from both the nose and throat and there results a spreading inflammatory process on through these ear tubes into the middle ear itself. now if this tube swells so much that it entirely closes, as so often happens in cases of "cold in the head" as well as in constant irritation from adenoids, then may follow a vast train of difficulties--earache, mastoiditis, etc.--with the result that the tiny bones in the middle ear which vibrate so exquisitely may become ankylosed (stiffened) and deafness often follow. everything known must be done to prevent baby's catching "cold in the head." if the sinuses become infected it may also lead to serious consequences. when the nose becomes clogged it may be opened up by repeatedly disinfecting the inside of the nose with oily sprays such as simple albolene or camphorated-albolene spray. the bowels should be quickly opened by castor oil, and the feedings should be cut down at least two-thirds or one-half. public drinking cups should always be avoided and kissing the baby be tabooed. grippe the treatment of influenza in infancy and childhood is to avoid contact with an older person suffering with the grippe. ordinarily, the so-called "grippe" is a common, mixed infection--not true influenza. coryza and cough are the chief respiratory symptoms which attend these widespread epidemics. often vomiting and diarrhea are seen in the young sufferers. in cases of grippe put the child to bed and call the doctor. in the case of the older children, the treatment and care to be recommended has been fully outlined by the author in the little work entitled _the cause and cure of colds_. complications from the grippe are very frequent in children--such as severe diarrhea, enlarged glands of the neck, running ears, bronchitis, pneumonia, and sometimes tuberculosis. every effort should be put forth to isolate and quarantine the first member of the family to be stricken with grippe so that the remaining members may, if possible, escape an uncomfortable and unhappy siege. sore throat the danger of permanent deafness which so often follows a sore throat as well as a cold in the head, should cause every mother or caretaker earnestly to begin treatment at the very first sign of a sore throat. when a little baby gulps or cries on swallowing, a sore throat should always be suspected and remedial measures promptly instituted. a most convenient article with which to examine an infant's throat is a small pocket flashlight. the pillars of the throat or the tonsils or both may be much inflamed, and since tonsillitis, diphtheria, and scarlet fever all begin with a sore throat, it is wise early to seek medical counsel in order that the differential diagnosis may be promptly made. we urge the mother, as a rule, not to attempt to diagnose severe cases of sore throat. send for the physician. tonsillitis is a severe form of sore throat which, fortunately, rarely troubles tiny infants; but for every sore throat, while waiting for medical help to arrive, lay your plans to empty the bowels, diminish the quantity of the food, swab or spray the throat, and later closely follow the physician's advice concerning the general treatment of the child. adenoids adenoid growths appear as grape-like lymphoid formations located in the upper and posterior-nasal pharynx. these adenoids secrete a very toxic, thickened fluid, which slowly makes its way down along the back wall of the throat, and reddens and inflames first the anterior and posterior pillars of the throat and then often inflames and enlarges the tonsils. adenoids not only obstruct the respiratory passage way to the throat and lungs, but they also exert a harmful influence on the general physical and mental development of the child. it is nothing less than criminal for heedless parents to allow adenoid growths to remain in the child's post-nasal pharynx. the little fellow's face is disfigured, more or less for life, his mentality dulled, while he is compelled to breathe through his mouth. an almost miraculous change often follows the complete removal of these obstructive adenoids--the child takes a renewed interest in everything about him. more oxygen finds its way to the tissues, his face takes on better color, he gains in weight, in fact, there appears to be a complete rejuvenation mentally and physically. the signs or symptoms of adenoids are mouth breathing, restlessness at night, snoring, recurring colds, nasal discharge, swelling of the glands of the neck, poor nutrition, loss of appetite, bed wetting, impaired hearing, lack of attention, and mental dullness. the removal of adenoids is neither a serious or difficult procedure, and they may safely be removed at any age. diseased tonsils tonsils which remain permanently enlarged and show signs of disease and debilitation--filled crypts--may be removed as early as the fourth or fifth year, if necessary. if proper treatment does not improve the tonsils as the child grows older, their removal should seriously be considered. the tonsils may serve some special secretory or defensive function during the first few years of life and we think best, therefore, not to advise their removal--except in extreme cases--until the child is at least four or five years old. when it is necessary to attack the tonsils, they should be thoroughly dissected out--not merely burned or clipped off. if they are properly removed, the danger of heart trouble, rheumatism, and many other infections may be considered as greatly lessened. after five years of age the normal tonsils should begin to shrink, and at about the beginning of adolescence they should be no larger than a small lima bean, hidden almost completely out of sight behind the pillars of the throat. while healthy tonsils may serve some useful purpose even in the adult, it is almost universally conceded that the thoroughly bad and diseased tonsil is utterly useless to the body--only an open gateway for the entrance of infection. bronchitis a very common disorder of early infancy and childhood is bronchitis--an inflammation of the bronchial tubes--accompanied by severe coughing. its tendency to pass into pneumonia renders it a disease for skilled hands to treat--a disorder hardly safe for even the well-meaning mother to undertake to manage without medical advice and help. and since bronchitis is usually accompanied by alarming symptoms of high fever, weakened heart, embarrassed breathing, mottled or blue skin, green stools, troublesome cough, disturbed sleep, "stopped up nose," and "choked up throat," it is of utmost importance not only to seek medical aid early, but also that the mother, herself, should have definite ideas concerning the proper manner of doing the following things in the line of treatment: . making and applying a mustard paste. . the fashioning of an oil-silk jacket. . improvising a steam tent. . flushing out the colon, and a score of other things which the watchful doctor may want given any moment. _mustard pastes_ are prepared by mixing one part of mustard and six parts of flour in warm water and applying to the chest between two pieces of thin muslin. it is left on just seven minutes and then talcum powder is thickly sprinkled on the moist, reddened skin; this powder quickly absorbs all the moisture and leaves the skin in a good condition--ready for another paste in three hours if it is so ordered. _the oil-silk jacket_, or pneumonia jacket, consists of three layers--the inside of cheesecloth, an inner thin sheet of cotton wadding, and an outside layer of oil silk (procurable at any drug store). it should open on the shoulder and under the arm on the same side. it is worn constantly (change for fresh cheesecloth and cotton every day) during the inflammatory stage; it is removed only during the mustard pastes. _a steam tent_ may be prepared by placing a sheet over the infant's crib and allowing steam to enter from a large paper funnel placed in the nose of a tea kettle of boiling water kept hot on a small stove of some sort. the mattress and bedding are covered with rubber sheeting and the infant's clothes protected from moisture. the baby should remain in this steamy atmosphere ten minutes at a time. another method is to hold baby in arms near the large end of a big funnel placed in a tea kettle on the gas stove or range, and then have an assistant help hold a sheet tent over both the mother and babe. or the baby carriage may be placed over a small tub of water into which are dropped several hot bricks. a sheet canopy spread over the carriage holds the steam in and baby reaps the benefits of the warm moisture. _colonic flushing_ is necessary when green stools accompany bronchitis. a well-lubricated end of a large davidson's syringe is inserted into the rectum, and with the hips of the baby brought to the edge of a basin (the heels held in the hands of the assistant), water is forced into the rectum. not more than one ordinary cup of water should be introduced at any one time. after expulsion, another may be gently injected. _the diet_ in bronchitis is always reduced so that no extra work will be thrown on the already overtaxed constitution of the child. _absolute rest_ is necessary and perfect quiet should prevail. the humidity of the room should not be lower than at any time, while the air should be moderately cool and fresh. numerous other details which may be necessary in the management of bronchitis will be directed by the physicians and nurses in charge of the case. spasmodic croup it is believed that children with enlarged tonsils and adenoids are much more subject to croup than others. although very sudden in its onset and very alarming, spasmodic croup, fortunately, is seldom dangerous. a little child goes to bed in apparently normal condition and wakes up suddenly with a coarse metallic cough, difficult breathing, and with a distressed expression on the face. alternate hot and cold compresses should be applied to the throat--first the hot cloths (wrung from very hot water) being applied over the throat, which should be covered with a single thickness of dry flannel. then after three minutes of the hot cloths a very cold cloth is applied to the skin itself for one half minute; then more of the hot compress, followed again by the short cold, until five such changes have been made. a bronchitis tent should be quickly improvised so that the child can be "steamed." vomiting must be produced by kerosene (three or four drops on sugar), alum and molasses, or ipecac (ten drops every fifteen minutes). some remedy must be administered continuously until free vomiting occurs. a good dose of castor oil should be given after the spasm. suitable treatment should be administered through the day to prevent a recurrence of the attack the next night. the general vital resistance should be raised by outdoor life, improved circulation, good food; adenoids if present, should be removed. medical advice should be sought in every case of severe croup, for membraneous croup usually is indicative of diphtheria, and the diagnosis is important, as on it hangs the determination of the administration of antitoxin. pneumonia pneumonia is always a serious disease. it is accompanied by high fever, painful, very short cough, and rapid breathing with a moving in and out of the edges of the nose as well as the spaces between the ribs. the possibilities of complications are always great--the dangers are many--so that the combined watchfulness of both the mother and a proficient trained nurse are required; not to mention the skill of the physician. the steam tent, the mustard paste, the oil-silk jacket and the colonic flushing (described earlier in this chapter) may all be asked for by the physician in his untiring efforts to prevent dangerous complications during the course of the disease. plenty of moderately cool, fresh air (without drafts) is of great benefit. never allow blue finger tips, or cold ear tips to exist; send at once for the doctor and administer a hot bath, or wrap in a sheet dipped in hot mustard water while awaiting his arrival. no mother should think of attempting to carry her baby through an attack of bronchitis or pneumonia without the best medical help available. chapter xxx the nervous child while each child possesses an individuality all its own, nevertheless, there are certain general principles of psychologic conduct and family discipline which are more or less applicable to all children. the so-called nervous child, in addition to the usual methods of child culture, stands in need of special attention as concerns its early discipline and training. this chapter will, therefore, be devoted to special suggestions with regard to the management and training of those children who are by heredity predisposed to nervousness, over-excitability, and who possess but a minimum of self-control. hereditary nervousness the so-called nervous child--all things equal--is the child who is born into the world with an unbalanced or inefficiently controlled nervous system; and while it is all too true that the common nursery methods of "spoiling the child" are often equally to blame with heredity for the production of an erratic disposition and an uncontrolled temper, nevertheless, it is now generally recognized that the foundation of the difficulties of the nervous child reaches back into its immediate and remote ancestral heredity. i no longer doubt but that many of these babies with a bad nervous heredity, who are born predisposed to saint vitus' dance, bad temper, chronic worry, neurasthenia, and hysteria could be spared much of their early troubles and later miseries by prompt and proper methods of early nursery discipline. these nervous babies are born into the world with an abnormal lack of self-control. their "inhibition control" over the natural and spontaneous tendency of the nervous system to manifest its inherent impulses and passing whims is decidedly deficient. the child is unduly sensitive, whines, hollers, or flies into a violent rage when its will is crossed in the least degree. such a child sometimes keeps its mother living in constant terror because, when its will is crossed in any particular, it will scream and hold its breath until it turns black in the face and sometimes actually goes into a convulsion. in dealing with these unfortunate little ones, fathers and mothers, while they should be firm and persistent in their methods of correction, should also be kind and patient; fully recognizing that whatever undesirable traits the little ones manifest they have come by honestly--these naughty tendencies being the result either of heredity or spoiling, for both of which the parents stand responsible. early training one of the very first things that a child, especially the nervous child, should learn is that crying and other angerful manifestations accomplish absolutely nothing. the greatest part of the successful training of the nervous child should take place before it is three and one-half years of age. it should early learn to lie quietly in its little bed and be entirely happy without receiving any attention or having any fuss made over it. it should not become the center of a circle of admiring and indulgent family friends and caretakers who will succeed in effectually destroying what little degree of self-control it may be fortunate enough to possess. when the little one is discovered to be nervous, fretful, impatient, and easily irritated early in the morning, it should be left alone in its bed or in the nursery until it quiets down. if it has a good, healthy crying spell, leave it alone. let it early get used to living with itself--teach the little fellow to get along with the world as it is--and you will do a great deal toward preventing a host of neurasthenic miseries and a flood of hysterical sorrows later on in life. you must not expect to train the nervous child by the simple and easy methods which are successful in the case of a normal child; that is, you cannot repeat a simple discipline two or three times and have the child learn the lesson. in the case of the high-strung nervous child it requires "line upon line and precept upon precept;" for, whereas a normal child will respond to a certain discipline after it is repeated a half dozen times, the nervous child will require the persistent repetition of such a discipline from twenty-five to one hundred times before the lesson sinks into his consciousness sufficiently to enable him to gain control of his erratic and unbalanced nervous mechanism. spoiling the child as bad as all spoiling methods are in child culture, they are decidedly disastrous--almost fatal--in the case of the nervous child; and yet it is these delicate, sensitive, cute little things that are the very ones who are most frequently the worst spoiled. nervous children simply must not be played with all the time. they must be by themselves a great deal, at least this is true in their earlier years. the nervous baby must early learn absolute respect for authority, so that what it lacks in its own nervous control may be partially made up for by parental suggestion and discipline. of course, as suggested in a later chapter, the more ideal methods of suggestion, education, and persuasion should be employed in your efforts to secure obedience and promote self-control; but, when through either the deep-rooted incorrigibility of a child, or the inefficiency of the parent's efforts in the employment of suggestion--no matter what the cause of the failure of your ideal methods to control temper, stop crying, or otherwise put down the juvenile rebellion, whether the child has been spoiled on account of company, sickness or through your carelessness--when you cannot effectively and immediately enforce your will any other way, do not hesitate to punish; spank promptly and vigorously and spank repeatedly if necessary to accomplish your purpose. you must not fail in the case of the nervous child to accomplish exactly what you start out to do. when the little fellow wakes up in the night and cries, see if he needs anything and administer to him. if you have previously tried the method of letting him "cry it out," which is usually entirely sufficient in the case of a normal child, and if such treatment does not seem to cure him, then speak to him firmly, give him to understand that he must stop crying, and if he does not, turn him over and administer a good spanking--and repeat if necessary to get results. in dealing with a nervous child we must follow the directions on the bottle of the old-fashioned liniment "rub in until relief is obtained." no "spoiling practices" should be countenanced in the case of nervous children. they should be taught to sleep undisturbed in a room in the presence of usual noises. they should not be allowed to grow up with a sleeping-room always darkened by day and a light to sleep by at night. they should be taught to sleep on without being disturbed even if someone does enter the room; they should be taught to sleep normally without having to quiet and hush the whole neighborhood. playmates the early play of nervous children should be carefully supervised and organized. under no circumstance should they be allowed exclusively to play with children younger than themselves. they must not be allowed to dictate and control their playmates; it is far better that they should play at least a part of the time with older children who will force them to occupy subordinate rôles in their affairs of play; in this way much may be accomplished toward preventing the development of a selfish, headstrong, and intolerant attitude. when the nervous child is miffed or peeved at play and wants to quit because he cannot have his way, see to it that he quickly takes his place back in the ranks of his playfellows, and thus early teach him how to react to defeat and disappointment. the nervous child must not be allowed to grow up with a disposition that will in some later crisis cause him to "get mad and quit." if the nervous baby has older brothers and sisters, see to it that he does not, through pet and peeve and other manifestations of temper, control the family and thus dictate the trend of all the children's play. early train him to be manly, to play fair, and when his feelings are hurt or things do not go just to his liking, teach him, in the language of the street, to be "game." it is equally important that the little girls be taught in the same way how to take disappointment and defeat without murmur or complaint. teaching self-control when nervous children grow up, especially if their parents are well to do, and they are not forced to work for a living, they are prone to develop into erratic, neurasthenic, and hysterical women, and worrying, inefficient, and nervous men; and in later years they throng the doctor's offices with both their real and imaginary complaints. these patients always feel that they are different from other people, that something terrible is the matter with them or that something awful is about to happen to them. their brains constantly swarm with fears and premonitions of disease, disaster, and despair, while their otherwise brilliant intellects are confused and handicapped because of these "spoiled" and "hereditary" nervous disturbances--with the result that both their happiness and usefulness in life is largely destroyed. the fundamental abnormal characteristic of that great group of nerve-patients who throng the doctor's office is sensitiveness, suggestibility, and lack of self-control. sensitiveness is nothing more or less than a refined form of selfishness, while lack of self-control is merely the combined end-product of heredity and childhood spoiling. i am a great believer in, and practitioner of, modern methods of psychological child culture, but let me say to the fond parent who has a nervous child, when you have failed to teach the child self-control by suggestive methods, do not hesitate to punish, for of all cases it is doubly true of the nervous child that if you "spare the rod" you are sure to "spoil the child." let me urge parents to secure this self-control and enforce this discipline before the child is three or four years of age; correct the child at a time when your purpose can be accomplished without leaving in his subconscious mind so many vivid memories of these personal and, sometimes, more or less brutal physical encounters. every year you put off winning the disciplinary fight with your offspring, you enormously increase the danger and likelihood of alienating his affections and otherwise destroying that beautiful and sympathetic relationship which should always exist between a child and his parents. in other words, the older the child, the less the good you accomplish by discipline and the more the personal resentment toward the parent is aroused on the part of the child. crime and intemperance while it is generally admitted that feeble-mindedness lies at the foundation of most crime, we must also recognize that failure on the part of parents to teach their children self-control is also responsible for many otherwise fairly normal youths falling into crime and intemperance. the parents of a nervous child must recognize that they will in all probability be subject to special danger along these lines as they grow up. the nervous child, as it grows up, is quite likely to be erratic, emotional, indecisive, and otherwise easily influenced by his associates and environment. nervous children are more highly suggestible than others, and if they have not been taught to control their appetites and desires, their wants and passions, they are going to form an especially susceptible class of society from which may be recruited high-class criminals, dipsomaniacs, and other unfortunates. it is true that any spoiled child, however normal its heredity, may turn out bad in these respects if it is not properly trained; but what we are trying to accomplish here is to emphasize to parents that the nervous child is doubly prone to go wrong and suffer much sorrow in after life if he is not early and effectively taught self-control. unspoiling the child if the child of nervous tendencies forms the habit of crying, sulking, or otherwise misbehaving when it is denied its desires, or when something it wants done is not immediately attended to, it will be found an excellent plan simply to stand still and let the little fellow have it out with himself, in the meanwhile kindly reminding him to say, "please mamma," "please papa," etc. i well remember one nervous little girl who would yell at the top of her voice and become black in the face the moment she wanted a door opened or anything else. a few weeks of patience and firmness on the part of the mother entirely cured her of this unbecoming trait. as a rule, it will be found best not to argue with the nervous child. the moment your commands are not heeded, when you have admonished the child once or twice without effect, take him quickly to the crib or the nursery and there leave him alone, isolated, until he is in a state of mind to manifest a kindly spirit and an obedient disposition. it is an excellent plan quietly and quickly to deprive such children of their pleasures temporarily, in order to produce thoughtfulness; and these methods are often more efficacious than the infliction of varying degrees of pain under the guise of punishment. nervous children must be taught to go to sleep by themselves. they are not to be rocked or allowed to hold the hand of the mother or the caretaker. the nervous baby should not be encouraged to exhibit its cuteness for the delectation of the family or the amusement of strangers and visitors. he should be especially trained in early and regular habits, taking particular pains to see that bed wetting and similar bad habits are early overcome; otherwise, he may drag along through early life and become the cause of great embarrassment both to himself and his parents. the control of these nervous habits is somewhat like the management of the slipping of the wheels of a locomotive when the track is wet and slippery. the little folks ofttimes endeavor to apply the brakes, but they are minus the sand which keeps the wheels from slipping. the parent, with his well-planned discipline, is able to supply this essential element, and thus the child is enabled to gain a sufficient amount of self-control to prevent him making a continuous spectacle of himself. when nervous children do not walk or talk early, let them alone. of course, if later on it is discovered that they are manifestly backward children, something must be done about it; but if the nervous child is encouraged to talk too soon there is great danger of his developing into a stutterer or a stammerer. preventing hysteria every year we have pass through our hands men and women, especially women, who possess beautiful characters, who have noble intellects, and who have high aims and holy ambitions in life, but whose careers have been well-nigh ruined, almost shattered, because of the hysterical tendency which ever accompanies them, and which, just as soon as the stress and strain of life reaches a certain degree of intensity, unfailingly produces its characteristic breakdown; the patient is seized with confusion, is overcome by feeling, indulges in an emotional sprawl, is flooded with terrible apprehensions and distracting sensations, may even go into a convulsive fit, and, in extreme cases, even become unconscious and rigidly stiff. now, in the vast majority of cases, if this nervous patient, when a baby, had been thoroughly disciplined and taught proper self-control before it was four years of age, it would have developed into quite a model little citizen; and while throughout life it would have borne more or less of a hysteria stigma, nevertheless it would have possessed a sufficient amount of self-control to have gotten along with dignity and success; in fact, the possibilities are so tremendous, the situation is so terrible in the case of these nervous babies, that we might almost say that, in the majority of such, success and failure in life will be largely determined by the early and effective application of these methods of preventive discipline. i was recently consulted by a patient whose nervous system was in a deplorable state, who had lost almost complete mental control of herself, and who really presented a pathetic spectacle as she told of the fears and worries that enthralled her. in an effort to get to the bottom of this patient's heredity i had a conference with her father, and i learned that this woman, in her childhood days, had been constantly humored--allowed to have everything she wanted. she was a delicate and sensitive little thing and the parents could not bear to hear her cry, it made her sick, it gave her convulsions, it produced sleepless nights, it destroyed her appetite, and so she grew up in this pampered way. the father recognized the greatness of his mistake and he told me with tears in his eyes how, when the ringing of the school bell disturbed his little girl baby, he saw the school directors and had them stop ringing the bell, and he even stopped the ringing of the church bells. he was an influential citizen and could even stop the blowing of the whistles if it disturbed his precious little daughter. and so this woman has grown up with this nervous system naturally weakened by heredity and further weakened by "spoiling"; and fortunate indeed she will be if off and on the most of her life she is not seeking the advice of a physician in her efforts to gain that self-control which her parents could have so easily put in her possession at the time she was three or four years of age, if they had only spent a few hours then, instead of the many months and years that subsequently have been devoted to medical attention. methods of discipline we run into many snags when we undertake to discipline the nervous baby. the first is that it will sometimes cry so hard that it will get black in the face and may even have a convulsion; occasionally a small blood vessel may be ruptured on some part of the body, usually the face. when you see the little one approaching this point, turn it over and administer a sound spanking and it will instantly catch its breath. this will not have to be repeated many times until that particular difficulty will be largely under control. it will be discovered when you undertake to break a bad habit in the case of a spoiled child who is of a nervous temperament, that your discipline interferes with the child's appetite and nutrition. the delicate little creature who has perhaps already given you no end of trouble regarding its feeding, will begin to lose in weight, and even the doctor often becomes so alarmed that he advises against all further methods of discipline. we think this is usually a mistake. both the nutrition and discipline should be kept in mind and carried harmoniously through to a successful finish. it will be necessary during such troublous times to conserve both the physical and nervous strength of the child; it should not be allowed to run about and over-play, as such high strung children often do. it should be given a reasonable amount of physical exercise, and two or three times a day should have short periods of complete isolation in the nursery, where it may quietly play with its blocks and toys, sing and croon or talk as the case may be, but should be left entirely alone. wise efforts should be put forth to keep the feeding up to the proper number of calories, and to see, if the child does not gain during this disciplinary struggle, that at least it does not lose; and i give it as my experience that i have yet to see a case in which both the child's nutrition and discipline cannot be efficiently maintained at one and the same time, though it does sometimes require adroit scientific and artistic management. but the game we are playing is worth the effort--the battle must be fought--and it can be fought with the least suffering and sorrowing the earlier the conflict is waged to a successful issue. i am decidedly opposed to allowing these young nervous children to over-play and thus wear themselves out unduly. this over exhaustion sometimes renders the training of the child much more difficult, as it is a well-known fact that we are all much more irritable and lacking in self-control when we are tired, more especially when we are over-tired and fatigued. let me emphasize the importance and value of proper periods of isolation--complete rest and partial physical relaxation. you can take a child who has gotten up wrong in the morning, whose nerves are running away with him, who is irritable, crying at everything that happens, who even rejects the food prepared for him, and who, when spoken to and commanded to stop crying, yells all the louder--i say you can take such a little one back to its crib, place it in the bed and smilingly walk out of the room. after a transient outburst of crying, within a very few minutes you can return to find a perfect little angel, winsome and smiling, happy and satisfied, presenting an entirely different picture from the little culprit so recently incarcerated as a punishment for his unseemly conduct. but let me repeat that while such methods of discipline often work like magic on normal children, they must be repeated again and again in the case of one who is nervous in order to establish new association groups in the brain and to form new habit grooves in his developing nervous system. respect for authority there are just two things the nervous child must grow up to respect; one is authority and the other is the rights and privileges of his associates. the nervous child needs early to learn to reach a conclusion and to render a decision--to render a decision without equivocation--to move forward in obedience to that decision without quibbling and without question; that is the thing the nervous man and woman must learn in connection with the later conquest of their own nerves; and a foundation for such a mastery of one's unruly nerves is best laid early in life--by teaching the child prompt and unquestioning obedience to parental commands. at the same time, endeavor so to raise the child that it acquires the faculty of quickly and agreeably adapting itself to its environment, at the same time cheerfully recognizing the rights of its fellows. it is a crime against the nervous child to allow it to hesitate, to debate, or to falter about any matter that pertains to the execution of parental commands. let your rule be--speak once, then spank. never for a moment countenance anything resembling dilatoriness or procrastination, let the child grow up to recognize these as its greatest dangers, never to be tolerated for one moment. false sympathy we are aware that many good people in perusing this chapter will think that some of the advice here given is both cruel and hard hearted; but we can safely venture the opinion that those who have reared many children, at least if they have had some nervous little ones, will be able to discern the meaning and significance of most of our suggestions. sympathy is a beautiful and human trait and we want nothing in this chapter in any way to interfere with that characteristic sympathy of a parent for its offspring--the proverbial "as a father pitieth his children"--nevertheless, there is a great deal of sympathy that is utterly false, that is of the nature of a disastrous compromise, for the time being making it easy for both parent and child, but making things unutterably more difficult later on in life when both (or perhaps the child alone) must face the calamitous consequences of this failure early to inculcate the principles of self-control and self-mastery on the mind and character of the nervous child. we so often hear "mother love" eulogized. it is a wonderful and self-denying human trait; but, as a physician, i have been led to believe that "mother loyalty" is of almost equal or even greater value. all mothers love their children more or less, but only a few mothers possess that superb loyalty which is able to rise above human sympathy and maternal love, which qualifies the mother to stand smilingly by the side of the crib and watch her little one in a fit of anger--yelling at the top of its voice--and yet never touch the child, allow the little fellow to come to himself, to wake up to the fact that all his yelling, his emotion, his anger, and his resentment are absolutely powerless to move his mother. thus has the mother--by her loyalty to the little fellow--taught him a new lesson in self-control, and thus has she added one more strong link in the chain of character which parent and child are forging day by day, and which finally must determine both the child's temporal and eternal destiny. system and order system and order are desirable acquisitions for all children, but they are absolutely indispensable to the successful rearing of the nervous child, who should be taught to have a place for everything and everything in its place. when he enters the house his clothes must not be thoughtlessly thrown about. every garment must be put in its proper place. these little folks must be taught a systematic and regular way of doing things. nervous children must not be allowed to procrastinate. they must not be allowed to put off until tomorrow anything which can be done today. they must be taught how to keep the working decks of life clear--caught right up to the minute. they should be taught proper methods of analysis--how to go to the bottom of things--how to render a decision, execute it, and then move forward quickly to the next task of life. when they come home from school with home work to do it would be best, as a rule, first to do the school work before engaging in play. in fact, all the methods which are needful for the proper discipline of the ordinary child are more than doubly needful for the training of the nervous child; while more than fourfold persistence is needed on the part of parents to make them really effective. emotional runaways whether the child be two years of age or ten years of age, when the parent discovers that the nervous system is "losing its head," that the child is embarking on a nervous runaway, or that it is about to indulge in an emotional sprawl, it is best to interfere suddenly and spectacularly. lay a firm hand on him and bring things to a sudden stop. speak to him calmly and deliberately, but firmly. set him on a chair, put him in the bed, or take him to a room and isolate him. in the case of the older children, tell them a story of the horse which becomes frightened, loses self-control, and tears off down the highway, wrecking the vehicle and throwing out its occupants. explain to them that many of the mistakes of life are made during the times of these emotional runaways, these passing spells of lost self-control. tell the little folks that you have perfect confidence in them if they will only take time to stop and think before they talk or act. explain to them that since you saw that they were rapidly approaching a foolish climax you thought it was your duty to call a halt, to stop them long enough to enable them to collect their wits and indulge in some sober thinking. personally, we have found it to be a good plan not to be too arbitrary with the little folks, like putting them on a chair and saying, "you must sit there one hour by the clock." they usually begin to indulge in resentful thoughts and a situation is often produced akin to that of the stern father who felt compelled to go back and thrash his boy three different times during his hour on the chair, because of what he was satisfied was going through the boy's mind. no, that is not usually the best way. put them on the chair with an indeterminate sentence. i prefer to carry it out something like this: "now, son, this will never do; you are running away with yourself. stop for a moment and think. now i am going to ask you to sit down in that chair there and think this over quietly. i will be in the next room. whenever you think you have got control of yourself and have thought this thing out so you can talk with me, you may get up from the chair and come into the room to me." sometimes five minutes, sometimes fifteen minutes, and the little fellow will walk in and talk to you in a very satisfactory manner. he will give you his viewpoint and you will be able to adjust the matter in a spirit of conference which will be satisfactory to both parent and child, without doing the least violence to the responsibility of the one or the individuality of the other. very little is to be accomplished, when the child starts to indulge in an emotional runaway, if the parent contracts the same spirit, begins to talk fast and loud, to gesticulate wildly, grabs the child, begins to slap and shake it--that is merely an exhibition on the part of the parent of the very same weakness he is trying to correct in his offspring. i am afraid it is entirely too true that for every time you shake one demon out of a child in anger, you shake in seven worse devils. when all other methods fail and you must resort to punishment, do it with kindness, deliberation, and dignity. never punish a child in haste and anger. the final reward the advice offered in this chapter is not mere theory. it has been successfully used by many parents in the management of their nervous children, and while all principles of child culture must be carefully wrought out and made applicable to the particular child in question, nevertheless, the methods of repeated and firm discipline herein set forth will enable you to take many a child who has been born into this world almost neurologically bankrupt, and, by this training and discipline, enable him in adult life to draw such dividends of self-control and self-mastery as will far exceed the outward results obtained in the case of many children who are born with sound nervous systems, but who were early spoiled and allowed to grow up without that discipline which is so essential to later self-control and dignity of character. chapter xxxi nervous diseases in this chapter we shall consider a number of the more common diseases which are associated with the nervous system of the child. some of these so-called nervous diseases are hereditary or congenital, while others are the result of infection and environment. sleeplessness--insomnia there are many conditions which cause sleeplessness or insomnia in a child aside from disturbance of the mental state or nervous system. for instance, late romping, too hearty and too late a dinner, lack of outdoor life during the day, illy ventilated sleeping rooms, too much bedding, too little bedding which causes cold extremities, too much sleep during the day, too much excitement (movies or receptions), intestinal indigestion which is associated with accumulation of gas, and constipation--any or all of these are causes of sleeplessness. some peculiarly nervous children--those with an hereditary strain of nervousness--are easily upset or disturbed by any of the conditions above mentioned. the treatment of insomnia consists, first, in finding the cause and removing it. children with a nervous tendency should be let alone as nearly as possible, and just allowed to grow up as the little lambs and calves grow up. they should be fed, watered, kept clean and dry, and allowed to live their lives undisturbed and without excitement. the medicinal remedies on the market for insomnia are all harmful if used too long or in excess, and we most earnestly urge the mother not to seek drug-store information concerning remedies for sleeplessness. the neutral bath is beneficial in ninety per cent of these cases. it is administered as follows: enough water is allowed to run into the bath tub to cover the child. the temperature should be to f. it should be taken accurately--and should be maintained. bath tub thermometers may be purchased at any drug store. the restless child, after the bowels have been freely moved, is placed in the water, and, without whispering, talking, or laughing, he remains there for at least twenty minutes, after which he is carefully lifted out, wrapped in a sheet and very gently dried off with soothing strokes and placed at once into his night clothes. as before said, ninety per cent of restless children will go at once to sleep after such a treatment. another method of treating sleeplessness is by the wet-sheet pack. three single woolen blankets are placed on the bed and a sheet large enough to wrap the child in is wrung from warm water, about f. the child is stripped and this sheet is brought in contact with every portion of his body, quickly followed by bringing the flannel blankets about him and he is allowed to remain there for twenty minutes--if he does not fall asleep before the lapse of that time. with witch-hazel or alcohol, the body is sponged off, night clothes are put on and a restful night usually follows. if fresh air is lacking, open the windows. if there is too much bedding, remove some of it. talcum powder the sweaty back and neck and make the child perfectly comfortable. give a small drink of water and turn out the light. night terrors night terrors are probably due to some digestive disturbance, with a coexisting highly nervous temperament. they oftentimes, in older children, follow the reading of thrilling stories or a visit to an exciting moving-picture show. the child goes to sleep and gets along nicely for two or three hours and then suddenly jumps up out of bed and rushes to its mother with little or no explanation for the act. in his dreams the thoughts and the imaginations of his waking moments are all confounded and alarming. we recall one little fellow who constantly feared big, black birds coming in the window and attacking him--he had been reading about sinbad the sailor and his experiences with the big bird. he so feared this big, black bird that he could not go to sleep. for a number of nights he did not have the courage to tell his parents that it was the fear of the big bird that kept him from going to sleep, but finally he confided in his mother and told her of his fear. the mother and father both entered into a conversation with him through an open door which connected the two rooms, after the lights were out; they laughed and talked about the big bird, they openly talked of it and allowed their imagination to work with the child's imagination in planning how he could combat with the bird, should it really come, asking him how big it really was and what color he thought its eyes were and how big an object he thought its feet could carry. they all three planned a fairy story they might write which would rival the fairy stories of the arabian nights. in a very short time--possibly a week or ten days--the little fellow felt quite equal to these imaginary assaults, his fears were quieted and his slumbers were no more disturbed by visions of the big, black bird. everything should be done to relieve the stomach and intestines of laborious work during the sleeping hours, hence let the evening meal be light and eaten early enough to be out of the way, as far as digestion is concerned, by bed time. nervousness during the formative period of the nervous system--the first few years--under no circumstances should the children be played with late at night, when they are tired and sleepy, or hungry, for it is at such times that the nervous system is so easily excited and irritated. when the baby is to be played with, if at all, it should be in the morning or after the mid-day nap. rest and peaceful surroundings are of paramount importance to the nervous child, and he should be left alone to amuse himself several hours each day. it is a deplorable fact that the nervous child--the very one that should be left alone--is the very child that usually receives the most attention, the very one who is most petted, indulged, and pacified; all of which only tends to increase his lack of self-control and to multiply the future sorrows of his well-meaning but indulgent parents. headache headache attacks old and young alike, and the young infant that is unable to tell us he has a headache manifests it by rolling the head from side to side, putting his hand to his head, or by wrinkling up his brow. headaches may be occasioned by disorders of the brain and spinal column, such as meningitis. it nearly always accompanies fever, and is often a result of constipation, intestinal indigestion, overeating, as well as eating the wrong kind of food. the treatment of headache in children (aside from removing any known cause) consists of a hot foot bath, a brief mustard paste to the back of the neck, a light diet--sometimes nothing but water--and the administration of a laxative. convulsions--spasms in the very young, convulsions are easily produced. that which will produce but a headache in an adult will often produce a convulsion in the child. aside from diseases of the nervous system such as epilepsy, etc., convulsions frequently accompany gas on the bowels, intestinal indigestion, disordered dentition, an acute illness, intestinal parasites (worms), irritation about the genitals such as the need of circumcision, an adherent clitoris, adenoids and enlarged tonsils, inflammation of the ears, and poor nutrition of any sort such as rickets. the convulsion picture is a stiffening of the body--sometimes arching backwards--rolling or staring of the eye-balls, blueness of the skin, a drooling mouth (often foamy mucus at the mouth), clinched hands, biting the teeth--if there are teeth--and even biting the tongue. there is at first a succession of quick, jerking, convulsive movements of the body which in a few moments grow less and less violent and finally cease. the child begins to cry and then soon goes off into a deep sleep, while the body seems more heavy and logy than usual. in extreme cases, the child relaxes but for a moment of time, when he goes off into another convulsion, sometimes going from one fit into another until death relieves him. treatment for convulsions must be instituted at once. do not wait entirely to undress the child--pull off his shoes, place him at once into a good warm bath, temperature about to f. an ice cap should be placed to his head (cracked ice done up in a towel), and while in the bath or immediately upon taking him out, give a warm soapsuds enema. the bath that the child is placed in should be always tested with the bared elbow. a half cupful of mustard may be added to the bath. just as soon as the child is able to swallow, give a teaspoon of syrup of ipecac. enema after enema should be given until the water comes back clear. undue excitement after the bath only predisposes to repeated attacks, and while the mother may be very happy that the child is himself again, under no circumstances should she caress and fondle him. put the little one to bed and allow his nervous system to calm down; let him rest quietly and undisturbed. nervous twitchings habit spasms or "tics" are common in childhood, and are caused by an over irritability of the nerves supplying certain groups of muscles. it is not at all uncommon to see a child nervously blink the eyes, twitch the nasal muscles, shrug the shoulders, constantly open and close the hand, and execute a score of other minor habit-spasms; which, day by day, wear deeper and deeper paths into his nervous system as a result of their constant repetition. these minor habit-spasms of childhood are but telltales of an unstable nervous system, of a nervous heredity lacking poise and balance; and, mind you, if this nervous system is studied, treated, and properly harnessed with self-understanding and self-control, much may be accomplished; the habit may be more or less completely eradicated. if left to itself, unchecked, the habit deepens the "spasm-groove," and the "energy-leaks" grow bigger and bigger until finally, in later, adult life, all that is necessary to convert such persons into first-class neurasthenics or hysterics is some bad news, a few worries, or a sudden shock. by all means study to nip all childhood twitchings in the bud; remembering all the while that childhood--the formative period for the nervous system of the child--presents the golden opportunity to prevent and abort the more grave neuroses of later life. there may be a special contraction of one or more muscles of the eyeball which produces either a "cross-eye," when the contraction is convergent, or a turning of one eye outward when the contraction is divergent. it is not possible for the mother to correct this condition. the one important thing for her to do is to take the child to a skilled ophthalmologist early in his life, that treatment may be instituted for the correction of the difficulty. retention of urine not an unusual condition during childhood is a temporary retention of urine. it may follow an attack of colic or accompany any acute illness. increase the water drinking, and, after seven or eight hours, hot cloths should be applied over the bladder; a large enema (enema bag should be hung low) should also be given, retaining as much as is possible. these simple measures usually relieve the condition. if retention follows circumcision, due to swelling of the parts, the surgeon should be notified. bed wetting nocturnal enuresis (bed wetting) usually is found to "run in families." it is seldom the case to find that both the father and the mother escaped bed wetting during childhood when the child is sorely afflicted. early bad habits may be the prime factor in this distressing and humiliating difficulty. a little child that has been compelled to lie in wet diapers for hours at a time gradually becomes accustomed to "being wet," and the desire to urinate is not under the keen control of a will that has been trained by untiring patience to "sit on a chair" at regular intervals throughout the day. this lack of training in a child who possesses an unstable nervous system, creates the proper environment for the habit of bed wetting--which often marches steadily on until puberty. in the treatment of bed wetting give attention to the following: . the urine should be thoroughly examined. . the size of the bladder should be determined. . the last meal of the day should not be after four o'clock in the afternoon. . all during the day, in young children, systematic training should be begun--put the child on the chair every hour, then every hour and a half, then every two hours. let the work be done most painstakingly and much will be accomplished toward training the bladder to "hold its contents" during the night. for a time it will be necessary to set an alarm clock to ring every three hours during the night, that the bladder may be relieved at regular intervals. . no liquids whatever are allowed after four p. m.; even the four o'clock meal should be very light. . in older children the habit is often broken by appealing to the pride--by requesting or demanding the child to rinse out the bed linen and hang it up to dry himself. usually at puberty the trouble ends, and while no amount of whipping will correct the difficulty, the promise of rewards, an appeal to the pride, correction of dietetic errors, the establishment of regular times to empty the bladder, the removal of all reflex causes such as adenoids, need of circumcision, worms, etc.--these combined influences--will bring results in the end, if they are faithfully and intelligently applied. meningitis cerebro-spinal meningitis is not highly contagious. children old enough to complain of symptoms usually first complain of an intense headache with frequent vomiting and very high fever. great prostration is seen, the pulse is weak, the respirations are irregular, the child may have convulsions, or it may have chills and fever, and rigidity of the body may be present. the position of the child is very characteristic. it does not want to lie on its back but usually rests on one side, with the spine more or less arched. it is a very serious disease and demands the early attention of a physician. some cases are very mild and others are exceedingly grave. if the physician is secured early, and special remedies administered that are known today, many of the children may be saved. infantile paralysis infantile paralysis is a serious disease of the spinal cord which comes on very suddenly and is associated with vomiting, pain in the legs, and a high temperature. after these symptoms have lasted a day or two the paralysis is discovered. there may be convulsions. the paralysis is progressive, and the wasting of the muscles increases until by the end of a couple of months one limb is considerably shorter than the other. sometimes the baby goes to bed at night in apparent good health and wakes up in the morning paralyzed. in this disease the attention of the best physician in your community should be called to the case at once, for there are being developed in our large research laboratories special vaccines for this condition as well as for spinal meningitis. but what is done must be done very, very early, so let there be no delay in calling in medical counsel. there are other forms of spinal paralysis which, associated with tuberculosis of the spine and other spinal diseases, result in loss of power to one or more groups of muscles. the only treatment that can be given in the home is to keep all of the paralytic portions of the body very warm by external heat, care being taken to avoid burning, and secure medical advice. often, later in the course of the disease, by the aid of crutches and braces, the child can be taught to go to school and to get around the house about his little duties. the slight facial paralysis which is so often seen in babies that have been delivered with forceps, usually clears up in a few days or at the latest in a few weeks or months. saint vitus' dance saint virus' dance (chorea) is a peculiar disorder seen in nervous children, and which usually clears up in a few weeks or months under proper treatment. it is characterized by irregular jerkings pretty much all over the body, so that the child staggers as he walks, drops his food at the table, and executes many other noticeably abnormal movements. the child should be taken out of school at once and removed from association with children who might make sport of him or otherwise annoy him and thus increase these irregular jerkings. he should at once be put under the direction of competent medical authority. simple food, colon hygiene, more or less complete rest, and freedom from annoying circumstances, will usually bring about a speedy recovery. congenital disorders _water on the brain_ is characterized by an enlarged head due to an increased accumulation of fluid within the cranium. while the face remains small the head greatly increases in size so that oftentimes it must be braced while the child is compelled to remain in a wheel chair. the mentality is usually fairly normal, but the enormous weight of the head compels the life-long occupancy of a wheel chair. _deaf-mutism._ the child born deaf pays no attention whatever to sounds. an intellectual expression is seen on his face and by six months he is able to do all that a normal baby can do with the exception of hearing. the child should early be taken to an ear specialist in the endeavor, if possible, to correct the defect of hearing. such little ones who are destined to a life without sound, should be given every opportunity to learn to read the lips and to secure a good education--to be taught a vocation where eyesight is of more value than hearing. special institutions are in existence today which can take these deaf mutes when small and so teach them to make audible sounds that they can make themselves understood--at least partially. lip reading is a wonderful improvement over the deaf and dumb alphabet, and should be taught early. _congenital blindness._ perhaps not until the child is six months old can the observer distinguish between blindness and idiocy. the blind child of course will not fix his eyes upon any object; but the general lassitude and the inability to hold up its head, while seen in idiocy, is not present in blindness. _feeble mindedness._ a baby that is born with a weak mind is found to be very backward in all the normal developmental attainments of the growing child. a normal baby holds up its head at four months and should be able to sit erect at six months. the weak-minded baby will not do this, and often as late as two years it will not make any attempt to walk or to talk. there is an unnatural expression--a vacant look--to the face, while there is often much dribbling at the mouth. _early training should be instituted._ it is necessary to call the attention of a physician to these facts, that the parents may be instructed in regard to the early training which is so essential in all these weak-minded little folk. in our opinion it is best to remove these children early to special institutions, where their education can be superintended by those thoroughly accomplished and accustomed to dealing with this class. there are varying grades of feeble mindedness--the backward child who requires a longer time to learn things, and the child who is slow at school and possibly cannot get through more than the fourth or fifth grade--but as soon as weak mindedness is discovered, it is best to transfer the child to some special institution. chapter xxxii skin troubles one of the earliest skin troubles that the average normal child suffers from is prickly heat--a tiny, red-pointed rash always accompanied by sweating and usually resulting from over-dressing, stuffy rooms, and other conditions that make the child too warm. prickly heat produces more or less discomfort but usually little or no itching. ordinarily, a sponge bath followed by the application of talcum powder is sufficient to give relief in mild cases; but severe or neglected cases should be treated by means of bran baths, a cupful of bran being tied up in a gauze bag and suspended in water until the water assumes a milky color. soda baths, two tablespoons to a gallon of water, are also very soothing. a baby should never receive any friction with a towel after such baths, but should be rolled up in a clean linen towel and simply patted dry. chafing great care should be exercised in the choice of baby's soaps. among a number of soaps that might be mentioned castile soap is, perhaps, as good as any. frequent sponging is required to wash off the irritating perspiration; cool clothing, plenty of talcum powder, a dose of calcined magnesia, and a regulated diet are necessary to clear up the trouble. chafed skin, particularly between the buttocks or in other folds and creases, should be kept free from soap. either the starch or bran bath may be tried, while olive oil should be frequently and lightly rubbed over the chafed part. a bit of sterile cotton placed between the folds to prevent friction is often all that is necessary to correct the difficulty. dandruff or milk crust which is often seen on young babies' scalps has been described in detail elsewhere. it should early receive the vaseline rub at night which will often loosen up the hardened crusts. it may be gently removed in the morning with soap and water unless the case has gone on to great severity. in such neglected cases the mother should not undertake to correct the difficulty alone. taken early, when the scalp is covered with tiny flakes known as milk crust, it can be quickly relieved. vulvovaginitis vulvovaginitis is a very contagious disease, and before the days of hospital asepsis, which is so perfectly maintained today in our large institutions, this disease used to go right through a children's ward because of carelessness in the handling of soiled diapers, etc. the sign of this disease is a yellow-white vaginal discharge, while the surrounding skin covering the inside of the thighs and buttocks may be very much reddened. the baby should be taken at once to the physician at the first appearance of these symptoms. only rigid isolation can possibly prevent other children from getting it--essentials are separate towels, wash towels, soap (in the case of the older children), and, in the case of the baby, separate diapers and rigid scrubbing of the attendant's hands--in this way only can this infection be held in check. the infected child should sleep by herself, and utmost care must be exercised in preventing her fingers from first touching the itching vulva and then placing them to the eyes or to the mother's eyes. a vulva pad must be worn as long as the disease lasts. the physician will give you the proper medicines to be used in these cases, and if no physician is within reach, you are perfectly safe in dropping into the spread apart vulva a few drops of twenty-per-cent argyrol and then applying the vulva pad. after each treatment the hands of the mother or nurse must be most rigidly cleansed. eczema eczema is a very troublesome disease, particularly in infants; there are so many forms of it that there is neither time nor space in this volume to describe them individually. this disease may be produced in children by either internal or external causes--from friction on the skin, from coarse, rough woolen clothes, or from starched garments, or from lace or starched bonnet strings which rub into the folds of the skin. irritating soap, the contact of soiled diapers, cheap toilet powders, and discharges from the nose and ears may also be responsible for the disease. the particular internal causes are over-feeding, digestive disturbances, the too early use of starches which create fermentation in the intestinal tract. in the most frequent form of eczema the skin becomes red and then there appear tiny vesicles (water blisters) which soon rupture and "weep." this fluid which oozes from these tiny, ruptured vesicles, in connection with the perspiration and exfoliation of old skin, forms heavy crusts upon the face which are both unsightly and annoying. another form of eczema is simply a very badly chafed condition accompanied by intense itching, and commonly known as "dry eczema." a very disagreeable form is the pustular variety. one poor little sufferer that was once brought to us had so many pustules on his head that one could not put a ten cent piece on his scalp without touching a pustule. the treatment of these cases, in order to be effective and leave the child's head in normal condition, must be administered with the utmost patience every day for weeks. a doctor's help is always required in combating this sort of skin trouble. if the cause is external, then the clothes should be changed. all irritation should be removed--the clothing must not be allowed to scratch the skin. the child must not scratch himself. if necessary, little splints may be placed on the inside of his arms to prevent his bending the elbows if the eczema is on the face, while the little sleeves may be pinned to the side of the dress to resist the movement of the arms. eczema treatment the diet should be most carefully looked into. the nursing mother will earnestly look into every article of food she herself is eating, and carefully avoid all foods that produce fermentation or decomposition. the mother's urine should be examined and its acidity noted; if it is above normal she should take some alkalines such as ordinary baking soda or calcined magnesia. if it is a bottle-fed baby, any form of flour should be removed from the food and the quantity of the milk reduced. all this, of course, is done under the direction of the physician. repeated doses of castor oil may be given. the name of the medicinal agents that have been used in the treatment of eczema, is legion. perhaps one of the most widely used is the early varnishing of the affected skin with ichthyol (one part ichthyol, one part distilled water), which is swabbed on after the skin has been cleansed with olive oil. allow this to almost dry, and then sprinkle on talcum powder which smooths over the dry varnish of ichthyol. this is worn every night and during the day, in bad cases, even when the eczema is on the face. it is renewed each day, and is preceded by the olive-oil bath. no water or soap is ever used in eczema. fortunately, the eskimo has taught us that the skin really can be cleansed with oil as well as with water. in the appendix will be found two prescriptions, number one and number two, that have proved very beneficial in some of the most severe forms of eczema. hives and freckles hives, a crop of little raised red papules closely resembling lesions caused by the sting of a mosquito, may make their appearance upon the skin of the child, remain a few hours, and then disappear. hives are usually due to digestive disturbances and may be caused by such foods as strawberries, nuts, pastries, pineapple, certain sea foods, mushrooms, etc. a good cathartic, the taking of alkalines, such as baking soda or calcined magnesia, with a bran or starch bath, or possibly a soda bath, will usually correct the difficulty. the same treatment may be used in nettle rash or prickly heat. freckles seem to run in families. broad-brimmed hats or sunbonnets may be worn, but under no circumstance should a little girl be bidden to remain in the house and shun the beautiful, sunshiny outdoors just because she freckles easily. do not apply any lotions to the freckled face without medical advice, for great harm may be done the tender skin of the child. ringworm often upon the scalps of young children may be seen circles--rather, patches--which are slightly rough to the touch, and which cause the hair to fall out and the spots to remain bald. they are known as ringworms of the scalp. the affection may likewise appear on the body or the face, presenting a ring of reddened skin with a scaly border. ringworm on the scalp is hard to treat and medical help should be secured, for, in spite of all that can be done, the disease often runs its course, leaving round bald spots over the head. ringworm of the face, taken early, is helped by carefully painting with tincture of iodine. the mother should constantly bear in mind that ringworm is a "catching" disease, so that all handkerchiefs, towels, and clothes are to be kept separate. the disease known as mange which so often attacks dogs, is nothing more than ringworm, and children often contract the disease from dogs. ringworm, whether it be on children or dogs, may be greatly helped by the use of tincture of iodine and other appropriate remedies. boils the much poulticing of boils has done an untold amount of mischief. many children and adults are in their graves today because of improper treatment of boils. blood poisoning which so often follows the careless poulticing, as well as the uncleanly opening of boils, can all be avoided. before touching a boil, the surrounding skin should be thoroughly washed with sterile cotton and laundry soap and then disinfected with alcohol. then, with a scalpel or a surgeon's knife which has been either boiled for twenty minutes or allowed to remain in pure carbolic acid two minutes and then in alcohol two minutes, it should be thoroughly opened down to the core so that the pus may come out. it is very much better for the trained hands of a physician to do this than for any member of the family to undertake such an operation--where the danger of blood poisoning is always present. the only treatment of skin eruptions containing pus which is justifiable for the home folks to undertake is to simply paint them with iodine. under no circumstance should poultices be used. fever blisters it is not at all uncommon for small children to develop a group of fever blisters on the lips when suffering with any disease, or experiencing a high fever. even a simple cold or a spell of indigestion may be accompanied by fever blisters. they appear not only on the lips but also on the edges of the nose and may even be seen on the chin. early in their first appearance they may be treated with spirits of camphor or plain alcohol, which sometimes tends to abort them; but they usually run their course, and when they are fully developed they may be treated with zinc oxide, simple borated vaseline, or ichthyol. warts very often children's hands are disfigured by warts. they appear suddenly, develop rapidly, and many times disappear just about as suddenly as they appeared. every child suffering from warts usually passes through the stage of charms and lingoes which are popularly used to remove these disagreeable growths. we hardly see any efficacy in "bean-ie, bean-ie take this wart away," or any particular virtue in stealing mother's dishcloth, cutting it up into as many pieces as there are warts on the hand and rubbing each wart with a separate piece of the cloth; but you will find people in every town or village who will assure you that their warts were driven away by one of these charms or lingoes. warts are either better left alone or removed by a physician with the high-frequency spark or some other reliable method. birthmarks a red or purplish patch on the skin is the result, as mentioned in an earlier chapter, of an embryological accident in which one or more embryonic cells slipped out of place in the early days of skin formation. these accidental markings may occur on the face, the scalp, or on any other portion of the body, and they should be let alone, unless they show a tendency to grow, when it may prove best to give them proper surgical attention. a mole is also a birthmark, and if found upon the neck or shoulders where it is likely to disfigure, it may be removed by the high-frequency spark, or by surgery, in the same way as warts. never tamper with moles. leave them alone or turn them over to the surgeon. erysipelas erysipelas is a much-dreaded disease which is the result of infection with the blood-poisoning germ--streptococcus. it usually occurs about a wound, and is due to infection by this microbe. if it follows circumcision, it is due, of course, to infection, and may be very serious, even causing death. it attacks persons of any age and is oftenest seen on the face. in appearance, the skin is a bright and shiny red, with a definite line of demarcation slightly raised at the edges because of the swollen tissues underneath. on pressure, the redness disappears but reappears immediately upon relieving the pressure. the inflammation, pain, and fever often continues a number of days, during which the child should be isolated from all other members of the family. the bowels should be freely opened, and the diet should be liquid and soft; while local treatment is cared for by the physician who should always be called. should erysipelas develop on a very young baby it is very important that he should be removed at once from the mother. as stated before, the disease is produced by the blood-poisoning germ which is very much to be avoided in any and all stages of obstetrics. one attack in no way renders the patients immune. they may have repeated attacks of erysipelas. the treatments should be started early and kept up most rigidly. scabies and lice in thickly settled districts among the poor and uneducated, where filth and untidiness reign, the "itch" is a very prominent disease. it is caused by the itch mite, a parasite which burrows underneath the skin leaving behind its eggs in little irregularly shaped, bluish tinted ridges. such a profound itching is set up by this burrowing and depositing of eggs that the child cannot resist scratching, and all taken together produces the typical itch-rash. the common site for this rash is on the sides and between the fingers and toes; on arm pits and buttocks of the child, as well as at the waistline. the treatment is usually beyond home remedies. a physician should have charge of the case who will conduct a line of treatment which, if diligently followed, will rid the body of this scourge within a week or ten days. along with the itch are often found parasites of the head, or lice (pediculi). it is not at all infrequent to find them in the heads of uncared for children; but if a much-cared-for child is brought in contact with an infected head he will probably "catch" the infection. a most intense and disagreeable itching is set up at once. the treatment consists in getting the head clean by the use of a very fine comb, thus endeavoring to remove the adult parasites as well as the eggs or "nits." however, great care should be taken to avoid injuring the scalp. perhaps the simplest and most effective treatment known is the kerosene bath which should be applied at night, the hair being done up in a bandage until morning, when the kerosene is washed off with soap and water and then the hair given a vigorous vinegar shampoo in order to destroy the "nits." tincture of larkspur, or an ointment made from the seeds, may also be used. it is applied several days in succession and then washed out. chapter xxxiii deformities and chronic disorders reference has already been made to certain accidents of embryology during the very early days or weeks of the formative period of the embryo. common illustrations of such deforming developmental accidents are harelip, cleft palate, and club foot. harelip and cleft palate in the case of a partial or complete failure of the two sides of the face to come together in the median line, a deformity results which is known as harelip--a partial or complete cleft of the upper lip. it may be a single or a double cleft, exposing the teeth, or the cleft may even extend up into the nose. this deformity may seriously interfere with nursing, making it necessary to resort to feeding with a medicine dropper and later a spoon. the success of the operation for the relief of harelip, which should usually be performed during the early months of life, is often very remarkable. should this failure to unite be in the deeper structures of the head, then cleft palate is the result. this, too, may be partial or complete: partial as seen in a cleft of the soft palate only; and complete, when the hard palate also is involved. in such an instance it is the floor of the nose that is defective; hence the nose and mouth are one cavity. a specially devised apparatus which assists the child in nursing may be found on the market, for nursing is well-nigh impossible without the closure of the roof of the mouth. the operation for cleft palate is usually successful when performed at the proper time and by competent hands. in tongue-tie the weblike membrane underneath is attached too far forward, so that the child is quite unable to protrude his tongue, and this condition greatly interferes with sucking. the operation for the relief of this condition is slight, and should be performed as soon as the defect is discovered. deformed hands and feet occasionally there is a webbing of one or more fingers of the hand, and there are sometimes seen too many fingers or a double thumb. it is needless to allow such a deformity to continue; the operation for relief is often remarkably successful and should be performed very early. clubfoot results when short tendons or contracted tendons pull the toes inward or outward with raising of the heel. treatment must be instituted early; braces or splints are applied; and untiring efforts are put forth in massage and other lines to prevent a lifelong handicap of clubfoot. an inward rotating of the legs presents the deformity of pigeon-toe. the normal foot naturally inclines toward "pointing in," and such a condition should not be discouraged. many flat feet (broken arch) are due to shoe lasts which compel the toes to slant "out," and the bunions which so often follow such mistreatment may be exceedingly painful. by all means place shoes on the pigeon-toed child that possess straight lasts with flexible arches, and which admit of the exercise of many muscles of the foot which otherwise remain inactive. as the child grows older the toenails thicken, and often in their trimming they are cut so closely at the corners that sometimes a condition results known as ingrowing nails. such are very painful and must receive special attention. first of all, the nail is cut squarely, and after scraping it thin the corner is lifted and cotton so placed under it that the nail's downward and inward growth is stopped. spinal curvature curvature of the spine is more common than is usually thought. the most frequent variety of it is the lateral curvature. one shoulder is lower than the other, and the hips are therefore uneven. rickets, during infancy, is the most common cause of spinal curvature. improper sitting at school--sitting on the edge of the seat--or carrying heavy loads are often contributing factors to the production of lateral curvatures. only the muscles and ligaments enter into this deformity, hence the treatment should be started early and should consist of: . stretching exercises. . hanging from the rounds of a ladder securely fastened to the wall. . certain applications of hot fomentations to the spinal muscles for their relaxation. . firm cushion placed under one or other of the hips to encourage the re-establishment of muscular poise. . special supervision of the case. pott's disease pott's disease, or tuberculosis of the bone, often results in an angular spinal deformity. this curvature, unlike the lateral curvature, is a sequela of an actual disease of the bones. it is always very serious and demands early treatment from skilled hands. early in the disease there is a peculiar stiff, tottering gait. the little child holds the spine rigidly, and in picking up objects from the floor bends the knees instead of the spine. if the trouble is in the upper spine, the shoulders are held high and the head is stiffly poised, it is never rotated; in looking about the entire body turns. medical aid should be secured early. the x ray not only locates the difficulty but also determines the extent of the process. if the spine be put to perfect rest, outdoor life begun, a diet rich in fats established, the results are often wonderfully successful. another tubercular condition is seen in the much dreaded hip-joint disease which parents should always be on the lookout for. the earliest symptoms are crying out in the night suddenly, unnatural standing on one leg (to relieve the strain on the diseased hip) and so-called "growing pains." call in a physician very early and institute proper treatment. a posterior curvature of the spine is often associated with a bad case of rickets. it is of temporary duration, and usually clears up when the symptoms of rickets have been eradicated. it involves only the back muscles--not the vertebral bones. the young mother is often very much concerned over the misshapen head of the child as a result of a prolonged labor; and it does seem quite miraculous to see a head, more nearly resembling an egg than anything else, become beautifully round and shapely by the end of two or three days. protruding ears may be encouraged to lie more flatly by the wearing of a specialized bonnet at night. when the babies are too young to turn themselves they should be turned first to one side and then the other, while care should always be exercised in properly straightening out a curled under ear or an overlapping ear. rheumatism while we so often regard rheumatism an adult disease, nevertheless, children do suffer its aches and pains as well as the fever which so often attends the inflammatory type. the so-called "growing pains" are often of rheumatic origin. diseased tonsils not only are often--very often--the avenue of entry of infectious microorganisms that cause one type of rheumatism, but many forms of valvular heart disease are also directly traceable to these same diseased tonsils. the treatment consists in giving proper attention to the tonsils, even removal if necessary--and if the child is old enough. all other possible causes should be located and removed; the child should have absolute rest in bed with brisk cathartics and a liquid diet (no meat broths). the diet should consist more of alkalinizing foods as shown in the special table in the appendix. medicinal alkalines are often given when the urine shows a very high acid reaction. scurvy scurvy, seen in children who subsist on "prepared foods," is manifested by tender legs and swollen gums which have a tendency to bleed easily. pallor, loss of appetite, and insomnia accompany the condition. the treatment of scurvy is change of diet from "patent foods" to fresh cow's milk, with the addition of orange juice, daily. in older children the food must be very nutritious; out of door life, salt glows, friction baths (see appendix), and the taking of large amounts of fats are all essential to the cure. adenitis--enlarged glands enlarged glands, or what our grandmothers used to call "kernels" in the throat are often the result of inflammation in the mouth or throat, and occur in connection with many of the childhood diseases, notably diphtheria, scarlet fever, and scarlatina. glands appearing in the back of the neck may be occasioned by pediculli (lice), ring worm, or eczema, while those seen in the neck just back and below the ears may come from mastoiditis (inflammation of the middle ear) or adenoids. glands felt under the arm enlarge because of trouble or infection in the breast, hand, or arm; while glands in the groin are usually due to some infection of the feet, legs, or abdomen. these glands usually disappear when the general health and well-being of the child is improved by: . outdoor life. . morning dry-friction rub to the skin. . good liberal diet, including plenty of fats. . no feeding between meals. . the salt glow and general tonic treatment (see appendix). . the oil rub at night. rickets rickets (a disease of the bones) often follows in the wake of faulty feeding and unhygienic surroundings. the bones lack a proper amount of lime salts and other elements. development in general, especially that of the bones, is greatly interfered with. bowlegs, prominent square brow, enlarged perspiring head, weakness, and often tenderness of the flesh, are notable signs of the disease. the treatment varies little from that of scurvy, and will be provided in detail by the attending physician. malaria children often suffer from malarial parasites. sudden rise of fever on regular days (sometimes daily, every two days or every three days) should demand a careful medical examination including the examination of the blood where the offending organism is seen in the red blood cells. we recently saw a little girl who happened to have an earache and was about to be operated on for ear trouble, when examination of the blood revealed the fact that she was suffering from malaria. tuberculosis in the routine examination of adult patients, the x ray observations of the lungs often reveal deposits of lime salts which tell the story of a successful fight against tuberculosis (fig. ). and while it may seem surprising, we believe beyond a doubt that most of us have had some varying degree of tuberculosis while young--the unrecognized battle has been fought--and these small monuments of lime salts alone remain to tell the interesting story. the pity of it is that whole armies of little folks fall in this struggle against disease, for it is one of the common and fatal diseases of childhood. fresh-air schools, playgrounds, and free school lunches are saving hundreds of children from the ravages of this disease each year. tuberculosis is strictly a house disease, hence the little tubercular patient must seek outdoor life. all avoidable exposure to the disease must be denounced, and public sentiment must continue to be aroused to the hygienic betterment of the tenement districts and basement homes. the sanitary drinking cup and the bubble fountain must be encouraged, as must also the proper ventilation of all places where crowds assemble, be it the schoolroom, the theater, or the church. syphilis while tuberculosis is known as the "great white plague," syphilis and gonorrhea constitute the "great black plague," which seen in the little folks is pitiable indeed, leading us to realize that surely "the children's teeth have been set on edge" because of the careless eating of sour grapes by the parents. syphilitic parents who have not been properly treated, should think many times before they take upon themselves the awful responsibility of bringing into the world a tainted child. proper mercurial treatment should be instituted at once not only for the child but also in the case of both parents. [illustration: fig. . x ray showing tuberculosis of the lung] chapter xxxiv accidents and emergencies in this chapter we wish to instruct the mother or the caretaker in doing the one thing needful for every one of the more common household accidents and emergencies while waiting for the doctor. in every household there should be found an accident and emergency "kit" of necessary paraphernalia for the quick application of the one necessary medicine, dressing, etc. this "kit" should contain baking soda for burns, bandages and sterile gauze for cuts or tears, together with adhesive plaster, needle and thread, etc. insect bites and stings far greater harm is often done the skin by the subsequent scratching of the insect bite with dirty finger nails than by the bite itself; and so it is very important that we remember to allay quickly the intense itching by the application of ammonia water or camphor. almost instantly the itching is stopped, and the added "scratching" irritation to the already injured skin is thus avoided. by the aid of a magnifying glass, and often by the naked eye, we may detect the stinger which has been left behind by the greedy guest, and which should be removed by a pair of tweezers. ice-water compresses will stop the swelling and even an old-fashioned mud dressing, which was used and appreciated by our great grandmothers, is a thing not to be despised. if the much admired shrubbery be removed one hundred feet away from the porch, mosquitoes would trouble the household less. it has been demonstrated in many localities that clearing away the near-by clumps of shrubbery permits the family to sit on unscreened porches unharmed. mosquitoes multiply rapidly in stagnant pools of water, but if oil is poured over these stagnant waters the increase of mosquitoes is abated, and their total extinction is not unheard of in swampy districts receiving such care. whenever baby is out of doors where mosquitoes, flies, or other insects are to be found, he should be properly protected from such pests by mosquito netting stretched over a frame eighteen inches above his face, for we can think of nothing more uncomfortable than a mosquito netting dragging over a sweaty baby's face. the fact that mosquitoes, flies, roaches, and other insects are carriers of tuberculosis, infantile paralysis, typhoid fever, cholera, yellow fever and malaria, as well as a host of minor ailments, should make us the more anxious for either their extermination or the protection of our children from their greedy bites and stings. dog bites and snake bites dogs, cats, rats, or mice bite at any time of the year, and provision should always be made for ample protection against such accidents. such a wound should always be squeezed or sucked until it has bled freely, and then be cauterized by a red-hot iron or touched with an applicator that has been dipped in sulphuric acid or nitric acid. a subsequent dressing of balsam peru is healing. the dog should be watched, and if it shows signs of hydrophobia the bitten child should be promptly taken to the nearest pasteur institute for treatment. in the case of snake bites the same sucking and cauterizing treatment is indicated, with the additional tying of a handkerchief or cord a few inches above the wound to stay the progress of the blood and to keep the poison out of the general circulation. a solution of twenty-per-cent permanganate of potash should be used to wash the wound. the popular administration of large draughts of whiskey is of no benefit, for the secondary depressant effect of alcohol increases the body's poison burden, and those who survive do so in spite of the whiskey, and not because of it. swallowing foreign bodies small articles such as buttons, safety pins, thimbles, coins, etc., are often swallowed by little folks, and if they lodge in the throat and the child struggles for his breath the treatment is as follows: grasp him by the heels and turn him upside down while a helper briskly slaps him on the back. the foreign body generally flies across the room. if it is lodged high up in the throat it may often be dislodged by the thumb and finger. if it cannot be reached and it will not go down, lose no time in seeking an x-ray laboratory where its exact location may quickly be discovered and proper measures instituted for its removal. a troublesome fish bone is easily dislodged by swallowing a half-chewed piece of bread which carries it down to the stomach. cathartics and purgatives are not to be given; in due time the object will appear in the stool. in all instances it is well to locate its exact position by the x ray--that there may be assurance that it will do no harm. it is surprising what large objects can be swallowed. one old gentleman swallowed his false teeth, and a six months old baby swallowed, or at least had lodged in its throat, a silver dollar. all detachable parts should be removed from toys that are given to babies, such as the whistle from rubber animals, the button eyes of wool kittens and dogs, and other such removable parts. foreign bodies in the eye to begin with, do not get "panicky," but carefully, painstakingly, and patiently do the following: . rub the well eye until the tears flow plentifully in both eyes. . blow the nose on the injured eye side, closing the other side. this often encourages the tears to wash the foreign speck down through the tear duct, into the nose and out into the handkerchief (in case the child is old enough to follow such instruction). if the foreign body be sharp, as a piece of steel or flint is likely to be, it may be driven right into the eyeball. seek a physician who will drop medicine into the eye to deaden the pain and then if it cannot be gently rubbed off the eyeball, a magnet will promptly remove it. an eye bath of warm boracic acid is always comforting and never does harm, so that may be given while waiting for the doctor to come, if the object seems to be beyond the reach of family help. if an alkaline, such as lime, be blown into the eye it is very painful, but much relief may be obtained by gently pouring into the eye, by means of a medicine dropper or eye cup, warm water to which has been added a little vinegar or lemon juice. likewise, acid in the eye produces much pain. in this instance, an eye bath of a weak soda solution is indicated. foreign bodies in ear and nose insects that have crawled into the ear may be suffocated by dropping sweet oil or castor oil into the ear, which, after twenty minutes, should be washed out by gentle syringing with warm water from a fountain syringe, hung one foot above the child's head. peas, beans, shoe buttons, or beads are sometimes put into the ear and nose by adventurous or experimenting children. the shoe button or bead will not swell as does the pea or the bean, and may often be safely washed out. if it is causing no pain and will not drop out in case of the ear, or will not be easily blown out in case of the nose, see your physician at once. he has in his possession just the necessary instruments for its immediate removal. peas and beans swell, and consequently cause greater discomfort the longer they are in; do not poke at any foreign body lodged either in the nose or the ear, for the ear drum may thus be injured, while in the former case it may be pushed into one of the accessory sinuses. earache one of the most comforting and highly effectual forms of heat for an aching ear is a four-candle-power carbon electric light on an extension cord that permits the light to come in close contact with the ear. a shade is made from a piece of stiff letter paper that fits the socket snugly and flares out to a three inch opening, which should extend below the point of the bulb one inch. this shade holds all the heat and light and directs it into the aching ear. in every well-ordered household there will be found a three-per-cent solution of carbolic acid and glycerine of which one drop should be put into the aching ear, and then the external heat, mentioned above, should be applied. a bag of warm salt, a hot water bag, or a warm plate will provide external heat if an electric light is not available. do not put laudanum or other remedies into the ear, other than are herein suggested, without your physician's knowledge. earache is always serious, and since it is usually indicative of trouble which, if left untreated, may cause deafness, it demands thorough treatment from skilled hands. running ears invariably need medical attention and should never be neglected. nosebleed if the nose bleeds whenever it is cleansed, more than likely there is an ulcer on the septum which will continue to bleed if left untreated. the physician should heal the ulcer, and the child should be taught always to vaseline the nostril before cleansing it. in case of persistent nosebleed, put the child to bed with the head elevated. pressure should be put on the blood vessels going to the nose by placing two fingers firmly on the outer angles of the nose on the upper lip, while a helper may put firm pressure at the root of the nose at the inner angle of each eye. an ice bag may be placed at the back of the neck, and another piece of ice held on the forehead at the root of the nose. if these measures do not stop the flow of blood a few drops of adrenalin may be put into the nose and repeated in five minutes if necessary. as the bleeding begins to stop, as well as during the bleeding, all blowing of the nose is forbidden as it will only cause the bleeding to start afresh. it sometimes helps to hold a piece of ice in the hands. cuts and tears a cut with smooth edges, if deep, should be allowed to bleed freely, should be washed in boracic acid solution, and its edges held together by a stitch which is usually put in by a physician; but if treatment is to be given at home, the hands of the nurse must be thoroughly washed and the thread and needle boiled for twenty minutes. if the physician has been sent for, make firm pressure over the wound by bandaging tightly with a dressing of sterile gauze dipped in boracic acid solution. in case of a slight cut, make it bleed freely, then wash in boracic-acid solution and apply sterile gauze held in place by a binder. if no odor or pain follows, let alone for two or three days, when a new dressing is applied. a physician should be called in case of ragged wounds or tears, as such usually leave bad scars. cleanse carefully, leaving no dirt in the wound, cause it to bleed, if possible, and apply a sterile gauze compress wet in boracic-acid solution, bandaged on as directed above. zinc ointment may be applied to surfaces that have been skinned. all dressings on dirty wounds should be changed daily. blood poisoning may readily follow a wound, hence the utmost cleanliness should prevail. the hands of the attendant, the dressings, the surrounding skin, must all be clean. the bowels should be kept open, and under-feeding rather than over-feeding is indicated. if a needle be needed to open a sore or boil, always disinfect the part and surrounding area by painting with tincture of iodine, and heat the needle to red heat through a flame before it touches the sore. in case of cuts or wounds of the eyeball apply a compress of sterile gauze wet in boracic acid, held on by a bandage, and go immediately to a good eye specialist. punctured wounds and slivers wounds made by pins, needles, fishhooks, tacks, and splinters are always very painful and great care must be exercised to force bleeding freely, which helps to wash out infection, as more than likely microbes entered with the instrument or sliver when the wound was made. fishhooks are exceedingly troublesome, as they often occasion the enlarging of the wound to get them out, especially if they have gone in beyond the barb. slivers are easily broken off, so great care is needed in their removal. a pair of tweezers is convenient for seizing the protruding portion, while all side movements are avoided lest it break off in the flesh, in which case it may be gotten out with a needle that has been sterilized in a flame. all puncture wounds should be dressed with the wet, sterile compress, covered over with wax paper and bandaged loosely; this encourages cleanliness and favors healing. bruises if left untreated, bruises swell, become highly discolored, and in the process of healing pass through the dark blue, green, and yellow stages. the treatment is as follows: apply hot and cold alternately--the heat should be as hot as can be borne and left on very hot for three minutes, then ice water compresses should be applied for one minute, then hot again--these changes should continue for an hour, and if carried out immediately after the injury all discolorations and most of the swelling may be avoided. witch-hazel compresses are comforting. if discoloration has taken place, the application of hot compresses will often hasten its disappearance. fractures and dislocations while there is very little a member of the family or a non-medical friend can do in case of a fracture, and while it is unwise to offer suggestions relative to the setting of bones, yet it is highly important that both the family and friends know how properly to support a broken leg while carrying a disabled person into the house or to near-by medical aid. for instance, in the case of a fractured leg below the knee, if a couple of flat boards three inches wide be tied about the leg with two pocket handkerchiefs, the ends of the fractured bone will not rub against each other and the pain will be much less in carrying. in this way all danger of causing the broken bones to protrude and thus "compounding" the fracture is also avoided. and also, if there is no near-by ambulance, a good emergency stretcher may be improvised out of two or three buttoned vests with two poles, rakes, or brooms run through the armholes--one vest under the shoulders and one under the hips and still another under the fracture. an injured person may in this way be carried for miles quite comfortably. two people may fashion a seat out of their four hands on which the disabled child may sit with his arms about the necks of his two friends. if the fractured end of the bone penetrates the flesh it is then known as a compound fracture and the utmost cleanliness must prevail--as in dressing other wounds. an x ray laboratory should always be sought, where convenient, to ascertain if the ends of the bones are in good position. in dislocations, the bone has slipped out of place at the joint. medical aid should be called to replace the bone, while hot applications may be used in the meantime. sprains all sprains (a twist or straining of a joint) should promptly be put into a very hot bath and held there for thirty minutes. if this is impossible, then a rubber tube or a handkerchief is tied snugly between the sprain and the trunk of the body. almost instantly the pain, which is often intense and severe, is very much lessened. the hot-water bath is very hot, and the joint should be very red on taking it out. immediately following the bath the injured joint is wrapped in a very cold wet compress, which is next completely covered by silk, gutta-percha, mackintosh, or many thicknesses of newspaper--anything that will hold all the heat in--as the cold compress is quickly heated up. lastly, a bandage of heavy flannel completely covers the whole--compress, impervious covering, etc. the joint is now elevated for three hours, when it is again immersed in a very hot bath and then again the cold compress is applied. this is continued every three hours, except during sleep, for two days, after which it may be done morning and evening. massage is now administered every three hours, first four inches below the injury then four inches above it, while in a day or so the joint itself may be gently rubbed with well-oiled hands. by the end of one week the patient begins to use the injured member. in the case of a sprained ankle a properly applied adhesive strap bandage will give no end of relief and support. various liniments may be applied, but usually the good obtained is from the thorough rubbing which always accompanies their use according to directions. sprains treated as above directed will often liberate the child in one-third the usual time generally allotted for its healing. frost bites and chilblains keep the child who has frozen some part of his body in a cool room, and rub the frost-bitten part with snow or ice water, or wrap it up in cold water compresses. the return to heat must be slow indeed, else much pain may be experienced; blisters followed by discoloration, and even mortification, may set in. you may be surprised some morning on awakening to find your child's hand twice its normal size and very red, because it was out from under the cover a good share of the night exposed to jack frost. do not bring it to heat quickly but immerse it in cold water, gradually and slowly raising the temperature of the bath until it is warm and comfortable. the intense itching and burning of a chilblain may often be relieved by painting with iodine or triple chloride of iron (monsel's solution). soap liniment has also been suggested, as well as alternate applications of hot and cold water. chilblains are troublesome, painful, and their yearly recurrence is often very annoying. swallowing poisons poisons of an acid nature, such as hydrochloric, sulphuric, nitric, or oxalic acids, are neutralized by alkalines, such as magnesia, chalk, soda, and soap, followed by soothing drinks or sweet oil. remember that carbolic acid is not an acid, and is not antidoted with alkalines. the swallowing of carbolic acid should be quickly followed by diluted alcohol, and if this drug is not ready at hand many of the numerous alcoholic patent medicines will do just as well. epsom salts should be given in abundance. poisons of an alkaline nature, such as lye, washing soda, ammonia, etc., are antidoted with vinegar or lemon juice, followed by soothing drinks or sweet oil. a complete table of poisons and their antidotes will be found in the appendix. poison ivy, as soon as detected, should be treated as follows: thoroughly scrub the affected part with tincture of green soap and hot water, which often prevents the trouble developing. clean pieces of gauze may be wrung out of lime water and placed over the inflamed and much swollen surface, keeping them very wet. at night an ointment of zinc oxide may be applied over a painting of "black wash" (to be obtained at drug stores). poison (trifoliolate, or _three-leaved_) ivy resembles virginia creeper, and all nurses and caretakers should be able to recognize it. another treatment for poison ivy which is said to be very efficient is as follows: moisten a bit of cotton with a ten-percent solution of carbolic acid and apply to the affected area--then immediately (about one-half minute) wipe off this carbolic acid with another piece of cotton saturated with alcohol. matches, roach powders, fly poisons, washing fluids, lye, paris green, antiseptic tablets, and pieces of green paper, should all be kept out of the child's reach; and, in case of accidental swallowing of any of them, the physician should be sent for at once, and with the message "come!" should be given the name of the poison swallowed--if it is known. after the antidote is given, soothing drinks are usually administered, such as raw white of egg, milk, flaxseed tea, slippery elm, etc. complete rest in bed is always essential, and external heat is necessary for the body chills easily as the child grows weak. toothache may be temporarily relieved by applying an ice bag below the jaw, thus diminishing the flow of blood to the tooth, and a hot-water bottle to the cheek, which causes the skin vessels to fill with blood, thus relieving the tension in the vessels of the tooth. if there is a cavity, a small piece of cotton moistened with oil of cloves and packed well into it may give much relief. children and adults should make a bi-annual pilgrimage to the dentist, who seeks out beginning cavities, early treatment of which will prevent these dreadful aches and later ill health. burns burns and scalds are not at all uncommon with children, whose eagerness to explore and desire to investigate often leads them into trouble. . the simple reddening of the skin--slight burns and sunburn--simply needs protecting oil, or equal parts of oil and lime water, and is to be covered with sterile gauze. . the burns which destroy the outer layer of the skin, producing a blister, are treated much as a wound would be treated. the blister, if larger than a half dollar, should be opened near the edge with a needle which has been passed through a flame. the serum should be pressed out and the parts protected by a piece of gutta-percha that has been disinfected with some antiseptic solution; this covering keeps the dressings from sticking, thus avoiding the destruction of the new-forming tissues. . when the tissues are injured in the more severe burns, the surrounding flesh is carefully disinfected with boracic-acid solution, and the same dressing applied as described for the "blister burns." balsam peru is a healing balm for burns of this classification. if a child's clothes catch on fire he is instantly to be thrown on the floor and any heavy woolen fabric, such as a curtain, table spread, blanket, or rug, is to be thrown over him (beginning at the neck) and the flames thus smothered. the clothing is now cut off, and if more than one-third of the body is burned the child should be taken to the hospital for constant care; and if more than one-half of the body is injured recovery is doubtful. great care should be taken in keeping the unburned portion of the body warm, as there is a great tendency for the child to become very cold as he weakens from both the nervous shock and from the absorption of toxins. acid chemical burns are treated with baking soda, except in the case of carbolic acid (misnamed), which is treated with alcohol; alkaline chemical burns are dressed in vinegar or lemon juice compresses. methods for restoring the drowned should be understood by every man, woman, and youth. these methods are more fully taken up in works devoted to emergencies and will not be discussed in detail at this time. fainting consciousness is quickly restored to the fainting child by lowering the head--laying him flat on the floor--while an assistant raises the legs perpendicularly. cold dashes of water may be slapped on the chest with a towel, while the face is bathed or sprinkled with cold water. consciousness is usually quickly restored by the above suggestions, in connection with plenty of fresh air. a sudden blow on the head occasionally results in a severe condition known as concussion of the brain. there is a partial or complete loss of consciousness lasting from a few moments to an hour or two. pallor of the skin and a sense of bewilderment accompany concussion of the brain. rest, quiet, and darkness should prevail until the physician arrives and makes an examination. external heat to the extremities may be applied, but no stimulants are to be administered until so ordered by the physician. it is wise to seek medical advice in the case of odd or unusual behavior after a fall on the head. chapter xxxv diet and nutrition most interesting is the study of the food as it passes through the processes of digestion, absorption, assimilation, and oxidation--all definite and important parts of the great cycle through which everything we eat passes on its way from the table to the tissues. elimination is the last step in nutrition, and is the process by which the body rids itself of the broken down cells and other poisonous and useless wastes. these various phases of bodily nutrition may be expressed in a single term--metabolism. what we eat and how much we eat must be carefully planned, for our body temple is really made of what we eat. if you were erecting a beautiful mansion you would not think of allowing cheap, trashy, and inferior building materials to enter into the construction of your home. neither should you permit unfit and inferior materials to become a part of the daily dietary of your little boy or girl, thus to become a part of their bodily structure. assimilation of food following the process of digestion in the stomach and intestine, the nutritive food elements are absorbed through the wall of the bowel by the wonderfully adapted little villus, and distributed by various routes to the uttermost parts of the body. the sugars (all starches are changed into sugar) are carried in the portal blood stream to the liver, where they are actually stored away in the form of glycogen which, in a most intelligent manner, is dealt out to the body from hour to hour as it is needed for fuel. if all the sugar, after a hearty meal, were poured into the circulation at once, the blood stream would be overwhelmed and the kidneys would be forced to excrete it in the urine. this unnecessary waste is avoided by the liver's storing sugar after each meal and dealing it out to the body as required. likewise, the proteins also pass through the liver on their way to the body. just what action the liver exerts upon proteins is not wholly known at the present writing. the digested fats are absorbed at once by the lacteals, the beginning of the intestinal lymphatic system, by which they are carried to the large veins at the root of the neck and there emptied into the blood stream. we have now traced our various food elements through the processes of digestion and absorption in the alimentary tract, some going through the liver, and others through the lymphatic system, until they circulate in the blood stream itself. it is from these food substances, circulating in the blood stream, that the various cells of the body must assimilate into themselves such portions as they require for purposes of heat and energy and for the repair of their cell substance. this specialized work of cell assimilation converts the dissolved watery food in the blood into solid tissues, exactly reversing the process of digestion. with a most profound intelligence, each of these body cells and tissues, bone and nerve fiber, muscle and organ, selects from the blood stream just its supply or portion of the food elements requisite to its upbuilding and maintenance. the mysteries of assimilation are effected by means of chemical substances called "enzymes," similar to those found in the digestive organs, but acting in an entirely different manner, in that they build up solids out of liquids instead of converting solids into liquids. elimination of body wastes metabolism consists of a twofold rôle--an upbuilding and a tearing down process. after the food is all digested, absorbed, and assimilated, having become a part of the bodily organ, bone, muscle, and nerve fiber, then begins the work of tearing it down--of liberating its heat and energy--to be followed by its elimination from the body through the sweat glands, uriniferous tubules of the kidneys, etc. the carbohydrates (starches and sugars), together with the fats, are completely burned up in the body and are then eliminated in the form of water (thrown off through the sweat) and carbonic acid gas given up by the lungs. the proteins, or nitrogenous foods, are not so completely burned up in the body. the ashes which result from their combustion are not simple substances like the water and co_{ } of the carbohydrates. this protein ash is represented by a number of complicated substances, some of which are solid (protein clinkers), which accumulate in the body and help to bring about many diseases, such as gout, headache, fatigue, biliousness, etc. these protein ashes and clinkers are further acted upon--split up and sifted--by the liver, and are finally eliminated by the kidneys in the form of urea, uric acid, etc. the body being unable to store up protein, is often greatly embarrassed when one eats more of this substance than is daily required to replenish the waste of the body, for it must all be immediately split up in the system, and the over-abundant and irritating ashes must be carried off by the eliminating organs. now, the overeating of sugars, starches, or fats, is not such a serious matter, as they may be stored in the liver and subsequently used; and even if they are eaten in excess of what the liver can care for they accumulate as fat or add extra fuel to the fires of the body, their ashes being carried off in the form of such harmless substances as water and carbon dioxide (co_{ }); but the overeating of protein substances is always a strain on the body and should be avoided. elements of nutrition there are seven distinct elements entering into the composition of human foods--protein, starch, sugar, fat, salts, cellulose, and water, not to mention enzymes, vitamines, and other little-known chemical principles. these elements are all variously concerned in the nourishment, energizing, and warming of the body. proteins the proteins are the structure builders of the body. while starches, fats, and sugars may be compared to the coal that feeds the locomotive, the proteins represent the iron and steel that are used from time to time to repair the engine and replace its worn parts. the essential chemical difference between starch and protein is that the latter contains nitrogen and a small amount of sulphur and phosphorus. the most common forms in which protein is used for food are the glutens of the grains, the legumes, nuts, cheese, the white of egg, and lean meat. starches the starches are by far the most abundant of all elements in human food. they enter largely into the composition of nearly all plants and seeds. under the influence of the sunlight, the green-colored plants gather up the co_{ } of the air and, with the water absorbed from the ground, build up starch. the plant takes all the carbon from which starch is made from the air, but while the atmosphere contains almost eighty per cent of nitrogen, the plant is unable to use it; it must secure its nitrogen from the decaying refuse of the soil. thus the plant utilizes the waste products found in air and earth in the building of its food substances. starch exists in the form of small granules. since each little starch granule is surrounded by a woody envelope of cellulose, it becomes necessary to cook all starches thoroughly in order to burst this cellulose envelope and thus enable the saliva to begin, and other secretions to continue, the work of digestion. fruit sugars the sugar of fruits represents a form of food requiring practically no digestion; while the sugar found in beets, the cane plant, and the maple tree, must be acted upon by the digestive juices of the intestine before their absorption can take place. during the winter, the maple tree stores its carbohydrates in its roots in the form of starch. with the advent of spring mother nature begins the digestion of this starch--actually turns it into sugar--and in the form of the sweet sap it finds its way up into the tree trunk to be deposited in the leaves and bark in the form of cellulose, a process very similar to that performed by digestion in the human body, where starch by digestion is first turned into sugar, and afterwards deposited in another form in the liver and muscles. dextrine is a form of sugar resulting from thoroughly cooking or partially digesting starch. there are about twenty-five stages or forms of dextrine between raw starch and digested starch or fruit sugar. dextrine is found in the brown-colored portions of well-toasted bread. fats fat is a combination of glycerine and certain fatty acids. as a food, it is derived from both the animal and the vegetable kingdom. animal fat consists of lard, suet, fat meat, etc., while fat of animal origin is represented by cream, butter, and the yolks of eggs. the vegetable fats are found in nuts, especially the pecan, cocoanut, brazil, and pine nuts; also in the grains, particularly oats and corn. the peanut also contains a considerable amount of fat. of the fruits, the banana and strawberry contain a trace of fat, while the olive is the only fruit rich in fat. as a food, fat is used in three forms. the emulsified form is represented by cream, olive oil, and nuts. when the tiny globules of fat, which are each surrounded by a little film of casein, are crushed--united into a solid mass--we have a free fat. this form is represented by butter and other animal fats. another form is fried fat--fat which has been chemically changed by heat with the development of certain irritating acids. mineral salts the mineral elements comprise but a small part of human food as regards weight, but they are extremely important to the health of the child as well as the adult. as found in the food, they are not in the form of mineral salts, like common table salt. the salts of food are living salts, organic or organized salts, such as are found in the growing plant. these salts are of great value to the various fluids of the body, and also as stimulants to nerve action, but more particularly in the work of building up the bones. salts are found largely in the cereals. a small amount is also found in vegetables, particularly the potato, as well as in most fruits. cellulose cellulose represents the great bulk of all vegetables and fruits. it is digested by most animals, but in man it is digested only to the extent of about thirty per cent. the presence of a large amount of cellulose in the food enables us often to satisfy the appetite without injury from overeating. it serves to give bulk to the food, and thereby possibly acts as a preventive to constipation. water water fills an important place in the nutrition of the body. the food changes in connection with digestion, assimilation, and elimination, can take place only in the presence of water. water constitutes from fifteen to ninety-five per cent of the various foods. the watery juices of vegetables and fruits consist largely of pure, distilled water, in which fruit sugar is dissolved, with added flavoring substances. water is absolutely essential to the performance of every vital function connected with human metabolism. animal heat the source of heat in the animal body was the subject of much superstitious speculation on the part of ancient scientists. it is now known that animal heat is derived from the food we eat by means of a peculiar process of vital oxidation--effected in the presence of oxygen--by the action of water and enzymes upon the food elements absorbed by the living cell. this process of oxidation liberates the heat and energy stored by the sun in the food, and thus the body is kept warm by this constant combustion of the digested foodstuffs. the starches and sugars, together with the fats, represent food elements which serve as the body's fuel. by this means we are able to maintain a constant body temperature of almost one hundred degrees. the average human body produces enough heat every hour to raise two and one-half pounds of water from the freezing point to the boiling point. this is equivalent to boiling about seven gallons of ice-water every twenty-four hours. differently expressed, the body gives off each hour the same amount of heat as a foot and a half of two-inch steam coil. this is the same amount of heat which would be produced by burning about two-thirds of a pound of coal. fuel value of foods expressed in terms of english weight, the fuel value of the three different food elements would be: ounce of carbohydrates . calories ounce of proteins . " ounce of fat . " it will be observed that fat contains more than twice as much heat as the carbohydrates. this is due to the fact that fat contains more carbon than either starch or sugar. next to fats, starches and sugars are the most important fuel elements. protein is a very extravagant form of food for fuel purposes. proteins are the most expensive elements of human food; they are incompletely burned in the body, and inasmuch as they leave behind distressing and disease-producing ashes, it is clearly evident that only sufficient amount of proteins should be eaten each day to supply the demand of the body for repairs. we should depend more largely upon the carbohydrates and fats for heat and energy. a large part of our food is required to furnish heat to take the place of that lost by radiation from the skin, and this is why children require more food than adults--they have a larger skin surface in proportion to their weight, and therefore lose more heat by radiation, and it is for this reason that the food for the growing child must be wisely and carefully selected. diet for child two to three years old _breakfast_, - a. m.: fruit; cooked or toasted cereal served with thin cream; a soft boiled or coddled egg; bread (two or more days old) and butter; plenty of milk. _dinner_, - : soups; creamed vegetables--tomato, corn, peas, and celery; any two of potatoes--creamed, mashed, or baked--carrots, beets, spinach, peas, cornlet, squash, cauliflower, asparagus tips, string beans; protein dish--the puree of dried beans, peas, or lentils; macaroni or carefully selected meats; dessert--apples, baked or sauce--or other fruits, junket, custard, milk. _supper_, - p. m.: fruit, bread (bran bread if constipated); milk; porridge, with rich milk or milk toast; sweetened graham crackers. foods allowed children of four years and older _protein dishes_: purees of dried peas; lentils; beans; macaroni; eggs--soft boiled, poached, scrambled, or omelette; meats--steak, chops, chicken, turkey, broiled fish. _cereals_: all the toasted-flake foods; toasted and not too fresh bread, including both graham and bran; hominy; corn meal; oatmeal; farina; rice; barley; tapioca; sago, etc. _soups_: creamed vegetable soups of all kinds and broths. _vegetables_: potatoes; all the small green vegetables; lettuce; stewed celery; beets; squash; cauliflower, etc. _fruits_: all, if stewed or baked. raw fruits--pears, peaches, ripe apples, berries, oranges, persimmons, grape-pulp without seeds, etc. _desserts_: custard; jellos; junkets; home-made ice cream; sponge cake; baked fruits with whipped cream, etc. foods to be avoided by young children . _doughy breads_, griddle cakes, insides of muffins, hot biscuits, etc. . _fried meats_, such as sausage, oysters, pork, ham, veal, salt fish, corned beef, dried beef, etc. . _foods that are hot when they are cold_--such as catsup, horse radish, mustard, highly spiced pickles, sauces, etc. . _rich pastries_, puddings, unripe fruit, salted peanuts, and highly concocted dishes. . _certain salads_, containing coarse but easily swallowed foods, with highly seasoned sauces. . _tea, coffee, and all alcoholic beverages._ . _soft candies_, chocolate creams, bon-bons, patties, etc. average normal children crave sweets, and since their normal food is about seven per cent sugar it is not to be wondered at. there are many forms of pure, hard candies which may be taken by the three-year-old child. they are stick candy, fruit tablets, sunshine candies, and other varieties which may be sucked. all soft candies, such as chocolate creams, bon-bons, patties, etc., are to be avoided. hard candies, taken along with the desserts at meal time, in no wise injure the normal stomach of the healthy child. the other members of the family should set a correct example by sucking the hard candies rather than chewing them; for if the hard candies are allowed to dissolve slowly in the mouth they produce a weak solution of sugar, which does not interfere with digestion as do the strong and concentrated sugar solutions which result from chewing chocolate creams, bon-bons, etc. candy, cookies, sandwiches, or bits of cake should never be allowed between the meals. eating between meals children who do not eat well at the breakfast table, if given a "piece" at a. m., will not be ready for the o'clock meal; and then another "piece" at p. m. interferes with the normal appetite at p. m. digestion is disturbed, the nervous system irritated, and a "puny child" is often the result. bring the three-or-four-year-old to a well-selected breakfast some time between and a. m. then nothing--absolutely nothing--but water must pass the lips between that breakfast hour and the o'clock meal, which should be a good one. then the interval until or p. m. is passed in the same manner. at the evening meal the appetite is again whetted: and a good appetite always means good gastric juice to digest the meal. and so, good mother, guard carefully the interval between meals if you would have good digestion and good health for the little folks. daily food requirement the following table, taken from _the science of living_,[b] shows the minimum of calories or food units required by boys from five to fourteen years of age and girls from five to twelve: boys skin daily age height in weight in surface in calories or years inches pounds sq. ft. food units . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . girls skin daily age height in weight in surface in calories or years inches pounds sq. ft. food units . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [b] sadler, william s., _the science of living; or, the art of keeping well_. a. c. mcclurg & co. chapter xxxvi caretakers and governesses because of her versatile adaptability to the management of details, woman, all through the ages, has willingly and happily sacrificed herself upon the altar of service. it is not in the province of this chapter to go into the details of the tribal life of the early hordes and clans that came from the north and from the east to establish civilization in the cities of rome and britain--space forbids. in this chapter we wish to hold up a picture to the mother, a picture which may speak volumes to her soul; one which perhaps she may ruthlessly throw away--nevertheless, we propose to exhibit it. homemaking vs. housekeeping a newspaper woman in my office recently told me a story of a mother who finished her high-school education, took some work in a university, and who yielded to the earnest pleas of her lover-classmate through grammar school, high school and college--and married him. to this happy family there came a number of beautiful children. the mother willingly, lovingly, cared for them during their helpless infancy--made their clothes, managed their meals, opened the door for them as they came home from school, met them with a cheery story, listened to their problems, helped them with their lessons--but all through it, first, last and all the time, she also managed the entire home. she dusted the furniture, changed the curtains, looked after the linen, mended the clothes, and even pressed the trousers of her "rapidly rising" husband that he might go out into his "club life" and enjoy the evenings with his associates. the duties of the day so wearied her, and the night vigils with the sick child,--looking after the little coughs, the uncovered shoulders, getting the drinks of water and performing a dozen other details--that she was too weary to accompany her husband to the dance, to the theater, to the social gathering or to ladies' night at the club; and so, in the course of a dozen years, the mother had grown old, and quite naturally she had grown "home centered." her world's horizon was the walls of her home. she was happy and quite contented in her children's smiles, in the cheery "how do you do" of her husband, in the fact that that gravy was good or that steak was fried to the king's taste. she was happy and contented until one day when the awakening blow came. in the attic she and her thirteen-year-old son, who was just entering high school, were looking through an old chest when she drew forth some examination reports and some old school cards--holding them up side by side. one set of the cards bore the father's name and the other set the mother's maiden name. in great surprise the boy exclaimed, "why, mother, i never knew you studied algebra and latin; why, mother, i never knew you were educated." her eyes were immediately opened, the scales fell off, she was awakened to the fact that her own son was coming to regard his mother as somewhat inferior, in intellectual attainments, to the father--that she was considered in that home as a mere domestic. true, the steak had been broiled well, the pudding was exquisite, the children's clothes were always in order, the husband's trousers were always beautifully pressed, his ties were cleaned as well as a cleaner could clean them; but where did she stand in her boy's mind and where was she in her husband's mind? "do you notice how trim and nice mrs. smith always looks? her clothes are always in the latest style, and she combs her hair so becomingly." such remarks as this from the well-meaning husband cut keenly, and it is well that they do, for often it is only such remarks that wake up our "home mother." dear reader, i want you to ponder this story. i wish to say to the mother who has started out upon a career in life, who has prepared herself for teaching school, for a business career, for story writing, for millinery, for lecturing, or has perhaps graduated in a domestic science course, that she makes the mistake of her life in settling down, just because she has taken another's name, to be perfectly satisfied with becoming the household domestic, the household mender, the household cook. mothers in the professions i have in my acquaintance scores of mothers in the professions, newspaper women, women who have carved out brilliant careers for themselves, women who have taught school for twenty years while their children have been growing up, women physicians who have risen in the esteem of all their professional brothers and sisters, women who have conducted cooking schools, who have occupied positions of trust in hospitals and in every walk of life, and who have successfully reared children at the same time. you will pardon me for being personal when i say that since our own little fellow was six weeks old his clothes have been washed and mended and his food has been prepared by earnest and honest women who had not fitted themselves for the career which this boy's mother had chosen. his mother went to her office, cared for her patients, kept up by the side of her husband in the battle of life. all the time there was a woman at home just devoted to that little fellow. a newspaper woman recently told me her story--a story which should impress everyone of my readers as it did myself, and she, like many other mothers in the professions, leaves her home as the little fellow goes to school. his hands have been washed, his bowels have moved, his hair has been combed, his breakfast has been eaten by the side of his mother--she has directed it all. he goes forth to the schoolroom and she goes forth to her profession. all through the day she lovingly keeps in mind these children that are growing up. she works the harder, real love entering into everything she does, because she is not merely earning the bread that goes into their mouths, but is forming a character not only for herself but, because of her broadened horizon, is instilling into their little minds the possibilities of their own career, their own opportunity to enter into the world's work as real world workers. i contend that the mother in a profession has many blessings that the mother who remains at home never has. the mother who remains at home has a viewpoint that is often quite likely, wholly unconsciously, of course, to become small, to become narrow, to become focused upon small details; on the other hand, the mother whose mind and whose heart are so full of the affairs of the office, of the newspaper article she has just written, or the lecture she has just given or is about to give, or the meeting that she is to preside over, is quite likely to become somewhat irritated sometimes if the little fellow doesn't stand quietly to have his hair combed, she is quite likely to "feel rushed;" but under all circumstances, dear reader, whether this mother be a home mother or in a profession, never, never must she allow mental panic to seize her. ever must we keep in mind that these little ones are just children--children that are still in the developmental stage. work outside the home and now for the home mother. i believe it is necessary and of paramount importance that she get away from her children (if possible) several hours each day; that she provide for them a caretaker who can relieve the children of her or relieve her of the children, whichever way you may look at it, for we are inclined to think that the children often tire of the mother just about as often as the mother tires of the children. i would have the woman who remains at home, whose husband is able to provide outside help for the heavy work of the house, enter into some uplifting neighborhood work, social settlement work, church work, wholesome club work--anything but bridge and whist and gambling games. i would have them bring into the nursery a woman who is cheery, who is capable of teaching games, of entertaining and amusing these little folks under their own roof. the woman who has graduated from high school, who has a diploma to teach, i would have take a school or, at least, do substitute work. she will be happier--far happier--continuing along the lines for which she has prepared herself, even if all the money she earns be used to pay the help. some women are especially fitted for the important work of mother and homemaker, and such wives will find for themselves a worthy career in the home and its neighborhood activities. each woman must find a field of action suited to her own temperament, education, experience, talents, and opportunities. selecting a caretaker for a caretaker, the professional or business woman should not select an ignorant servant girl; that would be a great mistake--a crime--a violation of the law that should govern the training of these little people who have come to us to be reared and cared for and fitted to occupy their place among the world's workers. as a rule, one soul does not possess the qualifications for scrubbing and laundry work and also the firm but gentle ministering qualifications necessary for a successful caretaker. they do not combine as a rule. it has been my experience, as a mother with a profession, and that of many others of my acquaintances, that an art student or a music student makes a splendid caretaker. there are hundreds and hundreds of genteel women, with winning manners and beautiful dispositions, who may be obtained to sew on the buttons, wash the faces, and change the clothes of our darlings while we are carrying forward in the world the great work for which we have fitted ourselves during the long struggles of our teens and early twenties. the young woman who is brought in to care for the child should be above the usual "servant" class. she must eat in our dining-room, she should be welcome in the living-room or sun parlor, and be treated as a respected member of the family. her salary is usually not large for she realizes that she is given something in that home--something that money cannot buy. the up-to-date mother now this young woman (the caretaker) wants to hold her position, and so she is very anxious to carry out in detail the laws and rules that are laid down by the mother. mother can keep abreast with the world, mother has time to read periodicals that keep her in touch with the great, wide, pulsating affairs of life. she is able to meet more women worth while, and with her husband attend lectures, musicals, theaters, and other places for intellectual culture. anyone of my readers need not look four blocks from her home to find a mother who is run down at the heel, whose dresses are calico, whose hat is five or six years old, whose black silk dress (the only one she ever had) is worn shiny or threadbare, who works and saves every penny that she can that her children may look well; and, even when the husband does invite her to go out with him, he will often be confronted with this remark: "john, i would like to go, but really my clothes are a little bit shabby." the world is just full of such women, with their very hearts being eaten out of them for the want of a beautiful gown, a beautiful hat or a pretty pair of evening shoes, and they might have them every one if they would be willing to allow the duties of the household to be presided over by a woman that cannot do the things the mother can do, while she goes out and accrues a number of dollars each week which will more than provide for the things that her soul desires so that she may go well dressed by the side of her husband in quest of that very necessary intellectual culture and social diversion. the wife of a prominent judge, in my office just this week, said to me that she believed that most of our social and domestic uneasiness was due to the fact that fathers and mothers and children went out together so seldom. the father goes to his club, the children go to their little gatherings, and mother usually stays at home; although of late, she is beginning to realize the value of the women's clubs. qualifications of the governess the caretaker should not be too old. it is a very great blessing if there is an older sister in the family who can come in and assist with this work, or if there is an aunt. if one is to be selected from the open market, then we suggest a woman in her late teens or early twenties whose heart is full of play, whose face is sunny, and who is young enough to appreciate and like the becomingness of youthful dress. it is needless to say she should be free from tuberculosis and other diseases. she should be trustworthy enough not to administer soothing syrups because the children won't sleep, or to give candy when mother has forbidden her, or to teach the children bad habits of any sort. it is impossible to exercise too much care in the selection of this substitute mother, and when you do find one it is often wise not to keep her too long. a year or so is plenty long enough for any person to be with our children. it is only necessary for anyone to walk out into the public parks and casually listen to the conversations of many of the "chewing-gum caretakers" to discover with what carelessness some people select caretakers for their children. the language they use is not only ungrammatical but oftentimes both slangy and profane. the flirtations carried on with many of the park policemen and bystanders lead us to feel that many people arrive at the idea that their little folks "will grow up some way." if the caretaker is a student, a young woman of culture, and is kept with the family, she will be found to be more circumspect and dependable. her gentleman friend, if she has one, should be allowed to come to the home. she does not have to meet him out in the park any more than a sister would have to go away from home to meet a friend; and, to my mind, everything centers around the viewpoint of the mother as she selects this caretaker, for if she is her social equal it puts her in a different place entirely to the well-meaning but ignorant servant girl to whose care is often intrusted the lives of the little people. hints for the caretaker there are a number of hints we wish to bring together in this chapter for the mother to suggest to the caretaker. for instance, here is a group that one author gives us: baby is happy because he is dry. he is healthy. his food is right. he has sleep enough. his meals are on time. he is dressed properly. he is bathed regularly. his habits are regular. his bowels move regularly. he has fresh air day and night. he is not dosed with patent medicines. he is not excited by frequent handling. he is not annoyed by flies or other insects. things bad for babies candy. pacifiers. thumb-sucking. soothing syrups. patent medicines. waterproof diapers. moving picture shows. sucking on empty bottles. being kissed on the mouth. play of any sort after feeding. sleeping in bed with the mother. whiskey or gin for supposed colic. sneezing or coughing in the face. irregular or too frequent feedings. sleeping on the mother's breast while nursing. spitting on handkerchief to remove dirt from baby's face. allowing a person with a cough or a cold to hold the baby. violent rocking, bouncing, and rollicking play at any time. dirty playthings, dirty nipples, dirty bottles, dirty floors. allowing any person with tuberculosis to take care of the baby. testing the temperature of the baby's milk by taking the nipple in the mouth. things to remember keep baby out of dust. don't cover his face. don't rock him to sleep. keep baby away from crowds and sick people. don't neglect a sore throat or a running ear. his health, growth, and happiness depend largely upon _you_. cats and dogs have no place about a baby. they carry disease. the baby is not a toy or a plaything, but a great responsibility. don't wipe out baby's mouth. it tends to cause ulcers and thrush. overcoming bad habits there are a few bad habits which older children fall into such as lip-sucking or thumb-sucking or finger-sucking which not only narrow and deform the upper jaw, but likewise deform the hand itself. they should be stopped at the earliest opportunity by pinning the sleeve to the bedding or putting mittens on the hand or putting a slight splint on the anterior bend of the elbow. some children suck their handkerchiefs, or bite holes in their aprons and neckties. children often bite their finger nails, and a habit of this kind fully developed during early childhood often remains with them throughout life; whenever a nervous spell seizes them they instantly begin to bite their finger nails. other people pick their nose when nervous, so during very early childhood these habits should be discouraged. one mother helped her little son by beautifully manicuring his nails for him each week. another child was cured by old-fashioned spanking. the finger tips may be painted with tincture of aloes, or dipping the tips of the fingers in strong quinine water will sometimes help. i know of nothing better for the adolescent child than to teach him how properly to manicure his own nails. another bad habit that children often get into is stooping or allowing the shoulders to become rounded. shoulder braces are not indicated in these cases. the children should be allowed to enter the gymnasium or the father should take off his coat and vest and go through gymnasium stunts with the boy. the mother can do the same for the girl. it is often the case that round-shouldered children are near sighted. the child really has to stoop to see things. when a child holds his head to one side constantly on looking at objects, astigmatism, an error of eyesight, is usually indicated. an eye specialist should be consulted, the eyes examined, and properly fitted eye glasses should be worn. just as early as possible in the life of the little child he should be taught to blow his nose, to spit out the coughed up mucus from his lungs, to hold out his tongue for inspection and to allow his throat to be examined. he should be taught to gargle, and to regard the physician as one of his best friends. attention to these minor accomplishments will make it very easy indeed for the physician in case of illness. chapter xxxvii the power of positive suggestions a child is the most imitative creature in the world. before he is out of pinafores he tries to talk and act just like his elders. it is because of this inherent tendency to say and do those very things which he hears others say and do, that, if faith-thoughts are early and constantly suggested to the unfolding mind of the child they will assist greatly in evolving a character of joy, confidence, and courage. on the other hand, if fear-thoughts are continuously sown in the young mind they will eventually distort the emotions, deform the conceptions, and wholly demoralize the health and life activities of the growing child. within the limitations of the possibilities of hereditary endowment, and in view of this wonderful imitative nature, we are able to make of a child almost anything we desire; not "an angel," in the ordinary acceptation of the term, but a child who knows his place and possesses the power of normal self-control. early fears from two to six years of age, when the imagination is most plastic and vivid, when the child's imitative instinct is so unconsciously automatic, is the most effective and opportune time to initiate good habits and lay the foundations for the later development of a strong and noble character. "baby's skies are mamma's eyes" is just as true as it is poetical. while a tired and worn-out mother, exhausted by a multitude of harrassing household cares, may be pardoned for her occasional irritability, nevertheless the little one unconsciously partakes of her spirit. when the mother is happy the child is happy. when mother is sick and nervous the child is impatient and irritable. it is unfortunate that this very time of a child's life, when we can do practically anything we choose with him, is the very time when so many parents fill the child's mind with the unhealthful fear-thoughts. "the bogie man'll get you if you don't mind mamma," or, "i'll get the black man to cut your ears off," or, "the chimney sweep is around the corner to take bad little boys," are familiar threats which are so frequently made to the little folks. these efforts to terrorize the young child into obedience never fail to distort the mind, warp the affections, and, more or less permanently, derange the entire nervous system. the arousal of fear-thoughts and fearful emotions in the mind of the growing child is very often such a psychologic and a physiologic shock to the child that the results are sometimes not wholly eradicated in an entire lifetime. just see how far we carry this unwholesome introduction of fear-thoughts--even to the almighty. thousands of us remember being told as a child that "god don't like naughty boys," or, "god will send the bad man to get you if you don't be good." thus, early in life, an unwholesome fear of the supreme being is sown in the mind of the child, and, as time passes, these false fears grow and come so to possess the mind and control the emotions that in adult life this early teaching comes to mold the character and shape the religious beliefs of the individual. to the child who has been reared to dread god, who has come to look upon the creator as an ever present "threat," how is it possible to convey the beautiful teaching of his fatherhood? fear of noises how frequently some unusual noise leads a parent to say: "keep still! what was that? did you hear that noise?" the little folks of the family are startled, their eyes grow large and their faces pale, while they cling to the frightened mother. of course, investigation usually shows that the strange and alarming noise was merely the slamming of a cellar door, the rattling of a curtain in the wind, some one walking about downstairs, or the action of the new furnace regulator in the basement. but meantime the harm is done to the children--fear, the worst enemy of childhood, has been unconsciously planted in the mind by the thoughtless and nervous parent. fear of darkness consider for a moment the thousands of children who are early taught an abnormal fear of the dark. even when the child is absolutely free from such a fear, when sent into a dark room some member of the family will thoughtlessly remark, "do you think it is quite right to send that child into that dark room? suppose something should happen." the child quickly catches the suggestion that something is supposed to be or happen in the dark, and in his mind is sown the seed of fear. when our boy was about two years old he was carried one night to the window by a caretaker, and as they looked out into the darkness the young woman said, "boo! dark!" the little fellow shuddered, drew back and repeated, "boo! dark! boo! dark!" that night, as was our custom after the evening story, we tucked him in his little bed, turned out the light, and saying, "sweet dreams, darling," closed the door. imagine our surprise to hear, "mamma, mamma, willie 'fraid of dark, willie 'fraid of dark," and it was with difficulty that he was induced to go to sleep in the dark. immediate inquiry revealed the occasion of his fears, and the next night we set about to eradicate the fear of darkness from the little fellow's mind. for ten successive nights we took his hand, and, leading him into a dark room, said, "nice dark, restful dark; we go to sleep in the dark; we're not afraid of the dark, no." each night, save one, we were met with, "no, no, naughty dark. willie 'fraid of dark." on the tenth night as we entered the room as usual, repeating, "nice dark, restful dark; we go to sleep in the dark; we're not afraid of the dark, no," his little mind responded. suggestion had at last routed fear and given birth to faith. we had won! but it had taken ten nights of constant work to undo one moment's work of a thoughtless girl. every night since he has gone to sleep in the dark without a murmur. the folly of making threats threats only show weakness on the part of the disciplinarian. most school teachers early learn the folly of making threats. when i was teaching school i recall that a number of slate pencils had been dropped on the floor one afternoon. thoughtlessly i threatened, "now the next child that drops a pencil will remain after school and receive punishment!" my fate! the weakest, most delicate girl in the room was the next to drop her pencil, and she was a pupil with a perfect record in deportment. the reader can imagine my embarrassment. i had threatened punishment, and so had to get out of the predicament as best i could. this experience effectually cured me of making such foolish threats. most of us live to regret the threats we make. "your father will thrash you when he comes home tonight," or, "you'd better not let your father see you doing that," or, "you wouldn't behave that way if your father was here," etc., are common threats which we hear directed at headstrong and willful boys. what is the result? do such threats cause the love of the child for his father to increase? they make the child actually afraid of his father. "i'll 'bust' your brains out," said a four-year-old to his pet lion, because it wouldn't stand up. now it should be remembered that these things do not originate in the minds of the boy and girl. they only repeat the things they hear others say. it betrays both cowardice and ignorance to undertake to secure obedience by such threats as "i will box your ears if you don't mind," etc. obedience that is worth anything at all is only secured by suggestion and love, never by promises of reward or threats of punishment. children who are called "cowards" recently we overheard a little fellow say, "father says i'm the only coward in the whole family." looking him straight in the face we said to him: "you're not a coward. such a fine boy as you couldn't possibly be a coward." the boy was greatly amazed, and, as we left him, he was saying over to himself, "i'm not a coward. she said i'm not a coward," finally adding, "she said i couldn't be a coward." this one thought, repeated to him several times and turned over and over in his mind, eventually overthrew the false fears instilled by his father. a short time ago the daily papers contained the story of the ten-year-old son of a new york business man who drew his few dollars from the savings bank, boarded a train for chicago, and, after three days of amusement and loneliness, his money all gone, was found in a hotel bitterly weeping. his identity was revealed, the parents were notified at once, and the boy was sent on the first train back to his home. on the way to the station he sobbed out through his tears, "well, my brother can't call me a coward any more, anyway." who knows but that this everlasting taunting of the child with the accusation of being a baby or being a coward has much to do with many such escapades and other daring exploits on the part of the juveniles who are chafed by such unjust insinuations? those of us who are acquainted with the vice and crime of a great city can imagine just what might have happened if this boy had been a little older, if his heredity had not been so good, if his money hadn't run out, if he had been able to remain in the big city long enough to make undesirable acquaintances. many criminals have confessed behind prison bars that when they were children they were called cowards. after a while they actually came to believe that they were cowards, and in their efforts to acquire courage and demonstrate their bravery they were led to desperate and even criminal acts. they prowled around the dark alleys just to convince themselves that they were not afraid, that they were not cowards, and there they made the acquaintance of the criminals who led them into new and dangerous paths. even if a child enters this world handicapped by heredity, let us not lessen his chances of success by adverse suggestion. faith-thoughts, thoughts of bravery and of courage, may just as easily be instilled into the mind of the normal child as thoughts of fear and cowardice. a child should never have suggested to him that he is afraid. he should be constantly assured that he is brave, loyal, and fearless. the daily repetition of these suggestions will contribute much to the actual acquirement of the very traits of character that are thus suggested. this does not mean that a child should not be taught caution and forethought. the girl who would "turn out bad" parents do not begin to realize how fearfully dangerous is this habit of constantly reiterated negative suggestion. let me illustrate by an actual incident: a beautiful girl in a near-by state grew up quietly in the little village until she was eighteen years of age, when suddenly she decided to run away from home, declaring she was old enough to do as she pleased. she confided in one of her girl friends that she was going to chicago, and had made all arrangements to lose herself in the "redlight" district. all that this girl friend said had not the slightest influence. as the train bore her away to the city and to ruin, a social worker in chicago was wired to meet her at a suburban station. the girl was met, taken from the train and whisked in a cab to the home of a christian woman. so possessed was this girl with the idea of throwing herself away that the captain of police was asked to talk to her; but the combined efforts of the police captain, a magistrate, and several christian people could not persuade her to recall her threat. she declared she would kill herself if her parents were notified. this siege lasted for ten days. then she finally broke down, saying: "i simply can't help it. all my life my mother has told me that i was going to turn out bad. no matter what would happen at home, if i broke a dish or went out with the young people and remained away ten minutes later than i was told to, it would always be thrown up to me. 'oh, some day you'll turn out bad.' i have heard it until i am sick of it, and something within seems to push me on and on, telling me i must turn out bad." of course the girl was persuaded to believe that these were only fear-thoughts; that she was a beautiful, virtuous girl, that she simply had received the wrong training, that she couldn't possibly turn out bad. she was thus saved by the sympathy and advice of understanding friends, was subsequently married and is today the mother of a splendid boy. what healthy faith-thought will do here is another story which illustrates what healthy faith-thought will do. a young man was not long ago selected for the highest position within the gift of a large religious organization. when he was a lad his parents held this thought constantly before his mind: "david, if you will be a good boy, if you will do what is right, you may some day be president of the general assembly." he became a minister of the gospel, a very successful one, and subsequently married a young woman who was also much interested in religious work. she continued to encourage him in this ambition, saying: "david, preach the best sermons you can; make an effort to bring many souls to christ, and some day i believe you will be president of the general assembly." the man presided over the general assembly of his denomination, not one term, but term after term. he kept his eye long fixed on that particular aim, and by faith he won it. the power of suggestion to see how powerful suggestion may be in a child's life take this incident that every parent knows: the little one trips and tumbles. mamma says, "oh, did you fall? well, never mind; come here, i'll kiss it. there, now it's well." immediately the child goes back to his play perfectly happy. one little fellow was taught that when he fell he should get up at once, rub the bump, and say, "that didn't hurt." all through his career the bumps and the hardships of life were met with the same pluck. on the other hand, a thoughtless caretaker will excitedly jump and catch up the slightly injured child, coddle it, rock it, pet it--and the crying continues indefinitely. this early training in meeting minor hurts and obstacles lasts throughout the lifetime. pluck and grit are lacking. the behavior of the man in the face of difficulties is foreshadowed by the attitude of the child toward his petty trials and bumps. successful child training follows in the path of positive suggestion. impatient words and careless threats of punishment can only contribute to the wrong training of the young mind. when is the best time to suggest to the child? catch the little fellow when he is happiest, when he is overjoyed and filled with glee; for it is at such times that the suggestions offered will meet with the least resistance. teach the children through the spirit of play and through the medium of the story. the boy or girl in the story always can have a clean face, always close the doors quietly, and otherwise so conduct himself or herself as to constitute a powerful positive suggestion for good. the story-child always says, "all right, papa," "all right, mamma," when corrected. bedtime a good time to suggest the "going-to-bed time" is the time _par excellence_ for suggestion in early childhood. after the play time, the study time, and the evening story, when all is quiet, in the peacefulness of the darkness, while you are seated in a low chair close beside the little bed, with your hand in his, repeat over and over again the positive suggestions which you desire to take root in the mind and bear fruit in the character. again and again tell the little fellow that he is the noblest and bravest of boys, that he loves truth and hates deceit. no matter what disturbs him, if it is the lessons at school or a wrong habit, first think out exactly what you desire him to be or to do, and firmly, but quietly, tell it over and over to him. as a concrete example: suppose henry, at three-and-a-half years of age has to be coaxed or almost forced to eat. say to him: "now, henry, you are a good little boy. papa and mamma love you dearly. if you are going to grow up to be a big man you must not forget to eat; so tomorrow when you go down to the table you will eat everything mamma or nurse puts before you. it won't be necessary for papa to feed you at all; you will eat the potatoes, the gravy, the toast, and the cereal, and drink your milk. you will make mamma very happy, and papa will be proud of you; and then after dinner we will have a good romp, and you will soon grow up to be big enough to have a velocipede and a watch." after two or three evenings of this suggestion you will be surprised to see there is a great difference in his eating. take the timid little girl who is unable to recite well at school, who is shy, and has great difficulty with her lessons. at the going-to-sleep time sit by the side of her bed and tell her that tomorrow she will have her lessons better, that she will not any more be afraid, that she will get up and recite without the least fear in her heart. by constantly repeating these suggestions she will be given confidence, and in most cases it will result in effecting the deliverance of the child from her bondage to fear. never tell her that she is shy or that she cannot do things. constantly tell her that she is a successful girl with a strong character, and that she is going to make a very useful and courageous woman. hold high aims and ideals before her. suggestion cannot atone for all the defects of character which may be inherited, but it can do much to help such unfortunate little ones gracefully bear their burdens. never accuse children of dishonesty never tell children that you suspect they are dishonest or untruthful. be very slow to accuse and suspect them of falsehood or theft. tell them over and over again they are the best boys and girls in the world; that they are going to make the noblest of men and women; that they love honesty and truth. even when you discover them in minor faults do not make the mistake of unduly magnifying and emphasizing the error. as soon as possible direct the thoughts and attention of the wrongdoer away from his error, and focus his thoughts and attention on the high goal you expect him to reach. this will not be construed as doing away with proper punishment for persistent faults after the more ideal methods seem to have failed. a patient recently called us to see her little girl, and as we made ready to make the examination the mother said: "now, mary, stop your playing and come and be undressed and let the doctor look at you." "i don't want to stop playing," murmured mary. "but you must come. you know you don't feel well at all, your cheeks are so red. now swallow and see if it don't hurt. now try again. i know you don't feel well." by the time we had begun our examination mary began to succumb to her mother's suggestions, and began to feel a trifle indisposed. she was being made temporarily ill by the unwise and unfortunate suggestions of the overanxious mother. the examination revealed that there was nothing whatever the matter with her. it is easy to form good habits let us get the truth firmly into our minds as parents that it is just about as easy to form a good habit as a bad habit, just about as easy to acquire helpful, happy thoughts as those that are injurious; and we can do it, if we will but see to it that our children early form correct and proper habits of thinking and acting. while the children are taught proper respect for authority, let fear be an unknown word to them. don't let a thought of the fear of insanity, of haunted houses, of drafts, of this and of that enter into your home. instead, live in the glorious sunshine of strong, healthy, faith-thought, and a supreme happiness will come into your life, and you will give a legacy to your children for which they will "rise up and call you blessed." chivalrous spirit the love of mother and sister can naturally and happily be turned early to a chivalrous attitude toward all women when it is developed by suggestion and other training. in giving up a chair or bringing one for a guest, in lifting the hat, in noticing ways to be polite and attentive to mother, a lifelong conduct may be ensured. each day gives us trying and sometimes shocking revelations of the prevalent lack of courtesy, or even humanity, on the street cars during the "rush" hours. the indifference to the comfort of women, even the aged, on the part of many men and boys in the matter of giving them seats or other care, indicates a dangerous social condition. the mother, instead of exercising selfish concern for her boy, should make it her duty very early to suggest that he give his seat to a woman or girl, as he would be glad to have someone do for his mother or sister. such unselfish service will become a habit of pleasure, and help the boy become a pure-minded, manly gentleman with that respect for womanhood without which a nation is doomed. chapter xxxviii play and recreation there are a number of theories advocated by late authors on the "psychology of play," in which they connect the free and easy play of the modern child with the more serious and sober pursuits of our ancestors--our racial parents of prehistoric and primitive times. we quote from _worry and nervousness_: and so we are told that the spectacle of the young infant suspending its weight while holding on to some object, and the early instincts so commonly shown to climb ladders, trees, or anything else available, are but racial mementos of our ancestral forest life. the hide and seek games, the desires to convert a blanket into a tent, the instinct for "shanties"--which all boys universally manifest--we are told that these forms of play are but the echo of remote ages when our ancestors sojourned in caves, lived in tents, or dwelt in the mountain fastness. in this same way the advocates of this theory seek to explain the strange and early drawings which the young lad has for wading, swimming, fishing, boating, and other forms of aquatic recreation.[c] in this chapter we purpose to discuss the play of the child, whose career we will divide, for convenience, into three stages: . the age from three to six--juvenile days. . the age from six to twelve--the "going to school" child. . the age from twelve to twenty--the adolescent youth. [c] william s. sadler, _worry and nervousness_, p. . juvenile play days as nearly as is possible the little child should be out of doors the greater part of his waking hours: to our mind it is nothing short of criminal to keep the little folks in the house when the weather permits outdoor life. of the outdoor games which we have to suggest, perhaps the sand pile stands at the head of the list. clean white sand should be placed in an inclosure just low enough for the child to climb over. many, many happy hours may be spent in this sand pile, at the same time the little fellow is in his own yard and the watchful mother knows the drift of the conversations which take place. in a previous chapter we called attention to the fact that the little girls' frocks should be provided with knickerbockers, so that she may run and jump, or sit as comfortable as the little boy, without a conscious reproof ever ringing in her ears, "mary, do keep your dress down." outdoor play tree climbing is another source of enjoyment to these little people and they should early be taught how to climb. instead of suggesting fear to the child let the mother go into the yard and talk with her something like this: "now, mary, put your foot in that fork, now catch hold of that upper limb, hold on tight, you will get there yet;" instead of the following conversation, which all of our readers have heard: "john, do take care or you will fall and break your neck; be careful, you will fall. there, i knew you'd fall!" etc. both mothers are trying to accomplish the same thing--one mother suggests "fore-thought," while the second mother thoughtlessly suggests "fear-thought." these little people should be provided with rakes, spades, and hoes, and a portion of the yard should be given them in which they are at liberty to dig and rake and have a royal good time. we have yet to see the child who is not interested in flower-bed making, and the mother should think of the virgin opportunity to instill the story of life into the child's mind as he plants the seed, and day by day watches its development and growth. a pen of rabbits may be a good thing, if proper measures are taken to prevent their burrowing out of the pen, destroying the lawn, causing much sadness of heart to their little keeper, and no end of annoyance to the neighbors. roller skating and hoop rolling, as well as sledding, are all valuable recreations. the snowman, snowballing, and the sled riding all bring the ruddy glow of health to the cheek, and are wonderful producers of good appetites and restorers of "tired out nerves." indoor games there is no end to the number of things that can be done when the weather shuts us in, but before we take up these games let us never forget that every child thoroughly enjoys going out in the rain well protected with rubber boots, raincoat, and umbrella. it is not extravagant to burn plenty of electricity or gas on cloudy days, for the artificial sunlight helps to cheer the heart. such indoor games as those which may be had from blocks, puzzles, cutting out of pictures, darning of cardboard, soldier games, dolls, housekeeping, etc., are all splendid means of recreation for the little ones. let the mother or caretaker join with the little folks in these pleasant games. for the older children, checkers and dominoes are most excellent indoor games. the "going to school" child first of all we must decide upon the bedtime hour, as well as the hour for rising. between the ages of six to twelve, the bedtime hour should be eight o'clock, or not later than eight-thirty, and the rising hour at seven, or seven-thirty in the morning, for children of this age require eleven to twelve hours sleep. again, there must be taken into consideration the home work that the children at school are asked to do by their teachers. while this home work is not usually taxing, yet the time spent in doing the work must be taken account of. in our opinion the best time for home work is an hour and a half to two hours after the little fellow gets home from school. he should be allowed to relax for one and a half or two hours, to play out of doors whenever the weather permits, and then with either his mother or his caretaker from one-half to three-quarters of an hour should be spent on the lesson for the following day. following this, the dinner hour is enjoyed with the parents, and after that there should always be provision in the daily duties of the father and mother for at least a half hour for the evening romp; so that play and recreation during the school age occupies possibly not more than two or two and one-half hours a day outside of school hours. the playgrounds of schools are of inestimable value, and we quite agree with one who said: "if we can only afford one of the two--the playground or the school--have the playground first and afterward the school." the small parks and playgrounds of the cities are a great blessing to the little folks. companions the companions of the school child are usually his playfellows at school, and we urge the throwing open of the home during inclement weather to allow these school friends to come in and make trains out of our chairs and tents out of our couch covers, steamer rugs, afghans, etc. we do suggest that caution be used in allowing children to play indoors who are suffering from colds in the head, running noses, running ears, tuberculosis, or other chronic disorders, which are often highly contagious. running noses and running ears, as well as tuberculosis, may be contracted by susceptible children when the play at recreation time takes place indoors; while such disorders are much less dangerous in connection with outdoor play. we are well aware of the fact that some playmates may choose the bathroom, requesting that doors be locked, or wish to play in a bedroom securely away from mother and the caretaker. under no circumstances should this be allowed. let the child early learn that good wholesome play in the open is better than secretive misdemeanor behind closed doors. the "in the house" hour it is a pitiful fact that many mothers apparently are wholly unconcerned as to the whereabouts of their little folks, even after dusk; this is unwise to say the least, for a boy or girl under twelve years of age should be found under the parental roof at dusk. the city mother should impress upon her child that when the street lamps are lighted his first duty is at once to come into the house. during the winter months this lighting of the street lamps occurs anywhere from four to six. during the summer months another rule should be laid down, depending upon the neighborhood, the character of the friends on the street, the surroundings, etc. by all means let us see that our young people are in the house by dusk. parties every mother who reads these lines has had to meet this question: "shall i let my little one begin to go to parties?" and every mother will have to answer that question for herself. we personally feel that the social life extended by the school, together with the meeting of the companions at sunday school, in the park, or on the playground, is quite enough; and we deplore the fact that many children grow into the idea that much time must be spent at "parties" in the drawing-room under unnatural surroundings, in dressed-up clothes, eating ice cream and cake, etc. outdoor gatherings of children are wholesome and hygienic, but most of these indoor gatherings of groups of children we consider decidedly unhygienic. one child coming down with scarlet fever, measles, or whooping cough can infect twenty others at an afternoon party. the eating of so much ice cream, candy, and cake is deplorable in that it upsets the digestion, and all this is irritating to the developing nervous system of the child; and not infrequently brings on a lot of other symptoms, resulting in discomfort and disease. we believe in outdoor picnics but not in too frequent indoor parties. picnics groups of children gathering in the park, on the beach, in the woods, when well chaperoned, are among the pleasant and profitable pleasures of childhood. it is just such gatherings that mothers and children should indulge in--and once a week is not too often during the long vacation. the mothers, too, should enter enthusiastically into the joys of a day's outing, where the enormous intake of oxygen, the hearty laughter, the races, the games, etc., all create a wonderful appetite, which can be so delightfully satiated from the well-filled lunch baskets; and while the children are thus playing together what a wonderful opportunity for the mothers to engage in an exchange of helpful ideas. each mother has her own way, which is "the best way" to make this cake or that salad; or has met this particular difficulty in child training in a carefully thought out way; a neighborhood women's club can thus be held out in the open, while the children are having the time of their lives in the frolic of the picnic. "movies" the movie is an institution that has come to stay, and today mothers everywhere are perhaps discussing this particular institution more than any other. the movie affords a wonderful opportunity to see the sights and scenes of other lands, of feeding the imagination of the child on travel pictures and nature pictures. it is a most deplorable fact, however, that this wonderful institution which is fraught with so many opportunities to educate and enlighten the mind of the growing child has carefully to be censored. women's clubs have done much to purify the movies for the school-age child; many theaters are now showing on certain days a special afternoon movie for the children; and while many of these movies have great possibilities for good, we most earnestly urge that the school child see the movie that he is to see before dinner, and not have his mind excited and his nervous system "thrilled" just before going to bed. someone asked me several years ago, "are you going to let your little fellow go to movies?" i instantly answered, "no, but i shall take him." if the mother or the father sits by the side of a growing child and carefully, thoughtfully, and, yes, prayerfully, points out the good and explains the evil, then even the questionable movies will prove the means of bringing father and son and mother and daughter, into closer companionship. under no circumstances should children under twelve years of age be taken to long lectures, entertainments, or concerts, which will keep them out until eleven. vacations let the vacation be well planned. this is the opportunity "de luxe" for the child to earn a few pennies to enlarge his bank account. allow him a truck garden, guinea pigs, chickens, anything remunerative, which will enable him to become one of the world's workers and one of the world's savers. let him start a bank account when he is six, and watch him as he puts the dime in the bank, instead of taking it to the ice-cream-soda cashier. some time during the vacation, if possible, mother and father should accompany the little folks to the camp, to the beach--somewhere, anywhere--to get back to nature and live like indians for a short time. each member of the family will come back rested, happier, and more ready for the next year's work. in the summer time learn to eat on the porch--it is great sport for the children. many meals can be served on porches that are so often served in hot, stuffy rooms. the "home" does not consist in the furniture, the rooms, the bric-a-brac, or the curtains. the home is the mother and the father and the children and the spirit of good fellowship which should possess them. make the companions of the little folks very welcome, letting them learn the early use and abuse of the different articles of furniture in the house. it is all right to play tent with the beautiful couch cover; it is all right at certain times to dress up in father's best clothes and mother's beautiful gown, but while they are thus having a good time let them learn that all these things are to be used and not abused. adolescent days the homely boy or the homely girl usually grows up free from the flattery and undue attention which are sure to be heaped upon the good-looking boy and the popular girl. way back in the early days of five or six, and all the way up to the ages of twelve to twenty, children should be taught that it is altogether natural and correct to do things well and to look well; parents should stop, and cause their acquaintances to stop, "making over" the boy or the girl just because they have done something well, or have beautiful curls, or because their eyes are a magnificent brown, etc. if a girl should be especially endowed with a charming complexion, a wonderful chin, and if she does possess a beautiful nose or neck, let her early realize that she has been made the custodian of goodly features and that she must give an account for this particular blessing, and under no circumstances must she become self-conscious about it. ofttimes a good frown to an unwise friend is all that is necessary to stop this "lip service" flattery. the "chewing-gum girl" is just a thoughtless girl, that is all; sit her in front of a mirror and compel her to chew gum for one-half hour and watch herself do it, and it will often suffice to cure her. young ladies should be taught that chewing gum should be done in the bedroom, but never in the living-room or on the streets. it is not only a disgusting habit, but it often creates an occasion for criticism as to the quality of one's home training. ice-cream parlors the mother who cares will not allow her lovely daughters nightly, or even semi-weekly, to frequent the ice-cream parlors and secluded soda fountains. she had far better arrange group dinners and group receptions in her own parlor; with ice cream served in her own dishes and eaten with spoons that she has supervised the washing of. young women and young men in their late teens crave companionship, and they should have it; but let it be under wise chaperonage at home or in public rooms, and not in the solitude of a lonely bench in the public park, or the seclusion of an out-of-the-way, ice-cream parlor. this "running the streets" which is so freely indulged in by the adolescent youth in the early teens need not occur, if wise provision is made for the assembly of small groups in the home. some elders think it pleasing and cute for young men and young women--fourteen to sixteen, or even seventeen--to wrestle and roll around on the floor like two huge kittens; but it is unwise and indiscreet and should be discouraged. dancing we hesitate to speak of dancing for we realize it is a very popular indoor recreation of today, but we most earnestly urge that if dancing must be done, it be done under proper chaperonage, and if young people must meet in public dance halls let them be municipal dance halls, where motherly matrons are in charge. many of the social dances which bring the participants into such close physical contact are to be discouraged and stricken off the list; and while dancing is a splendid form of exercise--let us add that it is also sometimes a dangerous one. questionable play after the boys and girls graduate from grammar school they may come into contact with such agencies as secret societies--which nine times out of ten are questionable--and while we realize that there is a contention both for and against these organizations, we may dismiss the subject here by simply adding that we have known little special good to come out of these societies. while it may not be any more wrong to hit a ball from the end of a stick--as in billiards--than it is to hit it from a mallet in croquet; or from a stretched tendon, as in tennis; or from a bat, as in baseball--we do not feel that we have to argue the point, when we remind the reader that billiards and pool, especially in the public parlors, do assemble questionable companions, who use questionable language; while these games are often accompanied by betting, which is always to be deplored. and so with card playing, we see no greater harm in playing a game of euchre, than a game of authors, as far as the cards are concerned, but your boy and girl, as well as mine, as a rule, have cleaner and purer minds at the home game of authors than is probable in a game of cards in a public place. in closing this chapter we have to announce a group of wholesome recreations which may be entered into by our lovely young people--the man and the woman of tomorrow--whom we one and all wish to keep clean and good and pure; all the while helping them to develop the sense of humor and the element of play. such recreations are tennis, golf, croquet, roque, boating, sledding, skiing, bicycling, motoring, horseback riding, and a host of others too numerous to mention. let us not forget that ofttimes pursuits such as garden-making and helping the parent in the office or in the home, may be made a great source of enjoyment to the adolescent youth, if they are allowed to earn a small amount of money each week, which they may deposit in the bank. we close this chapter "play and recreation" with the wish that all, old and young, would develop a greater sense of humor, a greater love for play and recreation, which will increase the health of both mind and body and prevent many nervous disorders such as neurasthenia. chapter xxxix the puny child in every neighborhood there is to be found the delicate child, and everywhere anxious mothers are putting forth every effort to improve the condition of their puny boys and girls. in carefully looking over the puny child, we see an underweight little creature with pale skin, and as he comes to the table everybody notes that he refuses more or less food. diet and hygiene as we give the child a closer examination we find that certain lymph glands are enlarged, possibly adenoids are present in the post-nasal pharnyx, and, in many instances, there are badly diseased tonsils. usually the puny child is constipated, hands and feet are cold, and he jumps and starts at any unusual noise, thus showing a tendency to nervousness. one of the first things necessary is to take this little one to a good specialist and if necessary have the adenoids and tonsils removed. this having been done, the diet should be carefully looked into. there should be served him for breakfast a generous bowl of dextrinized grains with a good portion of diluted cream, a glass of rich milk, a baked potato, and fruit. for lunch at twelve o'clock he should be given a glass of malted milk with egg, or eggnog, six or eight dates or three or four figs, a handful of pecan kernels, and perhaps a lettuce sandwich. for dinner at half past five, another nourishing meal of baked potatoes, a protein dish of either cheese and macaroni or eggs or meat, a generous fruit salad, a glass of rich milk, and bread and butter, should be enjoyed. there is no class of little folks who eat between meals more often than do these delicate children, for mothers painstakingly endeavor to feed these children all they can possibly take; so one mother thoughtlessly went about it something like this: the half past seven breakfast having been only touched--nibbled at--with the ten o'clock hour came this request: "mother, i am so hungry, i want something to eat." eagerly the mother prepared either a meat sandwich or a jelly sandwich and possibly a glass of milk. when it was time for the twelve o'clock dinner hour, or lunch hour, again the well-filled plate was refused, the appetite having been satisfied at ten o'clock. having taken very little nourishment at noon, by half past two the plaintive plea again came to the mother ears: "may i have a piece?" and again the well-meaning mother gave him the desire of his heart. so the day passed, the dinner making the fifth time food was taken into the stomach, and in all probability there was eaten a cookie in between. the reader can readily see that the digestion was consequently very much disturbed, fermentation occurred, decomposition of food took place in the digestive tract, with its result--constipation. improving the appetite not a morsel should pass the lips of any child, and particularly our delicate child, between meals. let him come to the table at half past seven or eight o'clock, and if he does not want to eat tell him frankly that that is all he is to receive until twelve--and stick to it. nothing more than water or fruit juices should be taken between meals. it may be necessary to create an appetite for the three meals we have just described, and as we now take up the outdoor hygiene we would not forget that some simple treatment should be instituted each day in a well-heated bathroom or bedroom. roller skating or ice skating, hoop-rolling, rope-skipping, and irish mail, or a coaster, all furnish splendid exercise for the delicate child. under no circumstances should he be allowed to remain all the time in the house; and so pleasing recreations must be provided for him out of doors. the sand pile should not be forgotten, flower-bed making, raking the lawn, a polished coasting board fastened in a slanting position to an upright which can be mounted by means of a ladder, create splendid outdoor sports for these children. the daily program take the child into a warm bathroom each morning and let him stand in six inches of well-warmed water. with a rough mitten made out of either mohair, crash, or turkish towel, the entire body should now be rubbed until it is pink. this procedure is known as a dry-friction rub. do not stop until the skin is pink, particularly the arms and legs, for the back and chest usually get pink quickly. then with simply a cold dash of water to the feet, dry them well and allow him to dress. twenty minutes before the meal hour, let him get out of the house and roller skate around the square as many times as he can in twenty minutes, or let him race and have a royal good time in the fresh morning air and then after this forced oxygen intake let him come in to breakfast. and now for school, and as we say "school," we regret that there are not more "open-air schools." some day the american people, more particularly the american mothers, will awaken to the fact that we need more schools with simply window space rather than so many closed glass windows. some day we will send our children with sweaters, leggings, stockinet caps, mittens, even in the cool days of spring and fall, to "open-air schools," and in the cool fresh air they will think better and work faster and make wonderful progress in both studies and appetites. the particularly delicate child, under treatment, will not spend the whole day in school. in all probability the forenoon session only will be attended, after which the half-past-twelve or one-o'clock meal that has been previously described will be given him. now if the appetite is variable, arrange a little surprise for him by serving this meal on the porch or in the living-room by the open grate, or out under the trees. in all probability such a meal will be taken eagerly, particularly if the mother will read a pretty story. now the afternoon is to be spent in doing a number of different things. we would like a pleasant walk, a visit to the park, hoop-rolling, roller-skating, rope-skipping, ice-skating, outdoor sliding, anything that will take our little fellow out of doors to increase his oxygen intake until possibly the half-past-three hour is reached, when he should come into the house and lie down and prepare for the treatment for that particular day. treatment suggestions twice a week he should be given a salt glow (described in the appendix). twice a week he should be given a thorough soap shampoo (also described in the appendix). after each of these baths a special rub should be administered to the spine, and as there is so often spinal curvature in these children, certain stretching movements of the spine are valuable, together with hot fomentations (see appendix) over the spinal centers. these are wonderful stimulants to the delicate child and should precede the salt glow twice a week. every afternoon a hot-and-cold foot bath may be given to create a better circulation. the feet are put in hot water from three to five minutes (as hot as can be borne), and then they are quickly plunged into the coldest water obtainable for three seconds, then back into the hot water, and vice versa, until three changes have been made, always finishing the treatment with the cold dip. on the three remaining days of the week at half past three, the child will simply relax in the hammock or on the porch couch while the mother aids in the relaxation by a pleasant story. we would suggest that on monday the salt glow be administered; tuesday a rest is taken; wednesday the soap shampoo is to be administered; thursday another rest; friday a salt glow; saturday another rest, and sunday the shampoo, etc. before going to bed at night, with the mother's hands well oiled with either olive or sweet oil, the circulation is again stimulated by the heavy friction rub. constipation is taken care of along the same lines as mentioned elsewhere in this book. it is surprising to see how often these delicate children are infested by worms, and while a great deal of dependence cannot be put in that single symptom "grinding the teeth at night," or "pallor around the mouth," yet we do believe that many a delicate child continues to suffer from worms many years. it is a very simple procedure to obtain a specimen of the stools. a cathartic should be given and after usual free-bowel movement, the second time the child desires to go to stool this should be saved and taken to the laboratory for a careful search for worm eggs which are usually in evidence if worms infest the child. the treatment for worms is described elsewhere in this work. we have seen scores of young people between the ages of eight and eleven who, before treatment, were pale, listless, under weight, irritable and cross, after three months of such treatment as has been outlined gain six to ten pounds and look as ruddy as their healthiest neighborhood friends. it is perfectly marvelous to notice how a child will put on from six to eight pounds in a short period, at the same time overcoming his irritableness and fretfulness. i am more and more inclined to believe that most bad children are sick children--are undernourished children--and it behooves us american mothers and fathers to give proper attention to this undernourished child, call a halt, and devote three months to giving him the help that he needs. he did not ask to come into this world; and it is "up to us" to give this child what he deserves--for every child in this world has a right to be well born, to be well fed, and to be well reared. chapter xl teaching truth we confidently believe that most of the sex immorality seen in young people is more or less the result of ignorance and curiosity; therefore we most earnestly desire in this chapter to portray so interestingly the beautiful story of life as seen in the vegetable and animal world, that our mother-readers will be seized with the great desire wisely to convey to the young child's mind this sublime and beautiful story. the questions most naturally arising in the mind of the reader at this time are: when shall we begin to tell this story? how shall we tell it? where shall we begin? where shall we stop? realizing full well that the subject is usually handled prematurely and with unpreparedness, we will attempt in this chapter to discuss it with courage and candor, believing that there is a right way, a right time, and a right place to impart this information. a lesson from nature when the little folks are about three or four years of age, when confidence and trust are at their height, they often come to us begging for a "story;" and this is the golden opportunity for the parent or caretaker to tell them the story of mr. and mrs. corn, and all their little babies; or mr. and mrs. morning glory and their little folks. there are a score of other equally interesting and instructive botanical stories which are just as beautiful in their sublimity, and fairy-like in their personality. the little children's eyes grow big with wonder as you tell the story of a whole township of families by the name of corn (see fig. ), who have their residences out in the wide country fields. [illustration: fig. ] [illustration: fig. ] we will first introduce the child to mr. corn, the tassel, waving proudly and majestically in the breezes, and seeming to say: "i am master of all i survey." the little fellow is filled with wonderment as he learns how the clouds give up their drops of water to quench his thirst and how the sun smiles upon him to yellow his beard; and how the wonderful all-important _pollen_ is developed and ripened. often the child eagerly asks, "and where, mamma, is mrs. corn?" and to that interested upturned face we relate the pleasing story of the beautiful silken tresses of mother corn. early in her life she is a beautiful shade of green, and as she thus gracefully hangs out from the ear of corn, day by day the smiles of sunshine turn this mother corn to brown, and then to a still darker shade. "and where, mamma, are the babies?" the child next inquires; and, as we take the ear of corn, removing the outer clothing--the husks--we find the underclothing, a much lighter shade of green, and here now we are in close contact with the babies themselves--the kernels--and to each little kernel or baby corn we find mamma closely clinging. here is a beautiful opportunity to teach mother-love and mother watchfulness, as also the opportunity to draw lessons from the baby kernels sitting there in even rows, with their faces clean, silently contented--just doing their duty. the stories that may be told are limitless, and possibly as interesting as are the myths and fairy-tales, yet all the while as true as truth itself, with no fakery, no legends--just simple truth. the all important pollen now on a second trip into the cornfield, another story may be told of the important work of the pollen. this "father part" of the plant falls upon the silken tresses of the "mother part," by which the pollen is carried down to the sleeping corn-baby seeds--the kernels. and when the "corn dust" does reach the sleeping seeds a great change begins to take place. this change is known to the adult as "impregnation;" to the little child it may be presented as "an awakening" of the sleeping seeds, so that they begin to grow, to develop, to expand and push out, until we have the full-grown seeds seen in the delicious and juicy roasting ear. sometimes, in the case of the larger plants and trees, father tree may be miles and miles away from mother tree and so this all important pollen must be carried by the wind or by the bees, and as it blows against the mother part of the plant-flower she catches it and pushes it downward to the seed babies. the wind scatters the pollen of the oak tree, the hazlenut, the walnut, the birch, the willow and many others; for, without the good kind wind or the bees, the pollen would never find its way to many a mother flower, and the "fertilization" of the seed could not take place. the morning glory family perhaps the story of life can be told as beautifully from the morning-glory as from any other flower. here the beautiful flower cup is the home of father and mother morning-glory and all their little babies. (see fig. ). as we carefully take away their little home, the flower cup, we have left a little green cup, and coming up from the center you will see five little stems, every one of them wearing a hat of powder or pollen and this--if you please--is papa morning-glory. look closely and you will see coming up from the center of these five stems (stamens) one central stalk without a hat, mother morning-glory, known in botany as the "pistil"; and as you follow down this pistil you will find an enlarged part at the base, which is known as the cradle-nest--the home of the seed babies. little was known about this wonderful fertilization of the seeds by the pollen two hundred years ago, and a whole century passed before the secret of the blossom and the bees was discovered; and even then it was not fully realized how great was the work of the bees in cross-fertilization. nor was it understood that the beautiful blossom of the flower, with its sweet nectar, was an exceedingly important factor in attracting the bees. another century passed before darwin gave to the world the story of the great work performed by the bees in cross-fertilization--in carrying the pollen from flower to flower, for it is now a well-known fact that all of the blossoms visited by the bees produce better fruit and better flowers. in the flower where the father and mother part matures at the same time, self-fertilization is the rule. cross-fertilization occurs in instances where either the father part or mother part ripen at different times, in these cases the pollen is carried from plant to plant by the wind or by the nectar-seeking bees. these busy bees, with their fluffy little feet and fuzzy coats, become completely covered with this all-important flower dust, and in seeking nectar from other flowers they leave the "awakening dust" behind, and thus cross-fertilization takes place; new types of babies are produced, new generations of fruits and flowers. how mother nature works dr. chadwick, in her _blossom babies_, gives us a beautiful recital concerning the fertilization of plants, which provides an endless number of interesting stories. the water plants are very interesting in that the pollen is just light enough to float on the exact level of the mother part of the flower, otherwise fertilization could never take place, and there would be no more lovely lilies. long throated blossoms are fertilized by their attraction for certain moths or humming birds who have long tongues. mother nature is exceedingly careful to reproduce her children, and in every conceivable way she sees to it that her plant-seeds are fertilized and distributed. we are all familiar with the dandelion and the thistle and a host of others which fly through the air with actual plumes, some seeds fly with wings, such as the maple; other seeds travel by clinging or sticking, such as the cockle burr; still others float and shoot; while we all know about a lot of seeds that are good to eat, such as the nuts and fruits, as well as many of the grains, such as corn, etc. an incubator about hatching time is a wonderful object lesson in teaching the story of life. take the children to visit one and let them actually see the live baby chicks coming forth from the seed-shells. other wonderful lessons may be drawn from the mother horse or the mother cow; and it is impossible to portray the close companionship, the sublime trust and confidence, which exists between the mother and the child who have been bound together by these ties and sentiments of truthfulness, trustfulness, and frankness. the salmon family the little fellow is daily learning that everything that grows comes from a seed, even the salmon which was eaten at lunch yesterday was the text for an impressive story about papa and mamma salmon. in the beautiful columbia river mother salmon is swimming about quietly seeking a shallow place in the stream where she may deposit her cluster of baby seeds, which looks very much like a mass of tapioca pudding as they gently sink to the bed of a shallow spot in the river. there they lay "sound asleep" until father salmon, swimming by, is attracted to the spot and, hesitating, talks something like this to himself: "why the idea, here are some helpless fish-baby seeds, they can't grow and develop without me, here they are sound asleep;" and, nestling over them, he contributes the self-same and all important "something"--comparable to the pollen of the plants--which wakes them up. in the case of the fish the "awakening" substance is not in the form of a powder as in the plant world; but is in the form of a semi-liquid mass, much resembling the white of an egg. the little seeds soon begin to tremble--begin to wake up--and then begin to swell and grow and develop. in a few days what do you suppose happens to these little bulging baby seeds? the very same thing that happened to the chick seed--they burst and out come hundreds of cute little fish minnows. in just a few hours they are all swimming about in a most wonderful fish-like manner. early questions some day you will be surprised by your little child suddenly asking you some such question as this: "mother, where did i come from?" while in the same frank manner you reply: "why from your mamma, of course; where do you think you could have come from? everything that grows comes from its mamma--oranges, apples, radishes, cabbages, cats, dogs, and chickies--everything that grows has to have a mamma and papa," and they are often satisfied with this answer for a long time. no child should go to kindergarten without knowing that he came from his mother, and this knowledge should come to him from his own mother's lips. these are different days than those in which our grandmothers lived. the spirit of investigation and of inquiry is in the air. the moving-picture show makes it necessary for children of nine or ten to understand these things--to have a knowledge of certain of the conventionalities of life. twenty years ago this may not have been so necessary--the youth of that day might have waited several years longer for certain phases of his sex instruction. it is highly important that this knowledge be obtained from a wise and pure and sympathetic mind--from the child's own parents. one mother put her little girl's questions off week after week, saying: "i will tell you when you get older, dear--no, not now, dear; run away, you are not old enough to know such things, you must forget about them." thus the unprepared mother sought to gain time in which to consult the doctor or the library. finally the day came when the mother felt that she was sufficiently wise to answer the query, "where did i come from," and so with her heart in her throat she approached her daughter, saying: "come, mary, mother is going to tell you all about it. i am now ready to answer your question." imagine her surprise and astonishment when mary said: "oh, you needn't mind, mother, kate told me all about it last week." now the question in my mind is: how did kate tell her? how much unnecessary information did this older and experienced kate put into the pure mind of this innocent little girl? one mother's awakening one mother in a western state--a county superintendent of schools--told us the following interesting story of her own experience, which we think may be of help to some of our mother readers. one morning her seven-year old son rushed into the house exclaiming: "oh, mother, there is a new calf out in the barn, and i know where it came from; i saw a wagon load of calves come by here yesterday, and one of them must have dropped off, for it is right out there in the barn with old bess this minute." the mother was very busy with her papers and her reports, and she let the incident pass with a smile, thinking it was a very pretty little story. a week later the six-year old brother came in saying: "mother, i think there must have been another wagon load of calves passed by, and one must have been lost off, for old nell is cleaning up a little calf out in the barn for all she is worth," while the older brother piped up: "sure, it was another load of calves; that is just exactly the way the other calf got here;" and the two little fellows went off to school. about a month later that county superintendent suddenly became a much wiser mother than she was before, although her heart was made to ache. both boys came home from school one day and the older one met her with something like this: "i am mad! i've been lied to; all the fellows at school say i have, and they are making sport of me, too," and with a glare in his reddened eye he continued, "you know that new calf did not come off that wagon; you know that calf came from old bess herself; all the fellows say so at school, and they are making all kinds of fun of me, and i don't want to go back. i'd like to run away from home." the mother quietly drew the boy to her side and reminded him that she had simply listened; that she had not opened her mouth; that he came into the room and told about the incident himself, but this did not satisfy him. he turned to her wounded and crushed, saying: "well, you let a fellow believe it, and that's just as bad;" and this educated mother--this trusted custodian of a county full of school children--beseeched me to warn mothers everywhere to teach their children the truth, and to never let a child go to school with a sex misunderstanding. she told me that it took her six months to get that boy's confidence back again. don't get shocked i believe that many mothers make the sad mistake of showing the child that they are shocked by trivial sayings and trifling experiences of their little people. if we could only get it into our heads for once and for all that our children are born into this world veritable little thieves and falsifiers, as well as adventurers and explorers, we would then cease being so shocked and outraged by their frank statements of what they have heard or have done. let the mother listen to all these things with calmness, while she seeks to direct the child's mind in pure and elevated channels--to help him upward by imparting "precept upon precept; here a little and there a little." children will come in with stories that at first thought do greatly shock the parent; but under no circumstances should the boy or girl discover that the parent is shocked, for if he does he will not likely come again with another such "shocking" difficulty. one mother told me that her seven-year-old boy, beginning third grade, came into her bedroom one morning saying: "mother, i am just busting to say something," and this mother very wisely said, "well, say it; certainly i don't want you to burst," and she told me that this boy whispered to her three of the filthiest words that he could possibly have heard on the streets. in relating this experience to me she said: "do you know, doctor, that i really did not know what to think at first, but i remembered that you had taught me never to be shocked, and so i looked up and asked: "do you feel better?" whereupon he breathed a big sigh and exclaimed: "what a relief! i have just been busting to say that to somebody." mother, to whom would you rather he would say these things? to you, or to some little girl out on the street, or to some older boy? think what trouble and possible mischief were avoided by whispering into the sympathetic ear of mother. this wise mother turned to that little boy and said: "son, that ear is always waiting for just such things and whenever you feel like saying something--like getting it off your mind--you just come to me;" and he came repeatedly. one time he came in saying: "i don't know whether you want me to play with harold or not; he does some of those things you told me about the other day." and the mother thoughtfully and wisely looked up and said: "did he do it in front of his mother? why of course he didn't. did he ask you to go into the bedroom or bathroom and lock the door?" and the little fellow quickly answered: "why sure he did; how did you guess it?" and added "now i suppose you are not going to let me play with him any more," and this wise mother, knowing that if she denied him this privilege that it would quite likely be frequently sought, said: "why, certainly play with harold in the open, but whenever he suggests secrecy--" she did not have time to finish the sentence, the boy said: "i am wise; whenever he gets to doing that 'funny business' i'll skiddoo." the confidence between that mother and son, to my mind, was wonderfully sublime--all the while practical and helpful in his daily training. don't repulse the child a little older child sees the fowls, the dogs, or the cats, "mating," and then, rushing into the house, inquires what it is all about; and unless the mother is on her guard some older member of the family may show surprise and thus thoughtlessly convey to the child's mind that his question is improper and entirely out of place. to the question, "what are they doing, mamma?" quietly answer, "just mating, dear, just as the flowers mate; everything that lives or grows comes as the result of mating." suppose that you were repulsed every time you approached a dear friend, your husband, or some other member of the family? take, for instance, the matter of a caress or an embrace--how would you react to repeated rebuff? and so with the little child; he comes into this world full of confidence and trust, full of wonder and curiosity; possessed with the spirit of exploration and investigation--everywhere and all the time he asks questions. usually, his questions are answered thoughtfully and without hesitancy, except along the line of one thought--that of sex. do not think for one moment that he is satisfied by your evasive answers. you have but to recall your own childhood experiences, and remember that today the moving picture show and general public sentiment has placed the age for such knowledge from one to five years earlier in this generation than in the past. i do not care what the child comes into your presence with, be it the most shocking thing in this world, do not under any circumstances let it disturb your mental poise, or raise your ire or shock you; for if you do, then and there--at that moment--occurs a break in the sublime confidence which the child reposes in you. necessary moral training while we are using the plant and animal world as object lessons in teaching our children the facts of sex and the secrets of life; while we face the commonplace sex matings of the animals about us without cringing, without appearing to be shocked when our children call attention to these things; nevertheless, when the child is old enough to take cognizance of these phenomena, he is old enough to begin to receive some definite instruction from his parents regarding the moral phase of these great biologic problems. we cannot safely and indefinitely utilize the animal world as an object lesson in sex education, without at the same time emphasizing the moral difference between man and the beast. many parents treat these sex problems so lightly and endeavor to act so naturally and unconcerned about these questions, that the child comes to look upon the promiscuous sexual relations of the animal world as something altogether natural; and, unless proper moral and religious training is carried on at this time, he stands in danger of coming to regard lightly the moral standards of modern society. at the same time of life that mother nature fully develops the sex instincts--at adolescence--she also awakens the religious emotions; the one being so necessary for the proper and adequate control of the other. let parents take a cue from old mother nature, and at the same time the sex relations of animals are freely discussed with the growing child, let the mother or father wisely call attention to the fact that but very few of the animals live family lives as do human beings. in this connection valuable use--by way of illustration--can be made of the ostrich and some of the ape family who are loyal and true to their chosen companions. moral and religious instruction must accompany sex-hygiene teaching just as soon as you leave the realms of botany and enter the sphere of zoology. we could here relate many a tragic experience which our patients have passed through as a result of volunteering too much sex knowledge and at the same time neglecting this very necessary moral instruction. santa claus and the stork we must bear in mind that the child believes what we tell him; he trusts us implicitly and we owe it to him to teach him the truth in answer to his numerous questions. we must keep his confidence. take the matter of christmas, for instance. how many confidences have been broken over the falsehood of santa claus and the chimney. two little fellows hesitated in their play in the back yard, and the following conversation was heard: "you know that story about santa claus is all a fake." "sure it is, i know it isn't so, i saw my father and mother filling the stockings. you know that stork story is all a lie too, there's nothing to it, babies don't come that way, and now i'm investigating this jesus christ story, i suppose that's all a fake too." the fact of the matter is, that while these children have discovered the truth of the first two stories, for a long time they will query the third story, for to them, that too is mysterious and fairy-like. they hadn't seen santa or the stork and had only heard about jesus. story of the human baby the story of the human baby may be told to any child of seven to ten years. each mother will have to decide in her own mind the right time to go into the details of the human baby seed. the child should have had an opportunity to have planted some seeds in the ground, to have visited an incubator, or to have visited the farm and observed the family groups of babies--the chicks, pigs, calves, etc.--with their mothers. let me see now how many different baby seeds do we know? yes, we do know the radish seeds, many flower seeds, chicken seeds, bird seeds, corn, potatoes, and many others, and we can tell them all apart. the boy and girl baby seeds are too tiny to be seen with the eye. they are so small that it takes about two hundred of them in a row to make one inch. we can only see these human baby seeds with the aid of a microscope. it is such a precious seed that it cannot be intrusted to the ground or to a tree nest for development. the great wise father decided that a mamma would love and care for it better than anything or anybody in all the world. so, just as there is a cradle bed in the mamma flower, so there is in the human mother's own warm body, tucked far away from the cold rains and the hot sun, a little bed, for the boy and girl baby seeds. right near to this little seed bed mother nature has prepared a little room, which holds the tiny "waked up" seed for nearly a year as it slowly grows into a little baby girl or baby boy. the mating story you remember the story of how bob robin found jenny robin, don't you? you remember mamma told you how bob came up from the southland early in the spring and asked jenny in lovely bird song to come and be his very own wife? how he promised her he would feed her on cherries, and currants and the fattest of worms? and that she told bob she loved him and went to live with him, and how they built that cute little nest to hold the eggs; and how jenny robin sat on the nest until the little baby robins were all hatched out. well, one day papa found mamma. he met her and loved her dearly and told her he wanted her to come and live with him, and they built their home nest and were very happy together, because they decided they would always love each other more than any one else in the world. after mamma and papa built their home and lived together, one day a wonderful change came to one of the baby seeds and it awakened and began to grow. mother nature whispered to it, and told it how to find its way into this little room and there it clung to the wall and grew for nearly a year. papa brought mamma nice things to eat, just as bob robin did jenny. papa did everything he could to make mamma happy and comfortable. for nearly five months this little seed just grew and did not let anybody know it was there, until one day it began to tap against the sides of the walls of this little room, and every time it did mamma's heart just bounded with joy as she thought of the precious seed growing to be a darling baby--and all inside of her very own body. and one day, after nearly a whole year had passed, the door to the room began to open, and, very soon, a lovely baby found its way out of this special room into the big, big world. mother nature then told this little baby that it might still remain close to the mamma it had been with so long, and so she taught it how to get its food every day from mamma's breast. at this point the child usually breaks out by saying, "now, mamma, i know just why i love you so much." unfolding the truth i shall always remember with pleasure my own son, not quite two-and-a-half years old, who sat at the table one day asking numerous questions such as, "mamma, what is that? mamma, where did that come from?" etc. he picked up a navel orange, and pointing to the navel said, "what is that?" i frankly said to him, "why, my dear, that is the baby orange." "why, mamma," he exclaimed, "do oranges come from oranges?" "certainly, dear child; where else could they come from?" "but," he says, "mamma, do potatoes come from potatoes?" "why, honey," i said, "orange babies come from orange mammas, potato babies from potato mammas, grapes come from grape mammas, little kitties from kitty mammas, and little boys from their mammas." we simply mixed all the babies up, just as you would mix up a delicious fruit salad. we took from the mind all question of mystery and surprise by quickly and honestly answering his question. thus, his first knowledge of his origin, if he is able to recall it, will ever be associated with oranges, grapes, potatoes, kittens, etc. we did not tell the whole story for some two or three years later, but day by day we simply answered the questions as he asked them. one day, when he was about three, he burst into my bedroom, saying, "mamma, dear, i did come from you, didn't i?" "why, yes, darling, from nobody else; just from your own mamma and papa." "say, mamma, was my hand in your hand, my foot in your foot, my head in your head?" "no, dear," i replied, "you were all curled up as snug as a little kitty is when it's asleep, and you slept for nearly a year in a little room underneath mamma's heart." it was a wonderful story. he threw his chubby arms about my neck, his legs around my waist, and said: "you dear, dear, mamma. i do love you and papa more, just awful much." the doctor's part in my private sitting-room, where william and i have had many conferences, there hangs my medical-class picture with classmates and faculty. a member of my family was one day answering the boy's queries as to who this one or that one was, etc. finally, on pointing to one particular face, the answer came to his inquiry, "that's dr. p. you wouldn't be here if it wasn't for him." that evening the little fellow, just past three years, came to me and asked, "mamma, didn't you say i came from you?" "yes, dear," i replied. "well, auntie says i wouldn't be here if it wasn't for dr. p. what did the doctor have to do with it?" "why, simply this, dear. the door to the little room in which you grew in mamma's body wouldn't open, and so kind dr. p. came and helped open the door." "and let me out?" exclaimed the eager child. "oh, i want to go and see dr. p. and thank him for helping me out!" and this little fellow was neither shocked or surprised, any more than he was over finding out that orange babies came from orange mammas. in the same frank manner in which the simpler questions are answered, strive to answer these important ones. if we seek to evade, to postpone, to wrap in mystery these sex questions, the little ones will not forget but will ponder and worry over them, and seek to obtain certain knowledge from others who oftentimes tell too much or too little, and such information is usually mixed with much unnecessary matter which may or may not be foreign to this particular subject. on the other hand, if we frankly and honestly answer the question at hand, curiosity is avoided and the child feels he understands it all. the subject drops into the background of his mind--into the marginal consciousness--with the countless other facts he has accumulated. a sense of "knowledge possession" is as comfortable to the child as it is to the adult. trusting your child often the question arises: "will they tell to other children this newly found knowledge?" if the wise mother makes them feel they are a part of a "family," and reminds them that such matters as the secrets about santa claus, the stork, and the baby nest are only discussed in "family groups," they are often seized with the normal pride which accompanies confidence, and often keep secrets as well or even better than do most adults. one day a little man, three-and-a-half years old, was posing for a photograph. the photographer said: "my little fellow, you pose well. we've had such a good time together. where did they get such a lad as you?" the mother's heart stood still. from her hiding place behind a large curtain at the back of the studio, she listened, wondering what would be his answer. at first he hesitated, but after a moment's pause, said: "really, mr. w. if you don't know i feel sorry for you, and i'd really like to tell you, but i can't, it's a secret between me and my mamma." children enjoy secrets. if possible, isolate a group of subjects that are not to be discussed with playmates, such as santa claus facts, the stork story, and the baby story; often the very isolation of one single fact stands out so big in the child's mind that he is many times tempted to mention it, when, if it were associated with a whole group of "family secrets" he would seldom be led to talk about it. as we have said, children can keep secrets much better than most adults; and just suppose they _should_ tell something--what harm? with twenty-five false stories in the neighborhood, suppose one story of truth should escape! no particular harm would result; but i find they keep these secrets well. numerous questions will arise which should be met with open frankness. no blush, no shame, should even suggest itself, for we are dealing with a wonderful truth, so let us give out our answers with clean hearts and pure minds. the great father will bless us and surround our loved "flock" with a garment of confidence in mother and father that will protect from much of the evil which is in the world, and, eventually, our little ones will grow into men and women whose very life of purity will cast its influence into the social circle. only the company of the good and the true and the pure will be sought when associating with the opposite sex; while, in the end, better mothers and better fathers will be developed for the work of the next generation. ten possible causes of secret vice . the attention of the little folks is often drawn to the sexual organs by a sensation of itching which accompanies a state of uncleanliness and filth. the genitals must be kept scrupulously clean. elsewhere in this book we paid our respects to the rubber diaper, and we wish to reiterate at this time that it is in all probability responsible for a great deal of masturbation. the constant moisture and heat keeps the genital organs in a state of congestion which is more or less accompanied by itching sensations. . a long or tight foreskin in the male child favors the accumulation of secretions which not only occasion itching sensations but oftentimes are the cause of convulsions in early infancy. in the case of the female, a tight foreskin over the clitoris will retain secretions which also cause an itching sensation. . unscrupulous nurses sometimes actually teach these little fellows to masturbate. . lying in bed on the back with a full bladder, in the case of the boy, often produces an erection of the penis, and this is usually accompanied by a feeling of fullness which serves to direct the mind to the genital organs. . lying in bed alone with nothing to do but to investigate often results in secret vice. . the unwise practice of allowing children to visit each other over night and sleep together, is often productive of mischief. . constantly telling a little girl to keep her feet down, to keep her dress down, makes her over conscious of sex and otherwise causes the attention to be directed in unhealthy channels. . teasing a child unnecessarily about a little sweetheart often produces an emotional reaction which is not altogether desirable. these suggestions are especially bad in the older children. . unwise sex knowledge is usually productive of curious investigations, which if not properly followed up, particularly in those children who are temperamentally secretive, and who do not fully confide in mother and father, often results in moral misdemeanors. . do not allow two young children habitually to isolate themselves in their play. direct their play away from the attic, the basement, and other places remote from direct observation. there is no use telling a child not to touch that part of his body, particularly if it is a boy, for it is going to be absolutely impossible for him to carry out such instructions. one mother overheard her caretaker say, "don't put your hand there, it isn't nice." immediately the wise mother called the caretaker to her and reminded her that most children usually continue to investigate even though they are told not to, and so the caretaker received this instruction: "when you see harry putting his hand to that particular part of his body, just gently draw it away and divert his attention to something else, and when he goes to sleep in his little bed teach him to lie on his side and bring his little hands up under his chin or the side of his face and remain near him telling him a beautiful story until the eyes begin to get sleepy and pick him up immediately on awaking in the morning." this mother was quite unlike the mother who once came to my office, saying: "doctor lena, i have done everything to prevent my boy's handling himself, why every time he wakes up at night i am always awake and i instantly say to him, charlie where are your hands? you see doctor, i am doing the best i know how." very likely it is unnecessary to call the attention of the reader to the fact that this mother was doing more harm than good in constantly calling his attention to the fact that he did have a sexual side to his nature. truth vs. exaggeration and just here let us add that while masturbation is an unclean habit, an impure habit, and a thing altogether to be shunned, we would not be honest to ourselves and to our readers if we did not explain that under no circumstances does it make foolish minds out of sound minds or insane minds out of sane minds. if your boy or your girl is going to grow up to be foolish or insane he had a through ticket for the feebleminded institution or the insane asylum when he was born into the world. the time when masturbation does affect the mind of the child is when the mind awakens to the fact that it is allowing an abnormal, unclean, or filthy habit to dominate mind, soul, and body, and then, and usually not until then, does this bad habit begin to cause mental depression and a host of other symptoms that so often accompany masturbation. in our worthy efforts to combat the evils of secret vice let us not go to the other extreme and create such a condition of mind in the youth of our generation as to lay the foundation for sexual neurasthenia later on in life, as a result of the protracted worry, constant brooding, and conscientious condemnation, which they so often experience following some brief or trivial indulgence in early secret vice. let us fight this vice with the truth, and not resort to over-exaggerated pictures which can only serve to blight the hopes and destroy the courage of over-sensitive boys and girls after they have grown up--as they look back on their lives and recall perhaps a single misstep in their childhood. in this way we can hope to do good today without mortgaging the child's happiness and mental peace in years to come. appendix appendix baths used to reduce fever . _the sponge bath._ the child, completely undressed but loosely wrapped in a wool blanket, is placed on a table so that the mother or a nurse may conveniently stand while administering the bath. close at hand have a number of soft linen towels and a large bowl of tepid water which may or may not contain a small amount of alcohol, witch-hazel, salt, or vinegar, according to the doctor's directions. the upper portion of the body is partially uncovered and the tepid water is applied with the hands to the skin surface of one arm. the hands may be dipped in water from one to four times, thus making repeated applications of the water to the arm. these are followed by careful drying--patting rather than rubbing. the other arm is now taken, then the chest, then the back and last the legs. . _the wet-sheet pack._ two light-weight wool blankets are folded to fit the child; they should extend eighteen inches below the feet and should be wide enough to lap well in front. a sheet just large enough to envelop the body is then wrung out of cold water and spread out over the woolen blankets. the feverish child is entirely disrobed and is placed on the wet sheet, which is quickly wrapped about the body, over the chest, under the arms, and between the legs--coming in contact with the entire skin surface. the dry blankets are quickly brought around and tucked snugly about the patient. this is a cooling wet-sheet pack and will often so relieve the nervousness and irritability of a feverish child that he will go to sleep in the pack. in the very young child, under two years, it is important to put some accessory warmth to the feet such as a warm-water bottle--not hot. the effect of this pack is very quieting, and is indicated when the temperature of the child reaches f. or more. . _the graduated bath._ this is usually administered in a large bathtub and is beneficial in the fevers of the older children. the temperature of the water should be one or two degrees higher than the body temperature, for example--if the child's temperature is f. then the bath starts out with a temperature of or f. the temperature is then gradually lowered, about a degree every two minutes, until it reaches or f. a helper should support the head while the mother or nurse briskly rubs the entire skin surface of the body. this friction greatly facilitates the fever-reducing work of the bath because it brings the blood to the surface where it is more readily cooled by the bath. this bath should last ten or fifteen minutes. . _the hot sponge bath._ often, in combating the high fever of typhoid, the hot sponge bath is valuable. the hands are dipped in water just as hot as can be borne and are applied to the chilly, mottled skin which is so often seen in high fever. this bath is administered just as is the tepid sponge bath. evaporation is allowed to take place to some extent by delaying the drying. in this instance the child should be wrapped in a warm wool blanket with only a portion of the body exposed at one time. . _the hot-blanket pack._ the hot-blanket pack is indicated at the onset of many fevers such as in typhoid, grippe, pneumonia, etc. like the wet-sheet pack, the blankets are spread upon the bed, abundant accessory heat is applied--such as a half-dozen hot-water bottles. in the absence of these, glass jars or hot ears of corn may be utilized. hot bricks or hot stove lids wrapped in paper are also serviceable. a blanket, in size to suit the individual (an adult would use a full single blanket, a child one-half of a single blanket), is wrung very dry from boiling water. this may be done by the means of a wash wringer, or two persons grasping the blanket by its gathered ends may so twist it that it looks very much like an old-fashioned twisted doughnut. the twist is now lowered into boiling water, and as each pulls the twist wrings itself. this is at once quickly spread out so as to let the child lay on the center, and then the hot sides are brought in contact with the skin, just as in the wet-sheet pack. the dry blankets are now brought quickly and snugly about the child. just outside the second dry blanket the accessory heat is placed to the sides of the trunk, the sides of the thighs, and one at the feet. a wrapped stove lid or a hot-water bottle is placed over the pelvis and one under the back. cold cloths are put on the face and around the neck, and these should be changed every three minutes. this pack continues for fifteen or twenty minutes, at the end of which time the accessory heat and the wet blanket are removed and the patient is cooled off by a cold mitten friction, a saline rub, a witch-hazel rub, or an alcohol rub; or the patient may be placed in a tub of water, temperature f., after which he should be carefully dried off. . _sweating baths._ another bath which is effectual at the onset of grippe or pneumonia is the sweating bath. the bowels should have moved some time before the treatment. have ready a large bowl of ice water, two turkish towels, one sheet, and four wool blankets. the bathtub is now filled with water at the temperature of f.; which is quickly raised up to or f. ice-water towels are applied to the head, neck and heart. the patient remains in this bath for about ten minutes, after which he steps out and at once gets into the four hot, dry blankets previously spread out on the bed. no time is lost, the patient is quickly wrapped in the hot blankets and sweating continues for twenty minutes. the covering is now loosened and gradual cooling takes place. it is well to go to bed at once. tonic baths . _the cold mitten friction._ the cold mitten friction is a bath that is applicable to any condition where the child or adult needs "toning up." it should always be preceded by heat to the feet. the following articles are necessary. four or five turkish towels, a warm wool blanket, a hot-water bottle for the feet, a bowl containing water, a generous piece of ice, and a rough mitten without a thumb. the patient's clothes are removed and he is wrapped in the warm blanket with heat to the feet. one part of the body is taken at a time, first the arm, then the other arm, then the chest, the abdomen, one leg, the second leg, and last the back and the buttocks. a dry turkish towel is placed under the part to be treated, and after the mittened hand is dipped in ice-water, brisk short friction strokes are given to the arm until it is pink. several dippings of the mitten in ice-water are necessary. one cannot be too active in administering this bath. slow, delsarte movements are entirely out of place at this time. action--and quick action--is a necessity. no part of the child's body is left until it is pink. it is an invigorating tonic bath and is indicated in all conditions of low vitality, functional inactivity, puniness, rickets, etc. . _the salt glow._ fill the bathtub half full of warm water, temperature f. slightly moisten one quart of coarse salt. stand the patient in the water, placing one foot on the side of the tub while you rub the entire leg with the salt until it is very pink. the other leg is treated in the same manner, as also are the arms, abdomen, chest, and last, the back. by this time he will be all aglow from head to foot. rinse off the salt, and give him a cold dash with the hands or a spray. the neutral bath fill the tub with water at just f., and remain in the bath for twenty minutes or more, with the eyes covered, all the while maintaining the temperature at f. dry gently with a sheet to avoid exertion and exposure. go at once to bed. fomentations hot fomentations often relieve suffering and are indicated in such conditions as menstrual pain, abdominal cramps, colic, backaches, etc. a good substitute for fomentations may be given as follows: fill a hot bag half-full of boiling water. over this place a wet flannel and two layers of dry flannel. apply for fifteen or twenty minutes over the skin area to be treated, finishing up with a cold water or alcohol rub. a very effectual way of applying moist heat to any portion of the body is by the means of hot fomentations which are given as follows: one-fourth of a single woolen blanket (part cotton) is folded and grasped at the ends and twisted like an old-fashioned doughnut. the twist is then immersed in boiling water, the hands still grasping the dry ends, and then by simply pulling out the twist (widely separating the hands) the fomentation wrings itself. this is placed steaming hot over the affected area which has been first covered by a dry flannel. it is allowed to remain on for three or four minutes, and then another hot one wrung from the boiling water replaces the cool one. about four or five such applications are made. the skin should be very red at the close of this treatment. it is finished up with a quick, cold application to the reddened skin area. the soap shampoo the undressed child is placed upon a low stool in the half-filled bathtub at f. with the feet in the warm water. a good lather is applied all over the body with good friction by the means of a shampoo brush and soap. he is then allowed to sit down in the tub and splash about all he pleases, rinse the soap off and allow him to have a good time generally. at the close of the treatment the water is cooled down and the treatment is finished with a brisk rub with the hands dipped in cold water. the skin of the child should be pink at the close of the treatment. moist abdominal bandage the moist abdominal bandage is indicated in such conditions as kidney inflammation which is so often seen in the second week of scarlet fever; or in congestion of any of the internal organs such as the liver, the stomach, intestines, etc., and is applied as follows: spread out the flannel bandage and over it place the mackintosh. wring dry the cotton strip from cold water, and spread it over the mackintosh. wrap all three layers, the wet cloth next the skin, closely about the body, so as to prevent the air from getting under it. be sure that the feet are warm while adjusting the bandage. in the morning remove the bandage, and rub the skin briskly with a turkish towel dipped in cold water, until the skin is pink and dry. the cotton strip should be boiled every other day to avoid skin eruptions. heating compress the heating compress is indicated in the following cases: sprained ankles, rheumatic joints, arthritis, sore throat, etc. directions: wring two thicknesses of cheesecloth from cold water, place over the painful part, and quickly cover with a mackintosh and two thicknesses of woolen blanket bandage. on removing in the morning, sponge with cold water or alcohol. mustard paste in the bronchitis of small children, particularly babies, mustard pastes are to be preferred to the hot fomentations which are used to such great advantage in children above ten. the mustard paste is administered as follows: one part of mustard and six parts of flour of the same measurements are quickly stirred up with warm water to a paste thin enough to spread well upon a piece of thin muslin, which is large enough to cover twice the part to be treated. one-half of this muslin is thus covered with the mustard and the dry piece of cloth brought over. the edges are then folded in such a way that the mustard will not run out. this is applied to the affected part and allowed to remain for seven minutes on an infant, nine minutes on a child, and ten or twelve minutes on an adult. it is then removed and the moisture which is always seen on the reddened skin surface is _not_ wiped off but talcum powder is sprinkled on thickly to absorb it. if this is done, a mustard paste may be repeated every two hours if necessary and no blistering or other harm will come to the skin. the oil-silk jacket the oil-silk jacket is used in bronchitis of babies and children. it consists of three layers, the innermost layer of cheesecloth, the middle layer of thin sheet wadding, and the outer layer of oil-silk. this jacket should comfortably cover the chest, front, and back; it has no sleeves, and is opened on the shoulder and under the arm. it should always follow the mustard paste in bronchitis. there should always be two such cheesecloth and cotton jackets with the oil-silk covering so they may be changed every twelve hours, thus allowing for airing. steam inhalations . steam inhalations are indicated in hoarseness and bronchitis. they may be given in a number of ways. perhaps that most convenient for the young infant is the "bronchitis tent." a sheet completely covers the crib, and, with the bed amply protected with rubber sheeting or an extra blanket, steam is allowed to enter under the sheet at the foot of the bed from a funnel put into the nose of the teakettle. the steam should continue for seven or eight minutes. . a large, heavy-paper funnel is put in the nose of the teakettle which is boiling on the gas range. the mother holds the child in her arms while she is enveloped with a sheet which also includes the funnel. a helper carefully guards the flame. the mother and baby may thus conveniently get the steam with very little difficulty. . for the older child or adult, steam inhalations are to be had from the ordinary croup kettle or from a twelve- or fourteen-inch tin can which is filled two-thirds full of boiling water. over the top is loosely spread a cheesecloth upon which a few drops of compound tincture of benzoin or eucalyptus are sprinkled. the opened mouth is brought near the top of this can and a towel is thrown over the head, can and all; the patient thus being able satisfactorily to inhale the medicated steam. lotions for sore mouth boric-acid-and-myrrh lotion. boric acid grains tincture of myrrh / fluidrachm glycerine fluidrachm water, enough to make fluid ounce apply frequently to the inside of the mouth for inflammation or thrush. for nosebleed tannic acid drachms glycerine fluidrachm water fluid ounces to be injected or snuffed into the nose in obstinate cases of nosebleed. throat gargles dobell's solution is an excellent throat gargle. a solution of half alcohol and half water is also a splendid gargle. mouth wash listerine teaspoons soda bicarbonate grains water ounces essence of cinnamon, six drops in one-half glass cold water, may also be used in brushing the teeth and in cleansing the tongue and mouth. disinfectants . carbolic acid. carbolic acid ( %) ounces glycerine ounces water gallon clothes should be soaked in this for several hours, then removed in a covered receptacle and boiled thoroughly. sheets may be wet with this and hung at the doors in case of infectious diseases. . chloride of lime. chloride of lime ounces water (rain) gallon in typhoid fever, all the movements from the bowels should be thoroughly mixed with this, covered and allowed to stand several hours before pouring down the water closet. all vomited matter should be treated the same way. poultices there are a number of mush poultices recommended for different conditions--boils, felons, etc., but we find the aseptic heating compress to be as effectual as any of these dirty, mush poultices and we suggest that our readers try the boracic-acid poultice which is put on as follows: over any infected area or abrasion of the skin a thick padding of cotton moistened by a saturated boracic-acid solution is placed. this is entirely covered with wax paper or oiled-silk, and held in place by a binder. it is sanitary and much to be preferred to any of the mush poultices of bygone days. cough syrup a very useful cough syrup may be made as follows: two tablespoons of flaxseed are steeped on the stove until clear, the jelly strained and flavored quite sour with lemon juice to which is added rock candy for sweetening. this will often effectively relieve the irritating coughs of childhood. lotions for chapped hands no. . glycerine ounces tr. benzoin / ounce water ounce no. . glycerine ounces lemon juice / ounce tr. myrrh / ounce no. . glycerine ounces rose water ounces acetic acid ounces eczema we wish to submit two very useful prescriptions for that troublesome skin disease which is so annoying in childhood as well as in adult life. prescription no. is a clear fluid, and after the affected area is thoroughly cleansed with resinol soap and rinsed in soft water, the lotion is applied and allowed to dry. no. is then patted on with sterile cotton and often repeated to keep the eczematous skin area moist. this has proved curative in many persistent cases. lotion no. . acid carbolic drachm listerine drachm rose water ounces alcohol q. s. ounces apply no. and allow to dry of itself. lotion no. . ichthyol drachms lime water ounce oil sweet almonds ounce glycerine ½ ounces rose water ½ ounces apply no. and repeat to keep moist. constipation we submit the following home regime, which has proved successful to many sufferers for the treatment of constipation. . on rising in the morning, remove the moist abdominal bandage (mentioned above); drink two-thirds of a glass of cold water; and spend fifteen to twenty minutes in the following exercises, before dressing: abdominal lifting with deep breathing, auto-massage, leg raising, trunk twisting, trunk bending--forward and to sides; lying down for the trunk raising, and sitting for the trunk circumduction. immediately following these exercises, go to stool. have feet raised from the floor eight or ten inches, in order to simulate the squatting position. . breakfast should include bran or bran bread, and two or three of the following foods: apples with skins, grapefruit, cranberries with skins (but little sugar), and figs. immediately after breakfast walk fifteen minutes in the open air, practicing deep abdominal breathing. if the results at stool before breakfast were not satisfactory, vaseline rectum and go to stool again. . lunch should consist of fruit only, while dinner should include bran bread and two of the following foods: spinach, celery, carrots, parsnips, squash, or cabbage. . before retiring, walk in the open air for fifteen minutes; after undressing, exercise same as morning; and on retiring, apply the moist abdominal bandage. table of poisons and antidotes _poison._ _antidotes._ unknown { emetic, followed by jeaunel's antidote { and soothing drinks. acid--acetic, hydrochloric, { an alkali, such as magnesia, chalk, sulphuric, nitric { whiting, soda, soap; followed by { soothing drinks or sweet oil. acid--carbolic, creosote { epsom salts in abundance; soap; no { oil. dilute alcohol. acid--oxalic, including { emetic, followed by lime (as chalk, "salts of lemon" { plaster, whiting) or magnesia, but { not by potash or soda; then soothing { drinks. acid--prussic { fresh air; ammonia to nostrils; cold { douche; artificial respiration. aconite { emetic, followed by digitalis; no pillow { under head; free stimulation. alcohol (brandy, etc.) { emetic; cold douche on head; warmth { and artificial respiration. alkalies--ammonia, spirits { vinegar or lemon juice, followed by of hartshorn, lye, caustic { soothing drinks or sweet oil. potash { antimony (tartar emetic). { emetic if vomiting is not already { profuse; then tannic acid freely, or { strong tea; later, milk or other { soothing drinks; finally, castor oil { to empty the bowels. { emetic, quickly followed by plenty of { a fresh mixture of the tincture of { chloride of iron with calcined magnesia, arsenic (fowler's { washing or baking soda, or solution, paris { water of ammonia, or by jeaunel's green, "rough { antidote. then white of egg, soothing on rats") { drinks, or sweet oil; castor oil { to empty bowels. atropine (see belladonna). { emetic; tannic acid freely; cold to belladonna (atropine) { head; coffee. stimulants and { warmth if needed. blue stone; blue vitriol (see copper). { emetic (but often useless); external chloral { heat; stimulants; strong coffee; { strychnine; atropine; artificial respiration. chloroform, inhaled { cold douche; friction of skin; inverting { child; artificial respiration. copper (blue stone; blue { emetic, followed by white of egg or vitriol; verdigris) { milk, yellow prussiate of potash; { then soothing drinks. { emetic, followed by white of egg or corrosive sublimate { milk; soothing drinks; tannic acid (bichlorid of mercury) { freely; castor oil to open bowels. cyanide of potash (see acid, prussic). fowler's solution (see arsenic). { inhalation of oxygen; artificial gas (illuminating gas, coal { respiration; ammonia to nostrils; gas) { cold douche. iodine {starch or flour mixed with water given { freely; emetic; soothing drinks. laudanum (see opium). lead (sugar of lead) {emetic, followed by epsom salts; { white of egg or milk; alum. matches (see phosphorus). morphine (see opium). nux vomica (see strychnine). {emetic (but generally useless); opium (including laudanum, { permanganate of potash in doses of morphine, paregoric, { or grains if case is seen early; soothing syrups, { strong coffee; atropine; keep child etc.) { awake and breathing by cold douche to { head and spine, walking, etc., but { not to extent of exhaustion; { artificial respiration. paregoric (see opium). paris green (see arsenic). phosphorus (match-heads, {emetic; then permanganate of potash some roach and rat poisons) { in doses of or grains well { diluted, and frequently repeated; { then epsom salts or magnesia to { open bowels, but no milk or oil of { any kind. poisonous plants (jimson {emetic, followed by tannic acid; weed, poisonous mushrooms, { strong coffee or brandy; ammonia deadly nightshade, { to nostrils; external warmth; tobacco, etc.) { artificial respiration. prussic acid (see acid, prussic). silver nitrate (lunar caustic) {table-salt, followed by emetic; milk { or white of eggs. spoiled food {emetic, followed by castor oil as { purgative. strychnine (nux vomica, {emetic, followed by tannic acid, some rat poisons) { bromide of potash freely, or chloral. tartar emetic (see antimony) table showing the average weight, height, and circumference of head and chest of boys[d] at birth. weight ½ pounds height ½ inches chest ½ inches head inches one year. weight pounds height inches chest inches head inches two years. weight pounds height inches chest inches head inches three years. weight pounds height inches chest inches head ¼ inches four years. weight pounds height inches chest ¾ inches head ¾ inches five years. weight pounds height ½ inches chest ½ inches head ½ inches six years. weight pounds height inches chest inches seven years. weight ½ pounds height inches chest ½ inches eight years. weight ½ pounds height inches chest ½ inches nine years. weight pounds height inches chest inches ten years. weight ½ pounds height inches chest inches [d] weights for the first four years are without clothes, after that with ordinary house clothes. the weight of girls is on the average about one pound less than boys. they are about the same in height. ichthyol suppositories ichthyol per cent cocoa butter q. s. ad. to make suppositories. sig. use one suppository in the rectum each evening for hemorrhoids. oil enema the best way to administer an oil enema is by means of a special enema can which holds one pint, to which is attached a rubber tube. it is wise not to use an ordinary fountain syringe as the oil spoils the rubber very quickly. this oil is allowed to flow in slowly, under low pressure, and should be retained over night. any oil is acceptable, the cheaper sweet oils will serve just as well as olive oil. table of infectious diseases disease. |incubation lasts-- | |date of characteristic symptom from beginning of invasion. | | |characteristic symptom. | | | |other principal symptoms. | | | | |whole duration of disease from onset. | | | | | |quarantine lasts from onset. | | | | | | typhoid fever. | to days. | | th or th day. | | |rose-red, slightly elevated spots. | | | |apathy; diarrhoea; nosebleed; headache. | | | | | to weeks. | | | | | |while disease lasts. scarlet fever. | to days. | | st or d day. | | |intense, bright-red blush over body. | | | |sore throat; often vomiting with onset. | | | | | to days or more (not including | | | | | desquamation). | | | | | | weeks. measles. | to days. | | th day. | | |dusky or purplish-red, slightly elevated spots, | | | scattered and in characteristic groupings. | | | |cold in head; running eyes; cough; hoarseness. | | | | | to days. | | | | | | weeks. german measles. | to days. | | st day. | | |pale, rose-red spots or uniform blush; no | | | characteristic groupings. | | | |slight sore throat; sometimes slight running | | | | of eyes and nose. | | | | | to days. | | | | | | weeks. chicken-pox. | to days. | | st day. | | |pea-sized, scattered vesicles. | | | |none; or slight fever. | | | | |a week or less. | | | | | | to weeks. varioloid (variola). | to days. | | d day (may be st or d). | | |red, elevated papules; then vesicles; then often | | | pustules. | | | |headache; backache; vomiting. | | | | |about days. | | | | | | to weeks. vaccinia (vaccination). | to days. | | st day ( d after vaccination). | | |a red papule, becoming a vesicle and then a pustule; | | | surrounded by a broad red area. | | | |often feverishness and malaise. | | | | |about weeks. | | | | | |none. erysipelas. | to days. | | st or d day. | | |bright-red blush; puffy skin; often vesicles. | | | |fever; pain. | | | | | to days, or several weeks if it | | | | | spreads. | | | | | |averages weeks. diphtheria. | to days. | | st or d day. | | |white membrane on tonsils and other parts of throat. | | | |debility; fever. | | | | | to days. | | | | | | to weeks. whooping-cough. | to days. | | th to th day. | | |a prolonged paroxysm of coughing followed by a | | | crowing inspiration (whoop). | | | |vomiting; spitting of blood. | | | | | to weeks. | | | | | | to weeks (while whoop lasts). mumps. | to days. | | st day. | | |swelling in front, below, and behind the ear and | | | below the jaw. | | | |pain when chewing. | | | | |a week or less. | | | | | | to weeks. influenza. |uncertain. probably to days. | | st day. | | |fever, prostration. | | | |various respiratory, digestive, or nervous | | | | symptoms, commonest being general aching and | | | | cough. | | | | | or days to two weeks or more. | | | | | |while disease lasts. hot colonic flushing the hot colonic flushing is particularly serviceable in combating the sick headaches of migraine. they should be taken at night just before retiring with the temperature of water as hot as can be borne, from to f. half of the water is allowed to flow into the colon and is retained as long as possible. this brings the heat in close contact with the sympathetic nervous system whose headquarters is in the abdomen. enemas _position for an enema._ lie on left side, knees brought up against abdomen, with the left arm well underneath. this will relax the abdominal muscles and allow the water to pass upward more freely. the water should be allowed to flow until it is felt low on the right side. _the one, two, three enema_ is an injection that is used for the relief of gas in the bowel. it consists of the following: one part epsom salts, two parts glycerine, and three parts soap suds. it is introduced by the aid of the colon tube and retained as long as is possible. glycerine and soapy water, equal parts, may be introduced into the bowel for temporary relief of a persistent constipation. in instances when feeding by the mouth is impossible, _nutrient enemas_ should be given every three or four hours during the day. the absorption does not take place in the large bowel as readily as in the small intestines, so only a small amount of a more highly concentrated solution is given at one time. a child one year of age will be given one teaspoon, from one to four years of age a teaspoon to a tablespoon is allowed, and up to twelve years from one to eight tablespoons are given in the nutrient enema. peptonized meat preparations may be employed in greater concentration than directed by the use of the mouth. peptonized milk containing an egg is often used. the pepsin is added to the mixture only when warm, and is injected at once. emetics . a glass of warm water containing as much common table salt as can be dissolved. . a teaspoon of mustard in a large glass of warm water. . a teaspoon of syrup of ipecac, repeated in fifteen minutes if necessary. any one of these emetics is useful in instances where it is desirable to empty the stomach at once. a calorie a calorie is the heat unit used in the estimation of the fuel value of various foods. for instance, an ordinary slice of homemade bread contains calories. an ordinary fig contains almost calories. a large orange or an apple or a glass of grape juice contains about calories. there are calories in three teaspoons of sugar or honey. a complete food list with the estimation of calorie value of foods is found in _the science of living_, page , while on page of the same book is a very helpful table showing the amounts of various foods required to equal calories. the reader will find this exceedingly practical in estimating food values for the household. acidifying and alkalinizing foods since we find that in all acute diseases the acidity of the urine is greatly increased and in time of health it is less acid, we submit two lists of foods which tend to acidify the urine or to alkalinize the urine. foods which tend to acidify. . _animal foods_: all forms of flesh foods, fish, fowl, etc., including all kinds of meat broths, soups, beef tea, bouillon, etc. . _eggs._ . _breadstuffs_: all kinds of breads, whether made of wheat, rye or corn, crackers, toasts, griddle cakes, etc. . _pastries._ all sorts of pies and cakes--except fruit pies, and other desserts containing milk or sour fruits. . _cereals_: rice, oatmeal, and breakfast foods of all kinds, including the flaked and toasted breakfast foods. . _peanuts_, plums, prunes, and cranberries. plums and cranberries fall in this column because of their benzoic acid, which the body cannot fully oxidize. foods which tend to alkalinize. . _dairy products_: milk, ice cream, cottage cheese, cheese, buttermilk, etc. . _potatoes_ and _bananas_. . _soups_: all forms of vegetable and fruit soups and broths. . _fruit juices_: all the fresh fruit juices except plums. . _fresh fruits_: all fresh fruits, sweet and sour, except plums and cranberries. . _vegetables_: all kinds, especially beets, carrots, celery, lettuce, and muskmelon. . _dried fruits_: figs, raisins, dates, currants--all except prunes. . _the legumes_: beans, peas, and lentils. . _the nuts_: all the nuts belong in this column, including almonds and chestnuts. cereal waters, etc. it is often necessary to give the infant or the young child cereal water to replace food in occasions of summer diarrhoea, etc. . _barley water._ one tablespoon of barley flour in one pint of water. boil for one-half hour, strain, and add sufficient boiled water to make one pint. . _flaxseed tea._ one tablespoon of flaxseed, one pint of boiling water; let stand and keep warm for one hour; strain. add juice of lemon. . _oatmeal jelly._ four tablespoons of oatmeal, one pint of water; boil for three hours in double boiler, adding water from time to time; strain. . _toast water._ one, two, or three slices of bread toasted dark brown, but not burned. put in one quart of boiling water, cover, and strain when cold. . _arrowroot water._ wet two teaspoons of arrowroot with a little cold water, and rub until smooth; then stir into one pint of boiling water and boil for five minutes, stirring all the while. . _oatmeal water._ one tablespoon of oatmeal to one pint of boiling water, cover and let simmer for one hour. add water from time to time as it evaporates; strain. . _rice water._ one tablespoon of (washed) rice to one pint of water. boil three hours adding water from time to time. fruit juices fruit juices are exceedingly beneficial all through life; particularly is this true during early childhood when the little ones are so likely to be constipated. any of the fruit juices are good, particularly the juices from oranges, raisins, prunes, apples, pears, and cranberries. all these juices are better cooked than raw with the exception of orange juice. all children should have some fruit juice every day. for the very young baby the juices are strained through a wire strainer and a clean cheesecloth so as to remove every particle of solid matter, and there should be added an equal amount of cold, boiled water for the infant under ten months. lemonade and eggnogs lemonade, along with orangeade, grapefruitade and limeade should be used for children above a year. they should be well diluted and not too sweet. eggnogs are splendid for children who need to be helped along with their diet. they may be given at the close of the meal, never between meals--unless so prescribed by a physician. the stomach should have ample time to complete the work of digesting one meal before another partial meal is allowed to enter it. eggnogs consist of a well-beaten egg into which there is placed a small amount of sugar, flavoring with either nutmeg, vanilla, or cinnamon, and the glass filled up with rich milk. milkshake milkshake is a delightful drink. the white of an egg with one or two teaspoons of sugar, two tablespoons of chopped ice, flavoring, and one ounce of cream are briskly shaken in a milk-shaker for two minutes. cold milk is added to fill the glass. meat and meat juices beef extracts are regarded by the medical profession as purely stimulants. beef juice is practically without food value. in the preparation of beef juice the extractives and juices leave the fibre. the food is in the fibre of the meat. the extractives are purely of a stimulating order. we do not advocate the giving of beef tea and beef juices to children; as a rule, we think that cereal, gruels, strained soups, and milk are preferable. the only reason for cooking meats is to destroy the parasites such as tapeworm, trichina, etc., which are so often found in the meat. the cooking of meat decreases its digestibility, as raw meat is more easily digested than cooked meat, but we feel it is necessary to advocate the cooking of meat in order to kill the parasites. coddled egg a fresh egg, shell on, is placed in boiling water which is immediately after removed from the fire. the egg then cooks slowly in the water, which gradually cools, for seven or eight minutes, when the white should be about the consistency of jelly. for a delicate digestion the white only should be given, with salt; it can be easily separated from the yolk. the above is the best form of egg for the young child. later on the eggs may be soft boiled or poached, or even soft scrambled. soups two varieties of soups are given children. in the early months of childhood, from six years to eighteen months, the soups are usually strained, but after eighteen months, soups may be thickened with flour and rich milk making a cream soup of it. most vegetables make good soups. the pulp from such vegetables as asparagus, carrots, beans, peas, tomatoes, and potatoes are made into cream soups by the addition of a little flour, rich milk, butter, and a dash of salt. breads new breads should never be given to a child. only bread twenty-four hours old should ever be given to a child under six years; it should be cut into slices and allowed to dry out; and even then is better if slightly toasted. we publish a recipe for bran bread and bran biscuits which are exceedingly good for children and adults. _recipe for bran bread._ two eggs, beaten separately; three-fourths of a cup of molasses, with one round teaspoon soda; one cup of sour cream; one cup of sultana seedless raisins; one cup of wheat flour, with one heaping teaspoon baking powder; two cups of bran; stir well and bake one hour. _bran biscuits._ mix one pint of bran, one-half pint of flour, and one level teaspoon of baking soda. mix one-half pint of milk and four tablespoons of molasses. add this to the bran mixture and bake in gem pans. index index abortion, advice on occurrence of, ; care needed at third month of pregnancy, ; consequences of, , ; defined, ; remedy for threatened, ; warning signs of, . _see also_ miscarriage; pregnancy adenitis, adenoids, air, supply of fresh, for baby, - , baby, care of the: abdomen, shape of, at birth, ; advice in care of baby, - ; bathing, - , - , - ; bed for, arrangement of, , ; bouncing harmful, ; bowels and bladder, training of, ; breast of baby, care of, ; buttocks, care of, ; chafing, how prevented, , ; chest, shape of, ; circumcision, when desirable, ; clothing of the, ; constipation, ; cord, dressing of, ; diet after first year, - ; ears, treatment of, - ; exercise of baby, ; eyes, treatment of, , - ; falls, to be prevented, ; feeding the, ; genitals of the, how cared for, , ; habits to be guarded against, ; hair, treatment of, , ; handling, ; head, treatment of, , , ; legs of, at birth, ; lifting the baby, how accomplished, ; mouth, treatment of, ; necessities for newborn baby, - , ; nose, treatment of, - ; pulse and respiration, ; putting to sleep, , ; registration of birth of, ; respiration, how started at birth, - ; second summer, care during, ; skin of baby, ; stools, regulation of, ; temperature of baby, ; the "spoiled" baby, ; things bad for babies, list of, ; treatment of baby during and after birth, , ; umbilicus, how cared for, ; urine of baby, , ; warmth necessary, ; water, how and when administered, , ; weight of baby at birth, ; when to give first feeding, . _see also_ colic; crying; nursery; nursing the baby; sleep; urine; _see also_ under several diseases babyhood, backache, cause of, ; method of relief for, - bathing the baby, toilet, etc., - . _see also_ baby, care of the bed for baby. _see_ baby, care of the; sleep bed-wetting, . _see also_ urine birthmarks, discussion of, , , , , bites, of dogs, snakes, cats, etc., blindness, precautions to avoid, in new-born infant, , . _see also_ baby, care of the blisters (fever), blood-pressure, ; observation of, boils, bottle feeding, additional foods, ; bottle, preparation of, ; ice-box, home-made, ; intervals between meals, ; nipple, how withdrawn, ; position of baby during feeding, - ; quantity of food, ; refrigeration a necessity, ; rules for, ; schedule for, ; stomach, capacity of, ; time allowance for, ; traveling, food for baby while, ; treatment of baby after, ; water, when and how administered, bowel, prolapse of the, bow legs, how avoided, bran bread, recipes for, bravery, how to instil in a child, - breasts, caked (mastitis), care of, , ff.; changes in, a sign of pregnancy, ; care of, during pregnancy, . _see also_ pregnancy bronchitis, bruises, burns, calisthenics, how applied, caretaker (for children), - carriages and go-carts, chafing, . _see also_ baby, care of the chicken-pox, - chilblains, child culture, cleft palate, clothing the baby, bands, ; booties, ; caps, ; diapers, ; errors in clothing, ; layette, the, - ; nightgowns, wrappers, and slips, ; rules for, ; shirts, ; shoes, ; short clothes, ; skirts and petticoats, ; sleeping-bag, ; stockings, ; suggestions for, ; suits for play, ; winter garments, ; wraps, clubfoot, colds, , colic, causes and treatment of, - , , confinement, bed and accessories, - , ; calculation of date of, , ; preparations for, ff., ; supplies needed for, ff.; room for, . _see also_ labor constipation, treatment of, , ; in baby, , , contagious diseases, how contracted, ; incubation period of various, ; spread of, . _see also_ under various diseases convulsions, coughing, cramps, croup, crying, abnormal, ; birth cry, ; cause of, ; colicky cry, ; fretful cry, ; habit cry, ; healthy crying, ; hunger cry, ; illness cause of, when, ; pain cry, ; "spoiled-baby" crying, ; temper cry, ; thirst cry, cuts, wounds, etc., deaf-mutism, deafness, deformities, causes of, delivery, calculation of date of, , depressors, function of, , determiners, function of, , development of child, - diarrhoea, , diet: appetite, improvement of the, ; assimilation, ; baby, diet of, - ; cellulose, ; eating between meals, ; elimination, - ; fats, ; food requirement (daily), ; foods, full value of, ; for children, ; fruit sugars, ; hygiene, ; mineral salts, ; nutrition, ; proteins, ; starches, ; treatment of child, daily program for, - ; water, . _see also_ feeding the baby; nursing the baby digestion: disorder of, chronic indigestion, ; stomach, disordered, ; stomatitis or thrush, ; vomiting, . _see also_ under various diseases diphtheria, discipline, methods of, - dislocations and fractures, doctor, choice of, earache, ears, running, eclampsia, , ; prevention of, . _see also_ urine eczema, - embryonic development, , enema, how administered, exercise, necessity of, during pregnancy, exercise of baby, eye infections, eyes, ears, and nose, care of, ; foreign bodies in, fainting, fear, overcoming of, in children, - feeble-mindedness, feeding the baby: bottle-fed baby, healthy characteristics of, ; changes in food to be gradual, ; constipation, how treated, , ; diarrhoea, cause of, , ; dissatisfaction, signs of, ; flatulence, ; formula, choice of, for, ; infant foods, - ; mistakes in formulas, ; mixed feeding, ; overfeeding, ; vomiting, ; weight of baby, . _see also_ diet; milk; nursing the baby fertilization, process of, , fever, . _see also_ sickness of child flatulence. _see_ feeding the baby "flour ball," how prepared, foods, for baby, , - ; full value of, . _see also_ bottle feeding; infant foods; milk freckles, frostbites, games for children, germ plasm, glands, enlarged, goitre, governesses, - grippe, habits, inculcation of good, - harelip, headache, in children, ; relief for, during pregnancy, ; sign of auto-intoxication during pregnancy, heartburn, care for, hemorrhoids, treatment of, heredity, effect of, on individual, , ; extent of influence of, , , , hip-joint disease, hives, homemaking, - hookworm, hospital, recommended for confinement, - ; requisites for, housekeeping, - hygiene, of baby, - ; of child, - . _see also_ diet hysteria, prevention of, indigestion, infant foods, - . _see also_ feeding the baby; nursing the baby infant welfare, insects, bites of, insomnia, relief for, ; in children, itch, the, - jaundice, kissing the baby, precautions against, labor, analgesia in, ; anesthesia in, - ; bath, preliminary, ; care of mother during and after, - ; chloroform and ether, administration of, ; duration of, ; duties of nurse before and during, ; "false pains" in, ; fear in, importance of allaying, ; laughing gas (nitrous oxid), administration of, ; effect of, ; pain of, , - ; preparations for, - , , - ; progress of, ; second stage of, ; "sunrise slumber" in, - ; symptoms of approaching, ; third stage of, ; "twilight sleep" in, - , - ; what to do in, before arrival of doctor, layette. _see_ clothing of baby leucorrhea, relief for, - lice, lime water, use of, in baby's food, lochia, the, lying-in period, the, ; abdominal binder, ; "after-pains," ; bowels, care of, ; breast binder, ; "cold-mitten friction" during, ; cystitis, how avoided, ; diet, rules for the, ; getting up from bed, when to be permitted, ; hemorrhage, treatment of, ; infection, advice for treatment of, ; lochia, the, ; nipples, care of, ; nurse, duties of, during, ; pneumonia, how avoided, ; rest and exercise during, ; temperature of mother, ; toilet of the vulva, malaria, maternal instinct, the, maternal impressions, explained and discussed, measles, - medical supervision in early days of pregnancy, medicine chest, the, meningitis, menstruation, cessation of, a sign of pregnancy, ; cessation of, due to other causes than pregnancy, ; passage of ovum at time of, . _see also_ pregnancy milk, acidity, how counteracted, ; analysis of cow's, ; analysis of mother's, ; annatto, test for, ; boiling, when necessary, ; bottled milk, care of, ; bottles, care of, ; buttermilk, when used, ; certified milk, ; condensed milk, how used, ; cow's milk, modification of, ; cream gauge, ; cream, gravity of, ; dairy, essentials of a good, ; "flour ball," the, ; food, special, ; formulas for feeding, , ; goat's milk, use of, ; herd milk desirable, ; lactometer, ; lime water, use of, ; "modification" of cow's milk, ; nipples, care of, ; pasteurization of, ; peptonized, ; preparation of, - ; schedule for feeding, ; seven per cent milk, ; spores, how guarded against, ; sterilization of, ; sugar, use of, with, ; "top-milk" formula, ; whey, how used, . _see also_ feeding the baby milk crust, miscarriage, care needed at seventh month of pregnancy, ; causes of, ; defined, . _see also_ abortion; pregnancy monstrosities, causes of, moral training of child, - morning sickness, a sign of pregnancy, ; remedies for, ff.; vomiting (pernicious), . _see also_ pregnancy mothercraft, ; science of, , - motherhood, characterized, ; preparation for, mouth of baby, care of, mouth wash for use during pregnancy, "mulberry mass," the, mumps, nails, ingrowing, nature, lessons from, in teaching children, - navel, bleeding from the, nervousness, hereditary (in child), - ; how overcome, - , - nervous system, absence of connection between, of mother and child, nitrous oxid, effects of, - nosebleed, nurse, choice of, - nursery, bath equipment, ; bed, arrangement of, , , ; cleanliness, necessity for, ; equipment of, ; heating and ventilation, ; lighting, ; refrigerator, ; sleeping blanket, ; ventilation of, nursing the baby, caked breasts, - ; diet of mother, ; foods to be avoided by mother, ; hygiene of nursing mother, ; importance of, ; irritability of mother, effect of, ; mastitis (caked breast), treatment for, ; milk supply, how increased, ; mixed feeding, ; mother's milk, constituents of, ; overheating of mother to be guarded against, ; position of mother when, ; regularity in feeding, ; sore nipples, how treated, ; stools, regulation of, ; successful or unsuccessful, how determined, - ; time of first feeding, ; to be avoided, when, ; water, administering, ; wet nurse, the, . _see also_ bottle feeding; diet ovary, the, ovum, development of, into foetus, , paralysis, infantile, parents, relation of to children, - pernicious vomiting. _see_ morning sickness physician, selection of, for treatment during pregnancy, - pigeon toe, placenta, role of, play and recreation, - playmates of children, pneumonia, poisons and antidotes, - pott's disease, pregnancy: bathing, necessity of, during, ; blood-pressure in, , , ; breasts, care of the, ; cheerful anticipation, advantages of, ; clothing appropriate during, ; constipation, how avoided during, - , ; convulsions, treatment for, ; craving for special food, in, ; diet during, ff.; dizziness during, ; duration of, , ; exercise, necessity of, ; fresh air, necessity of, ; goitre in, ; hemorrhoids, treatment of, ; hygiene of, ff.; irritation of the bladder, ; kidney complications, ; medical supervision in early days of, ; mental state during, how regulated, ; miscarriage, danger of, at seventh month, ; morning sickness, remedies for, ; progress of, , ; quickening, ; resentfulness of mother, consequences of, ; rest, necessity of, ; signs of, ; swellings in, , ; teeth, care of, during, ; urine, diminution of, ; urine, testing of, ; vision, blurring of, the, ; water, necessity of, in, . _see also_ abortion; miscarriage puerperium. _see_ lying-in period "quickening," . _see also_ pregnancy rheumatism, rickets, ringworm, rupture, saint vitus' dance, saliva, flow of, not indicative of teeth-cutting, when, scalds, scarlet fever, - scurvy, senses of new born baby, , shortening clothes of baby. _see_ clothing the baby sickness of the child: abdomen in sickness, ; breathing, ; chest in sickness, ; convalescence, - ; cough, the, ; cry of infant in sickness, ; disinfectants for sick room, ; examination of sick child, ; facial expression, ; feeding directions, ; fever, ; gestures indicating sickness, ; head indicates sickness, ; medicine chest, the, ; medicines, ; mouth, the, ; nurse, the, ; nursing records, ; patent medicines, ; position of, in sickness, ; pulse, the, ; sick room, location of, etc., ; skin color, ; stools, the, ; swallowing, ; temperature and pulse, ; temperature, the, ; treatment of sick child, ; urine, the, . _see also_ under several diseases skin troubles, sleep: air, supply of fresh, - , ; bed-clothes, ; bedtime for baby, ; daily naps, ; food, effect of, on, ; position of baby in, ; putting baby to, , ; requirements of, by baby, ; soothing syrups, ; waking up in night, smallpox, soothing syrups, sore throat, spasms, speech of baby, sperm, blending of, with ovum, spinal curvature, - spoiling the child, sprains, stools of baby, , stream of life, the, sucking habits in baby, to be guarded against, , suggestion, effect of, , - summer complaint, . _see also_ diarrhoea; dysentery sunrise slumber. _see_ labor suppressors, function of, , swallowing of bones, buttons, etc., syphilis, , teeth, care of, during pregnancy, teething, - ; suggestions for treatment during, thrush, tonsils, diseased, ; tonsilitis, toys, selection of, tuberculosis, twilight sleep. _see_ labor twitchings, . _see also_ nervousness, hereditary typhoid fever, - umbilical cord, function of, uremic poisoning. _see_ urine urine: albumin and casts in, , ; bed-wetting, ; diminution of, during pregnancy, ; disturbance in, a sign of pregnancy, , ; eclampsia, ; examination of, ; irritation of the bladder, ; retention of, by child, ; testing of, during pregnancy, , , , , ; toxemia, indications of, ; uremic poisoning, ; urinating after labor, ; urination of baby, ; urine an index of disease or sickness, . _see also_ pregnancy; sickness of child uterus, entrance of fertilized ovum into, , vaccination, varicose veins, vice, secret, causes of, vomiting, . _see also_ digestion, disorders of; feeding the baby vulva, toilet of the, vulvovaginitis, walking of baby, warts, water: administered to baby, when, ; necessity of, during pregnancy, , , , ; part played by in nutrition of body, water on brain, weaning: breast-fed babies, ; bottle-fed babies, weight of baby, , - whooping cough, worms, transcriber's note: a few typographical errors have been corrected: they are listed at the end of the text. [illustration: eugenics hath its own reward] the eugenic marriage a personal guide to the new science of better living and better babies by w. grant hague, m.d. college of physicians and surgeons (columbia university), new york; member of county medical society, and of the american medical association in four volumes volume i new york the review of reviews company copyright, , by w. grant hague copyright, , by w. grant hague * * * * * [i] index of the four volumes note--the roman numerals i, ii, iii and iv indicate the volume; the arabic figures , , , etc., indicate the page number. accidents and emergencies, iv, . accouchement beds, how to prepare, i, . acne, iv, . adenoids, iv, ; how to tell when child has, iv, ; treatment of, iv, . adentitis, acute, iv, ; causes of, iv, ; symptoms of, iv, ; treatment of, iv, . advice to young wives, iii, . after-birth, expulsion of, i, . after-pains, i, . age at which to marry, iii, . albumen water, ii, . alcohol, in patent medicines, iii, . alcoholic drunkenness, i, ; dr. branthwaite on, i, ; dr. sullivan on, i, . amenorrhea, causes, ii, ; absence of menstruation, ii, ; treatment of, ii, . anemia, severe, iv, ; simple, iv, ; treatment of various forms, iv, . anesthetics, new, iv, ; use of in confinements, i, . angina, iv, . anti-meningitis, serum, iv, . aperient waters, abuse of in constipation, iii, . appendicitis, iv, ; treatment of, iv, . appetite, loss of, ii, ; poor, ii, ; treatment for loss of, ii, . arrest of hemorrhage, iv, . artificial food, ii, ; formulæ for, ii, ; mistakes in preparing, ii, . aseptic surgery, iv, . baby, amusing the, ii, ; bathing the, ii, ; care of eyes, ii, ; care of genital organs, ii, ; care of mouth and teeth, ii, ; care of newly-born, ii, ; care of skin, ii, ; clothing of, ii, ; constipation in bottle-fed, ii, ; food for first year, ii, ; fresh air for, ii, ; how it gets nourishment in womb, ii, ; how long it should sleep, ii, ; how to weigh, ii, ; hygiene and development of, ii, ; intervals of feeding, ii, ; night-clothes of, ii, ; overfeeding the, ii, ; proper way to lay in bed, ii, ; what to prepare for the coming, ii, ; why it cries, ii, . baby's comforter, ii, . bacteria, what happens if we inhale, iii, . barley gruel, ii, . barley water, ii, , . [ii] bath, bran, iv, ; cold, for reducing fever, iv, ; cold sponge or shower, iv, ; during pregnancy, i, ; hot air or vapor, iv, ; hot, iv, ; mustard, iv, ; tepid, iv, ; various kinds of, iv, . bathing, the baby, ii, . bed, proper way to lay baby in, ii, . bed-wetting, iv, . beef juice, ii, . beef or meat pulp, ii, . bichloride of mercury solution, iv, . binder, how to apply, i, . birth, management of, i, . birth-chamber, the, i, . birth marks, i, . bites, dog, iv, . blackheads, iv, . blood, children suffering from poor, iv, ; poor, iv, . boils, iv, . boracic acid, solution of, iv, . bottle-feeding, method of, ii, ; what a mother should know about, ii, . bowels, daily movement necessary, ii, ; how to wash out, iv, ; importance of clean, ii, . boy, building of, ii, ; chancre, the, ii, ; gonorrhea or "clap," ii, ; sex-hygiene for, ii, ; social evil, ii, ; sources of immorality, ii, ; syphilis or "pox," ii, . brain, complications of in syphilis, ii, . bran, as a food, ii, ; bath, iv, ; muffins, recipe for, ii, . branthwaite, dr., on alcoholic drunkenness, i, . bread, ii, . breasts, care of when weaning, i, ; colostrum in, i, ; how long should baby stay at, ii, ; putting baby to after labor, i, . bronchitis, iv, ; chronic, iv, ; diet for, iv, ; drugs in, iv, ; external applications for, iv, ; inhalations for, iv, ; in older children, iv, ; symptoms of in infants, iv, ; treatment of iv, . broncho-pneumonia, acute, iv, ; symptoms of, iv, ; how to tell when child has, iv, ; treatment of child with, iv, . bruise, or contusion, iv, . burbank, luther, on education, i, . burning clothing, how to extinguish, iv, . burns, and scalds, iv, . calomel, ii, ; how to take, ii, . cancer, in women, iii, ; what every woman should know about, iii, . carron oil, solution of, iv, . castor oil, ii, ; how to give dose of, ii, . catarrh, acute nasal, iv, ; symptoms of, iv, . catarrh powders, iii, . cathartics, calomel, ii, ; castor oil, ii, ; citrate of magnesia, ii, ; how to give children, ii, . cereals, ii, . chancre, the, ii, . change of life, conduct during, iii, ; the menopause, iii, ; symptoms of, iii, . cheerful wife and mother, iii, . chicken broth, ii, . [iii] chicken-pox, iv, ; symptoms of, iv, . child, the delicate, ii, ; diet of sick, ii, ; most helpless living thing, ii, ; rate of growth of, ii, ; sick, should be in bed, ii, ; washing mouth and eyes after birth, i, . child-birth, i, ; fear of, i, . children, acute intestinal diseases of, iv, ; constipation in, ii, ; hysterical, ii, ; rheumatism in, iv, ; temperature in, ii, ; with whom milk does not agree, iv, . cholera infantum, iv, . chlorosis, iv, ; symptoms of, iv, . chronic nasal catarrh, iv, ; treatment of, iv, . circumcision, should it be advised, ii, . citrate of magnesia, ii, ; how to take, ii, . clap, or gonorrhea, ii, . clothing, baby's, ii, . coddled egg, ii, . cold-pack, iv, . colds, catching, iv, . colic, iv, ; symptoms of, iv, ; treatment of, iv, . colitis, chronic, iv, . colon, irrigation of, iv, . colostrum, uses of, i, . condensed milk feeding, ii, ; objections to, ii, . confinement, choice of physician, i, ; convalescing after, i, ; domestic problem following first, i, ; how to calculate date of, i, ; how to prepare bed for, i, ; lacerations during, i, ; how long woman should stay in bed after, i, ; position and arrangement of bed for, i, ; preparations for, i, ; selection of a nurse, i, ; use of anesthetics in, i, ; what to provide for, i, . confinement chamber, presence of friends in, i, ; presence of relatives in, i, . constipation, ii, ; abuse of cathartics and aperient waters, ii, ; always harmful, ii, ; chief cause of, ii, ; cost of, ii, ; diseases of women and, ii, ; during pregnancy, i, ; in bottle-fed infants, ii, ; in breast-fed infants, ii, ; in girls between and , ii, ; in children over two years old, ii, ; in infants and children, ii, ; lack of bulk in food, ii, ; lack of exercise and, ii, ; lack of water, ii, ; negligence of, ii, ; pregnancy and, ii, ; significance of, ii, ; social exigencies and, ii, ; treatment of, ii, ; treatment of obstinate, ii, . consumption cure, iii, . consumptives, information for and those living with, iii, . contagious diseases, iv, ; conduct and dress of nurse for, iv, ; convalescence after, iv, ; rules to be observed in treatment, iv, ; what isolation means, iv, . contusion, or bruise, iv, . convulsions, iv, ; treatment of child with, iv, . cord, cutting, the, i, ; dressing the, ii, . cough, treatment of, iv, ; nervous or persistent, iv, . [iv] cream, for constipation in infants, ii, . croup, false, iv, ; treatment of false, iv, ; spasmodic, iv, ; treatment of spasmodic, iv, . deaf and dumb, i, . detention, symptoms of, ii, ; treatment of, ii, . desserts, ii, . diarrhoea, inflammatory, iv, ; summer, iv, ; symptoms of summer, iv, ; treatment of inflammatory, iv, ; treatment of summer, iv, . diet, of nursing mother, i, ; of the pregnant woman, i, ; of sick child, ii, ; for constipated child, ii, ; older children, ii, . dinner, the first after labor, i, . diphtheria, iv, ; symptoms of, iv, ; treatment of, iv, . disease, how we catch, iii, ; tendency to, iii, ; vice and, i, ; of womb, ovaries or fallopian tubes, ii, . disinfecting, clothing and linen, iv, ; mouth and nose, iv, ; sick chamber, iv, . dislocations, iv, . dog-bites, iv, . douche, how to give after labor, i, ; the use of when pregnant, i, . draw-sheet, the, i, . dried bread, ii, . dusting and cleaning, ii, . dysentery, cause of, iv, ; symptoms of, iv, . dysmenorrhea, ii, . ear, foreign bodies in, iv, ; inflammation of, iv, ; method of removing foreign bodies, iv, ; treatment of inflammation, iv, . earache, iv, . ears, do not box, iv, ; do not pick, iv, ; let them alone, iv, . eczema, iv, ; of the face, iv, ; rubrum, iv, . education, and the educator, i, ; eugenics and, i, ; dr. c. w. saleeby on, i, ; dr. helen c. putnam on, i, ; havelock ellis on, i, ; herbert spencer on, i, ; luther burbank on, i, ; wm. d. lewis on, i, ; true province of, i, ; what place sex hygiene will find in, ii, ; ella wheeler wilcox on, i, . educational systems, difficulty in devising, i, ; inadequate, i, . efficiency, requisites of, iii, . egg, coddled, ii, ; white of, ii, . ellis, havelock, on education, i, . emergencies and accidents, iv, . enema, high, iv, ; hot, . enteritis, cause of, iv, ; symptoms of, iv, . entero-colitis, iv, . enuresis, iv, . environment, i, . eruptions of the skin, ii, . establishing toilet habits, ii, . eugenic clubs, mother's, i, . eugenic idea, the, i, . eugenic principle, i, . eugenics, i, ; definition of, i, ; education and, i, ; and history, i, ; husband and, i, ; marriage and, i, ; motherhood and, i, ; [v] parenthood and, i, ; the unfit and, i, ; what every mother should know about, i, . exercise enough for husband, iii, ; lack of and constipation, iii, . eye, foreign bodies in, iv, ; method of removing foreign bodies from, iv, . fake medical treatment, for venereal diseases, ii, . father and the boy, ii, . fault-finding, iii, . feeble-minded, the, i, ; dr. john punton on, i, ; dr. max schlapp on, i, ; segregation and treatment of, i, . feeding, artificial, ii, ; artificial from birth to twelfth month, ii, ; the delicate child condition which will justify artificial, ii, ; during second year formulæ for artificial, ii, ; how to prepare milk mixtures, ii, ; intervals of, ii, ; overfeeding, ii, ; regularity of, ii, ; what a mother should know about, ii, ; why regularity is important, ii, . felon, run-around, or whitlow, iv, ; treatment of, iv, . female, beginning of, disease, iii, ; chief cause of diseases, iii, ; diseases are avoidable, iii, ; generative organs, ii, ; weakness cures, iii, ; what woman with disease should do, iii, . fermentation, of the stomach, ii, . fertility, conditions which affect women, ii, . fever, cold packs for, iv, ; cold sponging for reducing, iv, ; ice cap for reducing, iv, ; methods of reducing, iv, . finger, biting the nails, iv, . fit, the, only shall be born, i, . fits, iv, . fly, dangerous house, iv, ; to kill, iv, . fomentations, hot, iv, . food, allowable during first year, ii, ; bran as a, ii, ; formulæ for baby, ii, . foodstuffs, iv, . foreign bodies, in nose, iv, ; in throat, iv, . formative period, the, iii, . fraudulent testimonials, iii, . friends, choosing your, iii, ; your husband's, iii, . fruits, ii, . garbage, iv, . gastric indigestion, acute, iv, ; treatment of, iv, . gastro duodenitis, iv, . generative organs, female, ii, . genital organs, care of, ii, . girl, what a mother should tell her little, ii, . glands, swollen, iv, ; treatment of swollen, iv, . gleet, ii, gonorrhea, symptoms of in a man, ii, ; wife infected with, ii, . good health, requirements of, ii, . government investigation of patent medicines, iv, . [vi] habits, of delicate child, ii, . hair, falls out in syphilis, ii, . headache, iv, ; during pregnancy, i, ; remedies, iii, ; treatment of, iv, . heartburn, during pregnancy, i, . hemorrhage, arrest of, iv, ; nasal, iv, . heredity, i, ; and eugenics, i, ; function of education, i, . hiccough, iv, . high school, system fallacious, i, . hives, iv, ; cause of, iv, ; treatment of, iv, . home, good housekeeper, iii, ; owning a, iii, ; the ideal, iii, ; what makes the, iii, . honeymoon, the, iii, ; marital relations during, iii, . hot pack, iv, . housefly, dangerous, iv, . housekeeper, what constitutes an efficient, iii, . husband, and home, iii, ; is he to blame, ii, ; the, and eugenics, i, . hysterics, and children, ii, ; treatment of, ii, . ice-cap, for reducing fever, iv, . ileo-colitis, chronic, iv, ; treatment of, iv, . imperial granum, ii, . incontinence, iv, . indigestion, acute gastric, iv, ; acute intestinal, iv, ; symptoms of acute intestinal, iv, ; treatment of acute gastric, iv, ; treatment of acute intestinal, iv, . infants, constipation in bottle-fed, ii, ; jaundice in, iv, ; mortality of, i, ; records of, ii, . infection, direct, iv, . infectious diseases, iv, . inflammatory diarrhea, iv, . influenza, iv, ; symptoms of, iv, ; treatment of, iv, . injections, oil, ii, . insane, care of, i, . insomnia, during pregnancy, i, . interior organs, complications of in syphilis, ii, . intermittent fever, iv, . intestinal diseases of children, iv, . intestinal indigestion, acute, iv, ; symptoms of acute, iv, ; treatment of, iv, . intestinal worms, iv, . jaundice, catarrhal, iv, ; in infants, iv, ; in older children, iv, . junket, ii, . kelly pad, the, i, . knowledge, two ways of gaining, iii, . labor, after-pains, i, ; beginning of, i, ; clothing during, i, ; conduct during second stage of, i, ; conduct immediately following, i, ; douching after, i, ; first breakfast after, i, ; first dinner after, i, ; first lunch after, i, ; first stage of, i, ; importance of emptying bladder after, i, ; the lochia, or discharge after, i, ; management of, i, ; putting baby to breast after, i, ; second stage of, i, . lacerations during confinement, i, . [vii] la grippe, iv, ; treatment of, iv, . laryngitis, acute catarrhal, iv, ; treatment of, iv, . leucorrhea, cause of sterility, ii, ; in girls, ii, . lewis, wm. d., on education, i, . life and insurance, iii, . lithia water, iii, . lochia, or discharge after labor, i, . lunch, the first after labor, i, . malaria, intermittent fever, iv, ; serum for, iv, ; treatment of, iv, . malformation, ii, . man, building a, ii, . marital relations, when they are painful, iii, ; when they should be suspended, iii, . marriage, and motherhood, i, ; best age for, iii, ; certificate and vice, i, ; certificate, utility of, i, ; evils of early, iii, ; failures in, i, . mastitis, in infancy, iv, ; in young girls, iv, . masturbation, or self-abuse, ii, . meats, medical essentials of good, iii, ; preparation and selection of, iii, . measles, iv, ; complications in, iv, ; koplik's spots in, iv, ; rules of department of health, iv, ; symptoms of, iv, ; treatment of, iv, . medical, letter brokers, iii, ; reliable advice, iii, . medicine chest, contents of family, iv, . medicine concern run by women, iii, . menstruation, ii, ; irregular, ii, ; painful, ii, ; should not be accompanied with pain, ii, ; symptoms of, ii, ; treatment for painful, ii, ; why it occurs every days, ii, . milk, children with whom it does not agree, iv, ; difference between human and cows, ii, ; mixture, how to prepare, ii, ; peptonized, ii, . mind, training the, iii, . miscarriage, ii, ; after treatment of, ii, ; causes of, ii, ; course and symptoms of, ii, ; what to do when threatened with, ii, ; tendency to, ii, ; womb displacement in, ii, . mosquitoes, regarding, iv, ; rules of department of health, iv, . mother, the cheerful, iii, ; education of the, ii, ; existence of the average, iii, ; what she should know about eugenics, i, ; what she should tell her little girl, ii, ; what she should tell her daughter, ii, . motherhood, eugenics and, i, ; function of, i, ; preparing for, ii, . mothers, eugenic clubs, i, ; girls must not become, ii, . moths, iv, . mouth, how to disinfect, iv, ; sore, iv, ; treatment for ulcers in, iv, ; treatment of sore, iv, . mucous patches, and ulcers, ii, . mumps, iv, ; symptoms of, iv, . mustard bath, iv, . mustard paste, how to make, iv, . [viii] mustard pack, how to prepare and use, iv, . mutton broth, ii, . napkins, sanitary, i, . nasal discharge, chronic, iv, . nausea, during pregnancy, i, . nettle-rash, iv, ; cause of, iv, ; treatment of, iv, . night losses, or "wet dreams," ii, . nightmare or night terrors, iv, ; treatment of, iv, . nipples, care of, i, ; cracked, i, ; tender, i, ; treatment of cracked, i, ; what mother should know about bottle and, ii, . normal salt, solution of, iv, . nose, chronic discharge of, iv, ; complications of in syphilis, ii, ; foreign bodies in, iv, . nose-bleeds, iv, . nosophobia, or the dread of disease, iii, . nursery maid, qualifications of, i, . nursing mothers, i, ; diet of, i, ; mastitis in, i, ; nervous, i, . oatmeal water, for constipation in infants, ii, . oat-water, ii, . obstetrical outfits, ready to purchase, i, . oil injections, ii, . oiled silk, iv, ; what it is and why it is used, iv, . orange juice, ii, ; for constipation in infants, ii, . organs, transplanting from dead to living, iv, . otitis, acute, iv, . ovaries, disease of, ii, ; function of, ii, . overeating, ii, ; iii, ; symptoms of, ii, . overfeeding the baby, ii, . parents, and the boy, ii, ; a word to, ii, ; eugenics and, i, . parotitis, epidemic, iv, . patent medicines, and education, iii, ; and eugenics, iii, ; and the newspaper, iii, ; conspiracy against freedom of press, iii, ; dangers of, iii, ; fraudulent testimonials, iii, ; intoxicating effects of, iii, ; government investigation of, iii, ; pure food and drug act, iii, , . patent medicine evil, iii, , ; and the duty of mothers iii, ; what mothers should know about the, iii, . people, two kinds of, iii, . peptonized milk, ii, . physicians, what they are doing, iv, . pimples, iv, . pneumonia, iv, . poultices, iv, . pox, or syphilis, ii, . precautions to be observed, iv, . pregnancy, avoidance of drugs during, i, ; clothing during, i, ; constipation during, i, ; headache during, i, ; heartburn during, i, ; hygiene of, i, ; insomnia during, i, ; minor ailments of, i, ; morning nausea, i, ; sexual intercourse during, i, ; social side of, i, ; undue nervousness during, i, ; vagaries of, i, ; vaginal discharge, i, ; varicose veins, cramps and neuralgia during, i, . [ix] pregnant, few ailing women become, iii, ; conduct of woman, i, ; diet of woman, i, ; mental state of woman, i, ; when woman should first call upon physician, i, . prickly heat, iv, ; treatment of, iv, . principle, differences of, iii, . privy vaults, iv, . procreative function, abuse of, ii, ; iii, . procreative power, period of, ii, . puberty, age of, ii, ; period of in the female, ii, . pulse, rate in children and adults, ii, . punton, dr. john, on feeble-minded, i, . pure food and drug act, iii, , . putnam, dr. helen c., on education, i, . quacks, how they dispose of confidential letters, iii, . quarrel, the first, iii, . quinsy, iv, . race culture, i, ii. radium, iv, . rashes, of childhood, iv, ; other, iv, ; treatment of, iv, . records, infant, ii, . rectal irrigations, to reduce fever, iv, . reproductive organs, changes in, ii, ; function of the, ii, . resolves, making, iii, . rest and recreation, iii, . rest and sleep, iii, . rheumatism, in children, iv, ; treatment of acute attack, iv, ; treatment of tendency to, iv, . rhinitis, chronic, iv, . rice water, ii, . ringworm, of the scalp, iv, . rubbers, practice of wearing needs consideration, iv, . run-around, or felon, iv, ; treatment of, iv, . rupture, iv, . saleeby, dr. c.w., on education, i, . sanitary napkins, how to prepare, i, . santonin, for worms, iv, . scalds and burns, iv, . scalp, ringworm of, iv, ; wounds of, iv, . scarlet fever, iv, ; complications in, iv, ; eruptions, iv, ; measures to prevent spread of, iv, ; treatment of, iv, . scarlatina, iv, . scientific dressing, iii, . schlapp, dr. max, on the feeble-minded, i, . self-abuse or masturbation, ii, . self-culture, young wife's incentive to, iii, . serum, anti-meningitis, iv, ; for malaria, iv, . sexual excesses, ii, ; treatment of, ii, . sexual intercourse, during pregnancy, i, . shock, the condition of, iv, . sitz bath, during pregnancy, i, . " ," iv, . skin, care of, ii, ; care of in contagious diseases, iv, ; eruptions of, ii, . sleeplessness, causes of, iv, ; treatment of, iv, . social evil, what parents should know about, ii, . solutions, normal salt, iv, ; various, iv, . soothing syrup, iii, . sore mouth, iv, ; treatment of, iv, . [x] sore throat, iv, . sowing wild oats, ii, . spasms, iv, . spencer, herbert, on education, i, . spermatozoa, functions of the, ii, ; the male, or papa egg, ii, . sprains, iv, . sprue, iv, ; treatment of, iv, . stables, iv, . sterility, ii, ; causes of, in women, ii, . sterilizing, food for day's feeding, ii, . stomach, diseases of, iv, ; fermentation of, ii, ; function of the, ii, . stomach bitters, alcohol in, iii, . stomatitis, iv, . story, dr. thomas a., on education, i, . study habit, the, iii, . sullivan, dr., on alcoholic drunkenness, i, . success, attainment of, iii, ; formula of, iii, . summer diarrhea, iv, ; symptoms of, iv, ; treatment of, iv, . summer diseases of intestines, iv, . surgery, aseptic, iv, . syphilis, or the "pox," ii, . tape worms, iv, . teeth, care of the, ii, ; how they come, ii, . temperature, in children, ii, . thiersch's solution, iv, . thought, bad habits of, iii, ; what is a, iii, . thread worm, iv, . throat, foreign bodies in, iv, ; sore, iv, . thrush, iv, ; treatment of, iv, . thumb-sucking, iv, . tonsilitis: angina, "sore throat," iv, ; treatment of acute, iv, . transplanting organs of dead to living, iv, . tuberculosis, best treatment for, iii, ; facts about, iii, . turpentine stupe, the, iv, . typhoid, how to keep from spreading, iv, ; how to prevent getting, iv, ; symptoms of, iv, ; vaccine in, iv, . ulcers, in mouth, iv, ; mucous patches and, ii, . vacant lots, iv, . vaccination, method of, ii, ; symptoms of successful, ii, ; time for, ii, ; treatment, ii, . vaccine in typhoid fever, iv, . vapor bath, iv, . varicella, iv, . varicose veins, during pregnancy, i, . vegetables, ii, . venereal diseases, fake medical treatment for, ii, ; ten million victims of, i, . vomiting, of children between feedings, ii, ; significance of after feeding, ii, . washing dishes, iii, . water, drink plenty of, iii, . weaning, i, ; care of breasts when, i, ; menstruation and, i, ; methods of, i, ; rapid, when it is necessary, i, ; when to start, i, . wedding night, its medical aspect, iii, . what to eat and wear in hot weather, iii, . when delays are dangerous, iii, . whey, ii, . whitlow, or felon, iv, . [xi] whooping cough, iv, ; symptoms of, iv, ; treatment of, iv, . wife, her part, iii, ; the cheerful, iii, ; the indifferent, iii, ; what she owes to herself, iii, . wifehood, first weeks and months of, iii, . wilcox, ella wheeler, on education, i, . womb, function of, ii, ; how baby gets nourishment in, ii, ; how held in place, ii, . women, ailing, are inefficient, iii, ; diseases of, iii, ; who don't want children, iii, ; medicine concern run by, iii, ; most popular, iii, ; use of patent medicines in diseases, iii, . work, must be interesting, iii, . working for something, iii, . worms, intestinal, iv, ; round, iv, ; symptoms of tape, iv, ; symptoms of thread, iv, ; tape, iv, ; thread, iv, ; treatment of round, iv, . worry, freedom from, iii, . wound, cleaning a, iv, ; closing and dressing a, iv, ; removal of foreign bodies from, iv, . wounds, iv, ; of the scalp, iv, . x-ray, treatment and diagnosis, iv, . * * * * * volume i * * * * * [xv] table of contents eugenics. race culture chapter i conditions which have evolved the science of eugenics infant mortality--marriage and motherhood--heredity--environment--education--disease and vice--history--summary ... page chapter ii the eugenic idea the value of human life--the eugenic principle--"the fit only shall live"--eugenics and marriage--the venereal diseases--the utility of marriage certificates--the marriage certificates and vice--eugenics and parenthood--the principle of heredity--eugenics and motherhood--eugenics and the husband ... page chapter iii eugenics and education the present educational system is inadequate--opinions of dr. c.w. saleeby, ella wheeler wilcox, luther burbank, william d. lewis, elizabeth atwood, dr. thomas a. story, william c. white, dr. helen c. putnam--difficulty in devising a satisfactory educational system--education an important function--the function of the high school--the high school system fallacious--the true function of education ... page chapter iv eugenics and the unfit the deaf and dumb--the feeble-minded--a new york magistrate's report--report of the children's society--the segregation and treatment of the feeble-minded--what the care of the insane costs--the alcoholic--drunkenness ... page chapter v what every mother should know about eugenics page [xvi] child-birth chapter vi preparations for the confinement the birth chamber--what to provide for a confinement--ready to purchase obstetrical outfits--position and arrangement of the bed--how to properly prepare the accouchement bed--the kelly pad--the advantages of the kelly pad--should a binder be used--sanitary napkins--how to calculate the probable date of the confinement--obstetrical table--when should a pregnant woman first call upon her physician--regarding the choice of a physician--how to know the right kind of a physician for a confinement--the selection of a nurse--the difference between a trained and a maternity nurse--duties of a confinement nurse--the requisites of a good confinement nurse--the personal rights of a confinement nurse--criticizing and gossiping about physicians ... page chapter vii the hygiene of pregnancy daily conduct of the pregnant woman--instructions regarding household work--instructions regarding washing and sweeping--instructions regarding exercise--instructions regarding passive exercise--instructions regarding toilet privileges--instructions regarding bathing--instructions regarding sexual intercourse--clothing during pregnancy--diet of pregnant women--alcoholic drinks during pregnancy--the mental state of the pregnant woman--the social side of pregnancy--minor ailments of pregnancy--morning nausea, or sickness--treatment of morning nausea, or sickness--nausea occurring at the end of pregnancy--undue nervousness during pregnancy--the % baby--headache--acidity of the stomach, or heartburn--constipation--varicose veins, cramps, neuralgias--insomnia--treatment of insomnia--ptyalism, or excessive flow of saliva--vaginal discharge, or leucorrhea--importance of testing urine during pregnancy--attention to nipples and breasts--the vagaries of pregnancy--contact with infectious diseases--avoidance of drugs--the danger signals of pregnancy ... page chapter viii the management of labor when to send for the physician in confinement cases--the preparation of the patient--the beginning of labor--the first pains--the meaning of the term "labor"--length of the first stage of labor--what the first stage of [xvii] labor means--what the second stage of labor means--length of the second stage--duration of the first confinement--duration of subsequent confinements--conduct of patient during second stage of labor--what a labor pain means--how a willful woman can prolong labor--management of actual birth of child--position of woman during birth of child--duty of nurse immediately following birth of child--expulsion of after-birth--how to expel after-birth--cutting the cord--washing the baby's eyes immediately after birth--what to do with baby immediately after birth--conduct immediately after labor--after pains--rest and quiet after labor--position of patient after labor--the lochia--the events of the following day--the first breakfast after confinement--the importance of emptying the bladder after labor--how to effect a movement of the bowels after labor--instructing the nurse in details--douching after labor--how to give a douche--"colostrum," its uses--advantages of putting baby to breast early after labor--the first lunch--the first dinner--diet after third day ... page chapter ix confinement incidents regarding the dread and fear of childbirth--the woman who dreads childbirth--regarding the use of anesthetics in confinements--the presence of friends and relatives in the confinement chamber--how long should a woman stay in bed after confinement--why do physicians permit women to get out of bed before the womb is back in its proper place?--lacerations, their meaning, and their significance--the advantage of an examination six weeks after the confinement--the physician who does not tell all of the truth ... page chapter x nursing mothers the diet of nursing mothers--care of the nipples--cracked nipples--tender nipples--mastitis in nursing mothers--inflammation of the breasts--when should a child be weaned?--method of weaning--nursing while menstruating--care of breasts while weaning child--nervous nursing mothers--birthmarks--qualifications of a nursery maid ... page chapter xi convalescing after confinement the second critical period in the young wife's life--the domestic problem following the first confinement ... page * * * * * [xix] introduction despite the fact that much has been written during the past two or three years with reference to eugenics, it is quite evident to any one interested in the subject that the average intelligent individual knows very little about it so far as its scope and intent are concerned. this is not to be wondered at, for the subject has not been presented to the ordinary reader in a form that would tend to encourage inquiry or honest investigation. the critic and the wit have deliberately misinterpreted its principles, and have almost succeeded in masking its supreme function in the garb of folly. the writer has yet to meet a conscientious mother who fails to evince a reasonable degree of enthusiastic interest in eugenics when properly informed of its fundamental principles. the eugenic ideal is a worthy race--a race of men and women physically and mentally capable of self-support. the eugenist, therefore, demands that every child born shall be a worthy child--a child born of healthy, selected parents. no one can successfully assail the ethics of this appeal. it is morally a just contention to strive for a healthy race. it is also an economic necessity as we shall see. the history of the world informs us that there have been many civilizations which, in some respects, equalled our own. these races of people have all achieved a certain success, and have then passed entirely out of existence. why? _and are we destined to extinction in the same way?_ we know that the cause of the decline and ultimate extinction of all past civilizations was due primarily to the moral decadence of their people. disease and vice gradually sapped their vitality, and their continuance was impossible. [xx] it would seem to be the destiny of a race to achieve material prosperity at the expense of its morality. when conditions render possible the fulfilment of every human desire, the race exhausts its vitality in a surfeitment of caprice. the animal instincts predominate, and the potential vigor of the people is exhausted in contributing to its own amusement. each succeeding civilization has reached this epochal period, and has fallen, victim of the rapacity of stronger and younger invading antagonists, _themselves to succumb to the same insidious process_. the present civilization has reached this epochal--this transition--period. in one hundred years from now we shall either have accomplished what no previous civilization accomplished, or we shall have ceased to exist as a race. our success depends on the response of the people to the eugenic appeal. few appreciate the responsibility involved. it is not necessary, however, to combat or deplore the evils of the past. civilization has failed in the task of race-maintenance; it failed, however, in ignorance. we cannot plead the same excuse. we are face to face with conditions that we must solve quickly or our destiny will be decreed before we apply the remedy. a function of the eugenist is to gather and attest statistics, and to establish conclusions based on these statistics. it has been conclusively demonstrated that, if the race continues to progress as it exists now--that is, if conditions remain the same, and our standard of enlightenment, so far as racial evolution is concerned, does not prompt us to adopt new constructive measures--_every second child born in this country, in fifty years, will be unfit; and, in one hundred years, the american race will have ceased to exist_. we mean by this that every second child born will be born to die in infancy, or, if it lives, will be incapable of self-support during its life, because either of mental degeneracy or physical inefficiency. this appalling situation immediately becomes a problem of civilization. no state can exist under these conditions. if these statistics are reliable--and we know they are true and capable of verification by any individual who will go to the trouble of [xxi] investigating them--it is self-evident that a radical change must immediately be instituted to obviate the logical consequences that must follow as a sequence. the eugenic demand, that "every child born shall be a worthy child," is, therefore, the solution of the problem. this does not imply, however, that the eugenist must solve the elementary problem of how the state will ensure its own salvation by guaranteeing worthy children. worthy children can come only from fit and worthy (clean and healthy) parents. it becomes the imperative function of the state--the function on which the very life of the state depends--to see that every applicant for marriage is possessed of the qualities that will ensure healthy, worthy children. we must, therefore, sooner or later devise a system of scientific regulation of marriage, and it is at this point we stumble against the problem that has prompted the ebullitions of the wit and the sarcasm of the critic. a casual reference to the science immediately suggests to the layman an impossible or quixotic system of marriage by force. even the word "eugenics" is associated in the minds of many otherwise estimable old ladies, and others who should know better, with a species of malodorous free love, and their hands go up in holy horror at the intimation of a scientific regulation of this ancient function. unfortunately, the popular mind has received the impression that this incident constitutes the sum total of the eugenic idea, while the truth is that the eugenist is only slightly concerned with its modus operandi. this feature has been so magnified by widely published disingenuous discussion that it has assumed the aspect of a test problem, a judgment on which shall decide the utility of the science itself. should this decision be unfavorable, it would seem, according to its exponents, that it would not be worth while promulgating the doctrines of the science beyond this point. it is as though we were asked to deny ourselves the inspiration and pleasure of a trip abroad because the morning of the day on which the ship sailed happened to be cloudy. it is certainly no part of the function of the eugenist to uproot [xxii] instinct, or to trample into the dust age-long rights, though the instinct is simply the product of an established habit, based on an erroneous hypothesis, and the so-called rights simply acquired privileges, because the intelligence that would have builded differently was not awakened. eugenic necessity will render imperative the state's solution of this fundamental problem, for the reason that civilization will be driven to demand its just inheritance--the right to exist. the eugenist will not be compelled to open the door; it will be opened for him. we can afford, therefore, to wait with supreme confidence, because the good sense of the people will not always submit to the tactics of the jester when it needs a saviour. the eugenist does not seek to interfere with the liberties of the rising generation: a boy may choose whom he will; the girl may select the one who appeals to her most, and they may enjoy all the vested rights and romance that custom has decreed the lover; but, when they resolve to marry, _the state must decide their qualifications for parenthood_. this must be the crucial test of the future. the life of the state depends on it. the continuance of the race must be the supreme object of all future constructive legislation. we must recognize that "life is the only wealth," and that every other criterion of an advanced civilization must measure its success according to its wealth in worthy parenthood. the eugenist does not even dictate what the test for parenthood shall be. common sense, however, suggests that it will assume some form that will eliminate those physically or mentally diseased. he believes that, when the people are sufficiently educated to appreciate the object in view, they will devise a system that will meet with universal approval. eugenics concerns itself with problems on which the destiny of the race depends. it must not, therefore, be limited to questions relative to mating and breeding. every factor that contributes to the well-being and uplifting of the race, every subject that bespeaks physical or mental regeneration, that aids moral and social righteousness and salvation, and promises a greater social happiness and contentment, has a eugenic [xxiii] significance. so long as there exists an unsupported mother or a suffering child; so long as we rely on hospitals and prisons, penitentiaries and the police, to minister to the correction and regeneration of the unfit and degenerate; so long as we tolerate grafting politicians and deprive the poor of breathing spaces, sanitary appliances, and a hygienic environment; so long as war and pestilence deprive posterity of the best of the race for parenthood; so long as we emphasize rescue rather than prevention, so long must the eugenist strive unceasingly to preach his propaganda of race regeneration. the scope of eugenics is too far-reaching in its beneficent purpose to be fettered by the querulous triflings of the ancient or intellectual prude; nor should it be belittled by the superficial insight of the habitual scoffer. it is not a fantasy nor an idle dream. it is not even an inspiration. the destiny of the race has brought us face to face with conditions unparalleled in the history of this civilization, and the very existence of the race itself may be wholly dependent on the foresight of the minds that have made the science of eugenics possible. a brief consideration of the conditions that actually exist, with which we are face to face, and which certainly justify the existence of a science whose function it should be to demand serious investigation of methods of race regeneration, may help the reader to an intelligent and practical understanding of the tremendous importance of the subject. it has been already remarked that, at the present rate of decrease, the birth-rate will be reduced to zero within a century. if the birth-rates in england, germany, and france should continue to decrease as they have since , there would be no children born, one hundred years hence, in these countries. while we do not assert, and probably none of us believes that either or all of these nations will actually be out of existence in a hundred years--unquestionably because we feel, at least we hope, that our methods will be so changed in that time that the necessary modification will ensure a continuance of the race, nevertheless, the fact remains that _the inevitable result of continuing along present lines will be [xxiv] that, within the period of one hundred years, these peoples will cease to perpetuate themselves_. it is not necessary to enquire closely into the various causes for this unparalleled situation. the falling birth-rate in itself is not the prime cause. even admitting that there are enough babies born, too many of them are born only to die in infancy. we need no further proof of the urgent need for conscientious inquiry, call it by what name you please. the science of common sense is all-sufficient. the seemingly intelligent individual who can only find material for ribaldry in this connection is a more serious buffoon than he imagines. it is apparent that our methods are wrong. any constructive effort to correct them is commendable. when it is stated that per cent. of the american women are unable to bear children, and that per cent. of all the others are unwilling to assume the burden and responsibility of motherhood, we partly realize the gravity of the case. on the other hand, statistics show that the majority of men have acquired disease before they marry, and that a very large percentage of these men convey contagion to their wives. this condition, to a very large extent, accounts for the inefficiency of women as mothers. it is responsible for at least per cent. of the sterility that exists. the effect of this deplorable condition is directly responsible, also, for the ill health that afflicts women and that renders necessary the daily operations of a serious nature that are conducted in every hospital in every city in the civilized world. as a result of the dissemination of this poison, children are born blind, or are born to die, or, if they live, they are compelled to carry all through their helpless lives the stigma of disease and degeneration. it would surely seem that the individual to whom god has given intelligence and a conscience cannot think of these, the saddest facts in human experience, without resentment and humility. _surely the time has arrived when every boy should know, from his earliest youth, that there is here on earth an actual punishment for vicious living as frightful as any that the mind of man can conceive._ [page xxv] when we inquire into the cause of this trend toward race degeneracy, we find that poverty and the inability of the workingman to support large families, luxurious living, and the life of ease and amusement on the part of the women of wealth; the fact that an increasingly large number of women have entered professions that prevent motherhood, and that the number of apartment-houses where children are not wanted are on the increase, all play their part. in this age of intense living, it is not to be wondered at that many shrink from the responsibility of rearing children, and the same conditions that contribute to this decadent ideal intensifies sex-hunger, and it is this dominating passion that tolerates and makes possible the most frightful crime of the age--infanticide. greece and rome paved the way for their ultimate annihilation when their beautiful women ceased to bear children and their men sought the companionship of courtesans. baby contests have demonstrated that only one child in ten was found to be good enough to justify a second examination. in a test examination in the public schools, only eight in five thousand were competent to qualify in all the tests. one of these eight was a chinese boy and another an american-born son of a native greek. of the twenty million school-children in the united states, not less than per cent. need immediate attention for physical defects. while man has been assiduously improving everything else, he has neglected to better his own condition. every animal that man has taken from its native haunts and domesticated, he has efficiently improved. he has even produced more marvelous results by the application of the same principles to the vegetable kingdom. in his haste to civilize himself, however, he has failed to apply the principles that are essential to self-preservation. it is regrettable, also, to know that, while the government has spent many thousands of dollars in sending out literature to the farmers, instructing them how to raise profitable crops and to breed prize horses and pigs, absolutely none of the public money has been used in instructing american mothers how to raise healthy children. [page xxvi] a distinguished insurance expert has proved that there was an increase of nearly per cent. in the mortality from degenerative diseases in the united states between and . the growing prevalence of these diseases indicates a falling-off in the vitality of the race. it means that the diseases of old age are invading the younger ranks. the life extension institute, of new york city, in its recent report, states that "forty of every hundred men and women employed in the wall street district require medical attention; twenty of the forty need it immediately, and ten of the forty must have it to avert serious results." there are from one-quarter to three-quarters of a million of preventable deaths every years in this country. that number of individuals could have been saved with proper care and attention to health in the early stages of disease, or before it gained a start. practically all the diseases that carry business men off prematurely are curable in the early stages. of the percentage of wall street men who need medical attention immediately, most have kidney or heart disease. the others are victims of typical unhygienic habits, such as fast, gluttonous eating, neglect of exercise, too much tobacco and liquor, and bad posturing in the office. the business man considers these trifles, but they count heavily. business efficiency is greatly increased, first, by selecting men physically fit for work, and, second, by keeping them in that condition. there is a tremendous waste from inefficiency constantly going on, due to impaired health. wall street has an astonishing corps of neurasthenics. we need a broader interpretation of the term eugenics, so that we may gain a more sympathetic and tolerant audience. the remedy does not lie in an academic discussion of these problems; to continue the debate behind closed doors will not lead anywhere: the public must be educated to a just appreciation of existing conditions and the remedy must be the product of effort on its part. any condition that fundamentally means race deterioration must be [xxvii] rendered intolerable. the prevalant dancing craze is an anti-eugenic institution, as is the popularity of the delicatessen store. no sane person can regard with complacency the vicious environment in which the future mothers of the race "tango" their time, their morals, and their vitality away. we do not assume to pass judgment on the merits of the dance; we do, however, emphatically condemn the surroundings. the moving-picture shows, vaudeville entertainments, dancing carnivals, the ease of travel, the laxity of laws, the opportunities for promiscuous interviews, all tend to give youth a false impression of the reality of life and to make the path of the degenerate easy and attractive. the history of civilization is, curiously enough, the story of masculine brutality, self-indulgence, and vice. the history of the world also proves that woman's sphere has been to submit patiently and silently to injustice and imposition. _practical eugenics is the first worthy effort in the history of all time to hold men and women responsible for their mode of living._ it is a mighty problem. there is no greater nor more difficult one to be solved. it has taken eons to bring men to the point of questioning their right to do as they please; it will take time to compel them to realize their disgrace and acknowledge their duty. when we consider that there are eighty thousand women condemned to professional moral degradation in the city of london, and that every so-called civilized city on the globe contributes its pro rata share to this army of potential mothers, we begin to appreciate the vastness of the task. eugenics has already accomplished what no other movement has ever accomplished: it has created the spirit that gave birth to the thought of men's responsibility, and it has taught us that the female of the race has rights. we can now speak without fear; the light is no longer hidden. women must realize, however, that they have contributed, and continue to contribute, to race degeneracy. we hear and read much about the double standard of morals. as long as woman are willing to marry their daughters to reformed rakes, providing they have money and social position, [xxviii] so long shall we have a double standard. so long as young society women go into hysterics over pedigreed dogs and horses and then marry men reeking in filthy unfitness for parenthood, mothers cannot expect any other standard of morals. so long as one marriage in twelve ends in divorce, the ethics of the female need enlightenment. we shall not get another standard of morals until women themselves demand it and insist on it. if they lend themselves to breaking down the conspiracy of silence, the women may solve the marriage problem by refusing to marry rakes. we need a more liberal construction of the intent of eugenics in order to clarify the obtuse minds so that its propaganda of education may be easily and justly comprehended. there is no field for speculation in the analysis of right living. it conforms to the law of cause and effect. it is positively concrete in substance. a recital of the life history of jonathan edwards, in comparison with that of the celebrated "jukes" family, emphasises this assumption with a degree of positiveness that is tragic in its significance. jonathan edwards was born in england in queen elizabeth's time. he was a clergyman and he lived an upright life. so did his wife. his son came to the united states, to hartford, connecticut, and became an honorable merchant. his son, in turn, also became a merchant, upright and honored. his son, again, became a minister, and so honored was he that harvard university conferred two degrees on him on the same day; one in the morning and one in the afternoon. this learned man again had a son, and he became a minister. jonathan edwards was his name. now let us see, in , what this one family, started by a man in england who lived an upright life and gave that heritage to his children, produced: , descendants of this man have been traced and identified; were college graduates; were college presidents; were professors; were physicians; were clergymen; were lawyers; were judges; was vice-president of the united states; were army and navy officers; [xxix] were prominent authors; were railroad and steamship presidents; and in the entire record not one has been convicted of a crime. twelve hundred descendants have been traced from the one man who founded the "jukes" family. this record covers a period of seventy-five years; out of these, were professional paupers, who spent an aggregate of two thousand three hundred years in poorhouses; were evil women; were murderers; were habitual thieves; and were common criminals. it has been estimated that this one family was an economic loss to the state, measured in terms of potential usefulness wasted; costs of prosecution; expenses of maintenance in jails, hospitals and asylums; and of private loss through thefts, and robberies, of $ , , in seventy-five years, or more than $ , for each member of the family. _it would seem to be worth while to be well born, after all._ in order to succeed in the regeneration of the race, we must believe that race regeneration is possible, and, that it is worth while. we must preach its principles as we would a religion. the power of knowledge is a mighty lever. we are living in a period of transition, but we are nearer the future than the past. we are told by the average individual that it will be impossible to arouse the public to an intelligent appreciation of the scope of race regeneration. when the writer conceived the happy phrase, "better babies," a few years ago, he builded better than he knew. it has become the slogan of splendid achievement already, and there are a multitude of signs and tokens that the propaganda is established on a sure foundation. if the annihilation of all past civilizations was due to the refusal of its members to breed for posterity, may we not reasonably assume that we have, according to our statistics, reached the same crisis? if this is logical reasoning, and every factor warrants this conclusion, have we not reached the time when the perpetuation of the race is the most serious question of our times? is it not a problem for the enthusiastic and immediate [xxx] support of every statesman, politician, teacher, and preacher alike? can any question be of more importance? what will our marvelous material splendor avail if the race is destined to immediate extinction? we need the assistance of every intelligent citizen, we need most, the awakening impulse of the mothers of the race. we who are alive are responsible for environment and nurture, and we must believe that the purpose to be achieved is of supreme importance. every mother, through the power of knowledge, may become a practical eugenist. it is to aid her in an intelligent appreciation of the practical intent of the science that this work is presented. w. grant hague, m.d. new york city. * * * * * [ ] the eugenic marriage chapter i "nations are gathered out of nurseries." charles kingsley. "to be a good animal is the first requisite to success in life, and to be a nation of good animals is the first condition of national prosperity." herbert spencer. conditions which have evolved the science of eugenics infant mortality--marriage and motherhood--heredity--environment--education--disease and vice--history--summary. there has been evinced during recent years a desire to know something more definite about the science of eugenics. eugenics, simply defined, means "better babies." it is the art of being well born. it implies consideration of everything that has to do with the well-being of the race: motherhood, marriage, heredity, environment, disease, hygiene, sanitation, vice, education, culture,--in short, everything upon which the health of the people depends. if we contribute the maximum of health to those living, it is reasonable to assume that the future generation will profit thereby, and "better babies" will be a direct consequence. we are frequently told that we must take the world as we find it. this has been aptly termed, "the motto of the impotent and cowardly." "life is what we make it," is the more satisfying assertion of the optimist, and most [ ] of us seem to be trying to make existence more tolerable and more happy. it is encouraging to know that intelligent men and women to-day seek an opportunity to devote serious consideration to the betterment of the race, while yet the pursuit of wealth and pleasure are enticing and strenuous occupations. it would be superfluous in a book of this character to enter into any lengthy explanation as to how the science of eugenics proposes to work out its problems. we hope only to excite the interest of mothers in the subject, and to instruct them in its rudiments and principles. it will be of distinct advantage, however, first to briefly consider the conditions,--which are known to all of us,--which have led up to the present status of the subject. infant mortality.--no elaborate argument is necessary to prove that the present infant mortality, in every civilized country, is too high. it is conceded by every authority interested in the subject, no matter what explanation he offers, or what system he advances as a solution of the problem. marriage and motherhood.--every intelligent person knows that most young girls enter into the marriage relationship without a real understanding of its true meaning, or even a serious thought regarding its duties or its responsibilities. we know that their home training in domestic science is generally not adequate, and that their educational equipment is inefficient. we also know that economic necessity has deprived them of the tutelage essential to social progress and physical health, and has endowed them with temperamental characteristics undesirable in the mothers of the race. maternity is thrust upon these physically and mentally immature young wives, and they assume the principal rôle in a relationship that is onerous and exacting. we know that the duties of wife and mother require an intelligence which is rendered efficient only by maturity and experience. we know that many, if not most, young wives acquire habits which undermine their health and their morals unwittingly, and we also know that the product of this inefficiency results in the decadence and the [ ] degeneration of the race. heredity.--much remains inexplicable at the present time regarding this intensely interesting department of science. we do know, however, that its truths are being investigated and tabulated. our present knowledge of its principles has demonstrated the existence of laws from which we can ethically deduce explanations of conditions which were, in the past, not amenable to any classification. these relate to individual and racial characteristics. we are beginning to learn that we can modify these characteristics by proper selection, by environment, and by education. this process will, to an eminent degree, redound to the permanent advantage of mankind. we may reasonably aspire to a system of race-culture which will eliminate the undesirable or unfit, and conserve all effort in the propagation of the desirable or fit. this is a consummation to be desired, and if by any system of eugenics the promise of the future is realized it is deserving of the intelligent interest and the active coöperation of every aspiring mother. environment.--by environment we mean the provision of suitable surroundings in its largest sense. a child to be fit and efficient must be born of selected parentage, the home surroundings must be desirable, the educational possibilities must be advantageous, the sanitary and hygienic conditions must be suitable, opportunities for physical and spiritual culture must be provided, and the state must ensure justice and the right to achieve success. we know that--generally speaking--these conditions do not exist. we know that the dregs of the human species--the blind, the deaf-mute, the degenerate, the imbecile, the epileptic, the criminal even,--are better protected by organized charity and by the state than are the deserving fit and healthy. we know that in the slums thousands of desirable children waste their vitality in the battle for existence, and we know that, though philanthropy and governmental supervision and protection are afforded the deaf, the dumb, the blind and degenerate child, no helping hand is held out to save the healthy and efficient child, who must pay in disease and inefficiency the price of his normality in degrading toil, [ ] in factory and pit, where child labor is tolerated. we need the awakening which is the promise of the eugenist, that these wrongs will be righted, not by the statesmanship which believes that empires are founded and maintained by the power of material might, but by a process which will ennoble selected motherhood and give to every child born its due and its right. education.--the present system of education is one of the great reflections on the intelligence of the human race. one of the greatest of contemporary writers has characterized it as "a curse to modern childhood and a menace to the future." even the humblest of us--who would willingly believe the system efficient, who have no desire to invite criticism as to our opinion--are forced to acknowledge that there is something wrong with the educational system now in vogue. the writer is disposed to believe, however, that the fault is not wholly one of art. the conditions with which education has to contend are essentially hypothetical. it may be that the laws of heredity and psychology, when fixed, will evolve, at least, a more rational and a more ethical hypothesis. so far as eugenics is concerned with education, its limitation is defined and fixed. if the innate ability is not possessed by the child, no system of instruction, and no art of pedagogy, will ever draw it out. when the proper material is supplied by an adequate system of race culture, science may probably supply the requisite complementary data which will ensure an educational system that will really educate. disease and vice.--the eugenic idea is more directly concerned with disease which tends to deteriorate the racial type. the average parent has no means of adequately estimating the significance of this type of disease. it has been estimated that one-half of the total effort of one-third of the race is expended in combating conditions against which no successful effort is possible. think what this means. the struggle of life is a real struggle, even with success as an incentive and as a possible reward. it becomes a tragedy when we think of the wasted years, the hopeless prayers and the anguish of those who fight the battle which is predestined to end in [ ] apparent failure. we are disposed to doubt the justice of the omnipotent mind who created us and left us seemingly alone--derelicts in the eddies of eternity. this is but a finite fault, however. the truth is that the scheme of the universe is unalterable, we are but part of the whole and must share in the evolution of the process. an apparent failure is not necessarily a discreditable one. most lives are failures, if appraised by human estimate. take for example the life of a young wife who marries a man with disease in his blood. she begins her wedded life with certain commendable ideals. she is young, enthusiastic, ambitious, strong, and she inherently possesses the right to aspire to become an efficient home-maker and a good mother. she gives birth to a child, conceived in love, and during her travail she beseeches her creator to help her and to help her baby, as all women do at such a time. her baby is born blind and it is a weak and puny mite. the mother recovers slowly, but she is never the same vigorous and ambitious woman. later her strength fades away, her enthusiasm falters, the home is blighted and seems a desecrated spot. the baby is a constant worry, it is always sick, it needs expensive care and it exhausts the physical remnant of its mother's health. it finally dies and is laid away, not forgotten, but a sad, sad memory. the ailing and dispirited mother is informed that she must submit to an operation if she desires to regain her health, if not to save her life. she returns from the hospital--not a woman--a blighted thing, an unsexed substitute for what once was a happy, sunny, healthy, innocent girl. this is not an overdrawn tale,--it is a true story, a common, every-day story. who was to blame? why were her prayers not heard? why, indeed? one might as well ask why seemingly splendid civilizations decayed into forgotten dust, or why empires rotted away. the answer is the same. history.--from the eugenists' standpoint history is prolific only in negation. a correct interpretation of its pages teaches us that it has not taught the lesson of the "survival of the fittest," but rather the survival of the strongest. that the strongest is not always the "fittest" needs [ ] no commentary. that the fit should survive is the genetic law of nature, and it has been strictly obeyed by biology and humanity when these sciences have adhered to, and have been under the jurisdiction of the natural law. when religious schisms swayed the world, the stronger party, in material strength or in actual numbers, massacred the weaker, which was frequently the fitter from the standpoint of desirability as progenitors of the race. thus posterity was deprived of what probably was the representative, potential strength of generations. at a later date religious schism changed her _modus operandi_ but accomplished the same pernicious purpose, as the following shows: "whenever a man or woman was possessed of a gentle nature that fitted him or her to deeds of charity, to meditation, to literature or to art, the social condition of the time was such that they had no refuge elsewhere than in the bosom of the church. but the church chose to preach and exact celibacy, and the consequence was that these gentle natures had no continuance, and thus, by a policy, was brutalized the breed of our forefathers." when religion was not the dominating power, mankind was ruled by militant tyrants. the non-elect were slaves,--uneducated, uncivilized, debased and diseased. the elect were licentious and indolent. neither class practised any domestic virtues, or respected the institution of motherhood. the process of the selection of the fittest for survival for the purpose of parentage, and for the consummation of the evolutionary gradation, through which the human race is apparently destined to pass, was again in abeyance for a series of generations. in our own times, the fate of nations and the destiny of their people would seem to depend upon the size of the fighting force and the efficiency of the ships we build; our ability to dicker and barter, to gain a questionable commercial supremacy, and the loquaciousness of our politicians. this, at least, is the criterion upon which the modern statesman estimates the quality of present-day civilization. he is not [ ] apparently interested in the story of the ages. the progress of god's supernal scheme through æons of bigotry and darkness neither suggests nor inspires in him a loftier constructive analysis. he is content to leave the destiny of nations to tons of material, tons of men and tons of talk. nowhere do we find any reference to the quality of the blood-stream of the people. nor does it seem to have been discovered by those who wield authority, that the glory of a nation depends upon its brains, not its bulk; nor do they apprehend that the greatness of a people is not in its past history, but in its ever-existing motherhood; and that its battles, in the future, must be fought, not on battlefields, but in its nurseries. when we judge our national worth and wealth by the quality of our maternal material, and estimate our greatness and our glory by the record of our infant mortality, we will have carved an enduring niche in the celestial scheme that will be unchangeable and for all time. there are in britain to-day over a million and a quarter females of marriageable age in excess of the number of marriageable males. a war between britain and germany would unquestionably be the bloodiest war in all history, and it probably would be the last one, because it would only end in the dominance of one power over all the others. if we concern ourselves only with britain--from the eugenic standpoint--who would dare compute the ratio of marriageable females over the males after the war was over? the consequence of such a war on posterity would be tragic. it would mean the annihilation of the fittest for fatherhood for generations. only the unfit would be left from which to begin a new breed. the multitude of females who would necessarily be left unable to participate in the highest function of womanhood would have to be self-supporting. the economic problem would, therefore, have a far-reaching influence and even if solved adequately as an economic problem, it could never be solved satisfactorily as a sociological, or as a problem in eugenics. infant mortality is too high. apart from the statistical proof which [ ] shows it, we may rightly construe as further proof of it, the widespread effort being made in every civilized country in the world to ameliorate the condition. the laws and ethics of marriage are inadequate. its true purpose is frustrated and racial and individual injustice and imperfection are the products of existing conditions. motherhood, in its every aspect is not, and has not in the past, been elevated to the plane which a true estimate of its supreme importance to the race justifies. heredity as a scientific principle is undeveloped, and because of maladministration in past generations, the present generation is endeavoring to do the work, the fruits of which it should be enjoying. environment in its highest sense is impossible because of inadequate laws, imperfect hygienic and sanitary knowledge, incomplete education, vice and disease. if there was not some supremely important, cardinal error somewhere, it is reasonable to suppose that in one or other of the departments of human effort we would have reached the summit of idealism. the state, as an institution, would have evolved a perfection which would enable it to exist as an independent mechanism, complete and ideal in all its ramifications. we have had no such state, however. the highest type of empire has been ludicrously dependent upon the minor exigencies of individual human existence. science would have evolved the superman, but history, as we have seen, has persistently deprived science of the material wherewith to contribute him. the institution of marriage would have been a fixed and an inviolable guarantee of the happiness of the home, but human wisdom has erred and the solution is as yet apparently undiscovered. investigation into every field of human effort shows that the ultimate aim in view, if any, was something other than the welfare of the race, as a race or as individuals. * * * * * [ ] chapter ii "the public health is the foundation on which reposes the happiness of the people and the power of a country. the care of the public health is the first duty of a statesman." lord beaconsfield. the eugenic idea the value of human life--the eugenic principle--"the fit only shall live"--eugenics and marriage--the venereal diseases--the utility of marriage certificates--the marriage certificates and vice--eugenics and parenthood--the principle of heredity--eugenics and motherhood--eugenics and the husband. the eugenist believes the cardinal error of the past has been a failure to recognize the worth or value of human life. in the past human lives have counted for absolutely nothing. as we have seen, each generation has practically deprived posterity of the best of its breed, and we shall see, when we consider the facts which affect the present vitality of the race, that the same preposterous conditions still exist. it is not necessary to waste the reader's time in an effort to prove, simply from an argumentative standpoint, the logic of the eugenic idea. there is no existing economic problem that has established itself so firmly in the hearts of the people who understand it, as has the study of race culture. it is not the subject, but its scope of application, that is new. biologically, we see the manifestations of eugenics on every side. in the flower garden we breed for beauty, in the orchard for quality. in the poultry yard and on the stock farm the same process weeds out the unfit and cultivates the desirable. the value of the eugenic idea is most strikingly illustrated in the cultivation, or breeding, of the horse from a primitive creature into the splendid animals which represent the various types of equine present-day perfection. it has taken generations of the most [ ] painstaking intelligence to understand the traits which had to be evolved in scientific mating to reach the present standard. if the same rules, or lack of rules, applied to the mating of horses as applied to ourselves, there would be few, if any, "thoroughbreds" among them. the principle which we must recognize is that "life is the only wealth." progress and efficiency will be ensured and of an enduring character, when all human effort is consecrated to this fundamental principle as a basic law, and not till then. to cultivate the human race on prescribed scientific principles will be the supreme science of all the future, the object and the final goal of all honest governmental jurisprudence, and the ultimate judge of all true constructive legislation. the eugenic principle the eugenic principle is, that "the fit only shall live." this does not mean that the unfit must die, but that only the fit shall be born. occasionally, as a product of bad environment, or faulty training, or eccentricity, a horse gives evidence of vicious traits, but the scientific breeder never mates him. he is allowed to die out. if he were permitted to father a race, his progeny would develop murderous characteristics that would retard the type for generations. the fit only shall be born.--this implies the exclusion of those, as parents, who are incapable of creating fit children. fit children are children who are physically and mentally healthy. parents who are unfit to create physically and mentally healthy children are those diseased in body or mind, especially if the disease is of the type which science has proved to be transmissible, or which directly affects the vitality of the child. in such a category we place those who are deaf, dumb, blind, epileptic, feeble-minded, insane, criminal, consumptive, cancerous, haemophilic, syphilitic, or drunkards, and those known to be victims of disease of [ ] any other special type. it must not be inferred that the above classification is made arbitrarily. there are many arguments which may be advanced limiting the eugenic applicability of certain of these diseased conditions. these, however, do not directly come within the province of the mother. they may be safely left to special state regulation. we simply make the assertion that no mother would willingly, or designedly, ally her offspring with any member of society afflicted with any of the diseases enumerated. eugenics and marriage.--the eugenic idea, practically applied to the institution of marriage, means that no unfit person will be allowed to marry. it will be necessary for each applicant to pass a medical examination as to his, or her, physical and mental fitness. this is eminently a just decree. it will not only be a competent safeguard against marriage with those obviously diseased and incompetent, but it will render impossible marriage with those afflicted with undetected or secret disease. inasmuch as the latter type of disease is the foundation for most of the failures in marriage, and for most of the ills and tragedies in the lives of women, it is essential to devote special consideration to it in the interest of the mothers of the race. it is estimated that there are more than ten million victims of venereal disease in the united states to-day. in new york city alone there are two million men and women--not including boys and girls from six to twelve years of age--actively suffering from gonorrhea and syphilis. eight out of every ten young men, between seventeen and thirty years of age, are suffering directly or indirectly from the effects of these diseases, and a very large percentage of these cases will be conveyed to wife and children and will wreck their lives. no one but a physician can have the faintest conception of the far-reaching consequences of infection of this character. the great white plague is merely an incident compared to it. these diseases are largely responsible for our blind children, for the feeble-minded, for the degenerate and criminal, the incompetent and the insane. no other [ ] disease can approximate syphilis in its hideous influence upon parenthood and the future. the women of the race, and particularly the mothers, should fully appreciate the real significance of the situation as it applies to them individually. that they do not appreciate it is well known to every physician and surgeon. it is first necessary to state certain medical facts regarding these diseases. they exist for years after all symptoms have disappeared; no evidences exist even to suggest to the patient that he, or she, is not entirely cured. after the germs have been in the patient for some time they lose a certain degree of their virility, and a condition of immunity is established. in other words the tissue ceases to be a favorable medium for the development, or activity, of the germs. if these germs, however, are conveyed to another person, who has never had the disease, or whose tissue is not immune, they will immediately resume their full activity and virulence, and will establish the disease, frequently in its most violent form, in the person so infected. the startling deduction which we must draw from these facts is, that a man may infect his wife, and may thereby be the direct cause of wrecking her entire life, and may, in addition, as a consequence of the infection, cause a child to be born blind, without even remotely suspecting that he is in any way responsible for it. in the light of this knowledge, what is the percentage risk a young girl takes when she selects a husband, remembering that eight out of every ten husbands bring these germs to the marriage bed? reread the true story of the young woman on page five, accept my assurance that there are thousands and thousands of such cases, and ask yourself, who is to blame? we may certainly assure ourselves that no man living would wilfully desecrate his bride. he did not know,--did not even suspect that the disease he had years ago was still in his system. society is to blame--you and i--the laxity of the law is the culprit. had he been compelled to pass a physical examination before marriage he would have been told the truth. it is a notorious fact, that in every civilized city in the world, the number of operations that are daily performed on women, is increasing [ ] appallingly. every surgeon knows that nine-tenths of these operations are caused, directly or indirectly, by these diseases, and in almost every case in married women, they are obtained innocently from their own husbands. it is rare to find a married woman who is not suffering from some ovarian or uterine trouble, or some obscure nervous condition, which is not amenable to the ordinary remedies, and a very large percentage of these cases are primarily caused by infection obtained in the same way. when a girl marries she does not know what fate has in store for her, nor is there any possible way of knowing under the present marriage system. if she begets a sickly, puny child,--assuming she herself has providentially escaped immediate disease,--she devotes all her mother love and devotion to it, but she is fighting a hopeless fight, as i previously explained when i stated that one-half of the total effort of one-third of the race is expended in combating conditions against which no successful effort is possible. even her prayers are futile, because the wrong is implanted in the constitution of the child, and the remedy is elsewhere. these are the tragedies of life, which no words can adequately describe, and compared to which the incidental troubles of the world are as nothing. so long as these conditions exist need we not tremble for the future of the race? is not this future welfare a personal issue, or can we trust the future of our daughters to the same indiscriminate fate that has written the pages of history in the past? this problem has been debated from every possible angle without our reaching any seemingly practical solution. the promise of emancipation, however, came with the dawn of eugenics. it is the only solution that gives promise of immediate and reasonable success. for that reason alone it should receive the active support of every good mother in all lands. the utility of marriage certificates.--there would seem to be no question as to the utility of marriage certificates. we must remember, however, that there is a distinction between marriage and parenthood, and that [ ] eugenics is concerned only with parenthood. it is interested in the institution of marriage to the extent only that it may, by some system of regulation, be a positive and fixed factor in the production of exclusively healthy children. the eugenist demands fit children. if society can ensure fit children, as a consequence of any marriage system which may or may not include medical certification, the eugenic aim is fully met. at the present time the giving of a marriage certificate, which is really a permit to marry, would seem to be the most practical way promptly to accomplish the eugenic purpose. we should promptly question the honor of any prospective husband disposed to evade the examination simply because he was not compelled to obey by a legislative enactment. we believe that when the public is educated to the truth and intent of eugenics, there need be no compulsory examination. men and women will, of their own accord, desire to know if their marriage will jeopardize the race. there will be questions of heredity to elucidate, questions of inherited insanity, poison taints, of blindness and deafness, or it may be of drunkenness. further, marriage certificates, or permits, must be considered in regard to the future conduct of those to whom we refuse permits to marry. a refusal of the permission to marry will not change the desire to marry. many, of course, to whom a permit is refused, will accept the situation, will be thankful to be possessed of the knowledge of their incompetency in order that they may seek medical aid. these individuals will remain under medical supervision until their ailments are cured and their competency established. in this way the eugenic aim is materially furthered. others may not abide by the decree which forbids marriage. it would wholly defeat the eugenic idea if the unfit children were to continue to be born illegitimately. these individuals will comprise the few--probably the present unfit members of society--and the final solution of the matter must remain a question of education and evolution. when public opinion is educated to the degree necessary to establish a system of eugenic self-protection, we shall be provided with a race of children whose [ ] culture will achieve the ideal of parenthood by a process of education rather than legislation. the marriage certificate and vice.--if a prenuptial examination were made compulsory there is no doubt of the very prompt and salutory effect it would have on present-day vice. it has often been said that "you cannot legislate virtue or sobriety into a people." we are familiar too with the maxim that "you can lead a horse to the well, but you cannot make him drink." you can lead a horse to the well, however, and lo! he drinks. if you lead him at the right time he will always drink. if we legislate at the psychological moment we can legislate virtue and sobriety into a people. a very large percentage of existing vice is the immediate product of ignorance, and the larger percentage of the remainder is the result of propinquity and the idea that it will never be found out. very little of it is the outcome of innate degeneracy. it is an acquired degeneracy we must guard against, and that is the special educational motive of eugenics. young men will be taught the truth about vice, and if they have been victims in the past, they will willingly submit themselves to a _competent_ investigation of their fitness for marriage. if they are still pure, the desire to remain so, in order to be eligible for parenthood, will guard them against the risk of contamination. this will not only result in a distinct improvement of the moral tone, but the potential possibilities to posterity will be incalculable. legislation might therefore be the vehicle through which eugenic education could enlighten and evolve a fit race. eugenics and parenthood if the supreme end is a better race we must recognize that the great need for society to-day is to educate for parenthood. history teaches that a civilization that dissipates its virility in profligacy or spends its energy in political and commercial trickery, and gives no thought to the character of the men and women it produces, is destined to total failure. parenthood and birth--in these we have the eugenic instruments of the [ ] future. the only permanent way to cure the ills of the world is to prevent the multiplication of people below a certain standard. the elevation and the actual preservation of the race depends upon rendering it impossible for the unfit coming into existence at all. in other words the unfit or unworthy must be rejected, not necessarily as individuals, but as parents. eugenics is allied to the principle of heredity,--the principle that enables us to modify conditions so as to ensure the right children being born. the propaganda against infant mortality is directed only toward the provision of a good environment,--so that children, when born, may survive and attain the maximum of their hereditary promise. the two campaigns are essentially complementary. the one applies only before birth, the other after birth. the statistics of infant mortality unfortunately show that it is not a process that extinguishes the unfit only. the healthy succumb to unfavorable environment and it was to amend this condition that the campaign against infant mortality was undertaken. the two campaigns appeal to the same creed: that parenthood is the supreme function of the race, that it must not be indifferently undertaken; that it demands the most careful preparation; that it is a duty which can only be carried out eugenically by the highest attainable health of body and mind and emotions. eugenics and motherhood.--any plan or scheme which has for its object race regeneration must concern itself with the health, the education, and the psychology of woman; the environment which shall surround her period of motherhood, and her selection of the fathers of the future. society must safeguard her in all her relations. the race to-morrow are the babies of to-day. the wealth of a nation therefore is the type of baby that will constitute its civilization from generation to generation, and absolutely nothing else counts. we hear much about race suicide, but is it not monstrous to cry for more babies when we do not know how to keep alive those we have? it is a fact that everywhere the birth rate of the caucasian people is on the decline. our birth rate as a whole, however, is ample;[ ] it is the death rate that is significant and appalling. when we remember that one-third of all the babies born die before they reach the age of five years; and that the deaths of babies under one year of age comprise about one-fourth of the total death-roll; and that fully one-half of all these deaths are needless and unnecessary, wherein is the wisdom of working for a higher birth rate if it is merely that more may die? the majority of babies are born physically healthy, but because of our destructive process, we proceed to annihilate hundreds of thousands of them yearly, and because of defective environment and education we render thousands of others, including the fit and unfit, inefficient and incompetent as propagating factors. it is to remove this disastrous stigma on our intelligence that we have been forced to study the conditions which the eugenic idea represents. when these principles are understood and believed, and when they are acted upon, infant mortality will cease to exist. it was the design of the creator that human motherhood should be an exalted occupation. he placed in her care to nurture and to love, the most helpless living thing. few have regarded a baby from this viewpoint and fewer still understand its supreme significance. that it is the most utterly helpless thing possessing life is a self-evident fact, and that it should be destined to be king of all mammalian tribes as well as lord of all the earth is a superlative paradox. because of its utter inability to care for itself it is more in need of care than any other representative of the animal world. it is not only in need of immediate care, but it demands care longer than the young of any other species. it stands to reason, therefore, that the function of motherhood must be reckoned with in any scheme of race regeneration; that it must be provided with the most favorable environment; and that it must be relieved of any condition which would materially retard the meeting of the obligation to its fullest possible extent. in an ideal eugenic sense the state must ensure sustenance to those deprived of ample food and raiment, and [ ] science must continue to solve the problem of a fitter sanitary and hygienic environment for the congested and densely populated zones of habitation. philanthropy must not continue to be wholly misdirected, it must extend its aid to the deserving healthy and fit, as well as to be exclusively the protecting agency of the diseased and unfit. if life is the only wealth, and the preservation of childhood the highest duty of society and the state,--which it would seem to be, since the continuance and preservation of the race is obviously essential to the continuance of the state itself,--the life of every child must be considered an economic as well as a moral trust. if, therefore, every child is sacred, every mother is equally sacred. if every child is to be cared for, every mother must be cared for. if the state cannot afford to provide for what is imperatively essential to its own continuance, it might as well go out of existence, as it inevitably will in the end on any other basis, and as all preceding states have done. mothers must not be dependent upon their children's labor for their maintenance, because if children are compelled to work, they will not be able to work in the future,--and adult efficiency is necessary to the well-being of the individual, the race, and the state. no mother should work, because in the care of her children she is already doing the supreme work. the proper care of children is so continuous and exacting a task, and of such importance to posterity, that it must be regarded as the highest and foremost work--and adequate in itself--and its efficiency must not be hampered by mothers having to do anything else. motherhood must not be financially insecure, because this would defeat its eugenic purpose. society, therefore, as a matter of self-preservation, must ensure to woman her mental and economic security. civilization's margin is large enough to provide this. we spend large amounts on luxuries and evils which are contrary to the genesis of self-preservation, while motherhood is its basic necessity. when public opinion is educated in the essentials of eugenics much of this can be, and will be diverted to a nobler purpose. the total cost necessary to ensure the adequate care of dependent [ ] motherhood would be a mere fraction of the national expenditure, and not a tithe of what we spend in pension allowances yearly. the latter is regarded as an honorable debt and is at best the direct product of a decadent ideal, while motherhood constitutes the very germ of the only altruistic idealism for all the future. we concede, therefore, that the children and the mothers must be provided for, not only as a product of the true construction of the ethics of sociology, but in obedience to the fundamental law of a moral system of eugenics. we must go further and assert that children must be cared for through the mother. it has been the practice to divorce the improvident mother from her dependent children. this has been demonstrated to be not only an altruistic fallacy. it has proved to be an economic blunder. there is another type of evil which largely menaces the eugenic ideal of motherhood. it is those cases where married women who have children are compelled to be the bread winners of the family as well as its mothers. no woman can earn support for herself and children outside of her home and competently assume the responsibilities of motherhood at the same time. whatever aid a mother renders to the state, as a result of effort in factory or shop, is of infinitely less value, from an economic standpoint, than her contribution as mother in caring for her own children in her own home. a careful study of infant mortality, and the conditions of child life, so far as survival value is concerned, condemns in the strongest and most vital sense this whole practice. the preservation of the race is the essential requisite, and it is the vital industry of any people. any seeming economic necessity which destroys that industry is one that will contribute largely to the downfall of the people as a race. eugenics and the husband.--the question of the husband's moral and parental obligation, as dictated by the marriage institution and constitution, may be left out of this discussion. we may assert, however, that we do not believe the eugenic principle intends, in devising ways and means for [ ] the adequate protection, in its completest sense, of motherhood, to relieve the father of any of his moral or parental obligations. these obligations will be justly defined, and as previously stated, will be the subject of special state legislation. no legislation of an economic character can detract from the performance of a moral obligation, and by no process of sophistication can modern statesmanship accomplish the dethronement of motherhood. the duty of the father is to support his children and the mother of his children, and the duty of the state is to see that this is done. the fundamental law of the eugenist must be to recognize that fatherhood is a deliberate and responsible act, for which a fixed accountability must be maintained. whatever legislation is undertaken in this connection must be with the object in view of strengthening the efforts of the right kind of father and husband, and of rendering more difficult the path of the irresponsible father and husband. if the supreme duty of a state is the maintenance of justice, its whole effort in the future will be to legislate in harmony with the eugenic principle. * * * * * [ ] chapter iii "i hope to live to see the time when the increased efficiency in the public health service--federal, state and municipal--will show itself in a greatly reduced death rate. the federal government can give a powerful impulse to this end by creating a model public health service." ex-president taft. eugenics and education the present educational system is inadequate--opinions of dr. c. w. saleeby, ella wheeler wilcox, luther burbank, william d. lewis, elizabeth atwood, dr. thomas a. story, william c. white, dr. helen c. putnam--difficulty in devising a satisfactory educational system--education an important function--the function of the high school--the high school system fallacious--the true function of education. the fundamental law of eugenics demands that all education be exerted for parenthood. we have proved that the child is not only essential to the life of the state, but is the state. consequently any function other than parenthood is a non-essential so far as organic existence is dependent upon it. education can, therefore, have no higher or more righteous motive than as a contributory agency in the perpetuation of the function upon which all existence depends. if the only function of education is to make one a worthy citizen, or to make him, or her, self-supporting, or able to bear arms in defense of his country, rather than a perfect link in the complete chain of enduring life, its purpose is being perverted. it is not sufficient to provide a girl, for instance, with an exclusive environment which regards her simply as a muscular entity, as is the tendency in some of the "best" girls' schools to-day; nor to fit her as a domestic or society ornament; nor must she be regarded simply as an intellectual machine, as is done under the system styled "the higher education of women." any one of these is an example of misdirected excess and is [ ] only part of the whole. none of these systems strives to develop the emotional side of the complex female character, and any educational system which ignores the emotions is not only inadequate but reprehensible in the highest degree. the ideal which will strive for education for ultimate parenthood will more completely solve the question of complete (eugenic) living. the present educational system is inadequate.--there is no question that education, as conducted at the present time, is one of the most disastrous institutional fallacies of modern civilization. in support of this contention, we are prompted to quote at length from various authorities bearing on this subject. dr. c. w. saleeby, an international authority on education, writes as follows: "a simple analogy will show the disastrous character of the present process, which may be briefly described as 'education' by cram and emetic. it is as if you filled a child's stomach to repletion with marbles, pieces of coal and similar material incapable of digestion--the more worthless the material the more accurate the analogy--then applied an emetic and estimated your success by the completeness with which everything was returned, more especially if it was returned 'unchanged,' as the doctors say. just so do we cram the child's mental stomach, its memory, with a selection of dead facts of history and the like (at least when they are not fictions) and then apply a violent emetic called an examination (which like most other emetics causes much depression) and estimate our success by the number of statements which the child vomits onto the examination paper--if the reader will excuse me. further, if we are what we usually are, we prefer that the statements shall come back 'unchanged'--showing no sign of mental digestion. we call this 'training the memory.' the present type of education is a curse to modern childhood and a menace to the future. the teacher who cannot tell whether a child is doing well without formally examining it, should be heaving bricks, but such a teacher does not exist. in berlin they are now learning that the depression caused by these [ ] emetics (examinations) often lead to child suicide--a steadily increasing phenomenon mainly due to educational overpressure and worry about examinations. "short of such appalling disasters, however, we have to reckon with the existence of this enormous amount of stupidity, which those who fortunately escaped such education in childhood have to drag along with them in the long struggle towards the stars. this dead weight of inertia lamentably retards progress. "if you have been treated with marbles and emetics long enough, you may begin to question whether there is such a thing as nourishing food; if you have been crammed with dead facts, and then compelled to disgorge them, you may well question whether there are such things as nourishing facts or ideas." the gifted writer, ella wheeler wilcox, in an editorial in the _new york american_, expressed herself recently in the following terms: "a wave of dissatisfaction is sweeping over the country regarding our school system. and eventually this will cause a change to be made. the larger understanding of mothers regarding education will result in the personal element entering into the training of children. "when women have a voice in the affairs of the nation there will be more teachers, larger salaries, fewer pupils in each department, and more attention will be given to the temperaments and varying dispositions of children by their instructors. "instead of regarding the little ones who enter public schools as machines which must be taught to go according to one rule, each child will be studied as a threefold being, and his mind, body and spirit will be cared for and developed according to his own peculiar needs. all this will come slowly, but it will come. "before children enter the public schools there should be a great sifting process under the direction of a national board of scientific men. the brain equipment of each child, the tendencies given it at birth, should be tested; then the nervous, hysterical and erratic minds ought to be [ ] placed in a school by themselves, under the care of men and women who know the law of mental suggestion. "quiet, loving, wholesome rules, followed day after day and month after month, would bring these children out into the light of self-control and concentration. the hurried, crowding, exciting methods of the public schools are disastrous to fully half of the unformed minds sent into the intellectual maelstrom which america provides under the name of public schools. "for the well-born, normal-minded, healthy-bodied child, who has wise and careful guardians or parents to assist in his mental guidance, the public school forms a good basis on which to build an education. for the average american child of excitable nerves and precocious tendencies, it is like deep surf swimming for the inexperienced and adventurous bather. "the great foundation of education--character--is not taught in the public schools. there is no systematized process of developing a child's power of concentration; there is not time for this in the cramming process now in vogue and with the enormous pressure placed on teachers. no teacher can do justice to more than fifteen children through the school hours. in many of our public schools there are fifty and sixty children under one instructor. this is fatal to the nervous system of the teacher and deprives the pupils of that personal sympathy which is of such vital importance." luther burbank, the famous california horticulturist, declares that the great object and aim of his life is to apply to the training of children those scientific ideas which he has so successfully employed in working transformation in plant life. in an editorial, entitled, "teaching health," the _new york globe_ states, "anatomy and physiology are reasonably exact sciences, and nine-tenths of the hygienic abuses against which the doctors are preaching would be prevented if the laity had an elementary knowledge of physiology. such an educational reform could be carried out without causing any clash whatever between the warring medical sects." [page ] william d. lewis, principal of the william penn school, philadelphia, in an article entitled: "the high school and the girl," in a recent issue of the _saturday evening post_, wrote in part as follows: ... "the first thing that society wants of our girl is good health. this is the first essential for her efficient service and personal happiness in shop, office, store, school or home. the future of the race so far as she represents it, depends upon her health. what is the high school doing to improve the girl's health? in the overwhelming majority of cases absolutely nothing. on the other hand, it is subjecting her to a regimen planned for boys, without the slightest consideration of the physical and functional differences between the sexes. "it pays no attention to the curvature of the spine developed by the exclusively sit-at-a-desk-and-study-a-book type of education bequeathed to the girlhood of the nation by the medieval monastery: it ignores the chorea, otherwise known as st. vitus' dance developed by overstudy and underexercise; it disregards the malnutrition of hasty breakfasts, and lunches of pickles, fudge, cream-puffs and other kickshaws, not to mention the catch penny trash too often provided by the janitor or concessionaire of the school luncheon, who isn't doing business for his health or for anybody else's; it neglects eye-strain, unhygienic dress, uncleanly habits, anemia, periodic headaches, nervousness, adenoids, and wrong habits of posture and movements.... if you believe that the high school is a social institution with a mission of public service, regardless of the relation of that service to latin or algebra, then you must agree that it should look after what everyone recognizes as the foremost need of the adolescent girl. "one fact that every educator in both camps knows is that the home is not attending to the health of the adolescent girl. this problem is pressing upon us now largely because of the revolutions in living conditions that has come within the last quarter of a century." in a report of a recent conference on the conservation of school [ ] children held at lehigh university by the american academy of medicine, the following items appear. four great reasons why medical inspection in schools is needed were brought out by dr. thomas a. story of new york, who spoke from the educator's standpoint: "the first reason is concerned with communicable diseases, and the second with remediable incapacitating physical defects. it was reported in that over twenty per cent. of the children in the schools of new york city had defective vision, and over fifty per cent. had defective teeth. these defective conditions are amenable to treatment whereby the functional efficiency of the pupil is improved. he is capable of better work and the school efficiency is advanced. "the third reason is concerned with irremediable physical defects. the cripples, the deformed and the delinquents whose incapacitating defects are permanent should be found and classified. this enables special instruction and opens up educational possibilities otherwise unattainable, besides removing retarding factors in the progress of the normal pupil. "the fourth reason is concerned with the development of hygienic habits in the school child, and through the child, of the community. medical inspection which influences the health habits of the masses is a matter of supreme importance. the teacher will have pupils of cleaner habits and healthier, with fewer interruptions and disturbances from absences. "to make medical inspection successful physical examinations should uncover the anatomic, physiologic, and hygienic conditions. every piece of advice given to a pupil that can be followed up should be followed up and the result recorded. no system of medical inspection in schools can be complete and permanently successful which does not eventually educate the parent and child to a sympathetic and coöperative relationship with the system. medical inspection is a force working for a better general education in personal hygiene and should coördinate with the class room instruction. hence it must be a system in sympathetic relationship with the general [ ] management of the school, and should be under the same responsible control. since it is an educational influence and so directly related to the success of the school, it ought to be a part of the school organization." a paper was read by dr. helen c. putnam of providence, r. i., on "the teaching of hygiene for better parentage." she said: "life is a trust from fathers and mothers beginning before history; to be guarded and bettered in one's turn, and passed along to children's children. a definite conception of this trust is essential to right living. educators are finding that well directed correlation of human life, with phenomena of growing things in school gardens and nature studies, develops a wholesome mental attitude. since tens of millions of our population have only fractions of primary schooling, there is where the teaching must begin. these primary years are the time to lay foundations before a wrong bias is established. "education for parenthood cannot be completed at this early age. the strategic years for making it most effective are from sixteen to twenty-four, when home-making instincts are waking and strongest. we have , , young people of these ages in no schools, and eligible for such instruction. all state boards of education were recently petitioned by the american association for study and prevention of infant mortality to urge the appointment of commissions on continuation schools of home-making, to investigate conditions and needs in their respective states and to report plans for meeting them effectively through such continuation schools or classes." difficulty in devising a satisfactory educational system.--it will be observed that each of these authoritative writers criticises the system of education now in vogue. the criticism is not, nor could it justly be, specialized. it is simply an expression, from different viewpoints, of the feeling that we are not doing ourselves justice as yet, we are groping after something better. it may be, as i have previously stated, that no[ ] satisfactory system of education will be evolved until the laws of kindred sciences, which have organic relationship to what we understand as education, are fixed and better understood. we are just beginning to appreciate the true meaning of environment. we know little about heredity, but enough to appreciate its vital importance. psychology is a realm of much hope, but we have only tasted of its surface promise and know little of the mysteries it may unfold. eugenics, the infant giant of science, promises to establish the race on an enduring foundation. these sciences have laws which we do not yet understand; they relate to that part of human evolution which mind dominates. the quality of the mind's dominion depends upon the mind's education and environment, and since the laws of these sciences, upon which a perfect system of education depends, have not been revealed, it is quite evident that all past systems of education have been more or less deficient. it is further evident that evolution has suffered as a result of the mind's imperfect education,--a condition that is manifest all around us. it must be appreciated, however, that we are discussing a large subject. if we understood all there is to know about environment; if we knew the laws of heredity, and psychology, and eugenics, and then could apply them, and educate the product of this combination of forces, we would be very near to the super-man. one must have a sober mental horizon to evolve the picture which would be the product of the above solution and then to estimate its meaning on human happiness and progress. we are approaching the ethics of right living,--of justice and truth,--the divine in man. at no time in the history of man has civilization been so near a solution of life's supreme problem as at the present moment. education is an important function in life's scheme, and while we may regret that it is not possible to formulate a system that would be perfect and capable of immediate application, we can continue to work patiently and hopefully, with assurance that in the near future the problem will be satisfactorily solved. when heredity, psychology, and eugenics combine [ ] to dictate the system, we shall doubtless find, that, in the beginning, it will be a system of individualization. in the interest of health and of justice, and consequently of efficiency, this would seem to be the natural and the logical lead. so long as human nature is as it is, we must meet conditions as they exist. we know as parents, and some of us know as physicians, that a task easily performed by one individual, without any apparent harmful results, will tax the capacity of another individual to the very utmost. any educational system which does not recognize this law, is vicious. yet such is the system in vogue to-day in america. we must adapt the burden to the endurance of the pupil. the administration of an educational machinery must solve this problem from the individual standpoint. in the departmental work in our public schools there seems to be no system. each teacher prescribes home work without any knowledge of what others of the same grade do, and without any apparent consideration in favor of the individual pupil. the result is that the total amount for each night is absurdly in excess of the capacity of the ordinary, or for that matter the extraordinary, pupil. this engenders nervousness and irritability, and is contrary to the ethics of education,--the fundamental law of which should be the preservation of good health. we must have regard for the physical and mental health of each pupil, and as the capacity of each pupil is different, the system is committing an egregious wrong by sacrificing the weaker instead of adapting the burden according to the strength and endurance of the bearer. the high school system fallacious.--even the high schools do not seem to be wisely availing themselves of their opportunity from the eugenic or economic standpoint. according to the report of the commissioner of education of the united states the percentage of pupils studying some of the more important subjects in the year - is stated as follows:[ ] latin, french and german per cent. algebra and geometry " " english literature " " rhetoric " " history " " domestic economy,--including sewing, cooking and household economies " " if only barely four per cent. of the girls in our high schools are studying subjects which directly contribute to their efficiency as home-makers, what are the prospects for worthy parenthood in the light of the fact that seventy-five per cent. of all women between the ages of twenty and twenty-four are married? the function of the high school, so far as girls are concerned, is to conserve health, to train for domestic efficiency and motherhood, and if necessary for economic independence. it must also furnish the stimulus for mental culture and direct a proper aspiration for social enlightenment. the curriculum should include biology, hygiene, psychology, home beautifying, the story-telling side of literature, music and a few other studies tending to make woman more like woman than she is to-day. when we have this, teaching for mothercraft will be more nearly realized. from the eugenic standpoint the present system of education is not satisfactory. to attain our end it is essential to devise other means of education. it must be remembered, however, that no system of education alone can ever enable us to achieve our end, no matter how perfect the system may be. education can only draw out what is in the child; it cannot draw out what is not there. what the child is, depends upon its heredity. the pedagogic ability of the school-master will never make a genius. a child's mind may be likened to a block puzzle, each block representing a part of a picture, which can only be completed when they are all arranged in their correct places. each block is an ancestral legacy,--the child's heritage--and to find its proper place in order to complete the [ ] character picture--to solve the riddle of the jumbled blocks,--is the duty of the educator. he can only manipulate what is there, and the test of his system will depend upon his ability to solve the puzzle of the ancestral blocks. we must divorce ourselves from the idea that a child's mind, at the beginning, is an empty space, to be filled in with knowledge according to the ability of the teacher; or that it is like a sheet of paper, to be written upon. education, and the educator, is absolutely limited to "drawing out" what heredity put there. education frequently is given credit which rightly belongs to nature. a child cannot do certain things until nature intends that it should. a baby cannot possibly walk until the nervous mechanism which controls the function of walking is developed. many children walk at the first attempt, simply because they did not make the first attempt until after nature had perfected the mechanism and the innate ability to walk was already there. suppose we tried to teach that baby to walk a month before nature was ready; each day we patiently coax it to "step out," we guide it from support to support, and we protect it from stumbling. some day it walks, and we congratulate ourselves on the victory, when as a matter of fact, we not only had nothing to do with it but were impertinent meddlers, not instructors. nature was the teacher and she was quite capable of completing the task without our aid. it is reasonable also to assume that any effort to force a natural function is quite likely to do much harm. we have found this to be so in various departments of education when the system was wrongly conceived. in physical culture this principle has been demonstrated over and over again. if our ancestral legacy is a good one, our picture blocks will be numerous and it will be possible for the proper system of education, aided by a suitable environment, to arrange them into many designs. if, on the other hand, our heredity did not endow us abundantly the number of our picture blocks may be limited to three or four, and they will be easily arranged so as to form a simple picture. the one represents a child whom heredity has richly endowed, the other one whom it has meagerly supplied with innate[ ] possibilities. heredity therefore dictates the function of education; and the school-master can only fashion the picture put there. if the ancestral blocks are not there with which to make an elaborate picture he must content himself with what is there,--he or his art cannot create others. when he congratulates himself on achieving a wonderful result in graduating a particularly brilliant student, he is taking to himself unmerited honors. if his individual ability is responsible in one instance, why not apply the same system to all pupils? if this system is responsible for the brilliancy of one pupil, why does not the same system make all brilliant? the reader knows the answer,--because heredity did not endow them equally. men are not born equal, despite the declaration of independence. the school-master is not responsible for the apt and the inapt pupil. he is responsible for his system which dictates how he will differentiate between the apt and the inapt pupil, in order to achieve the best results without injustice to either. the inefficient teacher is a dangerous equation in the school system. i mean by inefficiency, the quality of being temperamentally unsuited to the profession. there are a large number of anemic, hysterical young women teaching in the public schools of our cities who should not be there. they should not be there in justice to themselves, nor should they be there in justice to their pupils. a strict, yearly medical examination should be made of the teachers to decide their physical and psychical fitness to fill their positions adequately. one teacher, physically or psychically inefficient, can do an inconceivable amount of harm in one school term. we cannot afford to experiment along this line. it means too much, and even at the price of one unhappy child it is too much to pay. the teacher who feels that she is not suited to the work; who has constantly to hold herself and her temper under control; whose nerves are such that she cannot do justice to herself, whose sense of justice is capable of perversion on purely sentimental grounds; or who has lost--or never possessed--the gift of maintaining discipline, should promptly find another position. she is [ ] earning her salary under false pretenses, and that alone condemns her. i believe, that a large percentage of the inefficiency of the new york schools is due, not to the academic or scholastic inability of the average teacher, but to the average female teacher's physical, and especially her psychical unfitness to teach. we must concede, however, that in many instances the teacher's unfitness is a direct product of the pernicious system itself. [illustration: _from "the village of a thousand souls," gesell, american magazine_ evidence of a feeble mind a dirty shack in a mud hole in the country is merely another reflection of the same condition that causes the slums of the city. in our glowing spirit of humanity we cry out to raise up "the submerged tenth." rather, should we not stamp them out of existence--treat them as a menace, and not as a thing of pity? men, in general, rise; their minds are subjectively or objectively educated to their mental limit. they cannot go beyond it. "the submerged tenth" exists because its mental limit is low--often close to the upper margins of feeble-mindedness--and because it is mentally incapable of rising to anything else.] [illustration: _from "the village of a thousand souls," gesell, american magazine_ evidence of a vigorous mind the family that is vigorous, healthy in mind and body, "up and coming," reflects itself in a hundred different ways. small matter whether or not it is "an old family," has wealth, social position, a college education. a daughter's or a son's happiness, the real, deep-down-inside happiness that is worth while, may be more certainly insured by marrying with an eye to mentality and stock than by a marriage into a so-called "first family." eugenics hath its reward.] under an ideal system of education the child would be left absolutely free until the age of seven. we do not believe that the physical apparatus of the mind is prepared for educational interference before that age, and we know that the growth of the brain, physiologically and anatomically, is not complete until after the seventh year. the greater portion of a child's education necessarily depends upon its environment. heredity and environment, therefore, are the two factors which determine the characters of any living thing. heredity gives to the child its potential greatness,--its promise of greatness. whether these potential qualities ever become real depends upon environment. a child may have the hereditary (innate) ability to become a shakespeare, but if his environment is not suitable to the development of this potential greatness, he will never realize his hereditary promise. in other words, the innate qualities which he has, and which will make of him a shakespeare are never "drawn out" or educated. hence he can never become great until environment furnishes the means to him. environment, including education, does not add to the potential qualities of inheritance. education can only educate what heredity gives; it can give or add nothing itself; it simply educates what is there already. there is plenty of material, but it is not the right material. what educators want is the right kind of material--the material which the eugenists will eventually supply. or as mr. havelock ellis has expressed it: "education has been put at the beginning, when it ought to have been put at the end. it matters comparatively little what sort of education we give[ ] children; the primary matter is what sort of children we have to educate. that is the most fundamental of questions. it lies deeper even than the great question of socialism versus individualism, and indeed touches a foundation that is common to both. the best organized social system is only a house of cards if it cannot be constructed with sound individuals; and no individualism worth the name is possible unless a sound social organization permits the breeding of individuals who count. on this plane socialism and individualism move in the same circle." education, then, as an exclusive factor, cannot achieve our ideal of race-culture. in order that education may achieve a large measure of success, it must have the proper material, and the right material can only come as a result of the working out of the eugenic principle. then--in the aftertime--our educational efforts will not be wasted and misdirected, as they are almost wholly to-day. if we could transmit our acquired characteristics, education would have a relatively smaller, and a much more fixed function in the "general scheme," but we cannot. we can only transmit what was inherent in us when created. this simply means that, at the moment of conception, the child is created,--it is a completed whole,--what it is to be is fixed at that moment, its inherent capacities are formed. nothing can affect it, in this sense, after that moment. no act of either parent can have any influence on it. whatever ability the father or mother possessed of an innate character is transmitted to the child at the instant of conception and that innate legacy constitutes the working instrument of the child for all time. it cannot be added to by education, or by environment, but both of these may have a large influence in deciding whether it will be developed to its highest possible limit of attainment. education, mental, moral and physical, is limited by this inability to transmit acquired character to the persons educated. each generation must, therefore, begin, not where their parents left off, but at the point [ ] where they began. the same difficulties and the same problems must be met at the beginning of each generation. the true province of education.--education may justly be the instrument, however, which will educate public opinion to a true appreciation of the function of race culture. in this way the cause of the eugenist will greatly prosper, and the race will profit through the effort which will further the conservation of the best and most fit specimens for parenthood. so also may education, through the molding of public opinion, create sound opinion,--when each individual will be a center of eugenic enthusiasm. especially does this responsibility fall upon parents and those who are in charge of childhood. the young must be taught the supreme sanctity of parenthood. they must be instructed in eugenic principles in a way that will impart to them the definite knowledge that it is the highest and holiest science. the eugenic education of children is the real beginning at the beginning, the indispensable necessity, if race culture is to assume its transcendent role in modern civilization. it is urgently necessary for both sexes but more especially for girls. "urgently necessary," because, though herbert spencer wrote the following criticism nearly fifty years ago, the conditions are much the same to-day:-- ... "but though some care is taken to fit youth of both sexes for society and citizenship, no care whatever is taken to fit them for the position of parents. while it is seen that, for the purpose of gaining a livelihood, an elaborate preparation is needed, it appears to be thought that for the bringing up of children, no preparation whatever is needed. while many years are spent by a boy in gaining knowledge of which the chief value is that it constitutes 'the education of a gentleman'; and while many years are spent by a girl in those decorative acquirements which fit her for evening parties; not an hour is spent by either in preparation for that gravest of all responsibilities--the management of a family. is it that this responsibility is but a remote contingency? on the contrary, it is sure to develop on nine out of ten. is it that the discharge of it is easy? certainly not. of all functions which the adult has to fulfill, this is the most difficult. is it that each may be trusted by self-instruction to [ ] fit himself, or herself, for the office of parent? no; not only is the need for such self-instruction unrecognized, but the complexity of the subject renders it the one of all others in which self-instruction is least likely to succeed." it must be our highest educational aim to cultivate or create the eugenic sense. in this way, and in this way only, may we feel satisfied that the foundation, upon which shall be erected the generations that are yet to come, will be of an enduring character. * * * * * [ ] chapter iv "it is only because we are accustomed to this waste of life and are prone to think it is one of the dispensations of providence that we go on about our business, little thinking of the preventive measures that are possible." charles e. hughes. eugenics and the unfit the deaf and dumb--the feeble-minded--a new york magistrate's report--report of the children's society--the segregation and treatment of the feeble-minded--what the care of the insane costs--the alcoholic--drunkenness. in order to achieve success in eugenics we must strive to encourage the parenthood of the worthy or fit, and to discourage the parenthood of the unworthy or unfit. the unfit are those, as previously explained, who, because of mental or physical disability, are unable to create fit or healthy children. the deaf and dumb.--the condition known as deaf-mutism is due to innate defect in about half of all cases. deaf children have one or two deaf parents or grandparents. there may be two or three such children in a family. that the deaf should not marry is generally conceded by those who work amongst them. it should be our aim to discourage the intimate association of the adolescent deaf and dumb in institutions. it has been found that such intimate association frequently results in marriage. they should be educated and instructed in the knowledge that they cannot marry. when they understand the eugenic principle upon which this social law is constructed they will be amenable to reason. no process of suasion will be necessary, however, if their intimate association is prevented. the feeble-minded.--this includes the criminal, the imbecile, the insane, and the epileptic. the feeble-minded, technically speaking, belong to the degenerate class. they enter life mentally deficient, not necessarily [ ] diseased. they should, therefore, be regarded as fit subjects for educational modification rather than for penal correction or punishment. it is conservatively estimated that there are five million feeble-minded people in the united states to-day and not one-eighth of them are receiving adequate treatment or education. recent statistics, from various countries, show that the percentage of deficient or feeble-minded children is decidedly on the increase. according to a bulletin issued by the united states bureau of education (august, ) there are , , school children suffering from physical defects which need immediate attention and which are prejudicial to health. it would seem as though the time had passed for anything other than radical measures in the interest of the race. apart from the eugenic fact that these feeble-minded children are not fit subjects for parenthood, they are a constantly contaminating influence on society morally, and are a detriment and a hindrance to social and economic advancement. one illustration of this contaminating process, which is of serious eugenic import, is the presence of these deficient children in our public schools. by reason of their lack of attention and concentration, their mental or psychic insufficiency, their moral delinquency, and uncontrollable instincts and impulses, they are a menace to the well-being and to the progress of the normal or fit pupils; they retard and undermine the discipline of the schoolroom, and they affect the efficiency of the teachers. they are allowed to stay in school because of the indifference of the authorities, or because of the influence and social standing, or political "pull" of the parents, despite the recognition of the injustice done. many of the parents of these children seek medical advice but, because of absurdly inadequate civic or state provision for such cases, the physician is practically helpless. most of these irresponsible children are allowed to wander through the years unrestrained and unprotected. they easily become the victims of vice and crime, and eventually they become degenerates and end their lives in insane institutions. because of the stigma of degeneration these feeble-minded individuals fall into the [ ] hands of the law and are thereby robbed of the medical assistance which society should afford them in the early years when improvement is yet possible. the following report which recently appeared in one of the daily papers is interesting and suggestive in this connection. one of the new york city magistrates, in his annual report, said: "there is growing up in this city a menacing army of boys and young men who are the most troublesome element we have to deal with.... from the ranks of these rowdies that are organized in bands, or bound up with chums or pals, come most of the crop of burglars, truck thieves, holdup men, gun-bearers, so-called 'bad men' and other criminals and dangerous characters. without reverence for anything, subject to no parental control, cynical, viciously wise beyond their years, utterly regardless of the rights of others, firmly determined not to work for a living, terrorizing the occupants of public vehicles and disturbing the peace of the neighborhoods, they have no regard for common decency." but it is to the records of the children's society that one must go for reliable statistics of the potential criminal, as there the only systematic study of their conditions is made and recorded by one of the greatest neurologists in the country, dr. max schlapp, of new york. as a specialist in nervous diseases he has been connected with the children's society and the children's court, where he has had wide opportunities for observing the relation between delinquence and mental defectiveness. in cases of viciousness or feeble-mindedness exhaustive studies have been made by dr. schlapp. and the extent to which society is daily at the mercy of uncontrolled potential criminality is alarming. "feeble-minded children and feeble-minded men," says dr. schlapp, "are roaming about the streets of new york to-day as free agents. parents are not compelled by law to put a feeble-minded child in custody. yet that feeble-minded child unsuspected as such, amiable and care-free as he usually is, is potentially a criminal, and at any moment may commit a crime. that child is permitted to grow up without restraint, except [ ] such as the parents exercise, and this has no effect whatever in these cases. the child is allowed to marry and bring forth children of his own kind, more feeble-minded and more dangerous. there is no system designed to pick out from the community persons so afflicted, and no law whatever to prevent their untrammelled movements. "the city street is a recruiting ground for the gangster because it is full of defective children, mental and moral, who are potential criminals. this question has never been seriously considered. when brought under corrective restraint it has hitherto long been the custom to herd all the cases together while serving time. but in the german government woke up to the fact that to per cent. of city children and those of isolated rural communities contain the 'moron,' or intellectually defective type, together with the moral imbecile." investigation showed recently that in a reformatory near berlin per cent. of the inmates were abnormal, while over per cent. were seriously defective or menaces to society. this has since been shown to exist in all the leading nations--england, france, italy, where, by the way, the camorrist type is the equivalent for our new york gangster. in the elmira reformatory per cent. are, as a rule, feeble-minded and consist of types that repeat their offense against society or commit some other crime. there is only one way to prevent these types from becoming a menace. restrain them while they are still developing; keep them from becoming free agents in the community they menace. types continually come up in the children's society and the children's court. they are carefully studied. from the actions of the child, from his parents and family history, from the frequency with which he repeats some offense particularly pleasing to him, and by virtue of psychological tests and careful medical examinations the examiners are able to pick out children who should receive scientific care and treatment. "the characteristics of the feeble-minded are usually deceiving. one expects to find them with low brows and furtive looks and more or less vicious in appearance after they develop criminal tendencies. one would[ ] expect them to show stupidity at a glance. on the contrary, they are sometimes bright on the surface, amiable, good-tempered under trying conditions, and almost likeable for their external social side. this is particularly true of the high grade defectives. the lower order may be taciturn, gloomy and retiring, and these traits may be noticed almost from infancy. but as they grow up their social nature may be developed, and they too may give the appearance of amiableness. one notable thing about them is their pose of frank innocence. in this they are engaging, and almost convincing. "the street type that makes a gangster is practically the same if cruder in development. these children usually exhibit absolutely no sign of affection for their parents, no sympathy, and are notably cruel toward animals. one boy we had in the children's society persistently killed all the dogs and cats his family kept. finally, when they ceased keeping the animals he got at the canary cage and killed the bird by pulling the feathers out singly. he had no compunction about lying, and looked you right in the eye when he lied. otherwise he was charming and natural." while moral insanity is hereditary, yet it can be produced in one generation. an alcoholic man with clean antecedents may leave tainted descendants. the only way to combat these conditions in the city is to have strict registration of all feeble-minded and insane. the state should discover them, examine them through public officials, and segregate them. not only physicians, but school teachers and officials in public institutions should detect them. there should be in each state an institution for feeble-minded delinquents. the history of the average "gangster" shows a taint of alcoholism. this is further aggravated by living under immoral surroundings, where petty crimes like stealing and lying are considered "smart." this is the starting point of the new york "gangster." he is handicapped, and under ancestral disabilities and the disadvantages of environment that is pernicious, he cannot get very far. a boy usually qualifies with a gang on his own [ ] personality and tastes. he will often wander from one gang to another until he has found his particular atmosphere. the best will never find any one gang congenial enough to hold him, and he finally emerges a decent citizen. it is all a process of finding himself. the aim of the police should be to discount as much as possible any swaggering and false hero worship. the time has come when this great nation should take national cognizance of this problem. there should be a national institution on some isolated island. civilization is coming to recognize such a necessity. with a close eye on the tide of immigration and a careful segregation of these defective types, we should soon rid ourselves of what is now growing to be a serious menace to the home and the nation. the segregation and treatment of the feeble-minded.--dr. john punton, of kansas city, mo., in an able and exhaustive article on "the segregation and treatment of the feeble-minded," writes as follows: "your attention is directed to a recent report issued by wentworth e. griffin, chief of police of kansas city, mo., in which he claims that recently within six months' time no less than , juveniles were arrested charged with crimes ranging from vagrancy to murder and that the majority of these boys and girls were not normal children, but degenerates who required medical rather than penal treatment. 'boys and girls,' says he, 'should not receive correction in the city jails, the work house or reformatories. these should be the last resort. to correct a boy you must have an idea of his mental processes. it is natural that the parents understand something of the child and use that knowledge to make a good boy out of him. certainly it cannot be done in the reformatories, for although the authorities there are competent, they are hardly medical psychologists. in my opinion, if any progress is to be made it is the parent and the doctor that must do the work, not the police and the courts.' "that our chief of police deserves credit for not only publishing this report, but also for the advanced position he takes in recognizing the appropriate care and treatment of the juvenile offender, is certain, [ ] for he understands the fact that the parents are often the chief culprits in the child's delinquency and that medical rather than penal treatment is more often indicated than is at present allowed or practiced. "when we come to inquire into the cause of feeble-mindedness, alcoholic heredity, syphilitic heredity, and consanguineous marriages are found to be the chief etiological factors. bourneville claims that per cent. of the idiots and imbeciles are the offspring of alcoholic parents.... acute and chronic diseases in the parents, fright, shock, injuries, parental neglect, faulty education, poverty, malnutrition, social dissipation and lack of proper control are all well-known factors in the production of feeble-mindedness. "segregation of the feeble-minded is advocated by medical authority the world over, and when this is done they can be made under appropriate medico-pedagogic treatment to become largely self-supporting. "as an economical as well as a humane measure, the various states can well afford to make such provision, more especially for the large body of feeble-minded who are now without any medical care whatever. moreover, where it is possible, laws prohibiting the marriage of such as well as all other defectives should be passed and enforced." what the care of the insane costs.--the total cost of the care of the insane, in this country, has been estimated to be $ , , a year. in estimating the cost of the insane we must take into account the value or worth of each adult to the state. this value has been computed to be $ a year. if, upon this basis, we count the adult membership of the insane class between the ages of eighteen and forty-five, we find that their worth is roughly about $ , , . the cost of maintenance in the various insane institutions is about thirty-three millions of dollars a year. it would be quite possible to justly increase this total by estimating the worth of the help whose whole time is devoted to the care of the insane. if these individuals worked at some other trade or profession, their time would. be of value to the [ ] state in general--not to a class who should be non-existent. the cost to the state of the potential criminal is not included in this estimate. from the above figures it may be observed that it costs more to simply maintain the insane each year than it costs to work the panama canal; or to pay for the total cost of the executive, legislative and judicial departments of our government. the total cost is more than the entire value of the wheat, corn, tobacco, and dairy and beef products exported each year from this country. alcoholic drunkenness.--alcoholism is a sign and a symptom of degeneracy and is a distinct indication of unfitness for parenthood. the only cure for alcoholism is to prohibit parenthood. it has been proved that alcohol taken into the stomach can be demonstrated in the testicle or ovary within a few minutes, and, like any other poison, may injure the sperm or the germ element therein contained. as a result of this intoxication of the primary elements, children may be conceived and born who become idiots, epileptics or feeble-minded. it is asserted that per cent. of all the idiots and imbeciles are the offspring of alcoholic parents. recent experiments show that parental alcoholism alone can determine degeneration. mr. galton quoted the case of a man who, "after begetting several normal children became a drunkard and had imbecile offspring"; and another case has been recorded of a healthy woman who, when married to a drunkard, had five sickly children, dying in infancy, but in a later union with a healthy man bore normal and vigorous children. dr. sullivan found on inquiry that: .... "of children born of drunken mothers died in infancy or were still-born, and that several of the survivors were mentally defective, and as many as . per cent. were epileptic. many of these women had female relatives, sisters or daughters, of sober habits and married to sober husbands. on comparing the death rate amongst the children of the sober mothers with that amongst the children of the drunken women of the same stock, the former was found to be . per cent., the latter . per cent., or nearly two and a half times as much. it was further observed [ ] that in the drunken families there was a progressive rise in the death rate from the earlier to the later born children." dr. sullivan cites as a typical alcoholic family one in which the first three children were healthy, the fourth was of defective intelligence, the fifth was an epileptic idiot, the sixth was dead born, and finally the productive career ended with an abortion. the nervous systems of many children of alcoholic parents are wrecked for life; many die in convulsions as infants. many, however, who do not die, live as epileptics. this action of alcohol on the health and vitality of the race is the most serious of the evils that intemperance brings on the community. the tendency of all children of alcoholics is toward nervous disorders of a grave type. statistics show a very high rate of still-births and abortions among the children of drunken mothers, show that drunken women must not be permitted to become mothers. dr. branthwaite in a lecture stated: "in my judgment, habitual drunkenness, so far as women are concerned, has materially increased, during the last twenty-five years, which i have spent entirely amongst drunkards and drunkenness. these people are not in the least affected by orthodox temperance efforts; they continue to propagate drunkenness, and thereby nullify the good results of temperance energy. their children, born of defective parents, and educated by their surroundings grow up without a chance of decent life, and constitute the reserve from which the strength of our present army of habitual drunkards is maintained. truly we have neglected in the past, and are still neglecting, the main source of drunkard supply--the drunkard himself; crippled that and we should soon see some good results from our work." dr. fleck, another authority, says: "it is my strong conviction that a large percentage of our mentally defective children, including idiots, imbeciles and epileptics, are the descendants of drunkards." therefore the chronic inebriate must not become a parent. * * * * * [ ] chapter v "the real undermining of health is not seen. it is done in an insidious way. it has to be carefully ferreted out." dr. harvey w. wiley. what every mother should know about eugenics in the preceding pages we have written about eugenics as a science; it is our intention now to point out briefly in just what way eugenics directly concerns the mothers of to-day. in the first place let us try to appreciate what it will mean to the race if "the fit only are born." "fit" children, it will be recalled, means children born healthy of healthy, selected parents, parents with a good ancestral history, conveying to their offspring a reasonably adequate legacy. if the "fit only are born" we start with a healthy stock. what a significant and tremendous advantage this is. at once we rid the world of the potential inefficients--the feeble-minded, the insane, the criminal, the deaf-mute, the drunkard. if we are correct in assuming that the reason why all former civilizations have failed and passed away, was because they bred a race of people physically and mentally unfit to survive, the demand of the eugenist that only "fit children shall be born" will strike at the very root of this evil. if we uproot the cause of racial degeneration we begin the building of a race that should not degenerate. if we establish a race that will not degenerate, it must gain strength and virility with each generation. this assumption is logically correct, but we must do more than breed "fit" children. we must take care of them after they are born. we must furnish them with a good environment (see page ). heredity without favorable environment counts for very little,--we must never forget that. heredity and environment are the two important determining factors in the life of every child born. if eugenics furnishes the heredity by ensuring the [ ] birth of the "fit" only, it depends upon the mothers of the race to provide the environment. every mother must know how to take the best care of herself and of her child. this book is devoted to instructing her in the details of this duty. we cannot hope, however, to reach this high altruistic plane by simply taking the first step in the right direction. we who are alive to-day must begin the work, and leave it to posterity to carry forward. we must do our part. every mother must become an enthusiastic eugenist. if she begins to teach, and preach, and practise its principles now, she will contribute to the heredity of unborn generations. to those of us who are alive to-day, environment is the vastly more important consideration, for our heredity is fixed and beyond the power of control. the question of eugenics for the present generation, therefore, is a question of environment. all our efforts must be directly in developing what heredity gives our children. we are wholly responsible for that. we must feed and clothe them properly; we must provide air spaces and playgrounds for exercise; we must educate them, and protect them from disease; and we must safeguard the birth of future generations by keeping our race stream pure. this is no small task, and the only way it will ever be satisfactorily accomplished is for each mother to realize her individual trust. the average individual does not realize the actual conditions that prevail. when recently the question of the public health was investigated by competent authorities, and the report furnished to the united states senate, it caused a tremendous sensation. if that is possible in a body composed of men who are supposed to be intelligent and wide-awake to existing conditions, how much more significant and appalling it should be to the average mother whose interest is centered in her own home. according to the statistics and statements given in that document the annual financial loss from needless deaths and accidents alone amounted to $ , , , . [page ] acute diseases are held responsible for a large part of the loss. chronic diseases are responsible for the greatest part of the waste of life, and they are believed to be increasing in their ravages. minor ailments, believed to be nine-tenths preventable, are now costing the nation many dollars through incapacitation of persons and through leading to serious illness. industrial accidents, largely preventable, are also exacting a heavy toll annually. that this great waste of life and health and the national economic loss that results can be modified by national action is asserted. here are to be found the reasons advanced for a great national department of health. the work of this department would be varied. it would include direct work in promoting health on the part of the government, such as administering the food and drug act; aiding the healing and educational agencies, both city and state; obtaining information concerning the cause and prevention of diseases, and disseminating scientifically proved information on all health subjects. it is maintained that the movement for the conservation of health is the most momentous of the conservation movements in this country, and that of all the national wastes which are to be condemned, this waste of health is the gravest. many startling statements are set forth in the document. dr. charles wardell stiles, of the united states public health and marine hospital services, declares that "the united states is seven times dirtier than germany and ten times as unclean as switzerland." he declares that: "lack of interest in preventive measures against diseases is slaughtering the human race." he takes the position that the real trouble is not so much race suicide as race slaughter, and that it is rather that too many children are allowed to die than that not enough children are born. it is estimated that tuberculosis, a preventable disease, costs the nations $ , , , annually. typhoid fever is estimated by dr. george m. kober, dean of the medical department of georgetown university, to cost over $ , , annually. [page ] in connection with acute diseases this statement is made: "the loss from tuberculosis has been reduced to half of what it was thirty years ago. nevertheless, of the , , people now living in the united states at least , , will be lost through this disease because adequate effort is not made to prevent it. besides the economic waste through deaths from any disease, the waste through sickness from the same disease is also colossal." great as are the reductions in the rates of infant mortality by improved milk and water supplies and by educational campaigns, the present rate is still enormous. "if some witch or wizard could conjure up the unnecessary babies' funerals annually occurring in this country it would be found that the little hearses would reach from new york to chicago. if we should add the mourning mothers and friends, it would make a cortége extending across the continent." while the death rates from acute diseases have been greatly reduced, the rates from chronic diseases have been steadily increasing. cancer is one of the chronic diseases apparently on the increase. that the annual death toll and the , , constant sick beds could be reduced from one-fourth to one-half by proper measures is asserted. in other words, there might be saved every day, as many lives as perished on the _titanic_, with the consequent enormous economic saving. these are surely impressive statements. it would seem as though it should be a simple task to pass a public health bill, establishing a bureau in washington, with a representative in the cabinet, whose sole duty it would be to preserve the public health. it has proved rather the reverse, however. we have been able to inaugurate various species of conservation,--of lands, of forests, of water,--but the conservation of human life is not important enough. even though states and empires depend upon their people for their very existence, our statesmen feel that human life is too cheap, too common, to take immediate steps in this direction. if women--especially mothers--would devote themselves to the eugenic [ ] end of legislation, men would soon obey. the application of eugenics to the human species, coming, almost in the spirit of an inspiration, at the time when women are about to be enfranchised, is significant. it may be that destiny has decreed that the one shall be the complement of the other; it is certainly beyond contradiction that in eugenics the women of the earth have a divine weapon with which to wage a righteous and an awaking propaganda of truth. a mother should be interested in every phase of the subject. her daughter's success in marriage should intimately concern her. her health and her happiness in that sphere should elicit her deepest maternal consideration. she may rightly hope to be proud of her daughter's offspring, and to find pleasure in the society of her grandchildren. she should, therefore, devote all her efforts to ascertain the truth, with reference to the physical and mental equipment of her future son-in-law; his ability adequately to support a family; his sobriety, his disposition, associates, etc., should all be carefully considered and pondered over. this is not going far enough, however; we must know positively that he is not diseased,--that he is not a victim of gonorrhoea or syphilis. when parents weigh in the balance the possibility of a wrecked life, of destroying the right to have children, or of bringing them into the world blind or diseased; of permanently destroying the hope of happiness, peace, and success, no combination of advantages in a son-in-law is deserving of the slightest consideration. we are treating of the sacred things of life--of life itself. if parents combine to crucify and betray their daughters--to sell them body and soul into bondage for social or other advantages; if they preserve silence when they should speak and thereby take all the sunshine, for all eternity, out of one existence; then, if on their death-beds these daughters should accuse them, the guilty knowledge that they were responsible will be the sting that will blast their hope of peace and forgiveness here and in the worlds to come. when mothers realize that, every day, in every large hospital in every city in the civilized world some woman (a daughter of some mother) is being [ ] unsexed because of these unjustly obtained diseases, surely their voices shall speak in no uncertain way. another eugenic suggestion that should deeply concern every good mother is, that the mother's milk is the private property of the babe, and whoever deprives the babe of this, the sole right it possesses, is not only a thief but a scoundrel. a curious and significant fact was discovered by investigators when studying the question of infant mortality a few years ago. it was found from a mass of statistics that there were two recent instances when the death rate of infants decreased suddenly and quite decidedly. the first instance was when the civil war in this country caused a cotton famine in england. as a result of the famine the factories of lancashire were all closed and the employees being then without work remained at home. as a large percentage of the workers were married women with children they had the time and the opportunity to nurse their children regularly. despite the fact that these women were starved and badly clad and deprived of the comforts of home, the death rate of the infants dropped steadily to an unprecedently low mark. a number of years later, when the german army surrounded paris during the franco-prussian war the besieged inhabitants of the capital suffered from hunger and disease. the death rate of the adult population increased enormously while the death rate of the infants dropped markedly. the explanation of this curious phenomenon was simply that while times were normal the women labored outside of their homes and as a consequence the babies were not fed regularly and when fed were not fed mothers' milk. it demonstrated a truth that we are apt to lose sight of, that mothers' milk, even the milk from badly-nourished, poverty-stricken mothers is infinitely better than an abundant supply of artificial food combined with neglect. in view of the fact that there is a distinct tendency to evade this maternal duty these facts should be suggestive and important. it is the duty of the mother with any eugenic sense to preach and to practise this gospel. [ ] paris learned the lesson of the siege because though she has the smallest birth-rate to-day, she nevertheless has the smallest infant death-rate of any large city in europe. the writer believes that in eugenics the women of the race have the instrument wherewith to save the world. he is assured that it is the supreme potential agency for the betterment of the race, and that mankind will never be inspired with a holier cause. he believes that through all the ages the human race has been growing better, coming nearer the truth, and that as a result of this patient progress, there has been evolved the eugenic idea that is to solve the problems of the human family. if the "fit only are born" think of the possibilities of education and of environment. each child is born with a great potential promise, and endowed with a reasonably good heredity, the whole effort of that child will be toward a higher moral attainment. if the effort of the individuals of the race is to achieve a high moral success, the quality of the civilization of future generations will be far superior to the type with which we are familiar. eugenics gives to women the supreme civilizing instrument of the future. it places the burden of the morality of the home and of the race on their shoulders. if we deny the writing on the wall it does not render the warning negative. the signs of the times are epochal. the great political parties are realizing, for the first time in history, that new and important issues concerning the family, the home, and the children, in other words the nation's manhood and womanhood, must be considered and included in their platforms. they know that the time has gone when statesmen will exclusively decide what shall be done with the sons and daughters which women bring into the world. they know that the mothers of the race must have a voice in deciding for peace or war since they create every soldier that will lie dead when war is over. women will help decide the question of taxation by government and by trusts, because they know that it comes out of their incomes and they need it all for their children. women know that their cause is the cause of freedom, and freedom is the[ ] cause of the eugenist. they know that the function of government should be justice and no code of justice can have higher ethics than the ethics of eugenism. mothers' eugenic clubs.--there should be established in every community a mothers' eugenic club. the object of the club should be to further the eugenic idea. papers should be prepared, read, and discussed on subjects having a eugenic interest. one of the main aims of these clubs should be to interest the local congressman and the member of the state legislature in eugenics. in all probability they will know nothing specific about race-culture--unless they are exceptional men--in which case it will be the duty of the members of the club to educate them. the object of such education of course would be to ensure that they will act intelligently when any legislative proposal is made having a eugenic interest. find out what they know about the public health as contained in the report on page , and if they will vote in favor of a public health bureau. you should know how your representatives stand on the pure food and drugs act; if they really appreciate the significance of the measure; if they would be in favor of pensioning mothers and widows who have children depending upon them; what their views are regarding compulsory marriage licenses; the reporting of venereal diseases to the local health authorities; if they would favor the segregation of the feeble-minded and their maintenance and treatment by the state; if they endorse the eugenic principle that "the fit only shall be born," and if they really understand just what that means. if the mothers in every community would take this step, they could control the legislation affecting such subjects in a comparatively short time. if the various states concede to women the right to vote--as they will sooner or later--such mothers' clubs would have a large and intelligent share in educating the women's votes on questions which directly concern their own immediate and remote welfare. the question of education would concern these clubs and much could be done by mothers to direct the authorities as to just what is needed to educate for [page ] parenthood, along the lines suggested elsewhere in this book. a mothers' eugenic club would rightly become an instrument for good in all local sociological interests. it could maintain a trained nurse to care for the sick and helpless, to teach the people how to live, and how to care for their homes and their children. the members themselves could visit the poor, the needy, and the sick. there are so many people in the world who are near the brink of failure,--so many who need a little hope infused into their lives,--and so many who are really deserving of help and sympathy and inspiration. the women who do this work for the work's sake are amply repaid by the good they find to do. the doing of such work is a consecration and an education. life means more, and the whole temperament reflects a truer sympathy and a stronger purpose. there are many mothers, for example, who are willing to do what is essential in the interest of their children, but they do not know what should be done. these people cannot afford a physician or a nurse to teach them, nor do they even know that their methods are wrong or that they need any instruction. we must carry the information and the explanation to them. we must show them the need for a change of methods. this is the work for those charitably disposed women who desire some worthy purpose in life, who really wish to do some genuine good. all the equipment they need is good common sense. they will explain why it is essential to pasteurize the milk before feeding it to the baby because most of the milk used by the poor is unfit for use as a baby food. they will show how to keep the nipples and the bottles clean, and they will give them lessons on how to prepare the food to the best advantage. they will instruct them how to dress the baby in hot weather, and they will explain why it is necessary to provide the baby with all the fresh air possible. they will gain the confidence of these mothers and they will tell them all they know, in tactful and diplomatic and common-sense language so that they may appreciate the eugenic reasons for everything they do regarding the care and well-being of the baby. in every city in the country this work is needed and is [ ] waiting for the missionaries who will volunteer. to teach mothers the need for boiled water as a necessary drink for baby and older children is alone a worthy avocation. to impress upon one of these willing but ignorant mothers the absolute necessity for washing her hands before preparing baby's food, that she must keep a covered vessel in which the soiled napkins are placed until washed, that she should frequently sponge her baby in hot weather,--and explain thoroughly why these are important details,--is a work of true religious charity. they should be taught to rid their houses of flies, and especially to keep them from the baby and from its food, bottles, and nipples. they should be instructed to discontinue milk at the first sign of intestinal trouble, to give a suitable dose of castor oil, and to put the child on barley water as a food until the danger is passed. they should be taught to know the serious significance of a green watery stool, that it is the one danger signal in the summer time that no mother can ignore without wilfully risking the life of her baby. they should be shown how to prepare special articles of diet when they are needed. if every mother were educated to the extent as indicated in the above outline the appalling infant mortality would fall into insignificance. it is not a difficult task, nor would it take a long time to carry out; it is the work for willing women who have time and who perhaps spend that time in less desirable but more dramatic ways. it is education that is needed, and it is education that is willingly received, as all mothers are ready to devote their time in the acquirement of knowledge that will help them save their offspring. this is the eugenic opportunity and it is an opportunity that should devolve upon the women of the race. such a mothers' club would receive the willing financial support of the men of the community. it should be placed upon a sound financial basis because, to be successful, it would have to bestow much material aid. i know of clubs that are self-supporting, however. each club needs a leader to begin it; will the reader be that one in her community? a mothers' eugenic club would of course discuss the practical side of [ ] the eugenic question: the proper feeding and clothing of children; hygiene, sanitation, housekeeping and homemaking, and the efficiency and health of each member of the home, and all other topics of interest to every wife and mother. the writer believes that in the very near future we shall have a mothers' eugenic club in every community in the united states; that these clubs will be guided by, and be an instrument of, a national eugenic bureau, composed of women, that will coöperate and harmonize the work as a whole, so that the conservation of human life will be effected to its maximum extent; that the excessive infant mortality will be overcome, because ignorant and incompetent mothers--the greatest cause of infant mortality--will be educated and instructed in the rudiments of eugenics and will consequently, to a large extent, cease to be ignorant and incompetent; that the desecration of young wives will stop, and stop forever, because vice and disease will be branded and exposed; that the feeble-minded, the deaf-mute, the imbecile, and the insane, will no longer be allowed to propagate their kind, to the permanent detriment of the race. when such clubs are established, and when all mothers do their individual duty in the interest of the race, we shall begin to see the dawn of a promise that will achieve its supreme success in the generations that will people the earth in the eugenic aftertime. * * * * * [ ] child-birth chapter vi "solicitude for children is one of the signs of a growing civilization. to cure is the voice of the past; to prevent, the divine whisper of to-day." kate douglas wiggin. preparations for the confinement the birth chamber--what to provide for a confinement--ready to purchase obstetrical outfits--position and arrangement of the bed--how to properly prepare the accouchment bed--the kelly pad--the advantages of the kelly pad--should a binder be used?--sanitary napkins--how to calculate the probable date of the confinement--obstetrical table--when should a pregnant woman first call upon her physician--regarding the choice of a physician--how to know the right kind of a physician for a confinement--the selection of a nurse--the difference between a trained and a maternity nurse--duties of a confinement nurse--the requisites of a good confinement nurse--the personal rights of a confinement nurse--criticizing and gossiping about physicians. the birth chamber the room in which the confinement is to take place should be selected with care. in many cases there will be no choice for the reason that there will be only one suitable bedroom available. where practicable however a room having the following accessories, or as many of them as is possible, should be given the preference. .--good light, and a southern exposure. .--capable of being well ventilated and well heated if necessary. .--running water if plumbing is modern. .--fairly large size (not a hallroom). .--a quiet room, free from street noises. if the house is a private one the room should be on the second floor. if the home is in an apartment house the confinement chamber should be as [ ] far removed from the living-room as circumstances will permit,--especially if there are other children who will make more or less continuous noise. all unnecessary furniture, pictures and draperies should be taken out of the room a few days before the confinement is due; the room itself, and everything left in it, should be thoroughly cleaned and aired. a small table for holding instruments, sterilizing basins, etc., should be provided and in readiness. what to provide for a confinement.--the following articles should be in readiness at all confinements:-- .--douche pan. .--bed pan. .--douche bag (fountain syringe) with glass douche tube. .--one rubber sheet ½ yards square. .--two bed pads, one yard square, made of absorbent cotton or old clean cloths, covered with washed cheese cloth and stitched here and there to hold in place. .--one dozen clean towels. .--one-half dozen clean sheets. .--a hot water bottle. .--one pound absorbent cotton (good quality). .--five yards sterile gauze. .--four quarts of hot, and as much cold water, that has been boiled. .--one-half dozen papers assorted safety pins. .--one box sanitary pads. .--four pieces of unbleached cotton or muslin, one and one-quarter yards long. .--four ounces powdered boracic acid. .--four ounces of brandy or whisky. .--one jar of white vaseline (unopened). .--one cake of castile soap. .--two or three agate or china hand basins. .--one slop jar. .--one pan under bed for after birth. the physician will direct that certain additional articles be provided according to his individual taste and custom. these will include an [ ] antiseptic and ergot; any other requisite found necessary can be sent for, or the physician can supply it, as he invariably has in his bag whatever may be required in complicated cases or in an emergency. all the items enumerated in the above list are absolutely essential, they may not all be used but it would not be safe to undertake a confinement without providing the essential requisites. many maternity outfits are prepared ready for use and can be obtained at the larger drug stores, costing from $ to $ . the articles in the above list can be bought for about $ , not including those articles which the patient is assumed to have. the following are samples of the ready-to-purchase outfits: ready-to-purchase obstetrical outfits outfit no. sterilized bed pad ( inches square). dozen sterilized vulva pads. sterilized mull binders ( inches wide). yards sterilized gauze. pound sterilized absorbent cotton (½ pound). rubber sheet, ½ yards by yards, sterilized. douche pan, sterilized. tube k-y lubricating jelly. sterilized nail brush. boric acid, powdered. tinct. green soap. bichloride tablets. lysol. tube sterilized tape. price $ . . outfit no. . sterilized bed pads ( inches square). dozen sterilized vulva pads. sterilized mull binders ( inches wide). sterilized towels. yards sterilized gauze. [page ] pound sterilized absorbent cotton (½ pound). rubber sheet, yard by ½ yards, sterilized. rubber sheet, ½ yards by yards, sterilized. quart sterilized douche bag with glass nozzle. douche pan, sterilized. sterilized nail brush. agate basins, sterilized. safety pins. tubes sterilized petrolatum. tube k-y lubricating jelly. boric acid, powdered. grms. chloroform (squibb's). fl. ext. ergot. tinct. green soap. bichloride tablets. lysol. tube sterilized tape. sterilized soft rubber catheter. sterilized glass catheter. stocking drawers, sterilized. talcum powder. bath thermometer. price $ . . these materials, being cleansed and sterilized, are ready for use at any time. these complete outfits are packed in neat boxes, thus enabling the contents to be kept intact until needed. the position and arrangement of the bed.--the bed should be a substantial single bed. if a double one is used, prepare the side for the confinement which will permit the physician to use his right hand,--that will be the right side of the patient as she lies in bed. one objection to a double bed is its tendency to sag. this tendency can be obviated however by placing an ironing board under the spring from side to side, or by using shelves from a book case. this expedient will support the mattress, thereby rendering the bed firm and free from any sagging tendency. the position of the bed in the room should be such that the patient will not directly face the window light, nor be in a direct draught between the window and the door. it [ ] should be so arranged that the nurse can get easily to either side, consequently it must not be pushed against the wall. how to prepare the accouchment bed.--over the mattress place the rubber sheet so that its center will be exactly under the hips of the patient. pin with large safety pins each corner of the rubber sheet to the mattress; now put the sheet on exactly as you do when making an ordinary bed. on top of the sheet, and in the middle of the bed (again where the patient's hips will rest), place a draw sheet. a draw sheet is a sheet folded once, placed across the bed, and pinned tightly with large safety pins to the mattress at each side. the advantage of this sheet is, that it can be removed when necessary, leaving the original clean sheet on the bed, without disturbing the patient. be particular not to have the top of the draw sheet higher than the middle of the patient's back. place the pad,--previously prepared for the purpose,--on the draw sheet and level with the top of the draw sheet. most physicians carry with them to all confinements a _kelly pad_. a kelly pad is a rubber pad with inflated sides, which is put under the patient's hips, and which retains all the discharges incident to a confinement so that when it is removed the bed is clean and fresh. the advantage of the kelly pad is twofold; first, it ensures a clean, compact, systematic confinement; second, its use subjects the patient to the least necessary movement at a time when movement is distressing, painful, and frequently dangerous. if a kelly pad is not used, it is desirable to place under the pad (between the pad and the draw sheet) a piece of oil cloth or rubber sheeting, or a number of newspapers will do. this will prevent, to a considerable degree, the discharges from soaking through the pad on to the draw sheet and sheet and mattress below. after the confinement is over and the patient is clean, remove the kelly pad, and the pad below if necessary, or the pad and newspapers if these are used,--place a clean pad under the patient and you are ready to place the binder on if a binder is to be used. [page ] should a binder be used?--medically a binder is not necessary, neither is it objectionable from a medical standpoint. it is supposed to hold the flaccid, empty womb in place. this it does not do and we are of the opinion, that it, in many instances, according to how it is put on, compresses the womb out of place. the binder is certainly appreciated by most patients because of its snug, comfortable feeling; and in cases when the abdominal wall is fat and the muscles soft, it holds them together in a way that is impossible by the use of any other device. to claim that the binder prevents hemorrhages is absurd. our personal rule is to put one on if the patient wants one, or if she has previously had one. to be effective, in any sense, the binder should extend from the waist line down to halfway between the hips and knees and should be snugly, but not too tightly pinned. sanitary napkins.--these can be purchased already prepared in most drug stores, or they can be made in the following manner: take an ordinary grade of cheese cloth, wash it, and when dry, cut it into half yard squares. in the center of each square place a strip, six or eight inches long, of absorbent cotton and fold the gauze lengthwise over it so as to make a pad. these can be used as napkins, and after they are soiled can be burned. it is absolutely wrong to use rags or any old cloths for napkins, as the patient can be infected and made seriously sick by this procedure. how to calculate the probable date of the confinement.--the duration of pregnancy extends for days from the end of the last menstruation. add seven days to the date of the last menstruation, and from that date count ahead nine months, or backward three months and you may have the probable date of the confinement. should you pass this time you will probably go on for two additional weeks. the reason for this is that the most susceptible time for conception to occur is either during the week following menstruation or a few days before menstruation. if, therefore, you pass the above probable date which was calculated from the end of the last menstruation, it shows that conception did not take place during the [ ] week following that menstruation; and the assumption will be that it took place a few days before the next menstruation, which will be about two weeks later than the date as calculated above. if, for example, a pregnant woman was last sick from january st to th we add seven days to the th, which is the th, to which we add nine months, which will give us, as the probable date of confinement, october th. should she go a few days over the th, the probability is that the confinement will take place on october th. table for calculating the date of confinement ----------------------------------------------------------------- jan. oct. ----------------------------------------------------------------- jan. oct. nov. ----------------------------------------------------------------- feb. nov. ----------------------------------------------------------------- feb. nov. dec. ----------------------------------------------------------------- mar. dec. ----------------------------------------------------------------- mar. dec. jan. ----------------------------------------------------------------- apr. jan. ----------------------------------------------------------------- apr. jan. feb. ----------------------------------------------------------------- may. feb. ----------------------------------------------------------------- may. feb. mar. ----------------------------------------------------------------- june mar. ----------------------------------------------------------------- june mar. apr. ----------------------------------------------------------------- july apr. ----------------------------------------------------------------- july apr. may ----------------------------------------------------------------- aug. may ----------------------------------------------------------------- aug. may june ----------------------------------------------------------------- sept. june ----------------------------------------------------------------- sept. june july ----------------------------------------------------------------- oct. july ----------------------------------------------------------------- oct. july aug. ----------------------------------------------------------------- nov. aug. ----------------------------------------------------------------- nov. aug. sept. ----------------------------------------------------------------- dec. sept. ----------------------------------------------------------------- dec. sept. oct. ----------------------------------------------------------------- [ ] the foregoing table affords us a handy means of finding the probable date of confinement at a glance. find the date of the last day of the last menstrual period in the upper row; the date immediately below it is the probable date of confinement. for example if the last menstrual period was from jan. st to th, we find january th and below it we note october th as the probable date of confinement. when should a pregnant woman first call upon her physician?--the earliest indication of pregnancy is the interruption of menstruation. when menstruation fails to appear at its regular time in a young married woman whose past menstrual history is good,--i.e., she has been sick every month regularly and without pain since she began menstruating as a girl,--the assumption would naturally be that she was pregnant. menstruation may however "miss" one month for other reasons than pregnancy just at this time, as is explained elsewhere, so it is wise to defer a positive assumption on such an important matter. when the second menstruation does not appear, and there are no specific reasons for its failure to appear, it may be safely assumed that pregnancy has taken place. a visit to the family physician one week after the second menstruation should have appeared, or at least long enough to feel absolutely certain that the sickness is not coming around, is not only necessary, but is the essential and correct step to take for a number of very good reasons. if a woman for example has not had a baby, how does she know she can have one? it is quite possible to become pregnant and yet it may be wholly impossible to give birth to a child. it is necessary to be constructed normally, or as near what is regarded as normal as is possible, in order safely to assume the responsibility of carrying a pregnancy to a successful completion. no one but a physician, who is skilled and familiar in the knowledge of what constitutes the proper size, and shape, and quality, and relations, one with another, of your bones, and ligaments, and muscles, can tell [ ] whether you can safely be permitted to carry a pregnancy to term or not. if the anatomical conditions are not just right; if circumstances from a medical standpoint are not favorable; if your personal risk is too hazardous; if, in other words, medical science should decide that you are one of the very few women who cannot have a baby, is it not of very great importance that you should know this as soon as possible? does not that fact alone render your early call upon your physician imperative? a physician can bring out facts, relating to the personal and family history, and habits, of the prospective mother, which will enable him to formulate advice which will prove of the highest value from the very beginning of pregnancy. instructions carried into effect at this early date, as to personal conduct, exercise, diet, etc., will have a distinctly beneficial influence, not only on the patient's health and the character of her confinement, but on the physical vitality of the coming baby. regarding the choice of a physician.--this is a matter that should receive the most careful consideration. while it is just to admit that every physician is capable of successfully conducting maternity cases, there are certain characteristics in the individual temperament that would seem to indicate that some physicians are better adapted to this special work. trustworthiness is an imperative essential in a physician who assumes the responsibility of confinement engagements. he must be clean in his personal habits as well as morally. he should possess the virtue of patience and be tactful, and above all he should be made to feel that he has your implicit confidence. if you will analyze these qualifications you will understand just what they imply. the physician who has the reputation of having the largest practice is not necessarily the man you want, nor does it imply that he is the best fitted to conduct your case to your satisfaction. the fact that he is a very busy man may be distinctly detrimental to your best interests. if the physician has the reputation of being an excellent doctor, but, "you can't always depend on him,--he may be out of town, or he may send his assistant, or substitute," you don't want him; it is too [ ] important an event to you to take a chance with. rely rather upon the man who, though his charge may be a little higher, is known to be trustworthy; who will take a personal interest in you, and is known to be patient and capable. the selection of a nurse.--a choice must be made between having a trained nurse and what is known as a maternity, or monthly, nurse. the choice may be dictated by the financial means of the patient. a trained nurse is paid from $ to $ per week, while a maternity nurse usually gets $ per week. a trained nurse is a graduate from a hospital where she has successfully completed a course of training. she is to be preferred, if she can be afforded, for the reason that she has been trained to obey absolutely the orders of a physician, and because she has the requisite knowledge to detect emergencies, and the necessary skill and experience to enable her to act intelligently of her own initiative in any emergency. the maternity nurse, on the other hand, has not had an adequate training and is absolutely helpless, so far as medical knowledge is concerned, in a real emergency. her experience is limited to what she has picked up in the various cases she has had. she, as a rule, has chosen this means of obtaining a living as a result of some domestic financial affliction. she does not understand the laws of sterilization and has not been trained to obey, without question, the instructions of a physician. the maternity nurse follows a routine which she is incapable of modifying to suit the particular case. she has old-fashioned ideas and notions which she carries out as a matter of course, and she overestimates the great importance of her experience to the extent of wholly disregarding the advice of the physician. she assumes the care of the patient and baby, and regards this as her right, and as a result she is frequently responsible for much injury to the mother and child. despite these objections we have worked with many of these nurses who were to be preferred to trained nurses. it is the individual after all that counts, and if a maternity nurse, though technically untrained, is adaptable, tactful, and will consent to be [ ] instructed to the extent of obeying without argument, she can become invaluable, and her skill and experience will carry her creditably over many trying incidents. the objection of the medical profession to an untrained nurse is based, not so much on her lack of ability, as upon her propensity to indiscriminate and indiscreet talk,--they have not been trained to know the value of professional silence, nor have they had the necessary education which would have enabled them to acquire through their experience the knowledge that "silence is golden" at all times. a trained nurse possesses the requisite knowledge, but may have an objectionable individuality. an untrained nurse may have sufficient knowledge, and what she lacks she may make up for in being congenial and adaptable. while the trained nurse strictly attends exclusively to the mother and the baby, a maternity nurse as a rule attends to the household duties in addition. she cooks the meals of the entire family, and dresses and cares for the other children if there is no one else to do it. the duties of a maternity nurse can be specified and agreed upon, and the terms arranged when she is engaged. the duties of a trained nurse are fixed by nursing laws and medical rules and cannot be changed or modified by private agreement. these laws and rules, however, are not sufficiently arbitrary to make it impossible for the nurse to be obliging, courteous, and sincere,--qualifications which every patient has a right to expect, and a right to insist upon from every graduate nurse. the selection of a nurse should receive careful consideration. she should be known to be honest, honorable, competent, healthy, and personally clean in habits and dress, and she should be tactful, obliging, and she should attend to her own affairs strictly. she should not be a gossip; she should not shirk her work or pry into family affairs that do not concern her; and she should not drag into the conversation her own personal or family secrets. the nurse has certain rights which the patient should willingly recognize. she is entitled to a comfortable bed, sufficient sleep, good food, and exercise in the open air every day. these are essential in order that [ ] she maintain her own health, as well as keep at the highest point of efficiency. when you select your physician consult with him regarding your nurse. if you know personally a capable nurse, there is no objection to selecting her, and no physician will oppose this procedure if you assume the responsibility of her capability. there are many advantages, however, in permitting the physician to provide a nurse. he assumes the responsibility of the nurse's capability, and it is safe to assume he will not recommend one whom he knows to be personally objectionable, or professionally incapable. every physician acquires certain individual methods in the conduct of maternity cases, which experience has taught him to be successful. a competent knowledge of these methods by the nurse greatly facilitates the details and ensures a harmonious conduct of the entire case,--facts which accrue to the comfort and the well-being of the patient. it is not out of place here to warn a young wife against being advised by a neighbor or a busybody, as to whom she should select as physician or nurse. you must not depend upon the gossip of the neighborhood. the physician or nurse whom you are told by one of these irresponsible individuals not to take, may be the one above all others whom you should take. when you hear a gossiping woman decry a physician, depend upon it, she owes him something,--most often it is a bill, but it may only be a grudge. there is no class of men in any community who are maligned and abused so much as are physicians. they seem to be the choice victims of the enmity and spite of every malicious feminine tongue. a woman should think twice before she utters a criticism regarding the work of a physician. she would, if she but knew how quickly she brands and advertises herself as irresponsible and lacking in ordinary courtesy and good breeding, as she is not qualified to criticise the professional capability of a physician, nor is she qualified to estimate the extent of the wrong she perpetrates. there is no class of men who do more conscientious work, day after day, than do physicians, [ ] and there is no class of men who are more deserving of the commendation of the entire community than the thousands of self-sacrificing, underpaid members of the medical profession. be suspicious therefore when you hear a criticism, and be very, very sure before you utter one,--rather give him the benefit of the doubt and you will do no wrong, and it may be at some future date you will be thankful you did not criticise. * * * * * [ ] chapter vii the hygiene of pregnancy. daily conduct of the pregnant woman--instructions regarding household work--instructions regarding washing and sweeping--instructions regarding exercise--instructions regarding passive exercise--instructions regarding toilet privileges---instructions regarding bathing--instructions regarding sexual intercourse--clothing during pregnancy--diet of pregnant women--alcoholic drinks during pregnancy--the mental state of the pregnant woman--the social side of pregnancy--minor ailments of pregnancy--morning nausea, or sickness--treatment of morning nausea, or sickness--nausea occurring at the end of pregnancy--undue nervousness during pregnancy--the per cent. baby--headache--acidity of the stomach, or heartburn--constipation--varicose veins, cramps, neuralgias--insomnia--treatment of insomnia--ptyalism, or excessive flow of saliva--vaginal discharge, or leucorrhea--importance of testing urine during pregnancy--attention to nipples and breasts--the vagaries of pregnancy--contact with infectious diseases--avoidance of drugs--the danger signals of pregnancy. conduct of the pregnant woman the young wife will arrange her daily routine according to the physician's instructions, which, by the way, she should faithfully carry out. if you are one of the fortunate many who enjoy reasonably good health, you have doubtless been told to follow a plan very similar to the one we shall now briefly outline. for the first six months she can safely continue to do her household work. it is to her advantage to do so for many reasons, but especially because it helps to keep her physically in good condition, and because it keeps her mind engaged, thus avoiding a tendency to nervous worry. after the sixth month it is desirable to give up the heavier part of the work. washing and sweeping should be absolutely prohibited. moving furniture or heavy trunks must not be done by the prospective mother, but all light work can and [ ] should be indulged in to the very end. find time to spend at least one hour and a half in the open air every day. unless there is a medical reason against active exercise there is nothing so beneficial to the pregnant woman as walking, nor is there any substitute for it. a drive or motor ride into the country, or a car ride around town, is an excellent device against ennui and is highly desirable during this time, but not as a substitute for the daily long walk. a pregnant woman must keep her muscles strong and in good tone if she hopes to do her share toward having a short and easy confinement. she must keep active to ensure perfect action of all her organs--the stomach must digest; the bowels and kidneys must act perfectly; the heart, and lungs, and nerves must be supplied with good blood and fresh air; the appetite must be keen, and the sleep sound. walking in the open air will do all this and nothing else can, to the same satisfactory degree. light passive exercise at home is desirable to those very few who cannot walk in the open air, but at best it is a poor substitute. it is necessary to avoid any exercise or any labor of the following character from the very beginning of pregnancy: stretching, lifting, jarring, jumping, the use of the sewing machine, bicycling, riding, and dancing. she should continue to employ the same toilet privileges she has been accustomed to except the use of the vaginal douche, which must be stopped from the date of the first missed menstrual period. this is the only safe rule to follow and no exception should be made to it except upon the advice of a physician. bathing during the entire course of pregnancy is a highly necessary duty. it is particularly advantageous during the later months because it relieves the kidneys at a time when they are called upon to perform an excess of work. the temperature of the bath should be warm and rapidly cooled at the finish. brisk rubbing with a course towel will ensure the proper reaction. sexual intercourse must be restricted during pregnancy; and it should be wholly abstained from during what would have been the regular menstrual periods, if pregnancy had not occurred, for the reason that abortion is[ ] apt to take place. it is most harmful during the early and late months of pregnancy. sexual intercourse is distasteful to most and harmful to every pregnant woman. clothing during pregnancy.--the clothing should be so constructed as to relieve any undue pressure on the breasts or abdomen. for this reason it should be suspended from the shoulder. when it is appreciated that clothing supported by the waist crowds the growing womb, and exerts pressure upon the kidneys, and is responsible for many of the kidney complications that occur during pregnancy, no further reason need be given for discarding all clothing, except very light garments, that are not held by some device whose support is from the shoulders. a specially constructed linen waist is made and sold for this purpose. it is fashioned so that all the lower garments and the garters can be fastened to, and supported by it. corsets should be absolutely discarded from the very first day of pregnancy. in a large woman with a lax abdomen, a properly made abdominal support will not only be a great comfort but of real advantage. it should exert a support upward by lifting the abdomen, not by constricting it. it should therefore be obtained from a reliable dealer and be made and applied to effect the above object,--otherwise it may do more harm than good. diet of pregnant women.--some degree of digestive disturbance and loss of appetite is the rule early in pregnancy. by the fourth month these conditions invariably cease, and the appetite and the ability to digest will greatly improve. the diet from the very beginning of pregnancy should be plain and easily digested. it is not possible to formulate an absolute table of what or what not to eat, as the same foods do not agree equally well with all patients. the individual taste should be catered to within, reason, and the meals should be taken at regular intervals. articles of diet that experience shows do not agree with the patient should be rigidly excluded from the menu. a varied diet of nutritious character is essential during pregnancy in order to ensure good blood, health, and strength. a monotonous diet, or a diet composed largely of stale tea, coffee, and [ ] cake, is not permissible, and may do untold harm. pastries and desserts of all kinds should be excluded. in the later weeks of pregnancy, because of the large size of the womb, the diet should be cut down as the stomach is interfered with in the process of digestion. should the patient at any time during pregnancy experience a loss of appetite, or an actual disgust for food as sometimes occurs, it is preferable to suggest a change of scene and surroundings rather than the use of medicine. a short vacation, a change of table, new scenery, will promptly effect a cure. this condition is mental rather than physical; the patient allows herself to become introspective; the daily routine becomes monotonous and stale; hence a change of a few days will be all that is necessary. if it is not possible for the patient to obtain a change of scene, a complete change of diet for a few days will often tide over the difficulty. we have known patients to take kindly to an exclusive diet of kumyss, or matzoon, or predigested foods, with stale toast or zwieback, to which can be added stewed fruits. alcoholic drinks should be left out entirely. the mental state of the pregnant woman.--the coming baby should be the text of many interesting, spontaneous talks between the young couple from the time when it is first known that a new member of the family is on its way. the husband should feel that he is a party to the successful consummation of the little one's journey. he can contribute enormously to this end. it should be his duty, born of a sincere affection and love, to formulate the programme of events which has for its main object the wife's entire mental environment. he should encourage her to live up to the physician's instructions, and arrange details so that she will obtain the proper exercise daily. he should read to her in the evening, and arrange his own business affairs so that he will be with her as much as is possible. in many little ways he can impress upon her the fact that they both owe something to the unborn babe and that each must sacrifice self in its behalf. his principal aim, of course, will be that she will not worry or have cause to worry. he will so direct her mental attitude that she will dwell only upon the bright side of the picture; she will thus strive to[ ] realize the hope that the baby will be strong and healthy, and she will, prompted by his encouragement and devotion, try to do her duty faithfully. working together in this way, much can be done that means far more than we know of, and in the end the little one comes into the world a welcome baby, created in love and born into the joy of a happy, harmonious, contented home. the social side of pregnancy.--the social side of the question should not be overlooked or neglected at this time. here again the imperative necessity arises to warn the young wife against certain individuals who seem to have a predilection toward recounting all the terrible experiences they have heard regarding confinements. it is astonishing to learn how diversified a knowledge some women burden themselves with in this connection. they can recount case after case, with the harrowing details of a well-told tale, and seem to delight in so doing. every physician has met these women. the young wife must not permit or encourage any reference to her condition. simply refusing to discuss the question is the only sure method of preventing its discussion. she will find among her friends a few who have her best interests at heart, and these few will strive sincerely to be of real usefulness to her. if she will keep in mind that the most important element in the success of the whole period, and consequently the degree of her own health, happiness, and comfort, as well as that of her unborn baby, is the character of her own thoughts from day to day, and month to month, she will be complete master of the situation. by constantly dwelling on happy thoughts, reading encouraging and inspiring books, admiring and studying good pictures, working with cheerful colors in sunny rooms, exercising, dieting, and sleeping in a well-aired room, she will have no cause to regret her share in the task before her, or the kind of baby she will bring into the world. minor ailments of pregnancy.--there are certain minor ailments which it would be well to be familiar with lest a little worry should creep into the picture. maternity is not only a natural physiological function, but it is a [ ] desirable experience for every woman to go through. the parts which participate in this duty have been for years preparing themselves for it. each month a train of congestive symptoms have taxed their working strength; pregnancy is therefore a period of rest and recuperation,--a physiological episode in the life history of these parts. if any ailment arises during pregnancy it is a consequence of neglect, or injury, for which the woman herself is responsible,--it is not a natural accompaniment of, or a physiological sequence to pregnancy. find out, therefore, wherein you are at fault, rectify it, and it will promptly disappear. morning nausea or sickness.--so-called morning nausea or sickness is very frequently an annoying symptom. it is present as a rule during the first two or three months of pregnancy. how is it produced and how can it be remedied? it is produced most frequently by errors in diet. it may be caused by an unnatural position of the womb or uterus, by nervousness, constipation, or by too much exercise or too little exercise. the physician should be consulted as soon as it is observed to be a regular occurrence. he will eliminate by examination any anatomical condition which might cause it; or will successfully correct any defect found. when the cause is defined his instructions will help you to avoid any error of diet, constipation, or exercise. many cases will respond to a simple remedy,--a cup of coffee, without milk, taken in bed as soon as awake will often cure the nausea. the coffee must be taken while still lying down,--before you sit up in bed. if coffee is not agreeable any hot liquid, tea, beef tea, clam bouillon, or chicken broth, or hot water may answer the purpose, though black coffee, made fresh, seems to be the most successful. ten drops of adrenalin three times daily is a very certain remedy in some cases, though this should be taken with your physician's permission only. if the nausea occurs during the day and is accompanied with a feeling of faintness, take twenty drops of aromatic spirits of ammonia in a half glass of plain water or vichy water. sometimes the nausea is caused by the gradual increase of the [ ] womb itself. this is not usually of a persistent character and disappears as soon as the womb rises in the abdominal cavity at the end of the second month. nausea frequently does not occur until toward the end of pregnancy. in these cases the cause is quite different. because of the size of the womb at this time the element of compression becomes an important consideration. the function of the kidneys, bowels, bladder, and respiration may be more or less interfered with, and it may be desirable to use a properly constructed abdominal support, or maternity corset. these devices support and distribute the weight, and prevent the womb from resting on or compressing, and hence interfering with, the function of any one organ. if the womb sags to one side, thereby retarding the return circulation of the blood in the veins from the leg, it may cause cramps in the leg, especially at night, or it may cause varicose veins, or a temporary dropsy. the correct support will prevent these troublesome annoyances; a properly constructed maternity corset is often quite effective. the diet should receive some special attention when these conditions exist. any article of diet which favors fermentation (collection of gas) in the stomach or bowel should be excluded. these articles are the sugars, starches, and fats. it can readily be understood that if the bowels should be more or less filled with gas, or if they should be constipated, it will cause, not only great distress, but actual pain. regulation of the diet, therefore, and exercise (walking best of all) will contribute greatly to the avoidance of these unnecessary sequelae. it must be kept in mind that the entire apparatus of the body is accommodating a changed condition, and though that condition is a natural one, it requires perfect health for its successful accomplishment. this means a perfect physical and mental condition,--a condition that is dependent upon good digestion, good muscles, healthy nerves, clean bowels, and so on. the slightest deviation from absolute health tends to change the character of the body excretions, the quality of the blood, etc. if the excretions are not properly eliminated, the blood becomes impure, and so we sometimes get itching of the body surfaces, especially of the abdomen [ ] and genitals; neuralgias, especially of the exposed nerves of the face and head; insomnia and nervousness. these are all amenable to cure, which again means, as a rule, correct diet and proper exercise as the principal remedial agencies. undue nervousness during pregnancy.--this is very largely a matter of will power. some women simply will not exert any effort in their own behalf. they are perverse, obstinate, and unreasonable. the measures which ordinarily effect a cure, they refuse to employ. it is useless to argue with them; drugs should never be employed; censure and affection are apparently wasted on them; they cannot even be shamed into obedience. the maternal duty they owe to the unborn child does not seem to appeal to them. we do not know of any way to handle these women and to our mind they are wholly unfit to bring children into the world. fortunately these women are few in number. the maternal instinct will, and does, guide most women into making sincere efforts to restrain any undue nervous tendency, and to be obedient and willing to follow instructions. there is nothing so beneficial in these cases as an absolutely regulated, congenial, daily routine, so diversified as to occupy their whole time and thought to the exclusion of any introspective possibility. frequent short changes to the country or seashore to break the monotony, give good results in most of these cases. the domestic atmosphere must also be congenial and the husband should appreciate his responsibility in this respect. women of this type should have their attention drawn to the following facts in this connection: while the most recent investigations of heredity prove that a woman cannot affect the potential possibilities of her child, she can seriously affect its physical vitality. the following illustration may render our meaning clear: suppose your child had the inborn qualities necessary to attain a per cent. record of achievement in the struggle of life; anything you may or may not do cannot affect these qualities--the child will still have the ability to achieve per cent. inasmuch, however, as a mother can affect the health or physical qualities of her[ ] child she is directly responsible, through her conduct, as to whether her child will ever attain the per cent. record, or if it does, she is responsible for the character of its comfort, its health, its enjoyment, all through its life's struggle toward the per cent. achievement record. she may so compromise its physical efficiency that it will succumb to disease as a consequence of the ill health with which its mother unjustly endowed it, even though it possess the ability to attain the per cent. if it lived. we often see brilliant children who are nervous and physically unfit, and we see others of more ordinary mental achievement who are healthy and robust animals. the one is the offspring of parents possessing unusual mental qualities but who are physically unable or unwilling to render justice to their progeny; the other parents may be less gifted mentally, but they are healthy and they are willing to give their best in conduct and in blood to their babies. many of these brilliant children never achieve their potential greatness because they fall by the wayside owing to physical inability, while the healthy little animals achieve a greater degree of success because of the physical vitality which carries them through. to achieve a moderate success and enjoy good health is a better eugenic ideal than the promise of a possible genius never attained because of continuous physical inefficiency. the nervous and willful mother should therefore consider how much depends upon her conduct. it cannot be too frequently reiterated and emphasized that every mother should do her utmost to guard and retain her good health. good health means blood of the best quality and this is essential to the nourishment of the child. to keep in good health does not mean to obey in one respect and fail in other essentials. it means that you must obey every rule laid down by your physician, willingly and freely in your own interest and in the interest of your unborn babe. in no other way may you hope to creditably carry out the eugenic ideal that "the fit only shall be born." headache.--this is a symptom of great importance. if it occurs [ ] frequently, without apparent cause, the physician should be consulted at once, as it may indicate a diseased condition of the kidneys, and necessitate immediate treatment. headaches may, of course, be caused in many ways and most frequently they do not have any serious significance, but they must always be brought to the attention of the physician. as a rule they are caused by errors of diet,--too much sugar, candy, for instance, late and indigestible suppers, indiscriminate eating of rich edibles, etc.,--or they may be products of nervous excitement (too little rest), as shopping expeditions, strenuous social engagements, late hours, etc. acidity of the stomach, and so-called heartburn.--these are sometimes in the early months of pregnancy annoying troubles. the following simple means will relieve temporarily: a half-teaspoonful of bicarbonate of soda or baking soda in a glass of water or vichy water; or a half teaspoonful of aromatic spirits of ammonia in vichy, or plain water; or a tablespoonful of pure glycerine. the best remedy is one tablespoonful of philip's milk of magnesia taken every night for some time just before retiring. heartburn is the result of eating improper food, or a failure to digest the food taken. starchy foods should be avoided. meats and fats should be taken sparingly. avoid also the et ceteras of the table, as pickles, sauces, relishes, gravies, mustard, vinegar, etc. good results follow dry meals,--meals taken without liquids of any kind. live on a simple, easily digested, properly cooked diet. chew the food thoroughly, take plenty of time and be cheerful. constipation during pregnancy.--most women are as a rule more or less constipated during pregnancy. it is caused by failure to take the proper amount of outdoor exercise, to take enough water daily, to live on the proper diet, to live hygienically, or because of wrong methods of dress. it is most important that the bowels should move thoroughly every day. pregnancy no doubt aggravates constipation by diminishing intestinal activity. consequently there is a greater need for activity on the part of the woman, and open air exercise is the best way to accomplish this. [ ] she should eat fruits, fresh vegetables, brown or graham bread, or bran muffins, figs, stewed prunes, and any article of diet which she knows from experience works upon her bowel. she should drink water freely; a glass of hot water sipped slowly on arising every morning or one-half hour before meals, is good. mineral waters, pluto, apenta, hunyadi, or one teaspoonful of sodium phosphate, or the same quantity of imported carlsbad salts in a glass of hot water one-half hour before breakfast, answers admirably. if the salts cannot be taken a three- or five-grain, chocolate-coated, cascara sagrada tablet, may be taken before retiring, but other cathartics should not be taken unless the physician prescribes them. rectal injections should be avoided as a cure of constipation during pregnancy. they are very apt to irritate the womb and if taken at a time when the child is active, they may annoy it enough to cause violent movement on its part, and these movements may cause a miscarriage. see article on "constipation in women." varicose veins, cramps, and neuralgia of the limbs.--when cramps or painful neuralgia occur repeatedly in one or both legs, some remedial measures should be tried. inasmuch as the cause of this condition is a mechanical one, it would suggest a mechanical remedy. the baby habitually seeks for the most comfortable position, and having found it stays there until conditions render it uncomfortable. he does not consult you in the matter, but he may be subjecting you to untold misery and pain. the child may rest on the mother's nerves or blood-vessels as they enter her body from her lower limbs. if the pressure is sufficient, it can interfere quite seriously with the return blood supply, because veins which carry back to the heart the venous or used blood, are vessels with thin, soft, compressible walls, while arteries which carry blood away from the heart cannot be compressed easily, because their walls are hard and tense. the condition therefore is that more blood is being sent into the limb than is being allowed to return; in this way are produced varicose veins. if these varicose veins burst or rupture we have ulcers, which may quickly heal,[ ] or they may refuse to heal, and become chronic. a dropsical condition of the leg may follow, and because of interference with the circulation of the blood we get cramps and neuralgias. how can we remedy this painful condition? sometimes we don't succeed, but at least we can try. so long as the cause exists, it is self-evident that rubbing the limb with any external application, will not give any permanent relief, though it is well to try. when rubbing, to relieve cramps at night, always rub upward. it is not a condition that calls for medicine of any kind, while hot baths and hot applications will only make the trouble worse. the remedy that promises the quickest and longest relief is for the patient to assume the knee-chest position for fifteen minutes, three times a day, till relief is permanently established. the patient rests on her knees in bed, and bends forward until her chest rests on the bed also. the incline of the body in this position is reversed; hips are highest, the head lowest. the baby will seek a more comfortable position and this new position may relieve the pressure and cure the condition. doing this three times daily for fifteen minutes gives relief to the leg by reestablishing a normal blood circulation, and very soon the baby finds a new position that does not interfere with its mother's blood supply, and the cramps, and neuralgia and dropsy, and maybe the varicose veins will soon show improvement. wearing the proper kind of abdominal support may help, as explained on page . if the varicose veins are bad, it is desirable to wear silk rubber stockings or to bandage the limbs. insomnia during pregnancy.--insomnia or sleeplessness is sometimes a vexatious complication during pregnancy. it seldom if ever becomes of sufficient importance or seriousness to interfere with the pregnancy or the health of the patient. nevertheless, a period of sleeplessness lasting for two or three weeks is not a pleasant experience to a pregnant woman. it is most often met with during the latter half of pregnancy. there can be no question that every case of insomnia has definite cause, and can be relieved if we can find the cause. the only way to find it [ ] is to systematically take up the consideration of each case, and this is best done by the physician. he must have patience and tact; you must answer each question truthfully and fully. your diet, personal conduct, exercise, condition of bowels, mental environment, domestic atmosphere, everything, in fact, which has any relation to you or your nerves, must be inspected with a magnifying glass. some little circumstance, easily overlooked, of seemingly no importance, may be the cause of the trouble. you may need more outdoor exercise, or you may need less outdoor exercise. you may need more diversion, more variety, or you may need less. you may need a sincere, honest, tactful, patient confidant and friend, or you may need to be saved from your friends. you may be exhausting your vitality and fraying your nerves by social exigencies,--those empty occupations which fill the lives of so many fussy, loquacious females,--echoless, wasted, babbling moments, of supreme important to the social bubbles who ceaselessly chase them but of no more interest to humanity than the wasted evening zephyrs that play tag with the sand eddies on the surface of the dead and silent desert. you may have wandered from the narrow limitations of the diet allowable in pregnancy, or you may be the victim of an objectionably sincere relation who pesters you with solicitous inquiries of a needless character. whatever it is, rectify it. a good plan to follow on general principles is to take a brisk evening walk with your husband just before bedtime, and at least two hours after the evening meal. follow this with a sitz bath as soon as you return from the walk. a sitz bath is a bath taken in the sitting position with the water reaching to the waist line. it should last about fifteen minutes and the water should be comfortably hot. it is sometimes found that this form of bath creates too much activity on the part of the child and defeats the purpose in view. this is apt to be the case in very thin women when the abdomen is not covered by a sufficient layer of fatty tissue. these women will find it advisable to take, in place of the sitz bath, a sponge bath in a warm room, using the water rather cool than hot but in a warm room. rub your skin [ ] briskly but waste no time in getting into bed. a glass of hot milk, before going to bed, or when wakeful during the night, may serve as a preventive. when these measures fail the physician should be called upon to advise and prescribe. ptyalism, or an excessive flow of saliva.--this is a common condition in pregnancy, but cannot be prevented. it is of no importance other than that it is a temporary annoyance. itching of the abdomen can usually be allayed by a warm alcohol rub, followed by gently kneading the surface of the abdomen with warm melted cocoa butter, just before retiring. a vaginal discharge.--soon after pregnancy has taken place the woman may notice a discharge. it may be very slight or it may be quite profuse. in some cases it does not exist at all during the entire period. as a rule the discharge is more frequent and more profuse toward the end of pregnancy. if the discharge exists at any time,--and it is no cause for worry or alarm if it does exist,--inform your physician. he will advise you what to do, because it is not wise for you to begin taking vaginal douches or injections without his knowledge, and at a time when they may do you serious harm. should itching occur as a result of any vaginal discharge the following remedial measures may be employed: a solution of one teaspoonful of baking soda to a douche bag of tepid water may be allowed to flow over the parts, or cloths saturated with this mixture may be laid on the itching part. a solution of carbolic acid in hot water (one teaspoonful to one pint of hot water), is also useful, or a wash followed by smearing carbolic vaseline over the itching parts. if your physician should suggest a mild douche for itching of the vagina as the result of a discharge, it may be promptly relieved by using borolyptol in the water. buy a bottle and follow directions on the label. testing urine in pregnancy--importance of.--one of the most important duties, if not the most important, of both the physician and the patient is to have the urine of the pregnant woman examined every month during the[ ] first seven months and every two weeks during the last two months. the urine examined during the first seven months should be the first urine passed on the day it is sent for examination. during the last two months of pregnancy the patient should pass all her water into a chamber for an entire day, and take about three ounces of this mixed water for examination. she should measure the total quantity passed during these days and mark it with her name on the label of the bottle. the physician will thus have an absolute record and guide of just how the kidneys are acting, and as they are the most important organs to watch carefully during every pregnancy, the greatest care should be taken to see that failure to note the first symptom of trouble does not take place. attention to nipples and breast.--the physician should inspect the breasts and nipples of every pregnant woman when she first visits his office. frequently the nipples are found to have been neglected, probably subjected to pressure by badly fitting corsets or too tight clothing. instructions gently to pull depressed nipples out once daily, if begun early, will result in marked improvement by the end of pregnancy. during the latter part of pregnancy the breasts should be carefully and thoroughly bathed daily in addition to the daily bath. this special bath should be with a solution of boric acid (one teaspoonful to one pint of water). after the bath apply a thin coating of white vaseline to the nipples. it may be necessary to resort to the following mixture to harden the nipples and to make them stand out so that the child can get them in its mouth: alcohol and water, equal parts into which put a pinch of powdered alum; this mixture should be put in a saucer and the nipples gently massaged with it twice daily. a depressed nipple may also be drawn out by means of a breast pump. if the nipples are not pulled out the child will be unable to nurse. it may then be necessary to put the child on the bottle and when the nipples are ready he may not take them after being used to the rubber nipple. the breasts may become caked and as a caked breast is a very painful and serious ailment it is wise to attend to this matter in [ ] time. the vagaries of pregnancy.--certain foolish, old-fashioned ideas, have crept into the minds of impressionable people regarding pregnancy, which are aptly termed vagaries. it is believed by some that if the pregnant woman is the victim of fright, or is badly scared, or witnesses a terrifying or tragic sight, her child will be, in some way, affected by it. if the incident is not of sufficient gravity to cause an abortion or a miscarriage it will not, in any way mark, or affect the shape of the child in the womb. it is believed by some that a child can be marked by reason of some event occurring to the mother while carrying it. this is not so; a child cannot be marked by any experience or mental impression of the mother. some believe that the actual character of a child can be changed by influences surrounding the mother while carrying it. the character of a child cannot be changed one particle after conception takes place, no matter how the mother spends her time in the interim. it should be carefully understood that the character of the baby is entirely different from the physical characteristics of the baby. were this not so it would be futile on the part of the mother to discipline or sacrifice herself in the interest of her baby. the baby's character will reflect the qualities of the combined union of mother and father. the baby's physical characteristics will largely depend upon the treatment accorded it by the mother during its intro-uterine life. hence we lay down rules of conduct, diet and exercise in order to produce a good, sturdy animal, while the character or mind of the animal is a part of the fundamental species already created. in other words, no matter how much care you bestow upon a rose bush, its flower will still be a rose,--it may be a better rose, a stronger, sturdier rose, a better smelling and a more beautiful rose, but it is still a rose. contact with infectious diseases.--the pregnant woman should be warned against the danger of coming in contact with any person suffering from any infectious or contagious diseases. to become the victim of one of these[ ] diseases near the time of labor would be a dangerous complication not only to the mother, but to the child. a woman is more liable to catch one of these diseases during the last month of pregnancy than at any other time. the most dangerous diseases at this period are scarlet fever, diphtheria, erysipelas, and all diseased conditions where pus is present. avoidance of drugs.--it is a safe rule during pregnancy to avoid absolutely the taking of all medicines unless prescribed by a physician. the danger signals of pregnancy.--the following conditions may be of very great importance and may be the danger signals of serious coming trouble. they must not therefore be neglected or lightly considered. when any of them make their appearance send for the physician who has charge of your case, at once, and follow his advice whatever it may be. . any escape of blood from the vagina, whether in the form of a sudden hemorrhage or a constant leaking, like a menstrual period. . headache, constant and severe. . severe pain in the stomach. . vertigo or dizziness. . severe sudden nausea and vomiting. . a fever, with or without a chill. * * * * * [ ] chapter viii the management of labor when to send for the physician in confinement cases--the preparation of the patient--the beginning of labor--the first pains--the meaning of the term "labor"--length of the first stage of labor--what the first stage of labor means--what the second stage of labor means--length of the second stage--duration of the first confinement--duration of subsequent confinements--conduct of patient during second stage of labor--what a labor pain means--how a willful woman can prolong labor--management of actual birth of child--position of woman during birth of child--duty of nurse immediately following birth of child--expulsion of after-birth--how to expel after-birth--cutting the cord--washing the baby's eyes immediately after birth--what to do with baby immediately after birth--conduct immediately after labor--after pains--rest and quiet after labor--position of patient after labor--the lochia--the events of the following day--the first breakfast after confinement--the importance of emptying the bladder after labor--how to effect a movement of the bowels after labor--instructing the nurse in details--douching after labor--how to give a douche--"colostrum," its uses--advantages of putting baby to breast early after labor--the first lunch--the first dinner--diet after third day. when to send for the physician in confinement cases.--the physician should be notified just as soon as it is known that labor has begun. the adoption of this course is necessary for a number of reasons. it is only just that he should have an opportunity to arrange his work so that he may be at liberty to give his whole time to your case when he is wanted. he may not be at home at the moment, but can be notified, and can arrange to be on hand when your case progresses far enough to need his personal attention. it will relieve your mind to be assured that he will be with you in plenty of time. [page ] don't worry unnecessarily if he does not come immediately when you notify him, provided you notify him at the beginning of labor. there is plenty of time. you have a lot of work to do before he can be of any help. many women entertain the idea that a physician can immediately perform some kind of miracle to relieve them of all pains at any stage in labor. this is a mistaken idea. no physician can hasten, or would if he could, a natural confinement. he waits until nature accomplishes her work, and he simply watches to see that nature is not being interfered with. if something goes wrong, as it does now and again; or if the pains become too weak, or if the proper progress is not being made, he may help nature or take the case out of her hands and complete the confinement. if it is thought best to do this, there will be plenty of time. the preparation of the patient and the conduct of actual labor.--it is assumed that the patient has adhered to the instructions of the physician given during the early days of her pregnancy. these instructions included directions as to exercise, diet, bathing, etc. having calculated the probable date of the confinement, it is the better wisdom to curtail all out-of-door visiting, shopping, social engagements, etc.,--everything in fact out-of-doors except actual exercise, for two weeks previous to the confinement date. the usual walk in the open air should be continued up to the actual confinement day. the daily bath may be taken, and it is desirable that it should be taken, up to and on the confinement day. the meaning of the term "labor."--by labor is meant, the task or work involved in the progress by means of which a woman expels from her womb the matured ovum or child. after the child has been carried in the womb for a certain time (estimated to be days) it is ripe, or fully matured, and is ready to be born. the womb itself becomes irritable because it has reached the limit of its growth and is becoming overstretched. any slight jar, or physical effort on the part of the patient, or the taking of a cathartic, is apt to set up, or begin the contractions which nature has devised as the process of "labor" by which the womb empties itself. [ ] the beginning of labor.--when the first so-called pains of actual labor begin they are not always recognized as such. the explanation of this seeming paradox is that the "pains" are not always painful. a woman will experience certain undefined sensations in her abdomen; to some, the feeling is as if gas were rumbling around in their bowels; to others, the feeling is as if they were having an attack of not very painful abdominal colic; while others complain of actual pain. the fact that these sensations continue, and that they grow a little worse; and that the day of the confinement is due, or actually here, impresses them that something unusual is taking place; then, and not till then, does the knowledge that labor is really approaching dawn upon them. in due time one of these new sensations, which constitute the first stage of labor, will be more emphatic; there will be a little actual pain so that she will feel like standing still, holding her breath and bearing down. that is the first real labor pain and marks the beginning of the second stage of labor, and may be the first absolute sign that will leave no doubt in her mind that labor has begun. the nurse will now inquire into the condition of the patient's bowels. if they have not already moved freely that day, she will give the patient a rectal injection of one pint of warm soap suds into which one teaspoonful of turpentine is put. after the bowels have been thoroughly cleansed, the patient will be made ready for the confinement. the clothing necessary consists of dressing gown, night gown, stockings and slippers. these are worn as long as the patient is out of bed, when all but the night gown will be discarded. the entire body of the patient, from the waist line to the knees, should be thoroughly cleansed, paying particular attention to the private parts; first with warm water and castile soap, and then rendered aseptic by washing with four quarts warm boiled water into which has been put one teaspoonful of pearson's creolin. a soft napkin is then wrung out of water that has been boiled and cooled to a suitable temperature, and laid over the genital region, and held in place by a dry clean napkin, [ ] and allowed to remain there until the physician takes personal charge of the case. length of the first stage of labor.--there is no definite or even approximate length of time for the first stage of labor,--that, you may recall, was the more or less painless stage, or as it has been termed, the "getting-ready" stage. inasmuch as it is an unimportant and practically painless stage, most patients do not mind it. they continue to be up and around and work as usual. the first stage of labor is utilized by nature in opening the mouth of the womb. the second stage of labor is utilized by nature in expelling the child into the outer world. length of the second stage of labor.--after the second stage has begun, the length of time necessary to end the labor, assuming everything is normal, depends upon the strength and frequency of the pains. the stronger and more frequent the pains, the quicker it will be over. first confinements necessarily take longer, because the parts take more time to open up, or dilate, to a degree sufficient to allow the child to be born. in subsequent confinements, these parts having once been dilated yield much easier, thus shortening the time and the pains of this, the most painful, stage of labor. the average duration of labor is eighteen hours in the case of the first child, and about twelve hours with women who have already borne children. the time, however, is subject to considerable variation, in individual cases, as has been pointed out. conduct of the patient during the second stage of labor.--she should remain up, out of bed, as long as she possibly can. the object of this is because experience shows that the labor pains are stronger, and more frequent, when in the upright position. even though this procedure would seem to invite more constant suffering, it must be remember that labor is a physiological, natural process, that there is nothing to fear or dread; and if the patient is in good health, it is to her advantage to have it over soon, rather than to encourage a long drawn out, exhausting labor. when the pains come [ ] she should be told to hold on to something, to hold her breath as long as possible, and to bear down. a good plan is to roll up a sheet lengthwise, and throw it over the top of an open door and let her grasp both ends tightly and bear down; or she can put her arms over the shoulders of the nurse and bear down. instruct her to hold her breath as long as she can, bearing down all the time, and when she can't hold it any longer, tell her to let up, and then take a quick deep breath and bear down again, repeating this programme until the pain ceases. tell her specifically to be sure to keep bearing down till the end of the pain, because the most important time, and the few seconds during which each pain does most of its work during the second stage of labor, is at the very end of each pain. when a woman understands that these instructions are for her good, and that they are given with the one purpose of saving her pain, and shortening the length of labor, she will try to obey. each pain is intended by nature to do a certain amount of work, and each pain will accomplish that work if the woman does not prevent it; and if she does prevent it, she is only fooling herself, because the next pain will have to do what she would not allow the former to do, and so on according to how she acts. the carriers of heritage [illustration: here is the actual bridge from this generation to the next. into these two little bodies--the larger not over one-twenty-fifth of an inch in diameter--is condensed the multitude of characteristics transmitted from one generation to another. the vital part of the _ovum_ is the _nucleus_, which contains the actual bodies that carry heritage--the little grains that are the mother's characteristics--_chromosomes_. this nucleus is nourished by oils, salts and other inclusions, known as _cytoplasm_. floating in the cytoplasm may be found a tiny body known as the _centrosome_, which acts as a magnet in certain phases of cell development. around this whole mass is a _cell wall_, more or less resisting and protective. the _spermatozoan_ is structurally much different from the ovum, but it also has its nucleus and chromosomes, which carry to the child the transmittable characteristics of the father. the ovum is usually comparatively large and stationary, and whatever motion is therefore necessary to bring it into contact with the male cell devolves upon the latter, which possesses what is known as a _locomotor tail_. in addition there are usually many sperms to one ovum, so that the chances are that at least one male cell will reach the egg and effect fertilization, and the beginning of a new life. the diagrams on the opposite page show the actual steps by which the spermatozoan unites with the ovum. it is the very first stage of the process of cell multiplication that results in the offspring.] the formation of a new life [illustration: _reproduced by permission from "genetics," walters, the macmillan co._] how a willful woman can prolong labor.--for a certain time, during the second stage of labor, a willful, unreasonable woman, can work against nature and save herself a little pain by prolonging the issue; but there will come a time when, the head having reached a certain position, the expulsive pains will be so great that she won't be able to control them and nature then seems to take her revenge. so if a woman holds back, and begins to cry, and scream, when she feels a pain coming, she renders the pain to a large degree negative, she prolongs her labor, adds to the total number of pains, exhausts herself, and endangers the life of her child. it must, however, be remembered in all justice that this is a time when it is much easier to preach than to practice. every confinement is a new experience; no matter how many a physician may have seen, there are no two alike. it is one of the interesting [ ] psychological problems in medicine to observe the conduct of women during their first confinement. some are calm, exhibiting a degree of self-control that is admirable. they are willing to be instructed, and they recognize that the advice is given for their benefit. they conscientiously try to obey suggestions, and they make praiseworthy efforts to keep themselves under control. they are stoics. others collapse at once; they go to pieces under the slightest excuse, and frequently without as much as an excuse. as soon as the pain begins, they willfully ignore all the instructions given and desperately and foolishly try to escape what they cannot escape. in this unreasonable selfishness they resent advice, and at the same time they implore you to "do something" for them. there is absolutely no excuse for this kind of conduct; and any prospective mother who, because of a willful trait in her disposition, refuses to profit by the kindly professional advice of her physician or nurse, should at least have some consideration for her unborn babe. it may seem unkind to criticise the conduct of any woman at such a time. it is not prompted by a lack of patience or justice however. these women permit, in spite of every assurance to the contrary, an unreasonable fear to overwhelm them; and because of this fear they refuse to be guided into a path of conduct that will save them suffering and shorten the pains which they complain of. it is our conviction that if a woman would try to follow the advice of the physician at this time, at least half of all the seeming suffering would be avoided. we are glad to be able to truthfully state that this type of woman is vastly in the minority. when the second stage has advanced far enough, the patient will decide to go to bed. it may be necessary to put her in bed earlier, if her pains are very strong, as there is always a possibility of suddenly expelling the child under the influence of a strong pain. she will, as previously stated, discard all clothing, except her night gown, which can be folded up to her waist line and let down as far as necessary after the confinement is over. the obvious advantage of this arrangement is that the gown remains [ ] unsoiled, and saves what would be needless trouble if it proved necessary to change the night gown at a time when the tired-out patient needs rest. much aid may be afforded the woman at this stage by twisting an ordinary bed sheet and putting it around one of the posts or bars of the foot of the bed. the patient may then pull on the ends during the pain; she may also find much comfort and aid by bracing her feet on the foot of the bed while pulling. it is desirable to instruct the nurse to press on the small of the back during these pains. some women appreciate a hot water bottle in this region. if the pains are hard the patient may perspire freely; it is always refreshing occasionally to wipe the face and brow off with a cloth wrung out of cold water. cramps of the limbs may be relieved by forcibly stretching the leg and pulling the foot up toward the knee. from this time until the child and after-birth are born the physician will take active charge of the case. the management of the actual birth of the child.--near the end of the second stage of labor it will be observed that the pains have grown strong, expulsive, and more frequent. very soon the advancing head will begin to push outward the space between the front and back passage; the rectum is pushed outward and the lips of the vagina open. if an anesthetic is to be used these are the pains that call for it. a few drops may be dropped singly on a small clean handkerchief held up by the middle over the nose, its ends falling over the face. a few drops will just take the edge off the pains, and render them quite bearable. as soon as the pain is over the patient should rest, relax completely, and not fret and exhaust herself worrying about the pains to come. it is astonishing how much actual rest a woman can get between pains if she will only try; and it is astonishing how much concentrated mischief a willful, unreasonable woman can do in the same time. she will not try to rest, but cries and moans and pleads for chloroform, until she succeeds in giving everyone except the physician and nurse the impression that she is suffering unnecessarily. her husband or her mother, whichever is present, gets nervous; they begin to wonder [ ] if the physician is really trying to help; assume a long, sad, serious face! forget their promise to look cheerful, and mayhap offer sympathy to the woman. it is a trying moment and needs infinite patience and tact. the physician attends strictly to his duty, which will now be to guard the woman against exerting too great a force during the last few pains. about this time, or before it in many instances, the "waters will break." this means simply that the bag or membrane in the contents of which the child floated burst because of the pressure of a pain. this is a perfectly natural procedure and should not cause any worry: simply ignore it as if it had no bearing on the labor in any way. as soon as the oncoming head has dilated the passage sufficiently, so that the edges of the entrance to the vagina will slip over the head without tearing, the physician allows the head to be born. it takes some time to do this, and he must hold the head back until just the right moment. it is best not to let the head slip through at the height of a pain, or rupture is sure to occur. wait till it will slip through as a pain is dying out, and if you have waited long enough and handled the head skillfully, the conditions will be just right at a certain moment to permit this without tearing the parts. there are some cases where a tear, and a good tear, is impossible to guard against. it is not a question of patience, or tact, or skill; it is a combination of conditions which patience, tact, and skill are powerless against. position of woman during birth of child.--the position of the woman is a matter of choice and is not contributory to the results at all. she can lie on her back, which is the ordinary way, or on her side, as the physician or the patient prefer. as soon as the head is born the physician should see that the cord is not round the child's neck; if it is, release it. the shoulders will most likely be born with the next or succeeding pain. the physician will permit the lower shoulder to slip over the soft parts first; this is done by retarding the upper shoulder by pushing it gently behind the pubic bone of the mother. when the shoulders are through, the rest[ ] of the body of the child slips out without effort. duty of nurse immediately following birth of child.--as soon as the child is born the nurse should sit by the side of the mother and hold the womb until the after-birth is expelled. the womb can be easily felt in the lower part of the woman's abdomen as a hard mass. it feels about the size of an extra large orange. the object of holding it is to prevent the possibility of an internal hemorrhage. it can be readily appreciated that the interior of a womb, immediately after a child is born, is simply a large bleeding wound. so long as the womb remains firmly contracted there is very little chance for an extensive bleeding to take place. as a rule the womb remains sufficiently contracted to preclude a hemorrhage until the after-birth is out. after the after-birth is expelled, the womb usually closes down firmly and the liability to bleed is very much reduced. because there is a distinct chance or tendency for the womb to bleed freely during the time the after-birth remains in, it is customary, as stated above, to watch it closely and to hold it securely. it is best held with the right hand. the fingers should surround the top of the womb and exert a slight downward pressure. should it show any tendency to dilate or fill with blood, get it between the fingers and the thumb and squeeze it, pushing downward at the same time. expulsion of after-birth.--the after-birth is usually expelled in about twenty minutes after the child is born. great care should be experienced in its expulsion. it should not be pulled at any stage of its expulsion. if it does not come easily give it a longer time,--it takes time for the womb to detach itself from the after-birth; and some after-births are very firmly attached. eventually it will come out with a little encouragement in the way of frictional massage of the womb through the abdominal walls. if the membranes remain in the womb after the body of the after-birth is out, do not pull on them. take the after-birth up in the palm of your hand and turn or twist it around, and keep turning it around gently, thereby loosening the membranes from the womb instead of pulling them, which would surely break them, leaving the broken ends in the womb, and, as a result, the[ ] chance of developing serious trouble. the patient should now be given one teaspoonful of the fluid extract of ergot, which should be repeated in an hour. should there be an excessive flow of blood after this period it may be again repeated at the third hour. cutting the cord.--as soon as the child is born, and of course long before the after-birth is expelled, the physician will tie the cord. this is best done at two places, one about two inches from the child, and the other two or three inches nearer the mother. cut the cord about one-half inch beyond the first ligature, which will be between the two ligatures. the cord should be tied with sterile tape made for the purpose, or heavy twisted ligature silk, or a narrow, ordinary, strong tape, previously boiled. it should be tied firmly and inspected a number of times within one hour of its birth. it is possible for a baby to lose enough blood from a cord badly tied to cause its death. a very good way to ensure against such an accident is to cut the cord one inch from the ligature nearest the baby, then turn this inch backward and retie with the same ligature, thus making a double tie at the same spot. cut the cord with scissors that have been boiled and reserved for this purpose. washing baby's eyes and mouth immediately after birth.--as soon after birth as is practicable, wash the baby's eyes with a saturated solution of boracic acid. immediately after the eyes have been washed the physician will drop into them a solution of silver nitrate, three drops of a two per cent. solution in each eye, or argyrol, three drops per cent. solution. this precaution is taken against possible infection during labor and, as explained elsewhere, it is a preventive against certain diseased conditions which, if present, would result in blindness. the physician should then wind a little sterile cotton round his moistened little finger, dip it in the boracic solution, and holding the baby up by the feet head down, insert this finger into the throat, thus clearing it of mucus. the tongue and mouth may be gently washed with the same [ ] solution. after the baby has cried lustily as an evidence of life and strength, he should be wrapped up in a warm blanket quickly, and immediately put in a cozy basket in a warm place, and left there undisturbed, with his eyes shaded from the light until the nurse is ready to attend to him. the baby should be laid on his right side. conduct immediately following labor.--as soon as the physician is satisfied that the patient is well enough to be left in care of the nurse or attendant, every effort should be made to favor a long, refreshing sleep. nothing will contribute to the patient's well-being so much as a quiet, restful sleep after labor. the nurse will therefore take the baby into another room, fix the mother comfortably, and give her a glass of warm milk,--draw the shades or lower the light and tell the tired-out mother to go to sleep. as a rule she will sleep easily, as she is sore and exhausted. after-pains.--in women who have had children the womb does not as a rule contract down as firmly as after the first confinement. this condition permits of slight relaxation of the muscular wall, at which times there is a slight oozing of blood. this blood collects and forms clots in the uterine cavity which acts as irritants, exciting contractions in the effort to expel them. these contractions cause what are commonly known as "after-pains." these pains last until the womb is free from blood-clots. they may be severe the first twenty-four hours and then gradually die out during the following two or three days. ordinarily in uncomplicated confinements they rarely annoy the patient longer than a few hours. it is a rare exception to observe them after the first confinement. rest and quiet after labor.--sometimes the birth chamber is the rendezvous for all the inquisitive ladies in the neighborhood. no one should be permitted in the lying-in chamber until the patient is sitting up, except the husband and the mother. this should be made an absolute rule in every confinement. this is a period that demands the maximum of uninterrupted rest and repose. the world and all its concerns should remain a blank to a woman during the whole period of her confinement. this is the only successful means of obtaining mental rest. the husband and mother [ ] should be instructed to present themselves just often enough to demonstrate their interest in the welfare of the patient and the baby. position of the patient after labor.--after delivery a woman should be instructed to lie on her back, without a pillow, for the first night. on the following morning she may have a pillow, but she must remain on her back for the first week. sometimes an exception may be made to this rule by letting the patient move around on the side, with a pillow supporting the back, on the fourth day. these exceptional cases are those whose womb has contracted firmly, as shown by the quick change in the amount and color of the lochia. women should be told why they must remain on their backs as explained in the chapter: "how long should a woman remain in bed?" the lochia.--the discharge which occurs after every labor is called the lochia. its color is red for the first four or five days; for the succeeding two or three days it is yellow; for the remainder of its existence it is of a whitish color. it lasts from ten days to three weeks. the odor of the lochia is at first that of fresh blood; later it has the odor peculiar to these parts. if at any time the odor should become foul or putrid it is a danger signal to which the nurse should immediately draw the physician's attention. if the amount of the lochia should be excessive it should be investigated. the events of the day following labor.--we will assume that the patient enjoyed a long sleep and wakes up refreshed, and with a thankful feeling that all is over and that baby is safely here. she will want to see and caress baby, of course. lay the baby down in bed beside her and let her love and mother it. tell her not to lift it, for the strain might injure her, then quietly steal away for ten or fifteen minutes, for these are precious, sacred moments. motherhood--that angel spirit, whose influence every human heart has felt--that guards and guides the world in its sheltering arms--is born in its divine sense, into the heart of every woman for the first time, as she gazes in ecstasy and wonder at her [ ] first-born. she feels that she has begotten a trust,--a trust direct from her creator, and she makes a silent resolve, as she gently and timidly feels the softness of baby's cheek, that she will watch over it, and guide it, and do all a mother can for it, with god's help. it is good for the race that mothers do feel this way: and it is good for all concerned that they be given the opportunity to be so inspired. just as gently take the baby away at the expiration of the allotted time. take it with a cheerful, smiling word, and do not comment upon mother's happy, thoughtful face, she will quickly collect herself and enter into the spirit of quiet congratulation that should now permeate the home. the first breakfast after labor.--if the patient has passed a comfortable night, feels well, and is free from temperature, and has a normal pulse, breakfast will consist of a cup of warm milk, or a cup of cocoa made with milk, a piece of toasted bread, and a light boiled egg; or if preferred a cereal with milk and toasted bread. this will be the breakfast for the two following days also. the milk, or the cocoa (whichever is taken), must be sipped, while the attendant supports the patient's head. the cereal, or the egg (whichever is taken), must be fed to the patient out of a spoon. the patient must not make any physical effort to help herself; she must remain relaxed. even when she sips her milk, or cocoa, she must not make any effort to raise her head; the nurse must support its entire weight. this will be the absolute routine of every meal until the physician gives permission to change the procedure. it is a waste of time to formulate rules only to disobey them. shortly after breakfast the patient's toilet should be attended to. she should have her hair combed, and her face and hands washed. the hair on the right half of her head should be combed while the head rests on the left side, and vice versa. the water used for washing the hands and face should be slightly warmed. it is best to keep the hair braided and to consult the wishes of the patient as to the frequency of combing it. [page ] the importance of emptying the bladder after labor.--an effort should be made now to have the patient urinate. this is very important at this time, as it is not an uncommon experience to find that the abdominal muscles are so worn out and overstrained with the fatigue of labor that they refuse to act when an effort is made to urinate. as a consequence the bladder becomes distended and may have to be emptied by other means. this condition is a temporary and a painless one, and will rectify itself in a day or two; meantime, if this accident has occurred, it is essential that the bladder should be emptied from time to time until the patient can do it herself. to test this function place the patient on the bed pan into which a pint of hot water has been put, and give her a reasonable time to make the effort to pass her water. should she fail, take an ordinary small bath towel and wring it out of very hot water, just as hot as she can tolerate, and spread it over the region of the bladder and genitals: if there is running water in the room, turn it on full and let it run while the towel is in position as above. if the bladder is full, there is a peculiar, irresistible desire to urinate when one hears running water. if this effort fails, report the fact to the physician when he makes his daily call; he will draw the urine and it will be part of his daily duty to give specific instructions regarding this function until nature reëstablishes it. no particular attention need be paid to the bowels for the first two days. on the morning of the third day, if they have not acted of their own accord, the physician will give the necessary instructions to move them. the means necessary to accomplish the first movement after a confinement is a matter of choice. the old-time idea was to use castor oil, and while other remedies are now more or less fashionable, castor oil is still an excellent agent. enemas are frequently used, but their use is questionable in this instance, inasmuch as a movement has not taken place for three days, the object is to clean out the whole length of the intestinal tract, and an enema is limited to part of the large intestine only,--according to how it is given. if the small intestines are not thoroughly emptied, [ ] particles of food may remain there, and if so, they will putrify and the patient runs the risk of developing gas,--sometimes to an enormous extent. this affliction is painful, and dangerous, and nearly always unnecessary. it is always, therefore, more safe, and more desirable, to use some agent by the mouth, and we know of no better one than castor oil; and as castor oil can be so masked as to be practically tasteless at any drug-store soda fountain there can be small objection to it. my custom is to send the nurse or husband with an empty glass to the drug store to have the mixture made there and brought back ready for use. we have frequently obtained it in this way and given it to the patient without her knowing what it was. the best time to give castor oil is two hours after a meal, and two hours before the next meal--i.e., on an empty stomach. it works quicker and does not nauseate when the stomach is empty. instructing the nurse in details.--the nurse will attend to the patient's discharges by changing the napkins frequently. the bruised parts should be washed twice daily, for the first three or four days. if the nurse is a trained graduate nurse a few directions will suffice. if she is not a trained nurse the physician should be explicit in his instructions. it would be better if he actually showed her just how he wanted this work done. the best way to cleanse the vulvæ or privates is to take an ordinary douche bag at the proper height (about three feet) and allow the solution ( to , bichlorid) to run over the parts into the douche pan, but do not touch any part of the patient with the nozzle of the douche bag. while she is directing the water with the left hand she should have a piece of sterile cotton in the right hand with which she will gently mop the parts. this method ensures disengaging any clotted blood and is aseptic. dry the parts afterwards with a soft sterile piece of gauze and apply a clean sterile napkin. douching after labor.--a nurse should never give a vaginal douche without instructions from the physician. douches are not necessary in the convalescence of ordinary uncomplicated confinement cases. when it is [ ] necessary to give vaginal douches after a confinement, there are good reasons why they should be given, and it is therefore absolutely essential that they should be given properly, and with the highest degree of aseptic precautions. if these rules are not observed, the danger of causing serious trouble is very great, and as the physician is directly responsible for the conduct of the case, he should in justice to himself and his patient, do the douching himself. how to give a douche.--the proper way to give a vaginal douche after a confinement, when the parts are bruised and lacerated, and when, as a consequence, the possibility of infection is very great, is as follows: instruct the nurse to boil and cool about two quarts of water and have another kettle of water boiling. boil the douche bag and its rubber tubing and the glass douche tube (do not use the hard rubber nozzle that comes with the ordinary douche bag). drain off the water after it has boiled for ten minutes, but instruct the nurse not to touch the bag or tube, to leave them in the pan, covered, till the physician uses them. when the physician calls, place the patient on a clean warm douche pan while he is sterilizing his hands and making the solution ready. while he is douching the patient the nurse will hold the bag. the bag should not be held higher than two feet above the level of the patient. advantages of putting baby to the breast early after birth.--the patient can now take, and will likely be ready for, an hour's nap. after the rest it is desirable to put the baby to the nipple, first carefully cleaning the nipple with a soft piece of sterile gauze dipped in a saturated solution of boracic acid. the reasons for this are as follows: st. there is in the breasts of every woman after confinement a secretion known as "colostrum" which has the property of acting as a laxative to the child, in addition to being a food. nd. it is advisable that the child's bowels should move during the first twenty-four hours and the colostrum was put there partly for that purpose. rd. the act of suckling has a well-known influence on the womb, in [ ] that it distinctly aids in contracting it, and thereby expelling blood-clots and small shreds of the after-birth which might cause trouble if left in. th. by nursing the colostrum out of the breasts, it will favor and hasten the secretion of milk. th. it is frequently easier for the baby to get the nipple before the breast is full of milk, and having once had the nipple it will be easier to induce him to take it again when it is more difficult to get. the first lunch after labor.--lunch will be next in order, and that should consist of a clear soup,--chicken broth, mutton broth, beef broth with a few graham wafers or biscuits, and a cup of custard or rice pudding. this will be the lunch for the two following days also. the same precautions are to be observed in giving this as were observed with breakfast and as will be observed with all other meals as clearly stated before, and repeated again, so that no mistake may be made. in the middle of the afternoon the patient can take a cup of beef tea or a cup of warm milk. the first dinner after labor.--dinner will consist of more broth, or a plate of clear consomme with a dropped egg, or a cereal, a little boiled rice with milk, and stewed prunes, or a baked apple. after the bowels have moved, on the third day, and provided the temperature and pulse have been normal since the confinement, the patient can be put on an ordinary mixed diet, particulars regarding which are given on page under the heading "diet for the nursing mother." * * * * * [ ] chapter ix confinement incidents regarding the dread and fear of childbirth--the woman who dreads childbirth--regarding the use of anesthetics in confinements--the presence of friends and relatives in the confinement chamber--how long should a woman stay in bed after a confinement?--why do physicians permit women to get out of bed before the womb is back in its proper place?--lacerations, their meaning and their significance--the advantage of an examination six weeks after the confinement--the physician who does not tell all of the truth regarding the more or less prevalent dread or fear of childbirth.--much has been written, and much more could be written upon this subject. inasmuch as this book is largely intended for prospective mothers to read and profit thereby, and is not for physicians and nurses whose actual acquaintance with confinement work would render such comments superfluous, it will not be out of place to consider this phase of the subject briefly, from a medical standpoint. when one considers that "a child is born every minute" as the saying goes, and which is approximately true, and at the same time remembers that statistics prove, as near as can be estimated, that there is only one death of a mother in twenty thousand confinements, it would really seem as though we were "looking for trouble" to even regard the subject as worthy of the smallest consideration. it is much more dangerous to ride five miles on a railroad, or on a street car, or even take a two-mile walk,--the percentage possibility of accident is decidedly in your favor to stay at home and have a baby. almost any disease you can mention has a higher, a much higher fatality percentage than the risks run by a [ ] pregnant woman. the real justification for actual fear of serious trouble is so small that it barely exists. these are facts that cannot be argued away by any specious if or and. why, therefore, should there be any real fear? did you ever hear of the remarks made by a famous philosopher who was given a dinner by his friends in celebration of his th birthday? in replying to the eulogisms of his friends he said in part: "as i look back into those blessed years that have faded away, i can recall a lot of troubles and many worries as well as much happiness and pleasure, and thinking of it all this evening i can truthfully say my worst troubles and worries never happened." so it is with the woman who for weeks or months has made her own life wretched, and possibly the life of her husband and friends, the same in imagining all kinds of dreadful things that never take place. it is undoubtedly an exhibition of weakness, an evidence of failure in the development of self-control. childbirth is a natural process,--there is nothing mysterious about it. if you do your part you have no cause to fear,--the very fact, however, that you entertain a dread of it, shows that you are not doing your part. one of the saddest parts of life, one of the real tragedies of living, is the fact that most of us have to live so long before we really begin to profit by our experiences. could we only be taught to learn the lesson of experience earlier, when life is younger and hope stronger, we would have so much more to live for and so many more satisfied moments to profit by. one of the most valuable lessons experience can teach any human being is not to worry and fret about the future. you can plant ahead of yourself a path of roses and be cheerful, or you can plant a bed of thorns and reap a thorny reward. cultivate the spirit of contentment, devote all your energy to making the actual present comfortable. don't fret about what is going to bother you next week, because, as the philosopher said, most of the troubles we anticipate and worry about never occur, but the worry kills. regarding the use of anesthetics in confinements.--anesthetics are as a rule given in all confinements that are not normal. to make this [ ] statement more plain it may be said, that, when it is necessary to use instruments, or to perform any operation of a painful character, it is the invariable rule to give anesthetics. as to the wisdom of giving an anesthetic when labor is progressing in a normal and satisfactory manner, there is a difference of opinion. much depends upon the disposition of the patient and the viewpoint of the physician in charge of the case. it is a fact that a large number of confinements are easy and are admitted to be so, by the patients themselves, and in which it would be medically wrong to give an anesthetic. in a normal confinement, however, when the pains are particularly severe and the progress slow, there is no medical reason why an anesthetic could not be given to ease the pain. in these cases it is not necessary to render the patient completely unconscious. sufficient anesthetic to dull each pain is all that is necessary, and as this can be accomplished with absolute safety by the use of an anesthetic mixture of alcohol, ether and chloroform, there can be no possible objection to it. the use of an anesthetic, however, is a matter that must be left entirely to the judgment of the physician as there are frequently good reasons why it should not be given under any circumstances. the presence of friends and relatives in the confinement chamber.--it is a safe rule to exclude every one from the confinement room during the later stages of labor. sometimes it is desirable to make an exception to this rule in the interest of the patient, by permitting the mother or husband to remain. if this exception is made, however, they must be told to conduct themselves in a way that will tend to keep the patient in cheerful spirits. they must not sympathize, or go around with solemn, gloomy faces. cheerfulness and an encouraging word will tide over a trying moment when the reverse might prove disastrous. practically the same rule applies to the entire period of convalescence during which time the patient is confined to bed. this is a very important episode in a woman's life and the consequences may be serious if it is misused in any way. friends and relatives do not appreciate the [ ] absolute necessity of guarding the patient from small talk and gossip, and an unwitting remark may cause grave mental distress, which may retard the patient's convalescence and disastrously affect the quality and quantity of her milk, thereby injuring the child. how long should a woman stay in bed after a confinement?--to answer this question by stating a specific number of days would be wrong, because, few women understand the need for staying in bed after they feel well enough to get up. if any answer was given, it should be at least fourteen days, and it would be nearer the truth medically to double that time. let us consider what is going on at this period. the natural size of the unimpregnated womb is three by one and three-quarter inches, and its weight is one to two ounces. the average size of the pregnant womb just previous to labor is twenty by fourteen inches, and its weight about sixteen ounces. we have, therefore, an increase of about % to be got rid of before it assumes again its normal condition. this decrease cannot be accomplished quickly by any known medical miracle. nature takes time and she will not be hurried: she will do it in an orderly, perfect manner if she is allowed to. the womb will again find its proper location and will resume its work, in a painless, natural way, in due time, if all goes well. the uterus or womb is held in its place by two bands or ligaments, one on either side, and is supported in front and back by the structures next to it. these bands keep the womb in place in much the same way as a clothes pin sits on a clothes line, and it will retain its proper place provided everything is just right. after labor, it is large and top heavy. if you put a weight on the top of a clothes pin as it sits on a clothes line, what will take place? it will tilt one way or the other, and if the weight is heavy, it will turn completely over. so long as the woman lies in bed the womb will gradually shrink back to its proper size and place; if she sits up or gets out of bed too soon, the weight of the womb, being top heavy, will cause it to tilt and sag out of its true position. as soon as it does this the weight of the bowels and other structures above will push and crowd it further out [ ] of place. this crowding and tilting interferes with the circulation in the womb and its proper contraction is interfered with, and thus is laid the foundation for the multitude of womb troubles that exist. it is a mechanical as well as a medical problem. being partly mechanical, it is subject to the rules that govern mechanical problems. the importance of this dual process will be appreciated by considering the following fact. many medical conditions tend to cure or rectify themselves because nature is always working in our behalf if we give her a chance. take for example an ordinary cold. you can have a very severe cold and you can neglect it, and in spite of your neglect you will get well. it is not wise to neglect colds, nevertheless, it is true that nature will cure, unaided, a great many diseased conditions, if she has half a chance. this, to a very large extent, is the secret of christian science, yet the principle is known to everyone. a mechanical condition, on the other hand, has absolutely no tendency to get well of its own accord, or without mechanical aid. this is why christian science cannot cure a broken leg. it is this principle that makes diseases of the womb so persistent, and so stubborn of cure. when a womb once becomes slightly displaced, the tendency always is for it to grow worse and never to cure itself. the longer it lasts the worse it gets. its cure depends upon mechanically putting it back in place and holding it long enough there to permit nature to reëstablish its circulation, and by toning and strengthening it so that when the mechanical support is taken away it will retain its position. there is no other possible way of doing it. now since it has been proved that nature takes many days to contract a pregnant womb, a woman is taking a risk, and inviting trouble by getting out of bed before that time. why do physicians permit women to get up before the womb is back in its proper place?--without offering the excuse that a woman will not stay in bed as long as a physician knows she should, there is, however, a large degree of truth in this excuse. and we are of the opinion that, if a physician made it a rule to keep all his confinement cases in bed for one month, [page ] he would very soon find himself without these patients. experience has taught us, however, that it is safe, under proper restrictions, and in uncomplicated confinements, to allow patients to sit up in bed on the th and in certain cases on the th day, and to get out of bed on the th or th day. when the patient is allowed to sit up, out of bed, it should not be for longer than one or two hours, and during that time she should sit in a comfortable rocking or morris chair, which should be placed by the side of the bed. each day the time can be lengthened, and the distance of the chair from the bed increased. this procedure gives her the opportunity to walk a little further each day, thereby to test her strength and ability to use her limbs. on the fourth day, if all has gone well, she may stay up all day and she may walk more freely about the room. she should be just to herself, however. as soon as she is fatigued she should not make any effort to try to "work it off." when a feeling of fatigue appears she should rest completely. if she has any pain or distress she should acquaint the physician with it at once. she should not try to hide anything on the mistaken idea that "it isn't much." she does not know, and she is not supposed to know what the pain may mean; it may be exceedingly significant. many women have saved themselves needless suffering, and their husbands unnecessary expenditure of money, by calling the physician's attention to conditions, which in time would have been serious, and would have necessitated long, expensive treatment. lacerations during confinement, their meaning and their significance.--the only interest a laceration or a tear has to a physician, is whether the laceration or tear is of sufficient importance to need surgical interference. the laceration can take place at the mouth of the womb, or on the outside, between the vagina and rectum. those of the mouth of the womb always take place, in every confinement, to some degree. they are never given any attention at the time of the confinement, unless under extraordinary circumstances, such as a more or less complete rupture of the womb, and this is such a rare accident [ ] that most physicians practice a lifetime and never see or hear of one single case. those on the outside are always attended to immediately after labor, or should be, unless they are very extensive and the patient is not in condition to permit of any immediate operative work. in such a case it is best to leave it alone until the patient is in condition to have it operated on at a later date. it is distinctly preferable to have it attended to immediately after labor when it is possible, and it is possible in a very large percentage of the cases. the explanation of this is because it is practically painless then, owing to the parts having been so stretched and bruised that they have little or no feeling. if it is left for a day or two and then repaired, it will be more painful, because the parts will have regained their sensitiveness. another good reason in favor of immediate repair is that a much better and quicker union will take place than if postponed. when a patient is torn, but not to the degree necessary to stitch, it is to her advantage to be told to lie on her back and keep her knees together for twelve hours, thus keeping the torn edges together and at rest, thereby favoring quick and healthy repair of the tear. some physicians go as far as to bind the patient's knees together so she cannot separate them during sleep. it is the custom of every conscientious physician to request every woman he confines to report at his office six or eight weeks after labor. the reason for this is to find out by examination the character and extent of the lacerations of the mouth of the womb. no physician can tell at the time of labor just how much damage has been done, because the mouth of the womb, at the time of labor, is so stretched and thinned out, that it is impossible to tell. after the womb has contracted to about its normal size, it is a very simple matter for any physician to tell exactly the character and extent of the lacerations. most of these tears need absolutely no attention; there are a few however that do. this is a very important matter for two very good reasons. st. every woman should know, and is entitled to know, just what [ ] condition she is in, because if she has been torn to an extent that needs attention, and is left in ignorance of it, her physical health may be slowly and seriously undermined and the cause of it may not be understood or even guessed at. a woman who becomes nervous and irritable, loses vim and vitality, has headaches, backaches and anemia, and no symptoms, or few, that point to disease of the womb, will suffer a long time before she seeks relief of the right kind, and will be astonished and outraged when she is told that it all results from a bad tear of her womb that she knew nothing about. nd. a physician should in justice to himself insist on this late examination, because if a woman is told, at some subsequent time, by another physician that she is badly torn, and she was not told of it by the physician who confined her, she is very apt to form an unjust opinion of his work and to entertain an unfriendly feeling toward him as a man. some physicians also, to their discredit, are not slow in permitting an unjust opinion of a colleague to be spread around, by preserving a silence, when an explanation would result in an entirely different opinion by the patient. they permit it to be inferred that the physician was responsible for the tear, when such is not the case. no physician on earth can prevent a tear of the mouth of the womb and this should be explained to the patient. where the physician is at fault is in the failure to examine his patients when it is possible to tell that a tear of any consequence exists. if such an examination is made, he is in a position to state that a tear exists of sufficient extent to justify careful attention. immediate operation is seldom necessary, and if the patient is comparatively young, it may not be wise to operate, because if pregnancy takes place within a reasonable time the womb will again tear. she should be told, however, that should she not become pregnant during the next three years she should be examined from time to time, and if the condition of her womb, or her health suggest it, she should have the tear attended to. if after this explanation she neglects herself she must blame herself, she will at least have no[ ] cause to harbor any resentment against her physician who has done all any physician is called upon to do under the circumstances. another important reason for finding out the character of the laceration is because these lacerations of the mouth of the womb frequently cause sterility. * * * * * [ ] chapter x nursing mothers the diet of nursing mothers--care of the nipples--cracked nipples--tender nipples--mastitis in nursing mothers--inflammation of the breasts--when should a child be weaned?--method of weaning--nursing while menstruating--care of breasts while weaning child--nervous nursing mothers--birth marks--qualifications of a nursery maid. the diet of nursing mothers.--a nursing mother should eat exactly the same diet as she has always been accustomed to before she became pregnant. if any article of diet disagrees with her she should give up that particular article. she should not experiment; simply adhere to what she knows agreed with her in the past. more, rather than less, should be taken, especially more liquids as they favor milk-making. it is sometimes advisable to drink an extra glass of milk in the mid-afternoon and before retiring. if milk disagrees, or is not liked, she may take clear soup or beef tea in place of it. in a general way milk in quantities not over one quart daily, eggs, meat, fish, poultry, cereals, green vegetables, and stewed fruit constitute a varied and ample dietary to select from. every nursing mother should have one daily movement of the bowels; she should get three or four hours' exercise in the open air every day; and she should nurse her child regularly. the diet of the nursing mother during the period immediately after confinement is given elsewhere. alcohol, of all kinds, should be absolutely avoided during the entire period of nursing. drugs of every variety, or for any purpose, should never be taken unless by special permission of her physician. care of the nipples.--as soon as the mother has had a good sleep after the confinement the nipples should be washed with a saturated solution of [ ] boracic acid, and the child allowed to nurse. the milk does not come into the breast for two or three days, but the child should nurse every four hours during that time. there is secreted at this time a substance called colostrum. this is a laxative agent which nature intends the child should have as it tends to move the bowels and at the same time it appeases the hunger of the infant. it also accustoms the child to nursing and gradually prepares the nipples for the work ahead of them. after each nursing the nipples should be carefully washed with the same solution and thoroughly dried. cracked nipples.--cracked nipples often result from lack of care and cleanliness. if they are not cared for as described above they are very apt during the first few days to crack. they should never be left moist. they should be washed and dried after every feeding. if the breasts are full enough to leak they should be covered with a pad of sterile absorbent gauze. nursing mothers should guard against cracked nipples, as they are exceedingly painful; frequently necessitating a discontinuance of nursing; and may produce abscess of the breast. treatment of cracked nipples.--in addition to washing the nipples, drying them thoroughly, and placing a pad of dry gauze over them after each feeding, they should be painted with an per cent. solution of nitrate of silver twice daily. before the next feeding, after the silver has been used, they should be washed with cooled boiled water. if the cracks are very bad it may be necessary to use a nipple-shield over them while nursing for a few days. tender nipples.--many women complain of the pain caused by the baby when it is first put to the breast. these nipples are not cracked, they are simple hypersensitive. they should be thoroughly cleansed and dried as above and painted with the compound tincture of benzoin. they should be washed off with the boracic acid solution before each feeding. after a few days under this treatment the tenderness will leave them. mastitis in nursing mothers.--when inflammation of the breast takes [ ] place in a nursing mother it is the result of exposure to cold, or it may result from injury. if infection occurs and an abscess develops, it results from the entrance, through the nipples, or cracks, or fissures in the nipple, of bacteria into the breast. there is fever, with chills and prostration, and very soon it is impossible to nurse the child because of the pain. nursing should be immediately discontinued, the breast supported by a bandage and the milk drawn, with a breast pump, at the regular nursing intervals. an ice-bag should be constantly applied to the painful area and the bowels kept freely open with a saline laxative. when the fever and the pain subside nursing may be resumed. if the gland suppurates in spite of treatment it must be freely opened and freely drained. weaning when to wean the baby.--medically there is no exact time at which the baby should be weaned. certain conditions indicate when it should be undertaken. it is desirable to wean the baby between the tenth and twelfth months. a month or two one way or another will not make much difference if the mother and child are in good condition. it should be weaned between the periods of dentition rather than when it is actively teething. the time of year is important. it would be better to wean it before the hot weather if it is strong and has been accustomed to taking other food than the breast milk. on the other hand it would be decidedly better to defer the weaning until the fall, rather than risk weaning at the tenth or twelfth months if these fall during the height of the hot weather. methods of weaning.--the best way to wean is to do it gradually. it is not desirable to take the mother's milk away suddenly unless there is a very good reason for it. the child should be fed small portions of suitable other food at the beginning of the tenth month. by the end of the tenth month he should be taking a feeding two or three times a day of food other than the breast milk. this feeding may be given in a bottle. in some [ ] cases the mother may be able to feed the child with a spoon instead of the bottle. the substitute feedings allowable at this age are given in another chapter. times when rapid weaning is necessary.--there are times when the child must be weaned suddenly, as, for example, at the death of the mother, serious sickness of the mother, or in cases where for any cause the mother suddenly loses her milk. in these cases it is best to wean at once. if an infant refuses to take the bottle under such circumstances, the best plan to adopt, and the wisest one in the long run, is to starve the child into submission. if he gets absolutely nothing but the bottle he will shortly take it without protest. if a meddling individual attempts to feed the child some other food and tries to coax it to take the bottle in the meantime, much harm may result; it is safe only to fight it out for a day or two and win than to half starve the child and lose in the end. the child should be weaned if it is not gaining in weight. this may indicate a deficient quality of the mother's milk, or it may indicate a lack of proportion between the child and mother. if a robust child is depending upon the nourishment furnished by a mother who is not in good physical condition the milk may not be adequate in quality and quantity. the child will not therefore develop normally and it may be necessary to wean it. if the mother becomes pregnant it will be necessary to wean, because pregnancy invariably affects the quality of the milk. it is a very good habit to accustom the child to take its daily supply of water from a bottle from a very early age. this procedure will make it easier to wean at any time. menstruation is not an indication for weaning as has been explained. if, however, the return of menstruation affects the milk so that it disagrees with, or fails to satisfactorily nourish the child, it may be necessary to wean, but not unless. the best reason for weaning a child at the twelfth month is that a mother's milk after that time is not adequate in quality for a child of that age. a child at one year of age has grown beyond the capability of its mother[ ] to nurse it: nature demands a stronger and a more substantial food than any mother can supply. a mother who nurses her child beyond that period is not only injuring herself, but she is cheating her child. the exception to this rule is, as has been explained, the second summer. the child will evidence its dissatisfaction with the breast supply if it is not enough; it will not gain in weight, it will be irritable and fretful, it will tug long and tenaciously at the nipple, it will be unwilling to cease nursing after it should have finished, and it will drop the nipple frequently with a dissatisfied cry. these are all signs of insufficient nourishment, and to the observant mother they will at once indicate that the child must be weaned and fed upon a mixed diet. care of breasts while weaning child.--the process of weaning should cause little or no discomfort. if the weaning is gradual it is necessary to press out enough milk to relieve the tension from time to time. it usually takes three or four days. if it is necessary to wean abruptly, as it is occasionally, there may be considerable distress. in these cases it is necessary to massage the breasts completely,--until all the milk is out, or as much as it is possible to get out,--then rub the breasts with warm camphorated oil, and bind them firmly. when the breasts are massaged for any reason, the rubbing should be toward the nipple and it should be done gently. if there are any hard lumps, or caked milk, in the breasts, they must be massaged until soft, and the binding renewed. it may be necessary to repeat this process for a number of days. in binding the breasts use a large wad of absorbent cotton at the sides, under the arms, to support the breasts, and another wad between the breasts. this renders the binding more effective; permits the binder to be put on tighter; and prevents it from cutting into the skin. when weaning has to be done quickly the patient should absolutely abstain from all liquids. a large dose of any saline, pluto, apenta, or hunyadi water, or rochelle salts, or magnesium citrate, should be given every morning for four or five days. [page ] if the weaning is gradually undertaken the child should be allowed to nurse less frequently. one less nursing every second day until two nursings daily are given. keep the two daily nursings up for one week and then discontinue them, after which the above measures may be adopted. to dry the milk up, the breasts may be anointed with the following mixture: ext. belladonna, drams; glycerine, ounces; oil of wintergreen, drops. nervous nursing mothers.--nervousness, considered not as the product of a diseased condition, but as a temperamental quality, is an unfortunate affliction in some nursing mothers. let us illustrate just how this characteristic is detrimental to the helpless baby. a mother was instructed to give her baby a half teaspoonful of medicine one-half hour after each feeding. she was told how to give it, and how to hold the baby when giving it. she was also told that the baby would not like it, and would try to eject it from its mouth rather than swallow it, and that when it did swallow it, it would make a little choking noise in its throat, but not to mind these, to go ahead and give it, as the baby could not strangle or choke. it was essential to give the baby this medicine, and hence the physician explicitly instructed her in these details. what was the result? on the following day when the physician called, and found the baby much worse, the mother said: "oh, doctor! i couldn't give the medicine, the baby wouldn't take it, she nearly strangled to death when i tried to give it." the physician asked for the medicine and placing the baby over his knee, gave it without the slightest trouble, much to the mother's amazement. the servant girl who was a hard-headed, cool, scotch girl, was instructed and shown how to give the medicine, which she did successfully. the mother was temperamentally nervous, was easily excited and became helpless the moment the baby objected, though she was a strong, robust, healthy woman. another mother was carefully instructed to drop into the eye of her baby two drops of medicine every four hours. she was told and apparently appreciated the urgent necessity of the medication as her baby's eye [ ] was badly infected. she was further told that if she did exactly as shown, the eye would be better in two or three days, and if she did not, the other eye would become infected, and blindness might result. she undertook to carry out the directions faithfully. she absolutely failed, however, to carry out the instructions. her husband informed the physician on the following day that she became so nervous and excited that she utterly failed to treat the eye once, and when he and a sister offered their assistance she became so unreasonable in her fear that "they might hurt the baby" that it was impossible to do anything with her. her sister was finally shown how to do it and carried the case through quite successfully. inasmuch as this book is intended to convey helpful instruction to every mother, the author would suggest to those of this type the necessity of resisting this tendency. it is a matter of will power, just make up your mind not to be silly and if you find that you cannot trust yourself to follow instructions, let someone else do it. when the physician tells you a certain thing must be done, and that no harm can result, do it, and don't imagine all kinds of impossible happenings. so much anguish and annoyance is caused in this world by imagining and anticipating trouble, that half the pleasure of life is denied us. you cannot do your whole duty by a helpless baby if you do not reason and act upon sound judgment. many babies are lost by mothers being afraid to do what should be done, and what they know should be done. it is not what the doctor does that brings a baby through a dangerous sickness; it is the faithfulness of the nurse in carrying out his instructions that is responsible for the outcome. a timid, halting, doubting nurse can quickly undo all a physician hopes to accomplish; while a prompt, faithful nurse, with initiative, and good judgment, can save a little life in a crisis, even in the absence of the physician. follow instructions implicitly, even though the carrying out of the instructions seem to cause the baby pain and suffering,--it is for the baby's best interest. [ ] birth marks.--much has been written on this subject which a later study of biology and eugenics have shown to be utterly false. let us consider the actual facts. the baby is already a baby, floating in a fluid of its own manufacture. it has absolutely no connection with its mother except by means of its umbilical cord,--which is composed of blood vessels. the blood in these vessels is the child's blood and never at any time does it even mix with the blood of the mother. it is sent along these vessels into the placenta, or after-birth, in which it circulates in small thin vessels, so close to the mother's blood that their contents can be interchanged. yet the two streams never actually mix. the carbonic acid and waste products, in the child's blood, are taken up by the mother's blood, and given in exchange oxygen and food, which is returned to nourish the child. there is absolutely no nervous connection between the mother and the child. how then is it possible for the mother to affect her child in any way except insofar as the quality of its nourishment is concerned? nor can a mother affect her child in any other sense. if the intermingling of blood could affect a child's education we would frequently resort to surgery. in the article on eugenics, under the heading, "education and eugenics," it is explained that the child is "created" at the moment of conception; that absolutely nothing can affect it after it is created; that no influence of the mother or father can in any way affect it for better or worse. a mother cannot create in her child any quality which she may desire no matter how she conducts herself. it was formerly thought that a mother could for example create a musical genius by devoting all her time to the study of music while she carried the unborn child; or that she could make a historian of it if she studied history; or an artist if she studied paintings. we now know this to be wholly wrong and for very excellent reasons. the mother must realize that the only aid she can bestow upon her unborn child is to give it the best possible nourishment. she must provide good blood because the quality of the maternal blood stream bespeaks a healthy or unhealthy, a fit or unfit, child. whatever the child is to be is [ ] already fixed, its innate characteristics art part of itself. whether it will have the vitality to develop its inherent possibilities depends, to a great degree, upon its intra-uterine environment,--and its intra-uterine environment depends upon the health of its mother and the quality of the blood she is feeding it upon. after birth its health, its success, its efficiency, depends upon the care it gets and the quality of its mother's milk. a mother therefore must be in good physical and mental health if she hopes to do her full duty as a mother. qualifications of a nursery maid.--when a helper, or maid, is employed to aid in caring for the baby, much precaution should be exercised in selecting her. the association of the nursery maid and the child, is necessarity an intimate one, and she should be willing to submit to a medical examination to prove her physical fitness. her lungs should be examined thoroughly, so also should the condition of her mouth, throat and nose be known. an observant and tactful mother will also find out if there are any other objectionable conditions existing, which would render her unfit for the position. a nursery maid should be naturally fond of children, she should be industrious, and sensible; of quiet tastes and good disposition. her work should be a pleasure not a task. * * * * * [ ] chapter xi convalescing after confinement the second critical period in the young wife's life--the domestic problem following the first confinement. the first three or four months following the first confinement is the second important period in the young wife's life. in one sense it is the most critical period. the first important period you will remember we stated to be the first few months after marriage. during these months the young wife passed through the period of adaptation. she found out that matrimony was not all sunshine and happiness. she learned that her husband was not the paragon she had idealized. she discovered his human side. she met daily trials and annoyances incident to domestic life. she found her level, and, in finding it, she discovered herself. she is not very safely anchored yet but she is trying to succeed and the future promises well. some day she awakes to the knowledge that she is pregnant and a multitude of new speculations enter into the situation. she finds she must go on striving and hoping and praying that she may have the strength and courage to do her part. time passes, and if she is an ordinary woman she scarcely does justice to herself. her duties are exacting, and her physical condition is not given the study and care which she ought to give it. she does not understand the importance of the hygiene of pregnancy, and the day of the confinement finds her more or less exhausted, and worn out. she passes through the crisis of maternity, however, and spends the customary ten days in bed. at the end of that period the nurse and physician leave her to face the most important problem of life alone. she is a mother, and has in her exclusive charge a human life. let us exactly understand what the real situation is. it would not further the object of this book or help in the solution of the problem the author has in mind to depict a false situation. we must concede the following[ ] facts to be true, if we understand the subject: . that the mothers of the human race are, in the vast majority, the poor. . that they are uneducated in the sense that they are not versed in the science of hygiene and sanitation, and consequently health preservation. . that even the fairly well educated are innocently ignorant of the science of heredity, environment, hygiene, sanitation and health preservation. . that to benefit the majority we must depict conditions as they exist among the poor, and reason from that standard. such books as have been written on this subject have based their facts upon too high a plane. their remedies are beyond the means and the understanding of the average poor mother. their analogies are based upon conditions that exist among the better class. the average poor housewife gets no practical assistance or help from their deductions, because her environment precludes any utilization of the data furnished; the data is not practical in her particular case. our young mother is in all probability a physically and mentally immature girl. she most likely entered the marriage relationship without a real understanding of its true meaning, or even a serious thought regarding its duties or its responsibilities. she was not taught the true meaning of motherhood before actual maternity was thrust upon her. she has probably innocently acquired habits which are detrimental to her health and her morals; and she has no conception of the fundamental duties of a homemaker. yet into the keeping of this woman a human life has been given. her home surroundings are not such as to inspire confidence or from which to elicit encouragement. it has been a struggle to make ends meet; to keep the peace; to be hopeful and cheerful. if she has succeeded in keeping her home neat and clean and comfortable, it has been at the expense of her not too robust constitution. if she has made efforts to observe the amenities of life, to be true as wife, companion and confidant, it has taxed her[ ] nerves, her courage and her vitality. she has frequently been at the breaking point but she has kept up because she felt it was her duty, and because there was nothing else to do. as she rests from her weary labor during the first long days after getting out of bed, the loneliness of it all crushes her. she is weak, nervous, and discouraged, and her white, wan face, with its tired, appealing eyes, bespeaks her anemic and hopeless condition. she is only a child herself, yet fate has crowned her with the holy diadem of motherhood. there are thousands of such mothers and yet posterity need not despair. this is just the beginning, and from such beginnings have sprung the heroes of the race. if the reader has carefully read the chapter on heredity she will understand that the temporary condition of this mother is not important so far as the destiny of the child is concerned. the really important question is, how will this mother develop? the environment of the child depends upon the conditions with which its mother surrounds it. if she is a failure, the child's environmental influences will be unfavorable; if she proves worthy of her trust, if she progresses and masters her difficulties; if she is a good mother and a good homemaker the child's surroundings and influences will be favorable to the full development of its hereditary endowment. but it must be remembered that even an unfavorable environment need not prevent the hereditary promise from dominating the life of the individual. to return to our girl mother, upon whose slender shoulders the weight of a great responsibility rests,--we wish to concede that her burden is great. her home duties are rendered more onerous because of her physical weakness and disability. the strain of nursing her fretful child is taxing her vitality and her nerves to the limit. her disposition is imposed upon by the exactions of an uncomprehending husband. she is inclined to fretfulness and melancholia by the seeming uncharitableness of fate and fortune. her moments of introspection are almost bitter. it is a critical period,--she has reached the breaking point. [page ] such moments are apt to be epochal. the turning of the wheel of fortune will decide the destiny of a human soul. it may be a friend who will supply the needed inspiration that will revitalize hope, and courage, and the determination to succeed. or it may be a prayer, breathed in the silence of despair that will inspire the courage to fight on, and change the complexion of life. once again we would advise such a young wife to calmly think matters over; to find out "what she is working for"; to assemble her ideals and to "know what she wants." there is nothing organically wrong. it is a condition, not a disease. she is discouraged, despondent, nervous and weak. the discouragement, despondency, and nervousness is a result of reduced physical vitality and lack of system. she is not efficient because she is not a trained worker. she is easily discouraged because anemia or bloodlessness fails to supply the oxygen necessary to a fight. there is no period in a woman's life when she is more apt to fall into a rut than at this time. every element, spiritual and physical, which is necessary to stagnation and indifference is present, and it will take a bold and brave effort to resist the temptation to failure which has encompassed her. how can we suggest a remedy? she must first regain her health. she has simply a condition to combat, not a disease, and a definite system, a well laid out plan strictly adhered to will effect the result. she must regain her health, because, without health, she cannot hope to be efficient in work or agreeable in disposition, and she owes both to herself, to her husband and to her child. she must get out of doors. she must walk in the open air. there is absolutely nothing in life that will effect so miraculous a transformation in a discouraged, tired, weary and sick woman, as systematic daily walks in the open air. she must walk briskly, however, and she must desire to get well. we cannot get well if we do not wish to get well. one who walks with a purpose will walk erect, firmly and briskly; she will hold her chest up, and will breathe deeply, and she will drink in hope, and health, and happiness. it takes time to regain strength [ ] after the strain of pregnancy and labor. many women complain that they feel weak and do not regain strength quickly, but they make no effort. they must make a beginning. sitting around waiting for it to come will not bring it. if they cannot walk a mile, they must walk half that distance to begin with; the five mile walk will follow in time. many young mothers get into the habit of taking baby out in his carriage for an airing, and regard this as exercise for themselves. they join the baby brigade and parade up and down the block, or select a sunny spot where there are others on a like quest, and sit around exchanging confidences. these outings usually degenerate into gossiping parties and are a dangerous and questionable practice. they are no doubt good for the baby, but they are morally and physically bad for the young mother. this daily habit is called exercise, but it is in no sense physical exercise. the young mother should select a certain time each day, immediately after a nursing when baby is likely to sleep, and devote this period to walking. one hour each day will accomplish much in regaining and establishing health and strength, and appetite for the mother. no indoor work can take the place of a walk out of doors. it is a duty on the part of the nursing mother to do this. it will enable her to supply better milk; it will banish her tendency to nervousness; it will ensure a good appetite, good spirits, and sound sleep. it will make her a better mother and a better wife. many young wives sow the first seeds of discontent, and ultimate failure during the natural depression that follows maternity. she must adopt system in the performance of her household duties. a good plan is to set aside a certain definite time for meals, when to begin cooking and when to end washing the dishes. then arrange regarding the general household duties. make a schedule for a week devoting each day to a certain task so that at the end of the week all the essential work will have been completed. by systematizing work in this way a great deal of ground can be covered and as time passes it will become easier, as many helpful ways will suggest themselves whereby time will be economized. [ ] adopt a system with the baby. many mothers are worn-out, nervous wrecks for no other reason than a lack of system in the management of the daily life of their offspring. if system is not adopted in feeding and caring for an infant it becomes irritable. to a sick, tired, weary mother an irritable child is an unspeakable torture. begin right. give it adequate, but no unnecessary attention. nurse it every two hours, and at no other time. wake it to nurse at its regular time. it will in a few days acquire the habit of feeding regularly and will sleep between feedings. do not overfeed it. remember babies never die from starvation, but many do by overkindness, and overfeeding is the most prolific cause of infant mortality known. read the article on "how long should a baby nurse?" keep the baby clean, comfortable and happy and you will not have a fretful child, but one that will be a constant inspiration and incentive to you. find time to rest, take a mid-day nap. get off occasionally to the country or the sea shore for a day or two. keep up your interest in your personal appearance, be neat and clean, and invite the attention of your husband during the evening hour. don't let him grow away from you. be cheerful, encourage him to tell of his hopes and plans, and show an interest in his health and in his work. do not forget the dominating influence on your efficiency, and on your happiness which the study habit possesses. interest yourself in some art, cultivate your mind, and soon, sooner than you think, you will have forgotten your troubles and you will have regained your health. there is no other way to do it. there is no royal way in which it can be done which is not open to the poorest mother. an ocean voyage, a trip to europe, a society doctor, a professional masseur, beauty experts and miracle workers cannot accomplish more than you can in your poor apartment, if you "go about it in the right way and in the right spirit." keep in mind always, that: "failure exists only in acknowledging it." every task that is worth while is won by self-sacrifice, by self-abnegation, by patient, persistent, enthusiastic effort, and in no other way. the joy of consummation is reward enough for all human sacrifice. * * * * * corrections made to printed original. index: constipation, in breast-fed infants: 'in-infants' (line-break) in original ibid.: gleet; mucous patches; pox; vol ii: vol i. in original ibid.: sanitary napkins; i, : i, in original ibid.: sexual intercourse; i, : i, in original page : whether there is such a thing: 'think' (hand-corrected) in original page : recruiting ground for the gangster: 'ganster' in original page : incident to a confinement: 'confiement' in original ibid.: the advantage of the kelly pad: 'paid' in original page : the patient should pass: 'pateint' in original page : advantages of putting baby to breast: 'adantages' in original page : anguish and annoyance: 'anoyance' in original the mother's manual of children's diseases. by charles west, m.d. fellow, and late senior censor, of the royal college of physicians: founder of, and formerly physician to, the hospital for sick children: foreign correspondent of the national academy of medicine of paris: etc. author of 'lectures on the diseases of infancy and childhood.' new york: d. appleton and company. . advertisement. i have often asked myself whether it would not be possible to give in a small compass, and avoiding all technical detail, such an account of the diseases of infancy and childhood, as might be of use and comfort to the intelligent mother. returning now, with health perfectly restored, to practise my profession for the rest of my life exclusively in my own country, i have brought with me this little book, in which the comparative leisure of my enforced sojourn at nice has enabled me to realise my purpose. the book is not intended as a handbook for the nursery; many such exist, and many of them are of great merit. neither has it the worse than idle pretence of telling people how to treat their children's illnesses, without the help of a doctor. its object is to give a description of the diseases of early life, such as may help a mother to understand something of their nature and symptoms, to save her from needless anxiety as to their issue, and to enable her wisely to second the doctor in his endeavours for their cure. charles west. harley street, cavendish square. _august , ._ contents. page advertisement v _part i._ introductory chapter i. mortality of children and its causes -- causes fourfold: intermarriage -- hereditary taint -- unhealthy dwellings -- unwholesome food chapter ii. general signs of disease -- shown by the cry, the temperature, the pulse and breathing -- rules for examination as to these points -- signs of absence of disease of the brain chapter iii. general management of disease -- mothers who cannot nurse their children when ill -- importance of truth and keeping child happy -- rules for management of bed-room and bed -- the bath -- poultices -- leeches -- cold applications -- medicines -- note-taking and relation to the doctor _part ii._ plan proposed to be followed chapter iv. on the disorders and diseases of children during the first month after birth -- still-birth -- premature birth -- imperfect expansion of lungs -- jaundice -- ophthalmia -- scalp-swellings -- ruptured navel chapter v. disorders and diseases of children after the first month, and until teething is finished -- infantile atrophy -- rules for artificial feeding -- management of indigestion -- thrush -- teething -- affections of the skin -- eczema _part iii._ disorders and diseases incident to all periods of childhood general characteristics of second period of childhood chapter vi. disorders and diseases of the brain and nervous system -- their mortality and its causes -- convulsions -- congestion of the brain -- sunstroke -- water on the brain -- inflammation from disease of the ear -- chronic water on brain -- brain disorder from exhaustion -- spasmodic croup -- epilepsy -- st. vitus's dance -- palsy -- neuralgia and headache -- night terrors chapter vii. disorders and diseases of the chest -- catarrh and snuffles -- bronchitis and pneumonia -- influenza -- pleurisy -- croup -- diphtheria -- hooping-cough -- asthma -- diseases of the heart chapter viii. diseases of organs of digestion -- description of process of digestion -- dyspepsia of weakly children -- jaundice -- diarrh[oe]a -- peritonitis -- large abdomen -- worms -- ulcerated mouth -- quinsy -- enlarged tonsils -- abscess at back of throat -- diseases of kidneys -- incontinence of urine chapter ix. constitutional diseases -- their nature -- chronic constitutional diseases -- consumption -- scrofula -- rickets -- acute constitutional diseases -- rheumatic fever -- ague -- mumps -- typhoid fever -- small-pox -- inoculation and vaccination -- chicken-pox -- measles appendix. mental and moral faculties in childhood, and the disorders to which they are liable index the mother's manual of children's diseases. part i. _introductory._ chapter i. on the mortality of children, and its causes. the purpose of this little book will probably be best attained, and needless repetition best avoided, if we begin by inquiring very briefly why so many children die, what general signs indicate that they are ill, and what general rules can be laid down for their management in sickness. the first of these inquiries would be as useless as it would be sad, if the rate of infant mortality were fixed by determinate laws, such as those which limit the stature of man or the age to which he can attain. but this is not so; the mortality in early life varies widely in different countries, in different parts of the same country, and in the same country at different times. thus, while in some parts of germany the mortality under one year was recently as high as to per cent. of the total births, and in england as , it was only a little above per cent. in norway. infantile mortality is higher in manufacturing districts, lower in those which are agricultural, and varies from per cent. in lancashire to in dorsetshire. it is then evident that mortality in infancy is in part dependent on remediable causes; and of this there is no better proof than the fact that the mortality in england under one year has been reduced from per cent. in to per cent. in . it would lead us far from any practical purpose if we were to examine into all the causes which govern the liability to disease and death during infancy and childhood, in the different ranks of society. we must therefore limit our inquiry to those conditions which are met with in the class to which my readers may fairly be assumed to belong. _first_ among the causes of sickly infancy and premature death may be mentioned the intermarriage of near relatives. the experience of the breeders of animals, who, by what is termed breeding in and in, undoubtedly obtain certain qualities of speed, or strength, or beauty, does not apply here. they select for their experiments animals whose qualities in these respects are pre-eminent, and eliminate from them all who do not occupy the first rank. in family intermarriages, however, it is rare that any consideration is regarded, save that of wealth; and the fact remains, explain it as we may, that the intermarriage of near relatives during several successive generations is followed by a marked deterioration of the children, physical, mental, and moral; and by the intensifying of any hereditary predisposition to consumption, scrofula, and other constitutional ailments which form the _second_ great cause of early sickness and mortality. these are facts known to all, which yet it is not easy to represent by figures. all the world is aware that consumption is hereditary, that consumptive parents are more likely than others to have consumptive children; and a fourth of all the patients admitted into the hospital for consumption at brompton stated that the disease had existed in one or other of their parents.[ ] scrofula, which is another disease closely allied to consumption, is hereditary also; and hip disease, disease of the spine, abscesses, and enlarged glands in any members of a family, point to risks for the offspring which should not be forgotten, how much soever mental endowments, personal beauty, or the charms of disposition may be considered, and sometimes reasonably enough, to outweigh them. the same liability exists with reference to epilepsy, insanity, and the whole class of affections of the nervous system. parents inquire, with no misplaced solicitude, what is her fortune, or what are the pecuniary resources of him to whom they are asked to entrust their son's or daughter's future. believe me, the question--what is the health of his family, or of hers? is consumption hereditary, or scrofula, or epilepsy, or insanity?--is of far greater moment, and touches much more nearly the future happiness of those we love. these two points regard the future parents themselves; but there are other conditions on which the health of children to a great degree depends; and of these the two most important are the _dwelling_ they inhabit, and the _food_ they eat. i do not refer here to the dwellings of the poor, situated in unhealthy localities, where fresh air does not enter, where the rays of the sun do not penetrate, with defective drainage and imperfect water-supply; but i speak of the nurseries of well-to-do people. 'this will do for our bedroom, and that will make a nice spare room, and that will do for the children,' is what one often hears. had you rare plants which cost much money to obtain, which needed sunlight, warmth, and air, would you not consider anxiously the position of your conservatory, and take much pains to insure that nothing should be wanting that could help their development, so that you might feast your eyes upon their beauty, or delight yourselves with their fragrance? and yet a room at the top of the house, one of the attics perhaps, is too often destined for the little one and its nurse; or if there are two or three children, one small room is set apart for the day nursery, and a second, probably with a different aspect, for a sleeping room, and so small that it does not furnish the needed five hundred cubic feet of air for each. and as a consequence, the children are ailing, any predisposition in them to hereditary disease is fostered, they have no strength to battle against any acute illness that may befall them, and yet surprise is felt that the doctor is never out of the house.[ ] it is needless to dwell on the hand-feeding of infants as one of the great causes of mortality in infancy, and of sickliness in later life. the statistics of foundling hospitals bear sad testimony to the fact of its dangers, and the researches of physicians show that a peculiar form of disease is produced by it, attended by symptoms, and giving rise to appearances after death, peculiar to the form of slow starvation from which the infant has perished. i will add, because it is not generally known, one fresh illustration of the influence of artificial feeding in aggravating the mortality of infants. in berlin the certificates of death of all infants under the age of one year, are required to state whether the little one had been brought up at the breast, or on some kind or other of artificial food. of ten thousand children dying under the age of one year, one-fourth had been brought up at the breast, three-fourths by hand.[ ] it is, as i said in the preface, no part of my plan to enter on any details with reference to the management of children in health. it may, therefore, suffice to have pointed out the four great causes of preventible disease among the wealthier classes of society; namely, the intermarriage of near relatives, the transmission of constitutional taint, the insanitary condition of the dwelling, and the injudicious selection of the food of the infant. footnotes: [ ] this is the proportion stated in quain's _dictionary of medicine_, to which the writer, dr. theodore williams, adds that of , cases in the upper classes per cent. showed direct hereditary predisposition, and per cent. family predisposition. [ ] many useful suggestions will be found in mrs. gladstone's little tract, _healthy nurseries and bedrooms_, published as one of the health exhibition handbooks. [ ] the actual numbers are , and , . see _generalbericht ueber das medizinal-und sanitätswesen der stadt berlin im jahre _. vo. berlin , p. . chapter ii. the general signs of disease in infancy and childhood. the signs of disease at all ages may be referred to one or other of three great classes: disorder of function, alteration of temperature, complaint of pain. in the infant it is the last of these which very often calls attention to the illness from which it is suffering. cries are the only language which a young baby has to express its distress; as smiles and laughter and merry antics tell without a word its gladness. the baby must be ill, is all that its cries tell one person; another, who has seen much of sick children, will gather from them more, and will be able to judge whether its suffering is in the head, or chest, or stomach. the cries of a baby with stomach-ache are long and loud and passionate; it sheds a profusion of tears; now stops for a moment, and then begins again, drawing up its legs to its stomach; and as the pain passes off, stretches them out again, and with many little sobs passes off into a quiet sleep. if it has inflammation of the chest it does not cry aloud, it sheds no tears, but every few minutes, especially after drawing a deeper breath than before, or after each short hacking cough, it gives a little cry, which it checks apparently before it is half finished; and this, either because it has no breath to waste in cries, or because the effort makes its breathing more painful. if disease is going on in the head, the child utters sharp piercing shrieks, and then between whiles a low moan or wail, or perhaps no sound at all, but lies quiet, apparently dozing, till pain wakes it up again. it is not, however, by the cry alone, or by any one sign of disease, that it is possible to judge either of its nature or of its degree, but the mention of this serves merely as an illustration, which anyone can understand, of the different meanings that even a baby's cry will convey to different persons. when a child is taken ill, be the disease from which it is about to suffer what it may, there is at once a change from its condition when in health, such as soon attracts the attention even of the least observant. the child loses its appetite, is fretful and soon tired, and either very sleepy or very restless, while most likely it is thirsty, and its skin hotter than natural. in many instances, too, it feels sick or actually vomits, while its bowels are either much purged or very bound. if old enough to talk, it generally complains of feeling ill, or says that it has pain in some part or other, though it is by no means certain that a little child has described rightly the seat of its pain; for it very often says that its head aches or that its stomach aches, just because it has heard people when ill complain of pain in the head or in the stomach. some of these signs of illness are, of course, absent in the infant, who can describe its feelings even by signs imperfectly; but the baby loses its merry laugh and its cheerful look; it ceases to watch its mother's or its nurse's eye as it was used to do, though it clings to her more closely than ever, and will not be out of her arms even for a moment; and if at length rocked to sleep in her lap, will yet wake up and cry immediately on being placed in its cot again. symptoms such as these are sure to awaken the mother's attention to her child, and the child's welfare and the parent's happiness alike depend, in many instances, on the way in which she sets about to answer the question, 'what is the matter?' some mothers send at once to the doctor whenever they see or fancy that anything ails their child. but this way of getting rid of responsibility is not always possible, nor, indeed, on moral grounds, is it always desirable, for the mother who delegates each unpleasant duty to another, whether nurse, governess, or doctor, in order to save herself trouble or anxiety, performs but half a mother's part, and can expect but half a mother's recompense of love. whenever a child is unwell, a mother may do much to ascertain what is the matter, and may by the exercise of a little patience and common sense save herself much needless heart-ache, and her child much suffering. the first point to ascertain is the presence or absence of fever; that is to say, whether, and how much, the temperature of the body is higher than natural. if the temperature is not higher than natural, it may be taken as almost certain that the child neither has any inflammatory affection of the chest, nor is about to suffer from any of the eruptive fevers. the temperature, however, cannot be judged of merely by the sensation conveyed to the hand, but must be ascertained by means of the thermometer.[ ] in the case of the grown person the thermometer is placed either under the tongue, the lips being closed over it, or in the armpit, and is kept there five or six minutes. in young children, however, neither of these is practicable, and i prefer to place the instrument in the groin, and crossing one leg over the other, to maintain the thermometer there for the requisite five minutes. the temperature of the body in health is about . ° fahr. in the grown person, and very slightly higher in childhood; but any heat above . ° may be regarded as evidence that something is wrong, and the persistence for more than twenty-four hours of a temperature of ° and upwards, may be taken as almost conclusive proof of the existence of some serious inflammation, or of the onset of one of the eruptive fevers. at the same time it is well to bear in mind that temporary causes, such as especially the disorders produced by over-fatigue, or by an over-hearty or indigestible meal, may suddenly raise the temperature as high as °, or higher, but the needed repose or the action of a purgative may be followed in a few hours by an almost equally sudden decline of the heat to the natural standard. it is well to learn to count the pulse and the frequency of the breathing; but to do the former accurately, requires practice such as is hardly gained except by hospital training; and indeed, with few exceptions, the value of the information furnished by the pulse is less in the child than in the adult. the reasons for this are obvious, since the rapidity of the circulation varies under the slightest causes, and the very constraint of holding the sick child's hand makes it struggle, and its efforts raise the frequency of the heart-beats by ten or twenty in the minute. the place at which to seek the beat of the pulse is at the wrist, just inside and below the protuberance of the wrist-bone; but if the child is very fat it is often difficult to detect it. when detected it is not easy to count it in early infancy, for during the first year of life the heart beats between and in the minute, diminishing between that age and five years to , and gradually sinking to at twelve years old. in proportion, moreover, to the tender age of the child, is the rapidity of its circulation apt to vary under the influence of slight causes, while both its frequency and that of the breathing are about a third less during sleep than in the waking state. the frequency of the breathing is less difficult to ascertain, while at the same time it furnishes more reliable information than the pulse. this is best tested when the child is asleep, remembering always that the breathing is then slower than in the waking state. the open hand, well warmed, should be laid flat and gently over the child's night-dress on the lower part of the chest and the pit of the stomach. each heaving of the chest, which marks a fresh breath being taken, may be counted, and the information thus obtained is very valuable. up to the age of two years the child breathes from to times in a minute, and this frequency gradually declines to from to till the age of twelve, and then settles down to from to as in the grown person. you would thus know that a sleeping infant who was breathing more than times, or a child of five who breathes more than times, has some ailment in its chest, and that the doctor should be sent for in order to ascertain its exact nature. it would answer no good purpose to give a description of the information to be obtained by listening to the chest. to learn from this, needs the well-trained ear; and harm, not good, comes from the half-knowledge which serves but to lead astray. a child may be very suffering, seem very ill, and its suffering and illness may depend on pain in the stomach owing to indigestion, constipation, or even to an accidental chill. after early infancy it is not difficult to make out the seat of the child's suffering: the warm hand placed gently on its stomach will soon ascertain whether it is tense or tender, whether the tenderness is confined to one particular spot, or whether it is more acute at one spot than at another; and, lastly, whether, as is the case when pain is produced by wind in the intestines, the pain and tenderness are both relieved by gentle rubbing. in the young infant the character of the cry will, as i have already said, give some clue to the seat of its pain, while, if you lay it down in its cot or in its nurse's arms in order to examine its stomach, it will often resist and begin to cry. its stomach then becomes perfectly tense, and you cannot tell whether pressure on it causes pain or whether the cries are not altogether the consequence of fretfulness and fear. it is therefore the best plan to pass your hand beneath the child's clothes and to examine its stomach without altering its posture, while at the same time the nurse in whose arms it is talks to it to distract its attention, or holds it opposite the window, or opposite a bright light, which seldom fails to amuse an infant. if there is no tenderness of the stomach the child will not cry on pressure; or if during your examination the presence of wind in the intestines should occasion pain, gentle friction, instead of increasing suffering, will give relief. the one thing which still remains to do, especially in the case of children in whom teething is not over, is to examine the mouth and ascertain the state of the gums, since some ailments are caused and others are aggravated by teething. a wise mother or an intelligent nurse will teach the child when well the little trick of putting out its tongue and opening its mouth to show its teeth when told to do so; and though it may sometimes indulge rather out of place in these performances when wished to behave especially prettily before strangers, yet when older it will quickly learn the proprieties of behaviour, and in the meanwhile you profit much by the lesson when illness really comes. sometimes, however, infants who when well will open their mouth and allow their gums to be felt without difficulty, refuse to do so when ill; and it is always desirable that the mother or nurse whose duty it is to tend the sick child constantly, should not frighten it, or lose its confidence, by doing forcibly that which the doctor who comes occasionally may yet be quite right in doing. you will, however, generally get a good view of the mouth and throat in young infants by gently touching the lips with your finger: the child opens its mouth instinctively, and then you can run your finger quickly over its tongue, and drawing it slightly forward perfectly see the condition of the throat, feel the gums as you withdraw your finger, and notice the appearance of the tongue. sometimes it is important to ascertain whether a tooth which was near coming through has actually pierced the gum, and yet the child's fretfulness renders it almost impossible to induce it to open its mouth. if now, while the nurse holds the child in her arms, you go behind her, you can, unseen and unawares, introduce your finger into its mouth and ascertain all you wish to know before the little one has recovered from its surprise. i have but little to say here about the general signs of brain disease in infancy and childhood, because they will need minute notice afterwards. all that i would at present observe is, that you must not at once conclude that a child's head is seriously affected, because it is heavy and fretful and passionate, and refuses to be amused. the head, as we know by our own experience, suffers by sympathy in the course of almost every ailment, certainly of every acute ailment, at all ages. if the babe is not sick; if its bowels can be acted on by ordinary means; if, though drowsy, it can be roused without difficulty; if, though it may prefer a darkened room, it does not shrink from the light when admitted gradually; if it has no slight twitchings of its fingers or of its wrists; if the head, though hot, is not hotter than the rest of the body; if the large vessels of the neck, or the open part of the head, or fontanelle as it is termed, in an infant in whom the head is not yet closed, are not beating violently; and, above all, _if when it cries it sheds tears_, you may quiet your mind on the score of the child's brain, at any rate until the doctor's visit, and may turn a deaf ear to the nurse or the friend who assures you that the child is about to have convulsions or to be attacked by inflammation of the brain. footnotes: [ ] the thermometer used for this purpose, called a _clinical_ thermometer, may be bought for about twelve shillings, of any chemist or instrument-maker, and its mode of employment can be learned in five minutes. no mother should be without it. chapter iii. the general management of disease in infancy and childhood. the management of the child when ill is difficult or easy in exact proportion to whether it has been ill or well managed when in health. the mother who lives but little with her children, who contents herself with a daily visit to the nursery, and who then scarcely sees her little ones until they are brought into the drawing-room in the evening in full dress, to be petted and admired and fondled by the visitors, cannot expect to take her place by the child's bed in its sickness, to soothe its pain, and to expend upon it all the pent-up tenderness which, in spite of the calls of business or of pleasure, still dwells within her heart. she must be content to see the infant turn from her to the nurse with whose face it has all its life been familiar; or to hear the little one tell her to go away, for her presence is associated with none of those 'familiar acts, made beautiful by love,' which win the young heart: the mother is but a stranger who brings no help, who relieves no distress. happy such a mother if she has found a conscientious and intelligent nurse to whom she can delegate her office; but she must remember that with the child, love follows in the steps of daily, hourly kindnesses, that a mother's part must be played in health if it is to be undertaken in sickness, that it cannot be laid down and taken up again at pleasure. there is another mother who cannot nurse her child to any good purpose, she who when it was well spoilt it from excess of love, who has yielded to each wayward wish, and has allowed it to become the petty tyrant of the household. the child is ill, it is languid, feverish, and in pain; no position is quite easy to it, no food pleasant to it, bed is irksome, medicine is nasty. it knows only that it suffers, it has been accustomed to have its will obeyed in everything, and cannot understand that its suffering is not at once taken away. it insists on getting up and on being dressed, or on lying in its mother's or nurse's lap, where the warmth of another person's body does but aggravate its fever; it screams with passion at the approach of the doctor, it will not allow itself to be examined, it will take no medicine; the doctor is powerless, the mother heart-broken. sickness is not the time to exercise authority which has not been put in force before; and, not once but many times, i have watched, a sad spectator, the death of children from an illness not necessarily fatal, but rendered so because it was impossible to learn the progress of disease, impossible to administer the necessary remedies. _what a child has been made when well, such it will be when sick._ one more point i must insist on before going into details, and that is as to the necessity of perfect truthfulness in dealing with sick children. the foolish device of telling a child when ill, that the doctor who has been sent for is its uncle or its cousin, is the outcome of the still more foolish falsehood of threatening the child with the doctor's visit if it does not do this or that. no endeavour should be spared by nurse or parent, or by the doctor himself, to render his visit popular in the nursery. three-fourths of the difficulties which attend the administration of medicine are commonly the result of previous bad management of the child, of foolish over-indulgence, or of still more foolish want of truthfulness. it may answer once to tell a child that medicine is nice when really it is nasty, but the trick will scarcely succeed a second time, and the one success will increase your difficulties ever after. if medicine is absolutely necessary, and the child is too young to understand reason, it must be given by force, very firmly but very kindly, and the grief it occasions will be forgotten in an hour or two. if he is old enough, tell him that the medicine is ordered to do him good, and firmness combined with gentleness will usually succeed in inducing him to take it. the advantage of perfect truthfulness extends to every incident in the illness of children, even to the not saying, 'oh, you will soon be well,' if it is not likely so to be. if children find you never deceive them, how implicitly they will _trust_ you, what an infinity of trouble is saved, and how much rest of mind is secured to the poor little sufferer! a little boy three years old was ordered to be cupped. the cupper, a kind old man, said to encourage him, 'oh, dear little boy, it's nothing.' the child turned to his mother, saying, 'mummy, is that true?' his mother said it was not, but that for her sake she hoped he would try to bear it well. and the operation was performed without a cry or a sound. i have spoken of the moral conditions implied in the successful management of sick children. there are certain physical conditions no less important. the sick child should not be left in the common nursery, of which he would taint the air, while he would be disturbed by its other little inmates. he must (and of course i am speaking not of some slight ailment, but of a more serious indisposition) be in a room by himself, which should be kept quiet and shaded, and at a temperature which should not be allowed to fall below ° if the chest is in any way affected, nor to exceed ° in other cases, and this temperature should always be measured, not by guess, but by the thermometer hung close to the child's bed. the room is to be shaded, not by curtains round the bed--for, save in special circumstances, curtains should be banished from the nursery--nor by closed shutters which exclude both light and air, but by letting down the blinds, so as to have a sort of twilight in the room, and by shading any light which at night may be burned in the apartment; while whether by day or night the child should be so placed that his face shall be turned from the light, not directed towards it. the room should be kept quiet, and this requires not only general quiet in the house, but quiet in the movements of all persons in the room; speaking, not in a whisper, but in a low and gentle voice; walking carefully, not in a silk dress nor in creaky shoes, but not on tiptoe, for there is a fussy sham quietness which disturbs the sick far more than the loudest noise. little precautions, so trifling that few think of noticing them, have much to do with the quiet of the sick-room, and consequently with the patient's comfort. a rattling window will keep a child awake for hours, or the creaking handle of the door rouse it up again each time anyone enters the room; and to put a wedge in the window, or to tie back the handle, and so quietly open and close the door, may do more than medicine towards promoting the child's recovery. there can, however, be no abiding quiet without a well-ordered room, and the old proverb carried out, 'a place for everything, and everything in its place.' a table covered with a cloth so that things may be taken up and put down noiselessly, and set apart for the medicine, the drink, the nourishment, cups, glasses, spoons, or whatever else the patient is in frequent need of; with a _wooden_ bowl and water for rinsing cups and glasses in, and a cloth or two for wiping them, will save much trouble and noise, and the loud whispers of the attendants to each other, 'where is the sugar? where is the arrowroot? where did you put down the medicine?' of which we hear so much in the sick-room, so much especially in the sick-room of the child, who is unable to tell how extremely all this disturbs him. one more caution still remains for me to give. do not talk to the doctor in the child's room, do not relate bad symptoms, do not express your fears, nor ask the doctor his opinion in the child's hearing. the child often understands much more than you would imagine, misunderstands still more; and over and over again i have known the thoughtless utterance of the mother, nurse, or doctor depress a child's spirits and seriously retard his recovery. it is consoling to bear in mind that how grave soever a child's illness may be, the power of repair is greater in early life than in adult age, that with few exceptions the probability of recovery is greater in the child than it would be from the same disease in the grown person. this too is due not simply to the activity of the reparative powers in early life, but also in great measure to the mental and moral characteristics of childhood. to make the sick child happy, in order that he may get well, is the unwritten lesson which they who have best learnt, know best how to nurse sick children. it may seem strange, that from so high a purpose i should at once come down to so commonplace a detail as to insist on the importance, even on this account, of keeping the sick child in bed. at the onset of every illness of which the nature is not obvious, during the course of any illness in which the chest is affected, or in which the temperature is higher than natural, bed is the best and happiest place for the child. in it repose is most complete, far more complete than after early babyhood it can be in the nurse's or mother's lap, and free from the great objection of the increased heat from being in contact with another person's body. nothing is more painful than to witness the little child, sick and feverish, with heavy eyes, and aching head, up and dressed, trying to amuse itself with its customary toys; then, with 'please nurse me,' begging to be taken in the lap, then getting down again; fretful, and sad, and passionate by turns; dragging about its misery, wearing out its little strength, in deference to the prejudice that bed is so weakening. _the bed does not weaken, but the disease does which renders bed necessary._ a child frets sometimes at the commencement of an illness if kept in its own little cot. but put it in its nurse's or mother's big bed, set a tea tray with some new toys upon it before the child, and a pillow behind it, so that when tired with play it may lie back and go to sleep, and you will have husbanded its strength and saved your own, have halved your anxiety and doubled the child's happiness. young infants, indeed, when ill often refuse to be put out of the arms, but over and over again i have found the experiment succeed of laying the baby on a bed, the nurse or mother lying down by its side, and soothing it to sleep. were there no other drawback, it is a waste of power to have two persons employed in nursing a sick child; one to keep it in her lap, and the other to wait upon her. it is important in all serious illnesses of children, as well as of a grown person, that the bed should be so placed that the attendant can pass on either side, and can from either side reach the patient to do whatever is necessary. most cots for young children have a rail round them to prevent the child falling out of bed when asleep or at play; but nothing can be more inconvenient than the fixed rail over which the attendant has to bend in order to give the child food or medicine, or for any other purpose. when i founded the children's hospital in ormond street, i introduced children's cots (the idea of which i took from those in the children's hospital at frankfort) the sides of which let down when needed, while on the top of the rail, or dependent from it, a board is placed surrounded by a raised beading on which the toys, the food, or drink may be put with great convenience. these bedsteads, with probably some improved arrangement for letting down the sides, may be seen now in most children's hospitals, but i have been surprised to observe how seldom they are employed in private nurseries, and how comparatively few bedstead-makers are acquainted with them. the result would probably have been very different had a patent been taken out for them, and had they been largely advertised as 'dr. west's improved children's bedsteads'! the uninclosed spring mattress, and the wedge-shaped horsehair cushion, both of which i introduced in ormond street, are also very valuable. the latter slightly raises the head and shoulders, and renders any other than a thin horsehair pillow for the head to rest on unnecessary. a few more hints about the bed may not be out of place. first of all, after early infancy is over, at latest after nine months, except for some very special reason the napkin should be done away with. it heats the child, chafes it, and makes it sore; it conceals the inattention of the nurse, and at the same time renders it less easy to keep the little one absolutely clean than if a folded napkin is placed under the hips, whence it can be at once removed when soiled. in all serious illness a piece of macintosh should be placed under the sheet, as is done in the lying-in room, and a draw-sheet, as it is termed, over it. the draw-sheet is, as its name implies, a folded sheet, laid under the hips, and withdrawn in part when needed so as to prevent the child ever lying on linen that is wet or soiled. it can be drawn away from under the child, and a portion still clean and dry brought under it, while the soiled part is rolled together and wrapped up in macintosh at one side of the bed until a new draw sheet is substituted, which is easily done by tacking a fresh sheet to that which is about to be withdrawn, when the fresh one is brought under the child's body as that which is soiled is removed. the greatest care should always be taken that the under sheet is perfectly free from ruck or wrinkle; in long illnesses the skin becomes chafed and bed-sores may be produced by neglect of this simple precaution. the complaint that a child throws off the bed-clothes is easily remedied by a couple of bits of tape tied on either side loosely from the sheet or blanket to the sides of the cot. when children are compelled to remain long in bed, great care is needed to prevent the skin from being chafed, which is the first step that leads to the occurrence of bed-sores. careful washing with soap and water daily of the whole body, not only of those parts which may be soiled by the urine or the evacuations; the washing afterwards with pure tepid water; careful drying, and abundant powdering with starch powder, will do much to prevent the accident. if, in spite of this care, the skin seems anywhere to be red or chafed, it should be sponged over with brandy or with sweet spirits of nitre before powdering. real bed-sores must be seen and treated by the doctor. the warm bath is a great source of comfort to the sick child, and in all cases of feverishness, of influenza, or threatening bronchitis, it should not be omitted before the child is put to bed, or must be given towards evening if the child has not been up during the day. the bath may be either warm or hot, the temperature of the former being ° to °, that of the latter ° to °. the temperature should always be ascertained by the thermometer, and the _warm_ bath only should be employed, except when the _hot_ bath is ordered by the doctor. the warm bath relieves feverishness and quiets the system, and promotes gentle perspiration; the hot bath is given when the eruption of scarlet fever or of measles fails to come out properly, or in some cases of convulsions at the same time that cold is applied to the head, or, in some forms of dropsy when it is of importance to excite the action of the skin as much as possible. it is not desirable that a child should remain less than five or more than ten minutes in the bath, and attention must be paid by the addition of warm water to maintain the bath at the same temperature during the whole time of the child's immersion. now and then infants and very young children when ill seem frightened at the bath, and then instead of being soothed and relieved by it they are only excited and distressed. if the bath is brought into the room, prepared in the child's sight, and he is then taken out of bed, undressed, and put into the water which he sees steaming before him, he very often becomes greatly alarmed, struggles violently, cries passionately, and does not become quiet again till he has sobbed himself to sleep. all this time, however, he has been exerting his inflamed lungs to the utmost, and will probably have thereby done himself ten times more harm than the bath has done good. very different would it have been if the bath had been got ready out of the child's sight; if when brought to the bedside it had been covered with a blanket so as to hide the steam; if the child had been laid upon the blanket, and gently let down into the water, and this even without undressing him if he were very fearful; and then if you wish to make a baby quite happy in the water, put in a couple of bungs or corks with feathers stuck in them, for the baby to play with. managed thus, i have often seen the much-dreaded bath become a real delight to the little one, and have found that if tears were shed at all, it was at being taken out of the water, not at being placed in it. in a great variety of conditions, poultices are of use. they are needed in the case of abscesses which it is wished to bring to a head; they are sometimes applied over wounds which are in an unhealthy condition, or from which it is desired to keep up a discharge. they soothe the pain of stomach-ache from any cause, and are of most essential service when constantly applied in many forms of chest inflammation. and yet not one mother or nurse in ten knows how to make a poultice.[ ] when applied over a wound they should not be covered with oiled silk or any impermeable material, since the edges of the wound and the adjacent skin are apt thereby to be rendered irritable and to become covered with little itching pimples. when used to relieve pain in the stomach, or as a warm application in cases of inflammation of the chest, they should be covered with some impermeable material, and will then not require to be changed oftener than every six hours. after poultices have been applied over the chest or stomach for two or three days the skin is apt to become tender, and then it is well to substitute for them what may be termed a dry poultice, which is nothing else than a layer of dry cotton wool an inch or an inch and a half thick, tacked inside a piece of oiled silk. a handy substitute for a poultice may be made of bran stitched in a flannel bag, heated by pouring boiling water on it, then squeezed as dry as possible and laid over the painful part. this is especially useful to relieve the stomach-ache of infants and young children. spongio-piline is a useful substitute for a poultice, especially when it is desirable to employ a soothing or stimulating liniment to the surface. it retains heat very well when wrung out of hot water, and any liniment sprinkled on it is brought into contact with the skin much better than if diffused through a poultice. i may just add that its edges should be sloped inwards, in order to prevent the moisture from it oozing out and wetting the child's night-dress. when i was young, leeches and bleeding were frequently, no doubt too frequently, employed. we have now, however, gone too much to the other extreme, for cases are met with from time to time of congestion of the brain, or of inflammation of the chest or of the bowels, in which leeches bring greater and more speedy relief than any other remedy. in applying leeches it is always desirable that they should be put on where they will be out of the child's sight if possible, and where it will be comparatively easy to stop the bleeding. hence, in many instances of inflammation of the bowels, it is better to apply the leeches at the edge of the lower bowel, the anus as it is technically termed, than on the front of the stomach, though, of course, this will not always answer the purpose. leeches to the chest may usually be put on just under the shoulder-blade; and leeches to the head on one or other side behind the ear, where they will be out of the way of any large vein, and where the pressure of the finger will easily stop the bleeding. steady pressure with the finger will, even where there is no bone to press against, usually effect this; and then a little pad of lint put over the bite, and one or two layers over that, and all fastened on with strips of adhesive plaster, will prevent any renewal of the bleeding. in the few cases where it is not arrested by these means, the application of a little of the solution of muriate of iron will hardly fail of effect. there is one more point to which i will refer before passing lastly to the question of how to manage in the administration of medicine; and this is the best way of applying cold to the head. this is often ordered, but very seldom efficiently done. cold is best applied by means of a couple of bladders half-filled with pounded ice, and wrapped in two large napkins; one of them should be placed under the child's head, the corners of the napkin being pinned to the pillow-case to prevent its being disturbed, while the other is allowed to rest upon the head, but with the corners of the napkin again pinned to the pillow so as to take off the greater part of its weight. thus arranged, the cold application will neither get displaced by the child's movements, nor will the child itself be wetted, as it too commonly is when wet cloths are employed for this purpose, nor irritated by their perpetual removal and renewal. in london and in large towns there are various contrivances of vulcanised rubber, which are, of course, far preferable to the bladders, but it is not everyone who lives in london, or who can command the resources furnished by a large city. the difficulties in the administration of medicine to children are in great part the fault, either of the doctor in giving needlessly unpleasant medicine, or of the parents or nurse who either have failed to teach the child obedience, or who are deficient in that tact by which hundreds of small troubles are evaded. as far as the doctor is concerned, all medicines should be prescribed by him in small quantities, and as free from taste and smell as possible: or where that cannot be, the unpleasant flavour should be covered by syrup, or liquorice, or treacle. bulky powders should be avoided, and the child who has learned to take rhubarb and magnesia, or gregory's powder without resistance, certainly does credit to his training. aperients are the medicines most frequently needed in the minor ailments of children, and a wise mother will not undertake herself the management of serious diseases. of all aperients castor oil is perhaps the safest, the least irritating, the most generally applicable; it acts on the bowels and does nothing more. the idea that it tends specially to produce constipation afterwards is unfounded; it does not do so more than other aperients. all aperients quicken for a time what is termed the peristaltic action of the bowels; that is to say, their constant movement in a direction from the stomach to the lower bowel, which, as well as a contraction on themselves, is constantly going on in every living animal, and continues even for some time after death. the bowels stimulated to greater activity of movement by the aperient, become for a time more sluggish afterwards; they rest for a while, just as after a long walk the muscles of the leg are weary and need repose. there are indeed aperients which do more than this, as grey powder and calomel act upon the liver, and so by promoting an increased flow of bile cause a more permanent excitement of the bowels, and consequently their more prolonged activity; or as epsom salts or citrate of magnesia, which by their action on the blood cause a greater secretion or pouring out of fluid from the coats of the intestines, and in this way have in addition to their purgative property a special influence in abating various feverish conditions. castor oil, senna, jalap, jalapine, and scammony are simple aperients. they empty the bowels and nothing more, and in cases of simple constipation, or where a child is ill either from eating too much or from taking indigestible food, are the best purgatives that can be given. a dose of castor oil, often one of the great griefs of the nursery, may generally be given without the least difficulty if previously shaken up in a bottle with a wine-glassful of hot milk sweetened and flavoured with a piece of cinnamon boiled in it, by which all taste of the oil is effectually concealed. the domestic remedy, senna tea with prunes which render it palatable, confection of senna, syrup of senna, and the sweet essence of senna are generally very readily taken by children, but all have the disadvantage of being liable to gripe. the german liquorice powder, as it is called, which is composed of powdered senna, liquorice powder, fennel, and a little sulphur with white sugar, is freer from this drawback than any other preparation, and when mixed with a little water is not generally objected to. it is important, as senna is often adulterated and loses its properties by exposure to the air, that this powder should always be obtained from a very good chemist, purchased in small quantities, and always kept in a glass-stoppered bottle. jalap, in the form in which it is usually sold--as compound jalap powder--is in general readily taken; it acts speedily, but often with pain, and is not a desirable domestic remedy. jalapine, which is a sort of extract of jalap, is much less apt to gripe, and owing to its small bulk is much handier. it may be given in doses of from two to five grains to children from two years old and upwards. scammony is another powerful simple aperient, apt to be violent in its action, and therefore not to be given except when the bowels have long been confined, or when it is given to expel worms. the compound scammony powder is the form in which it is usually given, and of that five grains would be a dose for a child two years old. scammony, however, is a costly drug, and therefore the caution given with reference to german liquorice powder applies here also. there is a preparation of scammony, the so-called scammony mixture, which consists of the resin or extract of scammony dissolved in milk, which is extremely useful when the stomach is irritable, or there is much difficulty in inducing the child to take medicine. it is almost tasteless, and a tablespoonful, which would be a proper dose for a child of five years old, can be given without being detected. much of the difficulty experienced in giving powders arises from their being mixed with the arrowroot or jam in which they are administered. a very small quantity of arrowroot, bread and milk, or jam, should be put in a tea-spoon; the powder then laid upon it, and covered over with the arrowroot or jelly, so, in short, as to make a kind of sandwich, with the powder, which would thus be untasted, in the middle. aloes is a purgative which acts chiefly on the large bowel and to some degree also on the liver, and is of most use in the habitual constipation of weakly children. in spite of its bitter taste the powder is seldom objected to if given between two layers of coarse brown sugar, while with most children the addition of a teaspoonful of treacle will induce them to take very readily that useful medicine, the compound decoction of aloes. both rhubarb, aloes, and indeed other remedies which are nauseous if given as a liquid and are bulky in the form of powder, may very readily be given in extract in the form of very tiny pills. thus i have constantly ordered the extract of rhubarb, which is nearly twice as strong as the powder, made up into pills scarcely bigger than what children call 'hundreds and thousands' and silver-coated. ten or a dozen of these go down in a teaspoonful of jelly unknown, and with no expenditure of temper or tears. the citrate of magnesia, or dinneford's magnesia, taken effervescing with lemon juice, or when the effervescence has passed off, or the french limonade purgative, are almost always very readily taken, and are often very useful in the little febrile attacks, or in the slight feverish rashes to which children are liable in the spring and autumn. mercurials should have no place among domestic remedies. i do not mean that the doctor need be called in to prescribe each time that they are given, but that the mother should learn from him distinctly with reference to each individual child the circumstances which justify their employment. they stimulate the liver, as well as produce thereby action of the bowels, but they have, especially if often employed, a far-reaching influence on the constitution, and that undoubtedly of a depressing kind: an influence more than made up for when really needed by their other qualities, and especially by their power in doing away with the results of many forms of chronic inflammation. they are 'edged tools,' however, and we know the proverb about those who play with them.[ ] grey powder, blue pill, and calomel are the three forms in one or other of which mercurials are commonly given. of the three, grey powder is the mildest; but it has the inconvenience of not infrequently causing nausea, or actual sickness. this objection does not apply to blue pill, which can be given either in the tiny pills of which i have already spoken, or else broken down, and given in a little jam, or in a teaspoonful of syrup or treacle. on the whole i prefer calomel in small doses. it has the great advantage of tastelessness, small bulk, and of never causing sickness. half a grain of calomel may be regarded as equivalent to two grains of grey powder or blue pill. i shall speak afterwards of other medicines, which may in various circumstances be given, to act upon the bowels; but the above include all that are at all fit for common use in the nursery. before leaving this subject i will add a word or two about the use of suppositories and lavements in infancy and childhood. a piece of paper rolled up into a conical form and greased, or a bit of soap, is not infrequently introduced by nurses just within the bowel, as a means of overcoming constipation in infants. the irritation of the muscle at its orifice (the sphincter, as it is termed) excites the bowels to action, and does away with the necessity for giving an aperient. the drawback from this, as well as from the use of the lavement, is that if frequently employed they become habitually necessary, and the bowels will then never act without their customary stimulus. the lavement, too, has the additional disadvantage that while the lower part of the bowel is in proportion more capacious in infancy and childhood than in the adult, this peculiarity becomes exaggerated by the constant distension of the intestine, and a larger and still larger quantity of fluid needs to be thrown up in order to produce the requisite action of the bowels. opiates and other soothing medicines should never be given except when prescribed by the doctor. thirty-two deaths in england under five years of age in represent but a very small part of the evil wrought by the overdose or injudicious use of these remedies. above all, soothing medicines of varying strength, as syrup of poppies, or of unknown composition, as dalby's carminative or winslow's soothing syrup, should never be employed. the only safe preparation, and this to be given only by the doctor's orders or with his approval, is the compound tincture of camphor, or paregoric elixir, as it is called, of which sixty measured drops contain a quarter of a grain of opium. ten to fifteen measured drops of this are a sufficient dose for a child one year old, and this ought not to be repeated within twelve hours. the repetition every few hours of small doses of opiates is quite as hazardous as the giving of a single overdose; and if it does not work serious mischief by stupefying the child, it renders it impossible to judge of its real condition. thus much may suffice with reference to the more important remedies. others will necessarily call for notice when the diseases come to be considered in which they may be of service. there are two points which still remain to be noticed before i leave the introductory part of this little book. the first of these concerns the importance of keeping written notes in the course of every case of serious illness. for want of doing this the most imperfect and conflicting accounts of what has happened are given to the doctor. no person can watch to any good purpose for four-and-twenty hours together; and no one's memory, least of all in the midst of fatigue and anxiety, can correctly retain all details concerning medicine, food, and sleep, which yet it may be of paramount importance that the doctor should be made acquainted with. i am accustomed to desire a record to be kept on a sheet of paper divided into six columns, one for food, a second for medicine, a third for sleep, a fourth for the evacuations, and a fifth for any special point which the nature of the illness renders it of special moment to observe, while the date is entered on the first column of all, indicating when food or medicine was given, or when and for how long the child slept. it is best to enter the variations of temperature on a separate paper, in order that the doctor may at a glance perceive the daily changes in this important respect. no one who has not made the experiment can tell the relief which the keeping this simple record gives to the anxiety of nursing the sick, especially when the sick one is loved most tenderly. the other point concerns the relations of the mother or of the parents to the doctor. i have often heard it said, 'dr. green always attends my husband and myself, but we have dr. white for the servants and children,' implying a lower degree of medical knowledge as required in their case, and to be acknowledged by a lower rate of remuneration. need i say that the assumption is a mistaken one--that as much knowledge, as large experience, are needed in the one case as in the other; while over and above, to treat children successfully, a special tact and a special fondness for children are needed? a man may be a very good doctor without those special gifts; but their possession, apart from real medical knowledge, may make a good children's nurse, but never a good children's doctor. another matter not to be forgotten is the confidence to be reposed in the doctor--the readiness to acquiesce in his sometimes visiting the child more frequently in the course of an illness than the symptoms may seem to you to require. were you involved in some civil action, in which your succession to large property was involved, you would scarcely expect your solicitor to give you his opinion on all the questions at a single interview. in the same way, the doctor, even the most experienced, may need to visit his little patient several times before he can feel quite certain as to the nature of the disease that is impending, while he may not wish to alarm you by suggesting all the possibilities that are present to his mind. the child after a restless night may be asleep, and it may be most undesirable to wake him; or he may be excessively cross and unmanageable, so that it is impossible to listen to his chest; or it may be very important to ascertain whether the high temperature present in the morning has risen still higher towards night, or whether, after free action of the bowels, it has fallen a degree or two, showing that no fever is impending, but that the undue heat of the body was occasioned by the constipation. or, again, some remedy may have been ordered, of the effect of which the doctor does not feel quite sure: he wishes to see for himself whether it is right to continue or wiser to suspend it. the wise physician, like the able general, leaves as little as may be to chance. nearly forty years ago, in addressing a class of medical students, i said to them: 'if you are carefully to observe all the points which i have mentioned, and to make yourselves thoroughly masters of a case, you must be lavish of your time; you must be content to turn aside from the direct course of investigation, which you would pursue uninterruptedly in the adult, in order to soothe the waywardness of the child, to quiet its fears, or even to cheat it into good humour by joining in its play; and you must be ready to do this, not the first time only, but every time that you visit the child, and must try to win its affections in order to cure its disease. if you fail in the former, you will often be foiled in your attempts at the latter. nor is this all; you must visit your patient very often if the disease is serious in its nature and rapid in its course. new symptoms succeed each other in infancy and childhood with great rapidity; complications occur that call for some change in your treatment, or the vital powers falter suddenly when you least expect it. the issues of life and death often hang on the immediate adoption of a certain plan of treatment, or on its timely discontinuance. do not wait, therefore, for symptoms of great urgency before you visit a child three or four times a day; but if the disease is one in which changes are likely to take place rapidly, be frequent in your visits as well as watchful in your observation.' each year has added to my conviction of the perfect truth of each word which i have quoted. if you believe your doctor to be a man of integrity and intelligence, be thankful for his frequent visits, which will cease as his anxiety abates. be convinced that in the mean time they are made, not for his sake, but for yours. if you doubt his integrity, change your doctor; but do not say to him in a tone and with an emphasis which there is no mistaking, 'well, if you think it _really_ necessary to come'! footnotes: [ ] i add in this note a few simple directions for making poultices, though, as i have stated in my preface, it is no part of my purpose to enter into all the details, important though they are, of a sick nurse's duties. for a linseed meal poultice, see that the water is _boiling_, not merely hot; warm the basin, put the water in _first_; sprinkle the meal on it, stirring the whole time, till it becomes of the uniform consistency of porridge, then spread it about half an inch thick over the linen, or whatever it is spread on, and turn up the edges for an inch all round to prevent the poultice crumbling and soiling the night-dress; and then having smeared the surface with a little oil, test its warmth by applying it to your cheek before putting it on the patient. a broad bandage of some sort or a soft towel must then be put round the body to keep the poultice in its place, and secured with safety pins. pure mustard poultices are never used in children, on account of the pain they occasion, and the too great irritation which they would cause of the delicate skin of children. a mixture of one part of mustard to two of linseed meal is, however, often of much use in the chest affections of children. bread poultices are less generally useful than those of linseed meal. they do not retain the heat nearly so well as those of linseed meal, and are chiefly used in cuts, wounds, or small abscesses; and also because they are so easily made. a slice of stale bread without the crust is put on a plate, boiling water is poured over it, and drained off; it is then placed on a piece of muslin, pressed between two plates to squeeze out the remaining water, and its surface is greased before it is applied with a little oil or lard. i would refer for details about how to make poultices, and for many other things well worth the knowing, to miss wood's _handbook of nursing_, london, mo, . [ ] i am not ignorant of the doubts which have been raised with reference to the special influence of mercurial remedies on the liver, but prefer in a book written for non-medical readers to leave the popular opinion unquestioned. part ii. all that has been said hitherto is only introductory to the great purpose of this book, which is to give an account of the nature, symptoms, and course of the more important diseases of infancy and childhood. any attempt at scientific arrangement of a popular book is useless. i prefer, therefore, to consult simply the general convenience of my readers. i think i do so best by considering first the disorders which beset the child in the first month of its existence, during what may be termed its transition from the condition of existence in the womb, to its living, breathing state as an inhabitant of this world; and next the more important ailments to which it is liable during that important time of development which ends with the completion of teething. afterwards may be studied the diseases of the head, the chest, and the bowels; next constitutional diseases, such as consumption and scrofula; and lastly, the various fevers, as typhoid, or, as it is popularly called, remittent fever, measles, scarlatina, and small-pox; and last of all i will add a few remarks on the mental and moral characteristics of childhood, and their disorders. chapter iv. on the disorders and diseases of children during the first month after birth. =still-birth.=--the infant cries almost as soon as it comes into the world. the cry is the evidence that air has entered its lungs, that the blood has now begun to take a different course from that which it followed before birth, and that the child has entered on a new existence. the child who does not cry, does not breathe; it is said to be _still-born_; its quietude means death. after a long or a difficult labour, or after the use of instruments, the child is sometimes still-born in consequence of blood being poured out on its brain, and it is thus killed before birth by apoplexy. this, however, is not usually the case, but the child is generally still-born because some cause or other, generally the protraction of labour, interfered with the due changes of its blood within the womb, and it is born suffocated before its birth, and consequently unable to make the necessary efforts to breathe afterwards. drowned people are often resuscitated; the child's case is analogous to theirs; and in both the same measures have to be pursued, namely to try to establish respiration. the degree of the warmth of the child's body, the resistance of its muscles, the red tint or the white colour of its surface, the presence or absence of perceptible beating of its heart, measure the chances of success. sometimes mere exposure to the cold air produces the necessary effect; at other times breathing is excited by dashing cold water in the child's face, by slapping it, by tickling its nostrils, or by dipping it for a few seconds in a hot bath at ° or °; and then swinging it a few times backwards and forwards in the air. much time, however, must not be lost over these proceedings, but the child must be laid on its back, the lower part of its body well wrapped up, the chest slightly raised by a folded napkin placed under it. the two arms must then be taken firmly, raised and slowly extended on either side of the head, then brought down again and gently pressed on either side of the chest; and this movement of alternate raising and extending the arms and bringing them back again beside the chest must be repeated regularly some thirty times in the minute, thus imitating the movements of the chest in breathing. these efforts, too, must not be discontinued so long as the surface retains its warmth, and as an occasional heart-beat shows that life is not absolutely extinct; and i believe that in many instances failure is due to want of perseverance rather than to the absolute uselessness of the measure. =premature birth.=--in spite of very extraordinary exceptions, it may be laid down as a rule that children born before the completion of six and a half months of pregnancy do not survive. after that date, each additional week adds greatly to the chances of the child living. there is a mistaken idea, founded on a superstition connected with the number seven, that a seven-months child is more likely to survive than one born at the eighth month. but this notion is as destitute of support in fact as it is opposed to common sense, and the nearer any woman has approached the full term of forty weeks of pregnancy, the greater are the chances of her child being born alive and healthy. the premature child is by no means necessarily still-born. it breathes, but does so imperfectly, so that air does not enter all the smaller air-cells; and its voice is a whimper rather than a cry. those changes in the heart and large vessels, which prepare, as pregnancy draws to a close, for the altered course of the blood when the child has to breathe through the lungs, are too little advanced for it to bear well the sudden alteration in its mode of being. the feebly beating heart and the not completely developed lungs seem but imperfectly to maintain the bodily heat. the glands of the stomach and intestines are not yet fit to perform digestion properly, while the muscular power is too feeble for the effort at sucking. everything is sketched out, but to nothing has the finishing touch been put, and hence the frail machinery too often breaks down, in the endeavour to discharge its functions. it is surprising, however, with what rapidity nature in some instances perfects the work which she has been called on prematurely to perform. it is our business to second nature's endeavours. first of all, and of most importance, is the duty of providing from without the warmth which the child is unable to generate. when very feeble, it must, even without any previous washing or dressing, be at once wrapped in cotton wool, and then in a hot blanket, and surrounded with hot-water bottles. a tin stomach-warmer filled with hot water is very convenient to place under the blanket on which the child lies. being too feeble to suck, it must be fed, a few drops at a time, from a small spoon; or still better, if it is able to make any effort at sucking, it may draw its nourishment through a quill. the mother after a premature confinement is almost sure to have no milk with which to nourish her child, at any rate for two or three days. it is, therefore, wise to obtain the help of a woman with a healthy baby. she must be allowed to bring her baby with her, since otherwise her supply of milk would fail, especially if she had no other means of getting rid of it than by the breast-pump or by drawing her breast. even though she may have her own baby, there are few women who can submit, for more than a very few days, to the artificial emptying their breast without the secretion being either greatly lessened or altogether arrested. this, therefore, must be regarded as a resource available only for a few days, and as the child gains strength every effort must be made to get it to take its mother's breast, if she has any supply, or that of the wet-nurse. if this is found impossible, it will be wisest to give up, at any rate for the present, the attempt to nourish the child from the breast, and to obtain for it asses' milk, which is the best substitute. by no means whatever can more than from a sixth to a fourth part of a pint of milk be obtained either by the breast-pump or by drawing the breast; and since a healthy infant of a few weeks old sucks about two pints of milk in twenty-four hours, it is evident that the supply artificially obtained must after the first few days be utterly inadequate. i have in cases of extreme weakness in premature children succeeded in preserving them by giving them every two hours for two or three days ten measured drops of raw beef juice, five of brandy, and two teaspoonfuls of breast milk. medicine has no place in the management of these cases; the question is one entirely of warmth, food, and for a time the judicious use of stimulants. =imperfect expansion of the lungs.=--children not premature and perfectly well nourished are yet sometimes feeble, breathe imperfectly, cry weakly, suck difficultly or not at all, and die at the end of a few days. their lamp of life flickered and went out. such cases are met with for the most part in conditions similar to those in which children are actually still-born; or now and then they take place when labour has been of unusually short duration, the child hurried into the world too rapidly; while in other instances it is not possible to account for their occurrence. for a long time the nature of these cases was not understood; but rather more than sixty years ago a german physician discovered that air had entered the lungs but imperfectly; that perhaps a third, perhaps even as much as half, of the lungs had never been dilated, but had remained solid and useless; that in consequence the blood was but half-purified, and vitality therefore but half-sustained. the lungs, however, were found to have undergone no real change; they were not diseased, but if air was blown into them the dark solid patches sunk below the level of the surrounding substance, expanded, grew bright in colour and like a sponge from which the water has been squeezed, and crackled, or crepitated as the technical term is, from the air contained within them. we breathe in health so without conscious effort that we never realise the fact that, according to the calculation of most competent observers, the mere elasticity of the lungs, independent even of the elasticity of the chest walls, opposes a resistance to each inspiration equal to pounds avoirdupois in the grown man and in the grown woman. the want of breath puts the respiratory muscles into play: the man takes a deep inspiration, and by this unconscious effort, he overcomes the resistance of the chest and the elasticity of the lungs. the new-born infant feels the same want and makes the same effort; but its muscular power is small, and its inspirations are often so feeble as to draw the air in some parts only into the larger tubes, while many of the smaller remain undilated, and much of the lung continues in the state in which it was before birth. the blood being thus but imperfectly purified, all the processes of nutrition go on imperfectly, the vital powers languish, the inspiratory efforts become more and more feeble, while the elasticity of the lung is constantly tending to empty the small cells of air and to oppose its entrance, and next the temperature sinks and the infant dies. cases in which this condition of the lungs exists usually present the history of the child from the very first having failed to utter a strong and loud cry like that of other children. even after breathing has gone on for some time, such children usually appear feeble, and they suck with difficulty, although they often make the effort. an infant thus affected sleeps even more than new-born infants usually do; its voice is very feeble, and rather a whimper than a cry. in the cry of the healthy infant you at once detect two parts--the loud cry, suffering or passionate as the case may be, and the less loud back draught of inspiration. the french have two words for these two sounds--the _cri_ and the _reprise_. the _cri_ is feeble, the _reprise_ is altogether wanting wherever expansion of the lung has to any considerable extent failed to take place, and you would hail this second sound as the best proof of an improvement in the child's condition. if you watch the child with a little attention you will see that while the chest moves up and down, it is very little, if at all, dilated by the respiratory movements. the temperature falls, the skin becomes pale, and the lips grow livid, and often slight twitching is observed about the muscles of the face. the difficulty in sucking increases, the cry grows weaker and more whimpering, or even altogether inaudible, while breathing is attended with a slight rattle or a feeble cough, and the convulsive movements return more frequently, and are no longer confined to the face, but affect also the muscles of the extremities. any sudden movement suffices to bring on these convulsive seizures, but even while perfectly still the child's condition is not uniform, but it will suddenly become convulsed, and during this seizure the respiration will be extremely difficult, and death will seem momentarily impending. in a few minutes, however, all this disturbance ceases, and the extreme weakness of the child, its inability to suck, its feeble cry, and its frequent and imperfect inspirations, are the only abiding indications of the serious disorder from which it suffers. but the other symptoms return again and again, until after the lapse of a few days or a few weeks the infant dies. i have dwelt at some length on this condition because it is important to know that during the first few weeks of life real inflammation of the lungs or air-tubes is of extremely rare occurrence, and that the symptoms which are not infrequently supposed to depend on it are really due to a portion of the lung more or less extensive never having been called into proper activity. i may add that we shall hereafter have to notice a similar condition of the lung--its collapse after having once been inflated--as occurring sometimes in the course of real inflammation of the organs of respiration in early life, and forming a very serious complication of the original disease. if the collapse of the lung is not so considerable as to destroy life within the first few hours or days after birth, the babe wastes as well as grows weaker and weaker, and this wasting coupled with the difficult breathing not seldom causes the fear that the child has been born consumptive and that its death is inevitable. no such gloomy view need be taken. collapse, or at least non-expansion of the lung to some extent, is by no means unusual: consumptive disease to such an extent in the new-born infant as to interfere with the establishment of breathing is extremely rare. the consumptive babe can suck, it is not so weak as the one whose lungs are imperfectly expanded; it has no convulsive twitchings, nor any of the strange head-symptoms which we notice in the former. it wastes less rapidly, it is feverish instead of having a lower temperature than natural, it seems less ill, and yet its death within a few weeks or months is absolutely certain; while the child whose lungs are not diseased but simply unexpanded may, if that accidental condition is removed, grow up to vigorous manhood. the treatment of these cases is abundantly simple. the child who breathes imperfectly but ill maintains its heat. it must be kept warm at a temperature never less than °; it may, like the premature child, need stimulants, and all the precautions already mentioned as to feeding. twice in the day it should be put for five minutes in a hot bath at °, rendered even more stimulating by the addition of a little mustard. the back and chest may be rubbed from time to time with a stimulating liniment, and an emetic of ipecacuanha wine may be given twice a day. the act of vomiting not only removes any of the mucus which is apt to accumulate in the larger air tubes, but the powerful inspirations which follow the effort tend to introduce air into the smallest vesicles of the lungs, and to do away with their collapse. let these directions be carried out sensibly, patiently, perseveringly, and three times out of four, or oftener still, the mother's ear will before many days be greeted by the loud cry, with its _cri_ and _reprise_ of which i have already spoken, and which assures her that her little one will live. there are no other affections of the lungs so peculiar to the first month of life as to call for notice here. i shall have a few observations to make about malformations of the heart, and the precautions for which they call in the after-life of children; but they will find their fittest place in the chapter on affections of the chest. =jaundice of new-born children.=--a certain yellow tinge of the skin, unattended by any other sign of jaundice, such as the yellowness of the eye and the dark colour of the urine, is by no means to be confounded with real jaundice. it is no real jaundice, but is merely the result of the changes which the blood with which the small vessels of the skin are overcharged at birth is undergoing; the redness fading as bruises fade, through shades of yellow into the genuine flesh colour. this is no disease, to be treated with the grey powder and the castor oil wherewith the over-busy monthly nurse is always ready. it is a natural process, which the intelligent may watch with interest, with which none but the ignorant will try to interfere. there is, however, beside this a real jaundice, in which the skin is more deeply stained, the whites of the eyes are yellow, the urine high-coloured, and in which the dark evacuations that carry away the contents of the bowels before birth are succeeded by white motions, from which the bile is absent. this condition is not very usual, save where children have been exposed to cold, or where the air they breathe is unwholesome. of this no better proof can be given than is afforded by the fact that in the dublin lying-in hospital, where the children are defended with the greatest care both from cold and from a vitiated atmosphere, infantile jaundice is extremely rare, while it attacks three-fourths of the children received into the foundling hospital of paris. still it does sometimes occur when yet no cause can be assigned for it, and it is noteworthy that it is sometimes met with in successive infants in the same family. as the respiratory function and that of the skin increase in activity, the jaundice will disappear of its own accord. great attention must be paid during its continuance to avoid exposure of the child to cold, while no other food than the mother's milk should be given. if the bowels are at all constipated, half a grain of grey powder or a quarter of a grain of calomel may be given, followed by a small dose of castor oil, and the aperient will often seem to hasten the disappearance of the jaundice; but in a large number of cases even this amount of medical interference is not needed. there is, indeed, a very grave form of jaundice, happily of excessive rarity, due to malformation of the liver, to absence or obstruction of the bile-ducts, and often accompanied with bleeding from the navel. i do but mention it; the intensity and daily deepening of the jaundice, the fruitlessness of all treatment, and the grave illness of the child, even though no bleeding should occur, render it impossible to confound this hopeless condition with the trivial ailment of which i have been speaking. the next chapter will furnish a fitter place than the present for speaking fully of the disorders of the digestive organs. i will say now but this: that whatever a mother may do eventually, she avoids grave perils for herself by suckling her infant for the first month; while the health of her child, just launched upon the world, is terribly endangered if fed upon those substitutes for its proper nutriment on which after the lapse of a few weeks it may subsist, may even manage to thrive. there are some local affections incident to the new-born child concerning which a few words may not be out of place; and first of the =ophthalmia of new-born children.=--it is the cause of the loss of sight of nine-tenths of all persons who, among the poor, are said to have been born blind. in the wealthier classes of society it is comparatively rare, and seldom fails to meet with timely treatment, yet many people scarcely realise its dangerous character, or the extreme rapidity of its course. it generally begins about the third day after birth with swelling of the lid of one or other eye, though both are soon involved. the eyelids swell rapidly, and if the affection is let alone, they soon put on the appearance of two semi-transparent cushions over the eyes. on separating the lids, which it is often very difficult to do owing to the spasmodic contraction of the muscles, their inner surface is seen to be enormously swollen, bright red, like scarlet velvet, bathed in an abundant yellowish thin secretion, which often squirts out in a jet as the lids are forcibly separated. great care must be taken not to allow any of this fluid to enter the eye of a bystander, nor to touch his own eye until the fingers have been most carefully washed, since the discharge is highly contagious, and may produce most dangerous inflammation of the eyes of any grown person. the discharge being wiped or washed away, the eye itself may be seen at the bottom of the swelling very red, and its small vessels very blood-shot. by degrees the surface of the eye assumes a deeper red, it loses its brightness and its polish, while the swelling of the lids lessens, and they can be opened with less difficulty; their inner surface at the same time becomes softer, but thick and granular, and next the eyes themselves put on likewise a granular condition which obscures vision. the discharge by this time has become thicker and white, and looks like matter from an abscess. by slow degrees the inflammation may subside, the discharge lessen, the swelling diminish, and the eye in the course of weeks may regain its natural condition. but the danger is--and when proper treatment is not adopted early the danger is very great--lest the mischief should extend beyond the surface of the eye, lest ulceration of the eye should take place, the ulceration reach so deep as to perforate it, and not merely interfere with the sight, but destroy the organ of vision altogether. in every instance, then, in which the eyelids of a new-born infant swell, or the slightest discharge appears from them, the attention of the doctor must at once be called to the condition. in the meantime, and during whatever treatment he may think it right to follow, the eye must be constantly covered with a piece of folded lint dipped in cold water; and every hour at least the eye must be opened and tepid water squeezed into it abundantly from a sponge held above, but not touching it, so as to completely wash away all the discharge. a weak solution of alum and zinc, as one grain of the latter to three of the former to an ounce of water, may in like manner be dropped from a large camel's-hair brush four times a day into the eye after careful washing. simple as these measures are they yet suffice, if adopted at the very beginning, and carried on perseveringly, to entirely cure in a few days an ailment which if let alone leads almost always to most lamentable results. i do not pursue the subject further, for bad cases require all the care of the most skilful oculist for their treatment. =scalp swellings.=--almost every new-born child has on one or other side of its head a puffy swelling, owing to the pressure to which the head has been subjected in birth, and this swelling disappears at the end of twenty-four or forty-eight hours. now and then, however, though indeed very seldom, the swelling does not disappear, but it goes on gradually increasing and becoming more definite in its outlines until at the end of three or four days it may be as big as half a small orange, or sometimes even larger, soft, elastic, painless, under the unchanged scalp, but presenting the peculiarity of having a hard raised margin with a distinct edge, which gives to the finger passed over it the sensation of a bony ridge, beyond which the bone seems deficient. this tumour is due usually to the same cause as that which produces the other temporary puffy swelling of the scalp, only the pressure having been more severe, blood has actually been forced out from the small vessels under the membrane which covers the skull, and hence its gradual increase, its definite outline; and hence, too, the bony ridge which surrounds it, and which is due to nature's effort at cure, in the course of which the raised edge of the membrane covering the skull (the _pericranium_) becomes converted into bone. when the nature of these swellings was not understood, they used to be poulticed, and to be opened with a lancet to let out their contents. we know now, however, that we have nothing to do but to let them alone; that by degrees the blood will be absorbed and the tumour will disappear, and as it does so we may trace the gradual transformation of the membrane which covered it into bone, as we feel it crackling like tinsel under the finger. two, three, or four weeks may be needed for the entire removal of one of these blood-swellings. the doctor will at once recognise its character, and you will then have nothing to do but to wait--often, unhappily, so much harder for the anxious mother than to meddle. =ruptured navel.=--there is a period some time before the birth of a child when the two halves of its body are not united in front, as they become afterwards; and hare-lip or cleft-palate sometimes remains as the result of the arrest of that development which should have closed the fissured lip or united the two halves of the palate. in a similar way it happens sometimes that though the skin is closed, the muscles of the stomach (or, more properly speaking, of the belly) are not in the close apposition in which they should be, so that the bowels are not supported by the muscles, but protected only by the skin. more frequently than this, especially in the case of children who are born before the time, the opening through which the navel string passes is large at birth, and fails to close as speedily and completely as it should do afterwards. when everything goes on as it ought, the gradual contraction of the opening helps to bring about the separation of the navel string and its detachment, and the perfect closure of the opening takes place at the same time, between the fifth and the eighth day after birth. if this does not occur, the bowels are very apt to protrude through the opening, and if allowed to do so for weeks or months, the opening becomes so dilated that its closure is impossible, and the child grows up afflicted permanently with rupture through the navel. this is always an inconvenience, sometimes even a source of serious danger; but if means are taken to prevent the condition becoming worse, nature seldom fails eventually to bring about a cure, and to effect the complete closure of the opening. if the muscles on either side do not come into apposition, but leave a cleft between them, the infant should constantly wear a broad bandage of fine flannel round the stomach, not applied too tightly, in order to give support. the circular bandages of vulcanised india-rubber with a pad in the centre are nowise to be recommended. the pad is apt to become displaced, and to press anywhere but over the navel, while its edges irritate the infant's delicate skin, and the pressure which it exerts if it is sufficiently tight to retain its place interferes with respiration. a pad composed of pieces of plaster spread on wash-leather, and of graduated sizes and kept in place by adhesive strapping,[ ] answers the purpose of preventing the protrusion at the navel, and of thus facilitating the closure of the ring better than any other device with which i am acquainted. they need, however, to be continued even for two or three years, and though they should have been left off it is wise to resume their use if the child should be attacked by whooping-cough, diarrh[oe]a, or any other ailment likely to occasion violent straining. footnotes: [ ] these plasters for ruptured navel in sets of a dozen are to be had of ewen, jermyn street, st. james's, london, and i dare say at many other places besides. chapter v. on the disorders and diseases of children after the first month, and until teething is finished. =infantile atrophy.=--in by far the greater number of instances, the wasting of young children is due to their being fed upon food which they cannot digest, or which when digested fails to yield them proper nourishment. i quoted some figures in my introductory remarks, to show from the evidence obtained at berlin how much larger was the proportion of deaths under the age of one year among hand-fed infants than among those brought up at the breast. foundling hospitals on the continent, in which the children are all drawn from the same class, and subjected in all respects to a similar treatment, except that in some they are fed at the breast, in others brought up by hand, show a mortality in the latter case exactly double of that in the former. it is as idle to ignore these facts, and to adduce in their disproof the case of some child brought up most successfully by hand, as it would be to deny that a battle-field was a place of danger because some people had been present there and had come away unwounded. but it is always well not merely to accept a fact, but also to know the reason why a thing is so. the reason is twofold: partly because the different substitutes for the mother's milk, taken for the most part from the vegetable kingdom, are less easy of digestion than the milk, and partly because, even were they digested with the same facility, they do not furnish the elements necessary to support life in due proportion. all food has to answer two distinct purposes: the one to furnish materials for the growth of the body, the other to afford matter for the maintenance of its temperature; and life cannot be supported except on a diet in which the elements of nutrition and those of respiration bear a certain proportion to each other. now, in milk, the proper food of infants, the elements of the former are to those of the latter about in the proportion of to , while in arrowroot, sago, and tapioca they are only as to , and in wheaten flour only as to . if to this we add the absence in these substances of the oleaginous matters which the milk contributes to supply the body with fat, and the smaller quantity, and to a certain extent the different kind, of the salts which they contain, it becomes apparent that by such a diet the health if not the life of the infant must almost inevitably be sacrificed. but these substances are not only less nutritious, they are also less easy of digestion than the infant's natural food. we all know how complex is the digestive apparatus of the herbivorous animal, of which the four stomachs of the ruminants are an instance, and how large is the bulk of food in proportion to his size which the elephant requires, compared with that which suffices for the lion or the tiger. the stomach of the infant is the simple stomach of the carnivorous animal, intended for food which shall not need to stay long in that receptacle, but shall be speedily digested; and it is only as the child grows older, and takes more varied food, that the stomach alters somewhat in form, that it assumes a more rounded shape, resembling somewhat that of the herbivorous animal, and suited to retain the food longer. the young of all creatures live upon their mother for a certain time after birth; but in all the preparation for a different kind of food, and with it for an independent existence, begins much sooner and goes on more rapidly than in man. young rabbits are always provided with two teeth when born, and the others make their appearance within ten days. in the different ruminants the teeth have either begun to appear before birth, or they show themselves a few days afterwards; and in either case dentition is completed within the first month, and in dogs and cats within the first ten weeks of existence. in the human subject the process of teething begins late, between the seventh and the ninth month, and goes on slowly: the first grinding teeth are seldom cut before the beginning of the second year, and teething is not finished until after its end. until teething has begun the child ought to live exclusively on the food which nature provides; for until that time the internal organs have not become fitted to digest other sustenance, and the infant deprived of this too often languishes and dies. to get from other food the necessary amount of nourishment, that food has to be taken in larger quantities, and, from the difficulty in digesting it, needs to remain longer in the stomach than the mother's milk. one of the results of the indigestibility of the food is that the child is often sick, the stomach getting rid of a part of that food which it is unable to turn to any useful purpose; and so far well. but the innutritious substances do not relieve the sense of hunger. the child cries in discomfort, and more is given to it, and by degrees the over-distended stomach becomes permanently dilated, and holds a larger quantity than it was originally meant to contain. the undigested mass passes into a state of fermentation, and the infant's breath becomes sour and offensive, it suffers from wind and acid eructations, and nurses sometimes express surprise that the child does not thrive since it is always hungry. while some of the food is got rid of by vomiting, some passes into the intestines, and there becomes putrid, as the horribly offensive evacuations prove. they come away, large and solid and white, for the secretion of the bile is inadequate to complete that second digestion which should take place in the intestines; or else the irritation which they excite occasions diarrh[oe]a--a green putty-like matter comes away mixed with a profuse watery discharge. what wonder is it that in such circumstances the body should waste most rapidly; for it is forced from its own tissues to supply those elements essential to the maintenance of life, which its food contains in far too scanty a proportion. every organ of the body contributes to the general support, and life is thus prolonged, if no kind disease curtail it, until each member has furnished all that it can spare, and then death takes place from starvation, its approach having been slower, but the suffering which preceded it not therefore less, than if all food had been withheld. do not suppose that in this description i have been painting too dark a picture, or that children who die thus have been exceptionally weak, and so under the acknowledged difficulties of hand-feeding at length became consumptive. they do not die of consumption, and in a large number of instances their bodies show no trace of consumptive disease, but present appearances characteristic of this condition of starvation, and of this only. along the whole track of the stomach and intestines are the signs of irritation and inflammation. the glands of the bowels are enlarged, actual ulceration of the stomach is often met with; while so far-reaching is the influence of this slow starvation, that even the substance of the kidneys and of the brain are often found softened and otherwise altered, though it might not unreasonably have been supposed that these organs lay quite beyond the reach of any disorder of digestion. no doubt all these grievous results do not always follow; and sometimes children exceptionally strong manage to take and digest enough even of unsuitable food to maintain their health, and may as they grow up, and the changes take place in the system which fit it for a varied diet, even become robust. in the majority of instances, however, hand-fed infants, and those especially who have been brought up chiefly on farinaceous food, are less strong than others, and are more apt to develop any latent tendency to hereditary disease, such as scrofula or consumption, than members of the same family who have been brought up at the breast. enough has already been said to satisfy all but those who do not wish to be convinced, how incumbent it is on every mother to try to suckle her child. but though it is most desirable that for the first six months of their existence children should derive their support entirely from their mother, and that until they are a year or at least nine months old their mother's milk should form the chief part of their food, yet many circumstances may occur to render the full adoption of this plan impracticable. in some women the supply of milk, although at first abundant, yet in the course of a few weeks undergoes so considerable a diminution as to become altogether insufficient for the child's support; while in other cases, although its quantity continues undiminished, yet from some defect in its quality it does not furnish the infant with proper nutriment. cases of the former kind are not unusual in young, tolerably healthy, but not robust women; while instances of the latter are met with chiefly among those who have given birth to several children, whose health is bad, or among the poor, who have been enfeebled by hard living or hard work. the children in the former case thrive well enough for the first six weeks or two months, but then, obtaining the milk in too small a quantity to meet the demands of their rapid growth, they pine and fret, they lose both flesh and strength, and, unless the food given to supply their wants be judiciously selected, their stomach and bowels become disordered, and nutrition, instead of being aided, is more seriously impaired. in the case of the mother whose milk disagrees with the child from some defect in its quality, the signs are in general more pronounced. either the infant vomits more than that small quantity which a babe who has sucked greedily or overmuch often rejects immediately on leaving the breast, or it is purged, or it seems never satisfied, does not gain flesh, does not thrive, cries much and is not happy. in these cases, too, the mother's supply of milk, though abundant at first, diminishes in a few weeks; she feels exhausted, and suffers from back-ache, or from pain in the breasts each time after the child's sucking; while, further, her general weakness leaves her no alternative but to wean the child. knowing the attempt to rear her child entirely at the breast to be vain, the mother may in such cases be tempted to bring it up by hand from the very first. but how short soever the period may be during which the mother may be able to suckle her child, it is very desirable that she should nurse it during that period, and also that her milk should then constitute its only food. for the first four or five days after the infant's birth the milk possesses peculiar qualities, and not merely abounds in fatty and saccharine matter, but presents its casein or curd in a form in which it is specially easy of digestion. these peculiarities indeed become less marked within a week or two; but not only is it of moment that the infant should at any rate make its start in life with every advantage, but the mother who nurses her little one even for a month avoids thereby almost half the risks which follow her confinement. for the indolent, among the wealthy, a numerous class who have but to form a wish in order to have it gratified, a wet-nurse for the baby suggests itself at once to the mother as a ready means of saving herself trouble, and of shirking responsibility. this course, to which love of pleasure and personal vanity tend alike to prompt her, often finds, in spite of all opposing reasons, the approval of the nurse, to whom it saves trouble, and the too ready acquiescence of the doctor in a course which pleases his patient. but many circumstances besides those moral considerations, which ought never to be forgotten before the determination is formed to employ a wet-nurse, may put this expedient out of the question, and it becomes therefore of importance to learn what is the best course for a mother to adopt who is either wholly unable to suckle her child, or who can do so only for a very short time. it is obvious that the more nearly the substitute approaches to the character of the mother's milk, the greater will be the prospect of the attempt to rear the child upon it proving successful. there is no argument needed to prove that the milk of some animal more closely resembles the mother's milk, and is more likely to prove a useful substitute for it than any kind of farinaceous substance. the milk of all animals, however, differs in many important respects from human milk, and differs too very widely in different animals. thus, the milk of the cow and that of the ewe contain nearly double the quantity of curd, and that of the goat more than twice the quantity of butter, and it is only in the milk of the ass that the solid constituents are arranged in the same order as in man. on this account, therefore, asses' milk is regarded, and with propriety, as the best substitute for the child's natural food. unfortunately, however, expense is very frequently a bar to its employment, and compels the use of the less easily digested cows' milk. but though the cost may be a valid objection to the permanent employment of asses' milk, it is yet very desirable when a young infant cannot have the breast, that it should be supplied with asses' milk for the first four or five weeks, until the first dangers of the experiment of bringing it up by hand have been surmounted. the deficiency of asses' milk in butter may be corrected by the addition of about a twentieth part of cream, and its disposition to act on the bowels may be lessened by heating it to boiling point, not over the fire but in a vessel of hot water; and still more effectually by the addition to it of a fourth part of lime-water or of a teaspoonful of the solution of saccharated carbonate of lime to two ounces or four tablespoonfuls of the milk. when cows' milk is given, it must be borne in mind that it contains nearly twice as much curd, and about an eighth less sugar, than human milk. it is therefore necessary that it should be given in a diluted state and slightly sweetened. the dilution must vary according to the infant's age; at first the milk may be mixed with an equal quantity of water, but as the child grows older the proportion of water may be reduced to one-third. mere dilution with water, however, leaves the proportion of curd unaltered, and it is precisely the curd which the infant is unable to digest. instead, therefore, of diluting the milk simply with water, it is often better to add one part of whey to about two parts of milk, which, according to the child's age, may or may not be previously diluted.[ ] attention must be paid to the temperature of the food when given to the infant, which ought to be as nearly as possible the same as that of the mother's milk, namely from ° to ° fahrenheit, and in all cases in which care is needed a thermometer should be employed in order to insure the food being given at the same temperature. human milk is alkaline, and even if kept for a considerable time it shows little tendency to become sour. the milk of animals when in perfect health likewise presents an alkaline reaction, and that of cows when at grass forms no exception to this rule. milk even very slightly acid is certain to disagree with an infant; it is therefore always worth while the moment that a hand-fed infant seems ailing to ascertain this point. if alkaline, the milk will deepen the blue colour of litmus paper, which is to be had of any chemist; if acid, it will discharge the colour and turn it red. it is, perhaps, as well to add that, as the oxygen in the atmosphere tends to redden litmus paper, it should not be left exposed to the air, but should always be kept in a glass-stoppered bottle. the milk of the cow is very liable to alteration from comparatively slight causes, and particularly from changes in the animal's diet; while even in the most favourable circumstances if the animal is shut up in a city and stall-fed, all the solid constituents of its milk suffer a remarkable diminution; while the secretion further has a great tendency to become acid, or to undergo even more serious deterioration. mere acidity of the milk can be counteracted for the moment by the addition of lime-water, or by stirring up with it a small quantity of prepared chalk, which may be allowed to subside to the bottom of the vessel; or if it should happen, though indeed that is rarely the case in these circumstances, that the child is constipated, carbonate of magnesia may be substituted for the chalk or lime-water. if these simple proceedings are not sufficient to restore the infant's health, it will be wise to seek at once for another source of milk supply, and to place the suspected milk in the hands of the medical officer of health or of the public analyst, in order that it may be submitted to a thorough chemical and microscopical examination. the difficulty sometimes found in obtaining an unvaryingly good milk supply, as well as practical convenience in many respects, has led to the extensive employment of various forms of condensed milk. they form undoubtedly the best substitute for fresh cows' milk which we possess, and are a great boon especially to the poor in large towns where the milk supply is often scanty, not always fresh, and sometimes of bad quality. i should certainly prefer condensed milk for an infant to milk from cows living in close dirty stables, such as my experience thirty years ago made me familiar with in some parts of london. still all the varieties of condensed milk are far inferior in quality to good fresh milk. they contain less butter, less albumen, that is to say less of the main constituents of all animal solids and fluids, and a greater proportion of what are termed the hydro-carbonates, such for instance as sugar; or, to state the same thing differently, the elements which serve for nutrition are in smaller proportion than in fresh milk to those which minister to respiration. they are not only less nutritious, but the large quantity of sugar which they contain not infrequently disagrees with the child, and causes bowel complaint. i do not know how far the so-called unsweetened condensed milk which has of late come into the market is free from this objection; but i have always preferred the aylesbury condensed milk, which is manufactured with sugar, to the swiss condensed milk, into which, as i have been given to understand, honey largely enters. how much food does an infant of a month old require? what intervals should be allowed between each time of feeding? and how should the food be given? are three questions which call for a moment's notice. the attempt has been made to determine the first point by two very distinguished french physicians, who weighed the infants before and after each time of sucking. their observations, however, were not sufficiently numerous to be decisive, and their results were very conflicting; the one estimating the quantity at two pounds and a quarter avoirdupois, which would be equivalent to nearly a quart, the other at not quite half as much; but the observations of the latter were made on exceptionally weak and sickly infants. infants no doubt vary, as do grown people, as to the quantity of food they require. i should estimate from my own experience and observation, apart from accurate data, a pint as the minimum needed by an infant a month old; and while dr. frankland's estimate of a pint and a half for an infant of five months seems to me very reasonable, i should doubt its sufficing for a child of nine months unless it were supplemented by other food. the infant during the first month of life takes food every two hours, and even when asleep should not be allowed to pass more than three hours; and this frequent need of food continues until the age of two, sometimes even until three, months. afterwards, and until six months old, the child does not need to be fed oftener than every three hours during the twelve waking hours, and every four hours during the sleeping time. later on, five times in the twenty-four hours, namely thrice by day, once the last thing at night, and once again in the early morning, are best for the child's health as well as for the nurse's comfort. how is an infant not at the breast to be fed? certainly not with the cup or spoon; a child so fed has no choice in the matter, but must either swallow or choke, and is fed as they fatten turkeys for the market. the infant, on the other hand, sucks the bottle as it would suck its mother's breast; it rests when fatigued, it stops to play, it leaves off when it has had enough, and many a useful inference may be drawn by the observant nurse or mother who watches the infant sucking, and notices if the child sucks feebly, or leaves off panting from want of breath, or stops in the midst, and cries because its mouth is sore or its gums are tender. but it is not every bottle which an infant should be fed from, and least of all from those so much in vogue now with the long elastic tube, so handy because they keep the baby quiet, who will lie by the hour together with the end in its mouth, sucking, or making as though it sucked, even when the bottle is empty. these bottles, as well as the tubes connected with them, are most difficult to keep clean; and so serious is this evil, that many french physicians not only denounce their use, in which they are perfectly justified, but prefer, to the use of any bottle at all, the feeding the infant with a spoon; and here i think they are mistaken. the old-fashioned flat bottle, with an opening in the middle, and a short end to which the nipple is attached without any tube, the only one known in the time of our grandmothers, continues still the best, and very good. my friend, mr. edmund owen, in a lecture at which i presided at the health exhibition in august last year, pointed out very humorously the differences between the old bottle and the new. an infant to be kept in health must not be always sucking, but must be fed at regular intervals. the careful nurse takes the infant on her knee, feeds it from the old-fashioned feeding-bottle, regulating the flow of the milk according as the infant sucks heartily or slowly, withdraws it for a minute or two, and raises the child into a sitting posture if it seems troubled with flatulence, and then after a pause lets it recommence its meal. this occupies her a quarter of an hour or twenty minutes of well-spent time, while the lazy nurse, or the mother who has never given the matter a thought, just puts the tube in the infant's mouth, and either takes no further trouble or occupies herself with something else. and yet, obvious though this is, how constantly one sees infants taken about in the perambulator with the feeding-bottle wrapped up and laid by its side, because it is said the child always cries when it is not sucking, and the intelligence and the common sense are wanting, as well as the patient love, that would strive to make out which it is of many possible causes that makes the infant cry. one more observation with reference to bottle-feeding may not be out of place. it is this: that no food be left in the bottle after the child has had its meal, but that it should be emptied, washed out with a little warm water and soda, and it and the india-rubber end should be kept in water till again needed. to insure the most perfect cleanliness it is always well to have two bottles in use, and to employ them alternately. how strictly soever an infant may be kept at the breast, or however exactly the precautions on which i have insisted are observed, sickness, constipation, or diarrh[oe]a may occur, causing much anxiety to the parents, and giving much trouble to the doctor. it sometimes happens, without its being possible to assign for it any sufficient reason, that the mother's milk disagrees with her infant, or entirely fails to nourish it, so that, much against her will, she is compelled to give up suckling it. in some instances this is due to errors in diet, to the neglect of those rules the observance of which is essential to health, as proper exercise for instance; and then the secretion is usually deficient in quantity as well as defective in its composition. in such cases the child often vomits soon after sucking, it suffers from stomach-ache, its motions are very sour, of the consistence of putty, and either green, or become so soon after being passed, instead of presenting the bright yellow colour and semi-fluid consistence of the evacuations of the healthy infant, and sometimes they are also lumpy from the presence of masses of undigested curd. in addition, also, the child is troubled with griping, which makes it cry; its breath is sour, or actually offensive, and the tongue is much whiter than it should be, though it must be remembered that the tongue of the sucking child always has a very slight coating of whitish mucus, and is neither as red nor as perfectly free from all coating as it becomes in the perfectly healthy child of three or four years old. in these circumstances, the diminution of stimulants, such as the stout of which young women are sometimes mistakenly urged to take a quantity to which they were previously quite unaccustomed, is often followed by an increase of the quantity as well as an improvement in the quality of the milk. it is true that a nursing mother may often find her strength maintained, and her supply of milk increased, by taking a glass of stout at lunch and another at dinner, instead of, but not in addition to, any other stimulant; but mere stimulants will no more enable a woman to suckle her infant better than she otherwise would do, than they would fit a man to undergo great fatigue for days together, or to go through a walking tour in switzerland. a tumbler of one-third milk and two-thirds good grit gruel taken three times a day will have greater influence in increasing the quantity of milk than any conceivable amount of stimulant. there is an entirely opposite condition in which the infant does not thrive at the breast, and this for the most part is met with when the mother has already given birth to and suckled several children. in these instances the secretion is sometimes, though not always, abundant, but the infant does not thrive upon it. the babe does not get on, is always hungry after leaving the breast, and cries as though it wanted more; in addition to which it is often purged, either while sucking or within a few minutes afterwards, though the motions, except in being more frequent and more watery than in health, do not by any means constantly show any other change. the mother's history explains the rest. she is constantly languid, suffers from back-ache, feels exhausted each time after the babe has sucked, probably has neuralgia in her face, or abiding headache. in many instances, too, her monthly periods return, though as a rule they do not appear in healthy women while suckling. all these symptoms show that her system is not equal to the duty she has undertaken, and that therefore, for her sake as well as for that of the infant, she must give up the attempt. one more case there is in which suckling has to be given up, at any rate in part, and that is when the milk is good in kind, but insufficient in quantity for the child as it grows older. this insufficiency of quantity shows itself at different periods after the infant's birth--at two months, three, or four. the child is not otherwise ill than that it is no longer bright, as it was wont to be, it ceases to gain flesh, it sleeps more than it used to do, though when it wakes it is always eager for the breast, and cries when leaving it, and if the experiment is made of giving it some milk and water immediately on leaving it, it takes that greedily. mothers are loth to believe this failure of their resources, and in the case of some who have firm and well-formed breasts, there is but little change in their appearance to show that what remains may serve for beauty, not for use. but if while the child is sucking, the nipple is taken suddenly from its mouth, instead of innumerable little jets of milk, spirting out from the openings of the milk-ducts, the nipple will be seen to be barely moistened by its languid flow. in conditions such as these the question of weaning partially or completely inevitably occurs, and where the mother's weakness is the occasion of the failure to nourish the child, half-measures are of no avail, for so long as she does not entirely give up the attempt to do that to which her health is unequal, her own state will grow worse, that of the child will not improve. when errors of diet or inattention to general rules of health incapacitate the mother from the performance of her duty, there may be hope from the adoption of a wiser course; while when the supply simply fails from its inadequacy, much may be hoped for from a wise combination of hand-feeding with nursing at the breast; the mother perhaps suckling the infant by day, but being undisturbed by demands upon her at night. last of all, i must refer to cases in which love has been stronger than reason, as indeed it often is, and in which young people with some pronounced hereditary taint of scrofula or consumption marry and have children. in such cases, if the consumptive taint is on the mother's side, it is, i believe, much wiser, in the inability to obtain a good wet-nurse, to bring up the child by hand rather than at the mother's breast. one word, however, applicable in such circumstances, age and long experience entitle me to add, and it is this. it is essential that, in the absence of that guarantee against the too rapid succession of pregnancies which suckling for a reasonable time presents, there should be self-restraint on both sides, lest the inscription on the young wife's grave should be, as i have too often known it, the same as, in despite of poetry and romance, her biographer assigns as the cause of the death of petrarch's laura, that she died worn out _crebris partubus_, by too many babies. in all of these cases the rules which i have already given with reference to hand-feeding have to be borne in mind: the preference for asses' milk at first, the careful regulation of the amount of curd in the cows' milk afterwards, increased or diminished by the greater or less proportion of whey mixed with it. sometimes, however much the quantity of curd or casein may be reduced, the child is yet unable to digest it, for it is firm and not easily acted on by the juices of the stomach. it is then best to omit it altogether, and to supply the necessary albumen by white of egg. a very good food in these circumstances is made of-- white of one raw egg, quarter of an ounce of sugar of milk, three teaspoonfuls of cream, half a pint of whey. in the course of a few weeks, or when the child seems to need stronger nourishment, one part of veal-tea, made with a pound of veal to a pint of water, may be added to one part of whey, with the white of egg and sugar of milk as before, and one part of white decoction, as it was called some two centuries ago in england. it is composed of-- half an ounce of hartshorn shavings, inside of one french roll, three pints of water--boiled to two, strained and sweetened. this forms an extremely useful way of introducing farinaceous food into the infant's diet, and preparing the way for a larger amount of it which by degrees becomes necessary. of these, one of the most generally useful is liebig's or savory and moore's food for infants, which has the advantage of not constipating as so many other farinaceous foods do. chapman's entire wheat flour is an extremely good food; and wheat, as you will remember, excels other farinaceous substances in its nutritive properties, but it is not so easy of digestion as liebig. there is, however, scarcely any kind of farinaceous food, among which nestlé's must not be forgotten, which may not answer for an infant; provided always that at first it is not given oftener than twice a day, that it is not made too thick, nor given in larger proportion than one-third of the farinaceous food to two-thirds of the whey, milk, or whatever it is mixed with; and besides, whatever the food may be, it should be prepared each time afresh. this is not the place for going into all details on the subject of feeding infants, or to explain how if wisely managed the child weans itself by degrees from the bottle or the breast--the best way, be it said, of weaning--or how by degrees it comes to its daily midday meal of beef-tea and bread, and then, when the first grinding teeth have been cut, to a small meat meal daily, finely minced or scraped, and so little by little adopts the modes of living of its elders. but, last of all, there are instances, though not so many as the public imagine, in which the infant, in spite of most judicious management, fails to thrive, and suffers from various disorders of its digestion. the most unmanageable and the least hopeful of these cases are those in which the infant is the subject of consumptive disease. it is very rare for its symptoms, even in cases of the most marked tendency to consumption on the part of the parents, to show themselves before the age of three months, and i think i may add, that apart from such tendency consumption never appears in infancy or early childhood, except when it follows on some acute illness, such as inflammation of the lungs, or on typhoid, or, as it is commonly called, remittent fever. consumption of the bowels, as it is popularly termed, may be said never to occur in early infancy apart from consumptive disease of the lungs, and is then always accompanied by an increase towards evening of the temperature from its natural standard of . ° to °. hence the absence of cough and the persistence of a natural temperature may be taken as almost conclusive evidence that there is no consumptive disease of the bowels. consumptive disease in infancy is invariably attended with glandular enlargement. the glands of the bowels when irritated always communicate their irritation to the glands in the groin and the bend of the thigh, which are felt hard and enlarged, like little peas, under the finger. but further, if there is real disease of the glands of the bowels, other tiny enlarged glands will be felt, like shot, under the skin of the belly, from which in the general progress of emaciation the layer of fat always present in the healthy baby will already have been removed. besides this, too, the veins running beneath the skin there, invisible in the healthy infant, will be seen meandering like blue lines, and telling the story that more blood than usual flows through them, because the diseased glands inside interfere with its ready passage through its proper channels. two cautions, however, have to be borne in mind with reference to both of these indications of disease. the first is, that the glands in the groin may be enlarged from mere irritation, independent of actual disease communicated to them from the glands inside. if, however, you find the glands at the corner of the lower jaw and those on either side of the neck enlarged too, you are then driven to the conclusion that the glands in the groin are enlarged not from mere local irritation, but from general disease, and that consumption is its cause. again, the superficial veins of the belly may be enlarged from any cause which interferes with the proper circulation through the vessels inside. hence they are often enlarged in grown people in dropsy, and hence too in infants and young children from flatulent distension of the bowels. but in this case the other signs of consumption are wanting; the emaciation, the cough, the increase of evening temperature, and the enlargement of the glands, are all absent. sometimes we meet with instances where the child does not digest its food, does not thrive, does not gain flesh, never passes healthy evacuations, at length wastes, loses strength, and dies, without having had any of the signs which i have pointed out as indicative of consumptive disease, and in fact without having suffered from it. now, these cases are connected with imperfect performance of the function of the liver, and sometimes with an imperfection of its structure. before birth the functions of the liver are not called into action in the same way nor to the same degree as afterwards, and its structure differs in this respect that it contains a larger amount of fat and a smaller proportion of bile-secreting cells than afterwards. it sometimes happens from causes which we do not understand that the liver structure not only does not undergo that higher development which should take place, but that the fat cells increase at the expense of the bile cells. in these circumstances the food is ill-digested and the health is much impaired, and at last wasting takes place to as great a degree as in the case of consumption, only there are no cough, no glandular enlargement, no big superficial veins, no increased temperature, while on a careful examination the doctor will seldom fail to find the rounded edge of the enlarged liver coming lower down than natural. in these cases too there is a disposition to convulsive affections, and to that peculiar form of convulsion called spasmodic croup, concerning which i shall have something to say later on. in its less serious form this is both a more frequent and a less grave condition than consumption, and its existence explains to a great degree those cases in which young children have failed to be nourished by the milk food which commonly suits their tender age, but have improved on beef-tea, raw meat or its juice, and food entirely destitute of saccharine matter. in cases where there is reason to apprehend consumptive disease, the skill and resources of the doctor will often be heavily taxed to meet each difficulty as it arises. a good wet-nurse, or, in default of her, asses' milk, with the addition of cream to supply the butter in which the asses' milk is deficient, a couple of teaspoonfuls of raw meat juice in the course of every twenty-four hours, much care in the introduction of farinaceous substances into the diet, and cod-liver oil twice a day, beginning with ten drops and gradually increasing the dose to a teaspoonful, are all that the mother herself can do. when the cod-liver oil is not borne by the stomach, or when--which, however, is not often the case--the child refuses to take it, glycerine may be substituted for it, though it must be owned that it is a very poor and inefficient substitute. the inunction of cod-liver oil is in any case not to be had recourse to; it makes the child unpleasant to itself and loathsome to others, while the power of the skin to absorb oily matters is far too limited to be worth taking into account. vomiting, though by no means a prominent symptom of either of the two very grave conditions of which i have been speaking just now, is yet a very common attendant on all disorders of digestion in early life. it is indeed much more frequent in the infant than in the adult, and the greater irritability of the stomach continues even after the first few months of existence are past, and does not completely cease during the early years of childhood. in every case of vomiting in childhood, therefore, the first question to set at rest is whether it depends on disorder of the digestive system, or whether it heralds the onset of one of the eruptive fevers, or of inflammation of the chest, or of affection of the brain; and in determining this all the directions given when i was speaking of the general symptoms of disease are to be carefully studied. vomiting often accompanies infantile diarrh[oe]a, even when the food taken cannot be regarded as its occasion; and now and then the stomach, with no obvious exciting cause, suddenly becomes too irritable to retain any food, and this indeed may be the case even though attended by few or no other indications of intestinal disorder. the child in such cases seems still anxious for the breast; but so great is the irritability of the stomach that the milk is either thrown up unchanged immediately after it has been swallowed, or it is retained only for a few minutes, and is then rejected in a curdled state; while each application of the child to the breast is followed by the same result. it will generally be found, when this accident takes place in the previously healthy child of a healthy mother, that it has been occasioned by some act of indiscretion on the part of its mother or nurse. she perhaps has been absent from her nursling longer than usual, and returning tired from a long walk or from some fatiguing occupation, has at once offered it the breast, and allowed it to suck abundantly; or the infant has been roused from sleep before its customary hour, or it has been over-excited or over-wearied at play, or in hot weather has been carried about in the sun without proper protection from its rays. the infant in whom from any of these causes vomiting has come on, must at once be taken from the breast, and for a couple of hours neither food nor medicine should be given to it. it may then be offered a teaspoonful of cold water; and should the stomach retain this, one or two spoonfuls may be given in the course of the next half-hour. if this is not rejected, a little isinglass may be dissolved in the water, which must still be given by a teaspoonful at a time, frequently repeated; or cold barley-water may be given in the same manner. in eight or ten hours, if no return of vomiting takes place, the experiment may be tried of giving the child its mother's milk, or cows' milk diluted with water, in small quantities from a teaspoon. if the food thus given does not occasion sickness, the infant may in from twelve to twenty-four hours be restored to the breast: with the precaution, however, of allowing it to suck only very small quantities at a time, lest, the stomach being overloaded, the vomiting should again be produced. in many instances when the sickness has arisen from some accidental cause, such as those above referred to, the adoption of these precautions will suffice to restore the child's health. if, however, other signs of disorder of the stomach or bowels have preceded the sickness, or are associated with it, medicine cannot be wholly dispensed with, and the advice of the doctor must be sought for. very likely in addition to directing the rules above laid down to be attended to, he may lay a tiny dose of calomel, as a quarter, half or a whole grain on the tongue, which often has a wonderful influence in arresting sickness; while he may further put a small poultice not much bigger than a crown piece, made half of mustard, half of flour, on the pit of the stomach for a few minutes, and may give the child a little saline, with a grain or two of carbonate of soda, and perhaps a drop of prussic acid. these, however, are not remedies to be employed by the mother, but must be prescribed, and their effect watched by the medical attendant. sickness, indeed, is not always a solitary symptom unattended by other evidences of disordered digestion, but is sometimes associated with signs of its general impairment, and this may be so serious as to lead to great loss of flesh, and even to end in endangering life. in many instances, however, the child does not lose much flesh though it digests ill, and its symptoms would be troublesome rather than alarming, if it were not that they are often the signs of an unhealthy constitution, out of which in the course of a few months consumption is not infrequently developed. long-continued indigestion in the infant always warrants anxiety on the part of the parent. in some of these cases there is complete loss of appetite, the infant caring neither for the breast nor for any other food. it loses the look of health and grows pale and languid, though it may not have any special disorder either of the stomach or of the bowels. it sucks but seldom and is soon satisfied, and even of the small quantity taken, a portion is often regurgitated almost immediately. this state of things is sometimes brought on by a mother's over-anxious care, who, fearful of her infant taking cold, keeps it in a room too hot or too imperfectly ventilated. it follows, also, in delicate infants on attacks of catarrh or of diarrh[oe]a, but it is then for the most part a passing evil which time will cure. in the majority of cases, however, the loss of appetite is associated with evidence of the stomach's inability to digest even the small quantity of food taken, and the bowels are irregular in their action, as well as unhealthy in their secretion. loss of appetite, too, though a frequent is by no means a constant attendant on infantile indigestion, but is replaced sometimes by an unnatural craving, in which the child never seems so comfortable as when sucking. it sucks much, but the milk evidently does not sit well upon the stomach; for soon after sucking, the child begins to cry and appears to be in much pain until it has vomited. the rejection of the milk is followed by immediate relief; but at the same time by the desire for more food, and the child often can be pacified only by allowing it to suck again. in other cases vomiting is of much less frequent occurrence, and there is neither craving desire for food, nor much pain after sucking; but the infant is distressed by frequent acid or offensive eructations; its breath has a sour or nauseous smell, and its evacuations have a most f[oe]tid odour. the condition of the bowels that exists in connection with these different forms of indigestion is variable. in cases of simple loss of appetite, the debility of the stomach is participated in by the intestines, and constipation is of frequent occurrence, though the evacuations do not always appear unhealthy. in other instances in which the desire for food still continues, the bowels may act with due regularity, but the motions may have a very unnatural appearance. if the child is brought up entirely at the breast, the motions are usually liquid, of a very pale yellow colour, often extremely offensive, and contain shreds of curdled milk, which not having been digested within the stomach, pass unchanged through the whole track of the bowels. in many instances, however, the infant having been observed not to thrive at the breast, arrowroot or other farinaceous food is given to it, which the stomach is wholly unable to digest, and which gives to the motions the appearance of putty or pipe-clay, besmeared more or less abundantly with slime or mucus. the evacuations are often parti-coloured, and sometimes one or two unhealthy motions are followed by others which appear perfectly natural; while attacks of diarrh[oe]a often come on, and the matters discharged are then watery, of a dark dirty green colour, and exceedingly offensive. children, like grown persons suffering from indigestion, often continue, as i have already said, to keep up their flesh much better than could be expected, and in many cases grow up to be strong and healthy. still the condition is one that not merely entails much suffering on the infant, but by its continuance seriously impairs the health, and tends to develop the seeds of any constitutional predisposition to consumptive disease. in these cases there are many respects in which the mother can most efficiently second the doctor. all causes unfavourable to health must be examined into, and as far as possible removed. it must be seen that the nursery is well ventilated, and that its temperature is not too high; while it will often be found that no remedy is half so efficacious as change of air. next, it must not be forgotten that the regurgitation of the food is due in great measure to the weakness and consequent irritability of the stomach, and care must therefore be taken not to overload it. if these two points are attended to, benefit may then be looked for from the employment of tonics, and as the general health improves the constipated condition of the bowels, so usual in these cases, will by degrees disappear; while if aperients are needed those simple remedies only should be employed of which i spoke in the first part of this book, and the use of mercurials is not to be resorted to without distinct medical order. the above mode of treatment is appropriate to cases of what may be termed the indigestion of debility, but a different plan must be adopted in those instances in which it depends on some other cause. the rule, indeed, which limits the quantity of food to be given at one time is no less applicable here, for the rejection of some of the milk may be the result of nothing more than of an effort which nature makes to reduce the work that the stomach has to do within the powers of that organ. but when, notwithstanding that due attention is paid to this important point, uneasiness is always produced by taking food, and is not relieved till after the lapse of some twenty minutes, when vomiting takes place, or when the infant suffers much from flatulence and from frequent acid or nauseous eructations, it is clear that the symptoms are due to something more than the mere feebleness of the system. it is not, however, the mere fact that the child vomits its food, or of the milk so vomited being rejected in a coagulated state, which proves that the stomach is disordered, but it is the fact of firmly coagulated milk being rejected with much pain, and after the lapse of a considerable interval from the time of its being taken, which warrants this conclusion. the coagulation of the curd is the first change which the milk of any animal undergoes when introduced into the stomach. the coagulum of human milk is soft and flocculent, and not so thoroughly separated from the other elements of the fluid, as the firm hard coagulum or curd of cow's milk becomes from the whey in which it floats. in a state of health the abundantly secreted gastric juice speedily redissolves the chief part of the curd in the stomach, while when it has passed into the intestine the alkaline bile which there becomes mixed with it, completes its solution, and converts the whole into a fluid which closely resembles one of the chief elements of the blood, is consequently very easily taken up by the minute vessels whose office it is to do so, and thus supplies with nourishment the whole body. milk tends, however, to undergo changes spontaneously, which produce its coagulation, and the occurrence of these changes is greatly favoured by a moderately high temperature, such as that which exists in the stomach. but the alterations of the fluid that accompany this spontaneous coagulation are very different from those which are brought about by the vital processes of digestion. an acid becomes formed within it, and the acid thus produced has none of the solvent power of gastric juice, but by its presence impedes rather than favours digestion. every nurse is aware that a very slight acidity of the milk will suffice to give an infant vomiting, stomach ache, and diarrh[oe]a, and the result must be much the same whether fermentation had begun in the milk before it was swallowed, or whether it commences afterwards, in consequence of the disordered condition of the stomach, and the absence of a healthy secretion of gastric juice. the nature of the food is the first point that requires attention in the management of these cases of infantile dyspepsia. if the child had been fed on cow's milk the symptoms may be due to the gastric juice not having been able to dissolve the curd, which you will remember is much firmer than that of human milk as well as twice as abundant. in this case the substitution of asses' milk, the employing whey either entirely or in part instead of milk, and the adding white of egg in order to present the elements of the curd in a more easily digestible form, may all be tried with advantage. sometimes children refuse whey; and then a mixture of cream and veal broth, more or less diluted either with water or with the white decoction, may be given instead. the addition of soda, potash, chalk or lime water to milk before it is given is also of service, since it not only prevents the occurrence of fermentation, but also renders the curd of cow's milk more easily soluble. the indiscriminate and over-free employment of these alkalies, however, as nursery remedies is by all means to be avoided, for the symptoms of indigestion for which a grown person if suffering would seek the advice of a skilful doctor require his help no less when the patient is a child. when acids will be of service in promoting the secretion of the gastric juice, when pepsine will be likely to be of use, when stimulants such as a little brandy, when aromatics to get rid of flatulence, opiates to relieve pain or check diarrh[oe]a, or when an occasional mercurial, or some other remedy may be of use by stimulating the liver to increased action, are questions which i would not advise any mother to try to answer for herself. much care and pains and knowledge and experience are often required by the doctor to enable him to answer them correctly. i must not leave the consideration of the ailments of the digestive organs in early infancy without some notice of that affection of the mouth popularly known as _thrush_ to which an exaggerated importance was once attached as the supposed cause of those symptoms of disordered health, of which it is in reality only the accompaniment. still it is a sign of such grave disorder that it needs a careful study. thrush.--if you examine the mouth of a young infant, in whom the attempt at hand-feeding is not turning out well, you will often observe its lining to be beset with numerous small white spots, that look like little bits of curd lying upon its surface, but which on a more attentive examination are found to be so firmly adherent to it as not to be removed without some difficulty, when they leave the surface beneath it a deep red colour, and now and then bleeding slightly. these specks appear upon the inner surface of the lips, especially near the angles of the mouth, on the inside of the cheeks, and upon the tongue, where they are more numerous at the tip and edges than towards the centre. they are likewise seen upon the gums, though less frequently and in smaller numbers. when they first appear they are usually of a circular form, scarcely larger than a small pin's head; but after having existed for a day or two, some of the spots become three or four times as large, while at the same time they in general lose something of their circular form. by degrees the small white crusts fall off of their own accord, leaving the surface where they were seated redder than before; a colour which gradually subsides, as with the infant's improved health the mouth returns to its natural condition. if the improvement is tardy the white specks may be reproduced and again detached several times before the mouth resumes its healthy aspect. in the worst cases the specks coalesce, and coat the mouth as though lined with a membrane which is usually of a yellowish-white tint instead of having the dead white colour of the separate spots. even here, however, though the surface is very red, it scarcely bleeds if the deposit is removed from it gently and with care. the popular notion that when the deposit of thrush appears not only in the mouth, but also at the edge of the bowel, it has passed through the child is altogether erroneous. the lining membrane of the bowel indeed is red, inflamed, and presents those conditions to which i have already referred when speaking of the atrophy of hand-fed children, but the actual deposit of thrush can take place only where there exists an appropriate structure for its formation, and that is to be found, not in the bowels, but only at the inlets and outlets of the digestive canal. the actual deposit at the outlet of the bowel is indeed exceptional, though the edges are often red and sore from the irritation produced by the acrid motions, and this irritation sometimes extends to the skin over the lower part of the baby's person, which becomes rough, and covered with a blush of redness. thrush in the child is of far less serious import than in the grown person. in the latter it indicates the existence of some very serious, almost hopeless disease, and hence it is that we meet with it in the last stages of dysentery, cancer, and consumption. in the child a slight attack of thrush may occur from causes which are by no means serious, and may disappear under the use of simple means, such as i have already described when speaking of the troubles of digestion in early infancy. while in any case it must rest with the doctor to regulate as he best knows how the constitutional treatment of the condition on which the thrush depends, it must be for the mother to see that appropriate local measures are adopted. one point of considerable moment, and to which less care than it deserves is usually paid, is the removing from the mouth, each time after the infant has been fed, of all remains of the milk or other food. for this purpose whenever the least sign of thrush appears, the mouth should be carefully wiped out with a piece of soft rag dipped in a little warm water every time after food has been given. supposing the attack to be but slight this precaution will of itself suffice in many instances to remove all traces of the affection in two or three days. if, however, there is much redness of the mouth, or if the specks of thrush are numerous, some medicated application is desirable. the once popular honey and borax is not the best application, and this for a reason which i will at once explain. the secretion of the mouth in infants is acid, disease increases this acidity; and it has been found that this acid state is not merely favourable to the increase of thrush, but also to the development between the specks of thrush of a sort of membrane formed by a peculiar microscopic growth, of whose existence, just as of that of the phylloxera which destroys the vine, or the muscardine which kills the silkworm, we were ignorant till brought to light by recent scientific research. you will therefore at once see why saccharine substances, apt as they are to pass into a state of fermentation, are not suitable, and why it is better to employ a solution of-- borax, twenty grains glycerine, one teaspoonful water, an ounce. now and then the use once or twice a day in addition of a very weak solution of caustic, as two grains of lunar caustic to an ounce of water, in bad cases is necessary; but of this it must be left to the doctor to decide. teething.--the transition is a very natural one by which we pass from the study of the dangers and difficulties which attend the feeding and rearing of young infants, to those which accompany _teething_. the time of teething is looked forward to by most mothers with undisguised apprehension, nurses attribute to it the most varied forms of constitutional disturbance, and doctors constantly hold forth to anxious parents the expectation that their child will have better health when it has cut all its teeth. the time of teething, too, is in reality one of more than ordinary peril,[ ] though why it should be so is not always rightly understood. it is a time of most active development, a time of transition from one mode of being to another, in respect of all those important functions by whose due performance the body is nourished and built up. the error which has been committed with reference to this matter, consists not in overrating the hazard of the time, when changes so important are being accomplished, but in regarding only one of the manifestations--though that indeed is the most striking one of the many important ends which nature is then labouring to bring about. a child in perfect health usually cuts its teeth at a certain time and in a certain order, just as a girl at a certain age begins to show signs of approaching womanhood; and at length attains it with but slight inconvenience or discomfort. the two processes, however, have this in common, that during both, constitutional disturbance is more common, and serious diseases are more frequent than at other times, and the cause in both lies far deeper than the outward manifestation. the great changes which nature is constantly bringing about around us and within us are the result of laws operating silently but unceasingly; and hence it is that in her works we see little of the failure which often disappoints human endeavours, or of the dangers which often attend on their accomplishment. thus when her object is to render the child no longer dependent on the mother for its food, she begins to prepare for this long beforehand. the first indication of it is furnished by the greatly increased activity of the salivary glands, which during the first few months of existence have scarcely begun to perform their function, a fact which accounts for the tendency to dryness of the tongue of the young infant under the influence of very trivial ailments. about the fourth or fifth month, this condition undergoes a marked alteration; the mouth is now found continually full of saliva, and the child is constantly drivelling; but no other indication appears of the approach of the teeth to the surface, except that the ridge of the gums sometimes becomes broader than it was before. no further change may take place for many weeks; and it is generally near the end of the seventh month before the first teeth make their appearance. the middle cutting teeth of the lower jaw are in most instances the first to pierce the gum; next the middle cutting teeth of the upper jaw; then usually the side cutting teeth of the lower jaw, and lastly, the corresponding ones of the upper. this, however, is not quite invariable, for sometimes all the cutting teeth in one jaw precede in their appearance any of those in the other. the first four grinding teeth next succeed, and often without any very definite order as to whether those of the upper or of the lower jaw are first visible, though in the majority of instances the lower are the first to appear. the four eye teeth follow, and lastly, the remaining four grinding teeth, which complete the set of first, or as they are often called, milk teeth. we must not, however, picture to ourselves this process as going on uninterruptedly until completed--a mistake into which parents often fall, whose anxiety respecting their children is excited by observing that after several teeth have appeared in rapid succession, the process appears to come to a standstill. nature has so ordered it that teething which begins at the seventh or eighth month, shall not be completed until the twenty-fourth or thirtieth; and has doubtless done so in some measure with the view of diminishing the risk of constitutional disturbance that might be incurred if the evolution of the teeth went on without a pause. as a rule the two lower central incisors or cutting teeth make their appearance in the course of a week; six weeks or two months often intervene before the central upper incisors pierce the gum, but they are in general quickly followed by the lateral incisors. a pause of three or four months most frequently occurs before we see the first grinding teeth, another of equal length previous to the appearance of the eye teeth, and then another still longer before the last grinding teeth are cut. though a perfectly natural process, teething is almost always attended with some degree of suffering. this, however, is not always the case, for sometimes we discover that an infant has cut a tooth, who yet had shown no signs of discomfort, nor any indication that teething was commencing, with the exception of an increased flow of saliva. more frequently indeed, the mouth becomes hot, and the gums look tumid, tense, and shining, while the exact position of each tooth is marked, for some time before its appearance, by the prominence of the gum; or the eruption of the teeth is preceded by much redness, and great heat of the mouth with profuse flow of saliva, and even with little painful ulcers of the edge of the tongue, or of the inner surface of either lip. with either of these conditions the child is feverish, fretful, and cries from time to time with pain, while at the same time the bowels often are relaxed, or the child coughs and wheezes as if it had caught cold. symptoms such as these make up what nurses mean when they say that the child is suffering from its teeth, and this opinion is constantly followed by a request to the doctor to lance the baby's gums. now this little operation when really called for often gives great relief, both to the local discomfort, and also to the general ailment from which the infant suffers, but it is often done when there is no occasion for it, and when consequently it causes needless pain, and does no good. there are four different conditions in which it may be right to have the child's gums lanced: first. when a tooth is very near the surface, and by cutting through the thin gum the child may be spared some needless suffering. second. when the gums are very red and hot and swollen; only in this case the gum is scratched or cut, to bleed it, not with the idea of letting out the imprisoned tooth. third. when the child has for some week or two been feverish and suffering; while, though the gum is tense and swollen, the tooth does not seem to advance. fourth. as an experiment, when during the progress of teething a child is suddenly seized with convulsions for which there is no obvious cause. the irritation of the teeth may have to do with their occurrence; and the chance of relieving it by so simple a means is not to be thrown away. if the process of teething is going on quite naturally, no interference, medical or other, is either necessary or proper. the special liability of children to illness at this time must indeed be borne in mind, and care must be taken not to make any alteration in the infant's food while it is actually cutting its teeth, but rather to choose the opportunity of some one of those pauses to which reference has been made, as occurring between the dates of appearance of the successive teeth, for making any such change. if the child is feverish, a little soda or seltzer water sweetened and given after the effervescence has subsided will be taken eagerly, and avoid the risk of putting the child too often to the breast, or giving it food too frequently. it seeks the one or the other because it is thirsty, and craves for moisture to relieve its hot mouth; not because it is hungry and needs nourishment. if the child has been weaned, still greater care will be required, for it will often be found that it is no longer able to digest its ordinary food, which either is at once rejected by the stomach, or else passes through the intestines undigested. very thin arrowroot made with water, with the addition of one third of milk, will suit in many cases, or equal parts of milk and water with isinglass, or equal parts of milk and the white decoction. the bowels of course must be kept open with very simple and mild aperients, but the bowels are in general more inclined to diarrh[oe]a than to constipation, and the diarrh[oe]a of teething children is often troublesome and requires good medical advice. the ulcerated state of the mouth is usually connected with special disorder of the digestive organs, and that condition of acidity for which i have already recommended soda, magnesia, and similar remedies, while locally the mouth needs just that local care which is applicable in cases of thrush. now and then, severe inflammation of the gums occurs, in which they become extremely swollen; and ulceration takes place of the gum just above where the tooth should come through, and even around some of those which have already appeared. these are cases in which lancing the gums would do nothing but mischief. they require the local care already insisted on, a mild plan of diet, and treatment to reduce any feverishness; and above all one medicine, the chlorate of potass, which in doses of four grains every four hours for a child a year old, is almost a specific. affections of the skin.--there are a few affections of the skin to which children in early infancy are especially liable, concerning which a few words must be said. the latin word _intertrigo_ is used for that _chafing_ of the skin of the lower part of the body of an infant which is by no means unusual, and is often very distressing. it is almost invariably due to want of care. either wetted napkins are dried, and put on again without previous rinsing in water, or they have been washed in water containing soda, and not passed through pure water afterwards, or attention is not paid to change the infant's napkin immediately that it requires; or a fresh napkin is put on without previous careful ablution of the child; or lastly it occurs almost unavoidably in cases of diarrh[oe]a from the extension of irritation beginning at the edge of the bowel. care is usually all that is needed to remove, as it is to prevent this condition. the precautions which i have referred to with regard to cleanliness must be carefully observed, and moreover, each time even after passing water, the child should be carefully washed with thin gruel, or barley water, then dusted abundantly with starch powder, while the napkin must be thickly greased with zinc ointment. after the first six or seven months of life the napkin can be almost always dispensed with, if the child has been brought up in good habits, and in all cases of chafing, it is much the better way to put no napkin on the child when in bed, but to lay under it a folded towel, which can be removed, and a clean one substituted for it as soon as it becomes soiled. there is a very obstinate form of chafing, with great redness of the skin, and disposition to crack about the edge of the bowel which depends on constitutional causes, and calls at once for the interference of the doctor. besides this purely local ailment, there is another skin affection which is seen over the body generally, and is known popularly by the name of _red gum_, or in latin _strophulus_. i mention the latin name because i have known persons sometimes, misled by the similarity of sound, fancy that it had some connection with scrofula. it is met with less commonly now than formerly, when people were accustomed to keep infants unduly wrapped up, and to be less careful than most are now-a-days about washing and bathing. it depends on over-irritation of the sweat glands of the delicate skin of the infant, the result of which shows itself in the eruption on the body and face of a number of small dry pimples sometimes surrounded by a little redness, itching considerably, and when their top has been rubbed off by scratching having a little speck of dried blood at their summit. a rash like this, a sort of _nettle rash_, more blotchy and causing little lumps on the skin, which in a day or two come and go, sometimes appears in the intervals between the pimples, sometimes takes their place, and causes, as they do, much irritation. this nettle rash is usually dependent on some error of diet, on some acidity of the stomach, and, on their being corrected soon passes away, leaving the pimples as they were before, but sometimes being reproduced if the pimples cause excessive irritation of the tender skin. the matter of chief importance for a mother to know, is that these rashes have no serious signification. their treatment is very simple. it consists in dressing the child very lightly, in bathing it very frequently with tepid water, avoiding as far as may be the use of soap, and in sponging it often to relieve the irritation with some simple alkaline lotion; such for instance as one recommended by the late dr. tilbury fox, and which is composed of twenty grains of carbonate of soda, two teaspoonfuls of glycerine, and six ounces of rose water. of course if the stomach is out of order that must be attended to, but a little fluid magnesia, once or twice a day, is all that is usually needed in the way of medicine. one other affection of the skin, very common, very distressing, very tedious, of which there are many varieties, generally known by the technical name of _eczema_, from a compound greek word which signifies to flow, needs that i should say something about it. it is not limited in its occurrence to infancy, nor does it of necessity cease when childhood is over, but continues to recur even in grown persons, and shows itself still from time to time even in the aged. for the most part, however, it makes its appearance between the fifth and twelfth month; sometimes seeming to be induced by the change of food when the child is weaned, and that even though the weaning may have been wisely managed; at other times showing itself when the irritation of teething begins, and in every instance being aggravated by the approach of each tooth to the surface, and abating in the intervals. it does not occur in all children with equal frequency or severity, and though there is no doubt but that it is often hereditary, and this especially in families some members of which have suffered from gout, yet it is by no means unusual for two or three of the children of the same parents to be affected by it severely, while no trace of it appears in the others. it shows itself in general first on the cheeks and sides of the face, where the skin becomes red and rough, and slightly puffy. on looking very closely--more closely indeed than most persons are wont to do--this appearance will be seen to be produced by innumerable small pimples, smaller than pins' heads, and which itch violently. now and then, even in the course of a few hours, these pimples disappear, leaving the skin rough, and peeling off in branny scales, while the surface beneath is red and irritable, a condition which also in a few days may subside. this, however, is less frequent than the opposite course of the affection, in which a drop of fluid forms at the top of each tiny pimple, and escaping forms a yellowish, thin, transparent, watery, irritating discharge, which reddens still more the raw and weeping surface of the skin. the fluid when abundant dries at length into yellowish flakes or crusts, which sometimes assume a brownish colour if the surface is made to bleed by irritating or scratching. if the crusts are not removed, the fluid which still continues to be poured out beneath them soon changes into matter or _pus_ as it is called, and this, shut up beneath the hard crust above, increases the irritation, and thickens the deposit. after a time the inflammation lessens of its own accord, the secretion diminishes, the crusts dry up, and at length fall off, leaving the skin red, slightly swollen, and its surface scaling off in flakes, which gradually cease to form, and the skin by degrees becomes quite sound again, and so remains, until perhaps the irritation caused by the approach of a new tooth to the surface, rekindles the old trouble, to go once again through the same stages as before. it is on the cheeks, the sides of the face, and the top of the head that these changes may be best studied, but there are other situations in which the same kind of process often goes on. it may be seen in the creases of the neck, or the folds of the thigh in fat children, only as two surfaces of skin are there in contact the fluid never dries to a crust, but the skin, red and sore and swollen, pours out an abundant secretion which, just as when it occurs behind the ears, gives out a strong and offensive smell. it occurs, too, at the bends of the joints, as under the knee, and at the inside of the elbow joint, as well as on the front of the chest, the back, and sometimes even over the whole body, and especially at any part where the pressure of the dress irritates the skin. when thus general, it seldom fails to pass into a chronic state such as to call for constant, skilled medical treatment. the attack often comes on with general feverishness, a hot skin, fretfulness, and restlessness, which subside when the skin begins to discharge, though the discomfort produced by the local irritation still continues. at other times, and this perhaps more often when the eruption first appears on the head, its onset is more gradual, and slight scurfiness and redness at the top of the head are first noticed, and then a little crust forms there which is firmly adherent, and is, therefore, often not entirely removed as it should be, and thus bit by bit the mischief extends until its cure becomes tedious and troublesome. when either from neglect, or from the ailment having set in acutely, the affection of the scalp is severe, the child's state is one of much suffering. the whole of the scalp becomes hot and swollen, and covered over a large surface by a thick dirty crust, through cracks in which a thick ill-smelling greenish-yellow matter exudes on pressure. at different points around, pimples form with mattery heads,--pustules they are called--while the glands on each side of the neck become swollen and tender. when thus severe on the head it will be found also not merely on the face, but also on the body, and the poor suffering child is not only a miserable object to look upon, but, worn by constant restlessness, it loses flesh, and seems almost as though it could not long survive. happily, however, the condition scarcely ever terminates fatally, though feeble health and stunted growth are not seldom the results of the early suffering. but besides, severe eczema in infancy always returns again and again in childhood and in after-life, and there is also a distinct connection between liability to eczema and to asthma; and this not simply nor mainly that the disappearance of an attack of eczema may be succeeded by an attack of asthma, but that the child who in infancy has had severe general eczema is more prone than another to develop a disposition to asthma as he attains the age of five or six, and this even though he should not have had any return of the skin affection in a severe form. it is evident then, that one cannot take too much pains to guard against the occurrence of eczema if possible, and at any rate to prevent its becoming severe. the disposition to it is often controlled by very simple precautions, such as bathing the face, the moment the skin shows any redness or roughness, with thin gruel or barley water, then powdering it with starch powder, and when the infant goes out, smearing the spot very lightly with benzoated zinc ointment, and making the child wear a veil. it will be observed that the exclusion of the air is in all these cases the object of the application far more than any specific virtue which it is supposed to possess, and many of the worst cases of eczema in grown persons are treated, in the great hospital for skin diseases in paris, by an india-rubber mask, or by india-rubber covering of the affected part, and benefit thereby without any medicated application whatever. the thin layer of scurf which often forms on an infant's head should not be allowed to remain there, since its presence is a source of irritation. if it is very adherent, the surface may be well greased overnight with a little clarified lard which will soften it, so that it can be readily washed off with weak soap and water in the morning. if, however, the skin is very irritable soap must not be used, but the head must be washed with yelk of egg and warm water, and instead of a sponge, which would be too harsh, it is better to employ a very large camel's hair brush or a soft shaving brush, which is more handy, and the surface after careful drying may be lightly smeared with zinc ointment. all ointments used must be washed off most scrupulously every day, otherwise they become rancid, irritate, and make matters worse. when eczema sets in acutely, with general feverish disturbance, cooling medicines are required, and the help of the doctor becomes necessary. these are the cases in which the eruption is not confined to the head or the face, but extends over the body generally. the child must be dressed as loosely as possible; and when in its cot, should lie there with no other covering than its little shirt; and nothing gives so much relief to the irritation as the abundant use of powder, either simple starch powder, or ten parts of starch powder to one of oxide of zinc, or carbonate of bismuth. all powders must be absolutely free from grit, or, in other words, quite impalpable; otherwise they irritate the surface. on the face and other parts where it can be employed, the puff may be used to apply the powder; but between the creases of the skin--which it is important to keep apart--fine linen, lint, or charpie must be employed, covered freely with powder, so as to prevent the surfaces from coming into contact. if the irritation is very distressing, a weak spirit lotion with a little carbolic acid may sometimes be sponged over the surface, and the powder renewed immediately; or other forms of soothing lotions may be used to abate the irritation. when the scalp is affected in the acute form of eczema crusts form very quickly; or in other cases they collect because people fear to disturb them when they see the raw surface beneath. it is, however, a grievous mistake to allow them to collect; they are in themselves a source of irritation, and they entirely prevent any application reaching the skin beneath. they must always be removed, and never be allowed to form again. they can be removed either by the employment of a poultice, half of bread, half of linseed meal, or by the application over-night of a handkerchief soaked in sweet oil, and covered over with a piece of oiled silk, which softens the crusts effectually, and allows of their easy removal by abundant washing with weak soap and water. the best applications afterwards vary so much that it is impossible to lay down any positive rule. sometimes the carron oil, as it is termed: a liniment compound of equal parts of linseed oil and lime-water--a popular and most useful application in burns--gives most ease to the irritated skin; sometimes the mere exclusion of the air by means of the india-rubber cap; sometimes the abundant use of powder. in every case, at least once in every twenty-four hours the whole surface must be washed quite clean with barley water or thin gruel; and when the discharge lessens or ceases, as it will do in the course of time, then, but not till then, various ointments may be of service. when the chronic stage arrives, in which the skin becomes dry and scaly, then is the time for tonics, for iron, sometimes for cod-liver oil, and for arsenic; of which latter remedy, however, the results are uncertain; while in the acute stage, its influence is simply mischievous. nothing is more difficult, nor calls for more skill, or larger medical experience, than the proper management of the various forms of chronic eczema. the question is sometimes asked whether it is safe to cure, or, as people call it, to dry up these eruptions in teething children. there can be no doubt but that it is very desirable to prevent their occurrence as far as may be by the use of the precautionary measures which i have explained. but when they have existed for some time, either attended with profuse discharge, or causing great irritation by their extent, there is no doubt but that care must be exercised in attempts at their cure, that soothing measures such as i have advocated should be chiefly employed, and that the sudden drying up of the discharge by a too abundant use of dusting powders must be avoided. if, too, the diminution of the rash were followed by a worsening of the child's condition, by feverishness, by heaviness of the head, or any sign of disturbance of the brain, the attempt to cure the rash must at once be abandoned. at the same time i must add that such occurrences are very rare, and that for one case where i have had to regret my success in curing the rash, i have seen fifty in which i have been mortified by the failure of my endeavour. footnotes: [ ] the directions given by the distinguished chemist, dr. frankland, to whom i am indebted for the suggestion, are as follows: 'one-third of a pint of new milk is allowed to stand until the cream has settled; the latter is removed, and to the blue milk thus obtained about a square inch of rennet is to be added, and the milk vessel placed in warm water.' (i may add that the artificial rennet sold by most chemists may be substituted for the other.) 'in about five minutes the rennet, which may again be repeatedly used, being removed, the whey is carefully poured off, and immediately heated to boiling to prevent its becoming sour. a further quantity of curd separates, and must be removed by straining through calico. in one quarter of a pint of this hot whey is to be dissolved three-eighths of an ounce of milk sugar, and this solution, along with the cream removed from the one-third of a pint of milk, must be added to half a pint of new milk. this will constitute the food for an infant of from five to eight months old for twelve hours; or, more correctly speaking, it will be one-half of the quantity required for twenty-four hours. it is absolutely necessary that a fresh quantity should be prepared every twelve hours; and it is scarcely necessary to add that the strictest cleanliness in all the vessels used is indispensable.' [ ] in our tables of mortality we find teething registered as having occasioned the death of nearly ( . ) per cent. of all children who died in london under one year old; and of . per cent. of those who died between the age of twelve months and three years. part iii. _on the disorders and diseases incident to all periods of childhood._ the ailments hitherto noticed are by no means all that may occur during infancy and early childhood, but those only which either happen then exclusively, or at least with far greater frequency than at other times. it will be most convenient to consider the others under the different systems to which they belong, as diseases of the head, of the chest, and of the bowels. before entering on these new subjects, however, a few words may not be out of place with reference to what may be termed the second period of childhood. it is above all a time of wonderfully lessened sickness and mortality. we have not the means of stating exactly the rate at which mortality is lessened between the cessation of the first and the commencement of the second dentition; but we do know that it is ten times less between the age of one and five, and nearly twenty times less between five and ten than it was in the first year of existence.[ ] a mother's anxiety then may safely be quieted after the first year of her infant's life, and still more after the first set of teeth have been cut, for if her child is strong and healthy then, there will be comparatively little to fear for its future. four years or thereabouts now follow, before any important change takes place in the child's condition, for it is not until between six and seven years old that the first set of teeth begin to be shed, and the second to take their place. this change of teeth too is of far less moment as far as the health is concerned, than was the cutting of the first set. the first dentition was the preparation for an entirely new mode of life for the child, and was intended to fit it for a life independent of its mother. the second has no such signification; it is a mere local alteration rendered necessary by the growth of the jaws, and takes place quietly, by the gradual absorption of the roots of the first set of teeth, brought about by the pressure of the others as they approach the surface. four teeth in each jaw are new, and replace no others, but usually they are cut without much discomfort, and the wisdom teeth do not concern us here, for they do not appear until childhood has long passed. but, though between the age of two years and of ten there is no important change, nor even preparation for a change in the constitution, the time is yet one of most active growth of the body, and consolidation of the skeleton. the stature increases from ft. in. to ft. in., and the weight nearly doubles, while at the same time the ends of the long bones previously connected with the shafts by means of cartilage or gristle, become firmly united by the conversion of that cartilage into bone, and a similar process goes on, though not completed till later, in the ribs and the breast bone. rapid increase of height and weight; conversion of the elements of bone into bone itself, formation of muscle out of the fat, which in the young child was stored up as so much building material for an edifice in course of construction, require for their accomplishment perfect health, and the power of converting to its highest purposes all the nourishment received. what wonder then, if from time to time, the machinery thus hardly taxed, fails to be quite equal to the demands upon it, if pains in the limbs--growing pains, as they are commonly called, or head-ache, tell of the inadequate nerve supply. or if from the same cause, a vague feverish condition comes on, in which the temperature is slightly raised, and the child listless, and yet fretful, loses its cheerfulness, is dull at its easy tasks, and yet indifferent to play. this too is the time when any unsuspected defects, physical, or mental, or moral, begin to show themselves distinctly; when short sight becomes apparent so soon as the child has to learn its letters, when the dull hearing is perceived which makes it seem inattentive, and gives to its manner an unchildlike nervousness; and the weak intellect is displayed in causeless laughter, causeless mischief, causeless passion, imperfect power of articulation, or want of words, and by a restless busyness in doing nothing. of all these things i shall have to speak later on more fully. they are the things however, which only those mothers notice who live much with their children, who do not banish them all day long to the nursery or the school-room, and learn from another whether they fare well or ill. they and only they will notice these things in whom there dwells that which the poet tells us of: the mother's love that grows from the soft child, to the strong man; now soft, now strong as either, and still one sole same love. footnotes: [ ] the exact numbers as given at p. xiv of the forty-fifth report of the registrar-general for all england in are to , living under one year deaths; from one to five . ; from five to ten . . chapter vi. the disorders and diseases of the brain and nervous system. it is stated on good authority[ ] that more than half of the deaths at all ages from these causes take place in children under five years, a fact which at first sight seems as inexplicable as it is startling. there is, however, a twofold explanation of it: the circulation through the much softer tissue of the brain, unenclosed within a _firm bony case_ as in after-life, varies with far greater rapidity in the infant than in the grown person, and hence the organ is far more easily overfilled with or emptied of its blood. besides, any organ in which growth is going on with great rapidity is proportionately liable to become disordered or diseased. now the brain doubles its weight in the first two years of life, and attains nearly its full size by the end of the seventh year. these two facts suggest a bright as well as a dark view of disorders of the brain and nervous system in early life. if disorder is more frequent, it is excited by slighter causes, is more likely to be temporary, and even its gravest symptoms, such as convulsions and paralysis, have a less serious import in the one case than in the others. if the grown man has a fit, and still more, if that fit is followed by paralysis, we fear and with reason that some vessel in the brain-substance has given way, or that some grave, probably irreparable damage has been inflicted on it. in the child, and especially in the young infant, these accidents may mean nothing more than that the brain has suddenly become over-filled with blood, or that it has been disturbed by irritation--i know of no better term--in some distant organ. convulsions.--there are in the body two great nerve masses, the brain and the spinal cord, through which all parts are brought into relation with each other. the spinal cord or spinal marrow receives impressions from all parts, imparts movement to the limbs, as well as gives activity to the functions of the various internal organs. the brain is the controlling power, and governs more or less consciously the movements which the spinal cord originates, and hence in proportion as the development of the brain advances, and its controlling power increases, those involuntary movements, fits or convulsions, which originate in irritation of the spinal cord, become rarer. the brain, at the age of three years, is more than twice as large as in the first year of life, and deaths from convulsions have then sunk to a third of their former frequency; while from the age of ten to fifteen years, when the brain may be said to be perfected, only four per cent., instead of nearly eighty per cent. as in the first years of life, of all deaths from disorders of the nervous system are due to convulsions.[ ] i dwell on this subject the more because there is in a fit of _convulsions_ something so intensely painful to behold that it is easy to exaggerate its danger, and to lose all presence of mind in panic. first, then, it is well to bear in mind that real disease of the brain rarely, very rarely, i do not say never, begins with convulsions; and next, that their real danger is in general in exactly opposite relation to the frequency of their occurrence. convulsions now and then return thirty, forty, or more times in twenty-four hours, and continue to do so sometimes for three or four days together. they are, indeed, not without peril, for the perpetually returning disturbance of the circulation may give rise to an overfilling of the vessels of the brain, or to a stagnation of the blood within them, or the spasm may affect the muscles which open and close the entrance to the windpipe, and the child may die choked as in a paroxysm of whooping cough, or in a fit of spasmodic croup, or lastly the violent and frequently repeated muscular movements may at length exhaust its feeble frame. but still, such frequently recurring convulsions are in themselves no evidence that the brain is diseased; they do but show that the irritability of the spinal cord is increased to a degree which the brain is no longer able to control, and which therefore manifests itself in violent convulsive movements. it is thus that the poison of scarlet fever or of small-pox sometimes displays its influence over the whole system by producing violent convulsions at the outset of those diseases; thus that they follow on some indigestible article of food, or that the mother, over-heated by violent exertion, or overwhelmed by the news of some unexpected calamity, sees her babe, to whom she is in the act of giving the breast, suddenly seized by a violent convulsion. in every instance, therefore, the first business is to ascertain the cause of the convulsion, to determine the seat of the irritation which has excited the nervous system to such tumultuous reaction. the convulsion which ushers in any one of the eruptive fevers in the infant or in the child, is only an exaggeration of the shivering which precedes the onset of fever in the adult. has the child been exposed to the contagion of measles, small-pox, or scarlatina? is it teething, and if so, when did its last tooth appear? of what did its last meal consist? when were its bowels last open? has it been exposed to the sun with its head uncovered? or has it, though in the shade, been sitting or playing out of doors in the intense heat of a summer's day? has it had a fall, or been frightened? or is it suffering from whooping-cough which has of late been very severe? or has its breathing been accompanied with a peculiar catch or crow, the sign of spasmodic croup, and have at the same time its hands been usually half clenched, and the thumb shut into the palm, the sign of that disturbance which at length has culminated in an attack of convulsions? such are the questions, which in less time than it takes me to write, or others to read, the intelligent mother will put to herself, and will answer, instead of, in unreasoning alarm, giving all up as lost, or hastening without reflection to do something or other that were better left undone. the first thing to do in every case of convulsions, be their cause what it may, is to loosen the dress, so that no string nor band may interfere with respiration, and for this purpose strings must be cut and dresses torn. the next thing is to dash cold water on the face to induce a deep inspiration, for sudden death in a fit almost always takes place from interruption to breathing. with the same purpose the forefinger should be put into the mouth, and run rapidly to the root of the tongue, which should be drawn forward. the object of doing this is twofold; first, to prevent the tongue falling back, as in these circumstances it is apt to do, over the entrance of the windpipe and so producing suffocation, and in the next place the act very frequently puts an end to the spasmodic closure of the windpipe, and is followed by a deep-drawn breath which announces the infant's safety. if the child has cut any teeth, the handle of a spoon, round which a bit of rag has been wrapped, or a bit of wood, or a thin strip of india-rubber, should be put between the teeth as far back as possible to prevent the tongue being bitten; and often this is all that can be done. there are two circumstances, and two only, in which the warm bath is likely to be of use. at the onset of one of the eruptive fevers, a hot bath is sometimes of great service by stimulating the skin and thus bringing out the rash. in these cases the fit scarcely ever comes on in a child previously in perfect health, but for some hours at least it has appeared very ill, tossing about with great restlessness, with a dry, hot skin, and twitching of the tendons of the wrists; or, perhaps, with a pale face and cold hands and feet, but with the temperature of the body as high as ° or °. here the hot bath at ° to °, even rendered more stimulating by the addition of mustard, and continued for not more than five minutes, is sometimes of great service, and is speedily followed by the cessation of the convulsions and the outbreak of the eruption. these, too, are the cases in which the use of the wet sheet, as practised in hydropathic institutions, is sometimes of great benefit, but i do not advise its employment except under medical advice. the second condition in which the bath, and here it is the tepid and not the hot bath--that is to say, the bath at from ° to °--is of service, is where the child is feverish and restless from over-fatigue or over-excitement, or from exposure to the sun or to an excessively hot atmosphere, and convulsions have come on in the course of this ailing. here the tepid bath for ten or fifteen minutes, coupled with the application of cold to the head, will soothe the excitement and prevent the return of the convulsions. in neither this case, nor in that in which the hot bath is employed, is the result of the agent as magical as people sometimes seem to expect. it is rarely that convulsions cease while a child is actually in the bath. for the most part the influence of the bath is limited to abating their severity, shortening their duration, and indisposing to their return. the bath, then, is to be used when either a stimulating or a soothing influence on the surface is likely to be of service, and only then. in cases where the fits are produced by constipation, by improper food, or by the irritation of a tooth pressing against the gum, it is idle to use it, and equally so in instances where many fits have been recurring in the course of the same day. where that is the case it must be self-evident that, be the cause what it may, it must be one over which either a hot or a tepid bath can have no influence, and that, painful as it must be to wait a passive spectator, that position is far wiser than that of a mischievous meddler. it is some consolation, also, to know that unconsciousness to suffering attends convulsions. there is one agent, chloroform, which often has a very remarkable influence in controlling frequently repeated convulsions. it is an agent, however, too hazardous to be trusted out of medical hands, and even when the doctor administers it himself, the parents must fully recognise the fact that, inasmuch as the child may die during a fit quite independently of breathing chloroform, so the occurrence of that catastrophe during its employment is not to be made a subject of self-reproach to them, or of blame to the doctor. but you may ask whether there are no _signs_ of that disturbance of the nervous system, by which you can judge beforehand that the occurrence of convulsions is probable. in proportion to the tender age of a babe, the greater is the probability, as i have already stated, that convulsions will be induced by slight causes, especially by such as digestive troubles. unless you are aware of the phraseology that used at any rate to be common among nurses, you may be much alarmed at being told that the child who had seemed scarcely unwell has been very much convulsed, when all that is meant is that the child has shown some of the signs that threaten convulsions--has had, in short, what in the time of our grandmothers used to be called _inward fits_. a child thus affected lies as though it were asleep, winks its imperfectly closed eyes, and gently twitches the muscles of its face--a movement especially observable about the lips, which are drawn as though into a smile. sometimes, too, this movement of the mouth is seen during sleep, and poets have told us that it is the angels' whisper which makes the babe to smile--i am sorry that its meaning in plain prose should be so different. if this condition increases, the child breathes with difficulty, its respiration sometimes seems for a moment almost stopped, and a livid ring surrounds the mouth. at every little noise the child wakes up; it makes a gentle moaning, brings up the milk while sleeping, or often passes a great quantity of wind, especially if the stomach is gently rubbed. when the disorder of the digestion, on whatever cause it depended, is removed, these symptoms speedily subside, nor is there much reason to fear general convulsions so long as no more serious symptoms show themselves. there is more cause for apprehension, however, when the thumbs are drawn into the palm, either habitually or during sleep; when the eyes are never more than half-closed during sleep; when the twitching of the muscles is no longer confined to the angles of the mouth, but affects the face and extremities; when the child awakes with a sudden start, its face growing flushed or livid, its eyes turning up under the upper eyelid, or the pupils suddenly dilating, while the countenance wears an expression of great anxiety or alarm, and the child either utters a shriek, or sometimes begins to cry. when a fit comes on, the muscles of the face twitch, the body is stiff, immovable, and then in a short time, in a state of twitching motion, the head and neck are drawn backwards and the limbs violently bent and stretched. sometimes these movements are confined to certain muscles or are limited to one side, and i may add that such cases are of more importance as far as the state of the brain is concerned than those in which the convulsions are general. the eye is fixed and does not see; the fingers may be passed over it without its winking, the pupil is immovably contracted or dilated; the ear is insensible even to loud sounds, the pulse is small, very frequent, often too small, and too frequent even for the skilled doctor to count it; the breathing hurried, laboured and irregular; the skin bathed in abundant perspiration. after this condition has lasted for a minute, or ten minutes, or an hour or more, the convulsions cease; and the child either falls asleep, or lies for a short time as if it were bewildered, or bursts out crying, and then returns to its senses, or sinks into a state of stupor, in which it may either be perfectly motionless, or twitching of some muscles may still continue; or, lastly, it may, though this seldom happens, die in the fit. it seems then, from all that has been said, that convulsions, though one of the most striking, are by no means one of the most conclusive signs of brain disease; that they are even more commonly the result of disorders of the nervous system from causes seated elsewhere, than of actual disease of what may be termed the great nervous centre. we may now therefore pass to the examination of these diseases, which for the purposes of this book may be considered under the two heads of congestion and inflammation. i am forced to use these terms in somewhat of a popular sense, for to attempt in a little book like this to define everything with strict scientific accuracy would simply confuse and mislead. congestion of the brain.--by _congestion of the brain_ is meant a condition in which its vessels are overcharged with blood; a condition which if it exists in an aggravated degree, ends either in the pouring out of blood on, or into the brain, on the one hand, or in inflammation on the other. either of these terminations, however, is so rare in the previous healthy child, that i shall confine my remarks entirely to congestion of the brain, an affection specially liable to occur in children during teething. a certain degree of feverishness almost always accompanies teething. it is, therefore, not difficult to understand how, when the circulation is in a state of permanent excitement, a very slight cause may suffice to overturn its equilibrium, and occasion a greater flow of blood to the brain than the organ is able to bear. congestion of the brain, however, is not by any means limited to this season, but may occur at other times without any obvious exciting cause, and with no other explanation than is furnished by the well-known fact that all periods of development such as childhood, are periods during which the growing organs are most apt to become disordered. in the great majority of cases the symptoms of congestion of the brain come on slowly; and for the most part, general uneasiness, or disordered state of the bowels, which are usually, though not invariably constipated, and feverishness precede for a few days the more serious attack. the head by degrees becomes hot, the child grows restless and fretful, and seems distressed by light, or noise, or sudden motion, and children who are old enough sometimes complain of their head. usually too, vomiting occurs repeatedly; a symptom of the greatest importance, since it may exist before there is any well-marked sign of head affection. causeless frequently repeated vomiting in a child not ill but ailing, is nine times out of ten a sign of mischief in the head. the degree of fever which attends this condition varies much, and its returns are irregular; but any one who knows how to feel the pulse will find it permanently quickened, and if the head is unclosed the pulsations of the brain may be seen and felt distinctly. the sleep is disturbed, the child often waking with a start, while there is occasional twitching of the muscles of its face, or of the tendons of its wrist. the child may continue in this condition for many days and then recover its health without any medical interference. this is especially likely to be the case with children while teething, the fever subsiding, the head growing cool, and the little one appearing quite well so soon as the tooth has cut through the gum, but the approach of each tooth to the surface being attended by the recurrence of the same symptoms. the fortunate issue of these cases though frequent, is by no means invariable, for sometimes they are but the precursors of that formidable, i might indeed say, all but hopeless disease, water on the brain. but even of itself congestion of the brain is by no means a trivial ailment, for it may pass into a stage in which the smaller discomforts of the child lead to the sad mistake that the condition of the child is improving, instead of which it is really the dulling of sensibility from approaching death. the head, indeed, becomes less hot, the flush of the face grows slighter and less constant; but the countenance is heavy and anxious, the indifference to surrounding objects increases, and the child lies in a state of torpor or drowsiness, from which indeed it can at first be roused to complete consciousness the manner on being roused is always fretful, but, if old enough to talk, the child's answers are natural, though generally very short; and murmuring, 'i am so sleepy, so sleepy,' it subsides into its former drowsiness. the bowels generally continue constipated, and the vomiting seldom ceases, though it is sometimes less frequent than before. in this state, without any apparent cause, the child sometimes has an attack of convulsions, which subsiding, leaves the torpor deeper than before. the fits return, and death may take place in one of them, or the torpor growing more profound after each convulsive seizure, the child at length dies insensible. now and then, especially in infants of only five or six months old, recovery takes place even where there seemed almost no ground for hope. the overfull vessels have at length relieved themselves, fluid has been poured out into the cavities of the brain, the yielding skull has given way under the pressure from within, and should the child after all survive, its large head, due to chronic water on the brain, tells to all who know how to interpret the signs, the tale of its past illness, and the manner of its imperfect recovery. cases such as these are obviously beyond the reach of domestic management, and call for all the resources of medical skill. the mistake commonly made is that of calling in the doctor too late, because it is not realised how grave may be the import of symptoms which at first appear so little alarming; and the so-called experienced nurse having said, 'oh! it's nothing but the baby's teeth,' time is lost and danger not anticipated till too late for remedy. the application of two, three, or four leeches at the very outset of these cases is often of great service, and sometimes cuts short symptoms which had seemed very threatening. the doctor, of course, must be the judge of its expediency, but i refer to it because i have known parents raise objections to it, and beg to have milder means tried first. it must be borne in mind then, that whenever leeches are of use it is at the beginning of an attack, and that the opportunity once let slip does not return. purgatives, cold to the head, saline medicines, and perhaps some carefully selected sedative, are the measures which will probably be employed in most cases, but success will in great measure depend on the minute care with which all the details which i dwelt on in the introduction, are carried out. it is not always, indeed, that active treatment is desirable, and gentle measures then suffice; but nothing except close and frequent watching can enable the doctor to steer safely between the two opposite dangers of too little and too much. when i come to speak of the eruptive fevers, i shall have to mention the convulsions and other signs of most serious brain disturbance, which sometimes occur at their outset, and which are due to the condition of the blood charged with the fever poison. a somewhat similar set of symptoms, attributed with reason to the overheated state of the blood, occurs in cases of _sunstroke_. it is true that sunstroke, with the formidable characters that it presents in hot countries, is not seen in england, but even here the mere exposure of an infant or young child to an overheated atmosphere, is by no means unattended with risk, and i refer to it here, because mothers are by no means aware of the danger, and believe that it suffices to guard the child from the direct rays of the sun. alarm, restlessness, and fretfulness, alternating with drowsiness, hurried, irregular breathing, intense heat of skin, violent beating of the open part of the head, twitching of the limbs, and starting of the tendons of the wrists, with a pulse too rapid to be counted, are the symptoms when the attack is severe. convulsions are rare, though they sometimes occur. sickness is almost invariable, the stomach rejecting everything, and the bowels are almost invariably relaxed, severe diarrh[oe]a or dysentery sometimes coming on, as the brain disturbance abates. the first shock may kill the child in a few hours, or it may sink under the subsequent diarrh[oe]a, but as a rule recovery eventually takes place. all cases, indeed, are not equally severe, but all require careful and gentle treatment, the cool and darkened room, the quiet, the cold to the head, the tepid bath, and on the part of everyone the care not to allow the apparently serious condition of the child to urge them to those active measures which will here be out of place, and destroy the hopes which would revive after a few hours of patience and gentle means. really acute inflammation of the brain is of so rare occurrence except as the result of accident or injury, and its symptoms are of so serious a character, even from the first, that medical advice is obviously needed at once. i shall, therefore, pass it over here, and endeavour to describe two forms of inflammation of the brain which are much more frequent, and at their commencement more likely to be overlooked. =water on the brain.=--one of these is the form of inflammation commonly known as _water on the brain_, a term which, though incorrect medically, has the advantage of being well understood. this, now, is not a simple disease, occurring in a previously healthy child, but it is a disease dependent on the same state of constitution as gives rise in other children to consumption, or scrofula, or disease of the mesenteric glands. it is this circumstance which renders the disease so serious, and recovery from it so extremely rare. this it is also which makes it so desirable to become acquainted with its symptoms, both that you may be alive to the approach of danger, and also not indulge in needless alarm when brain symptoms occur from other causes which have no relation whatever to those which give rise to water on the brain. the disease comparatively seldom comes on in a child who had previously seemed in perfect health; a state of vague ailing usually precedes its outbreak. the child loses flesh and strength, and the look of health, and the lustre of the eye, and the silky softness of the hair. the appetite becomes uncertain, the bowels irregular, with a tendency to constipation; there are little feverish attacks for a few hours, subsiding of their own accord. the sleep is not sound, the temper uncertain, the child tires even of its favourite toys; the brightness of the little face is changed for a strange, weird, wistful look--an unnatural earnestness; the child sits for moments gazing upward on vacancy, as though it saw, or sought something beyond. by degrees these vague premonitions, which may continue for weeks, become more and more marked till they pass into what may be called the first stage of the affection, in which there are signs of congestion of the brain, such as i have already described, coupled with general irregular attacks of feverishness. the child becomes more gloomy, more pettish, and slower in its movements, and is little pleased by its usual amusements. or, at other times, its spirits are very variable; it will sometimes cease suddenly in the midst of its play, and run to hide its head in its mother's lap, putting its hands to its head, and complaining of headache, or saying merely that it is tired and sleepy, and wants to go to bed. sometimes, too, it will turn dizzy, as you will know, not so much from its complaint of dizziness as from its suddenly standing still, gazing around for a moment as if lost, and then either beginning to cry at the strange sensation, or seeming to awake from a reverie, and at once returning to its play. the infant in its nurse's arms betrays the same sensation by a sudden look of alarm, a momentary cry, and a hasty clinging to its nurse. if the child can walk it may be observed to drag one leg, halting in its gait, though but slightly, and seldom as much at one time as at another, so that both the parents and the medical attendant may be disposed to attribute it to an ungainly habit which the child has contracted. the appetite is usually bad, though sometimes very variable; and the child, when apparently busy at play, may all at once throw down its toys and beg for food, then refuse what is offered; or taking a hasty bite may seem to nauseate the half-tasted morsel, may open its mouth, stretch out its tongue, and heave as if about to vomit. the thirst is seldom considerable, and sometimes there is an actual aversion to drink as well as to food, apparently from its exciting or increasing the sickness. the stomach, however, seldom rejects everything; but the same food as occasions sickness at one time is retained at another. sometimes the child vomits only after taking food, at other times, even when the stomach is empty, it brings up some greenish phlegm without much effort, and with no relief. these attacks of vomiting seldom occur oftener than two or three times a day, but they may return for several days together, the child's head probably growing heavier, and its headache more severe. the bowels during this time are disordered, generally constipated from the very first, though their condition in this respect sometimes varies at the commencement of the disease. the evacuations are usually scanty, sometimes pale, often of different colours, almost always deficient in bile, frequently mud-coloured and very offensive. the tongue is not dry, generally rather red at the tip and edges, coated with white fur in the centre and yellowish towards the root, but occasionally very moist, and uniformly coated with white fur. the skin is harsh, but not very hot, the temperature seldom above ° fahr., varying causelessly, but usually higher towards evening than in the daytime. the nostrils are dry, the eyes lustreless, and _the child sheds no tears_. it is drowsy, and will sometimes want to be put to bed two or three times in a day; but it is restless, sleeps ill, grinds its teeth in sleep, lies with its eyes partially open, awakes with the slightest noise, or even starts up in alarm without any apparent cause. at night, too, the existence of intolerance of light is often first noticed in consequence of the child's complaints about the presence of the candle in the room. i have purposely dwelt long on this preliminary stage because it is only in it that treatment is likely to be of any service, while the very indefiniteness of the symptoms constantly leads to their being overlooked, or referred to teething, or thought at any rate to be a mere temporary ailment for which it is not worth while to call in the doctor. after four or five days, however, the illness of the child becomes too marked to escape notice. all cheerfulness has fled, the eyes are closed to shut out the light, the child lies apparently dozing, but answers questions rationally, in a short quick manner in as few words as possible, and from time to time complains of its head, or utters a short, sharp lamentable cry. the night brings with it no other change than an increase of restlessness, attended sometimes with noisy cries, or with the wandering talk of delirium. sickness often diminishes, but the bowels continue constipated, and it is to be noted that whereas in fevers the bowels are distended with wind, here all wind has disappeared and the belly is sunken to a striking degree. next comes the last stage. each stage is distinguished by peculiarities of the pulse which tell the expert what is passing; quick and regular in the first stage; irregular and slower in the second; quick, variable, irregular from time to time in the third; growing more rapid and more feeble as the end arrives. squinting, stupor, dilated pupil, difficulty of swallowing, tremulous limbs, convulsions, profound insensibility, such are the series of occurrences which bring on death usually within a fortnight, always within three weeks from the appearance of the first decided symptoms. what are you to do in these cases? above all save yourselves the heartbreak of feeling that you have overlooked the premonitory symptoms of the disease. guard with special care the health of any child in whose family a disposition to consumptive disease has ever shown itself, and keep it at any cost from the risk of catching the hooping cough or measles. since, too, it is not in early infancy, but after the age of one year, and in the majority of instances between the ages of three and six years that this disease occurs, that is to say, at the time when the brain begins to be most actively exercised, when the new world on which the child is just entering brings with it new wonders every day; be very careful not to over-stimulate its intelligence, over-excite its imagination, or over-strain its mental powers. after the age of ten the great danger is over; up to that time it is the health of the body which requires care; not fuss, not rearing like a hothouse plant, but the healthy training that may fortify the system. when any signs such as i have described indicate the threatening of disease, do not look on them as within the scope of domestic management, but place the child at once under the watchful care of a skilful doctor. i have seen but one recovery in all my life, after the disease had fully set in, and that was a recovery almost worse than death. =earache.=--there is another form of inflammation of the brain which is likewise oftenest met with in children who are of weakly constitution, or of scrofulous habit, or in whom scarlet fever has left behind that very troublesome ailment, discharge from the ear. this is so tedious, so difficult to cure, so apt to return under the influence of very slight causes, that people are too ready to put up with it as an inconvenience which it is useless to try to remedy. in addition, however, to the risk of the child's hearing being impaired by the extension of the mischief to the internal ear, there is another still greater danger, namely, that of the _disease passing from the ear to the brain_, and producing inflammation of its membranes, or even abscess of its substance. it is therefore of the greatest moment that every case of chronic discharge from the ear should be looked on as important, and that no pains be spared to bring about its cure; and further, that during its continuance the slightest sign of disturbance of the brain--headache, sickness, feverishness, and dulness--should at once be noticed, and the advice of a competent doctor be immediately sought for. these dangers, however, follow almost entirely on long-continued discharges from the ear, but do not attend that acute inflammation of the passage to the ear which is often met with in childhood, and the symptoms of which sometimes cause needless fear, from being taken for those of inflammation of the brain. attacks of _earache_ are most frequent before the first set of teeth have been cut, and are by no means rare in young children, who are perfectly unable to point out the seat of their sufferings. the attack sometimes comes on quite suddenly, but usually the child is languid and fretful for a period varying from a few hours to one or two days before acute pain is experienced. in this premonitory stage, however, it will often cry if tossed or moved briskly; noise seems unpleasant to it, and it does not care to be played with; while children who are still at the breast show a disinclination to suck, though they will take food from a spoon. the infant seeks to rest its head on its mother's shoulder, or, if lying in its cot, moves its head uneasily from side to side, and then buries its face in the pillow. if you watch closely, you will see that it is always the same side of the head which it seeks to bury in the pillow, or to rest on its nurse's arm, and that no other position seems to give any ease, except this one, which, after much restlessness, the child will take up, and to which, if disturbed, it will always return. the gentle support to the ear seems to soothe the little patient: it cries itself to sleep, but after a short doze, some fresh twinge of pain arouses it, or some accidental movement disturbs it, and it awakes crying aloud, and refusing to be pacified, and may continue so for hours together. sometimes the ear is red, and the hand is often put to the affected side of the head, but neither of these symptoms is constant. the intensity of the pain seldom lasts for more than a few hours, when, in many instances a copious discharge of matter takes place from the ear, and the child is well. in some instances, indeed, the subsidence of the disease on one side is followed by a similar attack on the opposite side, and the same acute suffering is once more gone through, and terminates in the same manner. sometimes, too, this complete cure does not take place, but the earache abates, or altogether ceases, for a day or two, and then returns; no discharge, or but a very scanty discharge, taking place, while, for weeks together, the child has but few intervals of perfect ease. in infants, earache seldom follows this chronic course, but it does sometimes in older children, and is then of the more importance, since it shows that the disease is no longer confined to the external passage, but has extended to the internal ear. in children who are too young to express their sufferings by words, the violence of their cries, coupled with the absence of any sign of disease in the chest or the bowels, naturally leads to the suspicion of something being wrong in the head. there are several facts, however, which may satisfy you that the case is not one of water on the brain--the child does not vomit, its bowels are not constipated, there is but little fever, the cries are loud and passionate, and are attended with shedding tears. if you watch closely, you will notice the dread of movement and the evident relief afforded by resting one side of the head, and always the same side, while often the movement of the hand to the head, and the redness of the ear, with the swelling at its entrance, will all serve to point to that organ as the source of the trouble. sometimes, when in doubt, you will be able to satisfy yourselves that the cause of the suffering is in the ear by pressing the gristle of the organ slightly inwards, which will produce very evident pain on the affected side, while on the other side it will not occasion any suffering. the treatment of this painful affection is very simple. in many instances the suffering is greatly relieved by warm fomentations, or by applying to the ear a poultice of hot bran or camomile flowers, while at the same time a little warm oil and laudanum are dropped into the ear. when these means do not bring relief, a leech applied on the bone directly behind the ear seldom fails to give ease; while the disposition to the frequent return of the attack is often controlled by a series of small blisters, not larger than a sixpence, behind the ear. as soon as the tendency has sufficiently abated to admit of it, the ear should be syringed out twice a day with warm water, or with equal parts of warm water and goulard lotion; but if pain or discharge still continues, medical advice must in all cases be sought for. =chronic water on the brain.=--there is still another form of inflammation of the brain, concerning which a few words will suffice. it constitutes what is termed _chronic water on the brain_, and in this instance the term is a correct one, for the disease usually depends on a slow form of inflammation of the lining membrane of the cavities of the brain, often beginning before, still oftener very soon after, birth, which ends in the pouring out of a quantity of fluid into them sufficient to enlarge the head to three or four times its natural dimensions. such cases are very sad and very hopeless, and the great resource, which is sometimes adopted by medical men, of puncturing the head and letting out the fluid, is very seldom successful. but there are more hopeful cases sometimes met with, those namely of children in whom, either from simple weakness, or from that constitutional disorder called rickets, bone formation has been backward, and the head has consequently long remained unclosed. if such children, either from the irritation of teething, or from the straining during paroxysms of hooping cough, suffer from congestion of the brain, fluid may be poured out, which, not being compressed by the too yielding skull, may in consequence enlarge it. these cases, however, may be distinguished from the other more serious ones by the date of their commencement, which is always much later than that of the other form, by the symptoms which attend them being less severe, and by the enlargement of the skull being far slighter. still they require watching, for while with improved health the enlargement ceases, the fluid is in a measure absorbed, and the head diminishes in size, though always remaining larger than the average; brain mischief is yet more readily set up in children with such antecedents than in others. the anxiety of parents about the size or shape of their child's head after infancy has passed, is perfectly needless. when the head has once closed it always remains so. an odd shape, with an unusual protuberance of the forehead and the hind head, sometimes remain as the evidence of that condition in infancy to which i have just referred. it is, however, an evidence of mischief passed, not of mischief going on. in children too who have suffered from rickets, an affection rarely met with except among the poor in crowded cities, distortion of the limbs is often associated with a peculiar form of the skull, but in this too there is nothing to call for anxiety, still less to excite alarm. it is only a preternaturally small head and shelving forehead, which are found associated with mental deficiency; otherwise the greatest varieties of size and shape, of symmetry, or of want of it, may be associated with an equal variety of intellectual endowment, which is just as likely to be above as below the average. =brain disorder from exhaustion.=--it may at first sight appear strange that before leaving the subject of congestion and inflammation of the brain, i should find it necessary to give a caution against being misled by symptoms which though in some respects similar to those of congestion or inflammation, are in reality due to an exactly opposite condition. this mistake, however, is very possible; doctors themselves sometimes fall into it, and some distinguished physicians have thought it worth their while to lay down very minute rules for distinguishing between the two opposite states. headache we all know attends an overfull condition of the vessels of the brain, and grown persons usually suffer from it severely before an attack of apoplexy; but we also know that bad headache accompanies states of great weakness, and that it is one of the most distressing consequences from which a woman suffers who has lost much blood in her confinement. in just the same way, the infant who has been exhausted by diarrh[oe]a or by some trying illness, or who after weaning has been kept on a diet not sufficiently nutritious, may show symptoms of disorder of the brain. it may become irritable, restless, very startlish, with occasional flushings of the face, moaning in its sleep, and sleeping with half-closed eyes. but the head is not hotter than the rest of the body; if the head is not closed, the open part or fontanelle is not tense and pulsating, but flat or even depressed, the hands and feet are cool, and very readily become cold; there may be occasional vomiting, but nothing like the constant sickness of real brain-disease, the bowels are not shrunken but distended, constipation is not present, but on the contrary there is a disposition to diarrh[oe]a. if the symptoms are misinterpreted and wrongly treated, unmistakable signs of exhaustion at last come on, and the child may die from its not being borne in mind that results at first sight much the same may flow from causes diametrically opposite. the moral of this is too obvious for me to need insist upon it. cold to the head, low diet, aperients, possibly leeches, are needed in the one case; increased nourishment, perhaps stimulants, in the other. in every instance where symptoms of brain disorder occur in the child, remember the grievous consequences of a mistake as to their nature, and seek for further help and guidance to preserve you from the possibility of error. =spasmodic croup.=--i have already tried to explain how, in early life, the brain is often unequal to control the sensitiveness of the nervous system to various sources of irritation from without, and how, in consequence this irritation manifests itself by those involuntary movements which we call convulsions. but in addition to, or in the place of those violent contortions or convulsions, the same condition shows itself sometimes in disordered action of the muscles which subserve parts not directly subject to the will, as those for instance which open and close the entrance to the windpipe, or glottis as it is called in medical phraseology. cases in which this occurs are known in popular language as child-crowing, or _spasmodic croup_, from the peculiar catch or crow which accompanies the entrance of air through the spasmodically contracted opening of the windpipe; a spasm which if severe and sufficiently continued closes the opening altogether, so that after fruitless efforts to get its breath the child dies suffocated. this affection occurs chiefly during teething, just as the fits of a hysterical girl oftenest occur during the transition from girlhood to womanhood; but many other causes besides the local irritation of the teeth may produce it, such as constipation, indigestible food, or disorder of the bowels. it does not often occur in perfectly healthy children; but an infant who is attacked by it is usually observed to have been drooping for some time previously, to have lost its appetite, to have become fretful by day and restless at night, and to present many of those ill-defined ailments which are popularly ascribed to teething. at length, after these symptoms have lasted for a few days or weeks, a slight crowing sound is occasionally heard with the child's respiration, shorter, more high-pitched, but less loud than the hoop of hooping cough. usually it is first noticed on the child awaking out of sleep, but sometimes it is perceived during a fit of crying, or comes on while the infant is sucking. the spasm may have been excited by some temporary cause, and the sound which is its token may not be heard again; but generally it returns after the lapse of a few hours, or of a day or two, and its loudness usually increases in proportion as its return becomes more frequent. it will soon be found that certain conditions favour its occurrence; that the child wakes suddenly with an attack of it, that excitement induces it, or the act of swallowing, or the effort at sucking, so that the child will drop the nipple, make a peculiar croupy sound with its breathing, and then return to the breast again. throughout the whole course of the affection, its attacks will be found to be more frequent by night than by day; and to occur mostly soon after the child has lain down to sleep, or towards midnight, when the first sound sleep is drawing to a close. at first, the child seems, during the intervals of the attack, much as before; except, perhaps, that it is rather more pettish and wilful; but it is not long before graver symptoms than the occasional occurrence of an unusual sound when the child draws a deep breath excite attention, and give rise to alarm. fits of difficult breathing occasionally come on, in which the child throws its head back, while its face and lips become livid, or an ashy paleness surrounds the mouth, slight convulsive movements pass over the muscles of the face; the chest is motionless, and suffocation seems impending. but in a few seconds the spasm yields, expiration is effected, and a long loud crowing inspiration succeeds, or the child begins to cry. breathing now goes on naturally: the crowing is not repeated, or the crying ceases; a look of apprehension dwells for a moment on the infant's features, but then passes away; it turns once more to its playthings, or begins sucking again as if nothing were the matter. a few hours, or even a few days, may pass before this alarming occurrence is again observed, but it does recur, and another symptom of the disturbance of the nervous system is soon superadded, if it has not, as is often the case, existed from the very beginning. this consists in a peculiar contraction of the hands and feet; a state which may likewise not infrequently be noticed during infancy, unattended by any peculiarity in breathing. it differs much in degree; sometimes the thumb is simply drawn into the palm while the fingers are unaffected; at other times the fingers are closed more or less firmly, and the thumb is shut into the palm; or, coupled with this, the hand itself is forcibly flexed on the wrist. in the slightest degree of affection of the foot, the great toe is drawn a little away from the other toes; in severer degrees the toe is drawn away still further, and the whole foot is forcibly bent upon the ankle, and its sole directed a little inwards. affection of the hands generally precedes the affection of the feet, and may even exist without it, but the spasmodic contraction of the feet never exists without the hands being involved likewise. at first this state is temporary, but it does not come on and cease simultaneously with the attacks of crowing breathing, though generally much aggravated during its paroxysms. sometimes a child in whom the crowing breathing has been heard, will awake in the morning with the hands and feet firmly bent, though he may not have had any attack of difficult breathing during the night. when the contraction is but slight, children still use their hands; but when considerable they cannot employ them, and they sometimes cry, as if the contraction of the muscles were attended with pain. sometimes, too, there is a degree of puffiness both of hands and feet, a sort of dropsical condition, which, whenever it is present, adds much to the anxiety with reference to the child. as the condition becomes more serious, a slight crowing sound is heard each time the child draws its breath, the fits of difficult breathing are much more severe; they last longer, and sometimes end in general convulsions. the breathing now does not return at once to its natural frequency, but continues hurried for a few minutes after the occurrence of each fit of difficult breathing, and is sometimes attended with a little wheezing. the slightest cause is now sufficient to bring on an attack; it may be produced by a current of air, by a sudden change of temperature, by slight pressure on the windpipe, by the act of swallowing, or by momentary excitement. the state of sleep seems particularly favourable to its occurrence, and the short fitful dozes are interrupted by the return of impending suffocation, in one paroxysm of which longer and severer than the others the infant may fall back dead. it scarcely need be said that the great majority of cases have no such sad ending as i have described, but still, whenever this spasm exists, even in a slight degree, there is always the possibility, never to be forgotten, of a sudden catastrophe. usually, after some tooth has been cut which caused special irritation, or as disorder of the bowels has been set right, the symptoms abate by degrees, and then cease altogether, though liable to be reproduced by the same causes as those to which they were originally due. the seeking out and removing the exciting causes must be the care of the medical man, but there are some special precautions which come within the mother's own province to observe. first of all, as sudden excitement, and especially a fit of crying, are likely to bring on the attack, and since there is a possibility that any attack may prove fatal, the greatest care must be taken in the management of the child to avoid all unnecessary occasion of annoyance or of distress. although the benefit that accrues from fresh air, or from a change of air, is often very great, yet it is very important that the child should not be exposed to the cold or wind, for i have seen such exposure followed by a severe attack of difficult breathing, or by the occurrence of general convulsions. another reason for caution in this respect is that the occurrence of catarrh is almost sure to be followed by an aggravation of the spasmodic affection, which, though previously slight, may thereby be rendered serious or even dangerous. i have nothing to add to what i have already said with reference to the treatment of the attack, when actual convulsions come on. since, however, in this affection convulsions may occur quite unexpectedly at any moment, it is well always to have a basin of cold water and a bunch of feathers handy, in order to be able at once to dash the water on the child's face, and induce that deep inspiration which saves it from the threatening danger. if this should not suffice, the finger must be put into the mouth, and run over the back of the tongue in the way that i have already explained when speaking of convulsions. now and then it happens, though but very rarely, that violent _general convulsions_ come on in infancy quite independent of spasmodic croup, not preceded nor attended by any sign of disease of the brain, and which end in the course of some hours or of a few days in death, the child being partly worn out by the violence of the muscular movements, partly by the disturbance of breathing which each fit occasions. happily, however, in most of these instances the convulsions by degrees lessen both in violence and frequency, and the child recovers. =epilepsy.=--there is one other point of view from which convulsions in infancy and early childhood must be looked on with apprehension, and that is from their being frequently followed in after years by _epilepsy_. in nearly a fifth of all cases of epilepsy in childhood that have come under my notice the first occurrence of fits dated back to early infancy, and this, even though an interval of years had passed between the last fit in infancy and the first in childhood. it seems, indeed, as though there were in these cases a peculiar abiding sensitiveness of the nervous system, which, dating back from very early life, dependent often on hereditary predisposition, was kindled into activity by any special cause, such as the cutting of the second set of teeth, or the transition from boyhood or girlhood to manhood or womanhood. in the child, just as in the grown person, epilepsy manifests itself in two different ways; either by momentary unconsciousness, or by violent convulsions, in which latter there is little distinction from the occasional fit which may be observed at any period of infancy. the attacks of momentary unconsciousness often pass long unnoticed. they occur, perhaps, when the child is at play or at meals; it stops as if dazed, its eye fixed on vacancy; if standing, it does not fall, nor does it drop the toy or the spoon which it was holding from its hand. if speaking, it just breaks off in the midst of the half-uttered sentence. then, in less time than it takes to tell, it suddenly looks up again, finishes what it was saying, or goes on with its play, or with its meal as though nothing had happened; or it suffices to call the child and the cloud passes from its face, and it is itself again; and the nurse or perhaps even the mother, thinks that it is some odd trick which the child has got. by degrees the attacks become more frequent, and may continue to recur several times a day without any obvious cause, even for months; and this without any change in their character. by degrees, however, under their influence, an alteration takes place slowly in the child's disposition. it loses its cheerfulness and brightness, its face assumes a heavy look, it becomes fretful, and its intelligence grows duller. almost invariably after the attacks of this, which has been called the _petit mal_, have continued for some months, a change begins to take place, which does not fail to excite attention and to cause alarm. if seated, the child's head drops forward for a moment, and strikes against the table; if standing, it becomes for an instant dizzy, and staggers, or even falls, and then there is twitching of one limb, or of the muscles of the face, and then the complete fit of epilepsy, ushered in sometimes, but not always, by a momentary cry, and then the convulsive twitching of one limb, followed in a minute or in less time by convulsions of the whole body as well as of the limbs. the upturned eyes, which do not see, are horribly distorted, the child foams at the mouth, it is insensible, and the insensibility deepens into stupor, or is followed by heavy sleep, for a quarter of an hour, or an hour or more, from which the patient arouses feeling tired and bruised, and often with an aching head, but with no remembrance of what has passed during the seizure so distressing to bystanders. it has throughout been my endeavour not to lose sight of those for whom this little book has been written, and with reference to epilepsy, as with reference to many other things, i pass over much that would be important to the practitioner of medicine, to dwell on those points which mainly interest the parents, and which they are perfectly able to appreciate. the question is often put as to the probability of fits terminating in epilepsy; or, on the other hand, as to the ground for hope in any case that epileptic attacks, which have already often recurred, will eventually cease. in the first place, no conclusion can safely be drawn from the severity of a convulsion, nor from its general character, as to the probability of its frequent recurrence, or of its passing into permanent epilepsy. the severity of a fit certainly affords no reason for this apprehension, nor does its recurrence, so long as a distinct exciting cause can be discovered for each return. the fits, which cease in the teething child when the gum is lanced, and which, on each succeeding return are equally relieved by the same proceeding, do not imply that there is any great tendency on their part to become habitual. in the same way, the attacks which follow on constipation, or on indigestion, or on some other definite exciting cause, may probably with care be guarded against, and their return prevented. it is not the violence of a single fit, nor even the frequent return of fits for a limited time, which warrants the gravest apprehension; but it is their recurrence when all observable causes of irritation have passed away; it is their return when the child is otherwise apparently in perfect health. if, on the one hand, the violence of a convulsion does not by any means imply the greater proportionate risk of its recurrence, so neither can any hopeful conclusion be drawn from the slightness of an attack, or from its momentary duration. in childhood, such attacks are at least as common preludes to confirmed epilepsy as in the adult, and are the more deserving of attention from their very liability to be overlooked. i believe, too, that an imperfect suspension of consciousness, the child knowing what passes, though unable to speak, is not very uncommon, and further, that it is far from unusual to have the early stage of epilepsy in childhood announced by sudden incoherent talking for a few seconds, or by a wild look; a cry of surprise, or a short fit of sobbing, announcing as in a hysterical girl, the close of the paroxysm. the early symptoms of epilepsy in childhood are also the more likely to be misinterpreted from the circumstance that they are frequently accompanied by a moral perversion much more striking than any loss of mental power. it is true that in early life there are alternations of intellectual activity and mental indolence, of quickness and comparative dulness, which all who have had much to do with education are well aware of, and which are perfectly compatible with health of body and health of mind. but changes in the moral character of a child who is still under the same influences, have a far deeper meaning than is often attached to them; a child does not suddenly become wayward, fretful, passionate, or mischievous, except under the pressure of some grave cause. one other point there is also to be borne in mind; namely, that the child is compelled by the vague sensation of hitherto unknown dread, not to conceal the early symptoms of epilepsy as the grown person would do; longing as the child does for love and sympathy, and weakened in its moral force, it craves for more love, more sympathy, it exaggerates its symptoms, it assumes some which do not exist at all. the conclusion is a natural one, but none the less mistaken, that the child who is discovered to be shamming has nothing the matter with it--is simply a naughty child. this is a fact of much importance, on which i shall have occasion to insist further on. in the child, as in the adult, epilepsy blunts the intellect as well as weakens the moral powers; and does both more speedily and more effectually in proportion as the child is younger, and its mind and will are less developed. and yet this has its compensation; for as the powers fade quickly, so, if the attacks cease, they recover with surprising rapidity, and as the moral powers are the first to suffer, so they are the first to regain--i will not say full vigour, but at least a degree which raises the children to be objects of specially tender affection, rather than of pity and compassion. the conditions which justify the most hopeful view of any case of epilepsy are then, first, the absence of any history of frequently recurring convulsions in early infancy; secondly, the existence of a distinct exciting cause for the attacks; thirdly, the rarity of their return far more than their slight severity; and lastly, the more the attacks approach in character to what one knows as hysteria, the less profound the insensibility in the fit, the shorter its duration afterwards, the greater are the grounds for hope that the seizures will eventually cease. cases of this last class are to some degree, at any rate, under the child's control. i have several times seen a fit warded off by the threat of the shower bath, or even by calling to the child, and sending it to fetch something in another room. such cases may indeed pass into ordinary epilepsy, but often, under judicious management, moral rather than medical, they cease, so that one can venture on taking a more hopeful view of them than of others. and this brings me to the question of what can be done, or rather what can parents do to promote recovery from epilepsy. first of all, do not listen to what you may hear about this medicine or the other being a specific for it. there is no specific whatever for epilepsy, but there are certain remedies which in skilful hands do have a real though limited power to control the frequency and lessen the severity of the attacks. next, there are cases in which the attacks depend on some definite cause; it may be indigestion, or constipation, or the cutting of the second set of teeth, and on the irritation produced by those teeth being too crowded. thus, i remember a boy twelve years old, in whom two severe epileptic fits occurred apparently without cause. he was cutting his back grinding teeth, and in the lower jaw the teeth seemed overcrowded. i had a tooth extracted on either side, the fits ceased, and when i last heard of him many years afterwards they had not returned. epilepsy often lasts for many years, and no one's memory is retentive enough to be trusted with all the details between the different attacks, the causes which seemed to produce them, the measures which appeared at different times to be of service. i am therefore accustomed to advise people, any of whose children have the misfortune to be epileptic, to write as brief an account as possible of the child's previous history, and to supplement it by a daily record kept in parallel columns of date, food, state of bowels, sleep, medicine, attacks, specifying their character and duration; and general remarks, which would bear on the child's temper and general condition, and in which column any probable exciting cause of an attack would be recorded. it is surprising how much important information is gathered in a few months from such a record kept faithfully. the diet should be mild, nutritious, but as a general rule unstimulating; and should include meat comparatively seldom, and in small quantities. some fifty years ago, a very distinguished american physician, dr. jackson of boston, in the united states, insisted very strongly on the importance of a diet exclusively of milk and vegetables in greatly lessening the frequency and severity of epileptic attacks. i believe in the great majority of cases of epilepsy in childhood dr. jackson's advice is worth following. and i may add that, while i have little faith in the influence of mere drugs, i have a yearly increasing confidence in that of judicious management, mental and moral, as well as physical. the first requisite in all cases is a firm and gentle rule of love on the part of those who have charge of the child. as violent and sudden excitement of any kind will often bring on an epileptic seizure, so the influence of the opposite condition in warding off its attacks is very remarkable; and on several occasions i have received patients into the children's hospital who were reported to have epileptic seizures several times in a day, and who nevertheless remained a fortnight or more in the institution without any attack coming on. the disorder, however, was not cured, but only kept in check by the gentle rule to which the little ones were subjected. the order goes for much in these cases; the novelty goes for something too, for almost invariably i have found that after a time the apparent improvement becomes less marked, and though they continued better than when they first came to the hospital, the children were still epileptic; the advance of the disease had been retarded, but its progress had not been arrested. the quiet then which suits the epileptic, is not the quiet of listless, apathetic idleness, but the judicious alternation of tranquil occupation and amusement. the mind must not be left to slumber from the apprehension of work bringing on a fit, but the work must, as far as possible, be such as to interest the child. in the occupations of epileptics therefore, pursuits which not merely employ the mental faculties, but also give work to the hands, such as gardening, carpentering, or the tending of animals, are specially to be recommended; and if by these the mind can be kept awake, the grand object of teaching is answered, and backwardness in reading, writing, or those kinds of knowledge which other children at the same age have acquired, is of very little moment. many epileptics have an indistinct articulation, and almost all have a slouching gait, and an awkward manner. the former can often be corrected to a considerable degree by teaching the child simple chants, which are almost always easily acquired, and practised with pleasure. the latter may be rectified by drilling, not carried out into tedious minutiæ, but limited to simple movements; and the irksomeness of drill is almost completely done away with by music, while i believe that the accustoming a child to the strict control and regulation of all its voluntary movements is of very great importance indeed as a curative agent. it is difficult to carry out these minute precautions on which so much depends in the home with other children of the same family. it is therefore, i believe, better for the child, painful though it is to the parents, that he should be placed under the care of some competent person who will devote the whole of his time to the care of the patient. =st. vitus's dance.=--a state of unconsciousness, accompanied with more or less violent involuntary movements, is characteristic of epilepsy. involuntary movements without loss of consciousness constitute the disorder commonly known as _st. vitus's dance_. it is rare in early childhood, becomes more common after the age of five, and attains its greatest frequency between the ages of ten and fifteen, girls, owing to their more impressionable nervous system, being affected by it more than twice as often as boys. it seldom comes on in a child previously in perfect health, and strangely enough it occurs with special frequency in children who have before suffered from rheumatism. sudden shock or fright is often said to have been its exciting cause; but even then the symptoms seldom come at once, but are gradually developed in the course of two or three days. at first, it is noticed that the child has certain odd fidgety movements, usually of one arm, next of the leg of the same side, so that it stumbles in walking, and then the muscles of the face become affected, the child grimacing strangely, and next the limbs of the opposite side become involved, and as things go on from bad to worse, the child becomes unable to hold anything in its hand, to walk, or even to stand, and even if on the ground still writhes about with the strangest contortions of its body. if matters grow still worse, the child becomes unable to put out its tongue, it swallows with difficulty, it loses not only the power of distinct articulation but even the faculty of speech, while the mind itself becomes weakened, the child seems half idiotic, and even though the movements lessen in violence, power over the limbs is lost for the time, and they seem almost paralysed. happily cases so severe are very rare, and it is rarer still for them to have a fatal termination. almost invariably recovery takes place by degrees, the movements lessen, swallowing is performed with less difficulty, the power of speech, returns, and the intellect regains its brightness: but the child is left with a special liability to return of the affection, though the first attack is usually the most severe. even at the best, however, the disorder is always tedious, as is shown by the fact that its average duration is seventy days. it is very natural, therefore, that parents should be anxious when they see that their child has some awkward or ungainly habit, some odd trick or gesture never noticed before, lest it should be the beginning of this tedious ailment. now it is well to remember that st. vitus's dance does not begin with twitching of the muscles of the face, but that its earliest symptoms are involuntary movements of the arms and twitching of the fingers, and that contortions of the face do not come on till afterwards. movements of this sort too, even when not limited to the face, vary in the course of a few days in the parts which they affect, and show themselves, now in winking the eyes, then in grimacing, in twitching of the muscles of the face or neck, or in some awkward gait or manner. these are all best left unnoticed, for they are almost invariably made worse if the child's attention is called to them. they are, or at least before the days of board schools they were, scarcely ever met with among the children of the poor, for they almost invariably depend on mental strain; not of necessity on undue length of the hours of study, or on the difficulty of the tasks imposed, but often on a child's anxiety to make progress and to keep up with his schoolfellows. in corroboration of this being their cause i may say that, contrary to the rule which obtains with st. vitus's dance, these movements are more frequent in boys than in girls, for the over-mental strain of boys comes earlier; that of girls seldom occurs before the time of transition to womanhood, and its results are then different, though much graver. in cases of this kind, lessening the mental strain is almost always followed by a cessation of the movements; change of air, country amusements, and a generally tonic treatment perfect the cure, and dancing and gymnastics overcome the remains of any awkward habit. the movements in real st. vitus's dance do not shift about as these do from one part to another, but tend to involve various parts in succession, without previously ceasing where they had begun. the relative share which the parents and the doctor take in the treatment of these cases depends to a great extent on their severity. while attention to the state of the bowels, and a generally tonic treatment are almost always needed, gymnastics and drill are often of very great service in the slighter cases; and a very distinguished paris physician was accustomed to send children thus affected to march round the place vendôme, keeping step while the band was playing. the utility of gymnastics turns very much on the degree in which the child is able by attention to control his movements, and when either as in young children fixed attention cannot be roused, or as in severe cases the effort only adds to the child's nervousness, and in consequence increases the movements, they must be given up. all drill and gymnastics are best carried out in class with other children, and regulated not simply by word of mouth, but by a tune or chant. when recovery is in progress gymnastics will then in almost all instances find their place. even when drill and gymnastics cannot be practised, regulated movements of the limbs carried out twice a day for ten minutes at a time are of very real service. another's will here takes the place of that of the patient, and the limbs are thus taught, though far more imperfectly, to act in concert. two or three more cautions may still be of service. do not keep a child out of bed, and force it to try to exert itself when the movements are very severe; continued movement, voluntary or involuntary, fatigues. let the child lie in bed; it rests there, and the movements, which always cease during sleep, become at once greatly lessened. so important indeed is it to avoid the exhaustion caused by incessant violent movement, that in bad cases it is sometimes necessary to swathe the limbs in flannel bandages, and so to confine them to splints in order to restrain them. next, do not become over-anxious because the child grows stupid and ceases to talk; intelligence and the power of speech will certainly come back again. and, lastly, do not be impatient and think your medical adviser incompetent because the disorder lasts so long. an average duration of seventy days implies that while sometimes it ceases sooner, in others it lasts much longer than the two weary months of watching and waiting with which in any case you must lay your account. =paralysis, or palsy.=--when speaking of st. vitus's dance i said that there was a partial loss of power in the limbs as well as an inability to control their movements. after a fit of convulsions, or an epileptic seizure, power over some limb is often lost for a time which may vary from a few minutes to some hours. in the course of some serious diseases of the brain, one of the manifestations of the mischief is the impairment or the loss of power over one arm or leg, rarely over both; and lastly, that terrible disease diphtheria is often followed by a paralysis so general that the patient is sometimes for days unable to move even a finger, although the condition may eventually pass away. there is, however, a very _real paralysis_ which occurs sometimes in infants and young children. it comes on for the most part quite suddenly, often unaccompanied by any sign of brain disorder, but tending nevertheless to issue in great permanent impairment of the power over the affected limb or limbs, and eventually to interfere with their growth and thus to produce serious deformity. it is in general impossible to assign any distinct exciting cause for the affection, though the fact that in two-thirds of the cases it occurs between the ages of six months and three years, proves it to be in some way intimately associated with teething. the oldest child in whom i have ever seen it was aged between seven and eight years, and the youngest a little under six months. it is of excessive rarity for the arm alone to be affected, but it is by no means unusual for the legs alone to be paralysed; though in the majority of instances power is lost on one side only, the leg and arm being both involved. a child goes to bed quite well, or at the worst having seemed slightly ailing and feverish for a day or two, and on waking in the morning it is suddenly discovered that power is lost over one leg or both, or over both arm and leg of one side. the loss of power is at first seldom complete, though neither arm nor leg can be used to any good purpose, and during the ensuing twenty-four hours the palsy often grows worse, and sometimes affects one or both limbs of the opposite side. after that time recovery in general begins. it is now and then speedy, so that in three or four days all trace of the paralysis may have disappeared. this, however, is a fortunate exception to the general rule, which is that amendment is very tardy, showing itself first in the arm, afterwards in the leg, and, if both sides have been affected, more on one side than on the other. unless the improvement is very rapid, it is almost always only partial, and the palsied limb, though it does not lose sensation, regains but little power; it grows much more slowly than the other, is always colder and wastes considerably, while, some muscles still retaining more power than others, it becomes twisted out of shape, and requires all the skill of the orthopædic surgeon to remedy or at least to lessen the consequent deformity. it has been ascertained that this form of palsy depends on a state of congestion, or overfilling of the minute blood-vessels of the spinal marrow. when the child gets well the congestion has passed away; but it does this speedily, and recovery is then rapid as well as complete. if it does not soon pass away, other changes take place in the spinal marrow, and recovery is then slow, incomplete, or even does not take place at all. remedies are unfortunately of little avail here, but it is evident that when the palsy is quite recent all movement of the limb must be mischievous, and that the congestion of the spinal marrow to which it is due will be most likely to abate under the influence of perfect quiet, rest in bed, and soothing or fever medicines, or of such as are calculated to overcome constipation, or to correct any fault of digestion, while the importance of teething, and the possible expediency of lancing the gums must not be forgotten. afterwards comes the time for exercise of the paralysed limb, for friction, for shampooing, for galvanism; all continued perhaps for months or years with unwearied patience, and i must add with reasonable expectations as to the result. the only additional remark which i have to make is this, that to gain any real good from galvanism, a battery must be procured under the direction of some medical man specially skilled in the use of electricity, and the mode of employing it must be learned thoroughly from him. it is merely idle to purchase a toy machine, and, giving it to the nurse to turn the handle for ten minutes twice a day, to fancy that you are making a serious trial of the effects of galvanism. as a mere money question, a costly machine, and several fees paid in order to be thoroughly instructed in the way to use it, is much cheaper than a cripple child. a few words may not be out of place with reference to cases in which paralysis is mistakenly supposed to exist. much anxiety is sometimes expressed by parents concerning children who have long passed the usual age without making any attempt to walk; or who having once walked seem to have lost that power. now it often happens that after any weakening illness a child ceases for some weeks to walk, just as it ceases to talk. the power in both cases was newly acquired, it called for effort which, when strength is regained, will be put forth once more. the same applies to other instances in which children are late in learning to walk; or who, having once walked, leave off walking when a back tooth, or when one of the eye teeth is coming near the surface of the gum, and regaining the power lose it again, or lose at least the desire to exert it more than once during the active progress of teething. but, holding the child under its arms, you have but to put its feet to the ground, and at once it will draw up its legs though it will make no other movement; or take it on your lap and tickle the soles of its feet, and laughing or crying, as the mood takes it, it will move its legs about as freely as you could wish and show that the power is still there, though for the present the child will not take the trouble to exert it. gradual loss of power over one or other leg, especially if attended with pain either in the back or in the knee or hip, should always call for attention, and induce you to seek at once for medical advice. such cases generally occur later in childhood than the conditions of which i spoke in the former paragraph, and may depend on disease of the spine or of the hip-joint, two serious conditions which it needs the medical expert to discover and to treat. =neuralgia and headache.=--in the grown person neuralgia, as many of us know to our cost, is by no means infrequent; in the child it is very rare, and when a child complains of severe pain in the head, or of severe pain to the knee or hip apart from rheumatism, it is almost invariably the sign of disease of the brain in the one case, of the hip-joint in the other. to this rule there are indeed exceptions, but it will always be well to leave it to the doctor to determine--no easy matter by the bye--whether any given case is one of the rare exceptions or not. there is, however, one form of real _neuralgic headache_ which is by no means rare in children after the commencement of the second dentition, and which sometimes goes on into early manhood or womanhood, when it becomes what is commonly known as sick headache. it is essentially an ailment of development, incidental to the time when the brain is first called on for the performance of its higher functions. it does not by any means always depend on over-study, though i do not remember meeting with it in children who had not yet gone into the school-room; and i have frequently found it dependent on too continuous application, though the number of hours devoted to study in the course of the day may not have been by any means excessive. the child's brain soon tires, and the arrangement, so convenient to parents of morning lessons and afternoon play, works far less well for it than if the time were more equally divided between the two. the attacks not infrequently come on on waking in the morning, and rapidly become worse, the pain, which is almost always referred to the forehead, being attended with much intolerance of light and sound, with nausea, and often with actual vomiting. like the vomiting of sea-sickness, however, previous stomach disorder has no necessary share in its production, and i may add, indeed, that it is often difficult to assign any special exciting cause for the attack. the suffering is more often relieved by warm or tepid than by cold applications, and not infrequently pressure or a tight bandage greatly mitigates it. in no case does the attack last more than twelve hours--usually not more than half that time; it passes off with sleep, and leaves the patient weak and with a degree of tenderness of the head to the touch. such attacks may occur every fortnight, ten days, or even oftener, but their very frequent return, instead of increasing apprehension, should diminish anxiety. a first attack, indeed, may seem as though it threatened mischief, till it is seen how speedily and completely it passes off, and when afterwards a second or a third attack comes on with the same severity of onset, the same rapid worsening, and the same quick passing away, you will feel convinced that the symptoms have no grave meaning. there is a headache of quite a different kind to which i must for a moment refer, that, namely, which depends entirely on imperfect vision, and for which spectacles are the remedy, not physic. the infirmity is not noticed during the first few years of life, but in later childhood, when a tolerably close attention to study has become necessary. some of the minor degrees of short-sightedness, and want of power of adaptation of the eyes, such as exists in the aged, soon begin to interfere sensibly with the child's comfort, and the strain to which the eyes are subject produces a constant pain over the brow, the cause of which is often unsuspected.[ ] in all cases, therefore, in which a child complains of constant pain over the brow for which there is no obvious cause, it is well to take the opinion of an oculist, who can best ascertain the power of _reading at different distances_ and with each eye separately, and the real cause of symptoms which had occasioned much anxiety is thus often brought to light. =night terrors.=--before taking leave of the disorders of the nervous system, i must briefly mention the nightmare, or night terrors of children, which often cause a degree of alarm quite out of proportion to their real importance. it happens sometimes that a child who has gone to bed apparently well, and who has slept soundly for a short time, awakes suddenly with a sharp and piercing cry. the child will be found sitting up in bed, crying out as if in an agony of fear, 'oh dear! oh dear! take it away! father! mother!' while terror is depicted on its countenance, and it does not recognise its parents, who, alarmed by the shrieks, have come into its room, but seems wholly occupied by the fearful impression that has roused it from sleep. by degrees consciousness returns; the child now clings to its mother or its nurse, sometimes wants to be taken up and carried about the room, and by degrees, sometimes in ten minutes, sometimes in half-an-hour, it grows quiet and falls asleep; and then usually the rest of the night is passed undisturbed, though sometimes a second or even a third attack may occur before daybreak. seizures of this kind may come on in a great variety of circumstances, and may either happen only two or three times, or may continue to recur at intervals for several weeks. the great point, however, to bear in mind is that they depend invariably on some disorder of the stomach or bowels, and are never an evidence of the commencement of real disease of the brain. footnotes: [ ] reports of the registrar-general, as quoted at p. of my _lectures on diseases of children_. the actual numbers are , under five years old, out of a total of , . [ ] figures deduced from the th report of the registrar-general. [ ] before i called attention to this form of headache in the last edition of my lectures, it had already been noticed without my knowledge, by a friend of mine, dr. blache, of paris, in a very valuable essay on the headaches which occur during the period of growth. chapter vii. the disorders and diseases of the chest. in speaking of the ailments which occur during the first month after birth, i have already noticed the peculiarities of breathing in early infancy, and the difficulties that sometimes attend the complete filling of the air-cells of the lungs, and the readiness with which when once filled they become emptied of air and collapse. on this ground it is therefore needless for me again to enter, and i may pass at once to consider those ailments which rise in increasing importance from a simple cold or catarrh to inflammation of the air-tubes or bronchitis, inflammation of the lung substance, as pneumonia, and inflammation of the membrane which lines the chest and covers the lungs, or pleurisy. =catarrh.=--a common cold or _catarrh_ is not one of the ailments of very early infancy. the watery eyes, the sneezing, the cough, the slight feverishness and the heavy head are scarcely met with until after the age of three months; nor, indeed, are they often seen till the child is old enough to run about, to go out for a walk, and to encounter in consequence all the variations of temperature and of damp or dryness inseparable from the english climate. this, however, is not entirely due to the greater exposure of the child to these influences as it grows older, but in part also to the fact that the lining of the air-tubes is less sensitive in early infancy than it afterwards becomes. the young babe if it catches cold gets _snuffles_, or stoppage of the nostrils, which first become dry, and then pour out an abundant discharge, which sometimes dries and forms crusts, and causes the child to suck with difficulty, and to breathe uncomfortably and with open mouth. in a few days, however, at the worst this discomfort passes away; and the only additional remark i have to make is, that since obstinate snuffles are sometimes a constitutional disease, the doctor's advice should always be sought if they last longer than a week. it is needless to describe a cold, but it is much more to the purpose to say how its occurrence is to be prevented, and nine times out of ten the observance of two simple rules will suffice for this. first, take care that there is no great difference between the temperature of the day and of the night nursery. the one should never be above °, nor the other below °, and the undressing and the bath should always take place in the warmer room. second, never let the child wear the same shoes or boots in the house as it does out of doors. the change should be as much a matter of routine as the taking off its hat or its bonnet. the domestic management of a cold is simple enough. the usual error is the overdoing precautions, the keeping the room too hot, or overloading the child with extra garments, or its bed with extra covering, by which it is kept in a state of feverishness, or of needlessly profuse perspiration. if, for the first two days of a bad cold, the child is kept in bed, the room being at a temperature of °, with no extra covering on the bed, but a flannel jacket for the child to wear when it sits up in bed to play, a few drops of ipecacuanha wine several times a day, a warm bath, a linseed poultice to the chest, and a little paregoric at night, with a light diet of rice, and arrowroot, and milk, and a roasted apple, and some orange juice; nine times out of ten, or nineteen out of twenty, the cold will pass away with small discomfort to the child and no anxiety to the parents. often a child objects to stop all day in its little cot, but move it to its mother's or nurse's big bed; and with a large tray of toys before it, and a little of the tact which love teaches, the day will pass in unclouded content and cheerfulness. it must of course be borne in mind that measles set in with all the symptoms of a bad cold, followed on the fourth day by the appearance of the eruption; and, moreover, watchfulness must always be alive to detect increase of fever, hurry of breathing, hardness or extreme frequency of cough, the sign of the irritation of the larger air-tubes having extended and become more severe, the evidence that the case from simple catarrh has become one of bronchitis. =bronchitis and pneumonia.=--it is impossible to enable persons who have not received a medical education to distinguish between a case of bronchitis and one of pneumonia. neither, indeed, is it of much importance that they should do so, for in both the dangers are of a similar kind, and both call equally for the advice of a skilful doctor. in _bronchitis_ inflammation affects the lining of the air-tubes, travelling from the larger towards the smaller, and in bad cases extending even to their termination in the minute air-cells. the inflammation leads to the pouring out of a secretion, which by degrees becomes thick like matter, or even very tenacious, almost as tough as though it were a thin layer of skin. if this is very extensive, and reaches to the small air-cells, it is evident that air cannot enter, while that elasticity of the lung which i have already spoken of tends to drive out from the cells the small quantity of air they contained, and the child dies suffocated, partly from the difficulty in the entrance of air, partly from the collapse of air-cells from which the air has been slowly expelled. in _pneumonia_ or inflammation of the lung-substance the process is different. a portion of one or other lung, sometimes of both, becomes overfilled with blood, or congested, and though the air-tubes themselves are not the special seat of the congestion, yet the air-cells are pressed on by the surrounding swollen substance, and the entrance of air into them is impeded. if the mischief goes further the substance becomes solid and impervious to air, and lastly it becomes softened, its structure destroyed, and infiltrated with matter; the affected part becomes really an abscess, though not bounded by the distinct limits which would shut in an abscess of the hand or the foot. inflammation, and the formation of an abscess anywhere is, as we know, attended by fever and much general illness, and inflammation of the lung is of course attended by fever and general illness in proportion to the importance of the organ affected. to these, too, must be added all the disturbance inseparable from any ailment which gravely interferes with breathing. in the great majority of instances inflammation of the lung-substance does not go on to the last stage, and recovery is not only possible, but probable, from congestion and solidification of the organ. pneumonia, too, usually attacks only a portion of one lung, while in bronchitis the air-tubes of both are always involved. hence of the two, serious bronchitis is more to be dreaded than serious pneumonia. bronchitis is always developed out of previous catarrh, though there is a wide difference between the duration of the preliminary stage and the occurrence of serious symptoms in different cases; while it may be laid down as a general rule that the severity and danger of an attack are in proportion to the rapidity of its onset. an attack of pneumonia, or inflammation of the lung-substance sets in, as a rule, more suddenly, with fever, a temperature of ° to °, general distress, headache, not unfrequently delirium; the urgency of which symptoms, the hurried breathing and the short, dry, hacking cough, and the tearless eyes are too often misinterpreted, and the state of the chest not examined. the doctor, of course, skilled in auscultation, will listen to the chest and give to all these symptoms their true signification. the lesson for the parent to bear in mind is never to neglect in a child the symptoms of what may seem to be but a common cold, but to seek for advice the moment the cough shows any disposition to become hard, or the breathing hurried. next, when any sudden illness sets in with very high temperature and much general ailing, not to let the disorder of the head, or the delirium, make you shut your eyes to the import of the short cough, the dry eyes, the hurried breathing; and lastly, to remember that, grave though the symptoms may be, the tendency in pneumonia is to eventual recovery, and that in early life bronchitis is the graver of the two diseases. a caution may not be out of place with reference to cases which may occur during the epidemic prevalence of _influenza_. a child is sometimes struck down by it, just as grown persons are sometimes, with great depression, extreme rapidity of breathing, and very high fever, which, passing off in a couple of days, leave a state of great exhaustion behind. it is well to bear in mind that such symptoms have no such grave meaning when influenza is prevalent as they would have at another time; and the knowledge of this fact may serve in some degree to control your anxiety. =pleurisy.=--it is not possible for anyone, without medical experience, to discriminate between pneumonia, or inflammation of the substance of the lung, and pleurisy, or inflammation of its covering. some degree of the latter, indeed, very often accompanies the former, and this accounts for the pain which interferes with every attempt of the child to draw a deep breath. when pleurisy comes on independent of affection of the lung-substance, it generally sets in suddenly with severe pain in the chest, and a short hacking cough which causes so much pain that the child tries as much as possible to suppress it. after a few hours the severity of the pain usually subsides, but fever, hurried breathing, and cough continue, and the child, though usually it looks heavy and seems drowsy, yet becomes extremely restless at intervals--cries and struggles as if in pain, and violently resists any attempt to alter its position, since every movement brings on an increase of its sufferings. the posture which it selects varies much; sometimes its breathing seems disturbed in any other position than sitting straight up in bed; at other times it lies on its back, or one side; but whatever be the posture, any alteration of it causes much distress, and is sure to be resisted by the child. the variations of posture depend on the seat of the inflammation; the pain depends on the two inflamed surfaces of the membrane rubbing against each other, and accordingly is relieved not merely by the abatement of the inflammation, but also when either the two surfaces become, as they often do, adherent to each other, or when fluid is poured out into the cavity of the chest, and thus keeps them asunder. i dwell on this, because when fluid is poured out, the most distressing symptoms greatly abate, or even disappear, and parents sometimes put off in consequence sending for the doctor, while yet, if unattended to, the fluid may increase to so large a quantity as to press upon the lung, and so interfere with the entrance of air, or it may, if the mischief is not checked, change into matter, and then have to be let out by tapping the chest, for just the same reason as it may be necessary to open an abscess in any other situation. whenever, then, symptoms, such as i have described, come on, send at once for medical advice, and do not let some diminution of suffering, or slight general improvement, lead you to delay. =croup.=--i endeavoured to explain, a few pages back, the cause of that peculiar sound which is heard in spasmodic croup. the contraction of the opening of the windpipe changes the sound which passes through it, just as the opening or closing the keys of a wind instrument modifies the sound which it gives forth. but the windpipe is not simply a wind instrument, it is a stringed instrument too, and the strings or vocal cords, as they are termed, give forth, as they vibrate, tones now deeper, now more shrill. the action of this delicate apparatus is readily disturbed, if the nerve-supply to it is disordered by irritation in some distant organ, and then the breathing is accompanied by the peculiar sound of spasmodic croup, or in older children this may show itself in a different way, as in the loud, barking cough heard in some cases of constipation, or of disordered digestion; or another illustration of it is furnished by the loud, long breath--the 'hoop,' which gives its name to hooping-cough. but there is one sound that sometimes attends the breathing of children, which more than any other causes, and justly causes, the greatest anxiety to a mother; and that is the sound which is characteristic of croup. the word croup, which comes from the lowland scotch, signifies merely hoarseness in breathing or coughing, and is therefore, strictly speaking, the name of a sign of disease, rather than that of the disease itself. the peculiar sound is heard in two different conditions--the one in which a child having caught cold, instead of the air-tubes alone being affected, the windpipe, and especially its upper part, becomes congested, and the lining membrane swollen. partly owing to this, partly owing to its nerve-supply being disturbed, the child breathes noisily and hoarsely, and the cough has a peculiar metallic clangor. in the other case there is not merely the congestion of the windpipe, the disturbed nerve-supply, and the swollen state of the membrane; but in connection with the influence of the special poison of diphtheria, a deposit takes place at the back of the throat, whence it extends to the windpipe, and in many instances even far beyond it, blocking up its canal, and mechanically excluding the entrance of air. to determine at once to which class a case of croup belongs is so far from easy, that i should advise that on the first sound of voice, or cough, or breathing resembling that of croup, medical advice should at once be sought. i dwell on the difference between the two: the first which has been called false croup, or better catarrhal croup, and the second called true croup, or diphtheritic croup, in order to save much needless apprehension to parents, in whose mind the croupy sound is invariably associated with nothing short of that most dangerous disease--diphtheria. as a general rule catarrhal croup is rarely met with after the age of six. children in whom it occurs have either seemed quite well, or at most have been a little ailing for a day or two with cold, and cough, and perhaps slight hoarseness. they go to bed and fall asleep as usual, but the cough, which does not wake them, becomes suddenly noisy, ringing, croupy, and the breathing is speedily attended with a long-drawn sound, half-hissing, half-ringing, and the child soon wakes alarmed, and fighting for breath, the skin bathed in perspiration, the face flushed and anxious. the cough, the difficult breathing, and the struggle for air last for an hour or two, or sometimes all night long, though they gradually subside, at any rate towards the approach of morning, when the child falls asleep, and, but for a somewhat hoarse sounding cough, and a look of fatigue, there are but few signs of all that it has endured. the attack may not return, or it may recur for two or three successive nights, though in general with lessened severity, the child during the daytime seeming to suffer only from a slight cold, or now and then, and so rarely that i have not known it to occur above once or twice in all my experience, it may end in real inflammation of the windpipe; but not in diphtheria. attacks of this kind may recur three, four, or more times even in childhood, while diphtheria has no tendency to recur, but like measles or scarlatina seldom appears more than once, though the rule is subject to more numerous exceptions than are found in the case of the eruptive fevers. still the fact of an attack of this sort returning should of itself lessen apprehension and make the parents look forward to its issue with less anxiety than that with which they regarded its first occurrence. a fact which shows how large a part is played by disturbance of the nervous system in these cases is the liability of children who have suffered from it to attacks of asthma, often of great severity as they grow older, while very often after the transition from childhood to youth has passed these attacks too lessen in frequency and severity, and often altogether cease. there are two measures which, while waiting for the doctor's arrival, may at once be taken, and which sometimes remove the symptoms almost as if by magic, while even were the case one of diphtheria they would still be of some service, and could not possibly do any harm. they are the hot bath, and a full dose of ipecacuanha wine. the former should be as hot as it can be borne, ° or °, and the child should be kept in it for five minutes, and the latter should be given in a full dose, as a teaspoonful in warm water every quarter of an hour till free vomiting takes place. how much better soever the child may seem after the use of these remedies, it should still be kept for two or three days under careful medical observation. =diphtheria.=--in _diphtheria_ croup is only one, though the most frequent, and one of the most serious, of the many dangerous symptoms which attend it. the croupal symptoms hardly ever come on quite suddenly, but are almost always preceded for some days by slight feverishness, languor, and restlessness, in spite of which the child still amuses itself; and if too young to express its sensations, the slight degree of sore-throat it experiences is manifested rather by a disinclination to take food than by any obvious difficulty in swallowing. there is no cough, nor any change of voice when the child is awake, but when asleep--and the sleep is generally uneasy--it often breathes with its mouth open, it snores slightly, or there is a little hoarse sound accompanying the breathing owing to a trivial swelling of the throat; while, if sought for, there will generally be found a very little enlargement, and a very little tenderness of the glands at the corner of the lower jaw. the eyes are sometimes tearful, there may be slight running at the nose, and the child is said to have a bad cold with slight sore-throat--the most remarkable feature of the case being generally that the depression of the patient is out of proportion to the severity of the local ailment. if now the throat is examined--and examination of the throat should never be omitted in any case where there is the slightest difficulty of swallowing--nothing may at first be seen but a very little swelling, and some redness of one or other tonsil. in a few hours more, white specks like little bits of curd will be seen first on one tonsil, then on the other, and next these specks will have united to form one continuous layer of a sort of yellowish-white membrane over the palate and tonsils. the examination of the throat, often so difficult when children are ill, is attended with almost none, if while they are well they have been taught the little trick of opening their mouths to show their throat, and of allowing the introduction of a spoon to keep down the tongue, a proceeding which though certainly unpleasant they will almost always readily agree to, like martha trapbois, in the 'fortunes of nigel,' 'for a consideration.' the deposit on the throat may disappear of its own accord, and not be reproduced, and this even though no treatment has been adopted, and in two or three days the child may be pretty well again, though strength is in general regained less rapidly than might have been expected from the comparative mildness of the attack. in cases so slight it is no easy matter to recognise the features of a highly dangerous disease; still, out of forerunners so trivial as these, croupal symptoms may be developed, and their advances may be most insidious, and unless both parents and doctor have been closely on the watch they may be surprised all at once by the breathing suddenly becoming very laboured, by that and the cough becoming attended by the sounds characteristic of croup, and by the child's life being in extreme jeopardy, or in danger even beyond the hope of recovery. it is not that here, as in cases of catarrhal croup, the ailment has really come on suddenly, but that the disease has been silently making unsuspected progress. whenever then a child, after a few days of slight causeless ailing, accompanied with some little discomfort in swallowing, is seen to have white patches at the back of its throat, do not allow yourselves to be lulled even by their disappearance into a feeling of absolute security. watch the child, and beg the doctor to watch it carefully, until it is perfectly well again, for though the deposit may have disappeared from the back of the throat it may continue to be formed in the windpipe, and in the somewhat depressed state of the nervous system which attends diphtheria it may not excite that irritation which any such cause would produce in a child in perfect health, and consequently not announce its presence until its amount has become so considerable as to offer an almost insurmountable obstacle to the entrance of air. any, even the slightest, hurry of breathing, a hissing sound when the child draws its breath, hoarseness of voice, or a ringing cough, should quicken your apprehension of danger, and make you seek for immediate help. it may be as well, however, to mention here, that not every white speck seen at the back of the throat is of necessity due to diphtheria, but that in some cases of ordinary sore-throat white spots may form on the surface of the tonsils. these white spots are due to the collection at their openings of the secretion formed in the minute glands which beset the surface of the tonsils, and which at these seasons is poured out in greater abundance than usual. they are distinct from each other, and do not coalesce into a membrane; the surface beneath is not the uniform red shining surface on which the membrane in diphtheria has formed, but the separate tiny openings from which the white matter has exuded may be distinctly seen if the surface is wiped with a camel's-hair brush. it is, of course, wise in every case to leave to the doctor the decision as to the nature of the deposit, but it may sometimes relieve needless anxiety to know beforehand that there is another cause besides diphtheria to which white spots at the back of the throat may be due. there are other dangers, indeed, besides those arising from croup, which accompany diphtheria, though those just mentioned are of all the most frequent. there are cases in which death takes place not from the severity of any local ailment, but from the intense depression of the nervous system. there are other instances too, in which the case assumes what is termed a malignant character; profuse discharge taking place from the nostrils, swallowing being from the first exceedingly difficult, membrane being deposited on the lips, behind the ears, or at the edge of the bowel; death taking place in twenty-four or thirty-six hours from the outset of the first serious symptoms, either in convulsions, or from utter exhaustion. but the very urgency of such cases must of necessity call for the immediate assistance of the doctor; and my business throughout this book is rather with those points which it is important for a mother to notice, and those things which it behoves her to do. what does diphtheria depend on? is a question more easily asked than answered. the disease is contagious, as scarlatina is contagious, though not to the same degree. i may add, it is not identical with scarlatina, nor does the one disease protect from the other. it would, perhaps, be too much to say that it is dependent on an unsanitary condition of a town, a village, or a house, but there is no doubt but that, as is the case with cholera, scarlet-fever, or typhus, unsanitary conditions favour its spread, and increase its severity. being contagious, it is most important to keep cups, glasses, spoons, towels, and bed-linen separate from those of other inmates of the house, and to remove the patient from any room occupied by other children. great care too is to be observed, if anyone is standing over the child during a fit of coughing, that none of the membrane which it spits up enters the mouth; and, that if the child's breath is caught, the attendant gargle immediately with a teaspoonful of condy's fluid in a tumbler of water. in the next place, as the depression of the nervous system in some cases of diphtheria is quite out of proportion to the local disease, and as children who have not seemed very suffering, have yet been known to die suddenly in an unexpected faint, it is of moment that the child remain constantly in bed from the commencement of the attack till complete convalescence. nor, indeed, in serious cases is even this precaution sufficient; but in such circumstances not only must the child not be taken out of bed for any purpose, but it must even not be suddenly raised in bed, from a recumbent to a sitting posture. i have, on several occasions, known the neglect of these precautions followed immediately by what cannot but be regarded as the needless death of the patient. during the illness, there is little for the mother to do, except to try to carry out the doctor's directions, and to give the child constantly little bits of ice to suck, which lessen the swelling of the throat, and relieve the pain and inflammation. if the child knows how to gargle, it should be induced to do so constantly, and finding the relief which this affords, will do so very readily. this is not the time, however, when the lesson 'how to gargle' can be learnt. a thoughtful mother teaches it while the child is well, and if the gargle is composed of raspberry vinegar and water, the lesson is learnt without tears. there comes a time, however, if the disease is at all severe, when gargling is no longer possible, for the muscles of the back of the throat lose their power; but now some medicated solution, employed by means of the spray-producer, may most efficiently take its place. when croupal symptoms have gone on growing worse and worse, and the child is in the agonies of suffocation, the doctor may propose to open the windpipe, in the hope of giving the child another chance of recovery, and even though the operation fail, of at least lessening its sufferings. the operation is sometimes objected to by the parents, on the ground of the uncertainty of the result, and the torture of the operation to the child. now the anguish of a child dying of croup is due to two causes; first, the actual mechanical impediment to the entrance of air produced by the deposit in the windpipe, and secondly, to the spasm of the muscles in the upper part of the windpipe which that deposit produces. how large an amount of distress the latter may produce, anyone can judge for himself, to whom it has ever happened to swallow the wrong way, as it is called. the opening made below the seat of the muscles which close the windpipe, leaves them in perfect rest, and does away with all the suffering produced by spasm, while there is always a fair prospect if the operation is not put off too long, of the deposit being limited to the part above the artificial opening, and of the good being permanent. it is true that we have no certain means of knowing the extent of the deposit beforehand; it is true also that the operation is not in itself a cure of the disease, but at any rate, it is a reprieve which gives time for remedies to take effect, and at the worst, it substitutes a comparatively painless death for one of intolerable anguish. it can, too, be performed under the influence of chloroform, so that the idea that it adds in any way to the child's distress is unfounded. who that has seen the calm, happy face, and watched the tranquil sleep of the child after the operation, who before was struggling, with distorted features and agonised countenance, to get a breath of air, but would feel as i do, that i would have it done in a child of mine for the sake of a painless death, even though i knew for certain that it would not prolong life even for an hour? one additional remark i have to make with reference to the loss of power, or palsy of various muscles, which frequently follows diphtheria. almost always there is some impairment of power in the muscles of the throat on which the deposit had taken place, and there is, in consequence, a little difficulty in swallowing for a few days. if this should get worse, food and especially drink sometimes return by the nose, and next there may be a slight squint, and the sight may become weakened, and an uncertain tottering gait; and sometimes for a week or two the child may be unable even to stand. in bad cases there is with these symptoms a general loss of nervous as well as of muscular power, though the child may still be fairly cheerful, and ready to amuse itself as well as it can. this condition may last for many weeks before it passes quite away, and if under the mistaken impression that the limbs will gain strength by exercise, the child is allowed to sit up and encouraged to exert itself, recovery will be delayed much longer; and dangerous weakness or fatal exhaustion may suddenly come on. the inference is too obvious for me to need dwell on it, that repose is the great resource, and quiet waiting the true wisdom. =hooping-cough.=--i need not say much about _hooping-cough_, for there is scarcely a nursery in which, to everyone's great discomfort, it is not known as a familiar and most unwelcome visitant. it varies remarkably in its importance, being sometimes so slight as scarcely to amount to an illness, but in other instances one of the most deadly of diseases. it causes the death of a fourth of all children who die under the age of five, and three out of four of these deaths take place in infants of less than two years old. it occurs, however, comparatively seldom during the first three or four months of life, probably because very young children are kept more at home than others, and are thus less exposed to catch it. though hooping-cough is undoubtedly very contagious, it seems to be communicated only by the breath, and there is absolutely no evidence to show that the clothes of a child suffering from hooping-cough can carry the infection as they might were the child suffering from measles, or smallpox, or scarlet-fever; still less that a person who has visited a room where children are suffering from hooping-cough can convey the disease to another house, or to other children. the disease derives its name, as everyone knows, from the peculiar sound which attends the cough, and which is due, as is the sound of croup, to spasm of the upper part of the windpipe. it is equally characterised by the cough returning in fits or paroxysms, which end in a long-drawn breath, attended by the hoop. an occasional sound like a hoop, in a young child who has a cold, is not so conclusive of a case being one of hooping-cough as is the recurrence of the cough in fits; for until teething is completed, slight and temporary irritation will suffice to produce a passing spasm of the upper part of the windpipe. an ordinary attack of hooping-cough begins like a common cold, but as the little ailment passes off, the cough still continues, the fits of coughing become more frequent, last longer, grow severer and more suffocative, and end with the loud long breath, the hoop; while sometimes no sooner is one fit over than another follows it almost immediately, and quiet breathing does not return until the child is tired out by its efforts. nevertheless, the child's health continues fairly good, and little or nothing ails it during the intervals of the cough. for about a fortnight the cough usually goes on to increase; and during this time the night attacks especially become more frequent. it then for a week or ten days continues stationary, and then declines, a diminution in the frequency and severity of the night attacks being in general the first sign of amendment, and at the end of six weeks from the beginning of the attack the child is in general quite convalescent. even then, however, a trifling cause will reproduce the characteristic cough for a few days, and not seldom for many months afterwards any cold which the child may catch will be attended by a paroxysmal cough undistinguishable save by its milder character and shorter duration from the previous hooping-cough, though i believe incapable of communicating that disease. in mild hooping-cough there is little or nothing to be done, save to follow the dictates of common sense, and not to neglect them in quest of some imaginary specific--some vaunted medicine which is said to be a certain cure; or such as shutting up the child in a room the atmosphere of which is charged with the vapour of tar, or of carbolic acid, or of sulphur. it cannot be too strongly impressed on the minds of parents that there is no specific whatever for hooping-cough; no remedy which will cut it short, as quinine cuts short a fit of ague. the domestic treatment of mild hooping-cough is the domestic treatment of a common cold, implying the same precautions as to the equal temperature of the day and night nursery, the little doses of ipecacuanha at night, but as seldom as possible during the day, in order not to interfere with the appetite and digestion, together with special care to insure the regular action of the bowels. it sometimes happens that after a week or two the severer fits of coughing are followed by vomiting; and the child may lose flesh and strength from inability to retain its food. in these circumstances food must be given, little in quantity, at short intervals, and of a kind that need not remain long in the stomach in order to be digested. good soup, beef-tea, milk, rice milk, or a raw egg beaten up in milk, and biscuit rather than bread, must take the place of the ordinary meals, and be given twice as often. the different liniments, and the favourite roche's embrocation, are of use when the disease is on the decline, and may also be of service if bronchitis should occur to complicate the hooping-cough, but not otherwise. change of air when hooping-cough is on the decline is often of great service, and change even from good air to one less good appears to be sometimes of use; but change in the early stages, or when hooping-cough has become really severe, is but adding another to the already existing dangers. the danger in hooping-cough arises through the medium either of the head or of the lungs, and through each of them with about equal frequency. the head becomes affected in consequence of the often recurring congestion of the brain, produced, as in spasmodic croup, by the constantly returning interruption to the breathing. in these cases the cough is frequent, and so violent that the child becomes livid during each paroxysm, and that instead of ending in a loud hoop it finishes by a fit of convulsions or by the child sinking into a state of semi-insensibility. increased violence of the cough, with suppression of the hoop, is always a bad omen in hooping-cough. on the other hand, when the cough becomes complicated with bronchitis, it ceases to recur in distinct fits which leave behind them intervals of comparative, or of absolute ease. the hurried breathing which precedes and follows a fit of coughing never entirely subsides, while each returning cough aggravates the irritation and inflammation of the air-tubes, and the child's condition becomes the very dangerous one of hooping-cough complicated with bronchitis. so long as a child seems pretty well in the intervals between the fits of coughing, as the hurried breathing subsides after each to a natural frequency, as a long loud hoop follows each cough, as vomiting takes place only after a fit of coughing and never in the intervals, as the child becomes flushed only and not livid during a cough, and recovers itself perfectly afterwards, as it does not complain of constant headache, nor spits blood, nor has nose-bleeding, nor is feverish, nor depressed, nor drowsy, you may feel happy about it. when any of the symptoms just enumerated show themselves you have reason for grave solicitude, and the child requires daily medical watching. one word in conclusion. a child who has recently had hooping-cough is more liable than another to be attacked by chicken-pox or measles; and, moreover, imperfect recovery from hooping-cough is apt, especially if there is any tendency to consumption in the family, to be followed by consumptive disease. =asthma.=--_asthma_, attended by distress of breathing quite as considerable as in the grown person, is by no means unusual in the child. recovery from it is far more likely to take place in the latter, since it is almost always independent of those diseases of the heart or lungs, which in the former occasion or aggravate it. it belongs to the class of what has been termed nervous asthma and is observed with special frequency in children who, when younger, had been liable to catarrhal croup; spasm of the air-tubes having taken the place of the previous spasm of the windpipe. independently of that antecedent it comes on sometimes about the time of the second teething in nervous and impressionable children, in whom an attack may be produced by indigestion, constipation, or over-fatigue. it is also by no means rare in children in whom that skin affection, eczema, of which i have already spoken, outlasts the time of infancy, and becomes general and severe. the improper performance of the functions of the skin seems to cause a peculiar sensitiveness of the air-tubes, and to render them liable to the occasional occurrence of that spasm which produces asthma. these cases are less hopeful than others, and the liability to the attacks ceases only when the skin-affection has been completely cured; a reason this for not neglecting eczema in infancy and early childhood. sometimes, too, it follows frequently-recurring attacks of bronchitis, and, though less often than might be expected, it succeeds severe hooping-cough, and in these two conditions the prospects of recovery are less hopeful than in the others. when asthma occurs in childhood, the first point is to ascertain the cause on which the attack depends; and it is worth any amount of care to discover and remove it; for if what may be called the asthmatic habit is not formed, the attacks will, in the majority of instances, cease between the ages of twelve and fifteen. bad habits of the body are, however, as difficult to get rid of as bad habits of the mind, and the boy who grows up an asthmatic youth is very unlikely to get rid of the disorder in later life. it is in that form of asthma which succeeds to frequent attacks of catching cold, and in which bronchitis precedes or accompanies each seizure, that change of climate is most useful. in the majority of instances a moderately sheltered seaside place, with a sandy soil such as bournemouth, is the best, and a few years' residence there not infrequently overcomes every disposition to asthma through the whole remainder of the patient's life. to this, however, there are exceptions, and i have seen instances in which residence at bournemouth and in the riviera have failed, but where a perfect cure has been wrought by the cold, still air of davos. =diseases of the heart.=--=malformed heart.=--every now and then one sees a little babe, carefully wrapped up in its nurse's arms to shield it, even on a warm day, from the air; and, on removing the shawl which covered it, one is struck by the sight of a little pale pinched face, with a livid ring around the mouth, and a blue instead of a rosy tint of lips and fingertips, as though perished with cold. the babe wakes on being disturbed, and gives a faint short cry of distress; the livid hue of its surface deepens, it struggles feebly, its mouth twitches as though convulsions might be coming on. soon, however, these symptoms subside, the babe smiles again, is cheerful, and save for the tints of its face and lips, it looks like other infants, but frailer. this condition has a name in medical writings, from a greek word expressive of the blue tint which characterises it, and is called _cyanosis_. it depends on the blood not having undergone completely those changes in the lungs which take place in the healthy state. the blood, as it returns through the veins to the right side of the heart, is of a deep purple hue. the right side of the heart contracting sends it to the lungs, where, in the minute vessels of the air-cells, it is purified, and returns vivified by the oxygen a bright scarlet stream, to be distributed by the arteries over the whole body; and thence to return once more for fresh purification to the right side of the heart. before birth, the blood does not run the same course, but is purified within the mother's body, the blood running through channels which close with the first breath the infant draws. the previously existing communication between the two sides of the heart ceases at the same time as the new channels are opened, by the shutting of a thin valve which had hitherto allowed the blood to pass from one side to the other. sometimes this closure fails to take place, or takes place but imperfectly; sometimes, in addition, the channels which should be disused after birth remain open still; and sometimes also the heart is otherwise imperfectly formed, and a large communication exists between the two sides of the heart, which long before birth ought to have been firmly partitioned off from each other. according to the freedom of communication between the two sides of the heart, there is more or less ready intermingling of the impure blood with that which is already purified; and this is betokened by the greater or less severity of the symptoms which i have described. when the heart is very malformed, and the blood consequently is very impure, life is but a short agony which ends in a few weeks; some slight movement, some little accidental cold deranging altogether the imperfect machinery, and bringing it to a sudden standstill. between this and the slightest cases there are all shades of difference, till, in the latter, a smaller power to maintain warmth, a less rapid growth, a smaller muscular development, a feebler power, a hurry of breathing on exertion, or in ascending a hill, or in going up a staircase, are all, except the sounds which the educated ear detects of the blood passing through its devious course, that tell of nature having, in this instance, ill done her handiwork. the one most natural question to which, in every instance, the doctor has to reply is this: 'will he or she outgrow it?' to this the answer is, '_yes_,' and '_no_.' in the worst cases the answer is obviously _no_; and in none does _yes_ imply a recovery so complete as to leave no trace behind, and to make the child heartwhole. but short of this, in many instances much may be hoped for. there is, as i shall have occasion again to repeat, a power in the growing heart to adapt itself in large measure to conditions other than those of perfect health. the channels, through which the blood ought not to flow, may shrink though they may not entirely close; the valve may shut more completely than at first the opening between the two sides of the heart; all inconveniences may lessen, and the child may at last become scarcely aware of the difference between himself and others. but for any such result, or for anything approaching it to be attained, certain conditions are absolutely essential which it is seldom easy to induce parents to observe. whatever can hurry the circulation is most carefully to be avoided. the child must be kept strictly out of the way of hooping-cough, measles, or any other fever; must be shielded from every risk of catching cold, and having smaller power of maintaining its warmth than others have, must be specially warmly clad, and must live in rooms at a temperature of deg. fahr., all the year round. great attention must be paid to the state of the bowels, so that constipation may not necessitate violent efforts to relieve them. moreover, for years the child must be carried upstairs; when old enough to take part in games, it must not be allowed to join in any which call for violent exertion, such as cricket, or lawn tennis, nor ride any other than a quiet pony at a gentle pace. it depends entirely on the parents whether, for the sake of a very great but far-off good, they will strictly observe these rules. the difficulty will not arise on the child's part, for it is not hard for those who have had charge of it from babyhood to bring it up to quiet pursuits and quiet amusements, till it seeks no others, and, like the little cage-bred bird, does not care to emulate the flight of others stronger on the wing. =inflammation of the heart.=--the above remarks do not comprise all that is to be said about heart-affection in early life. _inflammation_ may attack the investing or the lining membrane of the heart at all ages, may produce in the child the same suffering as in the grown person, and may tend to destroy life in a similar manner. the causes, indeed, which produce heart disease, are far more frequent in the grown person than in the child, and advancing age brings with it changes which, wholly apart from active inflammation, produce grave forms of disease unknown in early life. there is, however, one cause of heart disease which is far more frequent in childhood and early youth than in later life, namely, rheumatism. eight out of ten of all cases of heart disease under the age of fifteen are of rheumatic origin, and in eighteen out of twenty cases of acute rheumatism under that age, whether slight or severe, the heart becomes more or less involved. now and then, though rarely, the heart becomes affected in the course of scarlatina, and still more seldom in the course of the other fevers, and every now and then affection of the heart is associated with some other form of inflammation of the chest. pain is by no means a constant attendant on it, but fever, more or less considerable, a quickened pulse, and hurried breathing are all but invariable, and one great reason for seeking the immediate help of the doctor is, that his skilled ear may at once detect by the altered sounds the heart-affection at its very outset, and employ the measures calculated to arrest its progress. death in the acute stage of a first attack of inflammation of the heart is of extreme rarity, but the damaged heart is liable to returns of acute mischief, any one of which may prove fatal. independently of this, life with diseased heart is one of suffering, attended as it is by symptoms similar in kind, though not identical with those which i have already mentioned as attendant on malformation of the organ. the hopeful element, however, to which i have already referred as present in cases of malformed heart, exists here in even a greater degree; since repair of injury is possible, while the reconstitution of an organ faulty from birth is obviously beyond nature's power. i can but repeat the directions already given as to the importance of allowing the heart as much rest, and giving it as little work, as is possible with a never-resting organ; and this with the added motive for perseverance furnished by the happy issue which may be hoped for as its reward. one word i must add about the occasional occurrence of _irregular action of the heart_ during the years of growth, especially from the age of ten to fourteen. this is often quite independent of any disease, and ceases when with added strength the nervous system becomes less impressionable. chapter viii. diseases of the organs of digestion. =manner of performance of digestion.=--the organs situated in what is called in medical language the abdomen, have in the child no other duty to perform than such as subserve the processes of digestion and nutrition. the saliva secreted by the appropriate glands in the mouth, mixing with the food, facilitates the further changes which take place in the stomach. in the stomach the food is acted on and dissolved by the gastric juice or pepsin, which is poured out by an almost infinity of minute tubes, or follicles as they are termed. when the stomach has done its work, its contents in a semi-fluid state pass into the small intestine, and mix there with the bile, the secretions from the intestines themselves, and with those of the large gland, the pancreas (in culinary language known as the sweetbread), which seems to have the special power of dissolving fatty matters. as the food, thus acted on, travels along the intestines, whose constant movement facilitates the passage of their contents from above downwards, its elements are taken up, partly by the blood-vessels, partly by innumerable small vessels, called absorbents from their power of imbibing fluids, and lacteals, from the milky hue of the fluid within them when first absorbed. the fluid taken up by the blood-vessels is conveyed to the liver; that taken up by the absorbents to the mesenteric glands, and in these organs further changes take place in it, which fit it to be received into the mass of the circulating fluid. with this it is carried to the right side of the heart, and thence to the lungs and, lastly, from them to the left side of the heart, whence it is distributed, the great life and health giver, to the rest of the body. the useless inconvertible material, leaving every available element behind, is got rid of, either in a solid form by the bowels, or in a fluid form by the kidneys; and thus as long as life lasts there goes on more or less perfectly the wonderful process of constant change, of constant renewal, and during childhood and youth, of constant increase of size and stature. incomplete as this sketch is, it may yet suggest how readily one part of this complex machinery may be thrown out of gear, and further how not one part can suffer without all being disordered. solid food given to the child before it has cut its teeth, enters the stomach unreduced to pulp by the grinders, and unmixed with the saliva, which should help its solution, and which the undeveloped salivary glands do not yet furnish. too large a quantity of food, or food of an unsuitable character, on which the gastric juice cannot act readily, may pass into a state of fermentation; vomiting, flatulence, sour and offensive breath will be the result, and the food will pass into the intestine unprepared to be acted on by the bile. exposure to cold, or the opposite condition of excessive heat, may disturb the action of the liver, and interfere with the secretion of bile; and the food will then pass along the intestine in a state unsuitable for absorption. or, again, the mesenteric glands may be irritated by long-continued imperfect performance of the earlier stages of digestion, or their structure may be altered, and mesenteric disease, or consumption of the bowels, as it has been termed, may result. from want of muscular power, or from want of care on their part who have charge of the child, the bowels may become habitually constipated. health will then suffer, if the child carries about with it for days together matters which can serve no useful purpose, but which are to the body what an ill-kept dustbin is to the rest of the house. lastly, if the kidneys perform their duties imperfectly in consequence of exposure to cold, or of the changes which some diseases, such as scarlatina, sometimes bring about in their structure, the blood will be imperfectly purified; dropsy and various forms of inflammation may result; or the brain and nervous system may be disordered, and death in convulsions may attest the dangerous nature of this blood-poisoning. it would take too long to go in detail through all the phases of disordered digestion in early life. much has been already anticipated in a former part of this book, especially with reference to the troubles of digestion in infancy and early childhood. there is, indeed, but one form of indigestion whose characters are so special as to require that i should enter into any detail with reference to it. =dyspepsia of weakly children.=--children from the age of about three to ten years, whose health has been impaired by an attack of typhoid, or, as it is commonly called, infantile remittent fever, or who belong to a weakly family, or to one, some of whose members have shown a disposition to consumptive disease, are sometimes martyrs to indigestion. it does not need with them any special error of diet, or any casual exposure to cold to disorder their digestion; but every two or three weeks, even under the most scrupulous care, they lose their appetite, their tongue becomes thickly coated with yellow fur, their breath offensive, their bowels constipated, the evacuations being either very white or very dark, and frequently lumpy, and coated with a thin layer of mucus from the bowel, which also appears in shreds at the bottom of the utensil. with this condition, too, there is some, though not considerable, feverishness, and the urine becomes turbid on cooling, and throws down a reddish-white deposit, which disappears if heated. at the end of two or three days of rest in bed, of a diet of beef-tea and milk, with no solid food, with simple saline medicines, mild aperients, and perhaps a single small dose of calomel, the symptoms pass off; but return again and again at uncertain intervals, and without any obvious cause. in these cases, the children almost always, when in their ordinary health, have a peculiar patchy condition of the tongue, one part of it being covered with a thin white coating, through which little red points project, while another part is of a vivid red, and looks raw and shining, as though it had been scalded, while the red points, or the papillæ, as they are termed, project above its surface like so many pins' heads. children in whom this condition exists, require much watching and much care. i have dwelt upon it in order to impress on parents the conviction that it is not a state to be cured, once for all, even by the most skilful doctor, but that years are needed to eradicate a bad habit of the body, as much as to cure a bad habit of the mind. =jaundice.=--i have already spoken of the jaundice of new-born infants; but a sluggish condition of the liver, accompanied by very white or pale evacuations, constipation, and loss of appetite, with a sallow tint of the skin, and sometimes even with actual _jaundice_, are by no means uncommon during the first ten years of childhood. neither condition is serious; that of actual jaundice occurs mostly in the summer, and is then connected with the sudden onset of hot weather. when severe, it may be associated with some degree of feverishness, with dizziness, and complaint of headache, and occasionally with vomiting, while the child rests ill at night, or awakes in a state of alarm, and these symptoms sometimes give rise to the fear that the child is about to be attacked by water on the brain. but the following consideration may serve to calm anxiety on that score. the attack is not preceded, as water on the brain is almost invariably, by several days or even weeks of failing health. it is not attended by heat of head, nor by intolerance of light, nor by constant nausea; and the belly is full rather than shrunken. when to these symptoms are added tenderness on the right side, high-coloured urine and white evacuations, you may set your mind at rest, even before the yellow colour of the skin, which appears in a day or two, stamps the case unmistakably as one of jaundice. my business is, as i have said more than once, the endeavour to describe the symptoms of disease, to explain their nature, to indicate the principles to be observed in attempting their cure, and not to lay down definite rules for their treatment, with the idle expectation that i could thus enable every mother to be her children's doctor. =diarrh[oe]a.=--i have, therefore, comparatively little to say about _diarrh[oe]a_ in children, important though it is, for its symptoms force themselves on the notice even of the least observant. there are, however, a few points concerning it worth bearing in mind. before the commencement of teething, diarrh[oe]a is almost always the result of premature weaning, or of a diet in some respect or other unsuitable. as soon as teething begins, the liability to diarrh[oe]a increases greatly, and cases of it are more than twice as frequent, and twice as fatal, between the ages of six and eighteen months as they were in the first six months of life; while, as soon as teething is over, their number immediately declines again to the half of what it was during the continuance of that process. the practical conclusions to be drawn from these facts are that looseness of the bowels during teething is not a desirable occurrence to be promoted, as some mistakenly imagine, but a risk to be by all means avoided, and i may add, when it does take place, far less easy to control than constipation is to remedy. and next, that in order to prevent its occurrence, care should be taken to make changes in the diet of a child, not during the time when a fresh eruption of teeth is taking place, but during one of the pauses in that process. there are certain seasons of the year when diarrh[oe]a is specially prevalent, independent of any change in diet, or alteration, in any respect, of the circumstances in which the child is placed. thus, in may, june, and july, diarrh[oe]a is twice as prevalent among children at all ages as in november, december, and january; and in august, september, and october, its prevalence is three times as great as during the winter months. the high mortality of children in the summer months is due almost entirely to diarrh[oe]a, and even the bitter northern winter of a city like berlin is a third less fatal to infants and young children than the heat of its short summer. the next point to remember is that mere looseness of the bowels is never to be regarded during the first three years of life as of no importance; for i have seen infants die exhausted from its continuance, even though the examination of the body after death showed almost no sign of disease. doctors distinguish two forms of diarrh[oe]a: the simple, or, as it is technically called, catarrhal diarrh[oe]a; and inflammatory diarrh[oe]a, or dysentery. the one may pass into the other, just as a common cold, or catarrh, may pass, if unattended to, into a dangerous bronchitis. _simple diarrh[oe]a_ usually comes on gradually, and is some days before it grows severe, or passes into the more dangerous dysentery. simple precautions will often arrest its progress, and, among them, rest in bed is one of the most important. over and over again i have known a diarrh[oe]a which had continued in spite of all sorts of medicines so long as the child was running about, cease at once when the child was kept for a couple of days in bed. the reason of this is obvious; constant movement of the intestines themselves, which serves so important a part in maintaining due action of the bowels, is increased by the upright position and by movement, and is reduced to a minimum by the horizontal position. a second precaution concerns the diet; solid food and animal broths should for a time be discontinued, and arrowroot, milk and water, and rice substituted for it, for a day or two, with isinglass jelly, and the white decoction of which i have already spoken. it is not always that astringents are suitable at the beginning of an attack, and the sending to the neighbouring chemist for diarrh[oe]a medicine, which often contains an unknown quantity of opium, is always risky, frequently mischievous. in a first attack of diarrh[oe]a, the doctor should always be consulted, for when it is associated with disorder of the liver a mercurial may in the first instance be needed, or possibly very small doses of a saline medicine, such as epsom salts, with the addition of a few drops of the tincture of rhubarb; or, again, if the diarrh[oe]a sets in with profuse watery discharges, sulphuric acid for the first few hours is often of extreme service. it is at a later time that direct astringents commonly have their use; and the mother, who in her child's first attack of diarrh[oe]a has had the advice of a judicious doctor, will often be helped by him to manage for herself slight returns of the ailment. _inflammatory diarrh[oe]a_, or dysentery, not only follows the continuance of the simpler forms of the disease, but sometimes in the hot months of summer or autumn sets in suddenly with violence. it then frequently commences with vomiting, and the stomach may continue so irritable for twenty-four hours as not to retain even a teaspoonful of cold water. at the same time the over-action of the bowels sets in, and twenty or thirty evacuations may be passed in twenty-four hours. the motions soon lose their natural character, and become watery, slimy, and mixed with blood. they are at first expelled with violence, afterwards with much pain, effort, and often fruitless straining. with these local symptoms, the child, as might be expected, is very ill, feverish, and stupid, though without sound sleep, much exhausted, and its nervous system so disturbed as to occasion frequent twitchings of the fingers and of the corners of the mouth, while sometimes actual convulsions take place. the thirst is intense, the child calling constantly for cold water, and crying out for more the moment the cup is taken away from its lips; while the loss of flesh and the exhaustion are more rapid than in any other disease with which i am acquainted. the fat happy babe of four and twenty hours before is scarcely to be recognised in the miserable little being, with sunken lustreless eyes, and wizened features, and miserable countenance, lying in a state of half-stupor, sensible only to pain, which yet rouses it but to utter a moan, and then sinks again into silent suffering. i can well believe what we are told, that in some countries this, the so-called summer complaint of many of the american cities, sometimes carries off children in a few hours. if a fatal termination does not take place speedily, the disease passes into the chronic stage, the diarrh[oe]a diminishing in frequency, but the pain and straining, and the unhealthy character of the evacuations persisting. ulceration of the bowels has taken place, emaciation becomes extreme, and the child often sinks at the end of several weeks, worn out by suffering; while recovery, doubtful at the best, is always very slow. but i need not pursue this subject further: enough has already been said to show how little infantile diarrh[oe]a is a disorder for domestic management. =peritonitis=, or inflammation of the membrane covering the bowels and lining the cavity of the belly, is of excessive rarity in its acute form; and is attended by such general illness and such severe local suffering, that it is impossible to overlook it or to misapprehend its gravity. severe pain in the belly is sometimes complained of by children, and is due to what is termed colic, a spasm of the bowels which is generally associated with constipation. the great test of the cause of the pain is furnished by the presence or absence of tenderness on pressure. the pain of colic is relieved by gentle pressure and gentle rubbing. the pain of inflammation in any degree and of any kind is aggravated by them. this applies also to cases, not indeed very common, in which inflammation is set up by some small body, such as a cherry-stone getting fixed in a little offshoot or appendage of about the size and length of the little finger, connected with the commencement of the large bowel, and producing ulceration. in these circumstances the bowels are confined, there are nausea and sickness, together with pain and tenderness of the belly, especially on the right side. the disease is a very dangerous one, and often proves fatal in the course of a few days. i refer to it because i have often seen it overlooked both by parents and doctors at its outset, since the pain then is often not severe nor the tenderness intense, and because i have seen the patient's condition rendered hopeless by strong aperients being given to overcome the constipation which was supposed to be all that ailed the child. i repeat then the caution, never to overlook the existence of tenderness, never to attempt to treat a case in which it is present; but always to call in medical advice, and above all always to abstain, unless ordered by a medical man, in every such case from the use of aperients. =large abdomen.=--i must not leave the subject of disorder of the digestive organs without some reference to a condition which often excites much needless anxiety among mothers, namely, the large size of a child's belly. this is sometimes supposed to be a certain evidence of the presence of worms, at other times to be a positive proof of the existence of grave disease, especially of disease of the mesenteric glands, or glands of the bowels as they are popularly termed. it is evidence of neither the one nor the other. if you go into a gallery of the old masters, and look at any of the pictures of angels which are generally to be seen there in such abundance, you will probably be struck in the case of all the child angels by what will seem to you the undue size of their abdomen. you will notice this even in the works of painters who, like raphael, most idealise their subjects, while in those of others who, like rubens, interpret nature more literally, the apparent disproportion becomes grotesque; or, in the coarser hands of jordaens, even repulsive. these painters were, after all, true interpreters of nature. in infancy and early childhood the abdomen is much larger comparatively than in the grown person. for this there is a twofold cause; the larger size of the liver on the one hand, and the smaller development of the hips on the other. in a weakly child this appearance is exaggerated by its want of muscular power, which allows the intestines to become much distended with air. if the child is not merely weakly but also ricketty, the contracted chest will leave less room than natural for the lungs, while at the same time the ordinary development of the hips being arrested by the rickets, the disproportion is further increased both by that and by the flatulence due to the imperfect digestion with which the condition is almost always associated. in no case need the mere size of the abdomen occasion grave anxiety, so long as when the child lies upon its back the abdomen is uniformly soft, nor so long as even if tense it is not tender, and as it everywhere gives out a hollow sound like a drum when tapped with the finger. it is not for a moment meant that no notice is to be taken, nor opinion asked, as to the cause of excessive size of the abdomen, for its distension may be due to real disease; but it is yet worth while to remember that its mere size is not of itself evidence of disease, nor cause of grave anxiety. =worms.=--there is no mistaking or overlooking the existence of _worms_ when they are really present. their presence, however, is often suspected without any sufficient reason. ravenous or uncertain appetite, indigestion, flatulence, undue size of the abdomen, a dark circle round the eyes, itching of the nose and of the entrance of the bowel, a coated tongue, and offensive breath are no real proof of the presence of worms, and do not justify the frequent repetition of violent purgatives or of so-called worm medicines. the only real proof of the presence of worms is their being seen in the evacuations. the worms commonly found in children are either the round-worm, which resembles the earth-worm, the thread-worm, or the tape-worm; the appearance of each of which is clearly indicated by its name. none of them are spontaneously generated in the body, but they are all introduced from without; their eggs, or, as they are technically called, their ova, being swallowed unperceived in some article of food, or drink. a proof of this is afforded by the fact that an infant, so long as it is nourished exclusively at the breast, never has worms. the _round-worm_ occasions the fewest symptoms, and is rather an object of disgust than of grave importance, at least in this country, where it seldom happens that more than two or three are present. in other countries, as some parts of italy, for instance, where the drinking water is bad and stagnant, they are sometimes found in great numbers, as thirty or forty, and it is then not easy to determine whether the symptoms which accompany them are produced by the worms, or by the unwholesome character of the water in other respects. they appear to live on the contents of the intestines, and do not adhere to them, as the tape-worm does, and hence their comparative harmlessness, and they have no power, as has sometimes been mistakenly imagined, of perforating the bowels, and of thus producing grave mischief. the _thread-worm_ is the commonest variety of these creatures, and has the peculiarity of inhabiting the lowest twelve inches of the bowel, where it produces much irritation and causes very distressing itching. it is often present in great numbers, and is so rapidly reproduced, that in a week or two after it has been apparently got rid of, it may again be found as numerous as before. certain articles of food seem to favour its development, such as pastry, sugar, sweets, beer, fruit, and anything which is apt to undergo fermentation, and thereby to impart to the evacuations a specially acid character. these worms are often accompanied with more or less marked symptoms of indigestion, but otherwise the local irritation is usually the only indication of their presence. they produce, indeed, such disturbance of the nervous system as may attend indigestion in any of its forms, but i have never but once known convulsions occur apparently due to their presence in great numbers, and ceasing on their expulsion; and this was in a child between eighteen months and two years old. the _tape-worm_ is developed in the human body from a minute germ or ovum; one form of which exists in the flesh of the bullock, the other in that of the pig; and which seems to require for its growth the favouring conditions of warmth and moisture which are found in the intestines. it fixes itself to the lining of the bowels by means of its mouth, which is furnished with minute tentacles, and it thus derives its support from the juices which it imbibes. the head is so small as not to be seen distinctly without a magnifying glass; and immediately beyond it the jointed body begins; at first, scarcely bigger than a thread of worsted, but gradually enlarging, till at the distance of three inches it is an eighth of an inch wide, and thence rapidly widens till each joint is half an inch wide, and from a third to half an inch apart. it does not exceed these dimensions, even though it may grow to the length of four or six yards. portions of it, sometimes a yard or two in length, are thrown off from its lower end occasionally, and this occurrence often gives the first indication of its presence, the worm continuing to grow as before, and fresh portions being detached from time to time. it does not appear that the worm has the power of reproducing itself; hence its french name of _ver solitaire_, and the occasional presence of two or three would seem to be due to the development of two or three distinct ova within the intestine. deriving as it does its support from the system of the child, and not as the other worms do from the contents of the bowel, the tape-worm often produces graver inconveniences. it sometimes causes uncomfortable colicky sensations, which may even be very distressing, and the disorders of digestion which accompany it are often very considerable; certainly more so than in the case of the other varieties of worms; but i have seen no instance of convulsions which could be attributed to them, notwithstanding the generally received opinion to the contrary. when the existence of worms is suspected, one or two doses of a simple aperient, such as castor oil, repeated two days successively, seldom fail to produce evidence of their presence; which in the case of tape-worm is also furnished by the spontaneous detachment of some of the joints. it must be remembered, however, that until the head has been detached from its connection with the bowel, nothing has been gained, and the tape-worm will in a short time grow again. to obtain the detachment of the head it is necessary that any worm medicine should be given when the intestines are empty. i am, therefore, always accustomed to give a dose of castor oil about two hours after the child's mid-day meal; and to send the child to bed as soon as the aperient begins to act, and to give it no more food except a biscuit and a little milk and water during the rest of the day. in the early morning, the special worm medicine is given, and over and over again i have known the worm to be brought away completely after many previous failures. when the smallness of the joints shows that the greater part of the worm has been thrown off, and that little more than the head remains, it is necessary to have recourse to the unpleasant proceeding of mixing the evacuations with water, and then straining them through muslin, in order that the doctor may by means of the microscope make out whether or no the head has been really detached. this is no question of mere curiosity, but a matter of the gravest moment, since nothing has been really gained so long as the head of the worm remains adherent to the bowel. precautions such as these are not needed in the case of the other kinds of worms. thread-worms, however, are best attacked in their habitation; that is to say, in the lower bowel, by means of lavements. it is, therefore, desirable before they are administered that the bowels should be emptied by a dose of castor oil. the only other caution which remains for me to give refers to the peculiar effect which salicine, a very valuable medicine, especially in the case of thread-worms, has upon the urine. it sometimes turns the urine of a greenish-yellow, often of a red colour, as though it were mixed with blood. the appearance, however, has no grave meaning, but is due simply to a chemical action of the medicine on the colouring matter and salts of the urine. there still remain some local ailments of parts connected with the process of digestion, concerning which a few words must be said. =ulcerated mouth.=--first, with reference to the _sore-mouth_ of children. i have already noticed a form of inflammation and ulceration of the gums sometimes met with during teething, but the sore-mouth of which i am now about to speak is often quite independent of that process; though it may sometimes be found associated with it, and is indeed rarely met with after five years of age. in almost all instances it is preceded and attended with symptoms of indigestion, during the course of which the mouth becomes inflamed, hot and red, and small very painful shallow ulcers with sharp-cut edges, and a little yellowish deposit on their surface, appear at the edge of the tongue, on the inside of the mouth, and especially on the inside of the lower lip, and the adjacent surface of the gum. successive crops of these little ulcerations not unfrequently appear, so that for many weeks the child may be kept by them in a state of extreme discomfort; swallowing, and even speaking being the occasions of considerable suffering. it is seldom that nursery remedies, and the so-called cooling medicines, though often of some service, suffice to get rid of the ailment, which for the most part needs judicious medical treatment, and local as well as constitutional measures. now and then this condition comes on in the course of measles, and is then sometimes of serious importance. in the other form, the disease is usually limited to the gums, and affects especially those of the front of the lower jaw, which become swollen, ulcerated at their edges, where a very ill-smelling deposit takes place of a dirty white or greyish colour, the surface beneath being spongy, swollen, raw, and bleeding. the ulceration sometimes extends so as to lay bare a large part of the sockets of the teeth; but though loosened they seldom drop out. coupled with this, the glands at the angle of the jaw are swollen, and the child dribbles constantly a large quantity of horribly offensive saliva. in the children of the well-to-do classes the condition is seldom seen except in a slight degree; but even when severe it is rarely accompanied by any grave disorder of the general health. it seems to tend, whether treated or left to itself, slowly to get well; but its progress to a natural cure is extremely tedious, and the gums are left by it for a long time spongy, bleeding easily, and only very imperfectly covering the teeth. anxiety is sometimes excited by this condition; it being supposed that the white deposit on the edge of the gum implies some relation between it and diphtheria. this is not so, for though this peculiar ulceration of the gums has now and then been found associated with diphtheria, the nature of the two diseases is essentially different. it is, however, always wise to call in medical advice in order to settle this important question, and the more so, since there is one remedy, the chlorate of potass, which, in appropriate doses, acts upon the condition almost as a charm. i say nothing about a dreadful form of inflammation of the mouth which ends in mortification, because it is of infinite rarity except among the destitute poor, and even among them it is very seldom seen except as a consequence of measles, or of some kind of fever. it is only among the very poor that i have seen it, and even among them it has come under my notice only ten times in the whole course of my life. there is a very common but inaccurate opinion that sore-mouth in childhood is often produced by the employment of mercury. i never yet saw a sore mouth due to the administration of mercury in any child before the first set of teeth were entirely cut; and never but once out of , cases which have come under my notice in hospital or dispensary practice, have i seen in children of any age under twelve any affection of the mouth from mercury sufficiently severe to cause me a moment's anxiety. =quinsey=, or inflammatory sore-throat, has in it nothing specially peculiar to the child, but occurs at all ages with the same symptoms. it is, however, comparatively rare under twelve years of age, and is almost always less severe in childhood than at or after puberty, while i scarcely remember to have met with it under five years of age. this circumstance attaches special importance to sore-throat in young children, since it will usually be found to betoken the approach of scarlet fever, or of diphtheria, rather than the existence of simple inflammation, or quinsey. while this fact affords a reason for most scrupulous attention to every case of sore-throat in children, and this in proportion to the tender age of the child, needless alarm is sometimes caused by the appearance on the inflamed tonsils of numerous white specks, which are at once supposed to be diphtheritic. i have already pointed out the distinction between the two conditions when speaking of diphtheria, but the matter is so important that i will repeat what i then said. these spots are not in the form of a uniform white patch or membrane, which, on being removed, leaves the surface beneath red, raw, and often slightly bleeding; but they are rather distinct circular spots, firmly adherent to the tonsil, wiped off with difficulty, and evidently exuding from the openings of little pits, blind pouches, or glands, with which the surface of the tonsil is beset. i do not advise any parent to rest satisfied with his or her judgment on this matter the first time that they notice this appearance; but there are children with whom slight sore-throat is always attended by this condition, and others in whom the tonsils are habitually enlarged, and seldom free from these white spots flecking their surface. =enlarged tonsils.=--i have said that quinsey or acute inflammation of the tonsils is unusual in early childhood; but a sort of chronic inflammation of those glands which leads to their very considerable enlargement is far from uncommon; and is sometimes the cause of very serious discomfort. it is seldom traceable to any acute attack of sore-throat, but usually comes on imperceptibly in children who are feeble or out of health, or takes place slowly during the cutting of the first set of grinding teeth; the irritation which that produces being in some cases its only apparent exciting cause. not seldom the enlargement has become considerable before it attracts attention; one of the first symptoms that indicate it being the loud snoring of the child during sleep, who is compelled by the obstruction at the back of the nostrils to breathe with its mouth open. the voice at the same time becomes thick, and this and the snoring breathing are both greatly aggravated when the child catches cold. a greater degree of enlargement of the tonsils occasions deafness from pressure on the passage leading to the internal ear, and is also apt to give rise to a troublesome hacking cough which sometimes excites apprehension lest the child's lungs should be diseased. when still more considerable the enlarged tonsils block up the passage through the nostrils, and air consequently enters the lungs but very imperfectly. the nostrils thus disused become extremely small, narrow, and compressed, the upper jaw does not undergo its proper development, the teeth are crowded and overlap each other, the palate remains narrow and unusually high-arched, and the face assumes something of a bird-like character. besides this the child grows pigeon-breasted, owing to the lungs not being filled sufficiently at each inspiration to overcome the pressure of the external air on the yielding sides of the chest. when any considerable enlargement of the tonsils exists, each cold that the child may catch aggravates it, and if diphtheria, scarlatina, or severe sore-throat should occur, the temporary increase of the swelling may become the occasion of serious danger. the question arises, what are the chances that a child whose tonsils are enlarged will outgrow the condition, or when is it necessary to have the enlarged tonsils removed? it scarcely ever happens that any such enlargement of the tonsils exists in children under six years of age as to call for their removal. there is almost always ground for the hope that after the irritation caused by cutting the first four permanent grinding teeth has completely ceased, the tonsils may return by degrees to their former size. a similar shrinking of the enlarged tonsil sometimes takes place, especially in the boy, at the time of approach to manhood, when the vocal organs undergo full development. this can be counted on, however, only in cases where the tonsils are not of extreme size, and have not undergone frequent attacks of inflammation. whenever the hearing is habitually dull, and the voice always thick, when cough is frequent, the nostrils narrow, the chest pigeon-breasted, and the child feeble and ill-thriven, removal of the tonsils is absolutely necessary. in cases where the question is doubtful, its decision must turn on whether the tonsils have often been inflamed. so long as their surface is smooth, and their substance soft and elastic, delay is permissible. when their substance is hard, like gristle, and their surface uneven and corrugated, they have undergone such changes that absorption is impossible, and their removal absolutely necessary. i dwell thus particularly on the question of removal of the tonsils, because there is among many persons an unreasoning dread of the operation, which is entirely devoid of danger, requiring only a few seconds for its performance, and which may even be done under chloroform. the painting tincture of iodine behind the angle of the jaw, or the touching the tonsils with caustic, iodine, alum, tannin, or sweet spirits of nitre are utterly futile proceedings. they diminish the unhealthy and often offensive secretion from the glands which beset the tonsils, and restore the surface to a more healthy condition, but they are absolutely without influence in lessening their size. now and then all the symptoms of enlarged tonsils are present, but yet most careful examination fails to discover any increase of their size. when this is the case the symptoms are due to a thickening of the membrane at the back part of the nostrils, often attended with spongy outgrowths from their surface, which obstruct just as completely as enlarged tonsils would do the free entrance of air. it will, in any case where this condition is suspected, be absolutely necessary to seek the advice of some of those gentlemen who make a specialty of diseases of the throat, and who will have the necessary technical dexterity to discover the condition, and to treat it skilfully. =abscess at back of the throat.=--i should pass unnoticed, on account of its rarity, the occasional formation of an abscess at the back of the throat, behind the gullet, interfering both with breathing and with swallowing, but that the description of it in my lectures once enabled a lady in the wilds of russia to detect it, to point out the nature of the case to her puzzled doctor, to urge him to open the abscess, and thus to save her child's life. this abscess may form at any age, sometimes after fever, sometimes without any obvious cause. it shows itself by difficulty in swallowing and breathing, unattended by cough, but accompanied by a sound similar to that of croup, but not so harsh or ringing. the neck is stiff, the head thrown back, and often there is a distinct swelling on one or other side of the neck. the finger introduced into the mouth, and carried over the tongue to the back of the throat, feels there a swelling which projects over the top of the windpipe, and causes the difficulty both in swallowing and breathing. this swelling is the abscess; a prick with the surgeon's lancet lets out the matter, and saves the child. =diseases of the kidneys.=--the _kidneys_ perform very important duties in carrying off from the system a large amount of useless material, and thus supplement in many respects the action of the skin, and the purifying influence which is exercised by the air on the blood, as it passes through the lungs. it is evident, therefore, that their disorder in any way must be a matter of serious moment, though at the same time the knowledge of the skilled doctor is needed to determine the nature and degree of the ailment from which they are suffering, since that requires an examination of the urine, both chemically and by means of the microscope. my remarks on these diseases must consequently be few and fragmentary. in the grown person, what is known as _bright's disease_ is of frequent occurrence, assumes different forms, and depends on various causes. in the child it is comparatively rare, and is scarcely ever met with except as a consequence of a chill, or as a result of scarlatina. in these conditions the kidneys become overfilled with blood or congested, and the congestion may pass into inflammation, by which their structure may be irreparably damaged. dropsy is the great outward sign of the affection--either slight swelling of the face, eyelids, and ankles, or very great swelling of all the limbs, and even the abundant pouring out of fluid into the belly. the degree of dropsy is, however, by no means an absolute measure of the amount of kidney mischief. it therefore behoves every parent to follow out all directions most scrupulously even in cases of very slight dropsy, in order to guard against the risk of permanent injury to the kidneys being left behind; and especially to remember the liability to the occurrence of dropsy and disease of the kidneys after scarlatina. any check to the action of the skin while it is peeling or desquamating, as it is termed, is especially liable to be followed by these accidents. to avoid all risks as far as possible, i have been accustomed for many years to insist on a child remaining in bed for one-and-twenty days after the first appearance of the rash in even the mildest case of scarlatina, and i am absolutely sure that it is the height of imprudence ever to neglect this precaution. it will suffice to mention the fact that _diabetes_, though very rare, may yet occur in childhood, and that as a rule it is more dangerous in childhood than in the grown person. whenever a child loses flesh without obvious cause, suffers much from thirst, and at the same time passes urine in greater abundance than in health, the possibility that it may suffer from diabetes must be borne in mind. of far greater frequency than any other affection of the kidney is that in which the child passes _gravel_ with the urine, either in the form of a reddish-white sediment, which collects at the bottom of the vessel as the urine cools, or of minute glistening red particles, which resemble grains of cayenne pepper. these deposits, when abundant in the male child, have a tendency to collect in the bladder, and there to form a stone. this painful disease, too, is so much more frequent in childhood than at a later age, that more than a third--indeed, nearly half--of all the operations for stone performed in english hospitals are done on boys under ten years old. even when this grave consequence does not follow the presence of gravel in the kidneys, and its passage into the bladder, it is often accompanied with much suffering. the pain is like that of stomach-ache or colic, the child crying and drawing up its legs on every attempt to pass water, which sometimes is voided only in a few drops at a time, and now and then is completely suppressed for some hours. the very acute form of the ailment seldom occurs, except in infants who inherit from their parents a disposition to gouty or rheumatic affections. in them, however, a trifling cold, slight disorder of the digestion, a state of constipation, or the feverishness and general irritation which sometimes attend on teething, not infrequently produce these deposits and give rise to all these painful symptoms, the deposit disappearing and the pain ceasing so soon as the brief constitutional disturbance subsides. the very acute attacks seldom occur after the first two years of life, but similar symptoms, though less severe, are by no means unusual in older children, and continue to recur from very trifling causes, especially from errors in diet and disorders of digestion. in spite of the suffering which for the time attends it, there is no cause for anxiety with reference to the issue of each attack. the warm bath, a castor oil aperient, and soothing medicine soon relieve the pain, and the children return to their former state of health. it is the frequent return of the attack, even in a comparatively mild form, the persistent disposition to the formation of gravel, the remote risk in the case of male children of stone in the bladder, and the habitually imperfect performance of the digestive functions which call for special care. the avoidance of sugar, sweets, and whatever tends to impart acidity to the urine, the maintaining the due action of the skin by wearing flannel, and the judicious use of alkaline remedies, sometimes combined with iron, are the measures on which the doctor is sure to insist. the difficulty usually encountered in the treatment of these cases arises from the reluctance of the parents to continue for months and years the observance of the necessary rules. it seems so hard to deny their little one the small gratifications in which other children may indulge with impunity; and they fail to realise the heavy penalty, in the shape of gout, rheumatism, gravel, and stone, which in after-life their darling may have to pay for their over-indulgence in his early years. i will just mention that symptoms similar to those above described, less severe, though more abiding, yet unattended by gravel in the urine, are sometimes produced in little boys by an unnatural narrowness of the end of the passage for the urine. it is well to bear in mind this possible cause of the child's sufferings, and to consult a doctor with reference to it, since he will be able to relieve it by a trivial operation. =incontinence of urine.=--the irritation which this mechanical inconvenience produces sometimes has to do with that troublesome infirmity of some children, who wet the bed at night. this may also be induced by a very acid, and consequently irritating, state of urine, either with or without the appearance in it of gravel. often, however, it is a result of want of care on the part of the nurse, who neglects to cultivate regular habits in a child; and does not pay attention to the quantity of liquid taken at its last meal. something, too, is due to the fact that the sleep of a child is deeper than that of the grown person, so that the sensation of want, which would arouse the latter to full consciousness, does not have the same effect on the former. it sometimes happens undoubtedly from mere indolence; and this may always be suspected when a child, otherwise healthy, wets itself not at night only, but also in the daytime. lastly, it does sometimes occur from muscular feebleness in weakly children, the bladder being unable to bear more than a limited degree of distension. the accident usually happens either soon after going to bed, when the warmth stimulates the action of the bladder, or towards morning, when the bladder has become full. the posture on the back favours its occurrence very much, and it is therefore of importance that the child should lie on its side when in bed. the good effect of a blister on the lower part of the back as a means of cure was largely due to its forcing the child to lie on its side. this object can be attained, however, in a much kindlier way, by tying half a dozen cotton reels together, and fastening them at the child's back. the habit may also often be broken through by arousing the child in the night, and compelling it to empty its bladder, the hour being first ascertained at which the accident usually happens. for this, however, to be of any real use, the child must be awakened thoroughly; since otherwise it will mechanically, and quite unconsciously, empty its bladder while still asleep. the habit in this case is not in the least overcome; only for the time the bed escapes the wetting. the utensil must therefore be placed on different nights at different parts of the room, so that the child, in order to find it, must have been roused to thorough consciousness. lastly, i will add that the cases in which the accident is the result of mere indolence are very rare, and though in such cases strictness may be necessary, yet actual punishment is out of place. as a rule, reward answers much better. a penny, or a threepenny-piece every night that the accident does not happen, and a forfeit of a halfpenny or two pence for every night of misfortune, is a very efficacious help to a cure. when all these domestic means, persevered in for months, fail to produce any result, medical aid must be called in. chapter ix. constitutional diseases. there remains for consideration a large class of what may be termed _constitutional diseases_, in which the local ailment is the outcome of a previous disorder of the whole system. these diseases are either acute or chronic. the acute constitutional diseases belong to the class of fevers. these are marked by certain local characteristics, as the swelling of the joints in acute rheumatism, the sore-throat in scarlatina, or the eruption on the skin in smallpox, and their course is more or less strictly limited by distinct periods of increase, acme, and decline. no such rule obtains in the case of consumption, scrofula, and rickets, which are instances of chronic constitutional diseases. in them too the local manifestations of the general disease vary also: the lungs being affected in one case of consumption, the bowels in another; while scrofula may show itself by affection of the glands in one case, by the formation of abscesses in a second, or by disease of the bones in a third. =chronic constitutional diseases.=--it may perhaps be convenient to study first the chronic constitutional diseases; and afterwards to make a few, and they will be but few, remarks on fevers. =consumption= and scrofula, though similar, are not the same disease. both, however, depend on some defect in the blood, as the result of which certain materials, incapable of being converted into the natural constituents of the body, are deposited in the substance of different external parts or internal organs. if deposited in small quantities, these materials may be absorbed, as it is termed, that is to say, got rid of, by natural processes, which even now we understand but imperfectly. if deposited more abundantly, they press upon and gradually spoil the healthy parts in which they are seated, and thereby interfere with the proper performance of their duties. thus, the deposit of consumption encroaches on the proper substance of the lungs, and so lessens the area in which the blood is exposed to the air and purified: the deposit of scrofula around and in a joint interferes with its powers of movement. nor is this all; but wherever any deposit has once taken place, it tends especially to increase in that very spot, guided as it were by a certain affinity; and the substance of the previously healthy part is removed as fresh deposit comes to occupy its place. further, the matter deposited has no power of being changed into healthy substance of lung, or of bone, or of any other part. a fractured limb may be completely mended; a fluid is poured out around and between the edges of the broken bone; by degrees this hardens, it undergoes changes which convert it into solid bone, and the limb is once more as serviceable as before, though some indications of the fracture may still be perceptible in the texture of the bone itself. or, a person receives a severe blow on his arm or leg; in course of time the blood which had flowed from the ruptured vessels, and had formed a big bruise, is absorbed, and all is as before the injury was inflicted. if more serious damage has been done, the fibres of some muscles may have been torn, even though the skin remains unbroken. inflammation is set up, the injured parts die, and are melted down into the matter of an abscess. the abscess discharges itself, its walls contract, the opposite surfaces come into contact, and are welded together again, so that there is no loss of substance, nor anything save a scar on the surface to indicate what has happened. in the case of the deposits of consumption or scrofula these changes cannot take place. in technical language the matter is said to be incapable of organisation; that is to say, it cannot be transformed by nature's alchemy into anything good or useful. it is rubbish to be got rid of; and the patient's recovery depends on the possibility of getting rid of it. if there is much of it, so as to be removed from the vivifying influence which adjacent living structures still maintain about it, the deposit softens at its centre. this softening gradually extends to the circumference; the mass irritates more and more the parts around it, and where the irritation is greatest the structures yield, and are removed to make a way for its escape, and the patient spits up the contents of the abscess. but the abscess of the lungs is not like an abscess which follows an injury. it has not formed in the midst of previously healthy parts which are capable of reproducing the original structure; its walls are themselves involved in the disease, and, in accordance with the rule i have already mentioned, 'much will have more,' and the patient goes on spitting up the perpetually renewed contents of the abscess for months or years; until by its gradually increasing size, and the more and more abundant discharge of matter, and further and further destruction of lung-substance, death takes place. this fatal issue, however, is not invariable. in favourable circumstances, and especially in childhood, the radical constitutional defect may be amended, and with a healthier condition of the blood the unhealthy deposit may cease to take place. the lung-substance, however, with all its curious structure of air-cells and their network of minute vessels where, as in nature's laboratory, the blood receives its due supply of oxygen, is not reproduced. the lung shrinks, the sides of the abscess come together, and by slow degrees a dense material cuts it off from the adjacent healthy structure, but the most complete recovery leaves the patient with his breathing power lessened, and with his vigour consequently more or less impaired. when the deposit is less considerable, a different change takes place. the material dries by degrees, and is at last converted by a purely chemical change into a hard chalky substance, which in the course of time becomes of more than stony hardness. last of all; when the deposit is smallest in quantity, it may be completely got rid of; and a lung in which consumptive disease once existed, may eventually regain perfect soundness. i have dwelt on these processes as they take place in the lungs; but, allowing for differences of locality, they resemble such as take place elsewhere. three important conclusions follow from what has been said. first. it is only in quite the early stage of consumptive disease that absolutely perfect recovery can be hoped for. there is a euphemism, more amiable than honest, which doctors not seldom make use of, saying that a child's lungs are not diseased, but only tender. they mean by this, that on listening to the chest, they detect such changes in the sounds of breathing as their experience tells them are usually produced in the early stage of consumptive disease of the lungs. if the opinion is confirmed by a second competent medical man, _then, and not later_, is the time for precautions, for removing the child from school, and for selecting, as far as may be, a suitable winter climate. when the signs of disease are well marked, a reprieve, perhaps a long one, is all that can be confidently reckoned on. second. when softening of the consumptive deposit has taken place, of which certain sounds attending breathing are all but conclusive, recovery, even the most complete, always implies loss of a certain amount of lung-substance, and consequently loss of a certain amount of breathing power. third, and this is most important, as well as most cheering; consumption, which is at no age the absolutely hopeless disease that it was once supposed to be, admits of far more cheerful anticipations in children than in grown persons, or, for that matter, than in the youth or maiden. the principal _causes_ of consumptive disease are, hereditary predisposition, and improper feeding in infancy. there are besides two diseases incidental to childhood, and one of them almost peculiar to it, namely typhoid fever and measles, which are more apt than any others to develop a tendency to consumption. during convalescence from either of them, therefore, special care is needed. in the grown person, consumption almost always attacks the lungs, and this often to the exclusion of other organs. in the child, however, this is not so, and though the lungs are indeed oftener affected than other parts, yet in nearly half of the cases some one or other of the digestive organs is likewise involved, and in about one in seven instances the lungs are free and the digestive organs alone are attacked. fever, cough, and wasting are the three sets of symptoms which in some degree or other are always present in consumptive disease of the lungs. the fever in the early stages of consumption is not in general severe; but so long as the evening temperature of a child never exceeds °, there is no cause for anxiety. on the other hand, if the evening temperature for a week or ten days together always amounts to °, there is grave presumption that consumptive disease is present. in advanced consumption the evening temperature is constantly ° to °, while in the morning it may fall to ° or °. cough is but rarely absent even in cases where the lungs are but slightly involved, for the irritation of the digestive organs often excites a sympathetic cough, and in these circumstances observation of the evening temperature will often furnish a clue to the right interpretation of the symptoms. there is a form of cough which is oftenest observed in children between the ages of two and five years, which comes in fits closely resembling those of hooping-cough, and each fit ends in a sort of imperfect 'hoop.' this may depend on a particular form of consumption in which the _glands connected with the lungs_ (the bronchial glands as they are called) _are diseased_, and not the lung-substance itself. the enlarged glands press on some of the nerves connected with the upper part of the windpipe, and thus occasion the spasmodic cough. always suspect this when a cough persists for weeks together, not getting rapidly worse as hooping-cough would do, but at the same time not growing better, as would be the case with mild hooping-cough. the doctor on listening to the chest will solve your doubts; the thermometer will help you to decide whether his visit is necessary. i may add that this form of consumptive disease is less serious than that in which the lung-substance is involved. consumption sometimes follows bronchitis, especially when a child has been subject to frequent attacks of it. a very slow and imperfect recovery from an attack of bronchitis which had not been specially severe is always a reason for solicitude. now and then infants are born with consumptive disease. in that case the lungs are always affected; and the symptoms of fever, cough, and wasting usually show themselves within the first three or four months, and the infants almost invariably die within the year. now and then, however, an infant thus affected may continue apparently in good health for a few months, and then be suddenly attacked by symptoms of acute inflammation or of severe bronchitis which prove rapidly fatal; and it may be found after death that the acute attack destroyed life because the lungs were already the seat of extensive consumptive disease. no infant in whose mother's family a predisposition to consumption exists ought to be nursed by its mother, but by a healthy wet nurse; or, if that is impossible, it should be brought up on a milk diet, with but a small admixture of farinaceous food. there is a form of very rapid, or so-called galloping consumption, which is seldom observed before the age of seven years; generally two or three years later. its symptoms so closely resemble those of typhoid fever, that it may readily be mistaken for it. i refer to it in order to say that the doctor who mistakes the one for the other can scarcely be regarded as blameworthy; and the mistake is of the less importance since the treatment applicable to the one case would do no harm in the other. i have already noticed the connection between water on the brain and consumption. it is indeed nothing else than inflammation excited by the presence of the deposit of consumptive matter in the brain or its membranes. little has been said hitherto about the wasting which was referred to as one of the characteristics of consumption. when the disease is limited, or nearly so, to the lungs, the wasting is not considerable until the mischief in the chest is far advanced. it must be remembered, however, in order to judge of this, that while in the full-grown man the best sign of health is the persistence for years together of the same weight, the case of the child is different. the child ought to grow in height, and increase in weight, and during these changes the plump infant grows thinner, not by real wasting but by conversion of its fat into bone and muscle. the child is thinner, but is taller and weighs heavier. the only real test therefore of the condition of the child is afforded by its increase in height and in weight. one need not be solicitous about the child who increases in height, and maintains his previous weight, nor about him who while he does not grow yet becomes heavier; but the child who neither gains in weight, nor in height, or who loses weight out of proportion to his increased height, is in a condition that warrants anxiety. i have long been accustomed, in the case of children whose parents were resident in india, to instruct those who have charge of them to send every three months a statement of the height and weight of the children, as the best evidence of their state of health. =consumptive disease of the bowels.=--consumptive disease sometimes invades the whole system from the very first, while in other instances it attacks from the outset the organs of digestion, and continues throughout to affect them chiefly, and loss of flesh is then one of its earliest symptoms. in instances where there is a strong family predisposition to the disease, consumption of the bowels or mesenteric disease, or disease of the glands of the bowels, all three popular names for the affection, sometimes shows itself at the time of weaning. in the majority of cases, however, it comes on later, after the completion of teething, and between the age of three and ten years. indigestion such as i have already spoken of sometimes precedes it, with the irregular condition of bowels, and the patchy state of the tongue. but this is by no means constant, scarcely i think general; and not infrequently momentary, causeless, colicky pains precede for a short time any other symptom. in a few weeks after their occurrence, sometimes indeed independently of them, the appetite fails, or becomes capricious; the bowels begin to act irregularly, being alternately constipated and relaxed; and the motions are unnatural in character, being, for the most part, dark, loose, and slimy. sometimes indeed, they are solid, and then often white, as if from complete inactivity of the liver, and sometimes half-liquid, frothy, and like yeast. one peculiarity which they always present, be their other characters what they may, is their extreme abundance, quite out of proportion to the quantity of food taken, and due to their admixture with the unhealthy secretions from the bowels. the child next becomes restless and feverish at night, its thirst is considerable, and the colicky pains become both more severe and more frequent. sometimes the stomach grows very irritable, and the food taken is occasionally vomited, while the tongue, in the early stages of the affection, continues for the most part clean and moist, and except that it is often unnaturally red deviates but little from its appearance in health. next comes a change in the condition of the belly, the date of which varies considerably. it becomes larger than natural, owing to the filling of the bowels with wind, but at the same time it is tense and tender on pressure--two points of great importance to be noticed, and the glands in the groin, which in a healthy child cannot be felt, become enlarged, and are felt and perhaps even seen like tiny beans under the skin. as in other forms of consumptive disease, so here the progress from bad to worse seldom goes on uninterruptedly. pauses take place in its course, though each time they become shorter; and signs of amendment now and then appear, but they too promise less and less with each return. the child wastes rapidly; is always more or less feverish; the abdomen is constantly tender, but does not in general go on increasing in size; the pains become more frequent and more severe, and the bowels are almost always habitually relaxed. life is sometimes cut short by the lungs becoming affected, but when this is not the case the patient may linger on for weeks, or months, or even for two or three years, until, worn to a skeleton, death at last takes place from exhaustion. much apprehension is often needlessly excited in the minds of parents, with reference to any child whose digestion is imperfect, who loses flesh, and has a large abdomen; and the words mesenteric disease, sometimes uttered thoughtlessly by the doctors, seem to them to seal their little one's doom. now, first of all, it must be remembered that mesenteric disease, due to consumption, plays but a very small part in the production of the symptoms just described, but that the covering and the lining of the bowels are chiefly involved. next, enlargement of the mesenteric glands and disorder of their functions take place from many causes other than consumption. they are always more or less enlarged in typhoid fever; they become enlarged when irritated by unwholesome food in infancy, or they may swell in the course of chronic indigestion. in all these cases too, the glands in the groin may be enlarged by sympathy, and this without the existence of any actual abiding disease. a big abdomen is, of itself, no evidence of it, nor even when associated with indigestion and frequent stomach-ache; but when to these you add abiding tenderness, and an evening temperature always at least one degree above that in the morning, there is every reason to fear that consumptive disease has attacked the organs of digestion. even then, however, there is no ground for despair; for, while consumptive disease in any form is less seldom recovered from in childhood than in after-life, such recovery oftener takes place in cases of affection of the digestive organs than when the disease is seated elsewhere. =scrofula.=--with this word of comfort i leave the subject of consumption, and pass to that of the allied disease _scrofula_. briefly stated, two of the great differences between it and consumption are that scrofula is almost entirely limited to childhood and youth, while consumption may occur at any age; and next, that while scrofula attacks the bones and the glands, the skin and the membranes adjacent to it, consumption has its seat in the lungs, the brain, and the internal organs. scrofulous diseases of the bones come so exclusively under the observation of the surgeon, that i do not feel myself competent to say anything about them. i would however warn all parents to be very much alive to the importance of noticing the early symptoms of any such diseases, as shown by slight lameness, complaint of pain in the back, or difficulty in moving the hand or arm, or in turning the head or bending the neck. they may be but temporary accidents, due to cold, or to slight muscular rheumatism, or to some sprain not noticed at the time; but they may also be signs of the commencement of scrofulous disease of some bone; and in no disease whatever is early judicious treatment of greater value, or the result of neglect less remediable. besides these graver ailments which seldom appear until after the time of infancy has passed, there are others of a less serious nature which often show themselves within the first year of life. one of these consists in the formation beneath the skin of numerous small lumps of a rounded form, and of the size of a kidney-bean, slightly movable, and not tender. by degrees such lumps become adherent to the skin, the surface of which above them grows red, they project slightly above it, and at last open by a small circular aperture, discharge a little matter, and then subside. they collapse and disappear; a slight depression and a degree of lividity of the skin mark for a considerable time the situation they had occupied. i refer to them, because while they are a sign of a scrofulous constitution, which may require special care in diet and preparations of iron and cod-liver oil, they are best left absolutely alone--neither poulticed nor lanced. the same principle of non-intervention applies equally to the swellings which sometimes form on two or three of the fingers in infancy, not involving the joints but producing great thickening and a hard swelling around the bone. these swellings disappear by degrees as the constitutional vigour improves, and this is especially promoted by a long stay at the seaside; but they tend, if the health fails, to affect the bones themselves, and thus to occasion deformities of the hand. glandular swelling, discharges from the ear, offensive secretion from the nose, and in female children, even of very tender age, a discharge of whites, are all common signs of a scrofulous constitution, and all tedious and troublesome. they all, however, are very much under the influence of judicious medical treatment. it must at the same time be borne in mind that none of these ailments admit of what may be called active treatment. there are no royal means of dispersing scrofulous glands, or of curing discharges from the ear, or of doing away with the offensive smell which in some cases proceeds from the nostrils. fresh air, suitable diet, preparations of iron, residence at the seaside, and sea-bathing, measures directed to improve the general health, are of chief value, and without them local treatment is of small avail. a few words, however, may with propriety be added with reference to the local treatment of the minor ailments to which i have just referred. no local application is of use in the _scrofulous swellings of the fingers_. tincture of iodine, indeed, may be painted over them when quite small, while at the same time the joints are kept quiet by a small gutta-percha splint. when they become considerable, iodine is useless; and even if matter forms in the swelling it is much better to let it make its way out by a small opening spontaneously than to make a puncture with a lancet, since the edges of the wound would not heal, and the risk of the disease affecting the bone would be increased. the _glandular swellings_ of the neck or about the lower jaw are likewise best let alone, or merely covered with a layer of cotton wool, stitched inside a piece of oiled silk to maintain a uniform temperature. if they become suddenly painful and more swollen, a cooling lotion of goulard water and spirits of wine, constantly applied, will reduce the swelling and lessen the discomfort. when stationary, a mild iodine ointment may be smeared over the gland at bedtime, and covered with oiled silk. applications of iodine, however, need careful watching, for sometimes they over-irritate the gland, and cause an abscess. if the gland were out of sight there would be no objection to this, which would probably be a rapid mode of getting rid of the swelling; but the scar left behind, if the abscess burst or were opened, is an objection when the swelling is situated in the neck or at the jaw. if the skin over the top of the swelling becomes red, and its substance begins to feel soft, then, but not till then, it is desirable to apply a warm poultice constantly. at the same time the progress must be daily watched by the doctor, in order that he may seize the proper moment to make a small puncture and let out the matter. the small cut leaves a less puckered scar than the natural opening. the subsequent management of the case must be superintended by the doctor. _offensive discharge from the nostrils_ does not depend, in by far the majority of cases, on disease of the bones, but on an unhealthy condition of their lining membrane. it is exceedingly obstinate and difficult of cure, is four times more frequent in girls than in boys, and unfortunately often lasts into womanhood, and continues even when the general health is perfect. much may be done to abate the annoyance by diligent sniffing up the nostrils some weak disinfectant; or by regularly irrigating the nostrils by means of a simple apparatus, to be obtained from any instrument-maker. in spite of this, however, it is often necessary to introduce a little plug of cotton wool dipped in the fluid some distance up the nostrils, with a thread attached by which it can be withdrawn, and a fresh one substituted twice a day. the discharge of _whites_ is sometimes very troublesome, and apt to return from the commencement of teething up even to womanhood. it is a mere sign of debility, usually also connected with a scrofulous habit, but has no further or graver meaning. locally, constant cold ablution by means of a sponge held above the child, not touching it, is the great remedy, and this may have to be repeated every hour or two if the case is severe. astringent lotions of different kinds may be used in the same manner; while care must be taken that the child's drawers are large and loose, so as not to irritate her when sitting. general treatment, however, sea air and sea bathing are especially in these cases the great remedy. it must not be forgotten that all these ailments have a special tendency to recur; and that when people say 'dr. a. or dr. b. did the child good for the time, but this or that symptom returned as soon as the treatment was discontinued,' as though this were the doctor's fault, they are unjust; for the tendency to return of every form of scrofulous disease is one of the great characteristics of the malady. patience and perseverance on the parents' part, even for months and years, are often as much needed as skill on the part of the doctor. one more remark may not be out of place. some persons have an impression that there is something specially shameful in scrofulous disease, and while they will readily admit the existence of a consumptive tendency in their family, they almost resent the suggestion that their child's ailment is scrofulous. for this prejudice there is absolutely no foundation. there is no more reason for connecting scrofula in a child with any antecedent wrong-doing on the part of its progenitors, than there is for attaching that idea to the red hair or black eyes which a child may have in common with the rest of its family. =rickets.=--we sometimes see, especially in the poorer quarters of a great city, persons dwarfed in stature, with large hands, bowed legs, bent arms, swollen wrists and ankles, walking with an awkward gait, though usually holding themselves remarkably upright, with the face of a grown person on the body of a child, and we know that they suffered from _rickets_ when young. rickets is essentially a disease of childhood, and of early childhood, in which proper bone-formation does not take place, the soft material, or gristle, which should turn to bone, remaining long in the soft state. when, therefore, the child begins to walk, or to use its limbs, they bend under the weight of the body, or under their own weight, and with every slight movement which its feeble muscular power enables it to make. it does more, however, than interfere with the hardening of the limbs: it arrests growth to a great degree, interferes with development, retards teething, postpones the closure of the open part of the head, or fontanelle, weakens constitutional vigour, and impairs muscular power. to this feeble muscular power it is due that the child cannot make the effort to fill its lungs completely, and hence the pressure of the external air forces the soft ribs inwards, and gives to the chest the peculiar form of pigeon-breast. in the course of time the delayed bone-formation takes place, and the bones themselves become as hard as ivory, but the limbs do not straighten, and the deformity produced in infancy is but confirmed in after-life. the greater degrees of rickets are scarcely ever seen among the children of the wealthier classes, but over-crowded and ill-ventilated nurseries, cots from which the air is well-nigh shut out by closed sides and overhanging curtains; injudicious feeding, with undue preponderance of farinaceous food, often produce its slighter forms. i never yet saw rickets in a child while brought up exclusively at its mother's breast. the slighter forms of rickets show themselves in a tardy closure of the infant's head, which sweats profusely when the child is laid down to sleep; in big wrists, which contrast with the attenuated arms; in a general limpness of the whole body, and a bowing of the back under the weight of the head, which bends as a green stick would bend if a weight were placed upon it. they are further marked by backwardness in teething, and by the irregular order in which the teeth appear, and, further, by the peculiar narrowness of the chest, and by what has been termed the beading of the ends of the ribs: little round prominences due to a heaping up of gristle just where the ribs join on to the breastbone, marking the spots at which the tardy bone-making has come to a standstill. children who bear these stamps of rickets are far more apt than others to suffer from spasmodic croup, and in them it is also specially likely to be severe and to be accompanied by convulsions. they will also be more liable than others to attacks of bronchitis, they will suffer more during teething, they will be often constipated, and will be troubled by various forms of indigestion. now and then, too, they will have causeless attacks of feverishness lasting for a few days, or for two or three weeks, attended with general tenderness of the surface, and a disposition to perspiration, which brings no relief but serves only to weaken. it is true that these symptoms do not often become immediately dangerous to life, though spasmodic croup and bronchitis both have their perils; but they interfere with health, and growth, and good looks, and cheerfulness, and quick intelligence. if mothers would but ask themselves the real signification of these symptoms, and change the conditions which surround the child, and alter their mode of feeding it, they would many and many a time be spared the heart-ache of seeing their little ones grow up weakly, ugly, ill-thriven. unfortunately, it is so much easier to give cod-liver oil and iron than to turn the best spare room into a night nursery, and to uglify the cot by taking away the curtains which made it so pretty, and to give up some of the pleasures of society in order to superintend the preparation of the baby's food; that the doctor is called in to correct by drugs the evil which drugs cannot reach. iron and cod-liver oil are very useful in the second place; fresh air, good ventilation, and a wise diet must always occupy the first. =acute constitutional diseases.=--it still remains for us to glance rapidly at the characters of the _acute constitutional diseases_, all of which belong, as has already been stated, to the class of fevers. of them all but two are contagious--that is to say, are capable of being communicated directly from person to person. they are likewise infectious, or, in other words, articles of bedding or clothes which have been worn by the sick, retain a something--an exhalation from the breath, an emanation from the skin, or a secretion from the bowels--which may reproduce the same disease in a person previously healthy. to this contagious and infectious property there are two exceptions; the one is furnished by acute rheumatism, or rheumatic fever, the other by intermittent fever, or ague. =rheumatic fever.=--the main features of _rheumatic fever_ are the same at all ages. fever, pain in the limbs, swelling of the joints, sweats unattended by that relief which usually accompanies abundant action of the skin in fevers, are its characteristics. in the child all these symptoms are usually less even than in the adult. the swelling of the joints in particular is less considerable, and both the pain and the swelling are apt to wander from one to another joint, or to a different limb, instead of remaining fixed as they do in the grown person for several days in the same joint, even though fresh joints may be implicated in the course of the disease. these circumstances tend to make people look on rheumatic fever in the child too often as a comparatively trivial ailment; and this not only because the suffering which attends the disease is slighter, but because its duration is also shorter. but there is one fact which forbids this low estimate of its importance, and that is the great tendency to affection of the heart even in cases of comparatively mild rheumatism in the child; while in the grown person there is a direct relation between the general severity of the rheumatic symptoms and the liability of the heart to be involved. i have already stated that nine out of ten of all cases of heart disease in early life, not due to original malformation, are of rheumatic origin, and further that heart disease comes on in the course of four out of five cases of rheumatic fever in the child, slight as well as severe. it seldom occurs before the third or fourth day of the illness, so that if parents take the alarm at the very outset, it is usually though not invariably possible for the doctor by judicious treatment to anticipate and to prevent its occurrence, or at any rate greatly to control its progress. every threatening of rheumatism, therefore, is to be watched with the most anxious care, since so serious a complication as disease of the heart may accompany extremely slight general symptoms. it is wise too, to place any child in whom general feverish symptoms come on at once under medical observation, for though it does not usually happen, yet it does sometimes occur, that rheumatic inflammation attacks the heart before any other local signs of the malady have manifested themselves. it is scarcely necessary to add that tenfold precautions are needed when rheumatism has once occurred, since the liability to its return is very great, and the heart which escaped in the first attack may suffer in the second; or the comparatively small mischief done the first time may become an incurable disorder. =ague.=--_intermittent fever_ or _ague_ is very rare in childhood in london; or at any rate it is very rare among children of the wealthier classes. i believe it is everywhere rarer among children than among grown persons, probably because they are as a rule less exposed to those malarious influences which produce it. in the child it generally takes the form of tertian ague, that is to say the attack recurs every second day; one day of freedom intervening between two attacks. the three stages of shivering, heat, and sweating are less marked in the child than in the grown person, and this indistinctness of its symptoms is greater in proportion to the tenderer age of the child. shivering is scarcely ever well-marked, a condition of unaccountable depression usually taking its place, while once or twice i have known convulsions occur which gave rise to the apprehension that disease of the brain existed. the hot stage is long, and passes off gradually without the profuse perspiration that occurs in the grown person, and the child even between the attacks is almost always more or less ailing. a first and even a second attack may puzzle not the parents only, but also the doctor; but after the symptoms have returned a few times, the child being neither better nor worse in the intervals, it becomes evident that no serious disease is impending. the risk of an overhasty conclusion is that the depression and disturbance of the nervous system may be supposed to imply the existence of brain disease; and lead to unsuitable treatment, instead of the administration of quinine, which nine times out of ten proves a specific for ague. the rapid increase of temperature in the attack, and its equally rapid subsidence afterwards, will, if carefully noted, preserve from error. there is much that is obscure with reference to the nature both of rheumatic and intermittent fever. they differ from other fevers not only by being neither contagious nor infectious but also by their readiness to return, while a single attack of any of the others furnishes a guarantee, and often a complete guarantee, against its recurrence. in addition to these peculiarities, the fevers of which i have now to speak are characterised by running a certain definite course, being accompanied by certain peculiar appearances on the surface (generally rashes on the skin, whence their name of eruptive fevers); being attended each with its own peculiar dangers, and all having a tendency to what is termed epidemic prevalence; that is to say to occur one year, and without obvious cause with vastly greater frequency than in other years. =mumps.=--it has been questioned whether that painful but not dangerous ailment the _mumps_, ought or ought not to be classed with these fevers. i think it should, for it is contagious, infectious, runs a fairly definite course, is attended with invariable external appearances, often prevails epidemically, and one attack preserves in most instances from a second. it very seldom befalls children under seven years of age, and is more frequent in early youth than in childhood. it sets in with the ordinary symptoms of a cold, which are followed in about twenty-four hours by stiffness of the neck, and pain about the lower jaw, which is increased by speaking or swallowing. at the same time a swelling appears, sometimes on one side sometimes on both of the lower jaw, and increases very rapidly so as to occasion great disfigurement of the face. the swelling goes on to increase, and to become more tense, attended with more head-ache, fever, and discomfort for some forty-eight hours, but then it begins to lessen, and the general illness subsides rapidly, though the enlarged gland, for that is the cause of the swelling, sometimes does not return to its natural size for a week, ten days, or more; and now and then, though very rarely, an abscess forms, which is both tedious and troublesome. the treatment suitable for a severe common cold, together with the constant application of a warm poultice to the swollen gland, is all that is usually required, though the doctor's help is often needed to relieve the suffering which for the first day or two in many instances attends the ailment. =typhoid fever.=--there is no question as to the place which should be occupied by typhoid fever, smallpox, measles, and scarlatina, for all belong to the class of eruptive fevers. they are all specific diseases, each due to its own peculiar poison, and not capable of being produced by any mere unsanitary conditions, though such may aggravate their severity and facilitate their spread. the belief in the special character of each of these diseases has received strong confirmation from the researches of the eminent frenchman, m. pasteur, and others who have followed in his track. they have discovered in the blood and other secretions, and in some of the tissues both of men and animals, minute microscopic organisms which differ in their characters in different diseases. experiment has further shown that in some mysterious way these organisms are the cause of these diseases, for on inoculating animals with them the peculiar disease of which each was the accompaniment, and no other, was reproduced in the inoculated animal. as far as our knowledge goes at present then, we are forced to regard each of these as a separate disease, measles never passing into scarlatina, nor that into smallpox, but each, whether slight or severe, retaining throughout its distinct character. we have already seen how, in the course of various diseases, the pulse is quickened, and the temperature raised, constituting that state which we commonly call fever, but as the local ailment subsides the fever disappears. there is, apart from smallpox, measles, and the other so-called eruptive fevers, only one real essential fever commonly met with in childhood, and that is what the doctors call _typhoid fever_. the name, from the similarity of sound to _typhus_, from which, however, it is essentially different, has long been a name of terror in the nursery, and all sorts of epithets have been substituted for it, as gastric fever, and infantile remittent fever, and so on. name it as you may, the fever is one and the same with the typhoid fever, which one hears of as prevailing constantly in many continental cities, and proving dangerous and fatal in any district almost in direct relation to the neglect of drainage and of proper sanitary precautions. it is extremely rare in infancy, though i saw it once in a babe eight months old, and is comparatively seldom met with before the age of five years. from five to ten years old it is more frequent than from ten to fifteen, but it is consolatory to know that it is less fatal in early childhood than at any subsequent time of life, and that cases of such exceedingly mild character that the child's condition can be more properly described as ailing rather than ill, are then far from uncommon. the symptoms, however, are in all instances similar in kind, though widely varying in degree, and the duration of the fever is, as nearly as may be, three weeks. by this it is not meant that at three weeks' end the child who has had typhoid fever is well again, but only that the temperature, which had hitherto been high, and always higher at night than in the morning, has subsided, that the skin has become less dry, the tongue slightly moist, the intelligence more clear, that the fever has run its course. for the first week or ten days, the symptoms have probably become every day more grave; and for the next ten the doctor could find no better consolation than the assurance--happy if he could give it--that the condition was not worse, but that you must have patience, for the time for improvement had not yet arrived. if the attack has been severe, the child will be left greatly exhausted, sadly emaciated, and suffering from the effects of that ulceration of the bowels which accompanies the fever, and from which life may still be in imminent danger. but the fire is quenched; the question is no longer how to put out the conflagration, but how to repair the mischief it has caused. when mild, the disease usually comes on very gradually, the child loses its cheerfulness, the appearance of health leaves it, the appetite fails, and the thirst becomes troublesome; in the daytime it is listless and fretful, and drowsy towards evening, but the nights are often restless, and the slumber broken and unrefreshing. the skin is hotter, and almost always drier than natural, or if there is any perspiration, it comes on at irregular times, lasts but an hour or two and brings no refreshing. the thermometer will quite, in the early days, solve all doubt as to the nature of the case. in the morning the thermometer will be natural, or nearly so, but at seven o'clock in the evening it will have risen to ° or °, and will continue so during the early part of the unquiet night. after midnight it will begin to fall, and by six o'clock in the morning, or even earlier, will have regained its natural standard. there is no other disease but typhoid fever, and now and then some forms of galloping consumption, in which these oscillations of temperature take place regularly. other symptoms attend typhoid fever besides these, and serve to stamp upon it its distinctive character. the bowels are usually loose, or if not, a moderate aperient acts on them excessively, the evacuations being loose, often watery, of a light yellow-ochrey colour. the abdomen is full, the bowels being more or less distended with wind, sometimes tender, especially at the right side, and both tender and painful in all cases where the disease is severe. towards the end of the first, or at the latest by the middle of the second week, small rose-red spots or pimples appear on the abdomen, sometimes also on the chest and back. they disappear for the moment if pressure is made on them, but reappear the moment the pressure is withdrawn. now and then they are numerous, and sometimes two or three successive crops appear, the old ones fading as the others show themselves; but in childhood they are often scanty, though whether few or many, they are the external characteristic of the disease just as the rash is in scarlatina or measles. whenever a child of whatever age begins without obvious cause to lose appetite and health, to become feverish, with marked increase of temperature towards evening for several days together, and more or less disposition to diarrh[oe]a, it is all but absolutely certain that the child has contracted typhoid fever. when the disease comes on gradually, it seldom becomes dangerous, though until the end of the first week there is always considerable uncertainty on this point. the amount of diarrh[oe]a and the degree of disorder of the brain, as shown by restlessness, delirium, and stupor are the measure of the gravity of any case. there is, however, scarcely any disease from which even when most severe recovery so often takes place in childhood, and this not as persons so often imagine from some critical occurrence but by a process of gradual amendment. the first signs of amendment, too, may be taken as giving almost certain promise of complete recovery; but it is well to bear in mind that there is no disease of early life in which the mental faculties, though time brings them back at length uninjured, remain so long in a state of feebleness and torpor as in typhoid fever. though the first signs of improvement, too, are very seldom deceptive, yet the patient's convalescence is almost always slow, and interrupted by many fluctuations. though contagious, still typhoid fever is far less directly contagious than measles or scarlatina. it seems as if with this disease, just as with cholera, the contagious element were present in its most active form in the discharges from the bowels. these should therefore be disinfected by carbolic acid or some other disinfectant immediately; and should never be emptied in a closet used by other members of the family, and more particularly by children. special precautions also should be taken with the bed-linen, and night-dresses of the patient; and it must be remembered that wise precautions have nothing in common with exaggerated alarm. one more hint will not be out of place. in typhoid fever, and still more in the highly contagious measles and scarlatina, the person who sleeps in the patient's room is much more likely to contract the disease than she who sits up and watches at night keeping wide awake. whoever takes charge of a fever patient during the night should therefore sit up and watch, not lie down and doze, and this not for the patient's sake only, but for her own. it can scarcely be necessary to say that in every, even the mildest, attack of typhoid fever the attendance of the doctor is needed from first to last. he may come every day, and may daily do nothing but merely watch. the disease will run its course, the greatest skill cannot cut it short, though now and then instead of lasting for three or even four weeks it comes to an end spontaneously in fourteen days. skilled watching is what the competent doctor gives. you would not despise or underestimate the pilot's skill, who steered your barque through a dangerous sea in smoothest water, because he knew each hidden rock or unseen quicksand on which but for his guidance you might have made shipwreck. =small-pox.=--at the present day, thanks to vaccination, and to re-vaccination, _small-pox_ is rarely met with in the well-to-do classes of society, though it is not yet a century ago since it found its victims not only among the poor, but among the highest in the land. it does, however, occur sometimes after vaccination, and sometimes, though very rarely, an attack of small-pox fails to furnish an absolute guarantee against the occurrence of a second. small-pox, unmodified by previous vaccination, sets in in the child with violent sickness; vomiting, sometimes recurring frequently for forty-eight hours, with much depression, or even stupor; in some instances even actual convulsions, and fever; but neither with the sore-throat of scarlatina, nor with the sneezing, cough, and running at the nose of measles. at the end of from forty-eight to sixty hours, an eruption of pimples appears on the face, forehead, forearms and wrists, whence it extends to the body and the lower limbs. they are reddish in colour, rather pointed in form, and at first scarcely raised above the surface; so that the eruption looks at first like the very early eruption of measles; though the tiny pimples felt as if beneath the skin serve even then to distinguish the one disease from the other. in another forty-eight hours the character of the pimples has changed into that of little vesicles or pocks, depressed instead of pointed at their centre, and containing a little watery milky fluid. they next enlarge, and become once more prominent at their centre as they fill more and more with fluid, which becomes thicker, yellowish-white--looks like, and indeed is, matter. four or five days are occupied with this process; the matter in the pocks then begins to dry, and scabs to form, which gradually by the end of another week drop off, and leave the skin spotted with red or even scarred if the pocks went deep enough to destroy the skin, and to leave the indelible marks, the so-called pitting of small-pox. the danger of the disease is in childhood the nervous disorder at the outset, and then the exhaustion produced by the so-called maturation of the pocks when the thin watery fluid changes to the thicker matter, and depresses the patient in the same way as he would be depressed by an enormous abscess. the first outbreak of the eruption is followed always by a most remarkable abatement in the disturbance of the constitution, and for three or four days, even though the eruption is abundant, the patient may seem so well that it is almost impossible to realise the imminent peril to which he will be exposed in a few days' time. =inoculation and vaccination.=--the danger of small-pox is in direct proportion to the abundance of the eruption; and the great advantage of inoculation for the small-pox consisted in the much scantier eruption which followed it, as compared with that which commonly took place in the natural small-pox. the same advantage in a greater degree is obtained by vaccination, even in the exceptional instances in which it fails to render the person altogether insusceptible to the disease. the great advantage which inoculation secured was counterbalanced in great measure by the fact that it always maintained small-pox rife throughout the whole country, and that consequently all who either had neglected inoculation, or young children on whom, on account of their tender age, it had not yet been practised, were more than ever exposed to constant risk of infection. this very real danger led to the almost unanimous welcome which the practice of vaccination received towards the end of the last century, since it was hoped that by it not only would the risk attending small-pox be lessened, and the disease when it did occur be even milder in character than inoculated small-pox, but that small-pox itself would eventually be extirpated. these anticipations have not hitherto been fully realised; but the good effected by vaccination has been such as to render it, in the opinion of nearly everyone qualified to form an opinion on the subject, one of the greatest boons ever conferred on the human race. small-pox, like other eruptive fevers, has the peculiarity of occurring for the most part only once in a person's life. we do not know in the least on what this protecting influence depends. we know the fact, but are the less able to offer an explanation, since there are other constitutional diseases, such as gout and rheumatism, in which the local symptoms are equally the outcome of previous constitutional disorder, where exactly the opposite rule obtains, and in which their occurrence does but increase the liability to their return. the protective power is apparently possessed by the mild form of the disease communicated by inoculation as much as by the severer form of small-pox which is contracted by direct contagion or infection. this knowledge has been applied in the treatment of some of the diseases of animals, and it has been found in the case of the so-called small-pox in sheep (a disease which, however, is quite distinct from human small-pox) that while one in two of the animals who contracted it in the ordinary way died, death took place in only three per cent, or not one in thirty, of those in whom it was produced by inoculation; and the inoculated sheep were thereby safeguarded from subsequent attacks as completely as the others. this knowledge was more recently applied by the distinguished frenchman whom i have already mentioned, m. pasteur, in the case of a fatal pestilence among sheep in many parts of france, known by the name of _charbon_. the inoculated sheep died, however, in such large numbers, though in a somewhat smaller proportion than those who had been directly infected, that he found it necessary to weaken the matter which he employed by admixture with other innocuous materials. this experiment, however, again yielded unsatisfactory results; slight symptoms of the disease were produced, but the protection thus afforded was inadequate and uncertain. some few resisted the disease, but others contracted it and died. with that clear insight which constitutes genius, m. pasteur next tried the experiment of inoculating the sheep first with a weak matter which produced but slight symptoms, but at the same time enabled the animal to support a second inoculation with a stronger matter; and this second inoculation enabled them to bear, unharmed, subsequent exposure to the disease. a grateful country has given a pension, and conferred well-merited honours on the man who has preserved their flocks from pestilence, but whom the silly sentimentality of the anti-vivisectionists in england would have mulcted in a fine, and, if possible, have sent to prison. that weakening of the poisonous element which pasteur strove to attain by art, is already provided by nature in the cow-pox. the cow-pox is nothing else than small-pox modified in character, diminished in severity by passing through the system of the animal; but giving, when introduced into the system, a safeguard against natural small-pox at least as complete as that furnished by the inoculated disease. more than , children have come under my observation, either in hospital or in private practice; and i need not say that a physician having much consulting practice sees far more than the average of unusual and severe cases. twice, and only twice, i have seen infants die from vaccination, and in both instances death took place from erysipelas beginning at the puncture. the one case i saw twice in consultation with the family practitioner. the other which i watched throughout was that of a little boy, the fifth child of a nobleman of high rank, both his parents being perfectly healthy. he was vaccinated by the family doctor in the country, direct from the arm of another perfectly healthy infant, from whom ten other infants were vaccinated immediately afterwards. the little boy was seized with convulsions within twenty-four hours, and almost at the same time erysipelas appeared on the punctured arm. the erysipelas extended rapidly, convulsions returned more than once, and on the fourth day from the vaccination the child died. one of the other children vaccinated at the same time died in the country in the same manner; all the others passed through vaccination regularly, and without a single bad symptom. i have no explanation to offer; this case stands by itself just as do those of death from the sting of a bee or death from cutting a corn. that some people die of other diseases since the introduction of vaccination, is undoubtedly true, for many of those who would have died in early infancy of small-pox are cut off later by measles or bronchitis, or die during teething; since it is obvious that vaccination does not protect against any other disease than small-pox. that protection, indeed, is not absolute, nor was the protection afforded by inoculation absolute; but small-pox after vaccination, even when it does occur, is very rarely severe, and still more seldom fatal. there seems good reason for believing that the protecting power of vaccination tends to diminish with the lapse of time; though apparently this is not always the case, nor can any direct statement be made as to the conditions which favour this in one case, or prevent it in another. as a matter of fact, however, we do know that such a tendency does exist, and that this tendency calls for the repetition of vaccination from time to time; such re-vaccination carefully performed being as nearly as possible an absolute guarantee against small-pox. all persons engaged as nurses or attendants at the small-pox hospital during the past thirty-two years, have been vaccinated or re-vaccinated before entering on their duties, and during this period not a single case of the disease has occurred among the whole staff. the experience of other small-pox hospitals for a shorter period is identical. as far as we know, every seventh year is a reasonable interval at which re-vaccination should be performed. one great cause of the failure of the protective power of vaccination is the unintelligent and careless manner in which it is too often performed, especially among the poor. to this same cause it is also due that in some cases of almost infinite rarity one special constitutional disease has been known to be communicated. i have never seen such a case, but i know there are such. they are, however, no more a reason against vaccination than the occasional death from an overdose of opium is a reason against the use of that drug. to avoid any risk of this kind, and also with the idea that the power of the vaccine matter may have become weakened by transmission through many thousands of persons, vaccination direct from the calf has been introduced of late years, especially in america and on the continent. the time, however, that has as yet elapsed is scarcely sufficient to test the comparative preservative power of this as compared with vaccination from the human subject. its immediate local effects are somewhat more severe; i do not know any reason why its influence should not be equally abiding. there is absolutely no foundation for the idea that scrofula, consumption, or any similar disease can be transmitted by vaccination. in some infants, whose skin is very delicate, and especially in those, some members of whose family have been liable to eruptions on the skin, vaccination has seemed to act as an irritant, and to give occasion to an eruption, or aggravate an eruption already existing. such cases, however, are not frequent, and the eruption is not more troublesome than those which often appear in teething children. the occurrence of actual erysipelas around the puncture, while very dangerous, is, as i have already stated, of excessive rarity. a thoroughly dispassionate review of the whole subject appears to me to warrant the following conclusions:-- st. that vaccination, though not a perfect guarantee against small-pox, diminishes immensely the risk of its occurrence; and that by periodical revaccination, this guarantee is rendered all but absolute. nd. that a very large proportion of the failures of vaccination are due to its careless and imperfect performance. rd. that to such careless performance and to the introduction of the blood and not of the vaccine matter alone, from one child to another are due the extremely rare instances in which one special disease has been transmitted by vaccination. th. that there is absolutely no evidence of the transmission of scrofula, consumption, or any similar disease by vaccination. th. that vaccination direct from the calf appears to present some decided advantages; but it has not yet been practised for a sufficient time to admit of a comparison between its preservative power and that of vaccination from one child to another. th. that in either case it is expedient that vaccination be performed within the first three months after birth, so as to avoid the irritation of teething which is unfavourable to successful vaccination, and also because the disposition to those skin diseases which vaccination tends to aggravate is never so considerable before the age of three months as it becomes subsequently. even when vaccination fails to protect against small-pox it tends to produce a modified and so much milder form of the disease, that while one patient died out of every two in the homerton small pox hospital who had the disease naturally, the deaths were only one in four of those who had been imperfectly vaccinated, and one in forty-three of those whose arms bore evidence of perfectly good and successful vaccination. the influence of previous vaccination often scarcely shows itself in the stage which precedes the appearance of the eruption of small-pox, the fever being often just as intense, and the general symptoms just as severe as in the unmodified disease. the difference, however, becomes at once obvious with the appearance of the rash. the pocks are always much fewer than even in mild small-pox, sometimes even not more than twenty. they never attain above half the size of the ordinary small-pox pustules; they run their course and dry off in half the time, and consequently the dangerous fever which accompanies their development in the natural disease is almost or altogether absent in the vast majority of instances. if vaccination did no more than this it would be hard to overestimate its value, or to praise as it deserves the merit of its discoverer. =chicken-pox= is an ailment of such slight importance that it would scarcely call for notice if it were not that the resemblance of the eruption to that of small-pox sometimes leads to its being mistaken for that disease. it is highly contagious, and for this reason perhaps it is usually met with in infancy and early childhood. sometimes, though by no means constantly, the eruption is preceded for twenty-four or thirty-six hours by slight feverishness; but oftener the appearance of the rash is the first indication of anything being the matter. it shows itself in the form of small pimples, which in a few hours change into small circular pocks containing a little slightly turbid fluid. they appear on the forehead, face, and body, but very rarely on the limbs; they enlarge for some two or at most three days, then shrivel and dry up; and at the end of a week the crusts or scabs fall off, scarcely ever causing any permanent pitting of the skin. they are usually not above twenty or thirty in number, though every now and then they are much more numerous without any obvious reason. their distinction from the small-pox eruption consists not only in the smaller size of the pocks, and in the entirely different course which they run, but also in the fact that two or three successive crops of the eruption appear in the course of five or six days, so that new ones, those at maturity, and those on which the crusts have already formed, or from which they have already fallen, may be seen on the child at the same time. this is sufficient of itself to establish the difference between the two diseases, and also to distinguish between chicken-pox and the milder variety of small-pox which is sometimes observed in children who have been already vaccinated. =measles= is a disease with which almost everyone is familiar, and one which with proper care is not generally attended with danger. its great risks are twofold; first, that of its being complicated with bronchitis, or inflammation of the lungs during its progress, and next of its being followed by an imperfect recovery, and by the awakening into activity any tendency to scrofulous or consumptive disease. on these two accounts the disease is not to be made light of, and special watchfulness is to be exercised during the whole time of convalescence. it is also unwise when one child in a family is attacked by measles to expose the others, as is often done, to its contagion, in order, as people say, 'to get it over;' for its mildness in one case furnishes no guarantee of its mildness in another, and the danger of the disease is almost in exact proportion to the tender age of those who are attacked by it. the early symptoms of measles are those of a bad feverish cold; the eyes grow red, weak, and watery, and are unable to bear the light, the child sneezes very frequently, sometimes almost every five minutes, and is troubled by a constant short dry cough. about the fourth day, a rash makes its appearance on the face, forehead, and behind the ears, and in the course of the next forty-eight hours travels downwards over the body and limbs, and then in another forty-eight hours it fades in the same way, being at its height on the body when it has already begun to disappear from the face. it first shows itself in the form of small red circular spots, not unlike fleabites, but very slightly raised above the somewhat reddened skin, and looking for a few hours not unlike the very early stages of small-pox, before the eruption has lost the character of minute pimples. on the face the spots sometimes run together, and then form irregular blotches about a third of an inch long by half that breadth; while elsewhere they present an irregular crescentic arrangement. as the rash fades it puts on a dirty yellowish red appearance; the surface of the skin often becomes slightly scurfy, and it continues somewhat stained of a reddish hue for some days after the eruption has disappeared. the only other point on which it is necessary to dwell is this, that the symptoms do not, as in small-pox, become less severe immediately on the appearance of the eruption, but continue just as troublesome as before for twenty-four hours or more, the voice being hoarse, the cough even more incessant, and the throat often slightly sore and red. soon, however, improvement becomes apparent, the fever lessens, the cough grows looser; and in less than a fortnight the patient is usually convalescent. the above is pretty nearly the ordinary course of measles, for we do not meet with that extreme variation in its severity which is observed in scarlatina, where one child will seem scarcely to ail at all, while its brother or sister may be in a state of extreme peril. it is not wise, however, to trust a case even of apparently mild measles to domestic management, for while the cough is troublesome in almost every case, the ear of the experienced doctor is needed to ascertain whether it is merely the cough of irritation which attends the measles, or the graver cough due to bronchitis. one other caution will not be out of place. the danger of exposure to cold is very real, but that does not necessitate the loading the child with excessive covering, or the abstaining from washing its hands and face. the child should be kept moderately cool; and sponging its hands and face frequently with tepid water soothes it and relieves the painful irritation and itching. =german measles.=--there is a disorder which seems to hold a middle place between measles and scarlatina, akin to both, identical with neither, and furnishing no sort of protection from their occurrence. it is known in this country by the name of _german measles_, or sometimes by its german name of _rötheln_; the first clear description of its character having been given by german writers. it is unfortunate that a very slight resemblance of some of its symptoms to those of scarlet fever has led to its being sometimes mistaken for it, and as the ailment is almost always very trivial, doctors anxious to avoid alarming their patients' friends, too often allow the error to go unrectified, and the disease to pass as one of mild scarlet fever. the resemblance of german measles to scarlet fever is, however, extremely slight, and is almost entirely limited to the existence of a slight sore-throat, unaccompanied with glandular swelling. the rash in no respect resembles the uniform redness of the scarlatinal eruption, and there is no peeling of the skin, nor even any roughness of the surface left behind. slight feverishness sometimes precedes the appearance of the rash for twenty-four hours; but the cough, and sneezing, and running at the eyes and nose, which usher in measles are entirely absent. the rash usually appears in the course of twenty-four hours, is never postponed beyond the second day; it begins, like that of measles, on the face, and, like it, travels downwards, but always disappears on the third day, while that of measles is not entirely gone before the eighth or ninth. the rash itself also has a different character. it consists of small, slightly elevated, round red spots which now and then coalesce into small patches, but never have the somewhat crescentic arrangement observed in the rash of measles. the colour of the spots is somewhat darker than that of the eruption of measles, while the _skin between them remains pale_, and does not assume the flush of measles. as it disappears it simply fades, and does not at all change its tint as that of measles does, and it leaves the skin unroughened. now and then german measles are severe, and are attended with a good deal of fever for a day or two, and even with symptoms of bronchitis. these cases are, however, very unusual, are seen only at times when the disease prevails epidemically; and even then the symptoms of the affection are sufficiently marked to preserve from error all but those who wish to be deceived, and to flatter themselves that their child is henceforth protected from scarlatina. =scarlatina=, or =scarlet fever=, for the two names mean the same thing, the former being only the latin term, and not implying any greater mildness of the disease, is one of the most formidable ailments of childhood, and especially of early childhood, since the highest mortality from it takes place during the third year of life. it is more dreaded in a household, and justly so, than any other disease of childhood, though, indeed, it is not limited in its occurrence to early life, and instances are familiar to us all in which the mother, devoting herself to the care of her little ones, has herself fallen a victim to the poison. i do not think it so directly contagious, from person to person, as small-pox, chicken-pox, or measles, but its infection appears to be specially abiding in its character, and to cling longer to the clothes, the bedding, and even the room of a scarlet fever patient, than that of the other eruptive fevers, except perhaps small-pox. it is an object of special dread also for two other reasons. one of these reasons is the extreme and causeless variations in its severity; so that i have known more than one or two children in the same family to have it so slightly as scarcely to be ill, two to have their lives placed in jeopardy, and two to die. the other reason for special dread is that the mildness of the disease at its outset affords but a slight guarantee against the occurrence of serious complications in its course, and still slighter against secondary diseases which may follow in its train, and either destroy life directly, or leave behind some irremediable mischief. scarlatina has been divided by medical men into three classes, according to its different degrees of severity; the mild--that accompanied with bad sore-throat--and the malignant variety. we have specially to do with the first of the three; for it is in it only that there is danger of the disease being overlooked, or mistaken. the symptoms of scarlatina usually appear within three days after exposure to its contagion, and there is very good authority for believing that the interval never exceeds six days. i should not, however, feel quite secure until after the lapse of ten days, and during this time the child ought to be isolated from his brothers and sisters. in the mildest form of the disease the appearance of the rash upon the surface, usually with, but sometimes even without slight sore-throat and feverishness, may be the first indication of an affection which is sometimes so deadly. in the majority of cases, however, it is ushered in by vomiting once or oftener, accompanied by headache, heaviness, of head, great heat of skin, and some measure of sore-throat. the brain is easily disturbed in children, as has already been said, and delirium at night during the first twenty-four hours of an attack of scarlet fever need not excite anxiety, for it then often passes away, and the disease runs a perfectly favourable course. the continuance of delirium later is an attendant only on the graver forms of scarlet fever. the rash often makes its appearance within twenty-four hours after the commencement of the illness, at latest in the course of the second day. it usually shows itself first on the neck, breast, and face, whence it extends in twenty-four hours to the body and limbs, and is then not seldom specially vivid on the inside of the thighs. its colour is a very bright red, due in part to a general flush of the skin, in part to the presence of innumerable red dots or spots, which do not communicate any sense of roughness to the hand, though now and then extremely minute red pimples are interspersed. for three days the rash usually continues to become of a deeper colour, and more generally diffused over the whole surface; it then slowly declines, but does not wholly disappear until the seventh or eighth day of the disease. as the rash subsides the skin is left rough, and by degrees scales off, often in large flakes from the hands and feet, but elsewhere in a sort of branny scales. sometimes this process is over in five or six days, while in other cases the skin peels and is reproduced several times in succession, so that it is protracted for three or four weeks or even longer. the degree of this peeling also varies as well as its duration. it is usually most considerable where the rash has been most abundant, while where the rash has been scanty, it is sometimes scarcely apparent except at the tips of the fingers and toes and just around the insertion of the nails. besides the rash there are commonly other symptoms not less characteristic of scarlatina, and among them the sore-throat is one of the most invariable. even in mild cases, it is very rarely absent, and if not present at the beginning, it comes on on the second or third day. the palate and tonsils, in these circumstances are red, and the latter are usually more or less swollen, while swallowing is attended with pain, or at any rate with discomfort. the redness of the palate, which extends also to the back of the throat, is a finely spotted redness closely resembling the rash on the surface. the tongue is coated with a thick white or yellowish coating, through which project numerous bright red points, papillæ as they are called, and this appearance of the tongue is as distinctive of scarlatina as the rash itself. later, as the rash begins to fade, the coating separates from the tongue, which is left of a bright red colour, looking raw and shining, with the little raised red points projecting beyond its surface, and constituting what has been called in medical language, the strawberry tongue. when all these symptoms are present, no one can doubt but that the case is one of scarlatina. but the decision is far less easy in mild cases, for in them the rash is sometimes extremely evanescent, the general disturbance of health very slight, and the fever and accompanying rise of temperature small. the risk in such circumstances of the disease being altogether overlooked is even greater than that of its being confounded with some other eruptive fever. the rash of measles cannot be confounded with that of scarlatina, and the distinctly spotty character of the rash of german measles ought, apart even from other differences, to render mistake impossible. perhaps the best rule that can be laid down is that every diffused red rash, not obviously formed by distinct spots, even though it be not uniform but appears in patches on the neck, breast, back, or inside of the thighs, and persists for more than twelve hours, is scarlatinal. further, that in any instance in which even very slight feverishness, or very slight sore-throat, have preceded or accompanied the rash, the nature of the ailment is stamped beyond the possibility of doubt. mistakes are made from want of careful observation, much more than from any insuperable difficulty in distinguishing one disease from the other. when the least hesitation is felt as to the nature of any rash which may appear on a child, with, or without previous illness, the question should be at once referred to a medical man. people are too apt in these circumstances to wait for a few days, and then to appeal to the doctor when all traces of rash have disappeared, and when the grounds no longer exist on which he could base a positive opinion. i need not describe the symptoms of severe and dangerous scarlatina, for long before symptoms become really formidable, the patients will have been placed under medical care. it may suffice to say that the danger is almost always in proportion to the severity of the throat-affection and swelling of the glands, and not at all in proportion to the abundance of the rash. though severe cases usually set in with severe symptoms, yet this is not invariably the case, and medical watching is all the more necessary from the very commencement, since until the end of the first week it is impossible to calculate on the subsequent course of the disease. in malignant scarlatina happily of infrequent occurrence, the child is struck down, as though its blood were poisoned, from the very first; and death takes place often within forty-eight hours, the rash appearing just sufficiently to stamp the nature of the pestilence which has proved so deadly. it may form a useful conclusion to all that has been said in this little book about the diseases of children, if i endeavour to point out in what consist the duties of parents in cases of scarlatina, or of any disease which resembles it. . to watch carefully the commencement of every slight feverish attack in which a diffused red rash appears, even though this should be only in patches, and to bear in mind the possibility of its being due to scarlatina. . to remove the child immediately from the others, so long as there is any doubt concerning the nature of the case, and to remove with him his bed, bedding, and all clothes worn by him at the time when the illness began, or the rash appeared. . to place the child if possible in a room at the top of the house, so that the other children may not pass by his door. . inasmuch as scarlatina often proves fatal to grown persons who have not already had the disease, to obtain at once the attendance of a skilled nurse, in order to avoid the risk of the disease spreading through the household. the wife belongs to her husband, the husband to his wife; their mutual duties are paramount over even those of the parent; and neither has the right to jeopardise that life which belongs to the other. to say, 'i shall not catch the disease, because i have no fear,' is as idle as it would be for the soldier to say, 'because i am brave, therefore i am invulnerable.' i have been accustomed to insist on the absence from the room of father or mother, supposing either of them not to have had scarlatina, so long as i could give the assurance that every thing was going on well; but on the slightest anxiety i have referred to both parents for their mutual decision as to the course which they would choose to adopt. from a refusal to be guided by this counsel, it has more than once happened to me, to see the child recover from mild scarlatina without a bad symptom, and the mother who had insisted on nursing the little one die of the disease to which she had needlessly exposed herself. . so soon as the disease has declared itself as scarlatina, to take up the carpets and remove the curtains from the sick child's room, to empty the drawers of any clothes which may be in them, and to hang up outside the door a sheet moistened with a solution of carbolic acid. . to arrange for all food and necessaries to be placed in an adjoining room, or at the head of the stairs, so that there may be no direct communication between the attendants on the sick and the other inmates of the house. . to insist on the attendants not wearing either silk or stuff dresses, but dresses of some washable material; and on their changing their garments as well as scrupulously washing themselves before mixing with other inmates of the house, and especially with the children. . while in all respects obeying the directions of the doctor, to grease the child all over twice in twenty-four hours with suet or lard, to which a small quantity of carbolic acid has been added. this proceeding both lessens the amount of peeling of the skin in a later stage of the disease; lessens the contagiousness of the scales which are detached; and, by promoting the healthy action of the skin, diminishes the risk of subsequent disorder of the kidneys and consequent dropsy. . even when the case has been of the slightest possible kind, to keep the child always in bed for one-and-twenty days. this was a standing rule at the children's hospital, and i am certain that its non-observance will be followed three times out of four by dropsy and kidney-disease. . when the disease is over, to destroy, if the parents' means at all permit it, the clothes and bedding of the child. when this is not practicable, to have everything exposed to the heat of superheated steam in a washington lyons or other similar disinfector, and to have all linen boiled as well as washed. lastly, to have the ceiling whitewashed, the paint cleaned, the paper stripped, and the room repapered, as well as the floor washed and rewashed with strong carbolic soap. these precautions are troublesome and costly, but disease is costlier still; and who shall estimate the cost of death! appendix _on the mental and moral faculties in childhood, and on the disorders to which they are liable._ any remarks on the ailments of children would be incomplete if no notice were taken of the mental and moral peculiarities of early life. for want of giving heed to them, not only are grave mistakes made in the education of children, but in the management of their ailments, both by doctors and by parents: much needless trouble is given to the doctors, much needless distress to the child, much needless anxiety to the parents. the common mistake committed by those parents who do not make their child an idol to fall down and worship, and thus turn him, to his own misery and theirs, into the most arbitrary of domestic tyrants, is to treat him as though he were in mind, as well as in body, a miniature man; feebler in intellect as he is inferior in strength, but differing in degree only, not in kind. now the child differs essentially from the adult in the three respects; that . he lives in the present, not in the future. . his perceptions are more vivid, and his sensibilities more acute; while the world, on which he has just entered, surrounds him with daily novelties. . he has less self-consciousness, less self-dependence, lives as a part of the world by which he is surrounded--a real practical pantheist. the child lives in the present, not in the future, nor much even in the past, till the world has been some time with him, and he by degrees shares the common heritage of retrospect and anticipation. this is the great secret of the quiet happiness which strikes almost all visitors to a children's hospital. no one can have watched the sick bed of the child without remarking the almost unvarying patience with which its illness is borne, and the extremity of peril from which apparently, in consequence of that patience, a complete recovery takes place. much, indeed, is no doubt due to the activity of the reparative powers in early life, but much also to the unruffled quiet of the mind. no sorrow for the past, no gloomy foreboding of the future, no remorse, disappointment, nor anxiety depresses the spirits and enfeebles the vital powers. the prospect of death, even when its approach is realised--and this is not so rare as some may imagine--brings in general but small alarm. this may be from the vagueness of the child's ideas; it may be, as the poet says, that in his short life's journey, 'the heaven that lies about us in our infancy' has been so much with him, that he recognises more clearly than we can do 'the glories he hath known, and that imperial palace whence he came.' i dwell on this truth, because it is of great practical moment that we should bear in mind to how very large an extent the child lives only in the present; because it follows from it that to keep the sick child happy; to remove from it all avoidable causes of alarm, of suffering, of discomfort; to avoid, as far as may be, any direct struggle with its waywardness; and even if death seems likely to occur, to look at it from a child's point of view--not from that which our larger understanding of good and evil suggests to our minds--are duties of the gravest kind which weigh on the parent and the nurse, no less than on the physician. but not only does the child live in the present far more than it is possible for the adult, but there are, besides, other important mental differences between the two. not only is the mind of the child feebler in all respects than that of the adult, but, in proportion to the feebleness of his reasoning power, there is an exaggerated activity of his perceptive faculties, a vividness of his imagination. the child lives at first in the external world, as if it were a part of himself, or he a part of it, and the gladheartedness which it rejoices us to see is as much a result of the vividness with which he realises the things around him, as of that absence of care to which it is often attributed. this peculiarity shows itself in the dreams of childhood, which exceed in the distinctness of their images those which come in later life. it shows itself, too, in the frequency with which, even when awake, the active organs perceive unreal sounds, or in the dark, at night, conjure up ocular spectra; and then not merely colours, but distinct shapes, which pass in long procession before the eyes. this power fades away with advancing life; except under some conditions of disease, the occasional appearance of luminous objects in the dark is the only relic with most of us of the gift of seeing visions with which, at least in some degree, we were endowed in our early years. the child who dreads to be alone, and asserts that he hears sounds, or perceives objects, is not expressing merely a vague apprehension of some unknown danger, but often asserts a literal truth. the sounds have been heard; in the stillness of its nursery the little one has listened to what seemed a voice calling it; or, in the dark, phantasms have risen before its eyes, and the agony of terror with which it calls for a light, or begs for its mother's presence, betrays an impression far too real to be explained away, or to be met by hard words or by unkind treatment. impressions such as these are not uncommon in childhood, even during health. disorder, direct or indirect, of the functions of the brain, more commonly the latter, greatly exaggerates them, and i have known them to outlast for many weeks all other signs of failing health after convalescence from fevers. the unreal sights are far more common than the sounds. the sounds are usually of the simplest kind--as the tinkling of a bell, of which we all remember the exquisite use made by hans andersen in one of his nursery tales; or the child's own name, at intervals repeated, just as the little watchful boy heard it in far off judæa, when it was the prelude to a wondrous communication from the unseen world. it came to him as he woke from sleep, before the morning dawned, while the lamp, lighted overnight, was burning still; and still it is so far the same that these occurrences which suggest to us problems that we cannot attempt to solve, mostly take place at times of transition from the sleeping to the waking state. the ocular spectra are usually far more vivid and detailed. those which occur in the waking state are by no means always painful, though their strangeness not infrequently alarms the child, and his horror at the dark arises, not from his seeing nothing, but from his seeing too much. some imaginative children amuse themselves with these phantasms, and then, if encouraged to relate them, will constantly transgress the boundary line between truth and falsehood, and weave their little romance. when they happen on waking they are usually preceded by frightful dreams, but the image which the child sees then is not the mere recollection of the dream, but a new, distinct, though painful impression; generally of some animal to which the child points, as now here, now there. these night terrors from the very circumstantial character of the impressions which attend them, often, as i have already said, occasion needless anxiety as to the importance of the cause on which they depend. sleep-walking in its smaller degrees of getting out of bed at night, is by no means unusual in childhood; but the greater degrees of somnambulism are certainly rare; and i have always found them dependent on undue mental work; not always, indeed, on the tasks being excessive, but sometimes on the over-anxiety of the child to make progress. i have not yet known a poor person's child a somnambulist. but not only are the perceptions more acute in childhood than in adult life, the sensibilities are more intense. the child's emotions, indeed, are often transitory--generally very transitory; but while they last they produce results far greater than in the grown person. in the case of the latter, recollection of the past, anticipation of the future, or even the duties of the present, control the overwhelming sorrow, or call forth the energies needed to bear it. the child lives in the present, and this present is but the reflection of the world around, its impressions uncontrolled by experience, ungoverned by reason. the broken-heartedness of a child on leaving home is not the expression only of intense affection for its friends or relations, it is the shock of separation from the familiar objects which have surrounded it; and i have not infrequently seen children inconsolable when removed from homes that were most wretched, or from relations who were most unkind. every now and then, indeed, i have been compelled to send children home from the hospital because no love nor care could reconcile them to the change from home; and they have refused to eat, and spent their nights in weeping. the feeling is an unreasoning one, like the home-sickness of the mountaineer. but, moreover, sudden shocks may sometimes overthrow the whole moral equilibrium, and disarrange the balance of the nervous system so seriously as to cause the death of a child previously free from any important ailment. thus, i remember a little boy five years of age who died sixteen days after his father's funeral. the strange sad scene overcame him, though there had been no special tie between him and his father. he shivered violently, became very sick, complained by signs of pain in the head, for he had lost his speech, which he regained by slow degrees in the course of four or five days. improvement in other respects did not take place, he lay in a drowsy state save when he called for his mother, and at length the drowsiness deepened into stupor, and so he died. i suppose his mother was right; she said his heart was broken. it behoves us to bear in mind that the heart may break, or the reason fail, under causes that seem to us quite insufficient; that the griefs of childhood may be, in proportion to the child's powers of bearing them, as overwhelming as those which break the strong man down. every now and then we are shocked by the tale that some young child has committed suicide, and for reasons which to our judgment seem most trivial--from fear of punishment, or even from mere dread of reproof. these facts deserve special attention, they show how much more the susceptibility and sensitiveness of children need to be taken into consideration than is commonly done. this keenness of the emotions in children displays itself in other ways, and has constantly to be borne in mind in our management of them. the child loves intensely, or dislikes strongly; craves most earnestly for sympathy, clings most tenaciously to the stronger, better, higher around it, or to what it fancies so; or shrinks, in often causeless but unconquerable dread, from things or persons that have made on it an unpleasant impression. reason as yet does not govern its caprices, nor the more intelligent selfishness of later years hinder their manifestation. the waywardness of the most wilful child is determined by some cause near at hand; and those who love children, and can read their thoughts, will not in general be long in discovering their motives and seeing through their conduct. one word more must be said with reference to that intense craving for sympathy so characteristic of the child. it is this which often underlies the disposition to exaggerate its ailments, or even to feign such as do not exist, and in such attempts at deception it often perseveres with almost incredible resolution. over and over again i have met with instances where the motives to such deception were neither the increase of comfort nor the gratification of mere indolence; but the monopolising the love and sympathy which during some bygone illness had been extended to it, and which it could not bear to share again with its brothers and sisters. this feeling, too, sometimes becomes quite uncontrollable, and the child then needs as much care and as judicious management, both bodily and mental, to bring it back to health, as would be called for in the case of some adult hypochondriac or monomaniac. a caution may not be out of place as to the importance of not ministering to this tendency to exaggerated self-consciousness by talking of children's ailments in their hearing, or by seeming to notice the complaints they make as though they were something out of the common way. it will be observed that throughout i have dwelt more on disorders of the moral faculties than of the intellectual powers in childhood, and i have done so because i believe them to be the more common and the more important. in the feeble-minded the moral sense almost invariably participates in the weakness of the intellect; but it is by no means unusual for the former to be grievously perverted, while the intelligence is in no respect deficient. the moral element in the child seems to me to assert its superiority in this, that it is the most keenly sensitive, the soonest disordered-- 'like sweet bells jangled, out of tune, and harsh,' and the discord is first perceived in the finest notes. to a very great extent, a mixture of vanity and of a morbid craving for sympathy lie at the root of many of those perversions of character which excite a parent's anxiety. one of these consists in an over-scrupulousness with reference to the right or wrong of actions in themselves quite indifferent; in doubts as to whether the morning or evening prayer has been properly said, whether something was or was not absolutely true, whether this or that peccadillo was a grievous offence against god, and so on; and all these little cases of conscience are brought by the child several times a day to his mother or to his nurse for solution. if listened to readily the child's truthfulness becomes inevitably destroyed, and he grows up with a morbid frame of mind, which after-life will aggravate almost infinitely. one knows indeed the history of child saints; but it must be remembered that one great characteristic of pre-eminent sanctity at all ages of life is reticence, while these little people are perpetually seeking to interest others in themselves, their doubts, and feelings. if wisely dealt with, not by direct ridicule, but by a wholesome neglect of the child's revelations, treating them as of no special interest or importance, and discouraging that minute introspection which, of doubtful good at any age, is absolutely destructive of the simplicity of childhood, this unnatural condition will soon pass away. it will help this object very much, if the child is sent on a visit to judicious friends, and change of scene, of pursuits, of playmates, and amusements will be of all the more service since these morbid states of mind seldom come on in children whose bodily health is robust. another mode in which the same perverted feelings display themselves is in the disposition occasionally noticed to exaggerate some real ailment, or to complain of some ailment which is altogether imaginary. so far is this from being rare that my experience coincides entirely with that of the french physician m. roger, who has had larger opportunities than anyone else in france for observing the diseases of children, and who says, 'it must be borne in mind that simulated ailments are much more common in the children's hospital than in a hospital for adults.' it is difficult to assign any sufficient reason for this conduct. mere indolence seems sometimes to be the chief reason for it, oftener vanity; the sense of importance in finding everything in the household arranged with exclusive reference to itself appears to be the motive for it; and this may sometimes be observed to be very powerful even at an exceedingly early age. in many instances a morbid craving for sympathy is mingled with the love of importance, and both these sentiments are not infrequently exaggerated by the conduct of a foolishly fond mother. real illness, however, in almost all these cases exists at the commencement, though the child persists in complaining of its old symptoms long after their cause has disappeared. the great difficulty which the doctor meets with in the management of these cases arises from the incredulity with which his opinion is received. candour is looked upon as so eminently characteristic of childhood, that deceit seems impossible; the case is thought by the parents to be an obscure one which the doctor does not understand; and therefore it is said, he, with want of straightforwardness and of kindness, throws doubts on the existence of disease, and on the truthfulness of a most loving, most suffering child. the vagaries of a hysterical girl, the fits, the palsy, the half-unconsciousness have all been assumed within my own observation by children from ten to fifteen years old, and i have more than once had to give place to the ignorant and impudent pretender who traded successfully on the feelings of the parents. sometimes, one knows not why, except that the child has got tired of the part he was playing, the symptoms that had caused so much anxiety suddenly disappear, but even then the habit of mind left behind is anything but healthy. indeed in all cases of this kind it is much less the state of the body than that of the mind which excites my apprehension. the constant watching its own sensations, the habit of constantly gratifying every wayward wish and temper under the plea of illness, and the constant indulgence which it too often meets with in this from the over-kindness of its parents, exert a most injurious influence on its character, and it grows up a juvenile hypochondriac. a doctor is very unlikely to throw doubt recklessly on the reality of a child's illness. his hesitation should certainly not be attributed to unworthy motives; the parents should co-operate with him heartily in any course of observation which he desires to follow, and if necessary another medical man of experience should be associated with the first, and allowed to visit the child two or three times. one does not associate the idea of moral delinquency with hysteria; the child who shams belongs to the same class with the hysterical patient. it is only the strangeness of the occurrence in the eyes of non-medical people, that makes them fancy it something worse. if now the suspicion is justified that the child is either greatly exaggerating or altogether feigning illness, it does not by any means always follow that he should at once be charged with it, since it is often of much importance that his self-respect should not be destroyed. it must be remembered that there is in all these cases a measure of real ailment underlying all the half-unconscious exaggeration, and that if spoiling and over-indulgence do much to foster it, sternness and punishment interfere with recovery. to turn the thoughts away from self, to occupy the mind with new scenes, new amusements, new pursuits, to call forth by degrees self-control, and to let the child perceive rather by your manner than by what is actually said that the parents have not been duped by all his past vagaries; such are the simple means by which the little one will be brought round again to health of mind and health of body. unhappily, in the minds of too many people the idea of the doctor is associated with the administration of drugs and with nothing else; the treatment of disease is of much wider scope; and many of our best remedies are those which do not admit of being weighed or measured, and whose names are not inscribed on the drawers or bottles in apothecaries' hall. another phase of mental disorder in childhood sometimes presents itself as the result of overtasking the intellectual powers. this over-work too is by no means due in all cases to the parents' unwisely urging the child forward, but it is often quite voluntary on his part. the precaution too of limiting the hours of work is often inadequate from the want of some provision for turning the thoughts and energies during play hours into some perfectly different channel. in many of these cases nature happily takes matters into her own management. for a year or two, or more, the mind has grown apparently at the expense of the body; the parents take a fearful joy in their darling's acquirements; and if it should live, think they, of what remarkable talents will it not be the possessor! by degrees, the extreme quickness of intellect becomes less remarkable; but the body begins to increase in robustness; and a year will sometimes suffice to transmute the little fairy, so quick, so clever, but so fragile, into a very commonplace, merry, rosy, romping child. i may add that it is well to bear in mind the converse of this; to remember that body and mind rarely grow in equal proportion at one time; that the incorrigible little dunce, though not likely to prove a genius as he grows older, will yet very probably be found at twelve or fourteen to know as much as his playmates. a dull mind, and a sickly or ill-developed frame may make us anxious: but if the physical development is good, the mind will not be likely to remain long below the average standard. but sometimes, the over-tasked mind leads to mischief which nature cannot rectify; an attack of water on the brain destroys the child, or if not it sinks under almost any accidental disease. in other instances neither of these results takes place, but the whole nervous system seems profoundly shaken, and the moral character of the child seriously, and even permanently injured. i remember a quick and clever little girl aged five and a half years who was urged on by her governess to work which she delighted in, till at length the signs of over-taxed brain showed themselves in frequent extreme irritability, and occasional attacks of causeless fury amounting almost to madness. it was fully a year during which almost all mental work was suspended, while the child was sent to have complete change under most judicious management in the country, before her mind quite recovered its balance and she became able to resume her studies in a very moderate degree. cases such as this are instances of the slightest degree of a condition which if not remedied may pass into confirmed insanity. i believe the gradations to be almost imperceptible by which the one state passes into the other; and i have known instances in which the ungovernable temper and occasional fury of the child have passed in youth into abiding insanity which rendered the patient the inmate, and i fear the permanent inmate, of a lunatic asylum. in whatever circumstances insanity comes on in childhood, and it does sometimes, though very seldom, come on independently of any obvious exciting cause, it always assumes the character of what has been termed moral insanity, or of that condition in which the moral system rather than the mental power is chiefly disordered. idiocy is unquestionably of much more frequent occurrence in childhood, than any of those forms of mental or moral disorder of which i have been speaking hitherto. the term idiocy, however, is a very wide one, including conditions differing remarkably from each other both in kind and degree, while not seldom it is misapplied to cases in which there is mere backwardness of intellectual power. =backward children.=--_enfants arriérés_--as the french call them--constitute a class by no means seldom met with. they generally attain their bodily development slowly, and the development of their mind is equally tardy. they cut their teeth late, walk late, talk late, are slow in learning to wash and dress themselves, are generally dull in their perceptions, and do not lay aside the habits of infancy till far advanced in childhood. when the time comes for positive instruction, their slowness almost wears out everyone's patience; and among the poor indeed the attempt at teaching such children is at length given up in despair, and growing up in absolute ignorance, it is no wonder that they should be regarded as idiots. still, dull as such children are, there is between them and the idiot an essential difference. the backward child, unlike the idiot, does not remain stationary; his development goes on, but more slowly than that of other children, he is behind them in the whole course of their progress, and his delay increasing every day, places at length an enormous distance between him and them--a distance which in fact becomes insurmountable. in some of its minor degrees even, this backwardness not infrequently excites the solicitude of parents. it is sometimes observed in children who had been ill-nourished in infancy or who had been weakened by some serious or protracted illness, even though unattended by any special affection of the brain; but it is also met with independent of any special cause. the distinction, however, between such a case and one of idiocy is this, that though at four years old the child may not seem to be intellectually superior to most children at two, yet in manners, habits, and intelligence it does agree with what might be expected from the child at two; less bright perhaps, less joyous, but still presenting nothing which if it were but younger would awaken apprehension. it is well in all cases of unusual backwardness to ascertain the condition of the sense of hearing, and of the power of speech, for i have known the existence of deafness long overlooked, and the child's dulness and inability to speak referred to intellectual deficiency; and have also observed mere difficulty of articulation, dependent partly on malformation of the mouth, lead to a similar misapprehension. in both instances i have seen this inability to keep up ready intercourse with other children cast a shadow over the mind, and the little ones in consequence be dull, suspicious, unchild-like. i have already referred to a similar result as sometimes following serious illnesses. the child will for months cease to walk, or forget to talk, if these had been but comparatively recent acquirements; or will continue dull and unequal to any mental effort for weeks or months together, and then the mind will begin to develop itself once more, though slowly, possibly so slowly as never altogether to make up for lost ground. =idiocy.=--in _idiocy_, however, there is much more than the mere arrest of the intellect at any period. the idiot of eight years old does not correspond in his mental development to the child at six, or four, or two; his mind is not only dwarfed but deformed; while feebleness of will is often as remarkable as mere deficiency of power of apprehension. even in earliest infancy there is usually a something in the child idiotic from birth which marks him as different from babies of his own age. he is unable to support his head, which rolls about from side to side, almost without an effort on his part to prevent it. next it is perceived that the child, though he can see, does not notice; that his eye does not meet his mother's with the fond look of recognition, accompanied with the dimpling smile, with which the infant, even of three months old, greets his mother. then it is found to have no notion of grasping anything, though that is usually almost the first accomplishment of babyhood; if tossed in its nurse's arms there seems to be no spring in its limbs; and though a strange vacant smile sometimes passes over its face, yet the merry ringing laugh of infancy or joyous chuckle of irrepressible glee is not heard. as time passes on, the child shows no pleasure at being put down 'to feel its feet,' as nurses term it; if laid on the floor it probably cries, but does not attempt to turn round, nor try to crawl about as other babies do. it does not learn to stand or walk till late, and then stands awkwardly, walks with difficulty, crossing its legs immediately on assuming the erect posture, an infirmity which it often takes years to overcome. just, too, as the idiot is slow to notice, slow in learning to grasp anything, or to stand or walk, so he is late in learning to talk, he often acquires but few words, for his ideas are few. he learns even these few with difficulty, and employs the same to express many different things; he generally articulates them indistinctly, often indeed so imperfectly as to be almost unintelligible. in other instances the evidences of idiocy are not present at birth, or at any rate are not then noticed, but succeed to some attack of convulsions or to some illness attended with serious affection of the brain. sometimes too there is no point in the child's history which can be laid hold on as marking the commencement of the weakening of his intellect, but as the body grows the mind remains stationary, or its powers retrocede, until by degrees the painful conviction that the child has become idiotic forces itself upon the unwilling parents. here we have sometimes the sad spectacle of the body perfectly developed, hale and strong, but the mind obscured; the child in constant unrest, perpetually chattering, laughing without cause, destroying its clothes, or the furniture of its room, for no purpose; or sitting silent, with a weird smile upon its face, looking at its spread-out fingers, or stroking a piece of cloth for a quarter of an hour together as though the sensation yielded it a kind of pleasure. it would be almost endless to describe the various degrees of mental weakness; from the slight silliness down to the condition in which the child is, and remains all life long, below the level of the brute. parents as a rule are anxious to persuade themselves, and to persuade the doctor that their idiot child was once as bright and intelligent as others; and that the mind was darkened by some grave illness. we have, however, the highest authority, that of dr. down, for saying that as a rule which has but few exceptions idiocy from birth is more amenable to training than that which comes on afterwards, that in fact it is more hopeful to have to do with an ill-developed than with a damaged brain. the one great question which still remains is what can the parents do for best and wisest whom the affliction has befallen of having an idiot child. first. to moderate their expectations as to the results of any, even the best devised and most successful treatment. the child who has been born of weak intellect, or who has become so as the result of illness, will always remain at a lower level than others, and this, even though some one faculty, as the musical faculty, or the power of calculation, should be above the average. secondly. from the child's earliest infancy to occupy themselves in perfecting as far as possible the physical powers and aptitudes, and the habits of cleanliness and order. development of mind waits on development of body: to stand, to sit, to walk, to grasp an object put into the hand, are essential to bringing the idiot child into relation with the world around it; are its elementary education, to be given patiently, cheerfully, lovingly, even for years together. to attend to its natural wants, and by fixed routine to accustom it at stated hours to empty its bowels and its bladder is a lesson hard to teach; and not less difficult is it to make the child learn to masticate its food, to drink without slobbering, and then to use the spoon and fork, and to feed itself; and afterwards to dress itself, to wash itself, to tie its shoestrings; for idiots almost without exception are awkward as well as lazy. the common class of nurses, even the very kindest, find it so much easier to feed the child, to wash it, and to dress it, than to teach it to do any of these things for itself, that it too often grows up, till too old to remain in the nursery, without having made the slightest advance above the condition of completest babyhood. it is absolutely essential either that the mother should devote herself solely to the care and teaching of the idiot, or that she should engage a nurse who will have no other duty. such a person must be above the average in education and intelligence, and of course will command more than the ordinary wages. the mother, too, must resign herself to the little one's affection being transferred in a great degree from herself to the person who has constant charge of it--a hard trial this, but one to which, for her child's good, she must bring herself to submit. thirdly. so soon as the child has been taught at home to exercise these lower powers, and the question of what is termed its education arises, it is a matter of absolute necessity that he be sent to an institution specially set apart for the feeble-minded. it is absolutely impossible with the most devoted love and the most lavish expenditure of money, to do at home what can be, and is constantly, accomplished even in a pauper idiot asylum. the imitative faculty, which is usually very strongly marked in the idiot, furnishes one great means of his improvement; while besides there are many of the moral powers which cannot be brought out except in the society of other children of his own age and not differing too widely from him in mental power. i have warned, and i repeat the warning, against exaggerated expectations as to the results of even the wisest treatment. to teach cleanliness, order, and neatness; to impart knowledge enough to enable the idiot to take care of himself; to develop his affections; to enable him to read and write; to practise some easy handicraft; to partake of some simple pleasures, and so at length to return to the shelter of his own home, and to be there, not an object to be hidden away, too painful to look upon, but an object rather of special tenderness, repaying with his guileless love the sad self-sacrifice of his parents for many a year; these are endeavours almost sure of accomplishment in a well-conducted institution, sure never to be realised in a home. i have often sent afflicted parents, who shrank from parting with their children, to one institution near london; and i doubt not there are others in england, where pains, and care, and skill, and untiring love awake the slumbering intellect, arouse the dormant affections, and work miracles of healing on these helpless little ones. index. abdomen, large, its importance exaggerated, ---- tenderness of, very important, acute constitutional diseases, aperients, artificial feeding, its dangers, ---- ---- rules for, ---- ---- sometimes necessary, , ---- ---- substitutes for milk, asses' milk best substitute for human, asthma, atrophy, infantile, ---- its causes and symptoms, ---- symptoms essentially different from consumption, , ---- may depend on consumption, backwardness, bath, warm, management of, ---- ---- when to be used in convulsions, bed, importance of, in illness, bedsores, how to prevent, and treat, bedstead, best form of, for children, brain, disease of, cry in, ---- ---- proofs of absence of, ---- and nervous system, mortality from diseases of, ---- ---- convulsions as a sign of, ---- congestion of, ---- disorder of, from exhaustion, ---- inflammation of, . _see_ water on the brain. ---- disease from disease of the ear, ---- ---- symptoms of, ---- ---- treatment of, breathing, frequency of, in health and disease, bright's disease of the kidneys, bronchitis, ---- more serious than pneumonia, ---- its symptoms, catarrh, ---- its prevention and treatment, chafing, chest, cry in disease of, chicken-pox, childhood, characters of second period of, ---- mental and moral faculties, peculiarities in, ---- difference between child and adult, ---- patience of child, ---- vividness of imagination, ---- phantasms and sounds, ---- sensibility intense, ---- craving for sympathy in, children and infants, mortality of, ; _see_ mortality. ---- diseases of, their signs, ; _see_ diseases of children. ---- management, ---- spoiled, ---- sick, importance of truth with them, ---- keeping happy, chloroform in convulsions, chronic constitutional diseases, cold to the head, how to apply, colic, characters of, congestion of the brain, ---- fatal termination of, ---- chronic water on brain from, ---- treatment of, constitutional diseases, consumption, how distinguished from non-expansion of lungs, ---- its symptoms when cause of infantile atrophy, ---- its nature, ---- recovery from, ---- causes of, ---- symptoms, ---- dependent on disease of glands of lungs, ---- in infancy, ---- galloping, ---- of the bowels, convulsions, as sign of brain disorder, ---- less serious than in grown person, ---- signs of their approach, ---- causes of, various, ---- description of a fit of, ---- treatment of, ---- now and then without apparent cause, cough, from disease of glands of lungs, cow's milk, excess of curd in, ---- ---- easily deteriorated, cow-pox, its nature, croup, its nature, ---- its two kinds, ---- catarrhal, ---- distinction from diphtheria, ---- treatment of, ---- spasmodic, . _see_ spasmodic croup. cry in illness, various meanings of, ---- when lungs are imperfectly expanded, diabetes, diarrh[oe]a in childhood, ---- simple, ---- inflammatory, digestion, how performed, digestive organs, peculiarities of, in infancy, diphtheria, ---- its gradual progress, ---- caution not to overlook it, . ---- various dangers of, ---- management of, ---- opening windpipe in, ---- paralysis after, diseases of infants and children, their signs, ---- management, doctor, proper relation of parents to, dream images vivid in childhood, dyspepsia of weakly children, earache, symptoms of, ---- treatment of, ---- inflammation of brain from disease of ear, eczema, ---- its symptoms and course, ---- treatment, ---- alleged dangers of curing, epilepsy, its two forms, ---- prospects of recovery from, ---- moral perversion, from, ---- treatment of, ---- moral management of, exhaustion a cause of brain disorder, farinaceous food, why unsuitable, ---- ---- results of its excess, ---- ---- best forms of, feeding-bottle, best form of, feigned illness, fingers, scrofulous disease of bones of, food, quantity required by an infant, ---- best mode of giving, galvanism, in cases of paralysis, german measles, glandular enlargement in infantile consumption, ---- swellings from scrofula, gravel, grimacing, distinct from st. vitus's dance, gums in teething, when to be lanced, ---- management when ulcerated, head, varieties in shape of, unimportant, headache, neuralgic, ---- from defective sight, heart, malformation of, ---- ---- management of, ---- frequency of disease of, from rheumatic fever, , ---- inflammation of, hooping-cough, ---- management of, ---- its dangers, hysteria, relation of, to epilepsy, idiocy, , ---- its management, incontinence of urine, indigestion in infancy, , ---- its management, infants and children, mortality of. _see_ mortality ---- rules for artificial feeding of, ---- substitutes for mother's milk, ---- quantity of food required, ---- feeding-bottles, influenza, inoculation and vaccination, jaundice of new-born children, ---- in childhood, kidneys, disease of, lavements, their use and abuse, leeches very useful in some cases, ---- how to apply, liver, disease of, a cause of infantile atrophy, lungs, imperfect expansion of, ---- ---- ---- ---- its symptoms, ---- ---- ---- ---- ---- treatment, ---- inflammation of, rare in early infancy, measles, ---- its symptoms and dangers, ---- ---- management, medicine, choice and administration of, mercury, not cause of sore-mouth in children, mesenteric disease, ---- ---- its importance exaggerated, milk, why proper food of infants, ---- mother's, peculiarities of, soon after birth of child, ---- ---- best substitutes for, ---- ---- and that of animals compared, ---- substitutes for, ---- condensed, inferior to fresh milk, moral insanity in childhood, - ---- perversion from epilepsy, mortality of infants and children, ---- varies in different places and times, ---- causes of, ---- ---- intermarriage and hereditary taint, ---- ---- unhealthy dwellings, ---- ---- unwholesome food, ---- increased during teething, note mother not always good nurse, mouth, how to examine, ---- sore, mumps, napkins, inconvenience of, navel, rupture of, nettle-rash, neuralgia and headache, night terrors, nose, offensive discharge from, notes, importance of keeping in illness, ophthalmia of new-born children, opiates, palsy, ---- form of, peculiar to childhood, ---- its cause, ---- ---- treatment, ---- cases mistaken for it, peritonitis, ---- local, often overlooked, phantasms in childhood, pleurisy, pneumonia, ---- its symptoms, poultices, uses of, ---- how made, note premature birth, ---- ---- its management, pulse, frequency of, in health and disease, quinsy, red-gum, respiration, frequency of, in health and disease, ---- artificial, rheumatic fever, rheumatism, connection of, with st. vitus's dance, ---- chief cause of heart inflammation, rickets, round-worm, rupture of navel, scalp-swellings, scarlatina, ---- its dangers and symptoms, ---- characters of rash, ---- sore-throat of, ---- how recognised, ---- management of; duties of parents, scrofula, ---- abscesses under skin, ---- disease of bones of fingers, ---- glandular swellings, ---- offensive discharge from nostrils, shamming does not disprove illness, sick-room, management of, sleep-walking, small-pox, ---- after vaccination, snuffles, sore-mouth, ---- ---- not diphtheritic, ---- ---- not due to mercury, ---- throat of scarlatina, spasmodic croup, ---- ---- its nature and symptoms, ---- ---- ---- treatment, still-birth, stomach, how to examine, ---- ache, cry in, characteristic, st. vitus's dance, ---- ---- ---- its connection with rheumatism, ---- ---- ---- its symptoms, ---- ---- ---- distinct from mere grimacing, ---- ---- ---- its treatment, suckling, importance of, to mother and child, , ---- unfitness of some mothers for it, ---- sometimes has to be abandoned, sunstroke, tape-worm, tears, their value as a sign of disease, , teething, takes place later in man than in other animals, ---- order in which teeth appear, ---- when the gums should be lanced, ---- rules for management of, temperature, in health and disease, ---- of sick-room, ---- increase of, in infantile consumption, thermometer, importance of use of, , thread-worms, throat, white spots on, not always diphtheritic, ---- sore, inflammatory, or quinsey, ---- abscess at back of, thrush, tonsils, enlarged, ---- inflamed, ---- when to be removed, typhoid fever, ---- ---- its symptoms, ---- ---- ---- management, urine, incontinence of, vaccination, ---- m. pasteur's experiments, ---- death from, ---- re-vaccination, ---- animal, ---- alleged transmission of disease by, ---- conclusions with reference to it, ---- small-pox after, vomiting in infancy, ---- its treatment, ---- as sign of congestion of brain, water on the brain, acute, its early symptoms, ---- ---- ---- ---- symptoms of its progress, ---- ---- ----- ---- chronic, two kinds of, , whey, dr. frankland's rules for preparing, note ---- its uses, white decoction, whites in children, worms, ---- the round, and the thread-worm, ---- tape-worm, ---- treatment of, printed by spottiswoode and co., new-street square london [transcriber's notes: printer's errors have been corrected as follows: page --thoes corrected to those (to those conditions) page --do corrected to does (the experience ... does not apply) page --added comma (more gloomy, more pettish) page --removed space (distinguished) page --fidgetty corrected to fidgety (odd fidgety movements) page --added hyphen to round worm (round-worm) page --added quotation mark (a hospital for adults.') page -- corrected to (chicken-pox, ) all other spelling, hyphenation, and punctuation has been left as written. disclaimer the medical knowledge represented in this book is over a century old. the publication of this book is for historical interest only, and is not [illustration: a good sport for girls and boys] the woods hutchinson health series the child's day by woods hutchinson, a.m., m.d. sometime professor of anatomy, university of iowa; professor of comparative pathology and methods of science teaching, university of buffalo; lecturer, london medical graduates' college and university of london; and state health officer of oregon. author of "preventable diseases," "conquest of consumption," "instinct and health," and "a handbook of health." houghton mifflin company boston new york chicago copyright, , by woods hutchinson foreword "if youth only knew, if old age only could!" lamented the philosopher. what is the use, say some, of putting ideas about disease into children's heads and making them fussy about their health and anxious before their time? precisely because ideas about disease are far less hurtful than disease itself, and because the period for richest returns from sensible living is childhood--and the earlier the better. it is abundantly worth while to teach a child how to protect his health and build up his strength; too many of us only begin to take thought of our health when it is too late to do us much good. almost everything is possible in childhood. the heaviest life handicaps can be fed and played and trained out of existence in a child. even the most rudimentary knowledge, the simplest and crudest of precautions, in childhood may make all the difference between misery and happiness, success and failure in life. our greatest asset for healthful living is that most of the unspoiled instincts, the primitive likes and dislikes, of the child point in the right direction. there is no need to tell children to eat, to play, to sleep, to swim; all that is needed is to point out why they like to do these things, where to stop, what risks to avoid. the simplest and most natural method of doing this has seemed to be that of a sketch of the usual course and activities of a child's day, with a running commentary of explanation, and such outlines of our bodily structure and needs as are required to make clear why such and such a course is advisable and such another inadvisable. the greatest problem has been how to reach and hold the interest of the child; and the lion's share of such success as may have been achieved in this regard is due to the coöperation of my sister, professor mabel hutchinson douglas of whittier college, california. the author. contents good morning i. waking up ii. a good start iii. bathing and brushing breakfast going to school i. getting ready ii. an early romp iii. fresh air--why we need it iv. fresh air--how we breathe it in school i. bringing the fresh air in ii. hearing and listening iii. seeing and reading iv. a drink of water v. little cooks vi. tasting and smelling vii. talking and reciting viii. thinking and answering "absent to-day?" i. keeping well ii. some foes to fight iii. protecting our friends work and play i. growing strong ii. accidents iii. the city beautiful the evening meal a pleasant evening good night i. getting ready for bed ii. the land of nod questions and exercises the child's day good morning i. waking up if there is anything that we all enjoy, it is waking up on a bright spring morning and seeing the sunlight pouring into the room. you all know the poem beginning,-- "i remember, i remember the house where i was born; the little window where the sun came peeping in at morn." you are feeling fresh and rested and happy after your good night's sleep and you are eager to be up and out among the birds and the flowers. you are perfectly right in being glad to say "good morning" to the sun, for he is one of the best friends you have. doesn't he make the flowers blossom, and the trees grow? and he makes the apples redden, too, and the wheat-ears fill out, and the potatoes grow under the ground, and the peas and beans and melons and strawberries and raspberries above it. all these things that feed you and keep you healthy are grown by the heat of the sun. so if it were not for the sunlight we should all starve to death. while sunlight is pouring down from the sun to the earth, it is warming and cleaning the air, burning up any poisonous gases, or germs, that may be in it. by heating the air, it starts it to rising. if you will watch, you can see the air shimmering and rising from an open field on a broiling summer day, or wavering and rushing upward from a hot stove or an open register in winter. hold a little feather fluff or blow a puff of flour above a hot stove, and it will go sailing up toward the ceiling. as the heated air rises, the cooler air around rushes in to fill the place that it has left, and the outdoor "drafts" are made that we call _winds_. these winds keep the air moving about in all directions constantly, like water in a boiling pot, and in this way keep it fresh and pure and clean. if it were not for this, the air would become foul and damp and stagnant, like the water in a ditch or marshy pool. so the sun god, as our ancestors in the far east used to call him thousands of years ago, not only gives us our food to eat, but keeps the air fit for us to breathe. in still another way the sun is one of our best friends; for his rays have the wonderful power, not only of causing plants that supply us with food--the green plants, as we call them--to grow and flourish, but at the same time of withering and killing certain plants that do us harm. these plants--the colorless plants, we may call them--are the _molds_, the _fungi_, and the _bacteria_, or _germs_. you know how a pair of boots put away in a dark, damp closet, or left down in the cellar, will become covered all over with a coating of gray mold. mold grows rapidly in the dark. just so, these other colorless plants, which include most of our disease germs, grow and flourish in the dark, and are killed by sunlight. that is why no house, or room, is fit to live in, into which the sunlight does not pour freely sometime during the day. the more sunlight you can bring into your bedrooms and your playrooms and your schoolrooms, except during the heat of the day in the summer time, the better they will be. the italians have a very shrewd and true old proverb about houses and light: "where the sunlight never comes, the doctor often does." so you see that nature is guiding you in the right direction when she makes you love and delight in the bright, warm, golden sunlight; for it is one of the very best friends that you have--indeed, you couldn't possibly live without it. in one sense, in fact, though this may be a little harder for you to understand, you are sunlight yourselves; for the power in your muscles and nerves that makes you able to jump and dance and sing and laugh and breathe is the sunlight which you have eaten in bread and apples and potatoes, and which the plants had drunk in through their leaves in the long, sunny days of spring and summer. so throw up your blinds and open your windows wide to the sunlight every morning; and let the sunlight pour in all day long, except only while you are reading or studying--when the dazzling light may hurt your eyes--and for six or seven of the hottest hours of the day in summer time. perhaps your mothers will object that the sunlight will fade the carpets, or spoil the furniture; but it will put far more color into your faces than it will take out of the carpets. if you are given the choice of a bedroom, choose a room that faces south or southeast or southwest, never toward the north. ii. a good start when you are really awake and have had a good look to see what kind of morning it is, you will feel like yawning and stretching, and rubbing your eyes four or five times, before you jump out of bed; and it is a good plan to take plenty of time to do this, unless you are already late for breakfast or school. it starts your heart to beating and your lungs to breathing faster; and it limbers your muscles, so that you are ready for the harder work they must do as soon as you jump out of bed and begin to walk about and bathe and dress and run and play. when you jump out of bed, throw back the covers and turn them over the foot of the bed, so that the air and the sunlight can get at every part of them and make them clean and fresh and sweet to cover you at night again. though you may not know it, all night long, while you have been asleep, your skin has been at work cleaning and purifying your blood, pouring out gases and a watery vapor that we call _perspiration_, or _sweat_; and these impurities have been caught by the sheets and blankets. so after a bed has been slept in for four or five nights, if it has not been thrown well open in the morning, it begins to have a stuffy, foul, sourish smell. you can see from this why it is a bad thing to sleep with your head under the bedclothes, as people sometimes do, or even to pull the blankets up over your head, because you are frightened at something or are afraid that your ears will get cold. your breath has poisonous gases in it, as well as your perspiration; and the two together make the air under the bedclothes very bad. now you are ready to wash and dress. but before you do this, it is a good thing to take off your nightdress, or turn it down to your waist and tie it there with the sleeves, and go through some good swinging and "windmill" movements with your arms and shoulders and back. ( ) swing your arms round and round like the sails of a windmill; first both together, then one in one direction, and the other in the other. ( ) hold your arms straight out in front of you, and swing them backward until the backs of your hands strike behind your back. ( ) hold your arms straight out on each side, clench your fists, and then smartly bend your elbows so that you almost strike yourself on both shoulders, and repeat quickly twenty or thirty times. ( ) swing your arms, out full length, across your chest five or ten times. ( ) swing forward and down with your arms stretched out, until the tips of your fingers touch the floor. ( ) set your feet a little apart, swing forward and downward again, until your hands swing back between your ankles. [illustration: starting the day] when you come back from these down-swings, bend just as far back as you can without losing your balance, so that you put all the muscles along the front of your body on the stretch; and then swing down again between your ankles. this will help to tone up all your muscles, and limber all your joints, and set your blood to circulating well, and give you a good start for the day. iii. bathing and brushing now you are ready to wash and dress. you can easily take off the gown, or garments, that you have worn during the night; but there is one coat that you cannot take off--one that is more important and useful and beautiful than all the rest of your clothes put together, no matter of how fine material they may be made, or what they have cost. do you remember the old bible story about joseph and his "coat of many colors"? perhaps you've wished you had one just as nice. now, the fact is, your coat is more beautiful even than joseph's; and, as for its uses, it is the most wonderful coat ever made! this coat of yours changes its color from time to time; sometimes it is pink, sometimes red, sometimes a soft milky white, and sometimes a dull dark blue, or purple. i wonder if you guess what it is. sometimes it is dry and sometimes wet, sometimes it is hot and sometimes cold, sometimes rough and sometimes smoother than the softest silk--just run your hand gently over your cheek! now you have guessed my riddle. this "wonderful coat" is your skin, which covers you from top to toe. it fits more closely than any glove, and yet is so easy and comfortable that it never rubs or binds or hurts you in any way. [illustration: the skin-strainer the little pores open in furrows of the skin. this drawing is many hundred times as large as the piece of skin itself.] will the wonderful coat wash? yes, indeed, and look all the prettier. in fact, to keep it white and clear you must bathe often, not only your hands and face, but your whole body. your skin is a strainer, you know. it is a "way out" for some of the gases and waste water from the blood. what will happen, then, if you don't wash your skin? the little holes, or _pores_, that the sweat comes through may become clogged. the strainer won't let the poison out, and so it will stay inside your body. then, too, if you do not wash the skin, the little scales that are peeling off the outside coat will not be cleared away. you have noticed them, haven't you, sometime when you were pulling off black stockings? you found little white pieces, almost as fine as powder, clinging to the inside of the stockings. these little scales are always rubbing off from your skin. so every morning it is good to splash the cool water all over yourself, if you can, as the birds do in the puddles. you don't need a bathtub for this, though of course it is much pleasanter and more convenient if you have one. pour the water into a basin and splash it with your hands all over your face, neck, chest, and arms. then rub your skin well with a rough towel. next, place the basin on the floor; put your feet into it and dash the water as quickly as you can over your legs. then take another good rub. but you must not do this unless you keep warm while you are doing it, and your skin must be pink when you have finished. if you are chilly after rubbing, you should use tepid, even very hot, water for your morning bath. in summer you can bathe all over easily; but in winter, unless your room is warm, it is enough to splash the upper half of your body. once or twice a week you should take a good hot bath with soap and then sponge down in cool water. see how the birds enjoy their bath; and you will, too, if you once get into the habit of bathing regularly. now let us take a good look at this coat and see if we can find out what it is like. the other day i saw some boys playing basketball. they wore short sleeves and short trousers. four were indians, and five were white boys, and one was a negro. the skin of the white boys seemed to shine, it looked so white; and the negro's shone in its blackness; but the indian's looked a dull rich dusky brown. yes, you say, they belong to different races. but what causes the difference in their color? little specks of coloring matter, or _pigment_, which lie in the outer layer of the skin. even white skins contain a little pigment, they are not a pure white. a chinaman's skin has a little more of this pigment, so that it looks yellow; an indian's has still more; and a negro's has most of all, making him black. sunlight can increase the amount of pigment in the skin. the people who live in the torrid zone have much darker skins than those who live where the days are short and cold. you have noticed, yourself, that when you expose the skin of your face or arms to the hot sun, you become freckled, or tanned. this tanning, or browning, of the outer layer of the skin protects the more delicate coats of skin below from being scorched or injured by the strong light. when you are playing and running with your schoolmates, you see that their faces grow very red, and even their hands. why is this? because the heart has been pumping hard and has sent the red blood out toward the skin. the red color shines through the outer part of the skin. the pigment in the indian's skin, or the negro's, prevents the red blood underneath from shining through, as it does through yours. [illustration: the parts of the skin the pore p on the surface of the skin is the end of a tube through which sweat flows out. at o are the oil sacs that feed the hair h. at b are the little blood vessels that make the skin look pink.] the skin, you see, is made up of different layers. when you burn yourself, you can see a layer of skin stand out like a blister. it is white; but if the blister is broken, underneath you see the coat that is full of tiny blood vessels, so tiny and so close together that this whole coat looks red. the skin, like every other part of the body, is made up of tiny animal cells. in the outer coat they become quite flat like little scales and then wear off; and their places are taken by the newer cells that are growing from beneath. the skin grows from beneath, and bit by bit it sheds its old outer coat. this is how it keeps itself nice and new on the outside and "grows away" the marks of cuts and burns. now hold up your hand and look across it toward the light. what do you see? it looks fuzzy, doesn't it? ever and ever so many tiny little hairs are on it. the other day a little boy asked me what made his skin look so rough? i looked, and saw that all the little hairs were standing on end, so that his skin looked like "goose-flesh." it was because he was cold. the muscles at the roots of the hairs had shortened, so that they pulled the hairs straight up and made the skin look rough. what part of the body has a great deal of hair on it? the head, of course. isn't it strange that you have such long hair on the top of your head and none at all on the soles of your feet or the palms of your hands? the hair on your head protects you from cold and rain and the hot sun; but hair on your palms, would only be in the way. now look at the ends of your fingers. there the skin has grown so hard that it forms _nails_. if you look at your toes, you will see that the same thing has happened there. these nails are little pink shells to protect the ends of your fingers and toes. you see what a wonderful coat it is that you are wearing. does the skin coat keep you warm? yes, and not only that, but it keeps you cool, too. you have often seen little drops of water on your skin, when you were very hot. this sweat, or perspiration, as we call it, cools the body by making the skin moist. you know how cold it makes you to be wrapped in a wet sheet. well, the skin cools you in just the same way, when it becomes wet with sweat. the sweat comes from the blood under the skin; so that, as we saw before, by letting this moisture pass through, the skin acts as a sieve to let out the waste from the blood. then, too, the skin covers and protects all the other parts. it is thin where it needs to be thin, so as not to interfere with quick movements, as on the eyelids and the lips; and thick where it needs to be thick, to stand wear and tear, as on the soles of the feet and the palms of the hands. i remember once taking a sliver of shingle out of the back of a little boy who had been sliding down a roof. i had to sharpen my knife and press and push and at last get a pair of scissors to cut out the sliver. it was just like cutting tough leather. but even if we do sometimes get cuts and burns and bruises, yet our skin coat protects us far more than we really think. it keeps out all sorts of poisons and the germs of blood-poisoning and such diseases. these enemies can attack us only through a scratch or cut in the skin, for that is the only way they can get into the blood. the skin is better than any manufactured coat, too, because, if it is torn or scratched, it can mend itself. [illustration: reading by touch instead of sight these boys are blind; their books are printed with raised letters, which they read by feeling of them.] does your skin ever talk to you? no, of course not; yet it tells you ever so many things. shut your eyes and pick up a pencil. as you touch it, your skin tells you that it is round and smooth, and pointed at one end. you can feel the soft rubber on the other end, too. is it wet? no. is it hot? of course not. now place a book in the palm of your hand. is it flat or round, light or heavy, rough or smooth? all these things your skin tells you through little nerve tips, which are scattered thickly all over it. still another thing the skin does; if you touch anything sharp or hot, it says at once that it hurts. if your clothes are tight or uncomfortable, the skin soon lets you know. you see it is always on the lookout, always ready to tell you about the things around you and to warn you against the things that might hurt you. the fifth of your "five senses," the sense of _touch_, is in your skin. there are some parts of your skin-coat that should have special care. i hardly need tell you about washing your face carefully around your nose and in front of your ears. sometimes i have seen a "high-water mark" right down the middle of the cheek or just under the jaws or chin. of course your mother has told you about washing your hands! you see, our hands touch so many dirty things, and handle so many things that other people's hands have touched, that we ought always to wash them before a meal for fear some of the dirt or germs on them may get into our mouths and cause disease. and we really need to clean our nails as often as we wash our hands, for that little black rim under the nail is very dangerous. dust and disease germs and dirt of all kinds find it a good place in which to hide. trim your nails with a file, not a knife; and clean them with a dull cleaner, for a sharp-pointed one will scrape the nail and roughen it, or push the nail away from the skin of the finger underneath. [illustration: useful tools] trim and clean the edges of your nails carefully and thoroughly, but don't fuss much with the roots of them. that little fold of skin there may strike you as untidy, but it covers the soft growing part of the nail; and if you push it back with a nail-cleaner, it may cause the nail to crack and roughen or become inflamed and start a "hang nail" or "run around." if you push it back at all, do so only with the ball of your thumb or finger. the edges of the nails should be trimmed in a curve to match the curve of the end of the finger. of course you know that you should never bite your nails, not only because it is a bad habit and will bring a good deal of dirt into your mouth, but because you may bite, or tear down into, the tender growing part of the nail, sometimes called the _quick_; and then this part may become inflamed, and you will have a troublesome sore on the end of your finger. [illustration: do your nails look like these?] just as your nails are a part of your skin,--hardened from it and rooted in it,--so, too, are your teeth; and, like the rest of the skin, they should be kept thoroughly clean. every morning and evening at least they should be carefully brushed. if you take good care of your first teeth and have them filled when they need it, you will probably have good permanent teeth, and you won't have to suffer with toothache. the skin of your head, which grows such beautiful hair, and the hair itself, should be kept clean. there are two things needed for this. first, the hair should be brushed and combed night and morning. the skin of your scalp is shedding tiny thin scales all day and all night, just as the rest of your skin is doing. fortunately, your hair is growing from roots under the skin much in the same way as blades of grass grow from their roots; and, as it grows, it pushes up these scales from the surface of the scalp to where you can readily reach them with a good bristle brush. if they are not well brushed out, the dust and smoke from the air will mix with them, and the germs in the dust and smoke will breed in the mixture, and you will soon have "scurf" or _dandruff_ on your head. so give at least fifteen or twenty strokes with the brush before you use the comb. it isn't necessary to brush or scrape the scalp, and a comb should be used only to part the hair or take out the tangles. the second thing is to wash the hair and the scalp. boys ought to wash their hair every week; and girls, every two weeks; and girls, especially, should be careful to dry their hair very thoroughly afterwards. you will notice after washing your hair that it feels dry and fluffy, and sometimes rather harsh. this is because the soap and hot water together have washed out of the hair its natural oil, or grease, which kept it bright and soft; and this is why it is better not to wash the hair with soap and hot water oftener than once a week or so. but it shouldn't be shirked when the time does come. watch how hard your kitten works to keep her fur coat glossy, though it must be tiresome enough to lick, lick, lick. sometimes in cold weather your lips and knuckles crack and bleed. that is because the skin on those parts is so thin and so often stretched and bruised. if you will take a little pure olive oil or cold cream and rub it on your lips and hands, it will make the skin softer and not so likely to break. [illustration: shoes that show sense low heels and plenty of room for the toes.] sometimes your feet tell you that they need better care. perhaps your shoes are too tight, or too loose and rub your toes. soon the skin becomes very hard in one spot, and you have a "corn" on your toe. you must be very, very careful how your shoes and stockings fit. if you should find a corn, or the beginning of one, you had better tell your mother about it, and let her see that your stockings are not too big, so that they wrinkle into folds and chafe, or that your shoes are mended, or that you have a larger pair. and then, if you wash your feet in cold water every day, and put some vaseline or sweet oil on the hard spot night or morning, the corn will probably go away. not only your shoes, but all of your clothing must be comfortable if your skin and the parts under it are to do their work well. your clothes as well as your skin must be washed often, because the sweat, which is oily and greasy as well as watery, soaks into them, and the little white scales cling to them, and often dust and disease germs, too. one winter a little boy came to my school. the other children told me they did not like to sit by him, his clothes had such an unpleasant smell. i talked to him about it, and what do you suppose he said! "why, i can't bathe; the creek's too cold in winter." he was waiting till summer time to take a bath! no wonder the other children did not like to sit near him. yet, with all the bathing and rubbing and brushing, your skin won't be clean and beautiful and able to do all that it has to do, unless your stomach and heart and lungs are in good working order. so you must eat good food, sleep ten or twelve hours a day, and play out of doors a great deal, if you expect your skin to be healthy. breakfast when you are washed, it doesn't take you long to dress; and before you have finished brushing your hair, you begin to feel as if you were ready for breakfast. you know just where the feeling is--an empty sensation near the pit of your stomach, and you don't have to look at the clock to know that it is breakfast time. about this time something begins to smell very good downstairs; and down you go, two steps at a time, and out into the dining-room, or kitchen. you could do it with your eyes shut, just following your nose; and it is a pretty good guide to follow, too. if you will just go toward the things that smell good, and keep away from, or refuse to eat, those that smell bad, you will avoid a great many dangers, not only to your stomach, but to your general health; for a bad smell is one of nature's "black marks," and you know what they are. how nice and fresh and appetizing everything looks--the white cloth, the clean cups and saucers, and the shining spoons and forks. you are sure that a good breakfast is one of the best things in the world. you sit down and begin to eat, and everything tastes as good as it looks. [illustration: milk and sunlight don't agree the early riser can help a great deal by taking the milk bottles in out of the sun. milk spoils quickly if it is not kept cool.] a good breakfast would be an egg, or a slice of bacon or ham, with a glass of milk,--or two, if you can drink another,--and two or three slices of bread, or toast, with plenty of butter; and then some cereal with plenty of cream and sugar, or some fruit, to finish with. a breakfast like this will give you just about the right amount of strength for the morning's work. don't begin with a cereal or breakfast food; for this will spoil your appetite for your real breakfast. cereal has very little nourishment in proportion to its bulk and the way it "fills you up." bread or mush or potato alone is not enough. any one of these gives you fuel, to be sure; but it gives you very little with which to build up your body. for that you must have milk or meat or eggs or fish. it is most important that children should eat a good big breakfast. all the hundred-and-one things that you are going to do during the day--racing, jumping, shouting, studying--require strength to do; and that strength can be got only out of the power in your food, which is really, you remember, the sunlight stored up in it. sometimes, when you come down in the morning, especially if you haven't had the windows of your bedroom well open so as to get plenty of air during the night, you may feel that you are not very hungry for breakfast. or perhaps, if you have risen late, or are in a great hurry to get to school in time, you just swallow a cup of coffee or tea, and a cracker or a little piece of bread, or a small saucer of cereal. this is a very bad thing to do, because coffee and tea, while they make you feel warm and comfortable inside, have very little "strength," or food value, in them, and simply warm you up and stir up your nerves without doing you any real good at all. a cracker or a single piece of bread or one large saucer of cereal has only about one fourth of the strength in it that you will need for playing or studying until noontime. so after you have started to school with a breakfast like this, about the middle of the morning you begin to feel tired and empty and cross, and wonder what is the matter with yourself. children of your age are growing so fast that they need plenty of good, wholesome food. they get so hungry that they want to be eating all the time. for "grown-ups" three times a day is enough; but for you children, whose bodies use up the food so fast, it is well to take also a piece of bread and butter, or two or three cookies, or a glass of milk with some crackers, in the middle of the morning and again about the middle of the afternoon. it will not hurt your appetite for dinner or supper, and you won't be wanting to "pick" at cake and candy and pickles all day long. how does eating keep you alive and make you grow? eating is somewhat like mending a fire. you put wood or coal on the fire, and it keeps burning and giving out heat; but if you do not put fresh fuel on, the fire soon goes out. just so, putting food into your body feeds the "body fires" and keeps you warm, and at the same time makes you grow. of course the "body fires" are not just like those you see burning in the stove: there are no flames. but there is burning going on, just the same. the food you put into your body must be made soft and pulpy before it can burn in your muscles. now you can guess what your teeth are for. they chop, crush, and grind the food; and the tongue rolls it over and over and mixes it with the moisture in your mouth, until it is almost like very thick soup. then you make a little motion with your tongue and throat, and down it goes. [illustration: the food tube note the arrows. this is the trip made by every mouthful of food.] where does it go? it is passed down a tube that we call the _food tube_. while i tell you about it, you can look at the picture and then try to draw it yourself. the food goes quickly down the first part of the tube until it comes to a part much larger than the rest, which we call the _stomach_. here it is churned about for a long time, and the meat you have eaten is melted, or dissolved. then the food goes on into the next part of the tube, which has become narrow again. this lower part, which is about twenty-five feet long, is coiled up just below the waist, between the large bones that you can feel on each side of your body. these coils of the food tube, we call the _bowels_. winding all around the stomach and bowels are tiny branching pipes full of blood. they look somewhat like the creepers on ivy, or the tendrils on grapevines. these suck out the melted food from the bowels. they take what the body can use, and carry it away in the blood to all parts of the body. this is the fuel that keeps the "body fires" going. the tougher parts of the food, which the body cannot use, are carried down to the lower end of the bowels and pushed out by strong muscles. this waste should be passed out from the body once every day and at the same time each day. in the morning after breakfast is perhaps the best time. if you do not get rid of it every day, it makes poisons, which go into your blood and soon make you very sick indeed. you must keep clean inside as well as outside. going to school i. getting ready as soon as you have finished breakfast, and brushed your teeth and gone to the toilet, you are ready to run out of doors to play, if you have plenty of time, or, if not, to start for school. doesn't it seem a nuisance, in winter time, to have to put on a coat and overshoes and a cap or a hood, and sometimes leggings and mittens, too? but your mothers know what is best for you; and when you are young and growing fast, you have so much more surface in proportion to your weight than when you are grown up, that you lose heat from the blood in your skin very fast; and unless you are warmly dressed, you become chilled. when you are chilled, you are using up, in merely trying to keep yourself warm, some of the energy that ought to be used for growing and for working. it has been found out by careful tests that children who are not warmly dressed, and particularly whose arms and legs are not warmly covered, do not grow so fast as they ought to, and more easily catch colds and other infections. so take time to put on your cap and your coat, if the weather is cold; and, if it is snowy, to button on leggings over your stockings; and then you can play as hard as you like, and run through the snow, and keep warm and rosy and comfortable. wool is one of the best stuffs for coats and dresses and stockings and gloves and caps, not only because it is warm, but also because it is lighter in weight than anything else you could wear that would be equally warm, and because it is _porous_; that is, it will let the air pass through it, and the perspiration from the body escape through it. don't wear any clothes so tight that you cannot run and jump and play and fling your arms and legs about freely, or so fine and stylish that you are afraid of getting them soiled by romping and tumbling. it is best to wear fairly heavy, comfortable shoes with good thick soles; then you will not have to wear rubbers, except when it is actually pouring rain, or when there is melting snow or slush upon the ground. felt, or buckskin, or heavy cloth makes very good "uppers" for children's shoes; but only leather makes good soles. it is best not to wear rubbers too much, because the same waterproofness, which keeps the rain and the snow out, keeps the perspiration of your feet in, and is likely to make them damp. when they are damp, they are as easily chilled as if they had been wet through with rain or puddle water. always take off your rubbers in the house or in school, because they are holding in not only the water of perspiration, but the poisons as well; and these will poison your entire blood, so that you soon have a headache and feel generally uncomfortable. ii. an early romp the minute you are outside the door, the fresh morning air strikes your face, and you draw four or five big breaths, as if you would like to fill yourself as full as you could hold. if you have had a good night's sleep and a good breakfast, the very feel of the outdoor air will make you want to run and jump and shout and throw your arms about. this warms you up finely and gives you a good color; but if you keep it up long, you will notice that two things are happening: one, that you are breathing faster than you were before; the other, that your heart is beating harder and faster, so that you can almost feel it throbbing without putting your hand on your chest. if you run too hard, or too far, you begin to be out of breath, and your heart thumps so hard that it almost hurts. what is your heart doing? it is pumping; it is trying to pump the blood fast out to your muscles to give them the strength to run with. [illustration: an early run is a good preparation for the day's work] of course you have seen a pump? perhaps some of you have to pump water every day at home. you take the handle in your hands, lift it up, then press it down, and out pours the water through the spout; and, as you keep pumping, the water spurts out every time you press the handle down. it is hard work, and your arms are soon tired; but, as you cannot drink the water while it is down in the well, you must pump to bring it up where you can reach it. [illustration: the heart-pump the big tubes are the arteries and veins.] just so the heart pumps to keep the blood flowing round and round, through the muscles and all over the body. if you put your finger on your wrist, or on the side of your neck, you can feel a little throb, or _pulse_, for every spurt from your heart-pump; and that means for every heart-beat. this heart-pump is made of muscle, and is about the size of your clenched fist. and just as you can squeeze water from a sponge or out of a bulb-syringe, by opening and shutting your hand around it, so the big heart muscle squeezes the blood out of the heart. it squeezes it out from one side of the heart; and then, when it lets go, the blood comes rushing in from the other side to fill the heart again. so the heart goes on squeezing out and sucking in the blood, all day and all night as long as we live. when the blood comes to the muscles, it is a beautiful bright red; but after the muscles have taken what they want of it for food to burn, and warm you up, the "ashes" and the "smoke" go back into the blood and dirty its color from red to purple. then the blood is carried to the lungs, where the fresh air you breathe in blows away the "smoke" and makes the blood red again. the blood is pumped all over the body through tubes or pipes, called _blood vessels_. those that carry the red blood out from the heart, we call _arteries_. they are deep down under the skin, and we cannot see them. the pipes that carry the purple blood from the muscles and other parts back to the heart again, we call _veins_; and some of these are so close to the surface that we can easily see them through the skin. let your hand hang down a minute or two, then you can see the veins on the inside of your wrist, or on the back of your hand, if it is not too fat. [illustration: it is good to play out of doors till the bell rings--even in winter] the muscles, the brain, the skin, and other parts of the body get liquid food from the blood by "sucking" it through the walls of the smallest of the blood vessels, for these walls are very thin. in the same way, when waste passes from the muscles or the skin into the blood, it, too, soaks through the thin walls of the tiniest blood tubes, called _capillaries_. your heart beats or throbs about seventy-five times in a minute when you are well. look at the second hand of a watch, while you count the beats in your wrist or in your neck. does your heart ever become tired? not while you keep well, unless you over-drive it by running or wrestling too hard. it can rest between the beats. but the heart muscle, like any other muscle, must have plenty of good red blood to feed on. you put food into the blood by eating good breakfasts and dinners. the more you run and jump and play, the more work the heart has to do and the stronger it grows; and a good morning romp before school will send the blood flowing so merrily round from top to toe that you will feel fresher and brighter all the day. iii. fresh air--why we need it the heart is not the only thing that goes faster and harder when you run about in the morning and play hard. you are breathing faster and deeper as well, as if there were something in the air outside that you needed in your body as much as food. but, of course, you know that air is not good to eat. it has no strength in it, as food has; it isn't even a liquid like milk or coffee or tea. it is so thin and light that we call it a _gas_. indeed, i suppose it is pretty hard for you to believe that air is a real thing at all. but all outdoors is full of the gas called air, and everything that seems to be empty, like a room or an empty box, is full of it. you cannot even smell it, as you can that other gas which comes through pipes into our houses and burns at the gas jets; nor can you see it like the gas that comes out of a boiling kettle or from the whistle of a locomotive, and which we call _steam_. this is simply because air is so pure that it has no smell, and is so perfectly clear that we can see right through it. almost the only way that we can recognize it is by feeling it when it is moving. but it is a very real thing for all that; and, like sunshine and food, is one of the most important things in the world for us. what is it that air does in the body? we must need it very much, for we die quickly when we cannot get it: it takes us only about three minutes to suffocate, or choke to death, if we can't get it. you remember that the blood is pumped out from the heart, all through the body. everywhere it goes,--to the feet and the hands and the head,--it is carrying two things: food that it has sucked up from the food tube, and hundreds and hundreds of tiny red sponges called red _corpuscles_. these little sponges are full of air which they sucked up as the blood passed through the lungs. when we stop breathing,--that is, taking in air,--the little red sponges of course can't get any air to carry to the different parts of the body. the body is made up of millions of tiny, tiny animals, called _cells_,--so tiny that they can be seen only under a microscope. each of these cells must have food and air, just like any other animal. they eat the food the blood brings to them, and they take the air from the red corpuscles in the blood. with the air as a "draft," they burn up the waste scraps, as we burn scraps from the kitchen, in the back of the stove. suppose you light a candle and place it under a glass jar and watch what will happen. the flame will become weaker and weaker, and at last it will quite go out. you might think at first that the wind blew it out; but how could the wind get through or under the jar? no, the glass keeps all the outside air away from the flame; and that is just the reason why it does go out. unless it has fresh air, it cannot burn. there is something--a gas--in the air that makes the flame burn, and when it has used up all this gas inside the glass, and can't get any more, it stops burning. now you will want to know what this gas in the air is. when we write about it, we use its nickname, the large capital letter _o_; but its whole name is _oxygen_. just as the candle flame must have oxygen to keep it burning, so our cells must have oxygen to burn their impurities, or waste; and if they don't get the oxygen, and can't burn their impurities, they are poisoned by them and "go out," or die. you can see the flame when the candle is burning, but you can't see the fires that burn in our bodies; there are no real flames at all. i know it is hard for you to believe that there can be any burning when our bodies are so wet and damp. but if you can't see it, you can easily feel it. blow on your hand. how warm your breath is! touch your hand to your cheek. it is quite warm, too. if you run or play hard, you sometimes become so hot that you want to take off your coat. that is because your fires are burning faster. the muscles are using more food and making more scraps to be burned. you breathe faster and faster till at last you are "out of breath" and feel as if you would smother or choke. the blood has hard work to bring oxygen enough to keep the fires going. after the cells have burned the food scraps, they turn the "ashes" and "smoke" back into the blood-stream that is always flowing past them. if the cells did not do this, they would soon smother to death, just as you could not possibly live in a house without chimneys to carry off the smoke. and, of course, the blood wants to get rid of this waste just as quickly as possible. part of the waste in the body is liquid, like water, and can flow away through the blood pipes without needing to be burned. some of this watery waste comes out through the skin and stands in beads or drops upon it. that is the part we call perspiration, or sweat. the rest of it goes in the blood to another strainer called the _kidneys_, passes through this as _urine_, and is carried away from the body as the waste water from the bathtub and the sink is carried away from a house. for the "smoke" mother nature has still another beautiful plan. she sends the blood-stream flowing through the _lungs_, where it can send off its "smoke" and then get fresh air to carry to the cells in the muscles. when you breathe out, you are sending out the "smoke"; and when you breathe in, you are taking in fresh air. our body "smoke" is not brown or blue, like the smoke from a fire; it is a clear, odorless gas, called _carbon dioxid_. this is the same gas that makes the choke-damp of coal mines, which suffocates the miners if the mine is not well ventilated; and the same gas that sometimes gathers at the bottom of a well, making it dangerous for anyone to go down into the well to clean it. and this gas is poisonous in our bodies just as it is in the mine or the well. you see, then, how important it is that we should live much of our lives in the clear pure air out of doors, and should bring the fresh air into our houses and schools and shops. "fill up" with it all you can on your way to school, for the best of air indoors is never half so good as the free-blowing breezes outside. iv. fresh air--how we breathe it when you are running and breathing hard, and even when you are sitting still and breathing quietly, air is going into your lungs and then coming out, going in and coming out, many times every minute. how does the air get in and out of the lungs? it will not run in of itself; for it is light and floats about, you know. here, again, mother nature has planned it all out. she has made us an air bellows, or air pump, to suck it into the lungs. first we'll see what shape this pump is, and then how it works. [illustration: the chest that holds the lungs back of the lungs is the heart; its position is shown by the broken line. the black line across the chest shows how high the diaphragm rises when we breathe out quietly.] stiff rings of bone called _ribs_ run round your body, just like the hoops in an old hoop skirt, or like the metal rings round a barrel. here is a picture of the bones of the chest. perhaps your teacher can show you the skeleton of some animal. you will notice how the rings, or ribs, slant and are joined by hinges behind to the backbone and in front to the breastbone. it looks somewhat like a cage, doesn't it? put your hands on the sides of your chest and you can feel your own ribs. do they slant upward or downward? this chest-cage is our breathing-machine. before i tell you how it pumps, i want you to get a pair of bellows and see how they work. when you lift up the handle of the bellows, you make the bag of the bellows larger so that it sucks in air; and when you press the handle down again, the air puffs out through the nozzle. our air machine, though it is somewhat different from the bellows in shape, works in exactly the same way. you remember that you found that the ribs slant down and can be moved on hinges. suppose, now, you place your hands against your ribs and feel the ribs lift as you draw in a long breath. the air will be sucked into your nose just as it was into the bellows when you raised the handle. by lifting your ribs, you have made the chest-cage larger; and the air has rushed into your nose, down your windpipe, and filled your lungs. if you breathe very deeply, you will find that your stomach, too, swells out. this shows that the muscular bottom of the cage, called the _diaphragm_, has been pulled down, making the cage larger still. in this chest-cage are millions of tiny air bags that make up the lungs; and every time you take a breath, the air bags are puffed out with the fresh air that comes rushing in. by the time you let your ribs sink again, the air has given its oxygen to the blood, and the blood has poured its carbon-dioxid smoke into the air bags for you to breathe out. nature, with the same bellows, pumps in the oxygen and pumps out the "smoke." now, we breathe into our lung-bellows whatever air happens to be around us. so we should take care that the air around us is fresh air. unless the air were kept in motion by the heat of the sun, causing breezes and winds, it would become stale and wouldn't do at all for our lung-bellows to use. the air we breathe must be kept moving and fresh if it is to make us feel bright and strong and happy. mother nature has given us miles upon miles and oceans upon oceans of this clear, fresh air to breathe--"all outdoors," in fact, as far as we can see around us and for miles above our heads. she sends the winds to move the air about and blow away the dust and dirt; and the sunshine, you remember, not only to warm the air and keep it moving, but to burn right through it and kill the poisons. but this brings us to something else. you have learned that the air we breathe out would soon smother us, just as smoke would; and now we will see why. if you blow against the window pane on a cold day, the glass is no longer clear; and when you look at it closely, you see that it is covered with tiny drops of water. this is part of the breath you have just blown out. if the room is cold enough, you can see your breath in the air; that is, the steam in your breath becomes cold and appears as tiny water-drops. you have seen how in the same way, the steam, an inch or so from the spout of the teakettle, cools, making little water-drops that float in the air like clouds. part of the breath, then, is water; but most of it is a gas, and you can't see it at all as it floats away into the air about you. if your teacher has a glass of limewater, and will let you breathe into it through a tube, you will see that your breath soon makes the water look milky. this shows that the gas in your breath is not like the air about you; because air was all over the top of the limewater, yet did not change it at all. the milky look is caused by carbon dioxid, one of the poisons in your breath. when some people come close to you, you want to turn away your head, because you do not like the smell of their breath. even when one is quite well, the breath has a queer "mousey" odor, so that we never like to breathe the breath of another person. this disagreeable odor comes not only from the lungs but from the teeth. we are always breathing out poisons into the air. one of these you can see in the milky limewater, and others you can smell when you happen to come close to anyone else. [illustration: proving that the breath is not like the air] if you blow on your fingers, you feel that your breath is much warmer than the air. if people are crowded together in rooms with doors and windows shut, their breath soon heats and poisons the air, until they begin to have headache, and to feel dull and drowsy and uncomfortable. if they should be shut in too long, without any opening to let in the fresh air, as in a prison cell, or in the hold of a ship during a storm, the air would become so poisonous as to make them ill, and would even suffocate them and kill them outright. even the bees found this out thousands of years ago; and in their hives in hot weather they station lines of worker-bees, one just behind another from the door right down each of the main passages, whose business it is to do nothing but keep their wings whirring rapidly, so that they fan a steady current of fresh air into every part of the hive. [illustration: dusting--how shall we do it?] how does mother nature get rid of these poisons from our breath? of course, you say, "she uses the wind and the sunshine." yes, the winds can whisk up the poison and blow it away so fast, and the sunshine can burn up the horrid smell so quickly, that even the air above big cities, and in their streets, is quite clean enough for us to breathe, except where the people are very closely crowded together and very dirty. mother nature wants all of us to help in keeping the air clean. this we can do by keeping ourselves and our houses clean, and by being careful not to leave scraps of waste, or dirty things, in the streets and cars and parks and other public places. and you children ought to be very careful about your school yard and the halls and the classrooms, where you spend so much of your time. in school i. bringing the fresh air in the only place where air is absolutely sure to be fresh is out of doors. there, as we have seen, the sun and the winds keep it so all the time. but, unluckily, we cannot spend all our time outdoors, either when we are little or after we have grown up. so we must try in every way that we can to bring the outdoors indoors--to get plenty of fresh air and light into the houses that we live in, especially the bedrooms we sleep in and the schoolrooms we study in when we are children, and the offices or shops we work in when we are grown up. after you have your lungs and your blood well filled with air, either by walking briskly to school or by chasing one another about the school playground, you will suddenly hear the bell ring, and you march indoors and sit down at your desks. here, of course, the air cannot blow about freely from every direction, because the walls and doors and windows are shutting you in on every side. the room, to be sure, is full of air; but if the doors and windows are shut, this air has no way of getting outside, nor can the fresh, pure air out of doors--even though it be moving quite fast, as a wind or a breeze--get inside. [illustration: a classroom almost as good as the out-of-doors notice the windows open top and bottom, and the high windows under the roof. why are these good?] we must let the fresh air come in and the stale air go out. this is one of the things that windows are for; and this is why they are hung upon pulleys and made to slide up and down easily. of course, even when the windows are not open, they are letting in light, which, you remember, is a deadly enemy to germs and poisons. bright sunlight is best for purifying the air of a room, but even ordinary daylight has a good deal of germ-killing power. therefore, a room that is well lighted is not only much pleasanter to live in, but much healthier, than one that is dull and gloomy. you see why we need plenty of windows and doors: we must let in the breezes and the sunshine, and let out the poisons and the dirt. then, too, we must make the air in the building move about in order to keep it fresh; for if the air is not fresh, we soon grow tired and sleepy and have headaches. that is why your teacher keeps the windows open at the top a foot or so. you can easily see that when there are twenty or thirty of you breathing out poisons, and each one of you needing about four bushels of fresh air every minute, the old air ought to be going out and the fresh air coming in all the time. [illustration: ventilation watch the candle flames. which way is the air moving, and why?] that is also why your teacher gives you a recess, so that you can run out of doors and get some fresh air. then she can throw open all the windows and doors and have the air in the room clean and fresh when you come back again. so when recess comes, don't hang about in the hallways or on the stairs or in the basement, but run right out of doors into the playground and shout and throw your arms about and run races to fill your lungs full of fresh, sweet air and stretch all your muscles, after the confinement and sitting still. don't saunter about and whisper secrets or tell stories, but get up some lively game that doesn't take long to play, such as tag or steal-sticks or soak-ball, or duck-on-a-rock or skipping or hopscotch. these will blow all the "smoke" out of your lungs and send the hot blood flying all over your body and make you as "fresh as a daisy" for your next lesson. when you come back into the schoolroom after recess, the air will seem quite fresh and pure; but unless you keep the windows open, it will not be long before your head begins to be hot, and your eyes heavy, and you feel like yawning and stretching, and begin to wonder why the lessons are so long and tiresome. then, if your teacher will throw open all the windows and have you stand up, or, better still, march around the room singing or go through some drill or calisthenic exercises, you will soon feel quite fresh and rested again. in the mild weather of the spring or early fall, all you need to do to keep the air fresh in the schoolroom is to keep the windows well open at the top. but in the winter, the air outdoors is so cold that it has to be heated before it is brought in; and this, in any modern and properly built schoolhouse, is usually arranged for. the fresh air is drawn in through an opening in the basement and is either heated, so that it rises, or is blown by fans all over the building. this sort of fresh air, however, is never quite so good as that which comes directly from outdoors; so it is generally best to keep at least two or three windows in each room opened at the top as well, and never to depend entirely upon the air that comes through the heating system. sometimes this may mean a little draft, or current of uncomfortably cool air, for one or two of you who sit nearest the windows; but your teacher will always allow you to change your seat if this proves very unpleasant. if you have plenty of warmth in the room you sit in, unless the air outside is very cold, this "breeze" won't do you any harm at all; on the contrary, it will be good for you. instead of catching cold from a draft like this, it is from foul, stuffy, poisonous air, loaded with other people's breaths and the germs contained in them, that you catch cold. [illustration: gardens take us out of doors] in fact, staying indoors is usually the reason why people are sick. they don't go out into the clean fresh air for fear they'll be too cold! it seems a pity we can't just live out of doors all the time. perhaps we shall some day; for doctors are finding out that fresh outdoor air and good food are the very best medicines known, and the only "sure cures." they are pleasant to take, too. many cities are providing outdoor schools for children who have weak lungs or are not strong in other ways. perhaps some day all school children will be allowed to study in the open air at least part of every school day. ii. hearing and listening now you are all ready to go to work. what are you going to work with? books? pencils? paper? yes, but you have something better than those and all ready for use. it is that little kit of tools that are sometimes called our "five senses." you remember that we have already talked about one of them, the sense of touch in the skin. now which one are you going to use first this morning? if your teacher talks to you, i hope it will be the one we call the sense of hearing. suppose we try to find out something about this sense of hearing, and begin with a little experiment. take a piece of cork in your hand and lift it up high and then let it drop into a large basin or tub of water. what happens? the cork strikes and then goes bob-bob-bobbing up and down on its own waves. now watch the little waves all around the cork. where do they stop? they don't stop until they touch the edge of the pan; and no matter how big the pan is, the waves go on and on until they reach the edge. we can see these waves of water, and so we easily believe that they are there. now there are, just as truly, waves of air all around us. we cannot see the waves, because they are too small and roll too quickly. but some of these, when they roll against our ears, make us hear. they make what we call _sound_. you have heard about sending messages through the air, without telegraph wires. wireless messages are often sent to ships out in the middle of the ocean. this is done by starting tiny electric waves, which travel through the air much as the waves of water are traveling across the ocean beneath. of course there must be a machine, called a _receiver_, to catch the waves and "hear" the message. mother nature has given each of you two very delicate little receivers to catch the sound waves and carry them to your brain. you know what they are--you can name them. but how are these wonderful little machines made? you have never seen the whole of your ear. the part on the outside of the head, of course, you can easily see and feel. sometimes you notice a deaf person put his hand behind his ear and press it forward so as to catch the sound waves better. these waves roll in at the little hole you can see, and travel along a short passage till they come to a round _drum_, a piece of very thin skin stretched tight like a drumhead. have you ever beaten a drum with a stick? you felt the drumhead quiver under the blow, did you not? well, when the sound waves beat against the drum in the ear, it quivers and starts little waves inside the ear. each little wave in turn beats against a little bone called the _hammer_; the hammer beats against another called the _anvil_, and this against a third called the _stirrup_; and the quiver of the stirrup is passed on to a little window, opening into a little room with a spiral key-board; and from this, the wave travels along a nerve to the brain. as the waves reach the brain, the brain hears. in this way we hear all sorts of sounds, from the tick of a watch to the whistle of a train. [illustration: the way by which sound waves reach the brain a section through the right ear.] there is a sensible old saying, "never put anything smaller than your elbow into the inner part of your ear." now, of course, you can't put your elbow into such a tiny hole! so the old saying means, never put anything in. the eardrum is very thin and can easily be broken. even a slap on the ear, or a loud sound too close to it, might crack and spoil the drum and make one deaf. the outside ear needs careful washing; there are so many little creases that gather dirt and dust. the deep crease behind the ear, too, will become sore if it is not kept clean. besides cleaning your ears, you must train them to listen. some boys and girls hear just a word or two of what is said, and then guess at the rest and think they are listening, or else ask to have it repeated. we should try to hear exactly what is said; and if we listen carefully, it will soon be much easier to understand at once. of course, if you really cannot hear, the doctor can tell you what is the matter, and usually can help you very much. sometimes people become deaf simply because the throat is swollen. indeed, most deafness comes from colds and catarrhs and other inflammations of the nose and throat. these spread to the ear through a little tube that runs up to the drum cavity from the back of the throat. sometimes, when you are blowing your nose, you may feel your ear go "pop"; and that means that you have blown air up into the ear through this little tube. be sure to see a doctor if you don't hear well; and be sure, too, to tell your teacher, so that she may know why it is you do not hear what she says, and ask her to give you a seat near her, so that you can hear. then, too, you should learn to notice outdoor sounds--the songs of the birds, the noises that the animals make, the wind in the trees, and the patter of the rain. the old norsemen have a story that their god heimdall had such keen ears that he could hear the grass growing in the meadow and the wool growing on the backs of the sheep! your ears can never be so keen as that; but there are many, many happy outdoor sounds that you should listen for. they will help to make you happy, too. careful listening may sometime save your life. you can hear the car or the train coming, and you can learn to tell from which direction a sound comes. you can learn to tell one sound from another in the midst of many sounds. in more ways than you can think of now, this habit of listening will protect you from danger. the germans have a proverb, "hear much and say little." what does it mean? [illustration: "do you hear it? can you see it?"] iii. seeing and reading you can learn a great deal through your ears, but think how much more you can learn through your eyes. just count over all the things that you have had to get your eyes to tell you to-day, and then shut your eyes for a minute and think what it would mean never to be able to see. don't you think you ought to take very good care of your eyes? you are going to keep them very busy all your life, and they deserve the very best care you can give them. [illustration: the light on the page, not in the eyes] just as soon as lessons begin, you get out your books; and a good share of the day in school you have a book before you, reading it or studying it or copying from it. it makes a great difference to your eyes how you hold the book and how the light falls. in reading, you should always hold your book so that the light falls upon the page from behind you, or from over one of your shoulders. in this way, the brightest light that comes into your eyes is not from the window, but from the page of your book. if the light comes from a window in front of you, or if you sit in the evening with your face toward the lamp when you read, the light coming straight from the lamp or the window, as well as the light coming up from the pages of the book, pours into your eyes; and this dazzles and confuses your eyes, so that you can't see plainly and comfortably and are very likely after a while to find that your head aches. at home, of course, you can seat yourself with your back to the light when you read; and usually at school your seats are so arranged that the light falls from behind you or from one side. if not, by turning a little in your seat, you can get the light from over your shoulder. notice how the light falls upon the blackboard. when the light comes from the windows behind you, or from one side, you can see what is written there quite plainly. but if the blackboard happens to be between two windows, and especially if this is the lightest side of the room, you will find that the light dazzles you so that you cannot see the writing clearly. you must have noticed, too, that if, after you have been reading from the blackboard you look down again suddenly to the page of your book, for an instant you will not see the letters plainly. then, almost before you have time to notice it, you feel a little change take place inside your eyes, and the print upon the page of your book becomes quite plain. this is because your eye has to change the shape of one of the parts inside it, called the _lens_, before you can see clearly the things that are near you. this change, which is called _accommodation_, is made by a little muscle of the eye; and if you keep your eyes working at close work, like reading or writing or fancy-work, too long at a time, or if your eyes need glasses to make them see clearly, and you haven't them on, this little muscle becomes tired. then the print of your book, or your writing, or the stitches you have taken begin to blur before your eyes. your eyes begin to feel tired, and your head begins to ache. this is what we call _eye strain_. sometimes this eye strain upsets your appetite or your digestion and makes you sleepless and worried. the trouble may be caused by your own carelessness: you may have been reading too long, or in a poor light, or with the light shining right in your face instead of coming over your shoulder. but sometimes it is caused by the fact that your eyes are not just the right shape; and then the only way to relieve it is to have proper glasses, or spectacles, fitted, which will make up for this too flat or too round shape, or too large or too small size, of your eyes. if you cannot see clearly what is written on the blackboard when the light falls upon it from behind you, or above; or if, in a good light, you cannot read the words in your book quite easily, without straining at all, when you hold the book either at arm's length or a foot from your face; or if your head aches or your eyes begin to feel tired or uncomfortable, or the letters begin to blur, after you have read steadily--say, for half an hour,--it is a pretty sure sign that there is some trouble with your eyes. then you had better have them examined at once by your family doctor or by the school doctor. in many schools now there are doctors to test the children's eyes, and ears, too, so that each child may have a chance to see and hear everything that the other children can see and hear. not very many years ago people thought that glasses were only for old people, but now we know that many children's eyes need glasses, too. i knew a little girl whose sight was so poor that when she was standing and looked down at the grass, she couldn't see the green blades. she thought that the grass looked like a green blur to everyone, just as it did to her; and so she never said anything about it. she was twelve or thirteen years old before she found out that she couldn't see clearly. of course, trying hard to see things gave her a headache and made her tired and cross. so some one took her to a doctor, and he saw at once what was the matter and fitted her with glasses. soon she was quite well and strong; and how glad she was to see the leaves and a hundred other things she had not seen before! [illustration: the eyeball in its socket the muscle from m to m, which helps to turn the eyeball, has been cut away to show the optic nerve.] here we have a picture of the _eyeball_, as we call it. the little bands fastened to it are the bands of muscle; and as soon as i say _muscle_ you know what they are for--to move the eyeball about, up and down and from side to side. there are muscles outside the eye as well as inside. coming out from the back of the eyeball is a pearly white cord quite different from the muscle bands. this is what we call a _nerve_. this nerve in your eye carries to your _brain_, or thinking machine, picture-messages of whatever you look at. the nerve in your eye gets messages of light much as the nerve deep in your ear gets its messages of sound--from tiny waves in the air. the light waves are smaller and faster even than the sound waves, and the eye nerve is the only nerve that can get pictures of them. you know that, for wireless messages, the receiving machines are not all alike and cannot all take the same messages, if the messages are sent with different sorts of electric waves; and neither can our receiving machines. some get messages of sight, and some of sound, and some of touch, or taste, or smell. now shut your eyes as quickly as you can. how long did it take you? a minute? no, not a quarter of a second. it is about the quickest thing you can think of--"the twinkling of an eye." you shut your eyes "quick as a wink" whenever anything seems likely to fly or splash into them, and this is what the eyelids are for. if anything gets into the eye before the lids can shut, the eye "waters," and _tears_ pour out of it. these are made by a gland-sponge up under the upper lid, so as to wash any dust or sand or other harmful speck out of the eye before it can hurt the sensitive eyeball. now look at some one's eyeball. it is like the picture, isn't it?--bright white around the edge and then a ring of color, brown or blue or gray; and inside the color-ring, or _iris_, a little round black hole that we call the _pupil_. watch the little hole change as you turn the face toward the window. it becomes ever so much smaller. now turn the face away from the window, back again into the shadow. how did the pupil change this time? [illustration: eyes protect themselves against the light] the iris, or color-ring, acts like a curtain, like the ring-shutter of a camera, and closes up the hole, or pupil, when the light is too bright and would dazzle or burn the inside of the eye; but when the light is dim, the iris opens again, so as to let in light enough with which to see. look at the little window in your kitten's eyes. it is not the same shape as yours; but when you carry her to the light, you see how the iris closes in and leaves just a little black slit or line. you remember the blind children? isn't it wonderful how they can play games and study, too, even though they are blind! they have to make their senses of touch and hearing tell them many things that you learn through your sense of sight. many of these children _need not have been blind_, if the nurse who first took care of them when they were born had known enough to wash their eyes properly, not with soap and water, of course, but with just one or two drops of a kind of medicine--an _antiseptic_, as we call it--that makes the eye perfectly clean. but you children who have good eyes that can see, do you really see things when you look at them? you can train your eyes just as you can train your ears. you can teach them to read quickly down a page, and to find things in pictures, and, better still, to see things out of doors, in the garden and the woods and on the seashore. we hear a great deal about "sharp eyes," but most of us see very little of all we might see. our eyes are on the lookout, too, to protect us from dangers that may come; with our skin and nose and ears, they are constantly on the watch; so the better we see the safer we are. even if your eyes are perfect now, you will need to take good care of them to keep them strong. don't let any story, no matter how interesting it is, tempt you to read in a dim light or a light that is too strong. and if you can't see the blackboard easily, or can't read big print, like the school calendar, across the room, tell your mother or your teacher, so that she can ask the doctor to find out what the matter is. iv. a drink of water it is astonishing what thirsty work studying is! scarcely is the second recitation over before your throat begins to feel dry, and up goes your hand--"may i get a drink?" if anyone even says the word "water," it makes you thirsty. it is so good that just the thought of it makes you want some. i should like you to notice how much water you drink every day. perhaps a glass in the morning when you get up, and one at night before you go to bed, and three or four in between. why do we need so much water? well, how much do you weigh? perhaps you will find it hard to believe, but more than half of that weight is water; and because we are always giving off water from the skin and from the body, we need plenty more to take its place. no living thing can grow without water. take a bean, for instance, and put it in an empty glass on the window sill; and even if the sun shines full upon it, nothing will happen, except that after a few days it will shrivel and dry up. but fill the glass with water, and in a few hours the bean will begin to swell; and in a few days it will burst, and a little shoot will grow out of one end of it and a tiny root at the other. the water and the warmth together have made it sprout and grow. [illustration: a drinking-cup easily made] children at school and people on trains should have their own private cups, for serious diseases may be caught from the mouths of other people. you can get a metal pocket folding cup for ten or fifteen cents, or paper ones for a few cents a dozen. if you don't have your own cup, i hope you will get one and carry it. here is a pattern for a paper cup that you can easily make for yourselves. try it and see. when you have once learned how, you can make it very quickly and have a fresh cup every time you want one; but of course you should be sure first that the paper itself is clean. if you drink milk, this takes the place of some of the water and gives you food as well. it is both drink and food; and a very good food for children it is, too. you know, babies can live on it because it has everything in it to make them grow. do you know why it is that people are so careful nowadays about having milk and drinking-water very clean? it is because they have found that the tiny plants, called germs, that make people sick are often carried about in these drinks. a disease called _typhoid fever_ is carried in this way. fifty years ago, cities and towns used to be very careless about where they got their water supply, and would often take it out of streams into which other cities emptied their sewage. now, however, they are much more particular; and the health officers, or boards of health, are insisting that public water supply, such as is brought into our houses in pipes, shall be taken either from some spring or deep-flowing well, or from a stream or lake up in the hills, into which no drainage from houses or farmyards, and no dirty water from factories, empties. [illustration: a pipe for the city water supply this pipe is laid for many miles to bring water from the distant hills.] we are still, however, far from being as careful as we should be about this; and i am sorry to say that america has had more deaths from typhoid fever than any other civilized country. germany, which, of all countries in the world, is the most particular about keeping its water supply pure, has the fewest deaths from this cause, in proportion to its population--scarcely one fifth as many as we have. therefore, by taking proper care, it would be quite possible to prevent at least two thirds of our nearly , cases of typhoid fever and , deaths from typhoid, every year. it is not only cities and towns that ought to be careful of their water supply. in fact, now, out on the farms and in the healthy country districts, the death rate from typhoid fever has actually become higher than it is in our large cities. the main cause of this is the custom of digging the well in such a place that the waste water thrown out from the house, or the drainage from the barnyard or the pigpen or the chicken-house may wash into it, soaking down through the porous soil. far more typhoid fever now is spread by means of infected well water than by any other means. most dangerous of all is the leakage from the privy vault; as, by this means, the germs of typhoid fever and other diseases that affect the food tube and digestion may drain through the soil till they reach the drinking water in the well. these dangers can be avoided either by having the well dug at some distance from the house and in higher ground, or by having the drainage from the house, barns, and out-buildings piped and carried to a safe distance from the well. fortunately, there are only a few kinds of germs that make us sick. most germs are helping us all the time; we could not live without them. some of them make our butter taste good, and others make our crops grow, and others eat up the dirt that would make us sick. but since disease germs are so tiny that we cannot possibly see them with the naked eye, we must know where the water and milk that we use come from, and whether or not they are perfectly clean. boiling the water will kill these germs and make the water pure. it is better not to boil milk if it can be had from a dairy where the stable and the cows and the milkmen and the pails and bottles are quite clean. the fruits and fruit juices--lemon and orange and raspberry and lime and grape--give nice wholesome drinks. home-made juices are much better than those you buy; you can be sure that they are pure and really made from fruit. and just here i want to caution you against buying "pink lemonade" or soda water or any other drink of that sort from the penny venders and open stalls on the street. the drinks they sell are not made from pure fruit juices, but from different flavoring extracts that are made to taste like the fruit and are colored with cheap dyes. even the sweetening in them is not pure sugar, and they are often made or handled in a careless, dirty manner, or exposed to the dust of the street, and to flies. not long ago i was at the home of a friend where for supper we had the nicest grape juice i ever tasted. when i said, "how good it is!" one of the little girls piped up, "billy and i picked the grapes, and sister made it all by herself. she learned how at cooking school." when i was packing my suitcase to leave, this little girl brought out a big bottle of grape juice and wanted me to take it with me to remember her by. it was all beautifully sealed with wax, and even this she had done by herself! do you think i could have kept it that way very long? perhaps not, it was so good; but if i had wanted it for a keepsake, i could have kept it, sealed as it was, for years and years, and it would have been just as sweet and fresh as when it was given to me. suppose, instead of keeping it in its bottle, i had poured it out into a glass. can you tell me what would have happened to it then? in a few days little bubbles would have come, one after another, up to the top of the juice; and soon it would have been all full of bubbles. what causes the bubbles? floating all about in the air and sunshine are tiny specks called _spores_. these are to the tiny _yeast_ plants what seeds are to other plants. seeds fall into the ground and grow, but these yeast spores fall into the grape juice and grow. while they are growing in the grape juice, they eat what they want from the juice; and, as they eat, they make bubbles of carbon dioxid,--which, you remember, forms in our lungs and looks like air,--and of another substance called _alcohol_. of course, when they have changed the juice in this way, it tastes very different. it is then what we call _fermented_. _fermented drinks are harmful_; but some people like bubbling drinks so much that they leave good fresh grape juice open on purpose to let the little yeast plants get into it and make it into what we call _wine_. they treat apple juice in just the same way to make _cider_; and they even take fresh rye and barley and corn, and mash them up, and put yeast plants into the mash to ferment them and make them into _whiskey_ and _beer_. it does seem a pity, doesn't it, to take good foods like wheat and apples and grapes and make them into these things that really do us harm if we drink them. a very wise man named solomon, who lived thousands of years ago, warned people not to drink wine, not even to look at it when it sparkled in the cup. he said no really wise man would drink it. of course not; the wise man uses the food and drink that make his body grow strong and his brain work true, and no fermented drink can do that. there is no better drink for anyone than clear pure water, and no better food and drink in one than pure fresh milk. [illustration: a school kitchen where both boys and girls learn to cook] v. little cooks if you have to come so far to school that you cannot go back to dinner and so must bring a luncheon with you, be sure to take plenty of time to sit down and eat it slowly and chew every piece of food thoroughly. many children who bring luncheons to school just grab a piece of food in each hand and "bolt" it down as fast as they can possibly bite it off and swallow it, and then rush out to play. play is good and very important, but you had better spare ten or fifteen minutes of it in order to chew your lunch thoroughly and swallow it slowly, and then to sit or move about quietly for a few minutes before starting to play hard. this will give your stomach a chance to get all the blood it wants to use in digesting the food; for, you remember, when you romp and play, your blood moves outward toward your skin and away from your stomach. don't think that, just because you "picnic" at lunch, it is not as important as any other meal. i hope, however, that it will not be long before almost every school will have a school kitchen and a lunch room; first, so that every girl at least can learn to cook. it is well worth while being able to do; indeed, no girl ought to be considered properly educated until she has learned to cook, and no boy either, for that matter. then, if the school has this kitchen, it can be used to furnish hot luncheons, or dinners, for those children who cannot conveniently go home in the noon recess. hot lunches are much more digestible than cold ones, and they taste much better, and are much less likely to be eaten in a hurry. but why should we learn to cook? why shouldn't we eat our food raw instead of taking all this trouble and pains to cook it? i know of a boy--a big lazy fellow--who is always forgetting to do things. he used to go away in the morning without leaving wood enough for the kitchen fire. so his mother said to herself one day, "i'll teach him to remember." the next morning he went off again and left no wood. at noon he came back "hungry as a hunter." she called him in to dinner; and in he came, sat down, picked up the carving knife--then he stopped! what do you suppose was the matter? the beef was raw! then he lifted the cover of the potato dish, and there lay the potatoes raw! then he tried another dish and found nice green peas, but hard as little bullets. they were raw, too! not even the bread had been cooked; it was a soft, sticky mass of dough. his mother, who is a jolly old lady, fairly shook with laughter when she told me about it. she said she never again had to tell him to split wood. now that boy didn't need to be told one reason for cooking. we don't like our food raw; it doesn't taste so good. at first, perhaps, that doesn't sound like a very good reason; but it is more important than you think. for it is a fact that, just as soon as you smell food, your stomach begins to get ready the juice that is to digest it. if this very first juice, which is called the _appetite juice_, is not poured out, then the food may lie in the stomach some little time before it begins to be digested at all. so it is quite important that our food should smell and taste and look good, as well as have plenty of strength and nourishment in it. another reason for cooking is that it either softens or crisps our food so that we can chew it better and digest it more readily. you know what a difference there is between trying to eat a raw potato and a nice, mealy, well-baked one, or trying to eat popcorn before it is popped and after. another good thing, too, cooking does, which is very important. it kills any disease germs, or germs of decay, that may happen to have got upon the food from dust or flies, or from careless, dirty handling. of course, some of our food, such as apples and other ripe fruits, and celery and lettuce and other green vegetables, we can eat raw and digest quite well; but we should be careful to see that they have been thoroughly washed with water that we know to be pure. grocers often have a careless way of putting fruit and vegetables out upon open stands in front of the shop, or in open boxes or baskets inside the store, and leaving them there all day. this is very dangerous, because dust from the street, which contains horse manure and all sorts of germs, may blow in upon them; flies, which have been eating garbage or feeding at the mouths of sewers, may come in and crawl over them. you ought to be very sure that anything that you are going to eat raw, or without thorough cooking, has been well washed. and you ought to ask your mother to speak to your grocer, if he is careless in this way, and have him keep his fruit and vegetables, as well as sugar and crackers and beans and dried fruit, either under glass or well screened from flies and dust. more important than almost anything else in good cookery is to keep the food and the kitchen and the dishes and your hands perfectly clean all the way through, so that nothing that will upset your digestion can get into the food. after things are well cooked, it is very important that they should be nicely served on clean dishes, on a clean table cloth, with polished knives and shining spoons and forks. this means not only that everything about the table and the food will be perfectly clean and wholesome, but that you will enjoy eating it a great deal more. and when you enjoy your food, you remember, your stomach can _secrete_ the juice that is needed to digest it, very much faster and better than when, as you say, you are just "poking it down." if you have a school kitchen and a lunch room, you can learn the best way of cooking and serving things; and then, perhaps, you can do these same things at home and be a real help. most children are fond of trying to cook, and i am glad that they are. everyone, boys and girls both, should know how to cook simple things. perhaps some day you will be stranded, like robinson crusoe, on a desert island! perhaps the rest of the family may be sick. how nice it would be for you to be able to prepare breakfast for them. i know a family where the youngest boy often rises early and gets breakfast for five. he can fry the bacon and boil the eggs and make the coffee and mush and biscuit just as nicely as his mother can; and he takes pride in it and enjoys it. cooking is what we call an art. everyone, of course, can learn to do it; but some people can do it much better than others, just as some boys and girls can draw better than others. i hope some of you will be what we might call "artist cooks." take pride in the art and learn all that you can about it. there are so many things a cook should know. a great deal of good food is spoiled by bad cookery, particularly by frying slowly in tepid grease, or fat, so that it becomes soaked with grease. you should have the frying pan just as hot as possible before you begin to fry; and then the meat or potatoes or cakes will be seared, or coated over, on the outside, so that the fat cannot soak into them, and they will not only taste better, but will be much more digestible. in baking you will have to be careful not to let the oven become too hot, or else the meat or bread will be burned or scorched. even if the heat does not do this, it may harden and toughen the outside of the meat so that it is almost impossible either to chew or digest. sugar is really a very good food if you do not eat too much at once, and so pure candy is good for you if you do not eat too much. the very best time to eat it is at the end of a meal. if you learn to make it at school or at home, you can always have some to eat after your luncheon without having to buy it. if you do buy candy, don't get the bright colored kind; it looks pretty, but it may hurt you. and be sure to see that it has been kept under a cover, where the dust and flies could not get at it. dust is dirty, and flies don't wipe their feet. you want clean, pure candy. of course, after cooking, you will always be very careful to wash up all the pots and pans and dishes that you have used. food and scraps that are left sticking to dishes and cooking utensils very quickly turn sour and decay; and then the next time the dishes are used, you will perhaps have an attack of indigestion, and wonder why. there are two things you should always notice: whether the bread you eat is sweet and thoroughly baked; if it is soggy and sour, it will make trouble in your stomach. whether all your food is clean and fresh before it is cooked; this you can tell by your eyes and nose. vi. tasting and smelling when, at home, you give the baby a ball or a key or a watch to play with, what does he do with it the very first thing? he is never quite happy, is he, until he has put it into his mouth? does he want to eat it? no, he wants to feel it; and he has not yet learned to feel very carefully with his hands, as you do. can you feel with your mouth? if you have the least little hole in one of your teeth, you know it as soon as you rub your tongue against it. how big it feels and how rough the edges seem! if you take a looking-glass, you find, if you can see the hole at all, that it is just a tiny, tiny hole. your tongue and lips, like the rest of your skin, are always touching and feeling things for you and sending messages to the brain. they say whether your milk is hot or cold, and whether the food you eat is soft enough and quite right in other ways. your tongue is a very busy little "waiter": he passes the food about in your mouth for the teeth to chew, and he rolls it about at a great rate. but he does more than this; he tells you something about how it tastes--not everything, as you may think, but only whether it is _bitter_, _sweet_, _sour_, or _salty_. queer as it may seem, your nose tells you the other "tastes," which are really smells. it is your nose that says whether you have a strawberry or a piece of onion in your mouth, whether it is coffee or cocoa that you are drinking. of what other use is your nose?--for only a little patch in the upper part is for smelling and tasting. the greater part of the nose is to breathe through. you see, your nose warms and moistens the outside air that you take in, so that, by the time it reaches your throat, it is as warm as your body and does not hurt your throat. your nose also strains, or filters, out of the air the dust, lint, and germs that may be floating in it. you should always keep your lips closed and breathe through your nose. whenever you cannot breathe through your nose, there is something the matter. it may be that your nose is swollen shut with a "cold"; but that will last only a few days. if, however, your nose often feels "stuffed up," there is probably something in it or behind it, that ought to be taken away. a throat doctor can easily cure you; and, when he has, you'll be surprised how much better you feel and how much faster you grow. [illustration: a clear passage to the lungs (follow the arrows.)] i once knew a little girl whose nose was always blocked up. she had headache and felt tired most of the time and was behind in her classes. the doctor told her what was the matter, but her father and mother were afraid that it might hurt her to have the doctor take out what was clogging her nose. well, what did she do? instead of crying and being afraid, one day she walked right into the doctor's office and asked him to take out the _adenoids_, as we call these growths that block up the nose. and after the doctor had taken them out, she began to grow well and fat and strong so fast that she soon "caught up" in her classes. [illustration: a passage blocked by adenoids] when you breathe well through your nose, you can smell and taste better, too. in fact, when your nose is clogged, you cannot smell at all. how does this sense of smell help us? you say we can smell the flowers and the fresh air after the rain, and cookies baking, and all the things that we like so well. yes, and these give us pleasure; but how about the bad smells? the bad smells are warnings. if there is a dead mouse or rat about, we smell it; and that leads us to look for it and take it away. we smell the dirt and get rid of it, and thus keep away sickness. when we walk into a room, if the air is bad we smell it at once and open a window or a door, and so save ourselves from being poisoned. some people hurt their noses by smoking tobacco. the inside skin of the nose is very delicate, and the smoke going back and forth through the nose and the throat keeps them from doing their work properly. it is very bad for little children even to smell tobacco smoke. it seems in some way to keep them from growing as they would in clear fresh air. what a silly habit smoking is! it does no one any good. it hurts not only the people who make the smoke, but the people who have to smell it. most of the people who smoke tobacco have to learn to like it. it almost always makes them very sick when they first begin. sir walter raleigh, or the men he sent to america, first taught our great-great-great-grandfathers to smoke. his men bought tobacco of the indians here and took it back to england; and sir walter himself learned to smoke and made smoking fashionable. the first time that sir walter's servant saw him smoking, he thought his master was on fire; so what did he do but bring a big bucket of water and throw it all over him! i wish that that bucket of water had settled the matter, so that sir walter had stopped smoking and had never taught anyone else to smoke. if it had, think how much money might have been put to better use, for smoking is a very costly habit. and it is not only wasteful of money, but, worse still, of health; for it is the cause of a great deal of poor health and disease. remember that you want the air you breathe perfectly fresh and clean and not spoiled and poisoned by tobacco smoke. vii. talking and reciting when i was little and playing with my brothers, i did not always do what they wanted. so they'd sometimes say, "we'll put him in coventry, then he'll do it." they did not really _put_ me anywhere. they simply would not speak to me or answer anything i said. it was just as if i were entirely alone. of course it was a quick way to make me ready to take my part in the game again. how do you think you would feel if you never, never could speak to anyone, and no one could speak to you? what a quiet world we'd have! almost every day i meet a boy who can't hear and can't speak. how does he ask for things? he makes letters and spells words with his fingers, and his friends watch his fingers and read what he says. is that the way you do? "no, indeed," you say, "i talk." "what do you talk with?" "i talk with my mouth." yes, that's true enough; but if you did not use something besides your mouth, you'd never make a sound. where does the sound come from? feel gently with your finger and thumb along the front of your neck. do you find something harder than the rest of your throat? that is the large tube called your _windpipe_. do you feel a ridge sticking out from this? now sing or talk a little. you can feel the ridge move up and down, and the sound thrill in it. that is where the sound comes from. that is your voice-and-music box, or _larynx_. you have seen the little red rubber balloons, haven't you? you blow into them until they are big and round; and then, when you take your mouth away, out comes the air, making a squawking or whistling sound. now, if you look closely at the mouthpiece, you see a tiny piece of rubber tied across it. the air rushing past this rubber is what makes your balloon sing. your own music box is made on the same plan. when you breathe out, the air is pushed from your lungs up the pipe that we call the windpipe. in the upper part of this is the little box, a corner of which you can feel with your thumb and finger. across the box, inside, are stretched two folds of skin and muscle, just as the rubber is stretched across the opening of the balloon. whenever you like, you can blow out your breath between these folds of skin in your voice box. blow it out in one way, and what happens? you are singing. blow it out in another way, and you are talking; in still another way, and you are just making a noise--perhaps mewing like a kitten, or neighing like a horse. if you pull these folds of skin close together, you can close your windpipe and "hold your breath." a cough is made by filling your chest with air, holding the folds close shut, and then suddenly "letting go." how many sounds you can make from one tiny music box! of course the muscles of the mouth and throat, and the teeth and the tongue all help the voice box as much as they can. one of the best ways to keep your voice clear and strong is to dash cold water every morning on your throat and chest, then to rub with a coarse towel till your skin is pink and warm. gargle your throat with cold water if your voice is husky. singing is very good for you, too; but don't try to sing too hard. sing easily and gently, and see how many words you can sing without taking a breath. that is good for the lung-bellows as well as the voice box. always sing in fresh air, but not in cold air. when you talk, try to make all the words clear and distinct; open your mouth and let the sound out. once i had a big grown boy in one of my classes who did not open his lips properly when he spoke. so i asked him to prop his mouth open with a piece of stick and then talk. i made him do it until he learned to speak much more clearly. a famous greek orator, named demosthenes, who had a habit of mumbling his words, trained himself to speak clearly by putting pebbles in his mouth and then reciting in a loud voice. when you want your voices to sound pleasant,--and that is always, of course,--you must call on your brain to help. that is your thinking machine. always think twice before you let anything unpleasant or unkind come out of your voice box. how happy we could make everyone about us if we followed this rule! viii. thinking and answering suppose, as you are walking home from school to-day, you are about to cross the street when you see an automobile coming very fast. what do you do? you stop, of course; wait for it to go by, and then start on again. why do you stop? "why," you say, "if i didn't, the automobile might run over me." something of that sort would just flash through your mind, wouldn't it, in the very same second that you first saw the automobile coming. now, as you know, you think with your brain. but what was it this time that set your brain to thinking? "nothing," you say, "i just saw the automobile coming." and that is true in a way: you didn't need anything more than your eyes to tell you. but how did your eyes get the message to your brain, and how did your brain tell your legs to stop walking? we must have in our bodies a kind of telephone system. and that is, in fact, just what we have. our _brain_ is our "central office"; and our _nerves_ are the wires, running from all parts of our body to the brain, carrying messages back and forth. an old man and an old woman lived out on the very edge of a little town. one day their house caught fire and was blazing away before they noticed it. they rushed to their neighbor's telephone and rang up "central" to tell her to "phone" for the firemen and hose cart. _kling a-ling-a-ling!_ went their bell, but no "central" answered; and while a man was running to town to get the firemen, the fire got such a good start that the house burned down. you can see from this why we need a central office in good working order, when we use the "phone." all the wires run into the one building, and there must be some one there to receive calls and see that they are sent out to their proper places. in this case, you see, "central" should have been at her post to see that the message went on to the engine house, and then the fire would have been put out "double-quick." the "central office" of our body telephone system is just as important and just as necessary to keep in good working order. it would be very little use to have even the keenest of eyes and the sharpest of ears, with the readiest of nerve wires to carry their messages into the center of the body, unless we had some _organ_, or headquarters, there for switching the messages over to the nerves running to the right muscles to tell them what to do. if the brain-"central" should fail in its duty, or get out of order, then the body would be in serious trouble at once. every day we read in the papers of accidents because somebody didn't think, as well as see or hear. people see cars and automobiles coming, but don't give them a thought and so are run down and hurt. they hear the whistle of the engine at the crossing, but drive on just the same, without seeming to have heard it at all. they are absent-minded; the operator in the "central office" seems to be off duty, or busy about something else. but if we are going to get on in this world of cars and automobiles and all sorts of unexpected things, we must always "have our wits about us," as the saying goes, ready to send the messages out to the muscles in our legs and arms and fingers just as soon as any one of our "five senses" "rings up" the "central" in our brain. our body wires do not look at all like telephone wires; and the brain, if you could see it, would never suggest to you a central office. the nerves are fine white cords, the smallest ones finer than a hair, and the largest so big and strong that you could lift the body by it; and their branches run all over the body, to the muscles and the blood tubes and the skin and all the other parts, as the picture shows. you have already read how the skin can tell you when you feel warm and when you feel cold and when something hurts you. the brain is a soft wrinkled mass, partly gray and partly white. it is in the head; and because it is very soft and easily hurt, mother nature has put around it a strong wall, or shell, of bone--the _skull_, or brain box. feel your head and see how very hard this bone is. solomon, the hebrew poet-king, called it the "golden bowl." i suppose he called it a "bowl" because it is round like one, and "golden" because it is so precious. people do not often grow well again if the "golden bowl" is broken or even cracked. [illustration: the nervous system--our body telephone the picture shows the brain, or "central," and the thick nerve cord that runs down through the backbone, and the principal nerves of the back and the arms.] the big _nerve cable_, called the _spinal cord_, that connects the brain with the rest of the body, and carries all the messages backward and forward, runs down the back and is protected by the backbone, or _spine_, which is hollow, so that the cord can run down through it. this backbone is jointed together so beautifully, too, that you can bend your back about and stoop over, and carry heavy weights on your back, and yet the bony tube still protects the cord inside. solomon calls this the "silver cord," because it is so white and shiny that it looks like silver. you see, our bodies are full of beautiful as well as wonderful things. probably sometime when your teacher has asked you to recite a poem you have all learned, someone in the class has answered, "i don't remember it," or has stood up and recited the first few lines and then stopped, and thought, and finally had to say, "i can't go on." now what is the matter with this boy, or girl? he looks bright enough, and you will probably remember that he was in the class when you learned the poem. "oh," you say, "the poem didn't stay in his head." no, it didn't "stick" in his memory; but why didn't it? some of the messages that the five senses carry to the brain are answered at once, as when we move away from danger, or reach out our hands and help ourselves to butter, or take off a shoe to shake out a pebble. but there are other messages that do not call for an immediate reply, and are just stored away for future use in the big "central office" of our body telephone, in what we call our _memory_. and later, when the proper message is sent in by our eyes or ears, or other sense organs, which reminds us of this message which they sent before, perhaps several weeks, months, or even years ago, it wakes up the old message stored away in the memory, and we say we "remember" what happened to us, or what we learned at that time. so, when your teacher asks you to recite a certain poem, and your ears hear the title or the first line, you recall the rest of the verses and the lesson about it. how many things does the word "christmas" wake up out of your memory? or the sight of soldiers marching? or the first taste of strawberries in may? you think about a great many things that you never _do_. really you are thinking almost all the time you are awake. and besides the messages that "central" just stores away for future use, there are a great many messages being carried back and forth along the "telephone system" all the time, that you don't keep track of at all--the messages that keep the stomach and the heart and the lungs and everything in your body working together properly. how are we to take care of the telephone lines and "central" of our _nervous system_? whatever you do to build up and help the other parts of the body will help your brain to _feel_ and _think_ and _remember_; and will help your muscles and nerves to answer promptly and truly whatever the message may be. plenty of good food, plenty of sleep and fresh air, plenty of play, will keep your nerves and brain healthy and growing. "absent to-day?" i. keeping well how many times have you been absent this term? no oftener than you were obliged to be, i am sure; for it's almost as bad as being "put in coventry" to come back and hear about the good time the rest of the class have been having, and feel that you "weren't in it." of course, sometimes, when you are not well, you have to be absent; it is best that you should be. but it is better still to know how to keep well, so you won't have to be absent, and won't have to miss any good times in work or play all your life. you remember that all the parts of your body are fed and ventilated by the blood, which is pumped to them from the heart. so long as this blood is pure and has plenty of oxygen in it, it does good to every part of the body to which it comes. but the moment that poisons and dirt and waste begin to pile up in the blood, then the blood that comes to the different parts of the body may be poisonous to them, instead of helpful. such poisons in the blood are particularly harmful to the nerves and the brain, because these are among the most delicate and sensitive of all the structures in the body. often we think of the body as a beautiful house. now a house does not look very beautiful when it has dust and crumbs on the floor, buckets of greasy dishwater in the kitchen, and smoke from the furnace in the air! you could not live in such a place. no, the smoke must go out up the chimney, the dust and crumbs must be swept away, the dirty water must be drained off in pipes; the house must be not only cleaned, but kept clean all the time. this is true of your body, too. now mother nature sends the smoke from the body out through the lungs, and the crumbs and solid dirt down and out by means of the food tube. but the waste water--how does she get rid of that? the waste water, you remember, is in the blood vessels, mixed with the blood. how does she get it out of the blood? she sends it through three magic cleaners, or strainers,--the _skin_, the _liver_, the _kidneys_. that the skin is a strainer, you already know; for you know how the skin lets out the waste water in perspiration, or sweat, and how important it is that we keep the little holes of the strainer open and clean. and you know, too, that most of the water that passes out of the body goes first to the kidneys. the liver, however, is the largest cleaning machine of all and has to work very hard. the blood comes to it full of foods and poisons. this wonderful cleaner picks out the food it needs and takes up many of the poisons, too. "what does it do with the poisons?" you ask. some of them it changes into good food, and others it makes harmless and sends away down the food tube in a fluid called _bile_. if we are strong and healthy, the liver has the power to kill many of the disease germs that get into the body. that is why sometimes, when you have had a chance to take mumps or grippe or some other "catching" disease, you don't take it. your liver kills the germs, or seeds. see how carefully mother nature has planned that we may be clean inside as well as outside. [illustration: the position of the liver compare this with the diagram on page , and see how the liver partly overlaps the stomach.] but you must not over-work your liver. if you do, it may become too tired to do anything at all. then all these poisons will spread through the body; the skin and the whites of the eyes will grow yellow, and you will be what is called "bilious." when this happens, the poisons go to your brain, too, and make you feel sad; your tongue looks white instead of pink, and you have a disagreeable taste in your mouth. your happiness depends very much on your liver. "how shall i keep my liver rested and in good working order?" by eating only sound, wholesome, pure food, and avoiding dirty milk; by going to the toilet regularly every morning after breakfast; by keeping your windows open and avoiding the poisons and disease germs in foul air. then, if you run and play and work out of doors, so that the muscles move a great deal and you breathe in plenty of oxygen to keep the body fires burning briskly, that will help a great deal. last summer up in the mountains i saw a big log close by the path. it had been sawed across so that the end was smooth. it was brown and weather-stained, so of course i knew that it had lain there a long time. how surprised i was to see a pile of fine fresh sawdust on the ground beside it. as i came nearer, i saw piece after piece of sawdust dropping, dropping, dropping, one after the other, from a hole in the log. i looked into the hole, and what do you think i saw? hundreds of little brown ants, busy as could be carrying the sawdust, throwing it out, and then scurrying back to get some more. several feet inside the log, other ants were cutting the sawdust, hollowing out the rooms of their house; and in another part others were getting food for the workers, and still others taking care of the baby ants. they were all helping one another, and whatever one ant did helped all the rest. that is the way with the parts, or organs, of the body. when one part works well, it helps all the rest; when one squad of tiny cells in the muscles or liver or heart is doing its duty, like the little ants, it helps all the other cell-workers in the body to keep healthy. if you eat proper food, you help not only your stomach but your liver, too; for it has not so many poisons to get rid of. while you are helping your stomach and your liver, you are helping your heart and your brain, and so on. so what you do to help one helps all. there are, however, some poisons that the liver cannot get rid of; but these the skin or the kidneys carry away. have you ever seen kidney beans? the bean is the shape of a kidney. the kidneys are in the middle of your back, packed close to your backbone, on a line with your waist. this is a picture of them. do you see the little tubes leading down from the kidneys, carrying the waste water and poison down into a kind of bag? the walls of this bag, called the _bladder_, will stretch, and it will hold about a pint of waste water. from the bladder a tube carries the water down out of the body. [illustration: the kidneys and the bladder the large tubes are the artery and the vein that carry blood to and from this part of the body.] you can help your kidney-strainers by emptying your bladder at certain times each day. some children have to empty the bladder much oftener than others, but most children can form what we call _regular habits_ about it, by trying to do it at the same times each day. if you are quite strong, five times a day is often enough: when you first get up, at recess, at noon, at four o'clock, and at bedtime. many children do it much oftener than this; but as they grow older and the muscles grow stronger, they slowly outgrow this trouble, if they try to form the right habits. there are many diseases of the kidneys; for, like the liver, they are sometimes over-worked and do not carry the poisons from the body. you are helping your kidneys when you drink plenty of fresh clean water every day, and also when you play or work hard enough to get into a good perspiration; for, as perspiring carries out some of the poisons, it leaves less for the kidneys to pour out. you ought to get into a good perspiration at least once every day, or better, three or four times, if you wish to keep healthy. the bible says, "in the sweat of thy brow shalt thou eat bread"; and you must earn health and happiness at the same price. ii. some foes to fight you have seen that sitting or sleeping in rooms where the air is bad, or eating the wrong kind of food, or working after you are badly tired, will poison your blood and hinder the proper working of that beautiful machine, your body. these poisons are made inside your body, and you can prevent them by living healthfully and wholesomely. but there are other poisons, which may get into the blood from outside the body; and while it is best for you not to think too much about these, or to worry over dangers that may never come, yet it is well to know just enough about some of them to be able to keep out of their way, as far as possible. the most dangerous form of poisons from outside the body are those made by the germs of some rather common diseases, which, because you can "catch" them from some one else who has them, are called "catching," or _infectious_, or _contagious_. some of the germs of these "catching" diseases, like the germs of typhoid fever, of which we have spoken in connection with our drinking water, are carried in the water or milk that we drink, or upon the food that we eat; and one of the worst carriers of germs is the ordinary household fly. not so very many years ago, people did not know that _dirt makes people sick_. you see, they did not know anything about the disease seeds (germs) that grow so fast in dirt. they did not like to have flies about, because flies look so dirty and bite people and crawl over things and spot them. but nowadays, we will not have flies about because we know that they have been in dirty places where disease germs live, and that one little fly can carry thousands and thousands of these germs on his feet. have you ever looked at a fly through a magnifying glass or under a microscope? if you haven't, try it sometime. you will see that his legs are covered with little hairs; and it is on these little hairs that the germs lodge. they are too small for you to see except with a very powerful glass; but scientists have proved that they are there, and they have found that there are always typhoid germs among them. [illustration: the common house fly as he appears through a magnifying glass.] did you ever see a fly wipe his feet before he came into the house? no, indeed; and he goes anywhere he pleases, over the bread and into the cream. yet he was born in dirt and bred in dirt, and he lives in dirty places all the time he is not crawling over your clean things and spoiling them. flies are hatched from eggs; and these eggs can hatch only in piles of dirt, such as heaps of manure, or places where garbage and scraps from the house are dumped or thrown. we call the common fly the "domestic" or "house" fly, because he lives only in the neighborhood of houses and barnyards where heaps of manure and piles of dirt are allowed to gather. when the fly first hatches from the egg, it is a little white, wriggling worm called a _maggot_, like those that some of you may have seen in decaying meat or fish or cheese. the maggots must have decaying substances to eat and live upon while they are growing, and this is why the eggs are laid in manure heaps and garbage piles. [illustration: a maggot hatching from the egg (greatly magnified.)] it takes the maggot about five days to grow to its full size, and then it turns into a _chrysalis_. that is, it is shut up in a kind of case that it has spun for itself, like the cocoon of the silkworm or the caterpillar. in about five days more it breaks out of this cocoon and appears as a fly with wings. so, you see, the eggs must stay in that manure heap about two weeks if they are to hatch. if, within that time, the manure is carted away and thrown out somewhere where it will dry, the little unhatched flies will be killed, or prevented from hatching. all we have to do, then, to be entirely rid of flies about our houses is to see that the heaps of manure and all piles of cans and garbage are taken away at least once a week. [illustration: fly maggots on old newspaper note the size of the maggot compared with the newspaper type.] if manure heaps or piles of dirt cannot, for any reason, be carried away as often as this, then they can be sprinkled with something that is poisonous to flies, such as arsenic or kerosene. this will kill the maggots. if we keep every kind of waste and scraps from the house, and all the manure from the barn and the pig-pen and the hen-house carefully cleaned up, or sprinkled with some poison, we shall get rid of flies entirely and never need to use screens at the doors and windows. until we do this, it is best to put screens at the doors and windows in the summer time, and particularly to screen carefully any place where food is kept or cooked; for we know that a great many cases of typhoid and of other diseases of the stomach and bowels, such as _summer sickness_, or summer _diarrhea_, and _cholera morbus_, are carried to our food by the dirty feet of flies. many of the germs of "catching" diseases--most of them, in fact--are carried in the air, in scales that have rubbed off the skin of the persons sick with them, or in spray that they have coughed into the air, or in saliva that they have spit upon the floor. there is one sickness of this kind that i ought to tell you about, because it kills so many thousand people here in our own country every year. we sometimes call it the "great white plague." its common name is _consumption_, and the doctors call it _tuberculosis_. i dare say you have heard of it and wondered what it meant. a few years ago people thought it could not be cured. they thought that children had it because their parents had had it before them. but now, the cheering thing about it is that we have found that mother nature herself can cure it with fresh air and sunshine and wholesome food. we have found, too, that people catch it from others who are sick with it, and need not have it just because their parents did. [illustration: fresh air and sunlight are good doctors] this means, then, that thousands of people who have it need not die, but can be cured simply by living and sleeping out of doors and eating plenty of milk, eggs, and meat, nuts and fruit. there are camps for them in almost every state in the union now. the fresh air gives them such a big appetite that they can eat more than most healthy people, and they soon get strong and well. if all the people who now have consumption were taken out into the country and cured, there would be no one left for the rest of us to catch it from, and the disease would soon die. some day our boards of health will decide to do this, and then consumption will become as rare as smallpox is now, and will kill only a few hundred people a year in the united states instead of , every year, as it does now. people and governments are giving great sums of money, not only to cure the people who now have consumption, but to do something towards stopping the disease by keeping things so clean and people so strong that no one will ever have it. even little children can help to fight and kill this "great white plague," and i'll tell you how. we know that, when people have consumption in their lungs, what they cough and spit out of their mouths and blow out of their noses (we call it _sputum_) has the germs, or seeds, of the disease in it. so, to keep other people from catching the disease, they must hold something before the face when they cough, and they must catch the sputum in paper (newspapers or paper napkins are very good for this) and burn it, for burning kills the germs. then, too, they must not kiss other people on the mouth, and others must not kiss them. they must use their own drinking-cups, and never lend or borrow a cup. you see, you can look out for these things, yourselves. when grown people kiss you, just turn your cheek to them, instead of your mouth. your cheek will not carry anything to your windpipe and lungs. and be sure to carry your own drinking-cup, or, better still, make the one for which you already have the pattern, every time you need one. [illustration: his own cup and towel] this sounds easy enough; and it is, too. but sometimes people don't know when they have this "plague," and of course they do not feel that they must be careful. what is to be done, then? if people won't take care of themselves, then the government has to make health laws to protect them, and the health officers have to see that the laws are obeyed. in many of the states and cities, laws have been made so that nobody is allowed to spit on the sidewalk or in the cars or in any other public place; and common drinking-cups are forbidden at all park fountains and at the water-coolers in schools and trains and stations and other public places. you ought to know about these things, because, as i have just said, other sicknesses, too, are carried about in the nose and mouth. _grippe_, _pneumonia_ or lung fever, and what we call _colds_ are caught in exactly the same way. we used to think we caught them by being chilled; but we are much more likely to take them by being shut up in a hot, stuffy room with other people who already have them. mother nature never gave us such things in her beautiful, clean outdoors. we must wear clothes enough to keep us warm when we go out, and have bedclothes enough to keep us warm while we sleep; but we need not be afraid of catching any sickness from the clean outside air, either by day or by night. drafts are not dangerous, except when our blood is already full of poisons and germs from foul air. of course it is foolish even for strong, healthy people to run any risks that can be avoided, and there is one other thing that you should keep on the watch against doing; and that is, touching or kissing or playing with other children who may be sick. it is better not even to sit in the same room with them if you can avoid it. many of the infectious diseases--and nearly three fourths of all the diseases that children have are infectious--are caught, as we have seen, from germs that are carried in the air. that is one reason why so many infectious diseases are likely to begin with running at the nose, or sneezing, or cold in the head, or sore throat. the germs, having been breathed in with the air, catch on the sides of the nostrils or at the back of the throat, and start inflammation and soreness wherever they land. this is just the way that _measles_, _scarlet fever_, _chicken pox_, _whooping cough_, and _diphtheria_ begin. nearly all colds in the head, and sore throats with coughing, are infectious; so the best thing to do whenever you have a bad cold in the head, or a sore throat, is to keep out in the open air as much as you can, until it is better. of course, a cold is not such a serious thing in itself; but, if it is neglected, it may lead to some very dangerous troubles, particularly to inflammation of the lungs, and sometimes even of the kidneys or the liver or the heart. several of these infectious diseases--measles, chicken pox, and scarlet fever, for instance--have a rash, or breaking-out, called an _eruption_, upon the skin. this is another thing easy to look out for; and if you see anyone with a rash upon his face and hands, it is a good thing to keep away from him and not let him touch you. even if he should not have measles or scarlet fever or chicken pox, but only a disease of the skin itself, he still might spread the infection of that; for most diseases that cause a breaking-out upon the surface of the skin are infectious. some of these infectious diseases are so common among children that they are called _children's diseases_, or the _diseases of infancy_, just as if it were natural for you to have them while you are children, and as if they were something that you have to have as a matter of course, before you grow up. but it isn't necessary at all to have them, if you will take care of yourselves and help your doctors and the board of health of your county or town or city to prevent their spreading. these diseases, although usually very mild, never do anyone any good whatever, and may do serious harm; for their poisons may stay in the blood and injure the heart or the kidneys or the nerves. one thing i should like to urge you to do if you happen to get one of these "children's diseases"; and that is, to stay in bed or out of school or away from work just as long as your doctor tells you to. this is important, because it is very dangerous indeed to become over-tired or overheated or chilled, or to get your feet wet or romp too hard or sit up too late, before you have fully recovered; and you will not have fully recovered until at least three or four weeks after you are able to be out of bed. but if you take good care of yourselves for three or four weeks after measles or chicken pox or whooping cough or a very bad cold, you will avoid almost all danger of their poisons injuring your heart or kidneys or nerves, and causing chronic diseases, like bright's disease or heart disease, later in life. perhaps now i have told you enough about poisons and sickness. you must not be frightened about them. i have told you these things so that you may understand why you must bathe, and brush your teeth, and wash your face and hands, and wear clean clothes, and breathe fresh air, and keep your windows open, and play out of doors--in fact, keep your bodies clean inside and out. i know you will be glad enough to do these things, troublesome though some of them may be, if you know the reason why. the best of it is that when you keep perfectly clean and healthy, not even the "great white plague" and cold seeds, or germs, can hurt you, even though they get into your mouth or nose; for mother nature gives healthy bodies the power to kill germs, and quite without our knowing it. [illustration: enjoying "all outdoors" very discouraging to disease germs!] iii. protecting our friends if you knew that some of your little friends were sick with an infectious disease like measles or scarlet fever, of course you would keep away from them, so as to avoid catching the disease. and if they knew that they had a disease that was infectious, of course they would want to let all their friends know of it, so as to prevent them from coming and catching it. but how can they let all their friends know? sick people don't feel like writing letters; and, even if they did, some diseases can be carried in letters. so that might not be at all a friendly thing to do. this has always been the greatest difficulty in preventing the spread of infectious diseases--how to let other people know. so about fifty or sixty years ago, people got together and decided that the best thing to do was to appoint an officer known as a _health officer_, or a committee known as a _board of health_, in each town and in each county, whose business it should be to find out cases of infectious disease, and to warn other people against them. these officers first ask all the doctors in the town to report to this central health office, or board of health, every case of a patient with an infectious disease. then, when the case has been reported, that office sends some one with a card on which the name of the disease is printed in large letters, and he tacks the card upon the front of the house or upon the fence around the lot, so that everyone who goes near the house may know that there is danger, and keep away from it. then, sometimes, a messenger from the board of health goes into the house and talks to the family, and tells them how they can keep the patient in a room by himself, so as to prevent the rest of the family from catching the disease; and how they can best take care of the patient, and keep from carrying the infection through clothing or food or anything else. [illustration: one way in which the board of health protects us] then, because anyone who has been sick with an infectious disease will still be shedding the germs of the disease and spitting or coughing, not only as long as he is sick, but for two or three weeks after he is beginning to feel better, the messenger will tell the family that the patient must stay either in his own room or within his own house or yard, for so many days or weeks. this is called keeping _quarantine_. the word comes from the italian word _quaranta_, "forty"; because in the early days when the practice was first begun, the patients used to be kept by themselves in this way for forty days. while sometimes this is very inconvenient and hard and troublesome, it is really the only safe way of stopping the spread of these diseases; and i am sure anyone of you would be willing to take this extra trouble sooner than let any of your friends catch a disease from you, and perhaps die of it. quarantine is also the best and safest thing for the patient, because it keeps him quiet and at rest until he has completely recovered, and until all danger that the poison of the disease will attack his lungs or heart or kidneys is over. in some of the best schools now there is an examination of all the children every morning, by a visiting doctor sent by the board of health. if the doctor finds any child that has red and watery eyes, or is running at the nose, or sneezing, or coughing, or has a sore throat, he usually sends him home at once, so that the other children will not catch the infection. the school doctor is not thinking only about what seems to be a cold, although, as you know, it is very important that anyone with a cold should take good care of himself and should not let others catch it from him. the doctor sends the child home because this is just the way in which several other infectious diseases may begin--_measles_, _scarlet fever_, _chicken pox_, _whooping cough_, and _diphtheria_. for most infectious diseases, as you will remember, are caught from germs floating in the air and breathed into the nose and throat. the board of health takes care of the public in many ways besides these. it keeps a very careful watch upon the water supply of the town, or city, so as to keep the houses and factories from running their drainage, or _sewage_, into it; for this, as you already know, might cause the spread of typhoid fever and of other diseases of the bowels and stomach. the board of health sends men to examine, or inspect, the milk the dairymen bring, to see that it is sweet and pure, and that there are no infectious germs in it. and it sends men out into the country to examine the dairy farms and see that the cows are properly fed, and that the barns in which they are milked are kept clean; and that the water in which the milk pans and bottles are washed comes from clean, pure wells or springs. [illustration: what milk inspection means clean barns, cows, pails, and milkers mean clean milk. the cows here stand in fresh, clean sawdust.] another thing that the board of health does is to send an inspector round to look very carefully at all the meat that is sold in the butcher shops, and at all the fruits and vegetables at the grocers'. if he finds any meat that is diseased or tainted or bad, or any fruit or vegetables that are beginning to spoil, or any flour, sugar, or canned goods that have been mixed with cheaper stuffs that are not good to eat,--in fact, are what the law calls _adulterated_,--he may seize the bad and dangerous foods and destroy them, and summon to court the dealers who are trying to sell them. then the dealers are fined or perhaps sent to prison. so, you see, the board of health is one of the very best friends that you have, trying to keep your food pure and good, the water that you drink clean and wholesome, and the milk sweet and free from dirt or disease germs. you ought to help these officers and their inspectors in every way that you can. i know that it is sometimes troublesome to obey all their rules; and perhaps when you don't know what the dangers are which they are trying to guard you against, it seems to you that they are too particular about a great many things. but just see what they have done already to make our cities and houses healthier and pleasanter places to live in. only one hundred and fifty years ago, for instance, that terrible disease called _smallpox_ killed hundreds of thousands of people every year in europe; and it attacked the eyes and blinded so many of those who recovered from it, that nearly half the poor blind people in the blind asylums had had their sight destroyed by it. in smallpox there is a terrible eruption, or breaking out, upon the skin, which is likely to leave it pitted and scarred; and even fifty years ago it was exceedingly common to see people who had been pitted by smallpox, or, as the expression was, "pock-marked." cows have a disease somewhat like this, but much less dangerous, called cow-pox. years ago, before dairies were inspected as they are now, dairy maids often caught this disease from the cows they milked, so that their hands would break out with pock-marks. about a hundred years ago, a dr. richard jenner discovered that the dairy maids in the country district in which he lived, who had caught this mild infection from the cows they milked, never caught smallpox even when they were exposed to it. so after studying over the subject for some years, he took a little of the matter, or pus, from the eruption on the udder of a cow that had cow-pox, scratched the arm of a little patient of his, and rubbed some of the pus into it. only a short time after, the family of this little boy was exposed to smallpox, and all the other children took it badly, but he escaped. this was the beginning of what we call _vaccination_; and as soon as it was found that this scratching of the arm and putting a little of this _vaccine_ matter into it would cause only a few days of feverishness, and then after that give complete protection against smallpox, the boards of health all over the civilized world took it up and insisted upon everybody's being vaccinated when a baby. as a result, smallpox has become one of the rarest, instead of the commonest, of our infectious diseases. only a few dozen people die of it each year in europe, instead of several hundred thousands; scarcely one one-hundredth of the people now in our blind asylums have been sent there by smallpox, and i dare say that many of you have never even seen a pock-marked person. another disease that used to be very dangerous to little children is _diphtheria_. it was not only very infectious, but very deadly; and nearly half of the children who took it died of it, and the doctors didn't know anything that would cure it. about twenty years ago, two great scientists, one a frenchman named roux--a student of the great professor louis pasteur, of whom i am sure you have heard--and the other, a german, named behring, discovered an _antitoxin_ for diphtheria; that is, something to defeat the poison of the diphtheria germ. when this antitoxin is injected into the blood, it will cure diphtheria. the doctors and the boards of health took this up too, and insisted upon its being used in all cases; with the result that where the antitoxin is used early, scarcely one in twenty of the patients dies, instead of eight or ten out of twenty, as before. you know how careful we are all trying to be not to let consumption spread. by insisting that all houses shall be built so as to give plenty of light and fresh air to everyone; and by forbidding spitting upon the streets; and by insisting that food to be sold, especially milk, shall be clean,--by preventing the spread of the disease in every way, our boards of health have cut down the number of deaths from this disease nearly one half; and people in the united states, for instance, or in england, where these health laws are enforced, live now almost exactly twice as long on the average as they did one hundred years ago, or as they do now in india and in turkey, for instance, where the people are ignorant and dirty and careless. so you see that even if some of the health regulations do seem rather troublesome and fussy, it is well worth while to try to follow them and help the health inspectors in every way. even little children can help very much in keeping the houses and the cities in which they live clean and healthful and beautiful. work and play i. growing strong when school is over, out you go with a rush, into the open air. you have worked hard all day, and now you have two hours before supper to do just as you like. perhaps you will play tag, or prisoner's base, or stealing sticks, or town ball. they are all fine fun, and they exercise every muscle in your body and make your lungs breathe deeper and your heart beat faster, and make every part of you grow stronger. [illustration: better to take than medicine] perhaps you have a few chores to do or errands to run; but even these are almost as much fun as play and give you good exercise in the open air and, what is better still, a feeling that you are being of some use in the world, which is one of the happiest and most satisfactory feelings that you will ever have, if you live to be a hundred years old. [illustration: out for an afternoon in the park] but when you have finished your work, you must not forget to play real, lively, jolly games out of doors--ball and tag and hide-and-seek, and all those games that children love. hide-and-seek is a good game, because, when you are caught, you can stand still a few minutes and rest. when you are hiding, you can take a good breath for the home-run you have to make. most games, in fact, are planned like this--a run and a rest, and then another run. while you rest, some one else is taking his turn at the bat, or at being "it," or whatever is the hardest part of the work. this is one reason why games are so good for you to play. you see, when you run, you are working your muscles and heart-pump very hard; and if you kept running all the time, you would burn up so much food in the muscles that the heart couldn't pump blood fast enough to wash away all the waste, and would just chug-chug-chug till it tired itself out. when you are tired, it is time to stop and rest; for being tired means that the poisons are not being carried away from the muscles fast enough, and that your heart is working too hard. what is it in your body that gives it stiffening to stand upright, and makes levers in your legs and arms to move it about? when you feel your body and arms and head with your fingers, what are they like? isn't there something hard and then a soft kind of pad over it? we call the hard things _bones_. your teacher will show you some. these are white and chalky looking; but when they were alive, they were a beautiful pinkish white color. [illustration: skeleton of a man] so you have a pretty pearl-colored framework, the shape of your body. this, which is called your _skeleton_, makes you stiff enough to stand up and walk about. now bend your arm and turn your wrist and open and close your hand. you find that your frame-work is jointed. when you are tired standing, you can bend your joints and sit down. if you want an apple, you can close your fingers and pick it up. [illustration: the muscles of the arm] [illustration: when the muscles shorten] what are the soft pads that you felt over the bones of your arms and legs? stretch your right arm straight out in front of you and take hold of the upper part of it with your left hand. now clench your right fist and bring it toward your shoulder. can you feel the elastic pads, or bands, moving? what are they doing? they are pulling your hand up to your shoulder. when you walk, you can feel the elastic bands moving your legs along. so every move we make, these elastic ropes are at work pulling us about and letting us sit down and making us run and jump. we call them _muscles_. you have perhaps seen jointed dolls. the strings and rubber bands on their joints help to make them move; but the dolls don't act as if they were alive. they have no telephone system to tell their bodies how to move. if you will stop and think how many "moves" you make in a day, you'll know how hard your muscles have to work. they'd be quite tired out if they did not have plenty to feed on all the time and did not rest at least nine hours a day. i told you how the food is melted and carried about in the blood. it is the blood that brings the muscles their food and keeps them alive and makes them strong enough to move the joints and the bones. what does all this playing do for you? it makes you grow not only big, but strong, too. what puny little things you'd be if you couldn't get out and run and play and make your muscles strong and your nerves do just what you tell them to do. i know of ten or twelve little chickens that hatched a few weeks ago. there are so many cats about, that the poor little chicks have to be shut up in the barn all day. at first they ran and played and jumped on their mother's back, but now they hump their shoulders and hang their heads and don't seem hungry and look sad and sick. they are not so big as some that hatched later. can you tell me why? of course you can. you know that it is outdoor exercise and play that chickens need, and that you need to make you grow big and strong, too. of course, you will have to keep your backbone straight and your chest out and your head up; but all these things will be easy for you if you are perfectly well and strong. the school tries to take just as good care of your health and growth as it can. your lessons are short, and you change from one to another frequently, with perhaps drills or calisthenic exercises between, so that you need not sit still too long at a time; and the seats and desks are of different sizes so that you need not sit at a desk that does not fit you. when your teacher urges you to go out of doors and play at recess time, even if you do not want to, you must think to yourself, "it will rest me and make me grow big and straight and strong." when you come home from school, go out of doors and stay out just as long as you can. don't let dolls or toys or picture books tempt you to stay in the house. the pictures out of doors are ever so much prettier, as soon as you learn to see them. but some of you live in crowded cities. i hope you are near a park or a playground, where you can have a good romp with other children, and use the swings and see-saws and bars, and the skating pond in winter, and the swimming pool in summer. [illustration: a skating pond made out of a garden the school garden is flooded in winter--a fine place to skate right after school.] what fun swimming is! you can learn easily if you have a safe place and an older person to teach you the stroke. you can roll over on your back in the water, and float, and dive; but you must not stay in longer than twenty minutes, and not so long as that sometimes. as soon as you begin to feel chilly, come out. swimming not only cleans your skin, but is splendid exercise for your lungs and muscles. all this play out of doors will help your appetite, and that will make you ready to eat the right kind of food, and this food will get into your blood and keep your muscles firm and strong. [illustration: splendid exercise for lungs and muscles] ii. accidents i am going to tell you what to do in the case of some of the little accidents that may happen to anyone, and especially of the kind that children meet with in playing; but i don't want you to stop playing for fear you'll be hurt. mother nature can usually heal all the bumps and cuts and scratches that come from wholesome play. you can, however, help her very much by keeping the _scratch_ or _cut perfectly clean_. this is the chief thing to remember. wash it thoroughly in clean water. hold it under the pump, or faucet, and let the water pour down on it. if you can, pour some _antiseptic_, or germ killer, over the cut, and wrap it up in a clean cloth. there is a medicine called _peroxid of hydrogen_, which is good for cuts and wounds, but an older person will have to put it on for you. if the scratch is from a finger nail or the claw of a cat, or if the wound is the bite of some animal, you must be sure to have your mother or a doctor clean the wound with strong medicine. you see, nails and claws and teeth are, as a rule, dirty, and have on them germs that will get into the cut and make it swell and be very sore indeed. [illustration: the tight bandage higher than the cut] sometime you may have a cut that is deep. you will see the bright red blood spurt from it. this means that you have cut one of the blood pipes called arteries. if the cut is on the arm or the leg, you should take a cloth or bandage and tie it tightly around the arm or leg _above_ the cut; and if that does not check the blood, put a piece of stick under the cloth and twist the stick, as in the picture. for a cut like this you must get help as soon as possible, and keep quiet, or else you will increase the flow of blood. if you get anything in your eye, be sure not to rub the eye; don't even wink hard if you can help it. you will only make the pain worse, because you will scratch the eyeball. let some one take out the bit of dust or the cinder or the fly, or whatever it is, as quickly as possible. often, if you close the lids gently and hold them so, the tears will wash the speck down for you. if you should bruise yourself, the best way to treat the bruise is to pour either quite cold or quite warm water over it, and keep this up for several minutes; or to put it into a bowl of hot water. then tie it up in a bandage of soft cotton cloth or gauze and pour over it a lotion containing a little alcohol--about one sixth or one fourth. this, by evaporating, cools off the bruise and relieves the pain. if your ear, or nose, or a finger should happen to be frozen or frost bitten, the best thing to do is to rub it hard with snow until it thaws out and becomes pink again. above all, don't go too near the fire, and don't go into a very warm room too soon. if you get one of those uncomfortable itchy swellings on your feet called _chilblains_, which come from cold floors in your houses, or from wet feet, or from wearing too thin shoes and stockings, don't put your feet too near the fire, but rub them well with turpentine just before going to bed at night. this will often take all the pain and itching out of them. sometimes people make the mistake of drinking something that is poisonous. of course, one good way to prevent this is to have _every bottle in the house carefully marked_ and never to take anything from a bottle without reading the mark, or label. another good way is _not to have poisons about_ any more than we actually need to. still, even so, sometimes a mistake is made. if you ever make such a mistake, the best thing to do is to drink as much warm water as you can, and into the second cupful to put a tablespoonful of dry mustard or two heaping tablespoonfuls of salt. this will make you vomit, and up will come the poison. the water makes the poison weaker. if this doesn't make you throw up the poison, have some one tickle the back of your throat with a feather. there are a great many kinds of poison and as many things to take to cure them; but this is the only remedy i shall tell you about, because, by the time you have tried this, some older person will probably have come to help you. all the medicines that you see advertised as "headache cures" are dangerous poisons if taken in too large doses; and most of them in small doses weaken the heart. they are what we call narcotics; they just deaden the nerves to pain without doing anything whatever to relieve or remove the cause. if you have a headache, the best thing to do is to go and lie down quietly and rest or sleep, until it goes away. a headache always means that something is wrong; it is one of nature's most valuable danger signals. when your head aches, nature is telling you that you have been over-straining your eyes, or breathing foul air, or eating some food that does not agree with you, or forgetting to go to the toilet regularly, or not getting sleep enough. the sensible thing to do is not to swallow some medicine to deaden your nerves to the pain, but to find out what you have been doing that is unhealthful for you, and then stop it. most of the medicines called "patent medicines," which are advertised to "cure" all sorts of pains and troubles, contain poisons, and are particularly dangerous because they easily lead one to form the habit of taking them. nine tenths of them are either absolute frauds,--of no strength or use whatever,--or else they contain alcohol, or opium, or some of the dangerous drugs made out of coal tar. now about _burns_. you need not wash them, because the heat has killed the troublesome germs. they need to be covered from the air, if the blister is broken. cover them thickly with olive oil or vaseline, or common baking soda mixed with a few drops of water. this makes a good paste to put over them, and it will ease the pain. (this is the way to treat a _wasp_ or _bee sting_, too, after you have pulled out the "stinger.") if the blister of the burn is not broken, just keep putting vaseline or sweet oil on it every half hour or so, and the blister won't break; for the oil will make it limber and prevent it from bursting. if ever your clothes should catch fire, _do not run_; the wind you make will only fan the flames, so that they burn faster. _lie down and roll over and over_, as fast as you can. if there is a rug or a quilt handy, wrap yourself up tight in it. my youngest brother once saved a little child's life this way. he was not very old, but he remembered to put the child on the floor and roll him up in a rug. however, the best way to prevent accidents with fire is to let fire and lamps and matches and kerosene and sparklers and firecrackers alone. i am so glad that people are becoming sensible about keeping our nation's birthday, the fourth of july, and are doing away with the firecrackers that have killed so many thousands of children. the burns you get from firecrackers are much more dangerous than other burns. a dirt-germ often gets into them that may cause _lockjaw_. the name tells what it is: it locks the jaws together so that its victim cannot eat; and, of course, if he cannot eat, he cannot live very long. next fourth of july try getting flags and bunting and drums and horns, if you like, instead of these dangerous fireworks. in keeping the fourth one year not long ago, one hundred and seventy-one children lost one or more fingers; forty-one lost a leg, an arm, or a hand; thirty-six lost one eye, and sixteen lost both eyes; and two hundred and fifteen children were killed! this accounts for only the children; counting everybody, five thousand three hundred and seven people were killed or hurt. no wonder we begin to think that we ought to keep the fourth in some other way. in the city of washington, on one fourth of july, one hundred and four people were taken to the hospital; but the following year when no fireworks were allowed to be sold, the hospitals did not have a single patient from the accidents of the day. [illustration: a result of celebrating the fourth in the old way] water, as well as fire, has its dangers. if you ever fall into the water, _be sure to keep your mouth shut and your hands below your chin_. then paddle with your hands gently, and you'll swim, just as any other young animal does when first thrown into the water. even your cat, who hates water, can swim easily when she falls in. if you keep your wits as she does, you will get along as well. some people learn to swim just by trying by themselves. [illustration: working to start his breathing again] if anyone in your party, when you are out boating or swimming, should be nearly drowned, the best way to revive him is to lay him, as quickly as possible, flat on his face on level ground, just turning his head a little to one side so that his nose and mouth will not be blocked. then, kneeling astride of his legs, put both your hands on the small of his back and press downward with all your weight while you count three. this squeezes the abdomen and the lower part of the chest so as to drive the air out of the lungs. then swing backward so as to take the weight off your hands, while you count three again; and then swing forward again and press down, again forcing the air out of the lungs. keep up this swing-pumping about ten or fifteen times a minute for at least ten or fifteen minutes, unless the person begins to breathe of himself before this. don't waste any time trying to hold him up by the feet, or roll him over a barrel so as to get the water out of his lungs. just turn him over on his face as quickly as possible and get to work making a weight-pump of yourself on his back. if there is any life left in the body at all when it is taken out of the water, you will succeed in saving it. it is very seldom, however, that anyone who has been under water more than five minutes can be revived. and now the thing that i want you to be sure to remember, i have saved for the last. no matter what kind of accident happens, keep your wits about you and keep cool. be calm and _think_ what it is best to do, instead of letting yourself be frightened. of course, get some one to help you as soon as you can and, if need be, call for help as loud as your lungs will let you. but use that wonderful "phone" system to send in and out the messages that will help you to help yourself by telling your muscles what to do. iii. the city beautiful one morning i stopped a moment on the street to speak to a friend. her little nephew had just finished eating some candy, and down went his candy-bag on the pavement. his aunt happened to see it. "oh, no, claude," she said, "don't you see the big green can there? better put it into that." but claude was only three years old; and the can was so tall that he could not tell what it was, till we led him up to it. do you have cans like these in your town, too? it is good to think that every one of us, even such little fellows as claude, can help to keep the city beautiful. but it is not simply to make things look nice that we have so many cans--cans for ashes, cans for papers, cans for food scraps. no indeed, it is to keep the city clean and make it fit for people to live in; for if dirty papers and scraps were left to blow about the streets, they would fill the air with germs and filth. any dust that blows about the streets is likely to be carrying disease germs with it. that is why we have sprinklers driven through the streets to wet them and to keep down the dust; and why, in large cities, the streets are thoroughly flooded at night. if the streets are kept damp and clean, then the air above them is cool and fresh and pure. how does the city get rid of all the dirt and waste? from every house there are two kinds of waste. some is taken away in pipes from the sink and bathroom out into pipes that run under the street, and these carry it away from the city to some stream or deep water that takes it entirely away from the town. the waste stuffs that are not watery, but solid--cabbage leaves, apple cores, potato parings, and other scraps from the kitchen are carted away and burned or fed to pigs. the ashes and tin cans are carted away, also, and used in making new land or filling up hollow places. besides taking away the dirt, cities are careful to get clear, pure drinking water. they are very, very careful about this; and they usually have the water tested often, because, as you have learned, even water that looks perfectly pure may give people typhoid fever. that is why, when you are out in the country, on a picnic perhaps, you must not drink from the streams. they may receive the drainage from a farmer's barnyard, or the sewage from some house. the more we all learn about these things, the more careful will the city be to protect her people. to be sure, most cities now have boards of health who employ men and women to go about and see that the food in the stores is clean--no flies, no dust, and no tobacco smoke on it. they have laws, too, about keeping milk clean; and in new york alone these laws have saved the lives of thousands of babies. and they have laws about the care of streets and buildings and cars and parks and a great many other things. in all these things we have been talking about, i want you to be thinking how you can help. for a city is made up of people--boys and girls and men and women. the city is what its people make it; and everyone must help, even the smallest children, no older than little claude. the first and most important thing for you to do is to keep yourself clean and tidy. and the next thing is for you to keep your back yard as well as your front yard and the school yard and the street free from papers and sticks and cans and old playthings. you can put away your things when you are through playing; or, if you are making a railroad or a town or a playhouse, you can leave it looking nice and tidy. you can help chiefly by putting away your own things. you know the old saying, "a workman is known by his chips"; and a good workman always works in an orderly way. when you eat apples or bananas or oranges, don't throw the skins or peelings about, but put them in a garbage can or swill bucket or cover them with soft dirt in the garden or stable yard; and don't throw peanut shells, or scraps of paper and the like, about the streets or parks. you should begin to notice all these things and talk about them, and that will make other people begin to think about them, too. then you can make gardens instead of leaving bare, untidy back yards. i think that nicely kept vegetable gardens are almost as pretty as flower gardens. if you cannot mow the lawn, you can at least cut the long grass on the edges; and that makes such a difference! it is wonderful how much boys and girls can do in making and keeping a city really beautiful. i hope that you have plenty of room to play in now. of course, when you grow up, you will see that there are plenty of playgrounds and parks for the children. we are beginning to find out that the richest and the most beautiful city is the one whose streets are lined with families of happy, rosy-cheeked children. so, you see, the "city beautiful" is the one that takes best care of her children, and she can do this only by keeping her streets and houses perfectly clean and seeing that the food her people get is fresh and good, and their drinking water pure. if the city or town you live in is not like this, be sure you do your very best to make it better. [illustration: would you rather have a back yard like this?] [illustration: or like this?] there is one great evil that for hundreds and hundreds of years has been known wherever people are crowded together, and even in the open country, too; and which has been the cause of more untidiness and uncleanliness and unhappiness and disease than any other evil ever known. and that is the drinking of alcohol. people don't drink clear alcohol, but they can get a great deal of it--enough to poison them badly--in the fermented drinks you learned about some time ago. in the days when your grandfather was a little boy, every man thought that ale and wine and whiskey were good foods for him when he was well; and good medicine when he was sick. he believed that they gave him an appetite, and increased his strength. but now we have found, by carefully studying the effects of alcohol, in laboratories and in hospitals, that these beliefs were almost entirely mistaken. we know that all that wine, beer, and whiskey do is to make people feel better for a little while, without making them actually stronger or better in any way. in fact, in most respects these drinks make them weaker and worse instead. perhaps you will ask, "how do whiskey and wine and beer do us harm?" and here is only part of the answer: ( ) they tire the heart and, by enlarging the blood pipes in the skin, make the heart pump too much of the blood out to the skin. in this way they make a person feel warmer when he really is not any warmer. ( ) they make the liver work too hard. ( ) they dull the brain, so that it cannot think so clearly or so well. ( ) if one drinks them frequently, it is harder for him to get well when he is sick; more people die out of those who drink alcohol than out of those who do not. alcohol is a _narcotic_; that is, it deadens our nerves, for the time being, to any sensations of pain or discomfort, much in the same way that a very small dose of _morphine_ or _opium_ would. we may imagine it does us good because, for a little while after drinking it, we may cease to feel pain or fatigue or cold; but, instead of making us really better and able to do more work, it is dulling our nerves so that we work more slowly and more clumsily. men who have carefully measured the amount of work that they do have found that they do less work on days when they take one or two glasses of beer or wine than they do on days when they drink only water. the great insurance companies have found that those of their policy holders who drink no alcohol at all live nearly one fourth longer and have nearly one third fewer sicknesses than those who drink alcohol even in moderate amounts. indeed, so strong is the evidence as to the bad effects of alcohol, and so steadily is it increasing, that it will probably not be very many years more before the drinking of wine or beer by intelligent, thoughtful people will have become less than half as common as it is now. strong, healthy men may be able for a long time to drink small amounts of liquor without noticing any harmful effects; but all the time the alcohol may be doing serious harm to their nerves and brain and kidneys and liver and blood vessels, which they will not find out until it is too late to stop the trouble. useless and bad as alcohol is for full-grown men and women, it is even worse for young and growing children; and no child, and no boy or girl under the age of twenty-one, should ever touch a drop of it, except in those rare instances where it may be prescribed as a medicine by a doctor, just as many other drugs are, which in larger doses would be poisons. fortunately, it will be no trouble for you children to let it alone entirely; for not one of you would like the taste of it the first time--or, indeed, for the matter of that, for the first ten or twelve times--that you tried to drink it, if you should be so foolish. this is one striking difference between alcohol and all other foods and drinks. children have absolutely no natural liking, or taste, for the drinks that contain it, as they have for meat, milk, sugar, apples, and the other real foods. this is nature's way of telling them that it is not a real food, and not needed in any way for their growth and health. let it alone absolutely, until you are at least twenty-one years old; and by that time you will probably have become so convinced of the harm that it is doing that you will never begin using it at all. what we have been saying so far applies, of course, only to the moderate use of alcohol. how terrible the effects of the long or excessive use of alcohol are, you don't need to learn from a book. all you have to do is to keep your eyes open on the streets, and see the drunken men reeling along the sidewalk, and the wrecks of men that hang around the saloons. the poorhouses and the jails and the insane asylums are filled with them. the most terrible thing that can happen to anyone is to become a drunkard. the best and safest and only sensible thing to do is to keep away from the only stuff that makes drunkards. it may do you the most terrible harm, and it cannot do you the slightest good. your city can never become the "city beautiful" so long as this evil mars it; and, as you grow up, i hope you will do all you can toward making the right kind of city and home. the evening meal when you have had some good games of play after school, and have finished whatever errands you may have to run, or have done the chores about the barn or the garden or the house, you will begin to feel as if there were something missing somewhere. it won't take you very long to discover where that missing feeling is; and when you hear a call from the house, or a ring of the bell in the hall, you come running in for supper. if you have worked well in school and played hard and done your chores well, you will have a splendid appetite. in fact, you will think there is no other meal in the day that tastes quite so good. is your evening meal supper or dinner? if you have had a hot dinner at noon, you probably do not want anything more than a good supper. but if you had only luncheon, then you are ready to eat something hot and hearty about six o'clock. what are some of the things that you like for dinner? meat and eggs and bread and butter and jam and rice and potatoes and onions and celery and cookies and apples and oranges and oh, so many, many other things! mother nature has given us all these good things, that we may have not only enough to eat but plenty of different kinds. we soon grow tired of one kind, and that is how she tells us that we need many kinds. when i was little, oranges were not so common as they are now; and i never but once had as many as i wanted. that once, my father told me to eat all i liked, and i did; but for weeks afterwards i didn't want even to see an orange! did you ever feel that way too, though perhaps not about oranges? nature sometimes has to teach us not to eat too much of one kind at a time. some people like one thing, and some another. do all of you like onions? i think not; but those who do, like them very much. the same thing is true of tomatoes and sweet potatoes and red raspberries and oysters and many other things. but there are some things that almost everybody likes; and our grandfathers and great-grandfathers and great-great-grandfathers ate them. one of them is called the "staff of life" because we lean, or depend, on it so much; we have it for breakfast, dinner, and supper. that is bread, of course. meat and eggs and milk and butter, too, are among the foods that we all like. these might be called our "main foods," and we should eat one or two or even three of them at each meal. meat and milk and eggs and butter, animals give us. but these are not enough; we need besides some of the foods that plants give us, because, as i have told you, we need different kinds of food at one time to keep the body fires going briskly. what are some of the foods that plants give us? bread is made from a plant--from wheat. oatmeal comes from the oat plant; and hominy, from corn. some of our plant foods, such as potatoes, turnips, onions, sweet potatoes, parsnips, and radishes, grow under ground. some, such as peas and beans, grow on vines. then there are lettuce and cabbage and celery. and there are fruits--cherries, apples, peaches, plums, pears, melons, tomatoes, berries. nature has given us all these foods, and many more; and she wants us to use them all. she wants us to use, every day and every meal, some foods that come from plants and some that come from animals. a good dinner would be a slice of roast beef or mutton, a potato, a helping of some sort of vegetable like peas or beans or onions or tomatoes or celery; and a dish of milk pudding or apple dumpling, or stewed fruit with bread and butter, or pie that has only an upper crust or its under crust very well baked. when you are eating bread, remember that the crusts are the very best part, because they are well cooked and really taste the best. they are good for your teeth, too. [illustration: one of the happiest times of the day] perhaps, while i am talking about a good meal, i ought to talk a little about the way to eat and how to make mealtime pleasant. of course, to make our food soft, we must take little bites, eat slowly, and chew each mouthful a long time. be sure to remember this. so many of the children i know eat so fast that you'd think they had to catch a train! did you ever see anyone try to talk and chew at the same time or forget to shut his mouth while he was chewing? wasn't it a very awkward, disagreeable sight? think a moment, if you are tempted to talk with your mouth full, or put your knife into your mouth, or make a noise while you are eating, that these things are not pleasant for your neighbors. do you tell funny stories at the table and talk about happy tramps you have taken or games you have played, or about your pets or your books? if you do, your food will do you more good, and you will be helping the other people at the table, too. mealtimes should be the happiest times in the day. a pleasant evening when the supper things have been cleared away, you have two hours or so before going to bed, and i dare say you look forward to these as one of the pleasantest parts of the day. it is always best for you to take things rather easily and quietly and pleasantly for at least fifteen or twenty minutes after every meal; and after the heaviest meal of the day, whether this comes at noon or in the evening, it is better to stretch the time to half or three quarters of an hour. if you try to work or play hard right after a hearty meal, you will be drawing away to your brain or to your muscles, the blood that the stomach is trying to get for the digesting and melting of your food. i suppose that you have all found this out for yourselves; for, if you run and play too hard right after dinner, you are very soon out of breath, and if you keep up the exercise, you are quite likely to have an attack of indigestion or stomach ache. if you sit down to study directly after a meal, you soon feel heavy and lazy, and what you read doesn't seem clear to you, and in a little while you probably have a headache and an unpleasant taste in your mouth. if you try to do two important things like digestion and hard work with your brain or the muscles of your arms and legs at the same time, you will be very likely to do both of them badly. even if you have studying to do at night, it will be much better for you to spend half an hour or an hour in laughing and chatting, or in reading some good story, or in playing some of the many pleasant parlor games that rest you instead of tiring you, before you settle down to your books. you will find that when you do start to work, you get your lessons much more quickly and easily than if you had started in after eating. perhaps your sister is just waiting to show you that girls can play checkers better than boys can--"so there!" or some of your friends have come in for a game of dominoes or authors or snap or parcheesi or stage coach or pussy-wants-a-corner, or to try that new song you learned last week; and you will be surprised how quickly the time flies away and bedtime or study hour comes. most evenings, however, you will probably get out your favorite magazine, or that good story that you are reading, and you will all sit around the big lamp on the center table and go off on adventures to the uttermost parts of the earth, with the best and most lasting friends that you will ever make--friends who will never grow tired of you and will always come when you want them and are always willing to talk or play--the people that live in books. be sure to pick out the best of them for your chums--the bravest and the kindest and the most courteous, and the cleanest and the most honorable. you have the whole world to choose from; and it is never worth your while to get acquainted with cheap, badly behaved, second-rate people when you can have your pick of the best. your mother and your father and your teacher will help you to choose, and you will soon find that what they call "good literature" is good stories, and about the right sort of men and women and boys and girls--the kind that you would like to know, and that you would want to be like. once try it, and you find that you like that kind of reading better than you do the cheap, slangy, trashy stuff, just as you like, and never get tired of, good bread and butter and roast beef and apples and milk and cream and pudding and pie. good sound stories of home life and adventure and travel are just as important in making your minds wholesome and happy as these good foods are in keeping your bodies strong and healthy. be sure that the paper of the books and magazines you read is white and _not_ glossy, and is fairly thick and firm; for this makes them much easier to read and strains your eyes less. see, too, that the type is large and clear; for small, close type and yellow or shiny paper are very hard on the eyes. be sure, of course, when you sit down to read _not_ to sit with your face to the lamp and your head bending forward; but settle yourself in a comfortable chair with your back to the light, and hold your book so that you can keep your chin up and your head erect while you read. you can breathe better, and read better, and enjoy what you read better in this position than in any other. even if you have sums or writing to do, it is better to sit with your back, or at least your left side, toward the light; and often you will find it a great help to sit down with your back to the light in a large easy chair and do your writing on a big, thin book, or light piece of board, on a cushion on your knee. in winter, you will find that for the first half hour or so that you are reading after supper, you will want to keep fairly near the fire, because the blood is being drawn in from your skin to your stomach for purposes of digestion; but be sure to see that at least one, and better two, windows in the room are open six inches or so at the top, so that there is plenty of fresh air pouring into the room. [illustration: a cozy nook when evening comes] when study hour comes, take up your books and go briskly to work, forgetting that there is anything else in the world, and you will be astonished how quickly you will learn your lessons. besides, you will be learning one of the most valuable lessons in life--to do with your might whatever your hands, or minds, find to do. good night i. getting ready for bed by and by the clock strikes eight or nine, and your mother says, "children, time to go to bed!" sometimes you will have just come to the interesting point in the story, and would give anything to go on and finish it. but often you will be just nodding over your book, or beginning to wonder why the story is not quite so interesting as it was, or why the lines seem to be running into one another, and the book inclined to swing up and bump your nose. if you have had a lively, busy, happy day, you are quite sleepy enough to be ready for bed--that is, if you could drop into it with all your clothes on, without all the bother and fuss of undressing. so you pull yourself together bravely and answer, "all right, mother," and say "good night" to everybody, and upstairs you go. of course, you must take off your clothes, because you would find them most uncomfortable to sleep in. besides, the little pores all over your skin have been pouring out perspiration all day long; and a great deal of this has been caught by your clothes, just as it is caught by the bedclothes while you sleep. so it is a good thing to take off your clothes, and let your skin be well aired and cooled. don't leave your clothes all in a heap on the floor just where you happen to shed them, but hang them up over the back of a chair or on pegs, so that the air can blow through them all night long and sweeten and clean and dry them. clothes that are worn continuously become sour with perspiration, and for this same reason your mother gives you regularly, once or twice a week, clean underwear and clean shirts or dresses. after you have undressed for bed, wash your face and neck and hands; and if you have a nice warm room or bathroom, take a quick splash, or sponge bath, all over, before you put on your nightgown. this will wash away from your skin everything that the perspiration has been leaving on it all day long, as well as any dust, or dirt, that may have got on it during the day. if the room is not warm enough for you to do this, it is a good thing for you to strip to your waist and then to swing your arms about, much as you did in the morning, only not quite so long, and to rub your arms and neck and shoulders all over with your hands. this gives them an _air bath_, and rubs off any of the little scales of skin that may be ready to be shed, and gives you a sort of dry wash, which is next best to a wet one. then, when you have put on your nightdress, give your hair a thorough brushing. this is the best time of the day to do it. dust, smoke, soot, and germs have been blowing into your hair all day long, and a thoroughly good brushing will not only get these out of it before they have had time to work their way in and lodge on the scalp, but will keep the hair bright and healthy. before you get into bed, give your nails a quick scrub with a nail brush and hot water and soap, and go over them with a _blunt_-pointed nail cleaner, cleaning out any dirt that may be under their edges, and rounding off any ragged or broken points with the file. once a week or so, when you take your hot bath, it is a good thing to go over your toe nails in the same way, trimming them and cleaning them. remember, however, not to round off your toe nails at the corners, but to leave them square, as in this way you will prevent them from ingrowing under the pressure of your shoes. there is one thing that you should be very sure of before you get into bed, and that is that your teeth are as clean as it is possible for you to make them. if you attended to this also directly after supper, so much the better; for just as it is important to clean the dishes and knives and forks that you have been using, so it is important to thoroughly clean the ivory knives and forks that grow in your mouth. talk about being "born with a silver spoon in your mouth"! you were born with something much prettier and far more valuable. even though your teeth make a firm and even line in front and on their cutting edges, yet there are many little gaps and spaces between their roots, where bits of food can stick. if these scraps of food are not thoroughly and carefully removed after each meal, the warmth and moisture in the mouth makes them begin to decay. the acids from this decay will be likely not only to upset your stomach and digestion, but to act upon the glassy coating of your teeth. after a little while, spots will begin to form on the surface of your teeth; they will lose their bright, shiny, pearly look; the acids will eat further into the teeth, and very soon there will be holes, or _cavities_. though your teeth are very hard and glassy looking on the surface, they are much softer and chalkier inside; this glassy coating covers only the _crown_, or free part, of the tooth, which you can see. it leaves the softer inside part of the tooth bare just at the edge of the gums, and particularly between the roots of the teeth, where little scraps of food lodge and decay. when the acids that are formed by the decaying food have eaten away a good deal of the inside of the tooth, the hard, shiny surface is left just like a thin shell; and one day you happen to bite down upon a piece of bone in your food, or try to crack a nut with your teeth, and "crack" goes this brittle shell of your hollow tooth. [illustration: healthy gums mean healthy teeth if the gums are not kept clean and healthy, the second teeth that are getting ready to push out the first teeth will not come in strong and good, nor will the teeth remain good. this picture shows how the teeth grow. notice the gaps between the teeth, where food may lodge.] right in the middle of each tooth is a tiny hollow, or cavity, filled with a soft, living pulp containing one or two very sensitive nerves; and when the decay has eaten into the tooth far enough to reach this nerve pulp, it makes it ache, and then you have _toothache_. the one and only thing that is necessary in order to avoid all this decay and breaking away of your teeth, and throbbing toothache, is to keep the surface of your teeth, and particularly the sides where they are next one another, clean and smooth and unbroken. and all that is needed to keep your teeth perfectly clean and smooth is to use your toothbrush thoroughly after every meal and at bedtime; and then, if there are any little scraps of food between the teeth that have not been brushed away, to pick them out gently with a quill toothpick, or take a piece of silk or linen thread, push it up between the teeth, and gently saw backward and forward until you have cleaned out the space between the roots. you should take at least three to five minutes after every meal and before you go to bed at night to brush your teeth; and you should brush not only your teeth, but the whole surface of your gums close up to where they join the lips. it is almost as important to keep your gums pink and hard and healthy as it is to keep your teeth clean; and the same thorough brushing will do both. if the gums are perfectly healthy, they will come well down over the roots of the teeth, and keep them safely covered right down to where the glassy outer coating begins, and so leave no gap where the acids of decay can attack the teeth. be sure to brush your teeth, not merely straight backward and forward, but up and down and round and round as well, both to clean out thoroughly all the grooves and openings between them and to brush the gums well down over the teeth. it may seem strange, but one of the best ways to keep your teeth from growing crooked and irregular is to keep your nose clear and healthy, so that you can breathe through it freely at all times, both day and night. crooked jaws and irregular teeth are more often caused by mouth breathing than by any other one thing. you can see why it is best to be careful not to get grit or dirt or bits of bone in your food, and not to crack nuts or hard candy with your teeth. if you do, you may crack or scratch the delicate glassy coating of your teeth. but, on the other hand, it is a good thing to give the teeth plenty to do, and particularly to eat the crusts of bread, and some of the tougher parts of meat, and parched corn or other grains, and to eat celery, apples, and other foods that take a great deal of chewing. the teeth are like everything else in the body--they need plenty of vigorous work in order to keep them healthy. be very careful, though, to keep out of your mouth anything that might possibly crack or scratch the glassy coating, such as pins, pennies, pieces of wire, or slate pencils. it is best not even to try to bite off threads or pieces of string. there is, of course, another reason for not putting pencils and pennies and such things into your mouth: they may have dirt, or germs, on them and infect you with disease or at least upset your digestion. ii. the land of nod now you are all ready for bed; and the white pillow and the nice, clean sheets and the warm blankets look very good to you, and you are ready to go to the "land of nod." you need not be afraid of the cold at night. open your bedroom windows. have plenty of light-weight, warm covers; then the cold breezes won't hurt you, but will make you strong. just think how many hours you are in bed,--nearly half of your life,--and you need fresh, moving air all the time. be sure to open your windows from the top as well as from the bottom. you know why: your breath is warm so that it floats and rises like smoke; and if you open the window only at the bottom, this bad air, which rises to the top of the room, can't get out. it is best to have windows on two sides of a bedroom, so that the air can be kept moving through it all night long. if you don't breathe fresh air while you sleep, you will feel dull and stupid in the morning and perhaps have a headache. so run your window shades right up to the top and throw your curtains, or shutters, back, as well as open the windows. if you don't, the fresh air cannot blow through the room properly. even if this does let more light or noise into the room, this is of no importance whatever compared with abundance of fresh air. if you have played long enough out of doors in the daytime and have eaten a good supper and not stayed up too late, you will sleep soundly without being bothered at all by either lights or noises coming in through the windows. and no matter how cold or how light it is, don't put your head under the bedclothes. why? it is best for you to close your mouth while you are going to sleep, and breathe through your nose, so that the air will be properly purified and warmed before it reaches your lungs. if you can't do this, your mother can perhaps give you something to wash out your nose, so that you can breathe freely. if that does not help, you had better see a doctor, and he will find some way to clear your head so that you can use your nose comfortably. suppose you take a pencil and paper and write down all you did yesterday. wasn't it enough to make you tired and sleepy and want a chance to rest? even while you sleep, your heart keeps beating, and you don't stop breathing, of course. but your muscles are quiet, and your food tube rests. your brain rests, too,--better in sleep than at any other time,--so that when morning comes you are as "lively as a cricket" and quite ready for the new day. yet even in sleep your brain does not stop working entirely, but goes on receiving messages from the stomach and the skin and the memory, and mixing them up together in the strangest fashion, so that you _dream_, as you say. you ought not to dream very much if you are perfectly well; but as long as your dreams are pleasant or amusing, you need not pay any attention to them. but if you have had bad dreams, or you dream so hard all night long that you don't feel rested in the morning, then you had better speak to your mother about it, and let her see what is the matter with your digestion or your nerves, or take you to a doctor. bad dreams are always a sign of ill health and are a very disagreeable thing, from which there is no need that you should suffer any more than from headache or indigestion or colic. dreams, of course, do not mean or foretell anything whatever, except simply how bad, or good, the state of your digestion and your nerves is. now, how much time should you spend in bed? well, i think at your age nearly half the time. ten or eleven hours of sleep make you ready for all the hours of work and play, and you don't become cross and tired half so easily if you have plenty of sleep. though you are lying so quietly, you are not by any means wasting your time, for you probably are growing faster when you are asleep than when awake. babies, who are growing very fast, you know, sleep nearly all the time. so after you have opened all the windows wide, put out the light and jump into bed and lie down for a good night's rest without thinking about anything except how comfortable the bed feels when you are tired. questions and exercises good morning i. waking up. . if you were choosing a bedroom, on which side of the house--facing which direction--would you choose it, and why? . how does the air "down cellar" feel? . why do people often keep fresh fruit and vegetables there? . what are _bacteria_? . how can we prevent bacteria that cause disease from growing in our houses? . how would you know, without being told, that sunshine is good for you? . what does this book mean by saying that we are made of sunshine? ii. a good start. . when you jump out of bed in the morning, what do you do with the bedclothes? why? . stand in front of the class and show them the exercises that are good to do every morning. . tell the class why they are good. . do them every morning for a week, and then tell the class how you feel about keeping them up. iii. bathing and brushing. . if you grow very warm exercising, what change do you notice in your skin? what makes it turn pink? where does the moisture come from? . what kind of bathing do you like best? . what do we wash off besides perspiration and dust? . if a scab forms over a scratch or cut in your skin, what should you do to it? why? when will the scab come off of itself? . what makes the skin freckle or tan? . could your face stand the same hard rubbing as your hands? why not? . how do you take care of your hair? . what other parts of the skin can you tell about? . look at your nails; which of the "tools" on p. do they need now? . how, and when, do you care for your teeth? why is this brushing very necessary? . why must our clothes be washed every week? name each of your _five senses_. . what can your skin tell you that your eyes and ears cannot? . do you know of any trade or occupation in which it is necessary to train one's sense of touch? tell about it. . what are the blind children in the picture doing? (their alphabet does not look like yours, for the letters are represented by groups of raised dots or dashes or curves, which are more easily and quickly felt.) . what must you do besides washing and brushing to keep your skin in good order and looking well? breakfast . why do we need to eat? . do you like the breakfast suggested here? why do you need so much? . which of these foods come from animals? which from plants? which of them are the best "to grow on"? . how much milk is there in the two bottles in the picture on p. ? what is the difference between milk and cream? why is it better to buy bottled milk than milk dipped out of a can? . suppose that you are going to get the breakfast in this house; how will you use some of the milk in preparing it? how will you take care of what is left? . why is milk much better for you than coffee or tea? where does the food strength in the milk come from? . suppose that you have just bitten off a mouthful of food; what is the story of this mouthful before it is taken into your blood? where does most of it enter the blood? what becomes of the part that the blood cannot use? why is it very necessary that this be disposed of regularly? going to school i. getting ready. . how is it best to dress in winter? why? (if this is hard to understand, think which would cool faster--hot soup in a deep cup or the same soup poured out into a plate? in which dish would the soup have the larger surface from which to let off the heat? you may now weigh only half as much as you will when you are fully grown, but you already have much more than half as much size or surface.) . what quality should all clothing material have, and why? ii. an early romp. . which makes you more tired, to walk slowly, just "lagging along," for about twenty minutes, or to walk briskly for the same time? why? . how do you make your muscles strong? what is your heart made of? how can you make your heart strong? . why do you need a heart? . what is your _pulse_? where can you easily feel a pulse? count the pulse of someone else for half a minute by a watch. do this accurately. how many beats would there be in a minute? try this with different classmates. . what do we call the tubes through which the blood flows away from the heart? the tubes through which it flows back to the heart? . what is happening to the blood on its "round trip"? where does it get the liquid food that it delivers to the muscles? why must the blood be carried away from the muscles? iii. fresh air--why we need it. . if you were asked how we can tell that air is everywhere, what could you say? . what do we call a thin light substance like air? . what proof have we that the body needs it? how does it get around to the different parts of the body? . what is the body--its muscle, bone, skin, and all--made up of? how do these cells use the air? why do you need to breathe so often? . in the candle experiment, is all the air under the glass used up? what is used up? how can we compare a person in a closed room to the burning candle under the glass? . what is the gas that we breathe out? . in what three ways does the body "clean house"? iv. fresh air--how we breathe it. . where are your lungs? . draw a picture of the ribs. . in what position are they when the lungs are filled with air? in what position is the diaphragm then? . what are the lungs giving off in the breath besides carbon dioxid? how can you prove this? . how can you prove that the gas in your breath is not like the gas in the fresh air around you? . why does a room with people in it grow very warm if the doors and windows are kept closed? . how does nature keep the outdoor air clean? what makes the winds? . are you careful to keep your breath as clean as possible? how? how do you help keep the air in your house clean? in school i. bringing the fresh air in. . what do we mean by fresh air? why must the air we breathe have oxygen in it? . is the air in the room now the best you can have in it? how is the air moving? . is there always the same amount of air in the room? then, if there is more fresh air, there must be--bad air? if there is less fresh air, there must be--bad air? what is the quickest way to let the bad air out and the fresh air in? why are you given recess? . what is a draft? are drafts dangerous? . will night air hurt you? what air can you have in the house at night except night air? ii. hearing and listening. . have you ever slept in a house close to a railway? what did you notice whenever a heavy train went by? what made the bed tremble? . if you have stood very near a moving train, how did your ears feel? why? . how far do sound waves travel after they enter the ear? could a person be deaf who had two perfect ears? where would the trouble be? . draw a picture to show the parts of your _left_ ear, and name each part. . how do you take care of your ears? . comment on doing each of these things:--firing a bean shooter at anyone; throwing gravel or sand; firing off a cap or torpedo close to some one's head; boxing a person on the ear; running a nail cleaner or pencil point into your ear; putting on the baby's cap so that the ears are folded forward; asking your teacher to repeat her question. . have you tried to train your ears? how?--and why? . find out about some business, or occupation, in which it is necessary to have very keen hearing, and write a little story about it. iii. seeing and reading. . are you seated now in the best way for reading or not? why? . why is it well to look up often, as you read? . how far from your eyes ought you to be able to hold this book to read it easily? if you cannot, what should you do? . draw a picture of someone's eye, as you see it, naming the parts. . draw a picture of your eye as it would look if you could see the eyeball from the _left_ side, and name the parts. . what takes the sight message to the brain? . how does the nerve of the eye (the _optic nerve_) get its messages? what, then, is _light_? if the light waves enter the ear, can they make you hear? why not? . when a baby is born, what care should be taken of its eyes immediately, and why? . have you ever played any games in which the sharpest eyes won? what were they? . write a little story about the picture on p. . iv. a drink of water. . why do we want to drink water? how would you know that your body must have a great deal of liquid in it? . do you know where the water you drink at school comes from? if you don't, try to find out; and find out also just how it is brought to the school and why it flows up to the faucets. . if you get drinking water from a well, either at home or at school, tell where this well is--how near the house or the out-buildings. do you think that any waste from these buildings could drain into the well? why? . at your sand table or from a sandpile in the yard, lay out a farmyard, showing where the house, the barn, the chicken yard, and the pig-sty, also the privy vault, are. now locate the well so that it cannot receive drainage from any of these places. . what is the danger in using drinking water from a stream? . how could the germs of typhoid fever get into the milk we drink? . what do we mean by _fermented_ drinks? name some. what is in these drinks that is so very harmful? v. little cooks. . do you bring luncheon to school? what do you like to have for your luncheon? talk about this in class with your teacher, and find out what things are best for school luncheons. . how is your luncheon packed? why ought it to be neatly done? . how long do you take for luncheon, or for dinner at home? is this time enough? . what do you do right after eating? is this what you ought to do? why? . what foods do you know how to cook? write out the recipe for something you have made, showing what you mixed and how you did it; and in what, and how long, you cooked it. . give three reasons for cooking food. . how is fried food so often made indigestible? . are sweet foods good or harmful? what does sugar come from? how is it made? . write a little story about one of these things: my first lesson in cooking; our taffy party; how i kept flies out of the kitchen; how we boys cooked breakfast (or supper); my marketing. vi. tasting and smelling. . if anyone asked you how a lemon tastes, what would you say? what would you say about sugar? salt? pepper? pickles? strawberries? cheese? onions? radishes? how did you learn about each of these? . what does your tongue do besides receiving tastes? note in the picture (p. ) how strongly your tongue is rooted; point to the tip of it in the picture. . how does your nose help your throat and your lungs? how else may it help you? . draw a picture to show how air reaches the lungs. . what are _adenoids_? how may you know if you have adenoids? if you have, what ought you to do? why? . where do the men who want to smoke in the open trolley car have to sit? why? if children breathe tobacco smoke, what effect will it have on them? why is smoking a foolish habit? how is it often harmful? vii. talking and reciting. . when you are reciting in class, do you think how your voice and the words sound to the other people in the room? show the class how you can make your speech sound just as you want it to. . give three ways in which you can take care of your throat and voice. put your hand on the place where your voice is made. how is it made? . on your own picture of the throat, show where those little folds of skin are (the picture on p. shows, of course, only the fold of skin, or _vocal cord_, on the right half of the windpipe). viii. thinking and answering. . with two or three of your classmates, play telephone;--one must be "central" and one "information" at the central office, and one must receive your message and answer it. a number of the other children may join hands to make a long "wire" on each side of "central"; they will repeat the message softly from one to another all down their "wire." . now, suppose that you all represent the telephone system in the body. could you act out this "body-telephone" call:--the eye sees a burning match on the floor, and sends the message to its center in the brain; this center consults the memory ("information") as to what to do. memory recalls that burning matches are likely to set fire to other things and ought to be put out. so the brain sends a message to the muscles of the foot to get to work and stamp out the flame. in this play, what will you each call yourselves? . make up some other "body-telephone" plays. . what are some of the messages that are being carried by your nerves, that you know nothing about? . think how many messages a baby stores away before he is ready to answer them; what are some of these? why can he not answer them at once? what makes his brain and nerves and muscles grow? how can you take the best care of yours? . in the picture on p. , point to the brain; to the spinal cord. how near the surface of your back is your spinal cord? what keeps it from being easily injured? "absent to-day?" i. keeping well. . why do our bodies need "housecleaning"? how do we get rid of the waste part that is a gas? of the part that is water? what carries the carbon dioxid to the lungs? what carries the waste water to the sweat tubes and the kidneys? what other waste is there to be gotten rid of? . suppose that you and your chum each have an equal chance to take a bad cold from someone else; your chum catches it, and you don't. what might be one reason why you don't? place your hand over your liver. how can you keep it in good working order? . what is the bladder? why is it so very necessary to empty the bladder regularly? when you perspire freely, how does that help the kidneys? ii. some foes to fight. . you have seen moldy bread? what is, the mold? what makes it spread? . suppose you take some pieces of moldy bread or potato and turn a glass jar or bowl over them. catch a few flies and put them under the glass, and leave them to crawl over the moldy food. after a day, put the flies under another glass with some pieces of fresh bread or potato. if you find that the fresh food quickly becomes moldy, how will you think that the mold germs came to it? (if you keep the jars in a warm place, the germs will grow faster, and you won't have so long to wait before you can see the mold.) . what other kinds of germs do flies carry? how do they carry them? . a board of health caused a liveryman to be fined because he allowed a manure pile to remain behind his stable. why was his act a misdemeanor? from what do flies come, and how do they grow? . on your way to and from school, what have you noticed that could breed or attract flies? how could these things have been avoided? . the next time you go into a butcher shop or grocery store, notice how the things are kept and be ready to tell the class what you think about it. . in what ways may germs be carried, besides by flies? . what do we mean by the "great white plague"? why is it called this? what are people doing to try to cure it? . what can you do to help prevent it? . why ought you to stay away from other people when you have a cold? what do you need most in order to get well? . do you always have your own towel to use? why should you? . write a little story about the picture on p. . iii. protecting our friends. . is there a board of health in your town? if not, what takes its place? see if you can find out some of the things that the board or the officers have done for the town. . what do we mean by _quarantine_? what is the _quarantine station_ in ports where passenger steamers land? see if you can find out about any time when a city or port was guarding its people against an infectious disease. . have you been vaccinated? how was it done? why was it done? how do we all know that it is a very wise thing to have done? . how can you help the health officers to keep your town a healthful place? work and play i. growing strong. . when you play out of doors, what do you exercise? what do you exercise when you study? how ought you to play and study so as to get the most good from each? why is it good to play, and work too, out of doors? . what games have you played in the last day or two? how did the players divide the muscle exercise of the game? did they divide up the thinking part, too? . why must the blood be sent to the muscles? why must it be carried away again? when you feel tired, what is happening in your body? . what are muscles like? show how the elastic bands of your legs work when you sit on your heels. what makes the muscles at the back of your legs feel thicker? . what bones of your body can you feel? put your hands on them, as you tell what you can about each. . why do we need bones? what do we call our whole framework of bones? . have you ever seen anyone who had to stay all the time in bed or sit in a wheeled chair? how did this person show the lack of exercise? . what is the meaning of the picture on p. ? . choose one of the other pictures in this chapter and write a story about it to show how to grow strong. ii. accidents. . when you hear the word _accident_, what do you think of? what have you to help you to prevent accidents? if you have used your "look-out department" as well as you can, and still the accident happens, what will you do then? . show the class how to care for a very deep cut. what do we call a medicine that kills disease germs? . how would you treat a bruise? a burn? frost-bitten ears? chilblains? a bee sting? . if you are told to take some medicine from a certain bottle or box, do you always look at the label? why is it dangerous not to? what do you think of having medicines about not labeled or poured into old bottles with wrong labels? . if you should happen to swallow something poisonous, what ought you to do right away? . suppose your clothes or your hair should catch fire; what would you do? . how did you celebrate last fourth of july? write a short story about the picture on p. . . with one of your classmates, show how you would try to restore a person who had just been saved from drowning. how can you try to save yourself if you fall into the water? iii. the city beautiful. . have you a park near your home? when the people leave at the end of the day, how do the lawns and paths look? are there cans in the park to hold the papers and scraps? . how are the streets in your town cleaned in winter? in summer? . how do the houses get rid of their waste? . if the waste goes into a river, is the river water used for drinking? who decides where the drinking water for the town shall come from? . why are drinks containing alcohol harmful to take (give four reasons)? what is a _narcotic_? how does drinking alcohol lead to crime? . write down five ways in which you can help to keep your town or city beautiful. five ways in which you can help to keep your own home beautiful. . why should every city have parks for the children? the evening meal . play housekeeping, and order the dinner. . write down a list of things for a good supper. . why does nature give us so many different kinds of food? how does she teach us not to eat too much of one kind at a time? . write down on the board as many of each of these kinds of food as you can:--meats; vegetables; fruits; breads; sweet foods; fish; grains; food (not fruit) that does not need cooking; food to drink. . how do you help to make meal times pleasant? make up a story about the picture on p. , and tell it in class. a pleasant evening . just after a meal, what is your stomach doing? how can you help your digestion? . have you played any of the games mentioned here? how did you play them? . look at the picture on p. ; why is this a good after-supper corner? how do you sit and hold your book when you read in the evening? . what parts of your body are you exercising and taking care of when you read? of what use is a healthy, vigorous body without a healthy, vigorous mind? how can you keep your mind healthy? how can you keep it vigorous? . what kind of books do you like best to read? tell the class the names of some good ones. good night i. getting ready for bed. . at what hour do you go to bed? when do you get up? how many hours' sleep does this give you? is this enough? why do you need so much sleep? . as you undress, what do you do with the clothes you take off? why should you air your clothes every night? how can you take an air bath? is this as good as a wash? . how do you care for your hair at night? . do you ever go to bed without brushing your teeth? if you do, what happens all night long to the food scraps that were left around and between your teeth? as these scraps decay, what harm do they do? what makes a tooth ache? . draw a little picture of your own teeth as you see them in a looking-glass. are there any spaces that you can see where food might lodge and stay? how can you keep your teeth quite free from scraps of food? . why are teeth necessary? how must they grow to make good cutting tools? if they are not straight or sound, what can you do about it? . why ought children's first teeth to be thoroughly brushed every day? ii. the land of nod. . when you are ready for bed, how do you fix your windows? why is it even more necessary to have the air blowing through the room at night than in the daytime? . how else is your body being purified at night? does your body do any work while you are sleeping? what work? . what kind of sleep should you have if you are perfectly well? research, tradition and history (hearth). ithaca, ny: albert r. mann library, cornell university. http://hearth.library.cornell.edu (version january ). the maternal management of children, in health and disease. by thomas bull, m.d. physician accoucheur to the finsbury midwifery institution, and lecturer on midwifery, and on the diseases of women and children; author of "hints to mothers on the management of their health." . preface. this little book has been written for the young and inexperienced mother. it is intended to furnish her with that information which the experience and observation of some years convince the author, young mothers, almost without any exception, do not possess; and yet, from ignorance of which, the constitution of many an infant has received irretrievable injury, and life itself but too frequently fallen a sacrifice. in the first chapters, devoted to the general management of the child in health, the author has endeavoured to teach the young mother, that the prevention of disease is her province, not its cure; that to this object all her best efforts must be directed; and, moreover, that to tamper with medicine, when disease has actually commenced, is to hazard the life of her offspring. in the fourth chapter it has been attempted to point out, how the first symptoms of disease may be early detected by the parent. the subject has been felt to be a difficult one, and to give particular directions quite out of the question; but it is hoped that the suggestions thrown out will, in some measure, answer the purpose intended. on the advantage of an early and prompt application of remedies in the diseases of childhood, generally so active in their progress and severe in their character, it is unnecessary to offer any observation. the latter part of the work, consisting of the maternal management of disease, the author regards as a subject of high and serious moment. small as is the attention which has been hitherto paid to it, yet, in the diseases of infancy and childhood, how invaluable is a careful and judicious maternal superintendence to give effect to the measures prescribed by the physician. the author has endeavoured to arrange the contents of the work in a manner which shall be most easily understood and readily available; and he now publishes it with the desire to supply, in some degree, a deficiency in this important department of knowledge. finsbury place, june, . contents. chapter i. on the general management of infancy and childhood. sect. - page i. on the dietetics of infancy - . maternal nursing - plan of suckling - deficiency of milk - the injurious effects to mother and infant of undue and protracted suckling - mothers who ought never to suckle - . wet-nurse suckling - choice of a wet-nurse - diet and regimen of a wet-nurse - . artificial feeding, (bringing up by hand) - the kind of artificial food before the sixth month - the kind of artificial food after the sixth month to the completion of first dentition - the kind of artificial food most suitable under the different complaints to which infants are liable - ii. weaning - the time when - the mode - the drying up of the mother's milk - iii. on the dietetics of childhood - general directions, and of animal food - sugar - salt - fruits - water - wine, beer, and spirits - iv. sleep - during infancy - during childhood - v. bathing and cleanliness - during infancy - during childhood - vi. clothing - during infancy - during childhood - vii. air and exercise - in infancy - in childhood - chap. ii. on the use and abuse of certain remedies. i. aperient medicine - castor oil - manna - magnesia and rhubarb - the lavement - the aperient liniment - ii. calomel - iii. opiates - iv. leeching - v. blisters and poultices - vi. baths - the cold-water plunge bath - sea bathing - the shower bath - ablution, or sponging - the warm bath - chap. iii. on teething, and hints upon the permanent teeth. i. on teething. - the manner in which the temporary or milk teeth appear - the management of the infant when teething is without difficulty - the management of the infant in difficult teething - ii. hints on the permanent or adult teeth - the manner in which they appear - their value and importance - their management and preservation - chap. iv. hints for the early detection op disease in the child by the mother. i. signs of health - ii. signs of disease - of the countenance - of the gestures - of the sleep - of the stools - of the breathing and cough - iii. other circumstances which will assist in the early detection of disease - the influence of the seasons in producing particular forms of disorder - the influence of an hereditary predisposition to certain diseases - chap. v. on what constitutes the maternal management of the diseases of children. i. accidents and diseases which may occur to the infant at birth, or soon after - . still-born - . injuries received during birth - . retention of urine - . swelling of the breasts - . inflammation of the eyes - . hare-lip - . bleeding from the navel-string - . ulceration or imperfect healing of the navel - l . bleeding from the navel - . jaundice - . tongue-tied - . moles and marks on the skin, etc. - ii. disorders of the stomach and bowels; viz., indigestion - flatulence - vomiting - griping and looseness - . in the infant at the breast - o . at the period of weaning - . in the child brought up by hand - maternal treatment - iii. costiveness - in infancy - in childhood - iv. worms - not so frequent as popularly supposed; an error productive of mischief - how produced and how best prevented - v. scarlet fever - mild form - with sore throat - scarlet fever compared with measles - maternal management - vi. measles - description - compared with scarlet fever and small pox - maternal management - vii. small-pox - natural small-pox - small-pox in the vaccinated - maternal management - viii. hooping cough - description - maternal management - ix. croup - signs of its approach - maternal management - its prevention - x. water in the head - its prevention - maternal management - the maternal management of children. chapter i. on the general management of infancy and childhood. the line of demarcation made between infancy and childhood, both by ancient and modern writers, has always been arbitrary. i would draw the line between the two, at a period of time which appears to me to be the most natural, the most simple, and least likely to lead the reader into the danger of misapplying any part of the practical directions of this, or any future chapter of the work. we will consider, then, that-- infancy, commencing with birth, extends to about the end of the second year, when the first dentition is completed. childhood extends from about the second, to the seventh or eighth year, when the second dentition is commenced. sect. i. dietetics of infancy. in the early months of infancy the organs of digestion are unsuited to any other food than that derived from the breast of the mother. so little capable are they, indeed, to digest any other, even of the blandest and most digestible kind, that probably not more than one infant in six or seven ever arrives at the more advanced periods of life when deprived of the kind of nourishment nature intended for this epoch. it is not every parent, however, who is able to become a nurse; and with many this office would not only be highly injurious to their own health, but materially so to that of their offspring. this may arise from various causes, hereafter to be noticed, but whenever they exist a wet-nurse is demanded. again, the latter resource is not always attainable, so that the hazardous experiment of an artificial diet, or bringing up by hand, as it is then termed, is obliged to be resorted to. thus, infantile dietetics naturally divides itself into maternal nursing, wet-nurse suckling, and artificial feeding. . maternal nursing. plan of suckling. from the first moment the infant is applied to the breast, it must be nursed upon a certain plan. this is necessary to the well-doing of the child, and will contribute essentially to preserve the health of the parent, who will thus be rendered a good nurse, and her duty at the same time will become a pleasure. this implies, however, a careful attention on the part of the mother to her own health; for that of her child is essentially dependent upon it. healthy, nourishing, and digestible milk can be procured only from a healthy parent; and it is against common sense to expect that, if a mother impairs her health and digestion by improper diet, neglect of exercise, and impure air, she can, nevertheless, provide as wholesome and uncontaminated a fluid for her child, as if she were diligently attentive to these important points. every instance of indisposition in the nurse is liable to affect the infant. and this leads me to observe, that it is a common mistake to suppose that, because a woman is nursing, she ought therefore to live very fully, and to add an allowance of wine, porter, or other fermented liquor, to her usual diet. the only result of this plan is, to cause an unnatural degree of fulness in the system, which places the nurse on the brink of disease, and which of itself frequently puts a stop to the secretion of the milk, instead of increasing it. the right plan of proceeding is plain enough; only let attention be paid to the ordinary laws of health, and the mother, if she have a sound constitution, will make a better nurse than by any foolish deviation founded on ignorance and caprice. the following case proves the correctness of this statement:-- a young married lady, confined with her first child, left the lying-in- room at the expiration of the third week, a good nurse, and in perfect health. she had had some slight trouble with her nipples, but this was soon overcome. the porter system was now commenced, and from a pint to a pint and a half of this beverage was taken in the four and twenty hours. this was resorted to, not because there was any deficiency in the supply of milk, for it was ample, and the infant thriving upon it; but because, having become a nurse, she was told that it was usual and necessary, and that without it her milk and strength would ere long fail. after this plan had been followed for a few days, the mother became drowsy and disposed to sleep in the daytime; and headach, thirst, a hot skin, in fact, fever supervened; the milk diminished in quantity, and, for the first time, the stomach and bowels of the infant became disordered. the porter was ordered to be left off; remedial measures were prescribed; and all symptoms, both in parent and child, were after a while removed, and health restored. having been accustomed, prior to becoming a mother, to take a glass or two of wine, and occasionally a tumbler of table beer, she was advised to follow precisely her former dietetic plan, but with the addition of half a pint of barley-milk morning and night. both parent and child continued in excellent health during the remaining period of suckling, and the latter did not taste artificial food until the ninth month, the parent's milk being all-sufficient for its wants. no one can doubt that the porter was in this case the source of the mischief. the patient had gone into the lying-in-room in full health, had had a good time, and came out from her chamber (comparatively) as strong as she entered it. her constitution had not been previously worn down by repeated child-bearing and nursing, she had an ample supply of milk, and was fully capable, therefore, of performing the duties which now devolved upon her, without resorting to any unusual stimulant or support. her previous habits were totally at variance with the plan which was adopted; her system became too full, disease was produced, and the result experienced was nothing more than what might be expected. the plan to be followed for the first six months.-until the breast- milk is fully established, which may not be until the second or third day subsequent to delivery (almost invariably so in a first confinement), the infant must be fed upon a little thin gruel, or upon one third water and two thirds milk, sweetened with loaf sugar. after this time it must obtain its nourishment from the breast alone, and for a week or ten days the appetite of the infant must be the mother's guide, as to the frequency in offering the breast. the stomach at birth is feeble, and as yet unaccustomed to food; its wants, therefore, are easily satisfied, but they are frequently renewed. an interval, however, sufficient for digesting the little swallowed, is obtained before the appetite again revives, and a fresh supply is demanded. at the expiration of a week or so it is essentially necessary, and with some children this may be done with safety from the first day of suckling, to nurse the infant at regular intervals of three or four hours, day and night. this allows sufficient time for each meal to be digested, and tends to keep the bowels of the child in order. such regularity, moreover, will do much to obviate fretfulness, and that constant cry, which seems as if it could be allayed only by constantly putting the child to the breast. a young mother very frequently runs into a serious error in this particular, considering every expression of uneasiness as an indication of appetite, and whenever the infant cries offering it the breast, although ten minutes may not have elapsed since its last meal. this is an injurious and even dangerous practice, for, by overloading the stomach, the food remains undigested, the child's bowels are always out of order, it soon becomes restless and feverish, and is, perhaps, eventually lost; when, by simply attending to the above rules of nursing, the infant might have become healthy and vigorous. for the same reason, the infant that sleeps with its parent must not be allowed to have the nipple remaining in its mouth all night. if nursed as suggested, it will be found to awaken, as the hour for its meal approaches, with great regularity. in reference to night-nursing, i would suggest suckling the babe as late as ten o'clock p. m., and not putting it to the breast again until five o'clock the next morning. many mothers have adopted this hint, with great advantage to their own health, and without the slightest detriment to that of the child. with the latter it soon becomes a habit; to induce it, however, it must be taught early. the foregoing plan, and without variation, must be pursued to the sixth month. after the sixth month to the time of weaning.--if the parent has a large supply of good and nourishing milk, and her child is healthy and evidently flourishing upon it, no change in its diet ought to be made. if otherwise, however, (and this will but too frequently be the case, even before the sixth month[fn# ],) the child may be fed twice in the course of the day, and that kind of food chosen which, after a little trial, is found to agree best. [fn# ] see deficiency of milk, p. . leman's tops and bottoms, steeped in hot water, with the addition of a little fresh milk, and sweetened or not with loaf sugar, is one of the best description. if the stomach reject this, farinaceous food boiled in water, and mixed with a small quantity of milk, may be employed. or weak mutton or veal broth, or beef tea, clear and free from fat, and mixed with an equal quantity of farinaceous food. if this artificial diet is used before the sixth month, it must be given through the sucking-bottle; after this period with a spoon: in either case it must be previously passed through a sieve. when the large or grinding teeth have appeared, the same food is still to be continued, but need not any longer be expressed through the sieve. such is the plan of nursing to be followed by the mother until she wean her infant altogether from the breast. the period when this ought to take place, as also the manner of accomplishing it, are detailed in the section on "weaning."[fn# ] [fn# ] see page . the diet from weaning to the termination of infancy is pointed out under "artificial feeding."[fn# ] [fn# ] see page . deficiency of milk. if this deficiency exist from the earliest weeks after delivery, and it is not quickly remedied by the means presently to be pointed out, a wet-nurse must be obtained. it will be of no avail partially to nurse, and partially to feed the infant at this period and under such circumstances, for if it is not soon lost, it will only live for a few months, or a year at most, and be an object of the greatest anxiety and grief to its parent. this condition arises from the unwholesomeness of the mother's milk, united with the artificial food; for when the milk is deficient from the first, and continues so notwithstanding the means used for its increase, it is invariably unhealthy in its quality. this deficiency, however, may exist, and even at a very early period after delivery, and yet be removed. this, however, is not to be accomplished by the means too frequently resorted to; for it is the custom with many, two or three weeks after their confinement, if the supply of nourishment for the infant is scanty, to partake largely of malt liquor for its increase. sooner or later this will be found injurious to the constitution of the mother: but how, then, is this deficiency to be obviated? let the nurse keep but in good health, and this point gained, the milk, both as to quantity and quality, will be as ample, nutritious, and good, as can be produced by the individual. i would recommend a plain, generous, and nutritious diet; not one description of food exclusively, but, as is natural, a wholesome, mixed, animal, and vegetable diet, with or without wine or malt liquor, according to former habit; and, occasionally, where malt liquor has never been previously taken, a pint of good sound ale may be taken daily with advantage, if it agree with the stomach. regular exercise in the open air is of the greatest importance, as it has an extraordinary influence in promoting the secretion of healthy milk. early after leaving the lying-in room, carriage exercise, where it can be obtained, is to be preferred, to be exchanged, in a week or so, for horse exercise, or the daily walk. the tepid, or cold salt-water shower bath, should be used every morning; but if it cannot be borne, sponging the body withsalt-water must be substituted. by adopting with perseverance the foregoing plan, a breast of milk will be obtained as ample in quantity, and good in quality, as the constitution of the parent can produce, as the following case proves: on the th september, , i attended a lady twenty-four years of age, a delicate, but healthy woman, in her first confinement. the labour was good. every thing went on well for the first week, except that, although the breasts became enlarged, and promised a good supply of nourishment for the infant, at its close there was merely a little oozing from the nipple. during the next fortnight a slight, but very gradual increase in quantity took place, so that a dessert spoonful only was obtained about the middle of this period, and perhaps double this quantity at its expiration. in the mean time the child was necessarily fed upon an artificial diet, and as a consequence its bowels became deranged, and a severe diarrhoea followed. a wet-nurse was advised for the child as the only means of saving its life, and change of air for the mother as the most likely expedient (in connection with the general treatment pointed out above) for obtaining a good breast of milk. accordingly, on the th october, the patient, taking with her the infant and a wet-nurse, went a few miles from town. for three or four days it was a question whether the little one would live, for so greatly had it been reduced by the looseness of the bowels that it had not strength to grasp the nipple of its nurse; the milk, therefore, was obliged to be drawn, and the child fed with it from a spoon. after the lapse of a few days, however, it could obtain the breast-milk for itself; and, to make short of the case, on the th of the same month, the mother and child returned home, the former having a very fair proportion of healthy milk in her bosom, and the child perfectly recovered and evidently thriving fast upon it. where, however, there has been an early deficiency in the supply of nourishment, it will most frequently happen that, before the sixth or seventh month, the infant's demands will be greater than the mother can meet. the deficiency must be made up by artificial food, which must be of a kind generally employed before the sixth month, and given through the bottle. if, however, this plan of dieting should disagree, the child must, even at this period, have a wet-nurse. women who marry comparatively late in life, and bear children, generally have a deficiency of milk after the second or third month: artificial feeding must in part be here resorted to. the injurious effects to the mother and infant of undue and protracted suckling. upon the mother.--the period of suckling is generally one of the most healthy of a woman's life. but there are exceptions to this as a general rule; and nursing, instead of being accompanied by health, may be the cause of its being materially, and even fatally, impaired. this may arise out of one of two causes, either, a parent continuing to suckle too long; or, from the original powers or strength not being equal to the continued drain on the system. examples of the first class i am meeting with daily. i refer to poor married women, who, having nursed their infants eighteen months, two years, or even longer than this, from the belief that by so doing they will prevent pregnancy, call to consult me with an exhausted frame and disordered general health, arising solely from protracted nursing, pursued from the above mistaken notion. i most frequently meet with examples of the second class in the delicate woman, who, having had two or three children in quick succession, her health has given way, so that she has all the symptoms arising from undue suckling, when perhaps the infant at her breast is not more than two or three months old. since the health of the mother, then, will suffer materially from this circumstance, she ought not to be ignorant of the fact; so that, when the first symptoms manifest themselves, she may be able to recognise their insidious approach; and tracing them to their real cause, obtain medical advice before her health be seriously impaired. symptoms.--the earliest symptom is a dragging sensation in the back when the child is in the act of sucking, and an exhausted feeling of sinking and emptiness at the pit of the stomach afterwards. this is soon followed by loss of appetite, costive bowels, and pain on the left side; then, the head will be more or less affected, sometimes with much throbbing, singing in the ears, and always some degree of giddiness, with great depression of spirits. soon the chest becomes affected, and the breathing is short, accompanied by a dry cough and palpitation of the heart upon the slightest exertion. as the disease advances, the countenance becomes very pale, and the flesh wastes, and profuse night perspirations, great debility, swelling of the ankles, and nervousness ensue. it is unnecessary, however, to enter into a more full detail of symptoms. treatment.--all that it will be useful to say in reference to treatment, is this; that, although much may be done in the first instance by medicine, change of air, cold and sea bathing, yet the quickest and most effectual remedy is to wean the child, and thus remove the cause. the ill effects upon the infant.--there is another and equally powerful reason why the child should be weaned, or rather, have a young and healthy wet-nurse, if practicable. the effects upon the infant, suckled under such circumstances, will be most serious. born in perfect health, it will now begin to fall off in its appearance, for the mother's milk will be no longer competent to afford it due nourishment; it will be inadequate in quantity and quality. its countenance, therefore, will become pale; its look sickly and aged; the flesh soft and flabby; the limbs emaciated; the belly, in some cases, large, in others, shrunk; and the evacuations fetid and unnatural; and in a very few weeks, the blooming healthy child will be changed into the pale, sickly, peevish, wasted creature, whose life appears hardly desirable. the only measure that can save the life, and recover an infant from this state, is that which would previously have prevented it a healthy wet-nurse. if the effects upon the infant should not be so aggravated as those just described, and it subsequently live and thrive, there will be a tendency in such a constitution to scrofula and consumption, to manifest itself at some future period of life, undoubtedly acquired from the parent, and dependent upon the impaired state of her health at the time of its suckling. a wet-nurse early resorted to, will prevent this. it will be naturally asked, for how long a period a mother ought to perform the office of a nurse? no specific time can be mentioned, and the only way in which the question can be met is this: no woman, with advantage to her own health, can suckle her infant beyond twelve or eighteen months; and at various periods between the third and twelfth month, many women will be obliged partially or entirely to resign the office.[fn# ] [fn# ] see "weaning," p. . the monthly periods generally reappear from the twelfth to the fourteenth month from delivery; and when established, as the milk is found invariably to diminish in quantity, and also to deteriorate in quality, and the child is but imperfectly nourished, it is positively necessary in such instances at once to wean it. of mothers who ought never to suckle. there are some females who ought never to undertake the office of suckling, both on account of their own health, and also that of their offspring. the woman of a consumptive and strumous constitution ought not.--in the infant born of such a parent there will be a constitutional predisposition to the same disease; and, if it is nourished from her system, this hereditary predisposition will be confirmed. "no fact in medicine is better established than that which proves the hereditary transmission from parents to children of a constitutional liability to pulmonary disease, and especially to consumption; yet no condition is less attended to in forming matrimonial engagements. the children of scrofulous and consumptive parents are generally precocious, and their minds being early matured, they engage early in the business of life, and often enter the married state before their bodily frame has had time to consolidate. for a few years every thing seems to go on prosperously, and a numerous family gathers around them. all at once, however, even while youth remains, their physical powers begin to give way, and they drop prematurely into the grave, exhausted by consumption, and leaving children behind them, destined, in all probability, either to be cut off as they approach maturity, or to run through the same delusive but fatal career as that of the parents from whom they derived their existence."[fn# ] there is scarcely an individual who reads these facts, to whom memory will not furnish some sad and mournful example of their truth; though they perhaps may have hitherto been in ignorance of the exciting cause. [fn# ] combe's principles of physiology applied to the preservation of health, etc. it is, however, with the mother as a nurse that i have now to do, and i would earnestly advise every one of a consumptive or strumous habit (and if there is any doubt upon this point, the opinion of a medical adviser will at once decide it) never to suckle her offspring; her constitution renders her unfit for the task. and, however painful it may be to her mind at every confinement to debar herself this delightful duty, she must recollect that it will be far better for her own health, and infinitely more so for that of the child, that she should not even attempt it; that her own health would be injured, and her infant's, sooner or later, destroyed by it. the infant of a consumptive parent, however, must not be brought up by hand. it must have a young, healthy, and vigorous wet-nurse; and in selecting a woman for this important duty very great care must be observed.[fn# ] the child should be nursed until it is twelve or fifteen months old. in some cases it will be right to continue it until the first set of teeth have appeared, when it will be desirable that a fresh wet-nurse should be obtained for the last six months.[fn# ] if the child is partially fed during the latter months (from necessity or any other cause), the food should be of the lightest quality, and constitute but a small proportion of its nutriment. [fn# ] see "choice of a wet-nurse," p. . [fn# ] one that has been confined about six weeks or two months. but not only must the nourishment of such a child be regarded, but the air it breathes, and the exercise that is given to it; as also, the careful removal of all functional derangements as they occur, by a timely application to the medical attendant, and maintaining, especially, a healthy condition of the digestive organs. all these points must be strictly followed out, if any good is to be effected. by a rigid attention to these measures the mother adopts the surest antidote, indirectly, to overcome the constitutional predisposition to that disease, the seeds of which, if not inherited from the parent, are but too frequently developed in the infant during the period of nursing; and, at the same time, she takes the best means to engender a sound and healthy constitution in her child. this, surely, is worth any sacrifice. if the infant derives the disposition to a strumous constitution entirely from the father, and the mother's health be unexceptionable, then i would strongly advise her to suckle her own child. the mother of a highly susceptible nervous temperament ought not.--there are other women who ought never to become nurses. the mother of a highly nervous temperament, who is alarmed at any accidental change she may happen to notice in her infant's countenance, who is excited and agitated by the ordinary occurrences of the day; such a parent will do her offspring more harm than good by attempting to suckle it. her milk will be totally unfit for its nourishment: at one time it will be deficient in quantity, at another, so depraved in its quality, that serious disturbance to the infant's health, will ensue. the young and inexperienced mother, who is a parent for the first time, and altogether ignorant of the duties of her office, and at the same time most anxious to fulfil them faithfully, is but too frequently an instance in point; although at a future period she will generally make a good nurse. the following is an illustration:-- in december, , i attended a young married lady in her first confinement, and in excellent health. she gave birth to a fine, plump, healthy boy. every thing went on well for three weeks, the mother having an abundant supply of milk, and the infant evidently thriving upon it. about this time, however, the child had frequent fits of crying; the bowels became obstinately costive;--the motions being lumpy, of a mixed colour, quite dry, and passed with great pain. it became rapidly thin, and after a while its flesh so wasted, and became so flabby, that it might be said literally to hang on the bones. the fits of crying now increased in frequency and violence, coming on every time after the little one left the breast, when it would commence screaming violently, beat the air with its hands and feet, and nothing that was done could appease it. having lasted for half an hour or more, it would fall asleep quite exhausted; the fit recurring again, when again it had been to the breast. it was very evident that the infant's hunger was not satisfied, as it was also but too evident its body was not nourished by the parent's milk, which, although abundant in quantity (the breast being large and full of milk), was at this time seriously deteriorated in its nutritive quality. this was caused, i believe, from great anxiety of mind. her nurse became suddenly deranged, and the whole responsibility and care of the child thus devolved upon the mother, of the duties connected with which she was entirely ignorant. a wet-nurse was obtained. in a very few hours after this change was effected, the screaming ceased, the child had quiet and refreshing sleep, and in twelve hours a healthy motion was passed. the child gained flesh almost as quickly as it had previously lost it, and is now as fine and healthy an infant as it promised to be when born. whenever there has existed previously any nervous or mental affection in the parent, wet-nurse suckling is always advisable; this, with judicious management of childhood, will do much to counteract the hereditary predisposition. the mother who only nurses her infant when it suits her convenience ought not.--the mother who cannot make up her mind exclusively to devote herself to the duties of a nurse, and give up all engagements that would interfere with her health, and so with the formation of healthy milk, and with the regular and stated periods of nursing her infant, ought never to suckle. it is unnecessary to say why; but i think it right, for the child's sake, to add, that if it does not sicken, pine, and die, disease will be generated in its constitution, to manifest itself at some future period. the child, then, under all the foregoing circumstances, must be provided with its support from another source, and a wet-nurse is the best. . wet-nurse suckling. ill health and many other circumstances may prevent a parent from suckling her child, and render a wet-nurse necessary. now, although she will do wisely to leave the choice of one to her medical attendant, still, as some difficulty may attend this, and as most certainly the mother herself ought to be acquainted with the principal points to which his attention is directed in the selection of a good nurse, it will be well to point out in what they consist. choice of a wet-nurse. the first thing to which a medical man looks, is the general health of the woman; next, the condition of her breast, the quality of her milk its age and her own; whether she is ever unwell while nursing; and, last of all, the condition and health of the child. is the woman in good health?--her general appearance ought to bear the marks of a sound constitution, and ought to be free from all suspicion of a strumous character; her tongue clean, and digestion good; her teeth and gums sound and perfect; her skin free from eruption, and her breath sweet. what is the condition of the breast?--a good breast should be firm and well formed; its size not dependent upon a large quantity of fat, which will generally take away from its firmness, giving it a flabby appearance, but upon its glandular structure, which conveys to the touch a knotted, irregular, and hard feel; and the nipple must be perfect, of moderate size, but well developed. what is the quality of the milk?--it should be thin, and of a bluish- white colour; sweet to the taste; and when allowed to stand, should throw up a considerable quantity of cream. what is its age?--if the lying-in month of the patient has scarcely expired, the wet-nurse to be hired ought certainly not to have reached her second month. at this time, the nearer the birth of the child, and the delivery of its foster-parent, the better: the reason for which is, that during the first few weeks the milk is thinner and more watery than it afterwards becomes. if, consequently, a new-born infant be provided with a nurse, who has been delivered three or four months, the natural relation between its stomach and the quality of the milk is destroyed, and the infant suffers from the oppression of food too heavy for its digestive power. on the other hand, if you are seeking a wet-nurse for an infant of four or five months old, it would be very prejudicial to transfer the child to a woman recently delivered; the milk would be too watery for its support, and its health in consequence would give way. the nurse herself should not be too old!--a vigorous young woman from twenty-one to thirty admits of no question. and the woman who has had one or two children before is always to be preferred, as she will be likely to have more milk, and may also be supposed to have acquired some experience in the management of infants. inquire whether she is ever unwell while nursing?--if so, reject her at once. you will have no difficulty in ascertaining this point; for this class of persons have an idea that their milk is renewed, as they term it, by this circumstance, monthly; and, therefore, that it is a recommendation, rendering their milk fitter for younger children than it would otherwise have been. it produces, however, quite a contrary effect; it much impairs the milk, which will be found to disagree with the child, rendering it at first fretful,--after a time being vomited up, and productive of frequent watery dark green motions. last of all, what is the condition of the child?--it ought to have the sprightly appearance of health, to bear the marks of being well nourished, its flesh firm, its skin clean and free from eruptions. it should be examined in this respect, particularly about the head, neck, and gums. if a medical man finds that both mother and child answer to the above description, he has no hesitation in recommending the former as likely to prove a good wet-nurse. diet and regimen of a wet-nurse. the regimen of a wet-nurse should not differ much from that to which she has been accustomed; and any change which it may be necessary to make in it should be gradual. it is erroneous to suppose that women when nursing require to be much more highly fed than at other times: a good nurse does not need this, and a bad one will not be the better for it. the quantity which many nurses eat and drink, and the indolent life which they too often lead, have the effect of deranging their digestive organs, and frequently induce a state of febrile excitement, which always diminishes, and even sometimes altogether disperses, the milk. it will be necessary then to guard against the nurse overloading her stomach with a mass of indigestible food and drink. she should live as much as possible in the manner to which she has been accustomed; she should have a wholesome, mixed, animal and vegetable diet, and a moderate and somewhat extra quantity of malt liquor, provided it agree with her system. a very prevailing notion exists that porter tends to produce a great flow of milk, and in consequence the wet-nurse is allowed as much as she likes; a large quantity is in this way taken, and after a short time so much febrile action excited in the system, that instead of increasing the flow of milk, it diminishes it greatly. some parents, however, aware of this fact, will go into an opposite extreme, and refuse the nurse even that which is necessary. either excess is of course wrong. it is difficult in general terms to say what ought to be considered a proper daily allowance, but some is in general necessary; and whenever a woman has been used to drink malt-liquor, she will rarely make a good wet-nurse if she is denied a reasonable quantity of that beverage. good sound ale sometimes agrees better than porter. it may be well here to remark, that in london, i frequently meet with severe cases of diarrhoea in infants at the breast, fairly traceable to bad porter, which vitiating the quality of the milk, no medical treatment cures the disease, until this beverage is left off or changed, when it at once disappears. the nurse should take exercise daily in the open air. nothing tends more directly to maintain a good supply of healthy milk, than air and exercise; and the best wet-nurse would soon lose her milk, if constantly kept within doors. sponging the whole body also with cold water with bay-salt in it every morning, should be insisted upon, if possible: it preserves cleanliness, and greatly invigorates the health. united with this, the nurse should rise early, and also be regularly employed during the day in some little portion of duty in the family, an attendance upon the wants of the child not being alone sufficient. an amiable disposition and good temper are very desirable. a violent fit of passion may exert so peculiar an influence in changing the natural properties of the milk, that a child has been known to be attacked with a fit of convulsions after being suckled by a nurse while labouring under the effects of a fit of anger. the depressing passions frequently drive the milk away altogether. it is hence of no small moment, that a wet-nurse be of a quiet and even temper, and not disposed to mental disturbance. . artificial, feeding, or bringing up by hand. extreme delicacy of constitution, diseased condition of the frame, defective secretion of milk, and other causes, may forbid the mother suckling her child; and unless she can perform this office with safety to herself, and benefit to her infant, she ought not to attempt it. in this case a young and healthy wet-nurse is the best substitute; but even this resource is not always attainable. under these circumstances, the child must be brought up on an artificial diet "by hand,"--as it is popularly called. to accomplish this with success requires the most careful attention on the part of the parent, and at all times is attended with risk to the life of the child; for although some children, thus reared, live and have sound health, these are exceptions to the general rule, artificial feeding being in most instances unsuccessful. the kind of artificial food before the sixth month. it should be as like the breast-milk as possible. this is obtained by a mixture of cow's milk, water, and sugar, in the following proportions:-- fresh cow's milk, two thirds; boiling water, or thin barley water, one third; loaf sugar, a sufficient quantity to sweeten. this is the best diet that can be used for the first six months, after which some farinaceous food may be combined. in early infancy, mothers are too much in the habit of giving thick gruel, panada, biscuit-powder, and such matters, thinking that a diet of a lighter kind will not nourish. this is a mistake; for these preparations are much too solid; they overload the stomach, and cause indigestion, flatulence, and griping. these create a necessity for purgative medicines and carminatives, which again weaken digestion, and, by unnatural irritation, perpetuate the evils which render them necessary. thus many infants are kept in a continual round of repletion, indigestion, and purging, with the administration of cordials and narcotics, who, if their diet were in quantity and quality suited to their digestive powers, would need no aid from physic or physicians. in preparing this diet, it is highly important to obtain pure milk, not previously skimmed, or mixed with water; and in warm weather just taken from the cow. it should not be mixed with the water or sugar until wanted, and not more made than will be taken by the child at the time, for it must be prepared fresh at every meal. it is best not to heat the milk over the fire, but let the water be in a boiling state when mixed with it, and thus given to the infant tepid or lukewarm. as the infant advances in age, the proportion of milk may be gradually increased; this is necessary after the second month, when three parts of milk to one of water may be allowed. but there must be no change in the kind of diet if the health of the child is good, and its appearance perceptibly improving. nothing is more absurd than the notion, that in early life children require a variety of food; only one kind of food is prepared by nature, and it is impossible to transgress this law without marked injury. if cow's milk disagree with an infant--and this is sometimes unfortunately the case, even from its birth ass's milk,--diluted with one third its quantity of water, may be given as a substitute. i am now attending a lady in her fourth confinement, who is unable, from defect in her nipples, to suckle her children. the first child had a healthy wet-nurse, and has grown a fine healthy lad. the second, a girl, was unfortunate in her nurse, she being of a strumous and unhealthy constitution, although to a casual observer bearing the appearance of health. the child lived only three months, and the nurse died of a rapid consumption shortly after. this discouraged the mother from adopting wet-nurse suckling for the third child (a great error); and an artificial diet of cow's milk was resorted to. the third day from commencing this plan, flatulence, griping, purging, and vomiting came on, one symptom quickly following the other; the child wasted, and on the sixth day had several convulsive fits. the diet was immediately changed for ass's milk, and in less than twelve hours the sickness and purging ceased; the flatulence was relieved; the motions, from being green, watery, and passed with great violence and pain, became of a healthy consistence and colour, and the screaming ceased. the symptoms did not return, the child thrived, very soon consuming regularly one quart of the ass's milk daily, and is now a fine healthy girl two years old. a fortnight since the parent was confined with a fourth child. cow's milk was given to it for two or three days (from the difficulty of obtaining that of the ass), the same train of symptoms, precisely, came on with which the third child had been affected, which again gave way upon following up the same plan of diet--the substitution of the ass's milk for that of the cow. the evident conclusion from this is, that the breast-milk of a healthy woman is incomparably the most suitable diet for the infant; but that, if she be not of a healthy constitution, it may be destructive to the child; and that where this cannot be obtained, and cow's milk is found to disagree, ass's milk may sometimes be resorted to with the happiest results.[fn# ] [fn# ] an infant will generally consume a quart, or a little more, of ass's milk in the four and twenty hours; and as this quantity is nearly as much as the animal will give, it is best to purchase an ass for the express purpose. the foal must be separated from the mother, and the forage of the latter carefully attended to, or the milk will disagree with the child. sometimes the mother's breast, and every description of milk, is rejected by the child; in which case recourse must be had to veal or weak mutton broth, or beef tea, clear and free from fat, mixed with a very small quantity of farinaceous food, carefully passed through a sieve before it is poured into the sucking-bottle. the mode of administering it.--there are two ways--by the spoon, and by the nursing-bottle. the first ought never to be employed at this period, inasmuch as the power of digestion in infants is very weak, and their food is designed by nature to be taken very slowly into the stomach, being procured from the breast by the act of sucking, in which act a great quantity of saliva is secreted, and being poured into the mouth, mixes with the milk, and is swallowed with it. this process of nature, then, should be emulated as far as possible; and food (for this purpose) should be imbibed by suction from a nursing-bottle: it is thus obtained slowly, and the suction employed secures the mixture of a due quantity of saliva, which has a highly important influence on digestion. too much care cannot be taken to keep the bottle perfectly sweet. for this purpose there should always be two in the nursery, to be used alternately; and, if any food remain after a meal, it must be emptied out. the bottle must always be scalded out after use. the flat glass nursing-bottle itself is too well known to need description; it may be well, however, to say a word about the teat that covers its narrow neck, and through which the infant sucks the food. if the artificial or prepared cow's teat is made use of, it should be so attached to the bottle that its extremity does not extend beyond its apex more than half or three quarters of an inch; for if it projects more than this, the child will get the sides of the teat so firmly pressed together between its gums, that there will be no channel for the milk to flow through. this remark applies equally to the teat made of soft wash- leather, which many ladies prefer to that of the cow, and it is a good substitute; but then a fresh piece of leather must be made use of daily, otherwise the food will be tainted, and the child's bowels deranged. it is also necessary that both of these, when used, should have a small conical piece of sponge inclosed. the most cleanly and convenient apparatus is a cork nipple, upon the plan of m. darbo, of paris, fixed in the sucking-bottle.[fn# ] the cork, being of a particularly fine texture, is supple and elastic, yielding to the infant's lips while sucking, and is much more durable than the teats ordinarily used. [fn# ] sold by weiss et son, . strand, whatever kind of bottle or teat is used, however, it must never be forgotten that cleanliness is absolutely essential to the success of this plan of rearing children. the quantity of food to be given at each meal.--this must be regulated by the age of the child, and its digestive power. a little experience will soon enable a careful and observing mother to determine this point.--as the child grows older the quantity of course must be increased. the chief error in rearing the young is overfeeding; and a most serious one it is; but which may be easily avoided by the parent pursuing a systematic plan with regard to the hours of feeding, and then only yielding to the indications of appetite, and administering the food slowly, in small quantities at a time. this is the only way effectually to prevent indigestion, and bowel complaints, and the irritable condition of the nervous system, so common in infancy, and secure to the infant healthy nutrition, and consequent strength of constitution. as has been well observed, "nature never intended the infant's stomach to be converted into a receptacle for laxatives, carminatives, antacids, stimulants, and astringents; and when these become necessary, we may rest assured that there is something faulty in our management, however perfect it may seem to ourselves." the frequency of giving food.--this must be determined, as a general rule, by allowing such an interval between each meal as will insure the digestion of the previous quantity; and this may be fixed at about every three or four hours. if this rule be departed from, and the child receives a fresh supply of food every hour or so, time will not be given for the digestion of the previous quantity, and as a consequence of this process being interrupted, the food passing on into the bowel undigested, will there ferment and become sour, will inevitably produce cholic and purging, and in no way contribute to the nourishment of the child. the posture of the child when fed.--it is important to attend to this. it must not receive its meals lying; the head should be raised on the nurse's arm, the most natural position, and one in which there will be no danger of the food going the wrong way, as it is called. after each meal the little one should be put into its cot, or repose on its mother's knee, for at least half an hour. this is essential for the process of digestion, as exercise is important at other times for the promotion of health. the kind of artificial food after the sixth month, to the completion of first dentition. as soon as the child has got any teeth,--and about this period one or two will make their appearance,--solid farinaceous matter boiled in water, beaten through a sieve, and mixed with a small quantity of milk, may be employed. or tops and bottoms, steeped in hot water, with the addition of fresh milk and loaf sugar to sweeten. and the child may now, for the first time, be fed with a spoon. when one or two of the large grinding teeth have appeared, the same food may be continued, but need not be passed through a sieve. beef tea and chicken broth may occasionally be added; and, as an introduction to the use of a more completely animal diet, a portion, now and then, of a soft boiled egg; by and by a small bread pudding, made with one egg in it, may be taken as the dinner meal. nothing is more common than for parents during this period to give their children animal food. this is a great error. "to feed an infant with animal food before it has teeth proper for masticating it, shows a total disregard to the plain indications of nature, in withholding such teeth till the system requires their assistance to masticate solid food. and the method of grating and pounding meat, as a substitute for chewing, may be well suited to the toothless octogenarian, whose stomach is capable of digesting it; but the stomach of a young child is not adapted to the digestion of such food, and will be disordered by it."[fn# ] [fn# ] sir james clarke on consumption. "if the principles already laid down be true, it cannot reasonably be maintained that a child's mouth without teeth, and that of an adult, furnished with the teeth of carnivorous and graminivorous animals, are designed by the creator for the same sort of food. if the mastication of solid food, whether animal or vegetable, and a due admixture of saliva, be necessary for digestion, then solid food cannot be proper, when there is no power of mastication. if it is swallowed in large masses it cannot be masticated at all, and will have but a small chance of being digested; and in an undigested state it will prove injurious to the stomach and to the other organs concerned in digestion, by forming unnatural compounds. the practice of giving solid food to a toothless child, is not less absurd, than to expect corn to be ground where there is no apparatus for grinding it. that which would be considered as an evidence of idiotism or insanity in the last instance, is defended and practised in the former. if, on the other hand, to obviate this evil, the solid matter, whether animal or vegetable, be previously broken into small masses, the infant will instantly swallow it, but it will be unmixed with saliva. yet in every day's observation it will be seen, that children are so fed in their most tender age; and it is not wonderful that present evils are by this means produced, and the foundation laid for future disease."[fn# ] [fn# ] dr. john clarke's commentaries. the diet pointed out, then, is to be continued until the second year. great care, however, is necessary in its management; for this period of infancy is ushered in by the process of teething, which is commonly connected with more or less of disorder of the system. any error, therefore, in diet or regimen is now to be most carefully avoided. 'tis true that the infant, who is of a sound and healthy constitution, in whom, therefore, the powers of life are energetic, and who up to this time has been nursed upon the breast of its parent, and now commences an artificial diet for the first time, disorder is scarcely perceptible, unless from the operation of very efficient causes. not so, however, with the child who from the first hour of its birth has been nourished upon artificial food. teething under such circumstances is always attended with more or less of disturbance of the frame, and disease of the most dangerous character but too frequently ensues. it is at this age, too, that all infectious and eruptive fevers are most prevalent; worms often begin to form, and diarrhoea, thrush, rickets, cutaneous eruptions, etc. manifest themselves, and the foundation of strumous disease is originated or developed. a judicious management of diet will prevent some of these complaints, and mitigate the violence of others when they occur. the kind of artificial diet most suitable under the different complaints to which infants are liable. artificial food, from mismanagement and other causes, will now and then disagree with the infant. the stomach and bowels are thus deranged, and medicine is resorted to, and again and again the same thing occurs. this is wrong, and but too frequently productive of serious and lasting mischief. alteration of diet, rather than the exhibition of medicine, should, under these circumstances, be relied on for remedying the evil. calomel, and such like remedies, "the little powders of the nursery," ought not to be given on every trivial occasion. more mischief has been effected, and more positive disease produced, by the indiscriminate use of the above powerful drug, either alone or in combination with other drastic purgatives, than would be credited. purgative medicines ought at all times to be exhibited with caution to an infant, for so delicate and susceptible is the structure of its alimentary canal, that disease is but too frequently caused by that which was resorted to in the first instance as a remedy. the bowels should always be kept free; but then it must be by the mildest and least irritating means. it is a very desirable thing, then, to correct the disordered conditions of the digestive organs of an infant, if possible, without medicine; and much may be done by changing the nature, and sometimes by simply diminishing the quantity, of food. a diarrhoea, or looseness of the bowels, may frequently be checked by giving, as the diet, sago thoroughly boiled in very weak beef-tea, with the addition of a little milk. the same purpose is frequently to be answered by two thirds of arrow-root with one third of milk, or simply thin arrow-root made with water only; or, if these fail, baked flour, mixed with boiled milk. costiveness of the bowels may frequently be removed by changing the food to tops and bottoms steeped in hot water, and a small quantity of milk added, or prepared barley,--mixed in warm water and unboiled milk. flatulence and griping generally arise from an undue quantity of food, which passing undigested into the bowels, they are thus irritated and disturbed. this may be cured by abstinence alone. the same state of things may be caused by the food not being prepared fresh at every meal, or even from the nursing-bottle or vessel in which the food is given not having been perfectly clean. in this case weak chicken-broth, or beef-tea freed from fat, and thickened with soft boiled rice or arrow-root, may be given. sect. ii. weaning. the time when to take place.--the time when weaning is to take place must ever depend upon a variety of circumstances, which will regulate this matter, independently of any general rule that might be laid down. the mother's health may, in one case, oblige her to resort to weaning before the sixth month, and, in another instance, the delicacy of the infant's health, to delay it beyond the twelfth. nevertheless, as a general rule, both child and parent being in good health, weaning ought never to take place earlier than the ninth (the most usual date), and never delayed beyond the twelfth month. i should say further, that if child and parent are both in vigorous health, if the infant has cut several of its teeth, and been already accustomed to be partially fed, weaning ought to be gradually accomplished at the ninth month. on the other hand, that if the child is feeble in constitution, the teeth late in appearing, and the mother is healthy, and has a sufficient supply of good milk, especially if it be the autumnal season, it will be far better to prolong the nursing for a few months. in such a case, the fact of the on-appearance of the teeth indicates an unfitness of the system for any other than the natural food from the maternal breast. and again, if the infant is born of a consumptive parent, and a healthy and vigorous wet-nurse has been provided, weaning should most certainly be deferred beyond the usual time, carefully watching, however, that neither nurse nor child suffer from its continuance. the mode.--it should be effected gradually. from the sixth month most children are fed twice or oftener in the four-and-twenty hours; the infant is in fact, therefore, from this time in the progress of weaning; that is to say, its natural diet is partly changed for an artificial one, so that when the time for complete weaning arrives, it will be easily accomplished, without suffering to the mother, or much denial to the child. it is, however, of the greatest importance to regulate the quantity and quality of the food at this time. if too much food is given (and this is the great danger) the stomach will be overloaded, the digestive powers destroyed, and if the child is not carried off suddenly by convulsions, its bowels will become obstinately disordered; it will fall away from not being nourished, and perhaps eventually become a sacrifice to the overanxious desire of the parent and its friends to promote its welfare. the kind of food proper for this period, and the mode of administering it, is detailed in the previous section, on "artificial feeding."[fn# ] [fn# ] the kind of food after the sixth month to the completion of first dentition, p. . much exercise in the open air (whenever there is no dampness of atmosphere) is highly necessary and beneficial at this time; it tends to invigorate the system, and strengthens the digestive organs, and thus enables the latter to bear without injury the alteration in diet. the drying up of the mother's milk.--this will generally be attended with no difficulty. when the weaning is effected gradually, the milk will usually go away of itself without any measures being resorted to. if, however, the breasts should continue loaded, or indeed painfully distended, a gentle aperient should be taken every morning, so that the bowels are kept slightly relaxed; the diet must be diminished in quantity, and solid nourishment only taken. the breast, if painfully distended, must be occasionally drawn, but only just sufficiently to relieve the distention. in either case they must be rubbed for five or ten minutes, every four or five hours, with the following liniment, previously warmed:-- compound soap liniment, one ounce and a half; laudanum, three drachms. sect. iii. dietetics of childhood. childhood, as has been before intimated, extends from about the second to the seventh or eighth year, when the second dentition is commenced. no precise rules of diet can be laid down for this period, as this requires to be adapted in every case to the particular constitution concerned. there are, however, certain general principles which must be acted upon, and which can be easily modified by a judicious and observant parent, as circumstances and constitution may require. general directions, and of animal food.--the diet of the latter months of infancy is still to be continued, but with the important addition of animal food, which the child has now got teeth to masticate. this must be given in small quantity; it should be of the lightest quality, only allowed on alternate days, and even then its effects must be carefully watched, as all changes in the regimen of children should be gradual. a child at this age, then, should have its meals at intervals of about four hours:--thus its breakfast between seven and eight o'clock, to consist of tops and bottoms, steeped in hot water, a little milk added, and the whole sweetened with sugar; or bread may be softened in hot water, the latter drained off, and fresh milk and sugar added to the bread. its dinner about twelve o'clock, to consist, every other day, of a small quantity of animal food (chicken, fresh mutton, or beef, being the only meats allowed) with a little bread and water; on the alternate days, well boiled rice and milk, a plain bread, sago, tapioca, or arrow- root pudding, containing one egg; or farinaceous food, with beef-tea. its afternoon mealy about four o'clock, the same diet as formed the breakfast. at seven, a little arrow-root, made with a very small proportion of milk, or a biscuit, or crust of bread, after which the child should be put to bed. the child must be taught to take its food slowly, retain it in it's mouth long, and swallow it tardily. nothing must be given in the intervals of the meals. the stomach requires a period of repose after the labour of digestion; and if the child is entertained by its nurse, and its mind occupied, there will be no difficulty in following out this important direction. as the child grows older, the quantity at each meal should be increased; the tops and bottoms changed for bread and pure milk, boiled or not; meat may be taken daily, except circumstances forbid it; and a small quantity of vegetable also. if a child, then, be of a sound constitution, with healthy bowels, a cool skin, and clean tongue, the diet may be liberal, and provided it is sufficiently advanced in age, animal food may be taken daily. too low a diet would stint the growth of such a child, and induce a state of body deficient in vigour, and unfit for maintaining full health: scrofula and other diseases would be induced. at the same time let the mother guard against pampering, for this would lead to evils no less formidable, though of a different character. and as long as the general health of this child is unimpaired, the body and mind active, and no evidence present to mark excess of nutriment, this diet may be continued. but if languor at any time ensue, fever become manifested, the skin hotter than natural, the tongue white and furred, and the bowels irregular, then, though these symptoms should bebonly in slight degree, and unattended with any specific derangement amounting to what is considered disease, not only should the parent lower the diet, and for a time withdraw the animal part, but the medical adviser should be consulted, that measures may be taken to correct the state of repletion which has been suffered to arise. for some time after its removal, care should also be taken to keep the diet under that, which occasioned the constitutional disturbance. but if the child be of a delicate and weakly constitution (and this is unfortunately the more common case), it will not bear so generous a diet as the foregoing. during the three or four earliest years, it should be restricted chiefly to a mild farinaceous diet, with a small allowance only of meat on alternate days. the constant endeavour of the parent now should be, to seek to increase the digestive power and bodily vigour of her child by frequent exercise in the open air, and by attention to those general points of management detailed in the after- part of this chapter. this accomplished, a greater proportion of animal food may be given, and, in fact, will become necessary for the growth of the system, while at the same time there will be a corresponding power for its assimilation and digestion. a great error in the dietetic management of such children is but too frequently committed by parents. they suppose that because their child is weakly and delicate, that the more animal food it takes the more it will be strengthened, and they therefore give animal food too early, and in too great quantity. it only adds to its debility. the system, as a consequence, becomes excited, nutrition is impeded, and disease produced, ultimately manifesting itself in scrofula, disease in the abdomen, head, or chest. the first seeds of consumption are but too frequently originated in this way. a child so indulged will eat heartily enough, but he remains thin notwithstanding. after a time he will have frequent fever, will appear heated and flushed towards evening, when he will drink greedily, and more than is usual in children of the same age; there will be deranged condition of the bowels, and headach,--the child will soon become peevish, irritable, and impatient; it will entirely lose the good humour so natural to childhood, and that there is something wrong will be evident enough, the parent, however, little suspecting the real cause and occasion of all the evil. in such a child, too, it will be found that the ordinary diseases of infancy, scarlet fever, measles, small pox, etc., will be attended with an unusual degree of constitutional disturbance; that it will not bear such active treatment as other children, or so quickly rally from the illness. "strength is to be obtained not from the kind of food which contains most nourishment in itself, but from that which is best adapted to the condition of the digestive organs at the time when it is taken." sugar.--this is a necessary condiment for the food of children, and it is nutritious, and does not injure the teeth, as is generally imagined. "during the sugar season," observes dr. dunglison, "the negroes of the west india islands drink copiously of the juice of the cane, yet their teeth are not injured; on the contrary, they have been praised by writers for their beauty and soundness; and the rounded form of the body, whilst they can indulge in the juice, sufficiently testifies to the nutrient qualities of the saccharine beverage."[fn# ] sweetmeats, on the other hand, are most indigestible, and seriously injurious. [fn# ] elements of hygiem. philadephia, . salt.--this is necessary for the health of a child; it acts as a stimulant to the digestive organs, and if not allowed in sufficient quantity with the food, worms will result.[fn# ] it may, therefore, be added in small quantity, and with advantage, even to the farinaceous food of infants. salted meats, however, should never be permitted to the child; for by the process of salting the fibre of the meat is so changed, that it is less nutritive, as well as less digestible. [fn# ] lord sommerville, in his address to the board of agriculture, gave an interesting account of the effects of a punishment which formerly existed in holland. "the ancient laws of the country ordained men to be kept on bread alone, un-mixed with salt, as the severest punishment that could be inflicted upon them in their moist climate. the effect was horrible: these wretched criminals are said to have been devoured by worms engendered in their own stomachs." "the wholesomeness and digestibility of our bread are undoubtedly much promoted by the addition of the salt which it so universally receives. a pound of salt is generally added to each bushel of flour. hence it may be presumed, that every adult consumes two ounces of salt per week, or six pounds and a half per annum, in bread alone." dr. paris on diet. fruits.--these, and of all kinds whether fresh or dried, a delicate child is better without; except the orange, which when perfectly ripe may be allowed to any child, but the white or inner skin should be scrupulously rejected, as it is most indigestible. a healthy child may be permitted to partake of most fresh fruits. of the stone-fruits, the ripe peach, the apricot, and nectarine, are the most wholesome; but cherries, from the stones being but too frequently swallowed, had better not be allowed. apples and pears, when ripe and well masticated, are not unwholesome; and the apple when baked affords a pleasant repast, and where there is a costive habit, it is useful as a laxative. the small-seeded fruits, however, are by far the most wholesome. of these, the ripe strawberry and raspberry deserve the first rank. the grape is also cooling and antiseptic, but the husks and seeds should be rejected. the gooseberry is less wholesome on account of the indigestibility of the skin, which is too frequently swallowed. dried fruits a child should never be permitted to eat. water.--this should be the only beverage throughout childhood. toast- and-water, if the child prefer it, which is rendered slightly more nutritive than the more simple fluid. the water employed in its preparation, however, must be at a boiling temperature, and it ought to be drunk as soon as it has sufficiently cooled; for by being kept, it acquires a mawkish and unpleasant flavour. wine, beer, etc.--the practice of giving wine, or, indeed, any stimulant, to a healthy child, is highly reprehensible; it ought never to be given but medicinally. the circulation in infancy and childhood is not only more rapid than in the adult, but easily excited to greater vehemence of action; the nervous system, too, is so susceptible, that the slightest causes of irritation produce strong and powerful impressions: the result in either case is diseased action in the frame, productive of fever, convulsions, etc.; wine, accordingly, is detrimental to children. an experiment made by dr. hunter upon two of his children illustrates, in a striking manner, the pernicious effects of even a small portion of intoxicating liquors in persons of this tender age. to one of the children he gave, every day after dinner, a full glass of sherry: the child was five years of age, and unaccustomed to the use of wine. to the other child, of nearly the same age, and equally unused to wine, he gave an orange. in the course of a week, a very marked difference was perceptible in the pulse, urine, and evacuations from the bowels of the two children. the pulse of the first was raised, the urine high coloured, and the evacuations destitute of their usual quantity of bile. in the other child, no change whatever was produced. he then reversed the experiment, giving to the first the orange, and to the second the wine, and the results corresponded: the child who had the orange continued well, and the system of the other got straightway into disorder, as in the first experiment.[fn# ] [fn# ] marcellin relates an instance of seven children in a family whose bowels became infested with worms, from the use of stimulants. they were cured by substituting water for the pernicious beverage. in this town, spirits, particularly gin, are given to infants and children to a frightful extent. i have seen an old irish woman give diluted spirits to the infant just born. a short time since one of those dram-drinking children, about eight years of age, was brought into one of our hospitals. the attendants, from its emaciated appearance, considered the child was dying from mere starvation; which was true enough in a certain sense. food was accordingly offered and pressed upon it, but the boy would not even put it to his lips. the next day it was discovered that the mother brought the child very nearly a pint of gin, every drop of which before night he had consumed. it is easy to discover when children have been fed upon spirits: they are always emaciated; have a lean, yellow, haggard look: the eyes sunk, the lips pale, and the teeth discoloured, the cadaverous aspect of the countenance being most fearful. they are continually suffering from bowel complaints and convulsive disorders; which, under these circumstances, terminate invariably in an early death. sect. iv. sleep. during infancy.--for three or four weeks after birth the infant sleeps more or less, day and night, only waking to satisfy the demands of hunger; at the expiration of this time, however, each interval of wakefulness grows longer, so that it sleeps less frequently, but for longer periods at a time. this disposition to repose in the early weeks of the infant's life must not be interfered with; but this period having expired, great care is necessary to induce regularity in its hours of sleep, otherwise too much will be taken in the day-time, and restless and disturbed nights will follow. the child should be brought into the habit of sleeping in the middle of the day, before its dinner, and for about two hours, more or less. if put to rest at a later period of the day, it will invariably cause a bad night. at first the infant should sleep with its parent. the low temperature of its body, and its small power of generating heat, render this necessary. if it should happen, however, that the child has disturbed and restless nights, it must immediately be removed to the bed and care of another female, to be brought to its mother at an early hour in the morning, for the purpose of being nursed. this is necessary for the preservation of the mother's health, which through sleepless nights would of course be soon deranged, and the infant would also suffer from the influence which such deranged health would have upon the milk. when a month or six weeks has elapsed, the child, if healthy, may sleep alone in a cradle or cot, care being taken that it has a sufficiency of clothing, that the room in which it is placed is sufficiently warm, viz. degrees, and the position of the cot itself is not such as to be exposed to currents of cold air. it is essentially necessary to attend to these points, since the faculty of producing heat, and consequently the power of maintaining the temperature, is less during sleep than at any other time, and therefore exposure to cold is especially injurious. it is but too frequently the case that inflammation of some internal organ will occur under such circumstances, without the true source of the disease ever being suspected. here, however, a frequent error must be guarded against,-- that of covering up the infant in its cot with too much clothing throwing over its face the muslin handkerchief--and, last of all, drawing the drapery of the bed closely together. the object is to keep the infant sufficiently warm with pure air; it therefore ought to have free access to its mouth, and the atmosphere of the whole room should be kept sufficiently warm to allow the child to breathe it freely: in winter, therefore, there must always be a fire in the nursery. the child up to two years old, at least, should sleep upon a feather bed, for the reasons referred to above. the pillow, however, after the sixth month, should be made of horsehair; for at this time teething commences, and it is highly important that the head should be kept cool. during childhood.--up to the third or fourth year the child should be permitted to sleep for an hour or so before its dinner. after this time it may gradually be discontinued; but it must be recollected, that during the whole period of childhood more sleep is required than in adult age. the child, therefore, should be put to rest every evening between seven and eight; and if it be in health it will sleep soundly until the following morning. no definite rule, however, can be laid down in reference to the number of hours of sleep to be allowed; for one will require more or less than another.[fn# ] regularity as to the time of going to rest is the chief point to attend to; permit nothing to interfere with it, and then only let the child sleep without disturbance, until it awakes of its own accord on the following morning, and it will have had sufficient rest. [fn# ] the amount of sleep necessary to preserve health varies according to the state of the body, and the habits of the individual. as already observed, infants pass much the greater portion of their time in sleep. children sleep twelve or fourteen hours. the schoolboy generally ten. in youth, a third part of the twenty-four hours is spent in sleep. whilst, in advanced age, many do not spend more than four, five, or six hours in sleep. it is a cruel thing for a mother to sacrifice her child's health that she may indulge her own vanity, and yet how often is this done in reference to sleep. an evening party is to assemble, and the little child is kept up for hours beyond its stated time for retiring to rest, that it may be exhibited, fondled, and admired. its usual portion of sleep is thus abridged, and, from the previous excitement, what little he does obtain, is broken and unrefreshing, and he rises on the morrow wearied and exhausted. once awake, it should not be permitted to lie longer in bed, but should be encouraged to arise immediately. this is the way to bring about the habit of early rising, which prevents many serious evils to which parents are not sufficiently alive, promotes both mental and corporeal health, and of all habits is said to be the most conducive to longevity. a child should never be suddenly aroused from sleep; it excites the brain, quickens the action of the heart, and, if often repeated, serious consequences would result. the change of sleeping to waking should always be gradual. the bed on which the child now sleeps should be a mattress: at this age a feather bed is always injurious to children; for the body, sinking deep into the bed, is completely buried in feathers, and the unnatural degree of warmth thus produced relaxes and weakens the system, particularly the skin, and renders the child unusually susceptible to the impressions of cold. then, instead of the bed being made up in the morning as soon as vacated, and while still saturated with the nocturnal exhalations from the body, the bed-clothes should be thrown over the backs of chairs, the mattress shaken well up, and the window thrown open for several hours, so that the apartment shall be thoroughly ventilated. it is also indispensably requisite not to allow the child to sleep with persons in bad health, or who are far advanced in life; if possible, it should sleep alone. sect. v. bathing and cleanliness. during infancy.--too much attention cannot be paid to cleanliness; it is essential to the infant's health. the principal points to which especial attention must be paid by the parent for this purpose are the following:-- temperature of the water.--at first the infant should be washed daily with warm water; and a bath every night, for the purpose of thoroughly cleaning the body, is highly necessary. to bathe a delicate infant of a few days or even weeks old in cold water with a view "to harden" the constitution (as it is called), is the most effectual way to undermine its health and entail future disease. by degrees, however, the water with which it is sponged in the morning should be made tepid, the evening bath being continued warm enough to be grateful to the feelings. a few months having passed by, the temperature of the water may be gradually lowered until cold is employed, with which it may be either sponged or even plunged into it, every morning during summer. if plunged into cold water, however, it must be kept in but a minute; for at this period, especially, the impression of cold continued for any considerable time depresses the vital energies, and prevents that healthy glow on the surface which usually follows the momentary and brief action of cold, and upon which its usefulness depends. with some children, indeed, there is such extreme delicacy and deficient reaction as to render the cold bath hazardous; no warm glow over the surface takes place when its use inevitably does harm: its effects, therefore, must be carefully watched. drying the skin.--the surface of the skin should always be carefully and thoroughly rubbed dry with flannel,--indeed, more than dry, for the skin should be warmed and stimulated by the assiduous gentle friction made use of. for this process of washing and drying must not be done languidly, but briskly and expeditiously; and will then be found to be one of the most effectual means of strengthening the infant. it is especially necessary carefully to dry the arm-pits, groins, and nates; and if the child is very fat, it will be well to dust over these parts with hair-powder or starch: this prevents excoriations and sores, which are frequently very troublesome. soap is only required to those parts of the body which are exposed to the reception of dirt. napkins.--the frequency of the discharges from the bowels and bladder requires a frequent change of napkins. a nurse cannot be too careful of this duty from the first, so that she may be enabled to discover the periods when those discharges are about to take place, that she may not only anticipate them, but teach the child, at a very early age, to give intelligent warning of its necessities. thus a habit of regularity with regard to those functions will be established, which will continue through life, and tend greatly to the promotion of health. as the child grows older, the system of cleanliness must in no particular be relaxed, and it will be found the best preservative against those eruptive disorders which are so frequent and troublesome during the period of infancy. during childhood.--when this period arrives, or shortly after, bathing is but too frequently left off; the hands and face of the child are kept clean, and with this the nurse is satisfied; the daily ablution of the whole body, however, is still necessary, not only for the preservation of cleanliness, but because it promotes in a high degree the health of the child. plan to be pursued with the vigorous and healthy.--a child of a vigorous constitution and robust health, as he rises from his bed refreshed and active by his night's repose, should be put into the shower-bath, or, if this excites and alarms him too much, must be sponged from head to foot with salt water. if the weather be very cold, the water may be made slightly tepid, but if his constitution will bear it, the water should be cold throughout the year. then the body should be speedily dried, and hastily but well rubbed with a somewhat coarse towel, and the clothes put on without any unnecessary delay. this should be done every morning of the child's life. if such a child is at the sea-side, advantage should be taken of this circumstance, and seabathing should be substituted. the best time is two or three hours after breakfast; but he must not be fatigued beforehand, for if so, the cold bath cannot be used without danger. care must be taken that he does not remain in too long, as the animal heat will be lowered below the proper degree, which would be most injurious. in boys of a feeble constitution, great mischief is often produced in this way. it is a matter also of great consequence in bathing children that they should not be terrified by the immersion, and every precaution should be taken to prevent this. the healthy and robust boy, too, should early be taught to swim, whenever this is practicable, for it is attended with the most beneficial effects; it is a most invigorating exercise, and the cold bath thus becomes doubly serviceable. plan to be pursued with the delicate and strumous.--if a child is of a delicate and strumous constitution, the cold bath during the summer is one of the best tonics that can be employed; and if living on the coast, sea-bathing will be found of singular benefit. the effects, however, of sea-bathing upon such a constitution must be particularly watched, for unless it is succeeded by a glow,--a feeling of increased strength,--and a keen appetite, it will do no good, and ought at once to be abandoned for the warm or tepid bath. the opinion that warm baths generally relax and weaken, is erroneous; for in this case, as in all cases when properly employed, they would give tone and vigour to the whole system; in fact, the tepid bath is to this child what the cold bath is to the more robust. in conclusion: if the bath in any shape cannot from circumstances be obtained, then cold saltwater sponging must be used daily, and all the year round, so long as the proper reaction or glow follows its use; but when this is not the case, and this will generally occur, if the child is delicate and the weather cold, tepid vinegar and water, or tepid salt water, must be substituted. sect. vi. clothing. in infancy.--infants are very susceptible of the impressions of cold; a proper regard, therefore, to a suitable clothing of the body, is imperative to their enjoyment of health. unfortunately, an opinion is prevalent in society, that the tender child has naturally a great power of generating heat and resisting cold; and from this popular error has arisen the most fatal results. this opinion has been much strengthened by the insidious manner in which cold operates on the frame, the injurious effects not being always manifest during or immediately after its application, so that but too frequently the fatal result is traced to a wrong source, or the infant sinks under the action of an unknown cause. the power of generating heat in warm-blooded animals is at its minimum at birth, and increases successively to adult age; young animals, instead of being warmer than adults, are generally a degree or two colder, and part with their heat more readily; facts which cannot be too generally known. they show how absurd must be the folly of that system of "hardening" the constitution (to which reference has been before made), which induces the parent to plunge the tender and delicate child into the cold bath at all seasons of the year, and freely expose it to the cold, cutting currents of an easterly wind, with the lightest clothing. the principles which ought to guide a parent in clothing her infant are as follows:-- the material and quantity of the clothes should be such as to preserve a sufficient proportion of warmth to the body, regulated therefore by the season of the year, and the delicacy or strength of the infant's constitution. in effecting this, however, the parent must guard against the too common practice of enveloping the child in innumerable folds of warm clothing, and keeping it constantly confined to very hot and close rooms; thus running into the opposite extreme to that to which i have just alluded: for nothing tends so much to enfeeble the constitution, to induce disease, and render the skin highly susceptible to the impression of cold; and thus to produce those very ailments which it is the chief intention to guard against. in their make they should be so arranged as to put no restrictions to the free movements of all parts of the child's body; and so loose and easy as to permit the insensible perspiration to have a free exit, instead of being confined to and absorbed by the clothes, and held in contact with the skin, till it gives rise to irritation. in their quality they should be such as not to irritate the delicate skin of the child. in infancy, therefore, flannel is rather too rough, but is desirable as the child grows older, as it gives a gentle stimulus to the skin, and maintains health. in its construction the dress should be so simple as to admit of being quickly put on, since dressing is irksome to the infant, causing it to cry, and exciting as much mental irritation as it is capable of feeling. pins should be wholly dispensed with, their use being hazardous through the carelessness of nurses, and even through the ordinary movements of the infant itself. the clothing must be changed daily.--it is eminently conducive to good health that a complete change of dress should be made every day. if this is not done, washing will, in a great measure, fail in its object, especially in insuring freedom from skin diseases. in childhood.--the clothing of the child should possess the same properties as that of infancy. it should afford due warmth, be of such materials as do not irritate the skin, and so made as to occasion no unnatural constriction. in reference to due warmth, it may be well again to repeat, that too little clothing (that state of semi-nudity which the vanity of some parents encourage) is frequently productive of the most sudden attacks of active disease; and that children who are thus exposed with naked breasts and thin clothing in a climate so variable as ours are the frequent subjects of croup, and other dangerous affections of the air- passages and lungs. on the other hand, it must not be forgotten, that too warm clothing is a source of disease,--sometimes even of the same diseases which originate in exposure to cold,--and often renders the frame more susceptible of the impressions of cold, especially of cold air taken into the lungs. regulate the clothing, then, according to the season; resume the winter dress early; lay it aside late; for it is in spring and autumn that the vicissitudes in our climate are greatest, and congestive and inflammatory complaints most common. with regard to material (as was before observed), the skin will at this age bear flannel next to it; and it is now not only proper, but necessary. it may be put off with advantage during the night, and cotton maybe substituted during the summer, the flannel being resumed early in the autumn. if from very great delicacy of constitution it proves too irritating to the skin, fine fleecy hosiery will in general be easily endured, and will greatly conduce to the preservation of health. it is highly important that the clothes of the boy should be so made that no restraints shall be put on the movements of the body or limbs, nor injurious pressure made on his waist or chest. all his muscles ought to have full liberty to act, as their free exercise promotes both their growth and activity, and thus insures the regularity and efficiency of the several functions to which these muscles are subservient. the same remarks apply with equal force to the dress of the girl; and happily, during childhood, at least, no distinction is made in this matter between the sexes. not so, however, when the girl is about to emerge from this period of life; a system of dress is then adopted which has the most pernicious effects upon her health, and the development of the body, the employment of tight stays, which impede the free and full action of the respiratory organs, being only one of the many restrictions and injurious practices from which in latter years they are thus doomed to suffer so severely. sect. vii. air and exercise. in infancy.--the respiration of a pure air is at all times, and under all circumstances, indispensable to the health of the infant. the nursery therefore should be large, well ventilated, in an elevated part of the house, and so situated as to admit a free supply both of air and light. for the same reasons, the room in which the infant sleeps should be large, and the air frequently renewed; for nothing is so prejudicial to its health as sleeping in an impure and heated atmosphere. the practice, therefore, of drawing thick curtains closely round the bed is highly pernicious; they only answer a useful purpose when they defend the infant from any draught of cold air. the proper time for taking the infant into the open air must, of course, be determined by the season of the year, and the state of the weather. "a delicate infant born late in the autumn will not generally derive advantage from being carried into the open air, in this climate, till the succeeding spring; and if the rooms in which he is kept are large, often changed, and well ventilated, he will not suffer from the confinement, while he will, most probably, escape catarrhal affections, which are so often the consequence of the injudicious exposure of infants to a cold and humid atmosphere."[fn# ] if, however, the child is strong and healthy, no opportunity should be lost of taking it into the open air at stated periods, experience daily proving that it has the most invigorating and vivifying influence upon the system. regard, however, must always be had to the state of the weather; and to a damp condition of the atmosphere the infant should never be exposed, as it is one of the most powerful exciting causes of consumptive disease. the nurse-maid, too, should not be allowed to loiter and linger about, thus exposing the infant unnecessarily, and for an undue length of time; this is generally the source of all the evils which accrue from taking the babe into the open air. [fn# ] sir james clark on consumption. exercise, also, like air, is essentially important to the health of the infant. its first exercise, of course, will be in the nurse's arms. after a month or two, when it begins to sleep less during the day, it will delight to roll and kick about on the sofa: it will thus use its limbs freely; and this, with carrying out into the open air, is all the exercise it requires at this period. by and by, however, the child will make its first attempts to walk. now it is important that none of the many plans which have been devised to teach a child to walk, should be adopted--the go-cart, leading-strings, etc.; their tendency is mischievous; and flatness of the chest, confined lungs, distorted spine, and deformed legs, are so many evils which often originate in such practices. this is explained by the fact of the bones in infancy being comparatively soft and pliable, and if prematurely subjected by these contrivances to carry the weight of the body, they yield just like an elastic stick bending under a weight, and as a natural consequence become curved and distorted. it is highly necessary that the young and experienced mother should recollect this fact, for the early efforts of the little one to walk are naturally viewed by her with so much delight, that she will be apt to encourage and prolong its attempts, without any thought of the mischief which they may occasion; thus many a parent has had to mourn over the deformity which she has herself created. it may be as well here to remark, that if such distortion is timely noticed, it is capable of correction, even after evident curvature has taken place. it is to be remedied by using those means that shall invigorate the frame, and promote the child's general health (a daily plunge into the cold bath, or sponging with cold salt water, will be found signally efficacious), and by avoiding the original cause of the distortion--never allowing the child to get upon his feet. the only way to accomplish the latter intention, is to put both the legs into a large stocking; this will effectually answer this purpose, while, at the same time, it does not prevent the free and full exercise of the muscles of the legs. after some months pursuing this plan, the limbs will be found no longer deformed, the bones to have acquired firmness and the muscles strength; and the child may be permitted to get upon his feet again without any hazard of perpetuating or renewing the evil. the best mode of teaching a child to walk, is to let it teach itself, and this it will do readily enough. it will first crawl about: this exercises every muscle in the body, does not fatigue the child, throws no weight upon the bones, but imparts vigour and strength, and is thus highly useful. after a while, having the power, it will wish to do more: it will endeavour to lift itself upon its feet by the aid of a chair, and though it fail again and again in its attempts, it will still persevere until it accomplish it. by this it learns, first, to raise itself from the floor; and secondly, to stand, but not without keeping hold of the object on which it has seized. next it will balance itself without holding, and will proudly and laughingly show that it can stand alone. fearful, however, as yet of moving its limbs without support, it will seize a chair or anything else near it, when it will dare to advance as far as the limits of its support will permit. this little adventure will be repeated day after day with increased exultation; when, after numerous trials, he will feel confident of his power to balance himself, and he will run alone. now time is required for this gradual self-teaching, during which the muscles and bones become strengthened; and when at last called upon to sustain the weight of the body, are fully capable of doing so. in childhood.--when the child has acquired sufficient strength to take active exercise, he can scarcely be too much in the open air; the more he is habituated to this, the more capable will he be of bearing the vicissitudes of the climate. children, too, should always be allowed to amuse themselves at pleasure, for they will generally take that kind and degree of exercise which is best calculated to promote the growth and development of the body. in the unrestrained indulgence of their youthful sports, every muscle of the body comes in for its share of active exercise; and free growth, vigour, and health are the result. if, however, a child is delicate and strumous, and too feeble to take sufficient exercise on foot,--and to such a constitution the respiration of a pure air and exercise are indispensable for the improvement of health, and without them all other efforts will fail,--riding on a donkey or pony forms the best substitute. this kind of exercise will always be found of infinite service to delicate children; it amuses the mind, and exercises the muscles of the whole body, and yet in so gentle a manner as to induce little fatigue. the exercises of horseback, however, are most particularly useful where there is a tendency in the constitution to pulmonary consumption, either from hereditary or accidental causes. it is here beneficial, as well through its influence on the general health, as more directly on the lungs themselves. there can be no doubt that the lungs, like the muscles of the body, acquire power and health of function by exercise. now during a ride this is obtained, and without much fatigue to the body. the free and equable expansion of the lungs by full inspiration, necessarily takes place; this maintains their healthy structure, by keeping all the air-passages open and pervious; it prevents congestion in the pulmonary circulation, and at the same time provides more completely for the necessary chemical action on the blood, by changing, at each act of respiration, a sufficient proportion of the whole air contained in the lungs,--all objects of great importance, and all capable of being promoted, more or less, by the means in question. and be it remembered that these remarks apply with equal force to the girl as to the boy. she should be allowed, and even encouraged, to take the same active exercise. fortunately, this course is followed during childhood; not so, unfortunately (in the majority of cases, at least), after this period. young females are then subjected to those unnatural restraints, both in exercise and dress, which fashion and vanity impose, to be followed by effects which, though not immediately obvious, are capable of laying the foundation of evils that cannot afterwards be remedied. a good carriage is the point aimed at (and to which i particularly refer), and the means adopted for its cultivation fail, after all, in their end, just in proportion to their rigid employment. for this purpose the head is kept erect, and the shoulders drawn back, and they are to be kept in this position not for an hour or so, but continually. to preserve, however, this unnatural and constrained position, requires considerable muscular powers, such as no girl can exercise without long, painful, and injurious training; nor even by this, unless other measures be resorted to in aid of her direct endeavours. for instead of the muscles obtaining increased power and strength by these efforts (to enforce a good carriage), they are enfeebled, and soon become more and more incapable of performing what is required of them. this fact soon becomes perceptible; weakness is noticed; but instead of correcting this by the only rational mode, that of invigorating the weakened muscles, mechanical aid is called in to support them, and laced waistcoats are resorted to. these undoubtedly give support--nay, they may be so used as almost wholly to supersede the muscular efforts, with the advantage of not tiring, however long or continuously employed. improvement of carriage is manifested, the child is sensible of relief from a painful exertion, the mother is pleased with the success of her management, and this success appears to superficial observation fully to confirm the judgment which superintends it. yet what are the consequences to which her measures tend, and which such measures are daily and hourly producing? the muscles of the back and chest, restrained in their natural and healthful exercise by the waistcoat called in to aid them, and more signally, in after-life, by the tightly- laced stays or corsets, become attenuated, and still further enfeebled, until at length they are wholly dependent on the mechanical aid, being quite incapable of dispensing with it for any continuance. by and by a taper waist becomes an object of ambition, and the stays are laced more closely than ever. this is still done gradually, and, at first, imperceptibly to the parties. the effect, however, though slow, is sure; and the powers of endurance thus exercised come in time to bear, almost unconsciously, what, if suddenly or quickly attempted, no heroism could possibly sustain. this increased pressure impedes the motion of the ribs. for perfect respiration these motions should be free and unrestrained, and perfect respiration is necessary to those changes in the blood which fit it for nutrition, and the other purposes of the animal frame. in proportion as respiration is impeded, is the blood imperfectly vitalised, and in the same ratio are the nutrient and other functions dependent on the blood inadequately performed. here, then, is one source of debility, which affects the whole frame, reducing every part below the standard of healthful vigour. quickened respiration soon ensues, the heart becomes excited, the pulse accelerated, and palpitation is in time superadded. there are still further evils produced by tight lacing. for the pressure being chiefly made on the lower part of the chest, the stomach and liver are necessarily compressed, to the great disturbance of their functions; and being pressed downwards too, these trespass on that space which the other abdominal viscera require, superinducing still further derangements. thus almost every function of the body becomes more or less impeded. and again, the girl not being able always to have her body cased in the tight-laced stays, some relaxation must take place. under it the muscles of the back, deprived of their accustomed support, and incapable of themselves to sustain the incumbent weight, yield, and the column of the spine bends, at first anteriorly, causing round shoulders and an arched back; but eventually inclines to one or other side, giving rise to the well-known and too frequently occurring state of lateral curvature. this last change most frequently commences in the sitting posture, such females being, through general debility, much disposed to sedentary habits. such, though but very slightly sketched, are a few of the evils attending this baneful practice. but how, then, is a good carriage to be obtained; which is not only pleasing to the eye, but is, when natural, absolutely conducive itself to health? to insure a good carriage, the only rational way is to give the necessary power, especially to the muscles chiefly concerned; and this is to be done, not by wearying those muscles by continual and unrelieved exertion, but by invigorating the frame generally, and more especially by strengthening the particular muscles through varied exercise alternated with due repose. attention to general health, suitable diet, regular bowels, moderate but regular exercise, not of particular muscles only, but of the whole frame, cold-bathing or sponging, and other such measures, will maintain a good carriage, by giving that power which the more direct means so generally practised serve but to exhaust.[fn# ] [fn# ] the above remarks on "good carriage" are almost wholly taken from a valuable article of dr. barlow's, in the "cyclopaedia of practical medicine." chap. ii. on the use and abuse of certain remedies. sect. i.--aperient medicine. one of the greatest errors of the nursery is the too frequent and indiscriminate exhibition by the mother or nurse of purgative medicine to the infant. various are the forms in which it is given; perhaps the little powders obtained from the chemist is the most frequent, as it is certainly the most injurious, form, their chief ingredient being calomel. the choice of the aperient, or the dose, or the exact condition of the health of the infant, or whether it is an aperient at all that is required, are points entirely overlooked: a little medicine is thought necessary, because the child appears unwell, and a purgative, or a little white powder, is forthwith given. the great art of medicine is the proper application of the proper medicine, in the proper dose, at the proper time; points never considered in the nursery. for example, i have known a large dose of magnesia given by a nurse to an infant, that had been suffering from a diarrhoea of some days' standing, and very quickly cause death. now, magnesia is one of the most useful and harmless medicines that can be given to an infant when indicated; when prescribed in a dose suited to its age, and when the proper time is fixed upon for its exhibition; in the foregoing case, however, every thing forbad its use, but none of these points were considered. aperient medicine, too, is sometimes unwittingly repeated to remove those symptoms which it has itself produced. some incidental pain and uneasiness, some slightly greenish appearance of the motions, leads the mother to believe that more purging is necessary, when, in fact, both circumstances have probably been induced by the irritation caused by the purgatives already too freely administered. how frequently is this the case, during the first week or ten days of the infant's life, when the nurse doses the child with tea-spoonful after tea-spoonful of castor oil, for the relief of pain, which her repeated doses of medicine have alone created. the bowels of an infant in health should be relieved two, three, or four times in the twenty-four hours. the stools should be of the consistence of thin mustard, and of a lightish yellow colour, having little smell, free from lumps or white curdy matter, and passed without pain, or any considerable quantity of wind. and a parent is only justified in giving aperient medicine, when any deviation from these conditions exists; and only then, when what may be called healthy costiveness is present, viz. either the stools less frequent than they ought to be, or lumpy and partially solid. then, the only purgative medicines that can be given with safely to an infant, without medical sanction, are, castor oil, manna, rhubarb, and magnesia; the application of the lavement, and the aperient liniment. castor oil this is one of the mildest aperients, prompt in its action, and effective in clearing out the contents of the bowels; it is a medicine, therefore, particularly applicable to infants. during teething there is generally much torpor of the bowels; here, then, castor oil is a very appropriate and useful artificial means of increasing the frequency of the alvine discharges. then, again, no purgative can be so much relied on for overcoming habitual costiveness as castor oil; it may for this purpose be given daily for some weeks, gradually reducing the dose until only a few drops be taken; after which the bowels generally continue to act without further artificial assistance. even its occasional administration leaves the bowels in a relaxed state; a great advantage over other purgatives, which generally cause, after their action is passed off, a confined state. the proper dose will depend upon the age, and the known effect of aperient medicine upon the childsome requiring more, others less: under one year, one small tea-spoonful. under three years, two ditto. under six years, three ditto. under ten years and upwards, a table spoonful. the quantity being more or less according to the facility with which the bowels are purged. it may be given in various ways; poured upon a little mint water, or blended with a little moist sugar;--or, if the stomach is unusually delicate, the oil may be made into an emulsion with some aromatic water, by the intervention of the yolk of an egg and a little syrup of roses or sugar combined with it. the following proportions make an elegant and not at all a disagreeable mixture, of which a desert- spoonful (or more, according to the age,) may be repeated every hour until it operate: castor oil, six drachms; the yolk of an egg; mix well together, and add dill water, two ounces, syrup of roses, two drachms. manna. this also may be given with impunity to the youngest infant; it is sweet to the taste, and mild in its operation. it should be exhibited in doses of one to two drachms in a little warm milk; or if it cause flatulence in this form, in some aromatic water, a desert spoonful of carraway-seed or dill water. for children above two years, it must always be given with some other aperient: thus, it may be combined with castor oil by the medium of mucilage or the yolk of an egg; in fact, it might be substituted for the syrup of roses in the previous prescription for castor oil. magnesia and rhubarb. magnesia, besides being a laxative, allays irritability of the stomach; it is consequently useful during dentition, at which period there is both much irritability and a prevailing acescency of the stomach. the dose is from five grains to ten for an infant, increasing the quantity to fifteen grains or twenty to children of nine or ten years of age. when taken alone the best vehicle is hot milk, which greatly quickens its aperient operation. and whenever the bowels are distended with wind, the pure magnesia is preferable to the carbonate. it is well to mention here, that when the infant throws up the nurse's milk it is generally curdled; a fact which leads the inexperienced mother to infer that the child is suffering from acidity; and to counteract the supposed evil magnesia is given again and again. this is a useless and pernicious practice, for curdling or coagulation of the milk always takes place in the stomach, and is produced by the gastric juice, and is so far from being a morbid process, that milk cannot be properly digested without it. rhubarb, it should always be recollected, has an astringent as well as purgative property, according to the extent of the dose in which it is administered; the former of which never opposes or interferes with the energy of the latter, since it only takes effect when the substance is administered in small doses, or, if given in larger ones, not until it has ceased to operate as a cathartic. this latter circumstance renders it particularly eligible in cases of diarrhoea, as it evacuates the offending matter before it operates as an astringent upon the bowels. as a purgative it operates mildly, and may be given to the youngest infant; if from two to twelve months old, from three to six grains; for children above that age, the dose may range from ten grains to twenty. its operation, however, is much quickened by the addition of magnesia; both of which are more effective when thus united than when given separately. the following form, in a costive and flatulent state of the bowels, will be found useful[fn# ]; a tea-spoonful or more may be given every three or four hours until the desired effect is obtained:-- powdered rhubarb, half a drachm; magnesia, two scruples; compound spirits of ammonia, twenty drops; dill water, two ounces; simple syrup, two drachms. [fn# ] this may be made up and kept in the nursery for a long time without spoiling. rhubarb, mixed with flour and warm water, may be made into a poultice, and applied to the abdomen of a child that obstinately refuses to swallow medicine, and it will be found to produce the same effect as if the medicine had been taken into the stomach; it will purge briskly. the lavement. this is an excellent nursery remedy when the bowels are obstinately costive. it may then be employed as a substitute for medicine, a protracted and frequent use of which (even of the mildest aperients) is apt to injure the digestive functions, and to give rise to some degree of intestinal irritation. lavements, however, like aperient medicine, must not be resorted to for a long time together; for whilst the latter irritate, the former most certainly tend, after a long continued use, to debilitate the bowels, and thus render them less than ever disposed to act for themselves. they are an excellent occasional remedy. the simplest form of an aperient enema, is warm water; but barley- water, or thin gruel, or even milk and water, are to be preferred at all times, as they are of a more bland and less irritating nature. if it be desirable to increase the strength of the injection, castor oil may be added. the proportions of fluid which are necessary for the different stages of life, under ordinary circumstances, maybe stated as follows:--an infant at its birth requires about one fluid ounce; a child between the age of one and five years, from three to four fluid ounces; and a youth of ten or fifteen, from six to eight fluid ounces. the mode of administering an injection to an infant deserves particular attention, as injury might be caused by its being performed in a careless or unskilful manner. a gum elastic pipe should be always used instead of the hard ivory tube. having smeared this over with lard, and placed the infant on its left side, with its knees bent up in the lap of the nurse, it is to be passed a couple of inches into the bowel, in a direction not parallel to the axis of the body, but rather inclined to the left. the latter circumstance should never be neglected, for if not attended to, there will be difficulty in administering the injection. the fluid must then be propelled very gradually, or it will be instantly rejected; on the whole being thrown up (the pipe carefully and slowly withdrawn), the child must be kept quietly reposing on its nurse's lap, and in the same posture for some little time. the aperient liniment. a liniment to be rubbed on the stomach is another resource in cases of habitual costiveness, and will frequently be attended with great success when repeated purgatives have been resisted. olive or castor oil may be used for this purpose; they must be warmed and rubbed over the abdomen night and morning, for five or ten minutes. perhaps the best form of liniment that can be made use of is the following:-- compound soap liniment, one ounce; compound tincture of aloes, half an ounce. sect. ii.--calomel. calomel is one of the most useful medicines we possess; but though powerful for good, it is by no means powerless for mischief, and pages might be written upon the evil effects which have resulted from its indiscriminate use in the nursery; medical men are daily and hourly witnessing this fact. it is particularly eligible in the diseases of children; but then it is quite impossible for unprofessional persons to judge when it may be appropriately exhibited. and it cannot be too generally known, that the effect of this medicine upon the evacuations is always to make them appear unnatural. from ignorance of this fact, calomel is often repeated again and again to relieve that very condition which it has itself produced, causing, but too frequently, a degree of irritation in the delicate lining membrane of the bowel, which it may be very difficult for a medical man to remove, and perhaps a source of misery to the child as long as it lives. its frequent exhibition has also another evil attending it, for "the immoderate use of mercury in early infancy produces more, perhaps, than any other similar cause, that universal tendency to decay, which, in many instances, destroys almost every tooth at an early age."[fn# ] [fn# ] bell on the teeth. in the diseases of childhood it is often administered by the mother or nurse with a degree of careless excess which ultimately, if not immediately, produces severe and irremediable injury. i have met with such cases; but mr. bell details a remarkable instance in point: "a child, about three years of age, was brought to me, having a most extensive ulceration in the gum of the lower jaw, by which the alveolar process (that portion of the jaw which forms the sockets of the teeth) was partially denuded. the account given by the mother was, that the child had some time previously been the subject of measles, for which a chemist, whom she consulted, gave her white powders, one of which was ordered to be taken every four hours. it appears by the result, that this must have been calomel; for, after taking it for two or three days, profuse salivation was produced, with swollen tongue, inflamed gums, etc., followed by ulceration of the gum, lips, and cheek. on examining the denuded alveolar process, i found that a considerable necrosis (death of the bone) had taken place, including the whole anterior arch of the jaw from the first double tooth on the left side to the eye-tooth on the right. by degrees the dead portion of bone was raised, and became loose, when i found that the mischief was not confined to the alveolar process, but comprised the whole substance of the bone within the space just mentioned," etc. surely the knowledge of such a case as this would induce every prudent mother to exclude calomel from her list of domestic nursery medicines. sect. iii.--opiates. this class of medicine is often kept in the nursery, in the forms of laudanum, syrup of white poppies, dalby's carminative, and godfrey's cordial. the object with which they are generally given is to allay pain by producing sleep; they are, therefore, remedies of great convenience to the nurse; and i am sorry to be obliged to add, that, so exhibited, they are but too often fatal to the little patient. the fact is, that in the hands of the physician, there is no medicine the administration of which requires greater caution and judgment than opiates, both from the susceptibility of infants to their narcotic influence, and their varying capability of bearing it; the danger, therefore, with which their use is fraught in the hands of a nurse should for ever exclude them from the list of domestic nursery medicines. dalby's carminative and godfrey's cordial are, perhaps, more frequently used than any other forms; and some striking cases, illustrative of the fatal results of exhibiting them indiscriminately, and without medical sanction, are on record.[fn# ] the late dr. clark, in his "commentaries," mentions a case which he saw, where "forty drops of dolly's carminative destroyed an infant." dr. merriman gives the following in a note in underwood, "on the diseases of children:"-- [fn# ] two or three fatal cases, and upon which coroners' inquests were held, have occurred within the last two years. "a woman, living near fitzroy square, thinking her child not quite well, gave it a dose of godfrey's cordial, which she purchased at a chemist's in the neighbourhood. in a very short time after taking it the child fell into convulsions, and soon died. in less than a month the child of another woman in the same house was found to be ill with disordered bowels. the first woman, not at all suspecting that the godfrey's cordial had produced the convulsions in her infant, persuaded her friend to give the same medicine to her child. a dose from the same bottle was given, and this child was likewise attacked almost immediately with convulsions, and also died." convulsions and epilepsy, without such fatal results as the foregoing, are not uncommon as the effect of a single dose of an opiate given unadvisedly; and by their continued and habitual use (and the form of syrup of poppies is but too often administered by an indiscreet and lazy nurse, unknown by the parent), a low, irritative, febrile state is produced, gradually followed by loss of flesh, the countenance becoming pallid, sallow, and sunken, the eyes red and swollen, and the expression stupid and heavy, and the powers of the constitution at last becoming completely undermined. such an object is to be seen daily among the poorer classes,--the miniature of a sickly aged person: death soon follows here. sect. iv.--leeching. difficulty sometimes arises in putting a stop to the bleeding from leech-bites; a matter of considerable importance in the case of a delicate infant. the following measures may be resorted to for this purpose:-- . expose the surface of the part to the external air, so that a coagulum of blood may form at the orifice: this simple mode will frequently arrest it. . if this fail, make compression upon the part: this is one of the most effectual means of restraining haemorrhage. it is to be effected by taking a piece of lint folded three or four thicknesses, and the size of the finger-nail, to be steadily pressed upon the open orifice with the point of the finger until the blood has ceased to flow. the pledget of lint, however, must not be removed for some hours afterwards, or the bleeding will break out afresh. . if the compression fails in stopping the bleeding, or from the situation of the leech-bites it cannot be adopted, because there is no firm point of resistance upon which to make pressure, the part may be dusted with starch or gum arabic powder, or, if this is of no avail, the wound may be touched with lunar caustic. if none of these measures are successful, the assistance of the medical attendant must be obtained; and if firm pressure be made upon the part, no serious loss of blood can ensue before his arrival. leeches should never be resorted to by a parent for any of the diseases of infancy, without medical direction. sect. v.--blisters and poultices. a blister should never be applied for any infantile disease, except when ordered by a medical man, as its injudicious use might greatly aggravate the complaint. there are also one or two precautions in reference to the mode of the application of a blister, which it is always right for a parent to attend to. from the great irritability of the skin, it should never be allowed to remain on longer than from two to four hours. at the expiration of this time, the surface will usually become red and inflamed; and, if the blister is removed, and the part dressed with fresh spermaceti ointment spread on lint, or with a soft bread and water poultice, a full blister will soon be raised: the little patient is thus saved much suffering, and a very troublesome sore prevented. a piece of tissue or silver paper, interposed between the blister and the skin, will answer the same purpose; the blister will act well, and the evils before alluded to will be prevented. after a blister has been two or three hours applied, its edge should be carefully raised, to ascertain the effect produced; and if the surface be much inflamed, more particularly if little points of vesication (watery bladders) are present, it should be removed, and the above directions attended to. mustard poultices are invaluable in some of the diseases of infancy and childhood, and therefore frequently ordered. a mustard poultice is made by mixing two thirds of mustard flour and one third of wheaten flour with warm water or vinegar, in sufficient quantity to render the powder of the consistence of paste. it is then spread on linen from the size of a half-crown to that of the palm of the hand, according to the effect intended, and placed on the skin. how long it is to be kept on will depend upon the individual sensibility of the skin of the child; but, in general, from fifteen to twenty minutes will be found amply sufficient. the application, however, must at all times be carefully watched; for if it remain on too long, ulceration, and death of the part, might ensue; therefore, directly the skin is found tolerably red, the poultice should be removed. after its removal, the part may be exposed, or, if very painful, smeared over with fresh cream or common cerate. a bread and water poultice, although one of the commonest applications in use, is rarely well made or properly applied. it thus becomes injurious rather than useful; adding to the inflammation or irritation of the part, instead of soothing and allaying it. nothing, however, is more simple than the mode of its preparation. cut slices of stale bread of sufficient quantity, scald out a bason, put the bread into it, pour upon it boiling water, cover it over, and let it stand for ten minutes; next strain the water oft, gently squeeze the saturated bread in a thin cloth, so that the poultice shall not be too moist, and then spread it upon a cloth so that it shall be in thickness half an inch, and of a size large enough to cover the whole of the inflamed part, and a little more. apply it just warm enough to be borne, and cover it well with oiled silk. a poultice thus made, will act as a local tepid bath to the inflamed part; and the oiled silk preventing evaporation, it will be found, when taken off, as moist as the first moment that it was put on. sect. vi.--baths. baths are much resorted to during infancy and childhood, both in health and in disease. in the former state, they constitute an important measure of hygeiene (this has been briefly alluded to under the section "bathing"), and in the latter, a valuable remedial agent. their indiscriminate use, however, might be followed by serious consequences; it is therefore important to point out a few rules for their judicious employment. the cold water plunge bath. it consists of water in its natural degree of heat; its temperature varying, according to the season of the year or other circumstances, from degrees to degrees. the phenomena produced upon a strong and healthy boy plunging into this bath will be as follows:--he will first experience a sensation of cold, followed by slight shuddering, and, if the immersion has been sudden, a peculiar impression in the nervous system, called a shock. almost immediately after the shock, the feeling of cold will vanish, and give place to a sensation of warmth, speedily diffusing itself over the whole frame. if the boy leaves the bath at this time, or, at all events, before the warmth of the body goes off, and quickly dresses himself, a renewal of the reaction which had followed the shock of immersion will be experienced; he will be in a most delightful glow,-- there will be a general feeling of enjoyment, accompanied by a sensible increase of animal power, and invigoration of the whole system. but, on the other hand, if the boy greatly prolong his stay in the water, no reaction will ensue, and he will become chilly, which will gradually increase to a strong and general shivering;--his feet and legs will become benumbed, and the whole body will soon be languid, exhausted, and powerless. the same result will happen to the young and delicate infant, if plunged into this bath; the same sensations will be produced; except that here the shock is scarcely followed by any reaction, and therefore from the first moment of the immersion, the shivering and consequent train of sensations occur. this arises from the infant at birth having less power of producing heat than when further advanced in age. from the foregoing remarks, then, it will be seen, that, in early infancy, the cold bath is inadmissible, and water of a higher temperature than that which feels cool to the hand of the nurse should always be used at this age. but that, as the child grows older,--if of a healthy and vigorous constitution,--the cold bath is unquestionably most desirable; and, if used in a proper manner, will be found to act as a most powerful tonic to the system. the summer is of course the only period of the year when the cold plunging bath can be resorted to for the child. sea bathing. when sea bathing can be obtained, it is even more conducive to the health of the child than the fresh water plunge bath; for the sea water is more tonic, stimulant, and bracing, than fresh. the period of the year best adapted for sea bathing is the summer and autumn. the best time of the day for bathing is two or three hours after breakfast; except in very hot weather, when an earlier hour must be chosen. exercise is always useful previously to the bath; but it must be gentle, so as not to induce fatigue or much perspiration, then the bath must be entered suddenly, with a plunge, inasmuch as an instantaneous immersion produces a greater reaction than a gradual immersion.[fn# ] the length of time of remaining in will depend upon circumstances. one dip only is enough at the first bath. subsequently the time of remaining in the water may be prolonged, but this must be increased gradually; the positive necessity of leaving the bath while there still remains sufficient power of reaction being always kept in mind. exercise in the water, particularly that of swimming, is highly useful. the body should be speedily and well dried, immediately upon coming out; a rough jack towel is an excellent means of accomplishing this purpose, while at the same time it insures considerable friction of the surface of the skin. if the boy is in sound health, he may bathe daily. [fn# ] it is a matter of importance in bathing children, that they should not be terrified by the immersion, and every precaution should be taken to prevent this. as a remedy, sea bathing is highly serviceable. its employment, however, requires much caution, and great mischief is sometimes committed by its indiscriminate use. the child of a strumous habit may be greatly benefited by sea bathing, united with a few years' residence on the coast. indeed, by carefully following up a course of sea bathing, a suitable diet, and a judicious mode of living, the very temperament of the individual may be all but changed, and a power and activity imparted to the system, productive eventually of comparatively strong and robust health. a parent will do wisely, therefore, to send a child of such a habit to a school on the coast. great caution, however, must be observed when bathing is commenced, lest the shock be too powerful for the energies of the system, and be not followed by the necessary degree of reaction. it will be prudent to begin with the tepid bath ( degrees to degrees), and gradually reduce the temperature until the open sea can be resorted to without fear. the measures already mentioned for promoting reaction--exercise previous to immersion; the immersion at first only momentary, and followed by strong friction--must be diligently regarded in such a case. in the child of a delicate and feeble habit, much out of health, whose general debility is dependent on some organic disease, sea bathing is not only improper, but dangerous. instead of being strengthened, such a child will be rendered more weak and debilitated. on the other hand, when the child is of a weak and relaxed habit, but free from organic disease, the cold bath will be highly useful, provided sufficient power of reaction exist in the system. in this case the skin and flesh of the child is relaxed and flabby; there is a great tendency to warm perspirations in bed, capricious appetite, confined or relaxed bowels, indisposition to exertion, and weariness from the slightest effort. the shower bath. the effects of the shower bath are, on the whole, similar to those of the plunge bath of the same degree of temperature, except that the immediate shock of the shower bath is in general felt to be greater than that from simple immersion. this, however, may be met by putting warm water into the bottom of the bath in sufficient quantity to cover the ankles of the individual taking the bath, which tends at once to lessen the shock, and to increase the reaction. the apprehension and alarm experienced by young children in entering this kind of bath is easily overcome, by using at first a modification of it, lately brought into use. it consists of a tin vessel in the form of a large bottle, pierced at the bottom like a colander, and terminating in the upper part in a narrow tube, with an open mouth. when put into water it becomes filled, which is retained by closing the mouth of the tube with the finger; on removing which the water flows gradually out of the sieve-like bottom in a gentle shower. this may be used to the youngest child. at first the quantity of water employed should be small, and its temperature warm; as, however, the child grows older and accustomed to the bath, the former may be increased, and the latter lowered. its tonic effect may be augmented by the addition ofbay salt, and by much active rubbing. as the child gets older the common form of shower bath may be used, and throughout the year, if he enjoy robust health; during the winter season, however, the water should be made tepid. this bath should be taken immediately upon rising from bed. ablution, or sponging. by ablution is meant the process of applying water to the surface of the body by means of a sponge or towel. it is one of the best substitutes for the cold bath; and if done quickly and thoroughly, produces a glow and invigoration of frame almost equal to the former. it is also the surest preventive against catching cold. every child in health ought to be obliged, every morning of its life (when other means of bathing cannot be obtained), upon rising, and while the body still retains all the warmth of the bed, to sponge the whole body. if too young to do it for himself, it must be done for him. salt or vinegar should be added to the water; and if the boy be robust, cold water may be used throughout the year; if not, in the winter season it must be made tepid. as a remedy, cold water sponging, and the application of ice and iced water, are often ordered under certain states of disease by the medical attendant, and frequently followed by delightful results. but it is necessary that they should be properly applied to do good. cold water sponging is a convenient and grateful method of moderating febrile heat of the surface, provided undoubted powers of reaction be present in the system. it is frequently ordered, therefore, to be employed in eruptive fevers, as measles, scarlet fever, smallpox, and other fevers; and also in some local inflammations, particularly of the brain. vinegar may be added to the water under these circumstances with advantage. it should at first be used tepid or cool, but afterwards cold. as a general rule, the more dry and parched the heat of the surface, the more urgent the necessity for the application of the cold, and the more frequently and fearlessly ought it to be renewed,--every hour or half-hour not being too often. should the child fall asleep during the process, and begin to perspire, it must be intermitted, but resumed again on a recurrence of the parching heat. ice and iced water are most frequently employed in affections of the brain. the former is most conveniently applied in a well-cleaned pig's bladder, which should be half filled with broken fragments of the ice. the bladder prevents moisture about the clothes, and, from its smooth and pliant nature, readily accommodates itself to every part of the child's head. if iced water is used, care must be taken that the cloths are sufficiently large to cover the whole of the head, and they should be doubled to prevent their getting rapidly warm. indeed, in applying cold locally, as in inflammation of the brain, one rule it is of the utmost importance to observe, viz. that the application of the cold shall be continuous; therefore a second set of cold cloths or bags of ice should be applied before the former has become warm. this plan, especially pursued during the night, along with judicious internal treatment, will save many children from perishing under the most insidious and fatal disease of childhood--water on the brain. if neither water of a sufficiently low temperature, nor ice, can be procured, then recourse may be had to refrigerating mixtures, of which the following is a good form:-- common water, five pints; vinegar, two pints; nitre, eight ounces; sal ammoniac, four ounces. the warm bath. the warm bath judiciously prescribed is one of the most valuable remedial agents we possess; but although powerful for good, when misapplied, it is equally powerful for mischief. for instance, in active inflammatory affections, before the loss of blood, the use of the warm bath would greatly aggravate the disease; and yet, for an infant with active inflammation of the respiratory organs, it is continually resorted to. again, nothing is more common than for a child, when attacked with convulsions, to be put immediately in the warm bath; and, generally speaking, it is extremely beneficial in this class of diseases; but it is sometimes no less prejudicial, when applied without due examination of the peculiarities of individual cases. for, in plethoric and gross children, the local abstraction of blood from the head, and the complete unloading of the alimentary canal, are often necessary to render such a measure beneficial, or even free from danger. in convulsions, however, and particularly when arising from teething, a parent may, without hesitation, at any time immerse the feet of the infant in water as warm as can be borne, at the same time that cloths wet with cold water are applied to the head and temples. as a preventive, where there is a tendency to disease, the warm bath may be employed without scruple, and will be found most serviceable. its value in this point of view is very great, and it is to be regretted that it is not sufficiently appreciated and used. for example, a severe cold has been taken, and inflammation of the air- tubes is threatened: only put the child into a warm bath, and, with the common domestic remedies, a very serious attack may be warded off. again, in the commencement of a diarrhoea, a warm bath, and discontinuing the cause of the attack, will alone suffice to cure; and, more-over, in the protracted diarrhoea attendant upon teething, where, after various remedies have been tried in vain, the child has lost flesh and strength to an apparently hopeless degree, recovery has been brought about by the simple use of the warm bath. in the treatment of scrofulous children, warm and tepid bathing is of great value. in such cases, a course of warm sea bathing, with active friction over the whole surface after each bath, will at once relieve that abdominal fulness which is generally present, improve the functions of the skin, and give tone and vigour to the whole system. towards the termination of such a course of baths, their temperature must be gradually reduced till they become tepid ( degrees to degrees). the opinion that warm baths generally relax is erroneous: they are, no doubt, debilitating when used by persons of a weak and relaxed constitution, or when continued too long; but, on the contrary, they invariably give tone when employed in the cases to which they are properly applicable. a partial warm bath, such as the foot-bath, is of much service in warding off many complaints. if a child get the feet wet, plunging them into warm water will often prevent any ill consequences; and even when the first chill and slight shiverings which usher in colds, fevers, and other inflammatory complaints, have been complained of, the disease may be cut short by the use of a foot-bath, continued till free perspiration occurs. rules for the use of the warm bath. temperature of the water.--when the warm bath is used as a measure of hygeiene, as a general rule, any degree of temperature may be chosen between degrees and degrees, which appears to be most agreeable to the child; but on no account must degrees be exceeded. when ordered as a remedial measure, the temperature will of course be fixed by the medical attendant. the same degree of temperature must be kept up during the whole period of immersion. for this purpose the thermometer must be kept in the bath, and additions of warm water made as the temperature is found to decrease. these additions of warm water, however, must be regulated by the indications of the thermometer, and not by the feelings of the child. period of remaining in the bath.--this must depend upon circumstances. as a measure of hygeiene, it must be varied according to the age of the child. for the first four or five weeks, the infant should not be kept in beyond three or four minutes; and the duration must afterwards be gradually prolonged as the child advances in age, until it extends to a quarter of an hour, a period which may be allowed after it has attained the age of four years. when the bath is employed as a remedial agent, the time of immersion must be prolonged; this will be determined by the medical adviser. speaking generally, a quarter of an hour may be said to be the shortest period, an hour the longest, and half an hour the medium. when in the bath, care must be taken that the child's body is immersed up to the shoulders or neck, otherwise that part of the body which is out of the bath (the shoulders, arms, and chest), being exposed to the cooler temperature of the air, will be chilled. when the infant or child is taken out of the bath, the general surface, especially the feet, must be carefully rubbed dry with towels previously warmed; and when one of the objects of the bath is to excite much perspiration, the child should be immediately wrapped in flannel and put to bed. when, however, the object is not to excite perspiration, the child may be dressed in his ordinary clothing, but should not be allowed to expose himself to the open air for at least an hour. time of using the bath.--when resorted to for sudden illness, the bath must of course be employed at any time needed. when used for any complaint of long standing, or a measure of hygeiene, as a general rule, it should be taken between breakfast and dinner, about two hours after the former, or an hour and a half before the latter. this implies that the infant should never be put into the bath after having been freely nourished at the breast. neither should it ever be used when the child is in a state of free perspiration from exercise, or on awaking from sleep. chap. iii. of teething, and hints on the permanent or adult teeth. the infant at birth has no teeth visible: the mouth is toothless. it possesses, however, hidden in the jaw, the rudiments of two sets. the first of these which makes its appearance, are called the temporary or milk teeth; the second, the permanent or adult teeth, and these come up as the former fall out, and so gradually replace them. sect. i.--on teething. the manner in which the temporary or milk-teeth appear.--the first set of teeth, or milk-teeth as they are called, are twenty in number; they usually appear in pairs, and those of the lower jaw generally precede the corresponding ones of the upper. the first of the milk-teeth is generally cut about the sixth or seventh month, and the last of the set at various periods from the twentieth to the thirtieth months. thus the whole period occupied by the first dentition may be estimated at from a year and a half to two years. the process varies, however, in different individuals, both as to its whole duration, and as to the periods and order in which the teeth make their appearance. it is unnecessary, however, to add more upon this point. their developement is a natural process. it is too frequently, however, rendered a painful and difficult one, by errors in the management of the regimen and health of the infant, previously to the coming of the teeth, and during the process itself. thus, chiefly in consequence of injudicious management, it is made the most critical period of childhood. not that i believe the extent of mortality fairly traceable to it, is by any means so great as has been stated; for it is rated as high as one sixth of all the children who undergo it. still, no one doubts that first dentition is frequently a period of great danger to the infant. it therefore becomes a very important question to an anxious and affectionate mother, how the dangers and difficulties of teething can in any degree be diminished, or, if possible, altogether prevented. a few hints upon this subject, then, may be useful. i shall consider, first, the management of the infant, when teething is accomplished without difficulty;--and, secondly, the management of the infant when it is attended with difficulty. management of the infant when teething is without difficulty. in the child of a healthy constitution, which has been properly, that is, naturally, fed, upon the milk of its mother alone, the symptoms attending teething will be of the mildest kind, and the management of the infant most simple and easy. symptoms.--the symptoms of natural dentition (which this may be fairly called) are, an increased flow of saliva, with swelling and heat of the gums, and occasionally flushing of the cheeks. the child frequently thrusts its fingers, or any thing within its grasp, into its mouth. its thirst is increased, and it takes the breast more frequently, though, from the tender state of the gums, for shorter periods than usual. it is fretful and restless; and sudden fits of crying and occasional starting from sleep, with a slight tendency to vomiting, and even looseness of the bowels, are not uncommon. many of these symptoms often precede the appearance of the tooth by several weeks, and indicate that what is called "breeding the teeth" is going on. in such cases, the symptoms disappear in a few days, to recur again when the tooth approaches the surface of the gum. treatment.--the management of the infant in this case is very simple, and seldom calls for the interference of the medical attendant. the child ought to be much in the open air, and well exercised: the bowels should be kept freely open with castor oil; and be always gently relaxed at this time. cold sponging employed daily, and the surface of the body rubbed dry with as rough a flannel as the delicate skin of the child will bear; friction being very useful. the breast should be given often, but not for long at a time; the thirst will thus be allayed, the gums kept moist and relaxed, and their irritation soothed, without the stomach being overloaded. the mother must also carefully attend, at this time, to her own health and diet, and avoid all stimulant food or drinks. from the moment dentition begins, pressure on the gums will be found to be agreeable to the child, by numbing the sensibility and dulling the pain. for this purpose coral is usually employed, or a piece of orris-root, or scraped liquorice root; a flat ivory ring, however, is far safer and better, for there is no danger of its being thrust into the eyes or nose. gentle friction of the gums, also, by the finger of the nurse, is pleasing to the infant; and, as it seems to have some effect in allaying irritation, may be frequently resorted to. in france, and in this country also, it is very much the practice to dip the liquorice-root, and other substances, into honey, or powdered sugar-candy; and in germany, a small bag, containing a mixture of sugar and spices, is given to the infant to suck, whenever it is fretful and uneasy during teething. the constant use, however, of sweet and stimulating ingredients must do injury to the stomach, and renders their employment very objectionable. the management of the infant in difficult teething. in the child which has been partly or altogether brought up by hand, or who is of a feeble and delicate constitution, or imbued with any hereditary taint, the process of dentition will be attended with more or less difficulty, and not unfrequendy with danger. symptoms.--the symptoms of difficult dentition are of a much more aggravated description than those which attend the former case; and it is right that a mother should, to a certain extent, be acquainted with their character, that she may early request that medical aid, which, if judiciously applied, will mitigate, and generally quickly remove them. difficult dentition will be attended with painful inflammation and swelling of the gum, which is hotter, of a deeper red, than natural, and intolerant of the slightest pressure. there is often great determination of blood to the head, which a mother may recognise by the cheeks being red, hot, and swollen; the eyes red, irritable, and watery; and the saliva running from the mouth profusely. the fever is great, and the thirst extreme. the child is at one time restless and irritable, and at another heavy and oppressed: the sleep will be broken, and the infant frequently awake suddenly and in alarm from its short slumbers. such are the chief symptoms of difficult teething, and which will be present to a greater or less degree. treatment.--as most of the above symptoms are induced by the painful tension of the gum, it would seem that the most rational mode of attempting their relief is by freely lancing the swollen part. great prejudices, however, still exist in the minds of some parents against this operation. they think it gives great pain, and, if the tooth is not very near, makes its coming through the gum subsequently the more difficult. with regard to the first objection, the lancet is carried through the gum so quickly, that this is hardly possible; and the fact that the infant will often smile in your face after it is done, although previously crying from pain, is sufficient evidence that it is not a very painful operation. in reference to the second, that the scar which ensues, opposes, by its hardness, the subsequent progress of the tooth, it is quite groundless; for cicatrices, like all other new-formed parts, are much more easily absorbed than the original structure. of the practical utility and perfect safety of this operation we have ample proof in its daily performance with impunity, and in the instant relief which it often affords to all the symptoms. mere scarifying the gums is sometimes all that is required, and will afford great relief. this operation, therefore, should not be opposed by the mother. she, at the same time, should be acquainted with its precise object, lest the speedy return of the symptoms, and the non- appearance of the expected tooth, might tend to bring the operation of lancing the gums into disrepute. the parental management of the infant, then, and by which much of the pain and difficulty of teething may be removed or alleviated, consists in attending to the following directions:-- first, to the state of the mouth.--to this it is an important part of the mother's duty to pay especial attention; and, by so doing, she will save her child much suffering. the condition of the mouth should be carefully inspected from time to time; and should a swollen gum be discovered, it should immediately be attended to, not waiting till constitutional symptoms appear before she employs proper aid for her child. for this purpose the mother should make herself familiar with the appearances of the gum under distention and inflammation; a matter of no difficulty, accompanied, as this condition usually is, by a profuse secretion of saliva, heat of mouth, and at a time when the age of the child justifies the supposition that it is about to cut its first tooth, or, if it have some teeth, that others are about to appear. secondly, to the food.--if a child is teething with difficulty, it should always have its quantity of nourishment diminished. if it is being fed, as well as nursed at the breast, at the time, the former should be immediately withheld: if it is being fed alone, the only kind of food that should be allowed is milk and water. these cases are much aggravated by the not uncommon habit of parents giving the infant food whenever it cries from the irritation attending upon the process; and thus a slightly difficult dentition is converted into serious disease. thirdly, to the state of the bowels.--these must be carefully watched, that they may not become confined; it being necessary that they should be gently relaxed at this time. if a slight diarrhoea is present, it must not be checked; if it pass beyond this, however, medicine must be had recourse to, and great benefit will also arise from putting the child into a warm hip-bath, and warmly clothing the body, but keeping the head cool. fourthly, to the head.--the infant's head should be washed with cold water night and morning, and no other covering than that which nature has provided should be put upon it when within doors or asleep; and on no occasion should warm felt or velvet hats be worn during mild or warm weather, straw or white hats being much lighter and cooler. the child should be much in the open air. the sponging of the infant's body daily, either with cold or tepid water, must depend upon the season of the year and constitution of the child, as well as upon other circumstances. sponging the head with cold water night and morning is almost invariably atttended with great benefit, and may be resorted to in every case without fear; and now and then the use of the warm hip-bath, for several days together, will be ordered by the physician, which, by acting upon the skin, diminishes the determination of blood to the head, and thus forms an important source of relief. fifthly, of convulsions.--if they should occur, and they are not unfrequently excited by difficult teething, and then give great alarm to the parent, relief will be afforded by immersing the hips, legs, and feet of the infant in water as warm as can be borne, and at the same time applying over the head and temples a piece of flannel wet with cold water. i have also often cut the fit short by sprinkling cold water in the child's face while in the bath. the gums should always be looked to, and if they appear swollen, and painful, at once lanced. i have known the most formidable convulsions to cease immediately after this operation. sixthly, of the use of opiates.--it is the practice with some nurses to administer narcotics to quiet infants while teething. it is not only objectionable, but, from the uncertain effects of sedatives upon infants, a very dangerous practice, and they ought never to be given, except at the suggestion of a medical man. it is far better, if the child is restless at night, to have it frequently taken out of its cot, and carried about in an airy room; for the cool air, and change of posture, will do much to allay the feverishness and restlessness of the child. from these few hints, it must have been seen how much the sufferings from teething may be mitigated by judicious management. that, if the parent is able to support her infant upon the breast alone, teething will be found comparatively an easy process, and unattended with danger; the mother thus reaping a delightful reward for all the anxieties and privations nursing necessarily involves. that the child brought up partially, or entirely, by hand will always pass through dentition with more or less of pain and difficulty; but that even here, if the diet has been properly regulated, much less suffering and inconvenience will arise than when less attention has been paid to it. and, lastly, that, when teething is difficult, how highly important it is to call in proper aid at an early period, and to carry out fully the directions of the medical attendant, allowing no foolish prejudices to interfere with his prescriptions and management. if i stood in need of any argument to impress upon the mind of a parent the importance of attending to the last injunction, i would simply state, that its neglect is but too frequently the cause of disease of the brain, terminating in death, or a state of idiotcy far worse than death, of which i know more than one living instance. it may be as well to add, that eruptions about the ears, head, face, and various parts of the body, very frequently appear during the process of the first teething.[fn# ] if they are slight, they should be left alone, being rather useful than otherwise; if they are troublesome, they must receive that kind of attention from the parent which will be pointed out under the chapter on diseases. the same remark applies to enlargements of the glands of the neck, which frequently appear at this time. [fn# ] in some infants a rash always precedes the cutting a tooth. sometimes it appears in the form of hard elevated pimples as large as peas; in other instances in the form of red patches, of the size of a shilling, upon the arms, shoulders, and back of the neck. they are always harmless, require no particular attention, and prevent, i doubt not, more serious complaints. sect. ii. hints upon the permanent or adult teeth. parents are not sufficiently alive to the importance of attending to the condition of the mouth of their children at the period of changing the first for the second set of teeth; they do not seem to be aware how much the comfort, appearance, and future health of the child depends upon it. nor do they subsequently impress upon the minds of their children how necessary, on their part, is the observance of certain rules for the preservation of the teeth, and how distressing are the effects which result from their neglect. it is proposed, here, to say a few words for the information and guidance of the parent upon this subject. the manner in which they appear. the change of the temporary for the permanent or adult teeth commences, in the majority of instances, at about seven years of age; occasionally it occurs as early as five, and as late as eight years and a half. the necessity which exists for this change, and the mode by which it is effected, are striking and beautiful; it is, however, not our object to enter fully upon its consideration here. it has already been observed, that the infant is born with the rudiments of two sets of teeth in the jaw, although neither make their appearance till long after birth. the time when, and the manner in which the first set appear has been pointed out. now although these admirably answer the purposes for which they were given up to the seventh year, after this period they fail to do so: they are not sufficiently numerous,--in their structure they are not strong or durable,--nor is their power of mastication sufficiently great. they are not sufficiently large or numerous. if the mouth of a child at this age is examined, it will be seen, that a considerable interval has taken place between the teeth in consequence of the growth and expansion of the face; hence a larger set has become necessary to fill the arch. but it may be asked, do not the teeth grow with the growth of the body? and if not, why is it so? they do not, and for this reason: the important office which these organs are destined to perform requires that they should be composed of a substance too dense and of too low an organization to allow of any subsequent growth and enlargement. thus the size of the teeth is determined and acquired before they make their appearance through the gums. this being the case, it will be readily seen, that the teeth which would be of appropriate size in the mouth of the infant, would be quite inadequate to the enlarged dimensions of the adult; hence the necessity of a second set, exceeding in number, and size the teeth of the first. that a necessity also exists at this age, that the weak and delicate teeth of childhood should be exchanged for a set stronger and more durable in their structure, more robust and more powerful, will be sufficiently apparent, if we only recollect the great change which has gradually been taking place in the nature of the food of the two epochs of childhood and adult age. the second set, or permanent teeth, then, lying under the milk-teeth and hidden in the jaw, undergo in this situation their full developement, before they appear above the gum. this occurrence commences about seven years of age, at which period the first set begin to fall out from their roots becoming absorbed, and no longer retaining their hold of the jaw; to be entirely replaced in the course of a few years by the permanent set, which thus succeeds them. the first teeth of this set which make their appearance are the large double teeth, which emerge from the gum immediately behind the last of the temporary set. next the two front teeth of the lower jaw fall out, and are succeeded by two others of similar character and form, but of larger size; then the two corresponding teeth of the upper row are cast off, and their place supplied; shortly after the teeth immediately adjoining these; then the double teeth of the first set are exchanged for their smaller successors of the second. the eye-teeth after a time begin to make their appearance; and then more double teeth; making in all twenty-eight teeth, and occupying in their developement from the seventh to the fourteenth year of age. they are not, however, yet complete; for between the latter date and the twenty-first year four more teeth appear, called the wisdom teeth, making the adult set or permanent teeth to amount in all to thirty-two teeth. it should be observed, that whilst this is the most usual course in which this set appear, the line of succession is sometimes different. their value and importance. it would seem almost unnecessary to say a word upon so self-evident a truth, and yet perhaps the full extent of this statement is not generally appreciated. it has not, perhaps, occurred to the minds of all, that upon the right position and arrangement of the teeth the beauty and expression of the countenance much depends. but so it is; for however regular and perfect the general features, if the teeth are irregular or deficient, an unpleasing expression, proportionate to the extent of the displacement, is inevitably produced. now every mother should be alive to this fact, that she may early apply to the dentist to have any error of the above nature rectified, before it is too late. on their complete and entire state also depends the perfection of utterance and articulation. the child, for instance, makes no attempt at articulation until it has acquired several teeth; this faculty becomes also exceedingly imperfect during the process of changing them; from this time it continues to improve, until again it is permanently impaired in old age, when they are finally lost. and so again, if a child lose merely a single tooth from the front of its mouth, lisping will result; or if a supernumerary or irregular tooth be present, the articulation will be abrupt and imperfect:--the former plainly showing the importance of the entireness of the series, and the latter, the necessity of regularity in their arrangement and position. the teeth, however, are chiefly important in relation to the part they sustain in connection with digestion, viz. the mastication of the food. by this act the food, after being received into the mouth, is mixed with the saliva and broken down, till it becomes of an uniform pulpy consistence, fit for being easily swallowed, and acted upon by the gastric juice on its arrival in the stomach. that due mastication of the food is essential to healthy digestion, which will be promoted or retarded in exact proportion as it approaches or falls short of this point, is a fact so generally known as scarcely to need comment. suffice it to add, that, if food be introduced into the stomach unmasticated, the gastric juice will only act upon its surface; and after a number of hours it will be either rejected by vomiting, or pass on into the intestine, to give rise to cholic, bowel complaints, or flatulence, and very frequently in children to a serious attack of convulsions. their management and preservation. irregularity of arrangement and position.--every parent ought to have the mouth of her child inspected occasionally, during the advance of the permanent teeth, that any irregularity in their position or arrangement may be prevented. and it is equally her duty to see to it, that she choose a competent person to do this, since great mistakes are not unfrequently made in this matter, and which themselves become the source of evils far more serious than those they are intended to obviate. "i have known," says mr. bell, "no less than eight or even ten firm teeth forcibly removed from the jaws of a child at once, when there was not the slightest reason to apprehend any evil result from their being left alone." here there was a most cruel, because unnecessary, infliction of pain, as well as great hazard incurred of seriously injuring the permanent teeth by interfering with the secretion of their enamel. and besides all this there is another and yet greater evil, for, if the temporary teeth be removed, before the permanent ones are so advanced as to be ready to occupy their situation, the arch of the jaw will assuredly contract, and when, subsequently, the permanent teeth are fully formed, there will not be room for them to range in their proper situation. thus the operation which was intended to prevent irregularity becomes the cause of its occurrence, and that in its very worst form, producing a want of accordance between the size of the teeth and that of the jaw. the eye-teeth generally occasion most anxiety to a parent, from the prominent position in which they present themselves; but in the majority of cases nothing but time is required to reduce them to their proper station. but, whatever may be the peculiarities of each individual case, the dentist will decide what may be required; only, i would again repeat, do not neglect the occasional inspection of the mouth at this age, if you regard the future comfort and appearance of your child. their preservation.--the preservation of the teeth requires attention to several points; the first and principal of which is, to enforce the habit in the child of thoroughly cleaning the teeth by means of water and a brush night and morning, and rinsing out the mouth after each meal. the brush should not be very hard, as it will not only be more difficult to clean the interstices between the teeth, the part in which the tartar[fn# ] is most likely to be deposited, but by its friction, will occasion the gradual absorption of the gum and the exposure of the neck of the teeth. the hair of the brush should be firm and elastic, and not too closely set. [fn# ] a sort of calcareous substance, which becomes deposited at the roots of the teeth, from a want of proper attention to cleanliness; and, if allowed to remain, will destroy first their beauty, and then the organ itself. tartar.--if there is a tendency to the formation of tartar, then it will be necessary to have recourse to some tooth-powder. tooth-powders, however, must be chosen with care, as many of them are composed of substances highly injurious to the teeth. "many of the tooth-powders which are offered for sale, with the promise of rendering the teeth beautifully white, perform, for a time, all that is promised, at the expense of permanent and irremediable injury to the teeth; for they often contain a quantity of tartaric or other acid, which effects a gradual decomposition of the enamel."[fn# ] prepared chalk is one of the simplest and best tooth-powders. [fn# ] bell on the teeth. the following form, also, may be used with advantage:-- prepared chalk, three ounces; orris root, powdered, half an ounce; powdered myrrh, half an ounce; cuttle fish, powdered, one ounce; essential oil of cinnamon, four drops.--mix. the best preservative, then, against the formation of tartar, is to see that the child cleans his teeth thoroughly night and morning with the brush, powder, and water, and also (if possible) that he rinses out the mouth after each meal. if the gums should be tender, irritable, and bleed (as is frequently the case when an individual gets out of health, or the tartar accumulates) the mouth may be washed night and morning with a tumbler of tepid water, containing from ten to twenty drops of the tincture of myrrh, and the same quantity of spirits of camphor; or the following form may be used:-- alum, one drachm and a half; tincture of myrrh, two drachms; camphor mixture, five ounces and a half.--mix. acids.--the use of acids to the teeth cannot be too strongly deprecated: they decompose their substance, and lead to their rapid decay. hence the whiteness produced by acid tooth-powders and washes is not less deceitful than ruinous in its consequences. as has been just observed, they perform all that their vendors promise, causing the teeth, for a little while, to become very white and beautiful in their appearance, but, at the same time, injuring them irremediably: the enamel becomes gradually decomposed, the bone of the tooth exposed, and its death is the inevitable consequence. it is therefore of great importance when acid medicines are ordered for children that they should be taken through a glass tube, to prevent their coming in contact with the teeth. from a want of this precaution, i know a lady (and there are many such instances) who once had as sound and fine a set of teeth as any one could boast of, but from this cause has had nearly the whole of the upper row destroyed. she was in delicate health: it was judged requisite that she should take for a considerable time (with other medicines) sulphuric acid; but the glass tube was not thought of, and the consequences followed which have been described. calomel.--this medicine, as it is frequently given, alone, or in the little white powders, in infancy and childhood, by mothers and nurses, is productive of serious and indeed irremediable injury to the teeth. "the immoderate use of mercury in early infancy produces, more perhaps than any other similar cause, that universal tendency to decay, which, in many instances, destroys almost every tooth at an early age. it is certainly not unimportant to bear this fact in mind, in the administration of this sovereign remedy, this panacea, as many appear to consider it, in infantile diseases."[fn# ] [fn# ] bell on the teeth. heat and cold.--the teeth are exceedingly apt to suffer from sudden variations of temperature. fluids, therefore, should never be taken into the mouth so hot or so cold as to produce the slightest pain; and, for the same reason, the water with which the mouth is cleansed should in winter be always warm or tepid. when ices are taken, the precaution of placing them in the centre of the mouth, so as to prevent contact with the teeth, should be carefully observed. there are many other causes which might be mentioned as tending to induce decay of the teeth, but their consideration here is purposely avoided. it is hoped that enough has been said to draw the parent's attention to the subject of the teeth, to prevent their neglect, and yet at the same time to induce a cautious management. chap. iv. hints for the early detection of disease in the child by the mother. life is soon extinguished in infancy. at this epoch any disease is formidable, and must be met most promptly. it is either sudden and active in its assaults, or comes with slow and insidious approach. the first signs of its coming on are not always visible to an unpractised eye: it may have made dangerous advances before the mother's mind is awakened to its presence; and medical aid may be solicited when remedies and advice are no longer of any avail. it is therefore highly important that a mother should possess such information as will enable her to detect disease at its first appearance, and thus insure for her child timely medical assistance. this knowledge it will not be difficult for her to obtain. she has only to bear in mind what are the indications which constitute health, and she will at once see that all deviations from it must denote the presence of disorder, if not of actual disease. with these changes she must to a certain extent make herself acquainted. sect. i.--signs of health. the signs of health are to be found, first, in the healthy performance of the various functions of the body; the regular demands made for its supply, neither in excess or deficiency; and a similar regularity in its excretions both in quantity and appearance. if the figure of the healthy infant is observed, something may be learnt from this. there will be perceived such an universal roundness in all parts of the child's body, that there is no such thing as an angle to be found in the whole figure; whether the limbs are bent or straight, every line forms a portion of a circle. the limbs will feel firm and solid, and unless they are bent, the joints cannot be discovered. the tongue, even in health, is always white, but it will be free from sores,--the skin cool,--the eye bright,--the complexion clear,--the head cool,--and the abdomen not projecting too far,--the breathing regular, and without effort. when awake, the infant will be cheerful and sprightly, and, loving to be played with, will often break out into its merry, happy, laugh; whilst, on the other hand, when asleep, it will appear calm, every feature composed, its countenance displaying an expression of happiness, and frequently, perhaps, lit up with a smile. sect. ii. signs of disease. just in proportion as the above appearances are present and entire, health may be said to exist; and just in proportion to their partial or total absence disease will have usurped its place. we will, however, for the sake of clearness examine the signs of disease as they are manifested separately by the countenance,--the gestures,--in sleep,--in the stools,--and by the breathing and cough. of the countenance. in health the countenance of a thild is expressive of serenity in mind and body; but if the child be unwell, this expression will be changed, and in a manner which, to a certain extent, will indicate what part of the system is at fault. the brows will be contracted, if there is pain, and its seat is in the head. this is frequently the very first outward sign of any thing being wrong, and will occur at the very onset of disease; if therefore remarked at an early period, and proper remedies used, its notice may prevent one of the most fearful of infantile complaints--"water in the head." if this sign is passed by unheeded, and the above disease be threatened, soon the eyes will become fixed and staring,--the head hot, and moved uneasily from side to side upon the pillow, or lie heavily upon the nurse's arm,--the child will start in its sleep, grinding its teeth, and awake alarmed and screaming,--its face will be flushed, particularly the cheeks (as if rouged),--its hands hot,--but feet cold, its bowels obstinately costive, or its motions scanty, dark-coloured, and foul. if the lips are drawn apart, so as to show the teeth or gums, the seat of the pain is in the belly. this sign, however, will only be present during the actual existence of suffering; if, therefore, there be any doubt whether it exist, press upon the stomach, and watch the eifect on the expression of the countenance. if the pain arise simply from irritation of the bowels excited from indigestion, it will be temporary, and the sign will go and come just as the spasm may occur, and slight remedial measures will give relief. if, however, the disease be more serious, and inflammation ensue, this sign will be more constantly present, and soon the countenance will become pale, or sallow and sunken,--the child will dread motion, and lie upon its back with the knees bent up to the belly,--the tongue will be loaded,--and in breathing, while the chest will be seen to heave with more than usual effort, the muscles of the belly will remain perfectly quiescent. if the nostrils are drawn upwards and in quick motion, pain exists in the chest. this sign, however, will generally be the accompaniment of inflammation of the chest, in which case the countenance will be discoloured,--the eyes more or less staring, and the breathing will be difficult and hurried; and if the child's mode of respiring be watched, the chest will be observed to be unmoved, while the belly quickly heaves with every inspiration. convulsions are generally preceded by some changes in the countenance. the upper lip will be drawn up, and is occasionally bluish or livid. then there may be slight squinting, or a singular rotation of the eye upon its own axis; alternate flushing or paleness of the face; and sudden animation followed by languor. these signs will sometimes manifest themselves many hours, nay days, before the attack occurs; may be looked upon as premonitory; and if timely noticed, and suitable medical aid resorted to, the occurrence of a fit may be altogether prevented. the state of the eyes should always be attended to. in health they are clear and bright, but in disease they become dull, and give a heavy appearance to the countenance; though after long continued irritation they will assume a degree of quickness which is very remarkable, and a sort of pearly brightness which is better known from observation than it can be from description. the direction of the eyes, too, should be regarded, for from this we may learn something. when the infant is first brought to the light, both eyes are scarcely ever directed to the same object: this occurs without any tendency to disease, and merely proves, that regarding one object with both eyes is only an acquired habit. but when the child has come to that age when the eyes are by habit directed to the same object, and afterwards it loses that power, this circumstance alone may be looked upon as a frequent prelude to disease affecting the head. of the gestures. the gestures of a healthy child are all easy and natural; but in sickness those deviations occur, which alone will often denote the nature of the disease. suppose an infant to have acquired the power to support itself, to hold its head erect; let sickness come, its head will droop immediately, and this power will be lost, only to be regained with the return of health; and during the interval every posture and movement will be that of languor. the little one that has just taught itself to run alone from chair to chair, having two or three teeth pressing upon and irritating the gums, will for a time be completely taken off its feet, and perhaps lie languidly in its cot, or on its nurse's arm. the legs being drawn up to the belly, and accompanied by crying, are proofs of disorder and pain in the bowels. press upon this part, and your pressure will increase the pain. look to the secretions from the bowels themselves, and by their unhealthy character your suspicions, in reference to the seat of the disorder, are at once confirmed. the hands of a child in health are rarely carried above its mouth; but let there be any thing wrong about the head and pain present, and the little one's hands will be constantly raised to the head and face. sudden starting when awake, as also during sleep, though it occur from trifling causes, should never be disregarded. it is frequently connected with approaching disorder of the brain. it may forebode a convulsive fit, and such suspicion is confirmed, if you find the thumb of the child drawn in and firmly pressed upon the palm, with the fingers so compressed upon it, that the hand cannot be forced open without difficulty. the same condition will exist in the toes, but not to so great a degree; there may also be a puffy state of the back of the hands and feet, and both foot and wrist bent downwards. there are other and milder signs threatening convulsions and connected with gesture, which should be regarded:--the head being drawn rigidly backwards,--an arm fixed firmly to the side, or near to it,--as also one of the legs drawn stifly upwards. these signs, as also those enumerated above, are confirmed beyond all doubt, if there be present certain alterations in the usual habits of the child:--if the sleep is disturbed,--if there be frequent fits of crying,--great peevishness of temper,--the countenance alternately flushed and pale,--sudden animation followed by as sudden a fit of languor,--catchings of the breath followed by a long and deep inspiration,--all so many premonitory symptoms of an approaching attack. of the sleep. the sleep of the infant in health is quiet, composed, and refreshing. in very early infancy, when not at the breast, it is for the most part asleep in its cot; and although as the months advance it sleeps less, yet when the hour for repose arrives, the child is no sooner laid down to rest, than it drops off into a quiet, peaceful slumber. not so, if ill. frequently it will be unwilling to be put into its cot at all, and the nurse will be obliged to take the infant in her arms; it will then sleep but for a short time, and in a restless and disturbed manner. if it suffer pain, however slight, the countenance will indicate it; and, as when awake, so now, if there is any thing wrong about the head, the contraction of the eye-brow and grinding of the teeth will appear; if any thing wrong about the belly, the lips will be drawn apart, showing the teeth or gums,--and in both instances there will be great restlessness and frequent startings. of the stools. in the new-born infant the motions are dark coloured, very much like pitch both in consistence and appearance. the first milk, however, secreted in the mother's breast, acts as an aperient upon the infant's bowels, and thus in about four-and-twenty hours it is cleansed away; or if it should not, a tea-spoonful of castor oil accomplishes this purpose. from this time, and through the whole of infancy, the stools will be of a lightish yellow colour, the consistence of thin mustard, having little smell, smooth in appearance, and therefore free from lumps or white curded matter, and passed without pain or any considerable quantity of wind. and as long as the child is in health, it will have daily two or three, or even four, of these evacuations. but as it grows older, they will not be quite so frequent; they will become darker in colour, and more solid, though not so much so as in the adult. any deviation, then, from the above characters, is of course a sign of something wrong; and as a deranged condition of the bowels is frequently the first indication we have of coming disease, the nurse should daily be directed to watch the evacuations. their appearance, colour, and the manner in which discharged, are the points principally to be looked to. if the stools have a very curdy appearance, or are too liquid, or green, or dark-coloured, or smell badly, they are unnatural. and in reference to the manner in which they are discharged, it should be borne in mind, that, in a healthy child, the motion is passed with but little wind, and as if squeezed out, but in disease, it will be thrown out with considerable force, which is a sign of great irritation. the number, too, of stools passed within the four-and- twenty hours it is important to note, so that if the child does not have its accustomed relief, (and it must not be forgotten that children, although in perfect health, differ as to the precise number,) a little castor oil may be at once exhibited, and thus mischief be prevented. this, however, is not the place to discuss the question of disordered bowels, but simply to point out how this circumstance may be known.[fn# ] [fn# ] see section on disorders of the stomach and bowels, p. . of the breathing and cough. the breathing of a child in health is formed of equal inspirations and expirations, and it breathes quietly, regularly, inaudibly, and without effort. but let inflammation of the air-tubes or lungs take place, and the inspiration will become in a few hours so quickened and hurried, and perhaps audible, that the attention has only to be directed to the circumstance to be at once perceived. now all changes which occur in the breathing from its healthy standard, however slight the shades of difference may be, it is most important should be noticed early. for many of the complaints in the chest, although very formidable in their character, if only seen early by the medical man, may be arrested in their progress; but otherwise, may be beyond the control of art. a parent, therefore, should make herself familiar with the breathing of her child in health, and she will readily mark any change which may arise. of cough i should not have said any thing in this chapter, as it can never fail to be noticed, except that it is highly necessary to throw out one caution. whenever a child has the symptoms of a common cold, attended by hoarseness and a rough cough, always look upon it with suspicion, and never neglect seeking a medical opinion. hoarseness does not usually attend a common cold in the child, and these symptoms may be premonitory of an attack of "croup;" a disease excessively rapid in its progress, and which, from the importance of the parts affected, carrying on, as they do, a function indispensably necessary to life, requires the most prompt and decided treatment. the following observations of dr. cheyne are so strikingly illustrative, and so pertinent to my present purpose, that i cannot refrain inserting them:--"in the approach of an attack of croup, which almost always takes place in the evening, probably of a day during which the child has been exposed to the weather, and often after catarrhal symptoms have existed for several days, he may be observed to be excited, in variable spirits, more ready than usual to laugh than to cry, a little flushed, occasionally coughing, the sound of the cough being rough, like that which attends the catarrhal stage of the measles. more generally, however, the patient has been for some time in bed and asleep, before the nature of the disease with which he is threatened is apparent; then, perhaps, without waking, he gives a very unusual cough, well known to any one who has witnessed an attack of the croup; it rings as if the child had coughed through a brazen trumpet; it is truly a tussis clangosa; it penetrates the walls and floor of the apartment, and startles the experienced mother,--'oh! i am afraid our child is taking the croup!' she runs to the nursery, finds her child sleeping softly, and hopes she may be mistaken. but remaining to tend him, before long the ringing cough, a single cough, is repeated again and again; the patient is roused, and then a new symptom is remarked; the sound of his voice is changed; puling, and as if the throat were swelled, it corresponds with the cough," etc. how important that a mother should be acquainted with the above signs of one of the most terrific complaints to which childhood is subject; for, if she only send for medical assistance during its first stage, the treatment will be almost invariably successful; whereas, if this "golden opportunity" is lost, this disease will seldom yield to the influence of measures, however wisely chosen or perseveringly employed. sect. iii.--other circumstances which will assist in the early detection of disease. . the influence of the seasons in producing particular forms of disorder.--the recollection of the fact, that at the different seasons of the year some diseases are more prevalent than at other periods, will greatly aid a judicious parent in the early detection of the presence of disorder, and its kind, in her child. thus, in the early part of the winter, what is called catarrh, viz. an increased secretion of mucus from the membranes of the nose, fauces, and air-tubes, with fever, and attended with sneezing and cough, thirst, lassitude, and want of appetite, is generally prevalent. as the winter advances, the air-tubes of the lungs, and the lungs themselves, are liable to become the seat of disorder; and those signs will present themselves, which have been pointed out in the previous section as characteristic of such attacks. in the spring, we have still the same diseases prevalent, and in addition, measles, scarlet fever, small-pox, and chicken pox, which increase in liability towards the close of this season, and with the first weeks of summer. in the summer, disease is less prevalent than at any other period of the year; but towards its middle and close, and through the whole of the autumnal months, bowel complaints may be expected, in the forms of diarrhoea, cholera, and dysentery. . the influence of a hereditary predisposition to certain diseases.-- without entering into this subject at large, still it may be useful to remark, that in some families there is a predisposition to some diseases, which, occurring in the first child, will, as each succeeding child is born, attack at the same age. amongst other diseases of this class are, croup, hooping-cough, and water in the head. this observation should not only lead a mother to be alive to the possibility of the successional occurrence of these diseases in her family, and so early note their appearance, and seek medical advice, but should at the same time make her most anxious, on the one hand, to shield her child from all their exciting causes, and on the other, to adopt those measures which may contribute indirectly to overcome the constitutional predisposition to them. of the scrofulous constitution, i will merely mention here, that it is of the greatest importance, where a predisposition to this disease exists in a family, that a mother should immediately attend to any alteration in the gait or contour of her child, and give prompt attention also to any complaint made of swelling about a joint, although it may be unattended with pain. the importance of this remark will be seen by contrasting the result of the following cases which occurred in children of the same family. case i. a. b., a female child, having blue eyes, light hair, and a fair complexion, in the early part of the year , being then two years of age, had an enlargement of the left knee joint. for some weeks previous to this time, there had been a degree of heat about the part; but as no pain apparently existed, it was not regarded as of any consequence, and nothing was done. the child, living in the neighbourhood of london, was afterwards placed under medical treatment. two or three months having elapsed, it was brought to town, and shown to me, in consequence of a slight tumefaction over the lower part of the spine. this soon disappeared under the measures employed, and eventually the disease of the knee (evidently scrofulous) was arrested, so that now the case promises to be cured; but the joint will for ever be stiff, and the limb thus affected shorter than the other. case ii. g. b., the brother of the above, a handsome boy, with light hair, fine blue eyes,--indeed, very much like his little sister,--in the year , had enlargements of the glands in his neck, which were relieved by the treatment resorted to. in april, , being then eight years old, he was observed by his mother to limp slightly in walking, but complained of little or no pain. from the caution, however, which had been given to the parent at the time i was consulted about the previous case, to notice at an early period any symptom of this nature in her children, the fact was immediately attended to. the affection was evidently in the hip; there was imperfection in the gait, and pain upon pressing over the joint. a blister was applied, perfect rest to the limb enjoined, and steel medicines ordered; and in a fortnight the motions of the joint were restrained more effectually by the application of strips of soap plaster and a bandage. in three months the child was ordered to the sea- side, and eventually was able to walk without the slightest limp or pain, and may be said to be quite well. i would not say that in the first case, if the disease had been discovered early, and at that time met by judicious medical treatment, a stiff knee and shortened limb would have been prevented, although this is my belief; but in reference to the latter case, i have no hesitation in saying, that without the disease had been early detected by the mother, and as promptly attended to by her, the remedial measures might have failed,--certainly the result would not have been so highly satisfactory as it was. chap. v. on what constitutes the maternal management of the diseases of children. the especial province of the mother is the prevention of disease, not its cure. to the establishment and carrying out of this principle, every word contained in the preceding pages has directly or indirectly tended. this, however, is not all. when disease attacks the child, the mother has then a part to perform, which it is especially important during the epochs of infancy and childhood should be done well. i refer to those duties which constitute the maternal part of the management of disease. medical treatment, for its successful issue, is greatly dependent upon a careful, pains-taking, and judicious maternal superintendence. no medical treatment can avail at any time, if directions be only partially carried out, or be negligently attended to; and will most assuredly fail altogether, if counteracted by the erroneous prejudices of ignorant attendants. but to the affections of infancy and childhood, this remark applies with great force; since, at this period, disease is generally so sudden in its assaults, and rapid in its progress, that unless the measures prescribed are rigidly and promptly administered, their exhibition is soon rendered altogether fruitless. the amount of suffering, too, may be greatly lessened by the thoughtful and discerning attentions of the mother. the wants and necessities of the young child must be anticipated; the fretfulness produced by disease, soothed by kind and affectionate persuasion; and the possibility of the sick and sensitive child being exposed to harsh and ungentle conduct, carefully provided against. again, not only is a firm and strict compliance with medical directions in the administration of remedies, of regimen, and general measures, necessary, but an unbiased, faithful, and full report of symptoms to the physician, when he visits his little patient, is of the first importance. an ignorant servant or nurse, unless great caution be exercised by the medical attendant, may, by an unintentional but erroneous report of symptoms, produce a very wrong impression upon his mind, as to the actual state of the disease. his judgment may, as a consequence, be biased in a wrong direction, and the result prove seriously injurious to the welldoing of the patient. the medical man cannot sit hour after hour watching symptoms; hence the great importance of their being faithfully reported. this can alone be done by the mother, or some person equally competent. there are other weighty considerations which might be adduced here, proving how much depends upon efficient maternal management in the time of sickness; but they will be severally dwelt upon, when the diseases with which they are more particularly connected are spoken of. sect. .--accidents and diseases which may occur to the infant at birth, or soon after. still-born. sometimes the child comes into the world apparently dead, and, unless the most active exertions are made by the attendants, is lost. the superintendence of the means used devolves upon the medical man; but it would be often well if his assistants were already acquainted with the measures pursued under these circumstances, for they would be more likely to be carried into effect with promptitude and success, than they now frequently are. and again, the still-born child is frequently in this state from having been born very rapidly, and before the medical man can have arrived, it will be more especially useful in such a case, that the attendants in the lying-in-room should know how to proceed. the various causes producing this condition it is unnecessary to mention. the condition itself may exist in a greater or less degree: the infant may be completely stillborn, with no indication of life, except, perhaps, the pulsation of the cord, or a feeble action of the heart;--or it may make ineffectual efforts at breathing, or even cry faintly, and yet subsequently perish for want of strength to establish perfectly the process of respiration. under all these circumstances, a good deal can often be effected by art. in every instance, therefore, in which we have not positive evidence of the child being dead, in the existence of putrefaction, or of such malformation as is incompatible with life, it is our duty to give a fair trial to the means for restoring suspended animation; and as long as the slightest attempt at motion of the respiratory organs is evinced, or the least pulsation of the heart continues, we have good grounds for persevering and hoping for ultimate success. the measures to be employed to restore a still-born child will be a little modified by the circumstances present. if there is no pulsation--no beating in the cord, when the child comes into the world, it may at once be separated from the mother. this is to be effected by first tying the navel-string with common sewing thread (three or four times doubled), about two inches from the body of the child, and again two inches from the former ligature, and then dividing the cord with a pair of scissors between the two. and now the means for its restoration are to be made use of, which are detailed below, viz. inflation of the lungs, and perhaps the warm bath. if, with the above circumstances, the child's face be livid and swollen, some drops of blood should previously be allowed to escape before the ligature is applied to that part of the navel-string which is now only attached to the child. if there is pulsation in the cord, but respiration is not fully established, it must not be divided; and as long as pulsation continues, and the child does not breathe perfectly and regularly, no ligature should be applied. the first thing to be done here, is to pass the finger, covered with the fold of a handkerchief or soft napkin, to the back of the child's mouth, to remove any mucus which might obstruct the passage of air into the lungs, and at the same time to tickle those parts, and thereby excite respiratory movements. the chest should then be rubbed by the hand, and a gentle shock given to the body by slapping the back. if these means fail, the chest and soles of the feet must next be rubbed with spirits, the nostrils and back of the throat irritated with a feather previously dipped in spirits of wine, and ammonia or hartshorn may be held to the nose. inflation of the lungs.--these means not having been successful, and the pulsation in the cord having ceased, the infant must be separated, and inflation of the lungs resorted to. this is to be effected gently and cautiously as follows:-- the child, wrapped in flannel, is to be laid on its back upon a table placed near the fire. its head is to be slightly extended, and the nostrils held between the fingers and thumb of one hand, whilst with the fingers of the other slight pressure is to be made upon the pit of the stomach, so as to prevent the air from passing into that organ. the lungs of the child are now to be filled with air, by the operator applying his own lips--with a fold of silk or muslin intervening, for the sake of cleanliness--to those of the child, and then simply blowing in its mouth, he is to propel the air from his own chest into that of the infant. previously, however, to his doing this, he should make several deep and rapid inspirations, and, finally, a full inspiration, in order to obtain greater purity of air in his own lungs. when the chest of the child has been thus distended, it is to be compressed gently with the hand, so as to empty the lungs; and then the inflation, with the alternately compressing the chest, must be repeated again and again, until either the commencement of natural respiration is announced by a sneeze or deep sigh, or until after long-continued, steady, persevering, but unavailing, efforts to effect this object shall have removed all ground of hope for a successful issue. whilst these efforts are being made, some other individual must endeavour to maintain or restore the warmth of the infant's body, by gently but constantly pressing and rubbing its limbs between his warm hands. and after respiration is established, the face must still be freely exposed to the air, whilst the warmth of the limbs and body is carefully sustained. it will sometimes happen--and to this circumstance the operator should be fully alive--that when the child begins to manifest symptoms of returning animation, its tongue will be drawn backwards and upwards against the roof of the mouth, filling up the passage to the throat, and preventing further inflation of the lungs. this is to be remedied by the introduction of the fore-finger to the upper and back part of the child's tongue, and gently pressing it downwards and forwards, by which the difficulty will be removed, and the air again passes. the warm bath.--more reliance may be placed upon the above measure to restore animation, than upon the warm bath. still this is sometimes useful, and therefore must not be neglected. whilst inflation is going on, the bath may be got ready, then resorted to, and if unsuccessful, inflation may and ought again to be followed up.[fn# ] if the bath is useful at all, it will be so immediately upon putting the infant into it; respiration will be excited, followed by a cry; and if this does not occur at once, it would be wrong to keep the child longer in the bath, as it would be only losing valuable time which ought to be devoted to other efforts. the temperature of the bath should be about degrees; and if, upon plunging the infant into it, it fortunately excite the respiratory effort, it should then be taken out, rubbed with dry but hot flannels, and, when breathing is fully established, laid in a warm bed, or, what is still better, in its mother's bosom; letting it, however, have plenty of air. [fn# ] we should not relinquish our endeavours at resuscitation under two or three hours, or even longer; and if ultimately successful, the state of the infant should be carefully watched for two or three days. injuries received during birth. if a labour be long and tedious, the head and body of the child may be bruised and disfigured. the shape of the head is frequently altered by the compression it has undergone, so that it may be elongated, and measure from the chin to the back of the head as much as six or seven inches. this always excites surprise, sometimes apprehension, in the minds of the attendants: there is no ground for it. it must be allowed to regain its natural shape without interference. tumours or swellings upon the head are very common. they arise from pressure upon the part during the labour. the only treatment that is required, or safe, is, freedom from all pressure, and the application of cold lotions composed of brandy or vinegar and water. the swelling will gradually subside. it will be right to direct the attention of the medical man to this circumstance. the face may be frightfully disfigured from the above cause, exceedingly black, and the features distorted. nothing is necessary here; in a few days the face will recover its proper appearance. retention of urine. occasionally an infant will not pass any urine for many hours after its birth. this most frequently arises from the fact of none being secreted. in the last case of this kind that i was called to, three days had elapsed since birth, and no urine had been passed; it proved that none had been secreted. sometimes, however, it is the effect of another cause, which the use of the warm bath will be found to remove, which should always therefore be employed four and twenty hours after the birth of the infant, if it has not by that time passed any water. it now and then happens, but fortunately very rarely, that some physical obstruction exists. it is always important, therefore, for the nurse to pay attention to the above point; and it is her duty to direct the attention of the medical man to the subject, if anything unusual or unnatural be present. the same observation applies to the bowel also; and if twelve hours pass without any motion, the parts should be examined. swelling of the breasts. at birth, or two or three days subsequently, the breasts of the infant will frequently be found swollen, hard, and painful, containing a fluid much resembling milk. nurses generally endeavour to squeeze this out, and thus do great mischief; for by this means inflammation is excited in the part, and sometimes abscess is the result. if the breasts are simply slightly enlarged, it is unnecessary to do any thing more than rub them occasionally and very gently with warm almond oil, and a little time will restore them to their proper size. if, however, they are inflamed, hot, painful, with a red surface, and unusually large, a bread and water poultice must be applied every three or four hours, which will generally prevent either the formation of matter, or any other unpleasant consequence. in a few days, under this treatment, they will usually subside, and be quite well. inflammation of the eyes. its importance.--about the second or third day after the child's birth, an inflammation sometimes attacks the eye, which is of considerable consequence. the more so, from its commencing in a way not calculated to excite the attention, or alarm the fears, of the mother or nurse. the child cannot express its sensations, and the swelling of the eye conceals the progress of the disease, so that serious mischief is frequently done before the medical man sees the patient. in the first place, the inflammation is not immediately noticed; and, in the second, the measures employed are frequently insufficient to check its progress: hence it causes more blindness (i refer to the lower classes of society more particularly) than any other inflammatory disorder that happens to the eye; and the number of children is very considerable, whose sight is partially or completely destroyed by it. the parent or nurse is apt to suppose, when this inflammation first appears, that it is merely a cold in the eye, which will go off; and the consequences which i have just mentioned take place, in many cases, before they are aware of the danger, and before the medical man is resorted to for assistance. i only desire, in mentioning this complaint, to inform the attendants of the lying-in-room of its great importance, that it may not be trifled with, that upon its first approach the physician may be informed of it, and that the treatment he directs for its cure may be sedulously and rigidly followed. symptoms.--the inflammation commonly comes on about three days after birth, but it may take place at a later period. it may be known by its commencing thus:--when the child wakes from sleep, the eyelids will be observed to stick together a little; their edges will be redder than natural, and especially at the corners; the child experiences pain from the access of light, and therefore shuts the eye against it. a little white matter will also be observed lying on the inside of the lower lid. after a short time, the lids swell, become red on their external surface, and a large quantity of matter is secreted, and constantly poured from the eye; the quantity of discharge increasing until it becomes very great. but enough has been said to point out the importance of the disease, and the signs by which it may be recognised at its first approach. treatment.--keeping the eye free from discharge, by the constant removal of the matter secreted, is what the medical attendant will chiefly insist upon; and without this is done, any treatment he may adopt will be useless; with it, there is no doubt of a successful issue of the case, provided his attention has only been called to it at a sufficiently early period. hare-lip. this is a blemish too well known to require a formal description. the questions most interesting to a mother in relation to it, are,--how is her child to be nourished, that is born with it? and when ought an operation to be performed for its removal? the mode of feeding the infant.--if the defect is but trifling, the infant will be able to suck, provided the mother's nipple is large, and the milk flows freely from it. if this is not the case, the difficulty may be obviated by using the cork nipple shield.[fn# ] i have known this to answer the purpose admirably, when the mother had previously despaired of nursing her infant, the nipple being too small for it to grasp. [fn# ] see p. . if, however, the defect exists in a still greater degree, feeding by means of the spoon must be resorted to; the greatest care being necessary as to the quantity, quality, and preparation of the food.[fn# ] [fn# ] see "artificial feeding," p. . caution in reference to the operation.--with regard to the operation for the removal of this deformity, i would strongly warn parents against desiring its too early performance. various considerations contribute to make the distressed parents anxious for this. but very seldom indeed--except the deformity be very great, and implicating other parts beside the lip--will the operation be required, or ought it to be resorted to, before the second year and a half of the infant's life; and for this very cogent reasons exist. for instance, convulsions may thus be induced, which often terminate fatally. the most proper age for removing this deformity by operation, is from that of two years and a half to four years. bleeding from the navel-string. bleeding from the navel-string will sometime take place hours after it has been supposed to be carefully secured. this will arise, either from the cord being carelessly tied, or from its being unusually large at birth, and in a few hours shrinking so much that the ligature no longer sufficiently presses on the vessels. in either case, it is of importance that the attendants in the lying-in-room should understand how to manage this accident when it occurs, that it may not prove injurious or fatal to the child. the mode of arresting the bleeding.--the clothes of the child and the flannel roller must be taken off;--the whole cord without delay must be unwrapped, and then a second ligature be applied below the original one, (viz. nearer to the body of the infant,) taking great care that it shall not cut through the cord when drawn very tight, but at the same time drawing it sufficiently tight to compress the vessels. the ligature should be composed of fine linen threads, three or four thicknesses, and not of tape or bobbin, or any substance of this nature, as it cannot be relied on for this purpose. ulceration or imperfect healing of the navel. the cord separates from the navel generally some time between the fifth and fifteenth day from delivery, and the part usually heals without giving the slightest trouble. this, however, is not always the case, for sometimes a thin discharge will take place, which, if the part be examined, will be found to proceed from a small growth about the size, perhaps, of a pea, or even less. this must be removed by applying a little powdered alum,--or, if this fail, it should be once or twice slightly touched with blue-stone, and afterwards dressed with calamine cerate. at other times, though fortunately very rarely, excoriation of the navel and the parts around takes place, which quickly spreads, and assumes an angry and threatening character. if, however, the attention of the medical man is called to it early, it will always do well: until his directions are given, apply a nicely made bread and water poultice. bleeding from the navel. sometimes, a day or two after the cord separates, or at the time of separation, bleeding takes place from the navel: fortunately, this very seldom occurs; indeed, it is very rarely met with; and i only mention it, to observe that, upon its occurrence, the point of the finger should be placed over the part, and pressure steadily applied until medical assistance is obtained. now and then, in these cases, a growth sprouts up and bleeds. let this be touched with lunar caustic, or any other astringent application, or let pressure be employed, still it will bleed,--not freely or in a stream, but there will be a constant drain from the part, and the infant, as a consequence, will waste, and be brought to death's door. excise it, it will only make matters worse. the treatment in this case consists in simply winding a piece of very narrow tape round the growth, and then leaving it untouched. the bleeding will soon cease; the fungus will sprout over the upper margin of the tape; in a very short time it will, as it were, strangle the disease, which subsequently falling off, a complete cure is accomplished. jaundice. it frequently happens, during the first or second week after birth, that the skin of the child becomes very yellow, and it has all the appearance of having the jaundice. this gives rise to great distress to the parent when she perceives it, and she becomes very anxious for the medical man's next visit. now, ordinarily, it is of no consequence; commonly disappearing spontaneously, and requiring no medical treatment. if, however, it does not go off in two or three days, a tea-spoonful of castor oil should be given once, or oftener, if necessary. it is, of course, possible for an attack of real jaundice to occur at this early period, and a disease of a very serious nature will then have to be dealt with; but, except as a consequence of malformation (a very infrequent occurrence), it is not likely to arise; and therefore jaundice during the first and second week after delivery need not create alarm. tongue-tied. from what it arises.--this arises from the bridle under the tongue being so short, or its attachment to the tongue extended so near the tip, as to interfere with the motions of the organ in sucking, and, in after years, in speaking. it is a rare occurrence, although nothing is more common than for medical men to have infants brought to them supposed to be labouring under the above defect. how its existence may be determined.--the best guide for a parent to determine whether it exist or not, is for her to watch whether the infant can protrude the tip of the tongue beyond the lips: if so, it will be able to suck a good nipple readily, and nothing need or ought to be done. no mother will unnecessarily expose her infant to an operation, which, unless very carefully performed, is not altogether unattended with danger; and, if she suspects any defect of this kind to exist, she has only to observe the circumstance mentioned above, to satisfy her mind upon the subject. moles and marks on the skin, etc. the supposed influence of the imagination of the mother, in the production of the above appearances in the texture of the skin of her infant, has been fully discussed in the author's work "hints to mothers, etc." this part of the subject is, however, foreign to the present inquiry, which chiefly has reference to the probable effect of their presence upon the health of the child. they may be divided into two classes: the brownish mole, and claret- stain; and small but somewhat elevated tumours, either of a dark blue, livid colour, or of a bright vermilion hue. moles and stains.--they are of no importance, as far as the health of the infant is concerned. if situated in the face, however, they frequently cause great disfigurement, as the claret-stain, which may be seen sometimes to occupy nearly half the face. but they happily do not increase in size, remaining stationary through life; and as any operation that might be proposed for their removal, would only cause an equal, if not greater, deformity, they ought to be left alone. coloured spots or tumours.--these vary in their number, size, and situation. the same child is sometimes born with many of them. they may be as small as a pea, or as large as a crown piece. they are not only found on the skin, but on the lips, in the mouth, etc. etc. these, also, sometimes remain stationary in their size, having no tendency to enlarge, unless, indeed, they are subjected to friction or pressure. but as they frequently require surgical aid, in which case, the earlier the application of remedial measures, the less severe in their kind, and the greater the probability of a speedy and successful result,--so is it always important for the mother early to obtain a medical opinion, that the measure of interference or non-interference may be decided. sect. ii. disorders of the stomach and bowels of the infant. indigestion, flatulence, vomiting, griping, and looseness. disorder of the stomach and bowels is one of the most fruitful sources of the diseases of infancy. only prevent their derangement, and, all things being equal, the infant will be healthy and flourish, and need not the aid of physic or physicians. experience daily proves, that a large proportion of the children who die in infancy are lost from derangement of these organs, as the primary cause. there are many causes which may give rise to these affections; many of them appertain to the mother's system, some to that of the infant. all are capable, to a great extent, of being prevented or remedied. it is, therefore, most important that a mother should not be ignorant or misinformed upon this subject. it is the prevention of these affections, however, that will be principally dwelt upon in this chapter; for let the mother ever bear in mind, and act upon the principle, that the prevention of disease alone belongs to her; the cure to the physician. for the sake of clearness and reference, these disorders will be spoken of as they occur:-- to the infant at the breast. at the period of weaning. and to the infant brought up by hand. . to the infant at the breast. unhealthy milk.--the infant's stomach and bowels may become deranged from the breast-milk becoming unwholesome. this may arise from the parent getting out of health, a circumstance which will be so manifest to herself, and to those more immediately interested in her welfare, that it is only necessary just to allude to it here. suffice it to say, that there are many causes of a general kind to which it may owe its origin; but that the most frequent is undue lactation, a subject to which reference has already been made, and the effects both upon mother and child fully dwelt upon.[fn# ] to cure derangement of the bowels from this cause, a wet-nurse is the only remedy. [fn# ] see page . anxiety of mind in the mother will cause her milk to be unhealthy in its character, and deficient in quantity, giving rise to flatulence, griping, and sometimes even convulsions in the infant.[fn# ] a fit of passion in the nurse will frequently be followed by a fit of bowel complain in the child.[fn# ] these causes of course are temporary, and when removed the milk becomes a healthy and sufficient for the child as before. [fn# ] see page . [fn# ] see page . sudden and great mental disturbance, however, will occasionally drive away the milk altogether, and in a few hours. a mrs. s., aet. , a fine healthy woman, of a blonde complexion, was confined of a boy in october, . she had a good time, and a plentiful supply of milk for the child, which she continued to suckle till the following january, a period of three months, when her milk suddenly disappeared. this circumstance puzzled the medical attendant, for he could not trace it to any physical ailment; but the milk never returned, and a wet-nurse became necessary. in the following spring the husband of this lady failed, an adversity which had been impending since the date when the breast-milk disappeared, upon which day the deranged state of the husband's affairs was made known to the wife,--a fact which at once explained the mysterious disappearance of the milk. unwholesome articles of diet will affect the mother's milk, and derange the infant's bowels. on the th may, , i was called to see an infant at the breast with diarrhoea. the remedial measures had but little effect so long as the infant was allowed the breast-milk; but this being discontinued, and arrow-root made with water only allowed, the complaint was quickly put a stop to. believing that the mother's milk was impaired from some accidental cause which might now be passed, the infant was again allowed the breast. in less than four-and-twenty hours, however, the diarrhoea returned. the mother being a very healthy woman, it was suspected that some unwholesome article in her diet might be the cause. the regimen was accordingly carefully inquired into, when it appeared that porter from a neighbouring publican's had been substituted for their own for some little time past. this proved to be bad, throwing down, when left to stand a few hours, a considerable sediment; it was discontinued; good sound ale taken instead; the infant again put to the breast, upon the milk of which it flourished, and never had another attack. in the same way aperient medicine, taken by the mother, will act on the child's bowels, through the effect which it produces upon her milk. this, however, is not the case with all kinds of purgative medicine, nor does the same purgative produce a like effect upon all children. it is well, therefore, for a parent to notice what aperient acts thus through her system upon that of her child, and what does not, and when an aperient becomes necessary for herself, unless she desire that the infant's bowels be moved, to avoid the latter; if otherwise, she may take the former with good effect. again; the return of the monthly periods whilst the mother is a nurse always affects the properties of the milk, more or less, deranging the stomach and bowels of the infant. it will thus frequently happen, that a few days before the mother is going to be unwell, the infant will become fretful and uneasy; its stomach will throw up the milk, and its motions will be frequent, watery, and greenish. and then, when the period is fully over, the milk will cease to purge. it is principally in the early months, however, that the infant seems to be affected by this circumstance; for it will be generally found that although the milk is certainly impaired by it, being less abundant and nutritious, still, after the third or fourth month it ceases to affect the infant. is then a mother, because her monthly periods return after her delivery, to give up nursing? certainly not, unless the infant's health is seriously affected by it; for she will generally find that, as the periods come round, by keeping the infant pretty much from the breast, during its continuance, and feeding him upon artificial food, she will prevent disorder of the child's health, and be able in the intervals to nurse her infant with advantage. it must be added, however, that a wet- nurse is to be resorted to rather than any risk incurred of injuring the child's health; and that, in every case, partial feeding will be necessary at a much earlier period than when a mother is not thus affected. the milk may also be rendered less nutritive, and diminished in quantity, by the mother again becoming pregnant. in this case, however, the parent's health will chiefly suffer, if she persevere in nursing; this, however, will again act prejudicially to the child. it will be wise, therefore, if pregnancy should occur, and the milk disagree with the infant, to resign the duties of a nurse, and to put the child upon a suitable artificial diet;--if, however, pregnancy should take place before the infant is six month's old, a wet-nurse ought to be procured. from irregular nursing.--this is one of the most frequent sources of derangement of the stomach and bowels of the child. the infant that is constantly at the breast will always be suffering, more or less, from flatulence, griping, looseness of the bowels, and vomiting. this is caused by a sufficient interval not being allowed between the meals for digestion. the milk, therefore, passes on from the stomach into the bowels undigested, and the effects just alluded to follow. time must not only be given for the proper digestion of the milk, but the stomach itself must be allowed a season of repose. this evil, then, must be avoided most carefully by the mother strictly adhering to those rules for nursing which have been already laid down.[fn# ] [fn# ] see page . from teething.--the bowels of the infant at the breast, as well as after it is weaned, are generally affected by teething. and it is fortunate that this is the case, for it prevents more serious affections. indeed, the diarrhoea that occurs during dentition, except it be violent, must not be subdued; if, however, this is the case, attention must be paid to it. it will generally be found to be accompanied by a swollen gum; the freely lancing of which will sometimes alone put a stop to the looseness: further medical aid may, however, be necessary. from cold and damp, etc.--of course there are other causes besides these already alluded to, giving rise to bowel complaints, during this epoch,--causes not cognisable by the mother, however, and not mentioned therefore here. it is right, however, that she should be aware that these affections are sometimes the result simply of impressions of cold or damp, particularly at certain seasons of the year; in the autumn, for instance, when, as is well known, bowel complaints are very frequent. when thus produced, it is important early to seek medical aid, as inflammation is generally the result. . at the period of weaning. there is great susceptibility to derangements of the stomach and bowels of the child at the period when weaning ordinarily takes place, so that great care and judgment must be exercised in effecting this object. usually, however, the bowels are deranged during this process from one of these causes; from weaning too early, from effecting it too suddenly and abruptly, or from over-feeding and the use of improper and unsuitable food. there is another cause which also may give rise to diarrhoea at this time, independently of weaning, viz. the irritation of difficult teething. weaning too early.--the substitution of artificial food for the breast- milk of the mother, at a period when the digestive organs of the infant are too delicate for this change, is a frequent source of the affections now under consideration. the attempt to wean a delicate child, for instance, when only six months old, will inevitably be followed by disorder of the stomach and bowels. unless, therefore, a mother is obliged to resort to this measure, from becoming pregnant, or any other unavoidable cause, if she consult the welfare of her child, she will not give up nursing at this early period. but if she should be no longer competent to suckle, and her infant be delicate, a wet-nurse must be obtained; for, the infant's bowels becoming disordered, medicine or remedies will avail little without healthy breast milk. the age at which weaning ought to take place must ever depend upon circumstances; the ninth month would not be too early for some, the twelfth would be for others.[fn# ] [fn# ] see page . for sudden and abrupt alteration of diet.--depriving the child at once of the breast, and substituting artificial food, however proper under due regulations such food may be, will invariably cause bowel complaints. certain rules and regulations must be adopted to effect weaning safely, the details of which are given elsewhere.[fn# ] [fn# ] see page . overfeeding, and the use of improper and unwholesome food.--these causes are more productive of disorder of the stomach and bowels at the time of weaning than any yet referred to. if too large a quantity of food is given at each meal, or the meals are too frequently repeated, in both instances the stomach will become oppressed, wearied, and deranged; part of the food, perhaps, thrown up by vomiting, whilst the remainder, not having undergone the digestive process, will pass on into the bowels, irritate its delicate lining membrane, and produce flatulence, with griping, purging, and perhaps convulsions. then, again, improper and unsuitable food will be followed by precisely the same effects; and unless a judicious alteration be quickly made, remedies will not only have no influence over the disease, but the cause being continued, the disease will become most seriously aggravated. it is, therefore, of the first importance to the well-doing of the child, that at this period, when the mother is about to substitute an artificial food for that of her own breast, she should first ascertain what kind of food suits the child best, and then the precise quantity which nature demands. many cases might be cited, where children have never had a prescription written for them, simply because, these points having been attended to, their diet has been managed with judgment and care; whilst, on the other hand, others might be referred to, whose life has been hazarded, and all but lost, simply from injudicious dietetic management. over-feeding, and improper articles of food, are more frequently productive, in their result, of anxious hours and distressing scenes to the parent, and of danger and loss of life to the child, than almost any other causes. teething.--the irritation caused by difficult teething may give rise to diarrhoea at the period when the infant is weaned, independently of the weaning itself. such disorder of the bowels, if it manifestly occur from this cause, is a favourable circumstance, and should not be interfered with, unless indeed the attack be severe and aggravated, when medical aid becomes necessary. slight diarrhoea then, during weaning, when it is fairly traceable to the cutting of a tooth (the heated and inflamed state of the gum will at once point to this as the source of the derangement), is of no consequence, but it must not be mistaken for disorder arising from other causes. lancing the gum will at once, then, remove the cause, and generally cure the bowel complaint. . to the child brought up by hand. children brought up on an artificial diet are very liable to indigestion and bowel complaints; indeed none more so: and it is from these affections that so many of these infants perish. when, then, it is absolutely necessary from untoward circumstances to have recourse to this mode of nourishing the child, the rules and regulations laid down in the section on "artificial feeding" must be most strictly followed out, if the parent would hope to avoid disease and rear her child.[fn# ] and if these affections should at any time unfortunately manifest themselves, the mother ought carefully and diligently to examine whether the plan of feeding pursued is in every particular correct, particularly bearing in mind that the two causes most frequently productive of disorder in the child are overfeeding and the exhibition of unsuitable food--the two grand errors of the nursery. these results, however, have already been sufficiently dwelt upon as likely to take place at weaning, and they may of course occur to a child who is brought up on an artificial diet at any period. [fn# ] see page . maternal treatment of the disorders of the stomach and bowels. as must have been already seen, the maternal treatment chiefly consists in the removal of the cause of the disorder; medicine may occasionally be exhibited by the mother, but its use in her hands must be very limited indeed. unfortunately the general resource and only remedy of most mothers in affections of the stomach and bowels is an aperient, and a combination containing calomel is the one too frequently selected. the primary cause of the disorder is undetected, and consequently no measures taken for its removal, but purgative powder after purgative powder is given, the evil being supposed to rest in the bowels alone, and that such means must eventually get rid of it. the mother is not aware all this time that the real source of the derangement is probably in the diet itself; that there is some error here, and that unless this is corrected, the remedies must be worse than useless. the consequence of such a plan of proceeding is usually very sad; a confirmed and obstinate diarrhoea but too commonly ensues, and the infant is sometimes reduced to the last extremity. the removal of the cause of the disorder, then, in a large number of instances of derangement of the stomach and bowels, if effected early, will cure the disease, and without further remedy. but it will be asked, by what method is this cause to be detected? in this way. in all human probability the primary cause of the disorder is connected with the diet; this is the case in ninety-nine instances out of a hundred. well, then, is the sick child at the breast? if so, ascertain whether the breast-milk is healthy and wholesome, or whether any circumstances exist which have rendered it otherwise? if nothing faulty is found here, the next question would naturally be, whether the rules and regulations laid down for suckling have been strictly adhered to? or, whether the infant is sufficiently old to render it at all probable that a tooth may be irritating the gum? perhaps the child is being weaned; well, is there any error here? is the change being attempted too early? or too suddenly and abruptly? if this is not the case, then, has the child been overfed, or is the food given of the proper description? is the child being brought up by hand? then, there is every reason to suspect, either that the quality of the food given is not the most suitable, or, that the quantity exhibited is too great; in fact, that the rules laid down for "artificial feeding" have not been strictly acted upon. by a mode of investigation like this, any defect or error in the dietetic management of the infant producing the disorder will be easily detected by a careful mother; and its correction alone will, in very many instances, be all that is necessary to remove the symptoms. for example, if flatulence and griping, followed by diarrhoea, occur to an infant at the breast; if at the same time it becomes pale, its flesh flabby, its disposition fretful, always crying until it is put to the breast, the nipple of which it grasps eagerly, sucking eagerly, yet never satisfied, for its hunger continues, it is not nourished; if, too, the more it sucks, the more the stomach and bowels are deranged, the more it vomits and is purged; depend upon it the cause of all the evil will be found to be unwholesome milk. no medicine will avail any thing here; the cause must be removed; the best medicine, and the only remedy, is a breast of healthy milk. and if this is not procured early, there will be great danger of a diarrhoea setting in, which may probably prove fatal to the child. again; if there is simply vomiting of the breast-milk almost immediately after the child has been suckled, the milk coming up pure and unchanged, and discharged without any apparent effort, and the moment after the child is cheerful and happy, this will be found to depend upon repletion, and not upon unwholesome milk; in fact, the stomach has received too much. this must be prevented in future, not by giving medicine, but simply by removing the infant from the nipple immediately it ceases to draw strongly, the moment it begins to dally with the breast. again; if flatulence and griping occur to the child brought up by handy this derangement will generally be found to result from overfeeding: abstinence and diminution of the quantity of the food will generally be all that is necessary here. it will be well, however, for the mother in this case, and she may do it with the utmost safety, to unload the bowels of their indigestible contents by the exhibition of a tea-spoonful of castor oil. a dose or two of this medicine will effectually clear them out, without increasing the irritation, or weakening the child, whilst it will in most instances altogether remove the symptoms. if the flatulence, however, should continue, four or five grains of magnesia may be mixed with the last meal at night, and a little warm water thrown up into the bowel as an injection the next morning. diarrhoea occurring in a child brought up by hand, if it be not the result of overfeeding, will very frequently be found to arise from unsuitable diet, the food given not being of a kind suited to the infant's stomach; for what will agree with one child often disagrees with another. alteration of diet will sometimes alone suffice in these cases to cure, if this alteration is only made early enough, before any considerable irritation of the stomach and bowels has been induced. thin arrow-root made with water (prepared very carefully, or the child will refuse it,) should be given for five or six days; the warm bath used every night for the same period, a new flannel bandage rolled round the body, and the child cautiously protected from a damp atmosphere. the arrow-root, upon the cessation of the diarrhoea, may have cows' milk added to it, if milk is not found to disagree: when this is the case, chicken or weak mutton broth, free from fat, or beef- tea, thickened with farinaceous food, with a little salt added, are the best substitutes. should not the diarrhoea yield to the foregoing measures, and that readily, medical aid ought to be sought. diarrhoea is very frequent from the time of weaning to the third year of age, and certainly in its effects forms so important a disease, that, unless in the slight form noticed above, a mother is not justified in attempting its relief. in conclusion, i would observe, that i do not think a mother justified in attempting more than what has been laid down here for her guidance. it is believed that the few and plain common-sense directions given, if followed, will do much to prevent disease, and even to relieve it in its milder forms; they will not, however, cure disease itself when really established: and again i would repeat, let the mother recollect that to prevent disease is her province--to cure it, is the physician's. sect. iii.--costiveness. . in infancy. the principle to act upon in the management of the infant's bowels is this,--that they should be kept free, and by the mildest and least irritating means. if therefore they become accidentally confined (less than two stools in the four-and-twenty hours), and the infant is suckled, the mother may ascertain whether an aperient taken by herself will render her milk of a sufficiently purgative quality to act upon the bowels of her child. this is the mildest mode of all. if, however, this does not answer, or is not practicable from the child being fed artificially, then the mildest aperient medicines must be chosen to accomplish this purpose. the kind of medicine to be selected, and the doses in which to be adminstered, will be found in the section on "aperient medicine."[fn# ] [fn# ] see page . if, however, the bowels of the infant are disposed to be habitually confined, it should be ascertained whether this may not be dependent upon its diet. the same food that agrees perfectly well with one child will frequently cause costiveness in another. an intelligent and observing mother will soon discover whether this is the source of the mischief, or not. boiled milk, for instance, will invariably cause confined bowels in some children; the same result will follow sago boiled in beef tea, with others; whilst, on the other hand, the bowels may frequently be brought into regular order, and their confined state overcome, by changing the food to leman's tops and bottoms steeped in hot water, and a small quantity of unboiled milk added; or prepared barley, mixed in warm water and unboiled milk, will have the same effect. sometimes children are constitutionally costive, that is, the bowels are relieved every third or fourth day, not oftener, and yet perfect health is enjoyed. this occasionally will happen in large families, all the children, though perfectly healthy and robust, being similarly affected. when such is found by a mother to be really the habit of her child, it would be very unwise, because injurious to its health, to attempt by purgatives to obtain more frequent relief. at the same time it will be prudent and necessary for her to watch that the regular time is not exceeded. this condition seldom occurs to the very young infant. . in childhood. children of sound health, who are judiciously fed, and have sufficient exercise, very seldom need aperient medicine. errors in diet, a want of proper attention to the state of the skin, insufficiency of air and exercise, in fine, a neglect of those general principles which have been laid down for the management of health, and upon the observance of which the due and healthy performance of every function of the body depends, are the sources of bowel derangements, and particularly, at this age, of costiveness. i feel assured, however, that some children are more troubled with costiveness than others, from the simple but important circumstance of their not being early taught the habit of relieving the bowels daily, and at a certain hour. there is a natural tendency to this periodical relief of the system, and it exists at the earliest age. and if the mother only cause this habit to be fairly established in infancy, she will do much towards promoting regularity of her child's bowels throughout life. the recollection of this fact, and the mother's acting upon it, is of the greatest importance to the future health and comfort of her children. if the bowels are accidentally confined at this age, castor oil is certainly the best aperient that can be given: it acts mildly but efficiently, clearing out the bowels without irritating them. the dose must be regulated by the age, as also by the effect that aperients generally have upon the individual. great care must in future be taken to avoid the cause or accidental circumstance which produced the irregularity. when the bowels are habitually costive, much care and judgment is necessary for their relief and future management. fortunately this condition is very rare in youth. the activity and exposure to the air, usual at this period of life, render purgatives unnecessary, unless, indeed (as just mentioned), some error in diet, or some unusual circumstance, render them accidentally confined. should, however, the foregoing state exist, medicine alone will avail little; there are certain general measures which must also be acted up to, and most strictly, if the end is to be accomplished. they consist, principally, in an observance of great regularity with respect to the time of taking food, its quality, quantity, and due mastication; regular and sufficient exercise, horse exercise being particularly serviceable; the shower-bath, or daily ablution; early rising (the indulgence in the habit of lying in bed always predisposing to constipation); and, lastly, the patient habituating himself to evacuate the bowels at a certain hour of the day. after breakfast appears to be the time when the bowels are more disposed to act than at any other part of the day; this is the time, then, that should be chosen. all these points must be sedulously observed, and upon the principles laid down in the various chapters upon these subjects, if habitual costiveness is expected to be overcome. sect. iv.--worms. not so frequent as popularly supposed; an error productive of mischief.--almost all diseases have been, at one time or other, attributed to the generation of worms in the intestines. and at the present day it is not at all an uncommon occurrence for medical men to be called in to prescribe for children, to whom the strongest purgative quack medicines have been previously exhibited by parents, for the removal of symptoms which, upon investigation, are found in no way connected with or produced by worms. the results of such errors are always, more or less, mischievous, and sometimes of so serious a nature as to lay the foundation of disease which ultimately proves fatal. this observation, moreover, it behoves a mother carefully to regard, since the symptoms, popularly supposed to indicate the existence of worms, are so deceptive, (and none more so than that which is usually so much depended upon--the picking of the nose,) that it may be positively asserted to be impossible for an unprofessional person to form a correct and sound opinion in any of these cases. it was at one time imagined, and the idea is still popularly current, that worms were the occasion of a troublesome and lingering species of fever, which was therefore designated worm-fever. this notion is now entirely exploded; for if worms be present under such circumstances, it is a mere accidental complication; the fever referred to being generally of a remitting character, and neither caused by or causing the generation of worms. the symptoms of this fever, however, have led and continue to lead very many astray. this is not surprising, since they so closely resemble those which characterise the presence of worms, that an unprofessional person is almost sure to be misled by them. amongst other symptoms, there is the picking of the nose and lips, offensive breath, occasional vomiting, deranged bowels, pain in the head and belly, with a tumid and swollen condition of the latter, a short dry cough, wasting of the flesh, etc.; symptoms continually attendant upon the disorder now under consideration. these cases have hitherto been perpetually looked upon by mothers as worm-cases, and after having been treated by them as such, by the use of the popular worm-powders of the day, have, as perpetually, presented themselves to the physician greatly and grievously aggravated by such injudicious treatment. it is folly, at any time, for an unprofessional person to prescribe for a case where worms are actually known to exist: surely where there is any doubt upon the latter point it must be greater folly still. the infant at the breast is seldom, if ever, the subject of this disorder, whilst an artificial diet, or bringing up by hand, predisposes to it. worms most frequently occur, however, during childhood; much more so at this epoch than in adult age. they do not invariably occasion indisposition, for they are now and then passed without pain or distress by children who are in the enjoyment of perfect health, and in whom previously there was not the slightest suspicion of their existence. the idea, formerly so prevalent, of their being attended with danger, is without foundation; for unless the case be mismanaged, they rarely give rise to serious consequences. how produced, and how best prevented.--the causes of worms it is not very easy to explain; at the same time it is very certain that some known circumstances favour their production. if the general health of a child be enfeebled, particularly if the child be strumous, such a condition will favour the generation of these animals. the protracted use of unwholesome and innutritious articles of food, or a deficient supply of salt (the most necessary stimulant to the digestive organs), or other condiments, predisposes to worms. this observation is strikingly illustrated by an occurrence which formerly took place in holland, where an ancient law existed forbidding salt in the bread of certain criminals; they were in consequence horribly infested with worms, and quickly died. sugar, too, whilst a necessary condiment for the food of children, if given in the form of sweetmeats, and their indulgence, long persisted in, may so enfeeble the organs of digestion as to cause worms. and, lastly, (though many other causes might be referred to) the injudicious means occasionally employed to effect the removal of these animals, by the debility produced in the intestinal canal, favours not only their re-appearance but their increase. these, then, are so many causes which may occasion worms in the child, and of course the best and most effectual method to prevent their production is their avoidance. a mother, therefore, should at all times be careful in the regulation of the diet and general management of her child's habits and health, even if no stronger obligations existed than the dread of this disorder; and she must be more than ordinarily vigilant on this head, when the slightest disposition to such disorder is manifested. again; she must not forget that the symptoms so commonly ascribed as characteristic of worms are much more frequently caused by other diseases; that at no time, therefore, is she justified in giving worm powders, or strong doses of medicine for such symptoms; for if they do exist, their use is always attended with risk, and if they do not, the debility which they occasion in the stomach and bowels may itself become the source of their production. sect. v. scarlet fever. there are several varieties of this disease; it will be more perspicuous, however, for our purpose to speak of it under the two following forms:-- mild scarlet fever; scarlet fever, with sore throat. mild scarlet fever.--in this form of the disease there is only the rash with fever. symptoms.--the anticipating symptoms are those of fever: they precede the eruption. the degree of fever, however, is variable; for the symptoms are sometimes so moderate as scarcely to attract attention, slight and irregular shivering, nausea, perhaps vomiting, thirst, and heat of skin; whilst, at others, there is considerable constitutional disturbance, indicated by pungent heat of skin, flushing of the face, suffusion of the eyes, pain in the head, great anxiety and restlessness, and occasionally slight delirium. these symptoms are followed on the second day (in the majority of instances) by the rash. this first appears in numerous specks or minute patches of a vivid red colour on the face, neck, and chest. in about four-and-twenty hours it becomes gradually diffused over the whole trunk. on the following day (the third) it extends to the upper and lower extremities, so that at this period the whole surface of the body is of a bright red colour, hot and dry. the efflorescence, too, is not always confined to the skin, but occasionally tinges the inside of the lips, cheeks, palate, throat, nostrils, and even the internal surface of the eyelids. sometimes the efflorescence is continuous and universal; but more generally on the trunk of the body there are intervals of a natural hue between the patches, with papulous dots scattered over them, the colour being most deep on the loins and neighbouring parts, at the flexure of the joints, and upon those parts of the body which are subjected to pressure. it is also generally most vivid in the evening, gradually becoming paler towards morning. the eruption is at its height on the fourth day;--it begins to decline on the fifth, when the interstices widen, and the florid hue fades;--on the sixth, the rash is very indistinct; and on the eighth day it is wholly gone. the various symptoms with which the eruption is accompanied, gradually disappear with the efflorescence; but the tongue still remains morbidly red and clean. the peeling off of the cuticle (the outer layer of the skin), which begins about the end of the fifth day on the parts on which the eruption first appeared, proceeds; so that about the eighth or ninth, portions of the cuticle are thrown off, the thickest and largest being those detached from the skin of the hands and feet. scarlet fever, with sore throat.--in this form of the disease, the fever and rash are accompanied with inflammation of the throat. symptoms.--the symptoms are more severe than in the mild form of this disease, and, in the majority of instances, the inflammation of the throat appears with the eruption, and goes through its progress of increase and decline with the cutaneous eruption. sometimes, however, it precedes the fever; whilst at others it does not appear until the rash is at its height. it is generally in the course of the second day that the child complains of considerable stiffness in the muscles of the neck, extending to the lower jaw, and under the ears;--of a roughness of the throat, and difficulty in swallowing;--and some degree of hoarseness will be noticed: all so many indications that the throat is affected. very shortly, an increased secretion of the mucus of these parts occurs, and, collecting about the tonsils, aggravates the child's sufferings, from the frequent and ineffectual efforts made to expel it. if the inflammatory action be more severe, exudations of lymph will also be poured out, and intermingling with the mucus, greatly augment the difficulty of swallowing. at this time the lining membrane of the mouth, as also the tongue, assume a florid red colour; the red points of the latter becoming much elongated. the febrile symptoms are severe from the first; amongst others, there will be headach, sometimes accompanied by slight delirium, nausea, intense heat of skin, languor, and considerable inquietude and anxiety: and as the inflammation approaches its height, the fever increases, the pulse rises, the breathing becomes oppressed, the skin becomes more pungently hot and dry, and the thirst urgent. all these symptoms being increased towards evening, when the febrile restlessness is often succeeded by delirium. the rash is seldom perceptible before the third day, and then comes out in irregular patches on various parts of the body, particularly about the elbows and wrists; thus differing as to the time and mode of its appearance, from the mild form of the disease. it frequently recedes, or entirely vanishes, the day after it first comes out, and then reappears partially, and at uncertain times. this generally protracts the duration of the disorder, without, however, producing any perceptible change in the other symptoms. on the fifth or sixth day of the disease, the fever and inflammation of the throat begin to abate; at the same time the rash declines, and the peeling off of the cuticle soon follows. this is the ordinary course of scarlet fever with sore throat; but in many cases the symptoms run still higher, and the disease is alarmingly dangerous from its commencement. in some instances, there is an acrid discharge from the nostrils or ears, often accompanied with deafness; as also enlargements of the glands in the neck, followed by the formation of abscesses in their immediate neighbourhood. it is unnecessary, however, to follow out the symptoms of scarlet fever more fully; as all that has been attempted here, has been so to sketch out the more prominent symptoms of this disease, that the directions upon the parental management may be readily comprehended: they will be very brief, but a strict attention thereto will be found all-important to the well-doing and comfort of the child. character of scarlet fever compared with that of measles.--it will be seldom difficult to distinguish this disease from other acute eruptive disorders. the one to which it bears the greatest resemblance is the measles; but from this it is readily distinguished by the absence of the cough, the inflamed and watery eye, running at the nose and sneezing, which are the predominant symptoms in the early stage of the measles; but which do not usually attend on scarlet fever--at least, in any high degree. in measles, also, there is an absence of that restlessness, anxiety, and depression of spirits, by which scarlet fever is peculiarly distinguished.--the rash, too, in measles, does not appear till two or three days later than that of scarlet fever. it also differs in its characters. in scarlet fever, the eruption consists of innumerable minute dots or points, diffused in patches with uneven edges of various sizes and forms; and gives to those portions of the skin on which it appears, a diffused bright red colour. in measles, the rash comes out in irregular semi-lunar or crescentic shaped patches, distinctly elevated; the spots being of a deeper red in the centre than in the circumference, and leaving intervening spaces in which the skin retains its natural pale colour. maternal management.--the chief points to which the parent's attention must be directed, irrespective of a strict attention to the more immediate medical treatment directed by the physician, are the following:-- ventilation of the bed-room.--even in the mildest cases, the child must be kept in bed from the first accession of the fever. he must not be loaded, however, as was formerly the practice, with a quantity of bed-clothes, in order to encourage the fever and increase the quantity of eruption. a moderate quantity of clothing is all that is required, adapted to the heat of skin and feelings of the patient. the bed-room must be kept cool and well ventilated. this is of importance in the mildest cases; but in the more severe forms of this disease, in which the throat is much affected, the constant and free admission of pure air will have a most decided and marked good effect upon the symptoms. the air should be renewed, therefore, from time to time. the linen, both of the bed and the patient, should also be frequently changed daily,--if practicable. however mild the symptoms of this disease may be at the commencement, the child must always be carefully and vigilantly watched by the parent, as inflammation of some internal organ may suddenly arise (which is generally indicated by symptoms sufficiently obvious), and thus change an apparently mild form of this disease into one of an alarming character. cold sponging.--whenever the skin is pungently hot and dry, the whole surface of the body should be sponged with cold water, or with vinegar and water. the heat is by this means rapidly abstracted, and the child refreshed; and this may again and again be resorted to, as the heat again returns. by this application alone, "the pulse has been diminished in frequency, the thirst has abated, the tongue has become moist, a general free per spiration has broken forth, the skin has become soft and cool, and the eyes have brightened; and these indications of relief have been speedily followed by a calm and refreshing sleep. in all these respects, the condition of the patient presented a complete contrast to that which preceded the cold washing; and his languor was exchanged for a considerable share of vigour. the morbid heat, it is true, when thus removed, is liable to return, and with it the distressing symptoms; but a repetition of the remedy is followed by the same beneficial effects as at first."[fn# ] [fn# ] bateman's practical synopsis of cutaneous diseases. gargles and the inhalation of warm water.--when the throat is affected, gargles are sometimes ordered; but the pain and inconvenience which their employment gives rise to, frequently precludes their use: and children seldom understand how to employ them, even if the state of the throat permitted it. under these circumstances, the inhalation of the steam of hot water, or hot vinegar and water, may be substituted, and with decided benefit. mudge's inhaler is a good contrivance to effect this. when the throat is found by the mother to be early affected, an immediate application to the medical adviser is especially important. for, if he be called upon to treat this form of scarlet fever at its very commencement, by judicious treatment, the duration and violence of the disease may be both shortened and greatly mitigated. regimen.--cooling drinks, as plain water, toast and water, barley water flavoured with lemon peel, fresh whey, lemonade, and thin gruel, may all be resorted to in their turn. the child may also be allowed oranges, grapes, or lemons sweetened with sugar, particularly when the mouth is foul and dry; but care must be taken that neither the pulp nor the stones are swallowed. these will both refresh and feed the patient as much as is necessary until the decline of the disease. the parent must strictly forbid the attendants in the sick chamber giving, at this period, any heating or stimulating fluid, as also animal food; and this injunction must be strictly regarded, even in the mildest form of the disease. when the child is convalescent, mild nourishment will be required, such as arrow-root, tapioca, chicken or mutton broth, beef tea, jellies, and roasted apples; and by and by a mutton chop. wine is seldom necessary, except under circumstances of unusual debility after a protracted illness, when its moderate use tends much to assist the convalescence; but, if given unadvisedly, there will be great hazard of exciting internal inflammatory disease. relapses are sometimes caused by the child getting about too soon, and by indulgence of the appetite, particularly for food: a proper degree of restraint, therefore, must be placed upon the child by the parent, who cannot too strictly carry out the directions of the medical attendant upon the diet and regimen during this period. great attention must still be paid to the state of the bowels, and, indeed, to all the secretions and excretions. peeling off of the cuticle, and falling off of the hair.--to promote the more easy separation of the cuticle from the surface of the body, a warm or tepid bath may be usefully employed at the close of the disease. it will, moreover, greatly contribute to the comfort of the child, and induce a more healthy condition of the skin. occasionally the cuticle of the whole hand and fingers will peel off unbroken, when it will resemble precisely a glove in shape. as is the case in all fevers, more or less, so particularly after scarlet fever, there is a great tendency to the falling off of the hair. it will be always well, therefore, to shave the head at this time, and exhibit daily a tepid shower bath, as early as the strength of the child will permit. cautions, etc.--the contagious character of this disease requires the separation of the invalid from the rest of the family; and, when it is practicable, the children should be removed to a distance. this measure is imperatively called for, when the form of the disease is very severe in its character. great caution must also be exercised, after the convalescence of the patient, that the other children are not brought into too early contact with him: for infection may be thus produced, though several weeks may have elapsed from the period of the peeling off of the skin. the period at which the disease shows itself after the exposure of an individual to sources of contagion, is exceedingly various. one child will be seized within a few hours; another, not for some days; and now and then (though rarely), five or six weeks have intervened between the period of exposure and the manifestation of the disease. when this disease is rife in a family, it will frequently affect the individuals composing it very differently. some escape altogether;-- others have the mild form of the complaint;--others the severe;--and, again, the attendant in the sick room may be attacked with the sore throat and fever only, both of which may subside without any appearance of a rash. in conclusion, this disease is a complaint of infancy and childhood, rather than of adult age; generally affects the same individual but once during his life; and, though examples of a second attack have occurred, such a circumstance is extremely rare. sect. vi.--measles. measles consists of a fever, in which the mucous lining of the air- passages is principally affected, and which, after about three days' duration, results in an eruption of a red rash over the surface. it depends upon a specific contagion;--occurs most frequently during childhood and adolescence, though no age is exempt from it;--and affects the system but once; a peculiarity to which an exception is very rare, proved by the few instances of the kind which have been recorded. the period at which the disease manifests itself after infection is various,--generally about the ninth day; it has, however, been delayed until the sixteenth. description of the disease.--the child infected will be observed not to be as well as usual, less active, and out of spirits; his appetite will fail, and his sleep be restless and disturbed. it will soon be evident that he has apparently taken a cold in his head, and that this is accompanied by fever. his voice will be hoarse; there will be frequent cough, headach, sneezing, running from the nose and eyes,--the eyelids being somewhat swollen, and the eyes inflamed;--the skin will be hot and dry, and he will complain of occasional chilliness. in the course of the next two or three days, these symptoms will increase in severity, and perhaps be accompanied by oppression at the chest and hurried breathing, and towards evening by slight delirium. on the fourth day, the rash will appear, but the symptoms will be little, if at all, mitigated; indeed, they will sometimes increase in severity. the eruption will first be perceived about the head and face, in the form of small red spots, at first distinct from each other, but soon coalescing, and forming patches of an irregular crescent-like or semilunar figure, of a dull red colour, and slightly elevated (giving a sensation of hardness to the finger), while portions of the skin intervening between them will retain their natural appearance. at this time the eruption will also be found on the inside of the mouth and throat, and the hoarseness will consequently increase. on the fifth day, the rash usually covers the whole surface of the body, with the exception of the legs and feet; and is now very vivid on the face, which is not unfrequently so much swelled, especially the eyelids, that the eyes are quite closed up, as in small-pox. on the sixth day, it is fully out on the extremities, and is beginning to fade on the face. on the eighth, it is fading from all parts; on the ninth, it is hardly perceptible; and has entirely disappeared on the tenth day from the commencement of the fever, or the sixth from its own first appearance. as the fading proceeds, the spots drop off in the form of little branny scales, which are sometimes, from their minuteness, scarcely perceptible. they leave a slight discolouration on the skin, with considerable itching. such is the ordinary course of this disease; occasionally, however, deviations are met with. character of measles compared with scarlet fever and small-pox.--under the description given of scarlet fever, are noticed several signs by which that disease may be distinguished from measles: to these may be added the absence of cough, of water flowing from the eyes, and of redness and swelling of the eyelids as in measles. again, in measles, the eruption is more pointed, of a crimson instead of a scarlet hue, and does not appear until two days later than in scarlet fever. in small-pox, the fever abates as soon as the eruption makes its appearance. in scarlet fever, this is by no means the case; and as little so in measles: the vomiting, indeed, subsides; but the cough, fever, and headach grow more violent; and the difficulty of breathing, weakness of the eyes, and, indeed, all the catarrhal symptoms, remain without any abatement till the eruption has all but completed its course. maternal management.--measles, in its ordinary and simple form, is a mild, and by no means dangerous, disease: it is sometimes, however, accompanied or immediately followed by symptoms of a very serious character, and which, it is to be feared, in many instances, owe their origin to the carelessness of the attendants in the sick chamber. a mother's superintendence, therefore, is much required at this time to insure a careful attention to the medical directions, as also to those general points of management upon which the well-doing of her child much depend, of which the following are the most important:-- ventilation of the bed-room, etc.--the child must be kept in bed from the onset of the attack. he must have so much clothing only as will secure his comfort, avoiding equally too much heat or exposure to cold. to these points the parent's attention must be particularly directed. it is the practice with some nurses, in the belief that a breath of cool air is most pernicious, to keep the child constantly enveloped in a smothering heap of bed-clothes, with curtains closely drawn, and the room well heated by fire, by which means the fever and all its concomitant dangers are greatly augmented. it is equally a popular error (and yet by many it is still held and acted upon) to suppose that because in small-pox exposure to cold is useful, that therefore it must be of equal advantage in measles. it cannot be too generally known that the nature of the fevers accompanying the two diseases are widely different, and that the adoption of this error is productive of the most serious consequences; for it would most likely produce in measles inflammation of the lungs, which, in truth, is commonly the result of carelessness upon this point. the bed-room should be large and airy; free from currents of cold, but well ventilated, and not hot. the room, also, must be darkened, on account of the tenderness of the eyes; all noise excluded, and mental excitement or irritation carefully avoided. regimen.--little or no food must be allowed, and whatever is taken must be of the simplest kind, and in a liquid form. mild mucilaginous drinks, and warm, may be given liberally; as barley-water, or thin gruel, etc. sponging, etc.--the face, chest, arms, and hands should be sponged occasionally with vinegar and warm water (one fourth and three fourths). this will be productive of great comfort to the little patient; it removes the heat, dryness, and itching of the skin, which are often very distressing; and is especially useful at night in relieving wakefulness. if the cough be troublesome, it will be useful for the child to breathe the steam of warm water; not through an inhaler, but over a large basin, with the head covered with flannel large enough to hang over its edges. by this means the tender and inflamed eyes will at the same time derive advantage from the soothing effect of the vapour. cautions.--whenever the measles is known to be prevalent in a neighbourhood, and a child manifests symptoms of cold in the head and fever, it should at once be a reason for carefulness on the part of the parent. the diet should be light, cooling, and scanty; and the child should be carefully kept in doors. it has been before remarked, that in its ordinary course measles is a disease unaccompanied with danger, but that the mildest form may be speedily converted into the most dangerous. that is to say, a sudden change may lake place in the symptoms, arising out of circumstances which could not have been foreseen, and therefore unavoidable; or may be produced by improper management on the part of the nurse, such as the giving of stimulants, by too much heat, or by exposure to cold. now it is for the parent early to notice any change which may occur from the first source, and by her watchfulness to guard against the possibility of its arising from either of the second. in reference to the first, if the child should complain at any period of the disease of severe headach, with piercing pain through the temples, and if this is accompanied by wandering of mind, great increase of suffusion of the eyes, as also intolerance of light, the immediate attention of the medical man is demanded. so, if towards the dose of the eruption, that is, from the seventh to the ninth day, the breathing should again become hurried (this symptom is very generally present during the height of the eruption, and is not necessarily connected with disease of the lungs), with pain and oppression felt at the chest, the cough becoming hacking and incessant, etc. (all symptoms cognizable by the mother, and indicative of inflammation of the lungs), no time must be lost in seeking medical aid. with regard to the last cause (improper management), it may be well, in reference to it, to observe, that it sometimes happens that the rash comes out imperfectly, or, having appeared properly, suddenly retrocedes and disappears; and that under such circumstances the nurse will almost certainly, if not well watched, give the child "a good dose of sulphur in diluted spirit, or a glass of punch containing saffron," which are considered specifics for bringing out the eruption. nothing can be more injurious than such remedies, for generally the disappearance of the rash will be dependent upon the existence of some internal inflammation, or of too high a fever; for the removal of which the medical man ought to be instantly applied to. sometimes, however, it may be fairly traced to a careless exposure to cold: under such circumstances the child should be instantly, and without hesitation, put into the warm bath. measles are frequently followed by cough, and deranged bowels; and there is always great susceptibility about the child for some time. on this account he should be carefully screened from a cold or damp atmosphere; the diet should be carefully regulated; and flannel worn next to the skin. if the cough should continue, it must not be neglected on the supposition that it will wear off; for it demands the skilful and careful attention of the medical man. in conclusion, it may be remarked that very frequently during infancy and childhood, and particularly during the period of teething, eruptions very similar in appearance to this disease occur; unless, however, they are accompanied by the specific fever, and run the regular course, they may at once be decided upon as not being the measles. sect. vii.--small-pox. this disease, the most dreaded of all eruptive fevers, is not so commonly met with in the present day as formerly; thanks to that providence which led to the discovery of jenner. but although its occurrence is not so frequent, it still does occasionally present itself; when it will assume either a mild or severe form. if it attack a child that has not previously been vaccinated, it is called natural small-pox; and the chances are that the disorder will be severe in character;--if, on the other hand, it occur in the vaccinated, the disease will generally be much modified in its symptoms; the attack will be mild, and without danger. natural small-pox.--the infection of small-pox having been received into the system of a child that has not been vaccinated, fourteen days (on an average) will transpire before the commencement of the febrile symptoms, or eruptive fever. a distinct rigor or shivering fit then takes place, accompanied by pain in the back or in the stomach, with sickness, giddiness, or headach; as also great drowsiness. and if an infant be the subject of the disease, a convulsive fit will sometimes take place, or several in succession. at the end of eight-and-forty hours from the occurrence of the rigor (in the majority of cases), the eruption comes out; and shows itself first on the face and neck in minute flea-bite spots. in the course of the next four-and-twenty hours in some cases, and in others not until the expiration of two or three days, it completely covers the body; not being confined exclusively to the skin, but frequently extending to the mouth and throat, and even to the external membrane of the eye. in the course of two or three days from their first appearance the little pimples, increasing in size, will be found to contain a thin transparent fluid, to pit or become depressed in their centre, and the skin in the spaces between them will be found red. on the seventh or eighth day from the commencement of the fever, the fluid contained in the pimples will be no longer transparent, but opaque; and they will consequently appear white, or of a light straw colour. each pimple or pock will be no longer depressed in its centre, but will become raised and pointed, being more fully distended by the increased quantity of fluid within; and the skin around each pock will now be of a bright crimson. the head, face, hands, and wherever else the eruption shows itself, gradually swell; and the eyelids are often so much distended as to close the eyes and produce temporary blindness. there will always at this time be some degree of fever present, and its amount will vary with the circumstances of each individual ease. the skin too will be very tender, so much so sometimes as greatly to harass and distress the child. on the eleventh day the swelling and inflam of the skin of the body and face subside; the pimples upon these parts dry up and form scabs, which fall off about the fourteenth or fifteenth day. those on the hands, as they come out later, commonly continue a short time longer. the eruption leaves behind, in some cases, the peculiar marks of the disease; and in others merely discoloured spots, which disappear in the progress of a short time. the natural small-pox is sometimes much more severe in its character than the foregoing, and what is called confluent small-pox is said to exist. this form will be marked by great constitutional disturbance, and the eruption coming out earlier than in the milder form; instead of being distinct, that is, each pimple standing distinct and separate one from the other, they will coalesce, and appear flat and doughy, not prominent: they will more particularly run into each other on the face, where they will form one continuous bag, which soon becoming a sore, will discharge copiously. small-pox in the vaccinated.--when small-pox occurs to those that have been formerly vaccinated, the disease, in almost every instance, is much altered or modified in its character. indeed in children, in whom of course vaccination has been but comparatively lately performed, small-pox when it occurs will, in the majority of cases, be so mild that the real nature of the disease will be with difficulty determined: so mild, that again and again has a parent been heard to exclaim, "surely these few scattered pimples cannot be the small-pox!" if, however, as the pimples progress, they are narrowly watched, and are seen to become depressed in their centre; if there has been the precursory rigor, etc.; and if the source of the disorder can be traced to some case of undoubted small-pox, the child in fact having been exposed to contagion, no doubt ought to exist in reference to the nature of such a case, however slight may be the character of the disease. the usual progress, however, of small-pox modified by vaccination is as follows. the first stage is the same usually as in the natural form of the disease. as soon, however, as the eruption appears, the modifying power of the vaccination becomes apparent. the eruption will be found to be generally both less in quantity and more limited in its extent; or if even it should come out profusely, and cover a large extent of the surface of the body, still the controuling power of the vaccination will immediately show itself after its appearance,--first, in the complete subsidence of all the febrile symptoms which will now take place; and, secondly, in reference to the eruption, part of which will die away at once, and the remainder will by the fifth day be filled with the opaque yellowish fluid, then dry up, becoming hard and horny, and falling off will leave a mottled red appearance of the skin, and now and then slight pitting. such is the usual progress of the disease: subsequent to vaccination, it is a mild and tractable disorder. it is right, however, to mention that small-pox has occurred even to the vaccinated in almost as severe a form as the confluent natural small-pox, and running its regular course unaltered or unmodified. such instances, however, are extremely rare, and form the exceptions to the general rule; for "no reasonable doubt can be entertained, from the abundance of facts now before the world, that such modification is the law of the animal economy, and that the regular or natural progress is the exception." maternal management.--the grand principle in the treatment of small-pox is to moderate and keep under the fever; and however the plans adopted by different medical men may vary in particular points to accomplish this purpose, they uniformly make this principle their chief aim and object. to carry out this intention, however, the medical adviser is greatly dependent upon the aid and assistance of a judicious parent, and without this it is impossible to hope for a successful issue to the case. a clear knowledge, therefore, of those points of general management in which in fact a great part of the above principle consists (few and simple as these directions are), it must be all-important for the mother to be acquainted with: for the rest, she must and ought to look to the medical man. in the more rare and severe form of this disease, viz. the confluent small-pox, although in some instances it runs the same course as the milder form, the distinct or natural small-pox, still, usually, the constitutional symptoms are much more aggravated, and the medical and general treatment required will so much depend upon the character of the individual case, that we do not think it well to notice it here. bed and bed-room.--it will not be necessary at first for the child to be confined to his bed, but generally about the third or fourth day he will gladly resort to it; and if he does not, it will be prudent to keep him there. he must not, however, be loaded with bed-clothes, but lightly covered; and the bed and body linen should be changed daily, if possible. the bed-room should be capacious and well ventilated; fresh air frequently admitted; and if the season of the year permit, and there is no dampness of atmosphere, a window should be constantly open during the day: it is also desirable to keep the chamber darkened in all cases, as there is always a tendency to inflammation of the eyes. if these directions are not regarded, and a great heat of the apartment is permitted, with abundance of bed-clothes heaped upon the child, the hot bath is used, and hot and stimulating regimen given (upon the old and erroneous notion of bringing out the eruption), the mildest case will inevitably be converted into one of the most severe and dangerous. facts have abundantly shown that such measures invariably prove the most effectual means of exasperating the disease, and endangering life. regimen.--this must be most sparing. cold water may be given whenever the child asks for it. lemonade should form the common drink during the fever; and gruel, barley-water, and roasted apples are all else that is required during this period, and not until the disease is going off must any change be made in the diet. the above period having arrived, mildly nutritious food should be given, as chicken or mutton broth, beef-tea, arrow-root, tapioca, or sago; to be followed in a few days by the wing of a chicken or a mutton chop; remembering always, that solid animal food must at first be given cautiously and sparingly. wine or stimulants must be positively forbidden; unless, indeed, ordered by the medical man, for circumstances may arise which render them advisable. the state of the bowels must be carefully attended to at this time. the eruption.--in the natural and mild form of this disorder the pustules generally break from the sixth to the eighth day; dry scabs succeed; and in about nine or ten days the parts heal perfectly, requiring no treatment. in the more aggravated cases, however, in which the pustules are very numerous, running one into the other, and, bursting, discharge greatly, the whole surface of the body should be frequently and liberally dusted over with dried flour, or, what is better, starch powder. the sores in this instance are always tedious in healing, and followed by the well-known pits or marks: these arise from a loss of substance in the true skin, and occur more particularly on the face, from the great vascularity of this part causing the pustules to be more numerous here than elsewhere. it is a popular error to suppose that by wearing masks of fine linen or cambric illined with particular ointments, these scars or pits may be prevented: it is impossible to prevent them; and any local application, except a little cold cream or oil of almonds applied to the scabs when they harden, will prove more injurious than useful. the child's hands, however, should always be muffled to prevent its scratching or breaking the sores, for otherwise he will not be kept from thus attempting to allay the excessive itching which they occasion. the hair should be closely cut at an early period of the disease, and so kept throughout its continuance. this will contribute very much to the comfort of the child, by preventing the hair becoming matted together with the discharge from the pustules when they break, which gives rise to great pain and irritation. in the confluent and worst forms of this disease, this measure it is particularly necessary to attend to, as also to the application of cold lotions to the head when hot and dry (with other remedial means), as there is always a tendency in these cases to the formation of abscesses, the healing of which is troublesome and attended with difficulty. cautions, etc.--it has already been stated that a free ventilation of the bed-room is necessary to the well-doing of the patient. this measure, however, must not be confined to the chamber of the sick, but acted upon through the whole house. in conjunction with ventilation, fumigations by means of aromatic substances kept slowly burning should be resorted to. a solution of the chloride of lime too, a most powerful disinfectant, should be used to purify the different apartments. this is best accomplished by steeping in the solution pieces of linen, and hanging them about the rooms, as also frequently and freely sprinkling the walls themselves; and as soon as the invalid is removed, the chamber should be white-washed, the various articles of furniture well scoured with soap and water, and the room be well and freely ventilated prior to its being again occupied. the clothes of the patient and the bed linen should be frequently removed, and when taken away immediately immersed in boiling water, and whilst hung up in the open air sprinkled occasionally with a weak solution of the chloride of lime. if these directions are not observed, and the clothes are closely wrapped up, they will retain and give out the disease to others at a great distance of time. again: as the contagious property of smallpox hangs about the child as long as any scabs remain (which indeed may be said to retain the poison in its concentrated form), a parent must be most careful that the invalid is not too early brought in contact with the healthy members of the family. an observance of these precautions is imperatively demanded; they not only protect the healthy, but aid the infected. sect. viii.--hooping-cough. my chief inducement to notice the above disorder arises out of the well-known fact, that there is no complaint of childhood more frequently subjected to quackery and mismanagement than is this. indeed, there are few maladies against which a greater array and variety of means have been recommended, than against hooping-cough. i suppose from the circumstance of the simple and mild form of the complaint being so tractable (provided it remain such) that the simplest and mildest measures effect its cure, parents are tempted to undertake its management in the more severe and complicated forms; and the result is but too often the establishment of disease dangerous to life, and sometimes fatal to it. but although most imprudent for a parent to assume the office of the physician, her aid is essentially necessary in carrying out the measures prescribed. by her watchfulness and care the duration of the disease may not only be abridged, but, what is of much greater importance, a more serious and aggravated form of disease prevented; for although hooping-cough in itself is not a dangerous disorder, still the most simple and slight case, if neglected or mismanaged, may quickly be converted into one both complicated and dangerous. description of the disease.--hooping-cough commences with the symptoms of a common cold, which is more or less frequent. these symptoms continue from five days to fifteen; at the end of which time the cough changes its character, and assumes the convulsive form, which distinguishes the disorder. it occurs in paroxysms, varying with the severity of the disease from five to six in the twenty-four hours to one every ten or fifteen minutes; being generally more severe and frequent during the night than in the day. during a paroxysm the expirations are made with such violence, and repeated in such quick succession, that the child cannot breathe, and seems in danger of suffocation. the face and neck become swollen and purple from suffusion; and the eyes prominent, injected, arid full of tears. the little one, with a forewarning of the attack, which it dreads, falls on his knees, or clings closely to any thing near him. the paroxysm terminates with one or two long inspirations, attended with that peculiar noise, or "whoop," from which the disease has derived its designation. sometimes the fit of coughing is interrupted for a minute or two, so that a little rest is obtained; and is then succeeded by another fit of coughing and another hoop, until after a succession of these actions the paroxysm terminates by vomiting, or a discharge of mucus from the lungs, or both. the disease having continued at its height for two or three weeks, it begins naturally to decline; the paroxysms become less frequent and violent; the expectoration increases; the cough loses its characteristic hoop, and gradually wears away altogether; until at length, in two or three months from the first onset of the disease, the child is restored to perfect health. sometimes, however, particularly in the autumn, and at other seasons on the occurrence of easterly winds, the paroxysms of cough will return,--it will assume its spasmodic character, and be accompanied with the "whoop," after a month, or even two or three months, of perfect and apparent recovery. errors in diet will sometimes alone have a similar effect. it is a disease which usually occurs during childhood, rarely affects the same individual twice, and is seldom seen in the very young infant. in reference to the probable result of the disease, when it occurs in its mild and simple form in a healthy child, the termination is usually favourable; but it may at first assume this form, and afterwards become complicated, and consequently more or less dangerous, owing to injudicious management, or to various influences over which the mother has no control. it generally appears as an epidemic, and at those seasons when catarrhal complaints are most prevalent, and affects many or several at the same time. isolated cases, however, frequently occur, which seem to prove the disease to be infectious. some persons deny that it is so. mothers and nurses, however, who have not had the disease, will often contract it from the child under such circumstances, and thus it will be quickly propagated through the family. the nursing mother will occasionally take it from the infant at her breast. the child who has caught it from others whilst at school, and brought home in consequence, will communicate it readily to his brothers and sisters, although the disease did not exist previously in the family or neighbourhood, and was brought from a distant part of the country. all these instances are surely proofs of its infectious character, and point out the necessity of caution whenever hooping-cough may present itself in a family, and the necessity which exists for an early removal of the unaffected children from the sphere of its contagious influence. the infectious property diminishes as the disease declines. maternal management.--in the mild and simple form of this disease the medical treatment is one rather of prevention than cure, and the maternal management consists in assisting, by watchfulness and care, the fulfilment of this design. in these slighter cases little more is required of the mother during the jirst stage of the disorder (that is, before the cough becomes spasmodic) than attention to diet, regimen, and the excretions. the diet should be farinaceous, with milk, or as may be otherwise directed. the child must be confined to a mild equable temperature; in fact, to his apartment. it is a popular error to suppose that at this time change of air is beneficial to the disease: at a later period it certainly is so, but now injurious, and attended with great risk. should the weather be cold, the little patient must be warmly clad, and flannel worn next the skin; this latter precaution should always be taken in the winter, spring, and autumn. purgatives and other medicines will be required, and ordered by the medical attendant; the chief attention, however, of the parent must be directed to any change she may observe in the symptoms, breathing, etc.; she must be all on the alert to notice the first signs of local inflammation. of this, however, we shall speak presently. during the early part of the second stage, that is, when the cough becomes spasmodic, assuming its peculiar sound, the same diet and regimen must be continued, and the same watchfulness observed, lest any inflammatory symptoms manifest themselves. under the foregoing treatment the disease generally runs its course without any untoward event, and the child recovers perfectly. sometimes, however, although the patient is quite well, and the disease on the decline, the cough still continues. in these cases, and at this time, it is that change of air often proves so very serviceable. the sea-side is preferable, if the season of the year permit; and salt- water bathing, commencing with the warm or tepid bath, and passing gradually to the cold-bath (if no complication forbid it), will also prove certainly and rapidly remedial. crying, mental irritation, or opposition, frequently bring on a fit; and even the sight of another in a paroxysm will induce it in those affected by the disease. running or other active exercise will generally cause the fits to be more severe. young children, too, must be carefully watched at night, and be raised up by the nurse as soon as the fit is threatened. these hints the mother should bear in mind. so much for the simple form of the disease, and that in which it most frequently and commonly presents itself to our notice: a mild disease; and, if carefully managed and watched over, certainly not a dangerous one. of what, then, is a parent to be afraid, or against what is she to guard? lest other disease insidiously come on, and advance to an irremediable degree, masked by the cough, without attracting her attention. this is the great source of danger in hooping-cough. the physician, in a case of simple hooping-cough, is not in daily attendance upon his patient, and therefore not present to notice the commencement or first symptoms of those diseases which so frequently occur at this time, and the successful treatment of which will mainly depend upon their early detection, and the decision with which they are treated. when you hear of a child or several children in a family dying of hooping-cough, it is not this disease which proves fatal; but death is caused by some disease of lungs or brain, which has been super-added to the hooping-cough. the progress of hooping-cough, then, must be closely attended to by the parent, even in the most favourable cases. the most frequent complication with hooping-cough is inflammation of the air-tubes of the lungs. this is extremely frequent during spring and winter, especially in the months of february, march, and april, owing to the prevalence of easterly winds at this season. it is not my intention to detail the symptoms of this affection, only to point out those which will enable a parent to recognise its approach. a parent then may take warning, and fear the approach of mischief, when she observes the fits of coughing become more frequent and more distressing to the child, and the breathing hurried in the intervals of the paroxysm; when any exertion or speaking causes increased difficulty of breathing or panting; when the expectoration becomes less abundant, and difficult to get up; when there is no longer, or at all events less frequent, vomiting after the cough, and more or less febrile symptoms present. if the lungs themselves are attacked by inflammation, most of the symptoms already pointed out will occur; the cough will be frequent, in short paroxysms; the vomiting will not take place; the breathing will be very quick and hurried; and as the disease advances the hoop will cease. if hooping-cough attack a child whilst teething, or from six months to two or three years of age, it is very common for the brain to suffer, and convulsions and water on the head to occur, particularly if the latter disease prevails in the family. whenever the paroxysm of cough is increased in violence, the characteristic hoop disappearing, and the face becomes very livid; the hands clenched, and the thumbs drawn into the palms; the head hot, and marked fits of drowsiness and languor; and the child, during sleep, screaming out, or grinding its teeth,-- something wrong about the head ought to be anticipated. of the treatment we have here nothing to say, except that the gums must be carefully examined, and scarified if they require it, and the temperature of the head reduced by cold sponging, or the application of a bag of ice when necessary. the chief duty, however, of the parent is to be alive to these symptoms, and early to detect the incipient mischief, that by a prompt application of efficient means the accession of so formidable a malady may be prevented. to specific remedies for this disease it is scarcely necessary to allude, after what has been advanced, except by way of warning. in the simple form of the complaint such medicines are superfluous, or rather some of them, from their violent properties, most dangerous; in the complicated forms of the disease they are inadmissible. the indiscriminate use of purgatives, also, a parent should avoid. bowel affections are not an infrequent attendant upon hooping-cough, and always aggravate the primary disorder. of external applications all that need be said is this, that if they are not violently stimulating they do no harm; if, however, they contain tartar emetic, in addition to their doing no good to the disease, they cause unnecessary suffering to the patient, and are sometimes productive of dangerous and even fatal sores. sect. ix.--croup. this disease is one of the most formidable of childhood; sudden (generally) in its attacks, most active in its progress, and if not met by a prompt and decided treatment, fatal in its termination. hence the paramount importance of parents being acquainted with the signs which indicate its approach, that medical aid may be secured at the very onset of the disease. upon this early application of suitable remedies every thing depends. signs of its approach.--croup may appear in one of two ways: either preceded for two or three days by the symptoms of a common cold, accompanied with hoarseness and a rough cough; or it may attack with the most alarming suddenness, during the night for instance, although the child had been merry and well the previous evening. hoarseness, however, is the premonitory and important symptom of croup; for although it is not every hoarseness that is followed by this formidable malady, still this symptom rarely attends a common cold in young children, and therefore always deserves when present the serious attention of the mother, particularly if accompanied by a rough cough. the symptoms or signs of the approach of this disease have been ably and graphically depicted by the late dr. cheyne, "in the approach of an attack of croup, which almost always takes place in the evening, probably of a day during which the child has been exposed to the weather, and often after catarrhal symptoms have existed for several days, he may be observed to be excited; in variable spirits; more ready than usual to laugh or to cry; a little flushed; occasionally coughing, the sound of the cough being rough, like that which attends the catarrhal stage of the measles. more generally, however, the patient has been for some time in bed and asleep before the nature of the disease with which he is threatened is apparent; then, perhaps without awaking, he gives a very unusual cough, well known to any one who has witnessed an attack of the croup: it rings as if the child had coughed through a brazen trumpet; it is truly a tussis clangosa; it penetrates the walls and floors of the apartment, and startles the experienced mother--'oh, i am afraid our child is taking the croup!' she runs to the nursery, finds her child sleeping softly, and hopes she may be mistaken. but remaining to tend him, before long the ringing cough, a single cough, is repeated again and again. the patient is roused, and then a new symptom is remarked: the sound of his voice is changed; puling, and as if the throat were swelled, it corresponds with the cough; the cough is succeeded by a sonorous inspiration, not unlike the kink in hooping-cough--a crowing noise, not so shrill, but similar to the sound emitted by a chicken in the pip (which in some parts of scotland is called the roup, hence probably the word croup); the breathing, hitherto inaudible and natural, now becomes audible, and a little slower than common, as if the breath were forced through a narrow tube; and this is more remarkable as the disease advances," etc. etc. it is unnecessary for me to add to the foregoing picture. maternal management.--having early obtained medical assistance attend with the strictest obedience to the directions given. and in this disease, more than any other, it is particularly important that the mother should give her personal superintendence; for the activity of the progress of the disease leaves no time to retrieve errors or atone for neglect. the practitioner may be prompt and decided in the measures he prescribes, but they will avail little, unless they are as promptly and decidedly acted upon. the parent will have her reward; for, if timely aid has been afforded, and adequate means used, the event will be almost invariably favourable. its prevention.--croup, when it has once attacked a child, is very liable to recur at any period before the thirteenth or fourteenth year of age. it may even do so several times, and after intervals of various duration. it is very desirable, therefore, that a parent should be acquainted with the means of prevention. they consist simply in the following measures:--the careful protection of the child from cold or damp weather, particularly the north-east winds of spring following heavy rains. croup is most prevalent in those seasons which are cold and moist, or when the alternations of temperature are sudden and remarkable. if the residence of the child is favourable to the production of croup, (for instance, near a large body of water, or in low damp spots,) he should, if possible, be removed to a healthier situation. sponging or the shower-bath, with cold water and bay-salt, with considerable friction in drying the body, should be commenced in summer, and employed every morning upon the child's rising from bed. the clothing should be warm in the winter and spring, the neck always covered, and flannel worn next the skin throughout the year; but hot rooms, and much clothing when in bed, must be avoided. the diet must be light and nourishing; no beer or stimulant given; and the state of the bowels must be carefully watched. the above precautions are of course particularly necessary to enforce immediately after a recovery from an attack, for there is a great tendency to relapse. if the attack takes place during the winter or spring months, the invalid must be kept, until milder weather, in the house, and in a room of an equable and moderately warm temperature. if in the summer, change of air, as soon as it can be safely effected, will be found very useful. sect. x.--water in the head. water in the head is a formidable disease, and not unfrequent in its occurrence. it is often destructive to life, and the instances are numerous in which it has appeared again and again in the same family, carrying off one child after another, as they have successively arrived at the same age. but notwithstanding its frequency and fearful character, a mother may do much to overcome a constitutional predisposition to this disease, and thus prevent its appearance; as also she may assist greatly in promoting its cure, when it does occur. hence it is most important that a mother should be acquainted with the measures of prevention; and also, when it does manifest itself, that clear and accurate information should be possessed, upon what may be said to constitute the maternal management of the disorder. its prevention.--whenever there is found to exist in a family a predisposition to this malady, one or more children having suffered from it, a mother must make up her mind, and in the strictest sense of the word, to be the guardian of the health of any child she may subsequently give birth to. and not only during the period of infancy, but during that of childhood also, must she continue the same careful and vigilant superintendence. the infant must be brought up on the breast, and if the mother is not of a decidedly healthy and robust constitution, she must obtain a wet-nurse possessing such qualifications. the breast-milk, and nothing beside, must form the nutriment of the child for at least nine months; and if the infant is delicate or strumous, it will be prudent to continue it even six months longer. when the period arrives for the substitution of artificial food, it must be carefully selected; it must be appropriate to the advancing age of the child; nutritious and unirritating. good air and daily exercise, and the bath or sponging, are of much importance; in short, all those general measures which have a tendency to promote and maintain the tone and general health of the system, and thus induce a vigorous and healthy constitution, and to which reference has been so fully made in the first chapter of this work, must be strictly regarded and followed out by the parent. the condition of the digestive organs must be the mother's especial care. costiveness must be guarded against; and if at any time the secretions from the bowels indicate the presence of derangement, the medical attendant must be applied to, that appropriate remedies may without delay be exhibited. their disordered condition is frequently productive of head-disease. again and again have i clearly traced the origin of the complaint, of which i am now writing, as more immediately resulting from disorder of the digestive apparatus. to a child thus predisposed to water in the head, the healthy state of these organs is not only of first consequence, but any deviation from health to be dreaded, to be immediately attended to, and guarded against in future; and, as there is a great liability to these attacks at the time of weaning, the above remarks especially apply to that period, when due attention must be particularly paid to the plan of diet adopted. during teething the mother must be especially watchful, for it is at this time that the disease so commonly appears; the irritation produced by this process being a frequent exciting cause. every thing, therefore, that will tend to allay excitement of the system, must be strictly enforced, as well as all causes avoided, which would produce derangement of the stomach and bowels. the head should be kept cool. for this purpose it must be sponged night and morning throughout the whole period of teething; a horse-hair pillow used in the cot; and nothing but a light straw hat should be worn, except in winter, the diet should be moderate, and carefully regulated after leaving the breast, and the child should be as much as possible in the open air. the mouth must be occasionally examined, and if the gums become hot or distended, they must be scarified or lanced, as may be advised. if the parent finds at any time an unusual heat about the head, the medical man must be at once consulted; or if there is watchfulness or indisposition to sleep at the proper periods, or frequent startings in the sleep, irritability of temper, and much crying, danger should be apprehended, and prompt and judicious means employed. eruptions about the head, or sores behind the ears, discharging more or less, will sometimes make their appearance just before the cutting of a tooth, and disappear after it is cut; or it will sometimes happen that, if not interfered with, they will continue throughout the whole period of dentition. great caution should always be exercised in reference to these eruptions in all children; and when there is a predisposition to water in the head, it is dangerous to interfere with them at all, except they run to such an extent as to become very troublesome. the sudden healing of these cutaneous affections has again and again been followed by head-disease. they are unsightly in the eyes of a parent, but it must be recollected that they render the situation of such children much more safe; and when teething is completed they will generally disappear spontaneously; or, if they should not, they will readily do so by proper medical treatment. i have no doubt that many a child's life has been saved by the appearance and continuance of these eruptions; and so sensible are medical men of the benefit derived from them, that in individuals in whom they do not appear, and in whose family there exists a predisposition to the disease now under our consideration, an issue or seton, in the arm or neck, has sometimes been made, and had a remarkable influence in warding off this affection. dr. cheyne refers to the circumstance of ten children in one family having died of this disease; the eleventh, for whom this measure was employed, having been preserved. stimulants, throughout the whole period of infancy and childhood, and of every description, must be prohibited. children nursed by drunken parents, and who have indulged in the use of spirituous liquors during suckling, are never healthy; are the frequent subjects of convulsions, and many of them die eventually of water in the head. the practice of administering spirits to the child itself; a habit unfortunately not very uncommon among the lower classes; produces a similar result. narcotics may operate in a like manner: they derange the whole system when persevered in, particularly affecting the brain; promote disease; and sometimes give rise to the one in question. this remark should be borne in mind by the mother, as godfrey's cordial and other preparations of opium are too often kept in the nursery, and secretly given by unprincipled nurses to quiet a restless and sick child. all causes of mental excitement should be carefully avoided, and particularly the too early or excessive exercise of the intellectual faculties. if the child be endowed with a precocious intellect, the parent must restrain rather than encourage its exercise. nothing is more likely to light up this disease in a constitution predisposed to it, than a premature exertion of the brain itself. maternal management of the disease.--the early detection of this disease is of great importance. the chances that the medical treatment will terminate successfully much depend upon the early and prompt application of remedial means. the reason why these cases have so often terminated fatally has arisen from the physician being consulted when irremediable mischief had already taken place. it would be difficult, however, to point out the signs of its approach in all its forms (for this disease does not always commence in the same way, sometimes with fever, etc.), still it most frequently occurs preceded by certain striking and well-marked symptoms; and whenever the following are noticed by the parent apprehensive of mischief, she should at once send for her medical adviser:--watchfulness, or starting from sleep with a cry of alarm; prolonged screaming without any obvious cause; moaning and drowsiness; rolling the head from side to side on the nurse's arm, or thrusting it back against the pillow; knitting the brows and aversion from light, with heat of head, and constant carrying the little hand up to it; half closing the eyelids, and frequent vomiting. the chief and principal point in the maternal management (for it includes every other) is promptly and faithfully to administer the remedies prescribed by the medical attendant. a vigilant maternal superintendence is more necessary in this than almost any other disease; and it is highly desirable, therefore, that the mother should have a day and night nurse--individuals upon whom she can depend. a careful notice of symptoms and changes in the patient, in the intervals of the medical man's visits, and a true and faithful report to him upon his return, are of essential importance. a sleepy nurse will neglect the application of the most important remedies, and necessarily give an unfaithful report of symptoms; hours the most valuable to the child's well-doing are thus lost, and the chances of saving its life worse than problematical. the temperature of the room should be kept rather cool than warm, and the bed-clothes only sufficient to preserve the natural heat of the body. strong light must be excluded. great quiet should be observed. freedom from all excitement of the senses, and irritation of the temper, should be carefully avoided: this is particularly necessary where the child is naturally of a quick and sensitive disposition. all the excretions must be put aside for the inspection of the physician, but not kept in the sick chamber, which must be well aired, and perfectly free from closeness. the regimen must be only such as is ordered, and any departure therefrom will be attended with mischievous consequences. during the early periods of the disease, all that is required are cooling diluents, given frequently, and in small quantities at a time; and upon approaching convalescence great carefulness must be paid to the amount of nourishment allowed, lest the disease be rekindled: strict compliance, therefore, to medical directions must be given. a very useful and indeed powerful remedy prescribed in this disease, is sometimes rendered utterly useless from a want of a persevering and also proper mode of applying it, viz. cold applications to the head. it is to be effected either by means of cloths kept constantly wet with cold water, or evaporating lotions; or by means of a bladder containing pounded ice mixed with water. if the two former are employed they require frequent renewal, or they become dry, hot, and more injurious than useful; and whichever is used, it must be kept in constant contact with the forehead, temples, and upper part of the head. here is another error; they are seldom used large enough, and only partially cover these parts. with the further view of keeping the head cool, and preventing the accumulation of heat, a flat horse-hair pillow should be employed, and the head and shoulders somewhat raised. perseverance in the measures prescribed, even when the case appears beyond all hope, must ever be the rule of conduct. recovery, even in the most advanced periods of the disease, in cases apparently desperate, occasionally takes place. there is great reason to fear that many a child has been lost from a want of proper energy and perseverance on the part of the attendants in the sick room. they fancy the case is hopeless, and, to use their own expression, "they will not torment the child with medicine or remedies any longer." "whilst there is life, there is hope," is a sentiment which may with great truth be applied to all the diseases of infancy and childhood. striking, indeed, are the recoveries which occasionally present themselves to the notice of medical men; and those individuals may with great justice be charged with unpardonable neglect who do not persevere in the employment of the remedies prescribed, even up to the last hours of the child's existence. index. ablution, or sponging, . abstinence, its good effect, in flatulence and griping in the infant, . . accidents and diseases which may occur to the infant at birth or soon after, . acids, injurious to the teeth, . air and exercise, in infancy, . --, in childhood, . --, its importance to the mother whilst a nurse, . animal food, in childhood, . --, its injurious effects upon the young and delicate child, . aperient liniment, . --, medicine, . --, poultice, . artificial feeding; the causes rendering it necessary, . artificial food; the proper kind for the child before the sixth month, . --; the mode of administering it, . --; the quantity to be given at each meal, . --; the frequency of giving it, . --; the posture of the child when fed, . --; the proper kind for the child after the sixth month, to the completion of first dentition, . --; the kind most suitable under the different complaints to which infants are liable, . bath, the cold-water, plunge-bath, . --, the shower, . --, the warm, . --, rules for the use of the warm bath, . bathing, sea, . --, and cleanliness, during infancy, . --, during childhood, . bleeding, from leech-bites, how controlled, . --, from the navel string, . --, navel, . blisters, mode of application, . bottle, nursing, . bowels, disorder of, in the infant, . breasts of the infant, swelling of, . breathing, how affected by disease, . calomel, danger in its use, . --, injurious to the teeth, . carminative, dalby's, . carriage, "a good carriage;" how best obtained, . --; the sad results of the mode frequently adopted, . castor oil, . choice of a wet-nurse, rules for, . cleanliness and bathing, . clothing, in infancy, . --, in childhood, . clysters, what kind best for children, . --, mode of application, . cold, infants very susceptible of, . convulsions, , . cork-nipple teat, . costiveness, in infancy, . . --, in childhood, . cough, as a sign of disease, . countenance, in health, . countenance, in disease, . croup, . . dalby's carminative, . damp, induces disease in the infant, . dentition, easy, . --, difficult, . diarrhoea, in the infant, . . dietetics of infancy, . --, of childhood, . --, general directions upon, and of animal food, . --, sugar, . --, salt, . --, fruits, . --, water, . --, wine, beer, spirits, . diet, under the different complaints to which infants are liable, . --, and regimen of a wet-nurse, . digestion, in the infant; time requisite for its performance, . discharge, from the eyes of the infant, . disease, the importance of its early detection, and hints upon, . dress, in infancy, . --, in childhood, . enema. see clysters. eruptions on the skin in infancy; how best prevented, . --, about the head, and sores behind the ears, . --, during teething, . exercise and air, in infancy, . --, in childhood, . --, horse-exercise; its importance to delicate children, . eyes, of the infant, discharge from, after birth, . fever, scarlet, . flannel clothing, . flatulence and griping in the infant, . . . food, for infants. see artificial feeding. --, for children. see dietetics of childhood. --, and regimen, for nurses, . fruits, . gestures, of the infant, in health and disease, . godfrey's cordial, . grief, its effects upon the mother's milk, . gums, of the infant in difficult dentition, the importance of their being lanced, . hare-lip, how the infant may be nourished with this defect, . head, of the infant, swellings upon, when born, . hereditary transmission of scrofula and consumption; the best antidote to, . hooping-cough, . horse-exercise, its importance to delicate children, . hunter's, dr., experiments on the effects of wine upon children, . jaundice, in the infant after birth, . ice, how to be applied to the head, . indigestion, in the infant, . infant, food for. see artificial feeding. --; when still-born, how to be managed, . --; of injuries received during its birth, . --; retention of its urine after its birth, . --; swelling of the breasts after birth, . --; discharge from the eyes, . --; hare-lip, . --; bleeding from the navel string, . --; ulceration, or imperfect healing of the navel, . infant; bleeding from the navel, . --, jaundice in, . --, tongue-tied, . --, moles and marks on the skin, . inflation of the lungs of the infant, the mode, . lavement, the proper kind for infants and children, . leech-bites; the mode of controlling the bleeding of, liniment, aperient, . looseness, . lungs of the infant, inflation of, . magnesia, . manna, . maternal nursing, . --, management of the diseases of children, . measles, . --, how distinguished from scarlet fever and small-pox, . medicine, aperient, . mercury, . milk, the mother's; how to be preserved healthy during suckling, . --; deficiency of, . --; drying up of, . --, cow's; for infant's food, . --, ass's; for infant's food, . --, all kinds of, sometimes disagrees with the infant, . mind, anxiety of; effects upon the parent's milk, . moles and marks on the skin, . mothers, their duty in relation to suckling, . --; those who ought never to suckle their children, . . . motions of the infant; what the appearance of, and how frequent, in health, . . --; their deranged condition, a sign of disease, . napkins, the infant's, . navel, bleeding from, . --, ulceration or imperfect healing of, . navel-string, bleeding from, . naevi, or moles, . nurses, wet, rules for the choice of, . --, diet and management of, . nursery medicines, . nursing, maternal, . --; the plan to be adopted for the first six months, . --; the plan to be followed after the sixth month to the time of weaning, . --; the injurious effects to the mother of undue and protracted suckling, . --; the injurious effects of undue and protracted suckling to the infant, . opiates, . . --, in teething, dangerous, . passion, its effect upon the breast-milk, . porter, of its use, by the mother during suckling, --, when mischievous, . poultice, bread-and-water, how made, . --, mustard, how made and applied, . purgative medicine, . retention of urine in the infant, . rhubarb, . rules for nursing, . --, for the use of the warm bath, . salt, as a condiment, . scarlet fever, . --, how distinguished from measles, . scrofulous constitution, . sea-bathing, . seasons (the), their influence in producing particular forms of disorder, . shower-bath, . signs of health in the infant, what, . --, of disease in the infant, what, . skin of the infant, importance of its perfect cleanliness, . --, friction and sponging of, beneficial, . sleep, during infancy, . --, childhood, . --, how affected when the child is ill, . small-pox, . spirituous liquors, their pernicious effects to children, . . sponging, . spoon-feeding, . still-born, . stomach and bowels, their derangement, a fruitful source of disease, . --, disorders of, in the infant at the breast, . --, disorders of, at the period of weaning, . --, disorders of, in the infant brought up by hand, . --, their treatment, . stools of the infant, what the appearance of, and how frequent, in health, . . --, their deranged condition, a sign of disease, . suckling, plan of, . --, by a wet-nurse, . sugar, . swelling of the breasts in the infant, . teat of the cow--the artificial--the cork, . teeth, of the permanent or adult teeth, . --, the manner in which they appear, . --, their value and importance, . --, their management and preservation, . teething, easy; management of the child, . --, difficult; hints upon, . tight-lacing, evils of, . tongue-tied, . ulceration or imperfect healing of the navel, . urine, retention of it in the infant after birth, . ventilation of the sleeping-rooms of children, . --, its importance in sickness, . walking, the best mode of teaching a child, . warm bath, . --, rules for the use of, . --, directions for the use of, when the infant is stillborn, . water, as a beverage for children, . --, in the head, . weaning, the time when to take place, . --, the mode of effecting it, . --; drying up the mother's milk, . wet-nurse suckling, . --, rules for the choice of, . --, diet and management of, . wine, its pernicious effects in childhood, . worms, . the end. also by dr. bull, hints to mothers for the management of their health. second edit, greatly enlarged, foolscap vo. s. cloth lettered. opinions of the press. "a very valuable compendium for all who expect to become mothers.--in the short preface prefixed to this little work, dr. bull judiciously remarks, that feelings of delicacy often prevent many young married females from making to their medical attendant, a full disclosure of the circumstances connected with their state, and which render medical assistance necessary. the object of the work is to meet this difficulty, by furnishing a species of information for which married women are often very unwilling to ask, although they readily search for it in books. the matter of dr. bull's treatise is arranged completely in a popular form--in one that is best calculated to be understood by the fair readers to whom it is addressed; and contains a variety of useful information, so clearly conveyed as to render it a very valuable compendium for all women who expect to become mothers."--lancet. "a valuable monitor to the fair sex. it contains so much useful advice for every woman likely to become a mother, that married men would do well to provide it for their partners."--spectator. "this little volume is the benevolent contribution of good sense and professional skill, to the well-being of those who have the strongest claims on our sympathy. unfortunately a vast mass of erroneous notions exists in the class to whom it is addressed; to which, and to the concealment prompted by delicacy, until the time for medical aid is gone by, we are indebted for very much of the danger and suffering incident to the periods they are destined to pass through. dr. bull, in the true spirit of a physician and a gentleman, has by his perspicuous statements removed the first, and by his judicious and simple directions, anticipated the last of these fruitful sources of evil. there is no mother that will not be heartily thankful that this book ever fell into her hands; and no husband who should not present it to his wife. we cannot urge its value too strongly on all whom it concerns."--eclectic review. "we recommend it to our readers; and they will confer a benefit on their new-married patients by recommending it to them."--british and foreign medical review. "dr. bull has performed a very kind and important office in the publication before us."--patriot. "we never read any popular treatise, or directions rather, that bear more strongly the stamp of scientific and expert mental knowledge. the mere reading of our author's book will do more good in the way of encouraging the fearful, and banishing nervous anxiety, than a whole conclave of the wisest and most sanguine matrons that society can anywhere bring together."--monthly review. "this little manual will prove useful exactly in proportion to the extent of its circulation."--medical gazette. transcriber's notes: obvious typographical errors have been corrected and a few punctuation usages have been normalized. [illustration: courtesy of new york world more babies like these these nine little tots are all sound, healthy stock. the generations behind them had unconsciously been practicing eugenics through the process of natural selection. by luck, as it were, no strain was bred into the several families that would have caused these children to be unsound mentally, morally, or physically. it is through eugenics that we shall have more babies like these, and shall eliminate the possibility of children like those shown in the other illustrations to this volume.] the eugenic marriage a personal guide to the new science of better living and better babies by w. grant hague, m.d. college of physicians and surgeons (columbia university), new york; member of county medical society, and of the american medical association in four volumes volume iv new york the review of reviews company copyright, , by w. grant hague copyright, , by w. grant hague * * * * * table of contents accidents and emergencies chapter xxxiv common diseases of the nose, mouth and chest page "catching cold"--sitting on the floor--kicking the bedclothes off--inadequate head covering--subjecting baby to different temperatures suddenly--wearing rubbers--direct infection--acute nasal catarrh--acute coryza--acute rhinitis--"cold in the head"--"snuffles"--treatment of acute nasal catarrh, or rhinitis, or coryza, or "cold in the head," or "snuffles"--chronic nasal catarrh--chronic rhinitis--chronic discharge from the nose--nervous or persistent cough--adenoids as a cause of persistent cough--croup--acute catarrhal laryngitis--spasmodic croup--false croup--tonsilitis--angina--sore throat--symptoms of tonsilitis--treatment of tonsilitis--bronchitis in infants--bronchitis in older children--"don'ts" in bronchitis--diet in bronchitis--inhalations in bronchitis-- external applications in bronchitis--drugs in bronchitis-- chronic or recurrent bronchitis--pneumonia--acute broncho-pneumonia--symptoms of broncho-pneumonia--how to tell when a child has broncho-pneumonia--treatment of broncho-pneumonia--the after treatment of broncho-pneumonia--adenoids--how to tell when a child has adenoids--treatment of adenoids--nasal hemorrhage-- "nose-bleeds"--treatment of nose-bleeds--quinsy--hiccough-- sore-mouth--stomatitis--treatment of ulcers of the mouth-- sprue--thrush chapter xxxv diseases of the stomach and gastro-intestinal canal inflammation of the stomach--acute gastritis--persistent vomiting--acute gastric indigestion--iced champagne in persistent vomiting--acute intestinal diseases of children-- conditions under which they exist and suggestions as to remedial measures--acute intestinal indigestion--symptoms of acute intestinal indigestion--treatment of acute intestinal indigestion--children with whom milk does not agree--chronic, or persistent intestinal indigestion-- acute ileo-colitis--dysentery--enteritis--enter-colitis-- inflammatory diarrhea--chronic ileo-colitis--chronic colitis--summer diarrhea--cholera infantum--gastro-enteritis-- acute gastro-enteric infection--gastro-enteric intoxication--colic--appendicitis--jaundice in infants--jaundice in older children--catarrhal jaundice--gastro-duodenitis--intestinal worms--worms, thread, pin and tape--rupture chapter xxxvi diseases of children (continued) page mastitis, or inflammation of the breasts in infancy--mastitis in young girls--let your ears alone--never box a child's ears--do not pick the ears--earache--inflammation of the ear--acute otitis--swollen glands--acute adenitis-- swollen glands in the groin--boils--hives--nettle rash-- prickly heat--ringworm in the scalp--eczema--poor blood--simple anemia--chlorosis--severe anemia--pernicious anemia chapter xxxvii diseases of children (continued) rheumatism--malaria--rashes of childhood--pimples--acne-- blackheads--convulsions--fits--spasms--bed-wetting--enuresis-- incontinence--sleeplessness--disturbed sleep--nightmare-- night terrors--headache--thumb sucking--biting the finger nails--colon irrigation--how to wash out the bowels--a high enema--enema--methods of reducing fever--ice cap--cold sponging--cold pack--the cold bath--various baths--mustard baths--hot pack--hot bath--hot air, or vapor bath--bran bath--tepid bath--cold sponge--shower bath--poultices--hot fomentations--how to make and how to apply a mustard paste--how to prepare and use the mustard pack--turpentine stupes--oiled silk, what it is and why it is used diseases of children chapter xxxviii infectious or contagious diseases rules to be observed in the treatment of contagious diseases-- what isolation means--the contagious sick room--conduct and dress of the nurse--feeding the patient and nurse--how to disinfect the clothing and linen--how to disinfect the urine and feces--how to disinfect the hands--disinfection of the room necessary--how to disinfect the mouth and nose--how to disinfect the throat--receptacle for the sputum--care of the skin in contagious diseases--convalescence after a contagious disease--disinfecting the sick chamber--the after treatment of a disinfected room--how to disinfect the bed clothing and clothes--mumps--epidemic parotitis--chicken pox-- varicella--la grippe--influenza--diphtheria--whooping cough--pertussis--measles--koplik's spots--department of health rules in measles--scarlet fever--scarlatina-- typhoid fever--various solutions--boracic acid solution--normal salt solution--carron oil--thiersch's solution--solution of bichloride of mercury--how to make various solutions accidents and emergencies chapter xxxix accidents and emergencies accidents and emergencies--contents of the family medicine chest--foreign bodies in the eye--foreign bodies in the ear--foreign bodies in the nose--foreign bodies in the throat--a bruise or contusion--wounds--arrest of hemorrhage--removal of foreign bodies from a wound--cleansing a wound--closing and dressing wounds--the condition of shock--dog bites--sprains--dislocations--wounds of the scalp--run-around--felon--whitlow--burns and scalds miscellaneous chapter xl miscellaneous the dangerous housefly--diseases transmitted by flies--homes should be carefully screened and protected--the breeding places of flies--special care should be given to stables, privy vaults, garbage, vacant lots, foodstuffs, water fronts, drains--precautions to be observed--how to kill flies--moths--what physicians are doing--radium--x-ray treatment and x-ray diagnosis--aseptic surgery--new anesthetics--vaccine in typhoid fever--" "--transplanting the organs of dead men into the living--bacteria that make soil barren or productive--anti-meningitis serum--a serum for malaria in sight * * * * * accidents and emergencies chapter xxxiv common diseases of the nose, mouth, and chest "catching cold"--sitting on the floor--kicking the bed clothes off--inadequate head covering--subjecting baby to different temperatures suddenly--wearing rubbers--direct infection--acute nasal catarrh--acute coryza--acute rhinitis--"cold in the head"--"snuffles"--treatment of acute nasal catarrh, or rhinitis, or coryza, or "cold in the head," or "snuffles"--chronic nasal catarrh--chronic rhinitis--chronic discharge from the nose--nervous or persistent cough--adenoids as a cause of persistent cough--croup--acute catarrhal laryngitis--spasmodic croup--false croup--tonsilitis--angina--sore throat--symptoms of tonsilitis--treatment of tonsilitis--bronchitis in infants--bronchitis in older children--"don'ts" in bronchitis--diet in bronchitis--inhalations in bronchitis--external applications in bronchitis--drugs in bronchitis--chronic or recurrent bronchitis--pneumonia--acute broncho-pneumonia--symptoms of broncho-pneumonia--how to tell when a child has broncho-pneumonia--treatment of broncho-pneumonia--the after-treatment of broncho-pneumonia--adenoids--how to tell when a child has adenoids--treatment of adenoids--nasal hemorrhage--"nose-bleeds"--treatment of nose-bleeds--quinsy--hiccough--sore mouth--stomatitis--treatment of ulcers of the mouth--sprue--thrush. "catching colds" mothers frequently wonder where their children get colds. briefly we will point out some of the sources from which these apparently inexplicable colds may come. a. sitting on the floor.--children should not be allowed to sit or crawl upon the floor at any season of the year, but especially during the winter months. there is always a draught of cold air near the floor. it is a bad habit to begin allowing a child to play with its toys on the floor. use the bed or a sofa or a platform raised a foot from the floor. b. kicking the bed clothes off during the night.--the bed clothes should be securely pinned to the mattress by large safety pins. when it is established as a habit a child who kicks off the bed clothes should wear a combination night suit with "feet," made of flannel during the winter and of cotton during the summer. c. inadequate head covering.--professor kerley states that this is one of the "most frequent causes of disease of the respiratory tract in the young." he calls attention to the fact that "mothers carefully clothe the baby with ample coats, blankets, leggings, etc., before they take him out for the daily walk. they dress him in a warm room taking plenty of time to put on the extra clothes, during which time the baby frets and perspires. when all is ready they place upon the hot, almost bald head of the baby a light artistically decorated airy creation which is sold in the shops as children's caps. the child is then taken out of doors and because of the inadequate covering of the hot perspiring head, catches cold and the mother never knows how it came." every baby and child should wear under such caps a skull cap of thin flannel, especially in cold weather. in summer or windy day a light silk handkerchief folded under the cap is a very excellent protection. d. subjecting a baby to different temperatures suddenly, is liable to be followed by a cold--for example, taking the child from a warm room to a cold room, or through a cold hall, holding the child at an open window for a few moments. e. the practice of wearing rubbers needs some consideration.--they should never be worn indoors for even five minutes. they should not therefore be kept on in school, nor should they be worn by women in stores when they go shopping. when it is actually raining, or snowing, or when there is slush or wet mud they are needful; but they should not be worn simply because the weather is threatening or damp. children should not put them on to play--worn for any length of time when active they are harmful. if worn to and from school they should be taken off at once when in school or at home. wearing rubbers prevents free evaporation of the natural secretion of the skin, keeps the feet moist and invites colds and catarrh. in damp weather, or when children play during winter months, they should be shod with stout shoes with cork insoles. the same argument applies to storm coats of rubber, water-proof material. they should not be worn as overcoats all day, but only when going to and from school or business when it is actually storming. underclothing or hosiery should not be heavy enough to cause moisture of the skin. health demands a dry skin at all times. the necessary degree of body heat should be attained by the quality of the outer clothing, not by the quantity of the underclothing. many men and women wear heavy underclothing which causes moisture when indoors, with the result that they get surface chills when they go outside if the weather is cold and as a result catch cold. the underclothing should be just heavy enough to be comfortable indoors and the extra warmth necessary when outside should be supplied by a good overcoat or furs. f. direct infection.--a baby may catch cold if kissed or "hugged" by an adult who has a cold. catching cold while bathing is possible, but scarcely probable, if ordinary precautions are taken. it is very bad practice to permit children to use one another's handkerchiefs or the handkerchief of an adult. certain children are predisposed to attacks of "cold in the head" or acute coryza or nasal catarrh (these being the medical names for this condition). sometimes this is an inherited characteristic. there is no doubt, however, that most of these children acquire the habit by bad sanitary and hygienic surroundings. these children do not as a rule get enough fresh air. they are kept indoors most of the time in stuffy, overheated, badly ventilated rooms, unless the weather is absolutely perfect. the windows in their bedrooms are always kept closed, because they are "liable to catch cold." they are overdressed and perspire easily and as a result "catch cold." these conditions all tend to create an unhealthy condition of the nasal mucous membrane and of the throat, and this is rendered worse if the child lives in a damp, changeable climate, such as that of new york city. in these susceptible children the exciting cause of an attack may be trivial; exposure, cold or wet feet, inadequate head covering (as already pointed out), a draught of cold air even may excite sneezing and a nasal discharge; hence we have: acute nasal catarrh (acute coryza, acute rhinitis, "cold in the head", "snuffles").--acute nasal catarrh may accompany measles, diphtheria, influenza, and whooping cough. symptoms.--the onset is sudden with sneezing, and difficulty in breathing through the nose. in a few hours, or it may be not for a day or two, a mucous, watery, nasal discharge appears. there are redness and slight swelling of the nose and upper lip, caused by the discharge. there is no fever as a general rule except in very young infants, in whom the fever may be very high. the discharge interferes with the nursing and the child suffers from lack of nourishment. the inflammation may extend to the eyes and ears, causing painful complications, or to the throat and bronchi, causing hoarseness and cough. less frequently we have disturbances of the digestive tract with vomiting, or diarrhea. the mild form of the disease lasts for two or three days, the severe form from one to two weeks. repeated attacks are said to contribute to the production of adenoid growths. an acute attack of this disease is seldom a serious affliction in older children; it may be, however, very serious and even dangerous in very young infants. the tendency of the disease to extend downward, causing bronchitis or pneumonia, explains in part the possible danger to a baby. another reason is because it may seriously interfere with suckling and with breathing in these little patients. it may even cause sudden attacks of strangulation. an infant, therefore, suffering with an acute attack of rhinitis requires constant attention. it may be necessary to feed it with a spoon, and if necessary mother's milk should be so fed. plenty of fresh air should be provided. it may be essential to keep the mouth open in order that it may get enough fresh air. every effort should be made to keep the nostrils open. the secretions must be removed from time to time. causing the child to sneeze by tickling the nose with a camel's hair brush will clear the nose for the time being. the physician may be compelled to use a solution of cocaine for this purpose. treatment of acute rhinitis ("taking cold", nasal catarrh, acute coryza, "snuffles").--a child suffering with an acute attack of "cold in the head" should be kept indoors in a room with a constant, uniform temperature; the particular reason for this is, that, if a child is exposed to cold at any time during an attack of "cold in the head," it may cause the disease to invade the chest,--a tendency which it has at all times. the bowels must be kept open; if they do not move every day of their own accord they must be made to move by means of an enema of sweet oil or of soap-suds. the amount of food should be reduced to suit the circumstances and the condition of the patient. we treat the local condition in the nose with a menthol mixture. the following is a very good one: menthol, grains; camphor, grains; white vaseline, ounce. put some of this on the end of the finger and push it gently into each nostril. when the nostrils become blocked and the child cannot breathe through the nose, tickle the nose with a feather until it sneezes; this will clear the passage. immediately after the sneeze place the menthol mixture in each nostril. when the child is about to sneeze place a handkerchief before the nose, as this discharge is full of germs and will infect others when dry. internal remedies should not be used unless the child is distinctly sick and is running a fever, in which case a physician should look the child over and prescribe whatever is called for. the upper lip and the nostrils of the child should be protected, because the discharge very quickly irritates the parts and renders them raw and painful. vaseline or cold cream is very suitable for this purpose. mothers should not wash out the nose of a child with any solution advised for this purpose where force is used, as, for example, with a syringe. any forceful irrigation of the nose is dangerous, because it would carry the infection into the deeper parts and set up a more serious condition. if the above treatment is carefully carried out and the child unexposed to a fresh cold, two or three days will be sufficient to cure the disease. it is not, however, the treatment of an acute attack of "cold in the head" that is important; it is intelligently to follow out a plan which will prevent these attacks from repeating themselves that is of consequence. the tendency to take cold is a real condition in childhood and a very common one. when mothers appreciate that it is possible to prevent this condition and to cure it when it is seemingly an established habit, more interest will undoubtedly be taken in the subject. too frequently it is looked upon as an unfortunate affliction, but it is never regarded as a condition that is caused by neglect and ignorance. it is an exceedingly common occurence to find a mother worrying over her child's cold, dosing it with cod liver oil or some other unnecessary tonic, rubbing it with camphorated oil or plastering it over with certain useless patent plasters, dressing it with extra pieces of flannel on its chest and extra clothes pinned snugly around it, then shutting it up in a warm, stuffy, unsanitary, ill-smelling room, in order to keep it from "catching a fresh cold." can you imagine anything else she could do to defeat her purpose? no quantity of cod liver oil, no medicine, no coddling, will remove the tendency to "catch cold." the child's life must be lived amidst sanitary surroundings and hygienic conditions first; then other expedients may be utilized if necessary. these children must be kept out of doors most of the time, unless during the severest wet weather. they should sleep in a room the windows of which are open at the top and bottom every night in the year. they should not, however, be in a draught. the rooms in which they live should be of a uniform temperature, never too hot and never too cold, between ° and ° f. these delicate catarrhal children should be accustomed to light clothing on their beds. chest protectors, mufflers, cotton pads, and heavy wraps of any description should be absolutely prohibited. it is advisable to use flannel underwear winter and summer, light in summer and a medium weight in winter. during the summer months the mother should begin cold sponging of the face, throat, chest, and spine every morning and carry it into the winter. the entire process need take only a moment or two. always dry thoroughly with a fairly rough towel. if the cold sponging is begun in the warm summer time the child will become so accustomed to it that no objection will be made when the cold weather comes. if the child continues to be "catarrhal," despite a course of this treatment, it would be well to investigate whether any adenoids or adenoid tissue exist in the naso-pharynx. if adenoids are found no treatment will be successful until they are removed. it is a wise plan to place a flannel cap on an infant who has an acute attack of "cold in the head" (snuffles). this will prevent catching a fresh cold and it will aid in the speedy cure of the attack from which it is suffering when it is put on. chronic nasal catarrh--chronic rhinitis chronic discharge from the nose some children have a nasal discharge during all of their childhood. it is usually worse during the winter months. it may be a thin, watery discharge or a thick, nasty, yellow discharge. it is a condition that is very frequently neglected even by the family physician. this is unfortunate because it may lead to serious disease, permanent damage sometimes being done to the hearing, the speech, the smell, and to the lungs of the child. it may be caused by adenoids; disease of the bones or tissues in the nose; foreign bodies in the nose; or it may occur in children whose nutrition is bad. it may result from frequent acute attacks of "cold in the head." it also occurs in other less important conditions. the foreign bodies which usually cause a chronic nasal discharge are,--buttons, peas, beans, beads, paper balls, flies and bugs, cherry-stones, small pieces of coal, or stone, cork or other material. a child gets hold of a shoe-button for example and pushes it into its nostrils. in the effort to get it out the child pushes it further in. it may or may not cause pain at the time, and it may be overlooked, but shortly the mother will notice a discharge from one nostril. this discharge becomes thick and foul and when an investigation is made the button is found embedded firmly in the nose. it is sometimes quite difficult to get the button out and this should always be done by a physician. treatment.--remove the cause first then treat the catarrh. if it is a product of a constitutional disease that causes general poor health, such as tuberculosis, syphilis, or scrofula, the child will need "building up" and a decided change of climate. foreign bodies must be removed, adenoids taken out, large tonsils excised, and malformations of the nasal bones operated upon. the catarrh will in many cases be cured by removing its cause; if, however, it should persist it must be treated for some time with appropriate solutions. these solutions and the directions as to the method of giving them must be given by a physician, because there is great danger of carrying the disease to deeper structures if given wrongly. summary:-- st.--a chronic discharge from the nose is a sign that something is wrong and should be carefully and thoroughly investigated. nd.--the cause can usually be found out and the proper treatment will cure it. rd.--if the condition is neglected it may ruin the health of the child for the whole period of its life. nervous or persistent cough cough in an infant or growing child is usually the result of a cold and the structure affected is some part of the nose, throat or bronchi. it is a comparatively simple matter to discover just where the trouble is and to prescribe the appropriate remedy and effect a cure. there is another type of cough, however, that is of quite a different character. this cough will begin as an ordinary cough and it will only be discovered that it is not an ordinary cough because nothing will apparently cure it. we mean that the child is given cough remedies that usually cure a cold, is kept in the house and carefully watched for a sufficiently long period to justify a cure, and yet, despite this care and attention, the cough remains the same. the child is not sick, the appetite is good, there is no fever, it plays and seems to enjoy good health, yet for weeks and frequently for months the annoying cough hangs on. it is as a rule worse at night. it begins soon after the child falls asleep and spoils the entire night's rest or a great part of it. it may be a dry, hard, hacking cough, or a croupy, harsh bark. it may come in spells with a considerable interval between them, during which time the child falls asleep, or it may be almost constant, not quite severe enough to rouse the child, but bad enough to spoil the child's rest and the rest of the mother. if this condition lasts for a long time, as it occasionally does, the health of the little patient is apt to suffer from loss of sleep. treatment.--these children should be taken to a good physician and thoroughly examined. special care should be devoted to investigating the condition of the nose, throat, ear, stomach, heart, and lungs. a very large majority of these coughs are caused by adenoid growths in the back part of the nose. the child may not look like an adenoid child, nor may it breathe through its mouth when asleep, and it may have had its adenoids removed, yet in spite of these contra-indications it may have enough loose adenoid tissue in its nose to cause this kind of persistent cough. this has been proved many times. it is not only useless but positively harmful to give these children cough remedies. the cause of the cough must be found and treated. the cough may be indirectly caused by anemia (poor blood) or heart or stomach trouble, or it may have a number of other causes. whatever it is it must be found by a careful physical examination or a number of careful physical examinations, because these cases are as a rule obscure and difficult to diagnose, and even the most expert examiner cannot always tell where the trouble is without seeing the child a number of times. the parents must therefore have patience and confidence in the physician and must aid him all they can by watching and reporting all the symptoms, etc., to him. (see article on adenoids). summary:-- coughs that resist careful treatment are not "ordinary coughs." coughs of this type require special medical care. the usual cough medicines are not only useless in these coughs, but dangerous. don't give them. acute catarrhal laryngitis: spasmodic croup: false croup croup is one of the common diseases of childhood. it usually follows a catarrhal "cold in the head" with a cough. croup is most frequently associated with large tonsils and adenoids. it may come on gradually or it may occur suddenly. there is always fever with croup. one of the first symptoms is a hard, dry, croupy, barking cough, which gets worse toward night. if it occurs suddenly, the child will wake about midnight with the characteristic croupy cough. the disease may go no further than this and under the proper treatment is well in a few days. in other cases, however, there develops marked interference with breathing. every inspiration is accompanied by a loud hissing or "crowing" sound. this feature of the disease is one that frightens the parents, though it seldom means anything serious. the child sits up in bed, frightened, and struggles for breath. it may clutch its throat with its hands as if something was tied round its neck. the lips may become slightly blue and the perspiration appears upon the child's brow. after some time,--it may be two or three hours,--the attack wears away and the child goes to sleep. next morning it wakes up apparently well except for the croupy cough. the attack may repeat itself the next night and mildly on the third night. treatment.--the object of treatment during an acute attack, when the child is struggling for breath, is to relax quickly the spasm of the larynx which interferes with the breathing. the simplest way is to give the child a teaspoonful of the fresh syrup of ipecac. if the child does not vomit in fifteen minutes, give another teaspoonful and keep on giving it every fifteen minutes till the child vomits. one or two doses is usually enough, but it must be given till the child vomits. if the attack comes suddenly during the night and there is no syrup of ipecac in the house, the physician should be sent for at once and informed that the child probably has croup, so he may know what to take with him. while waiting for the physician the mother should apply over the front of the neck (in the region of adam's apple), hot applications. these are best made of flannel wrung out of quite hot water every two or three minutes: also a hot mustard foot bath. when the physician takes charge of the case he will also direct the treatment for the following day in order that the attack of the next night may be a very mild one, if it should came at all. children who have a tendency to frequent attacks of croup should receive the same attention as the children do who are subject to attacks of tonsilitis and acute catarrhal rhinitis. summary:-- st. spasmodic croup always requires prompt and efficient treatment. nd. it is called "false" croup, because "true" croup is always diphtheritic and is a very serious disease. rd. for that reason a physician should always be called because if it is "true" croup antitoxin must be given at once. th. don't worry unnecessarily because, though "spasmodic croup" can make the child look exceedingly sick for a very short time, an uncomplicated case in a healthy child is seldom if ever dangerous. tonsilitis: angina: "sore throat" this is one of the frequent diseases of childhood. we rarely see it in infants. it is caused by inhaling air which contains poisonous germs. these germs quickly develop when conditions are favorable. they lodge in the pores or follicles of the tonsils and set up an active inflammation. the tonsils swell up and the follicles exude a thick fluid which looks like curdled cream. this fluid sticks in the mouths of the follicles forming spots. if enough of this fluid is coming out, these spots join together forming patches, and the patches may join together forming membrane. this is why it is sometimes so difficult to tell whether the case is one of tonsilitis or diphtheria. conditions are favorable to the development of tonsilitis if the child is not in good health when he happens to inhale the infection, when the feet are wet or cold, or when the child is allowed out during inclement weather and it becomes chilled or numbed from cold, when the child has a cold in the head and a running nose, or when its stomach is out of order. any condition in which the child should be carefully watched and tended to, rather than allowed further liberties, or risks, conduces to sore throat of some kind. some children have the disease a number of times; they seem to be predisposed toward a sore throat. these are children who have large tonsils or who are rheumatic. the tonsils should be removed in the one case, and the tendency to rheumatism should be the main treatment in the other case. these children should be encouraged to cleanse the throat and nose morning and night with a warm salt solution (half a teaspoonful of ordinary table salt to three-quarters of a cup of warm water). this will help greatly to prevent these chronic sore throats. symptoms of tonsilitis.--the disease begins suddenly. the child may have a chill or be seized with sudden vomiting or diarrhea. a very young infant may have a convulsion. the usual way is for the child to develop a fever quickly, to complain of being sick and tired. muscular pains all over the body and a severe headache are constant symptoms. the fever is usually high from the beginning. the child will tell you its throat is sore, but there is as a rule very little pain in the throat. the little spots or patches can be seen on one or both tonsils. the general symptoms are more pronounced than the local throat symptoms. the amount of physical depression that is caused by a tonsilitis is out of all proportion to the seriousness of the disease. tonsilitis lasts three days usually. the throat symptoms may take a day or two longer to clear up, and the patients feel more or less weak for some time after all the symptoms have disappeared. tonsilitis is medically regarded as one of the mild diseases of childhood. it is, however, of very great importance because of its likeness to diphtheria, and inasmuch as a positive diagnosis must be promptly made, in the interest of the patient, it is given close attention and treated with considerable respect by the medical profession. the chief differences between the two diseases are as follows: tonsilitis begins abruptly with pronounced prostration and a high fever the first day. the patient feels distinctly sick all over. the second day the patient feels somewhat better, the fever is lower and the prostration and pain are not so marked. the third day he feels better still, and but for a little weakness would feel well. diphtheria begins slowly and insidiously, with very little prostration and a very low fever the first day. the patient scarcely feels sick. the second day more prostration is present, the fever climbs upward a little more, and the patient begins to feel sick. on the third day the prostration is much more profound, the fever is higher, and all the evidences of a serious sickness are present. two very different pictures: the one begins bad and ends easy, the other begins easy and may end bad. the important fact, however, so far as the similarity of the two diseases is concerned, is, that we must make the diagnosis positive on the first or second day, because if we are dealing with a case of diphtheria we must give antitoxin at once. this is essential, because the efficacy of antitoxin is greatest when given early in the disease. by "early" we mean the first or second day of the disease. when antitoxin is given late (the third or fourth day of the disease) it is much less efficacious and must be given in relatively larger doses. the need, therefore, of a quick, positive diagnosis is a real one. another important element involved in a speedy diagnosis is, that we must not take any chances of infecting other children. so important are these conditions that it is the proper treatment to give antitoxin at once in every case of tonsilitis that in the slightest way resembles diphtheria. an examination of the throat contents,--a culture of which is taken during the first visit of the physician,--will, of course, reveal the true condition and dictate the future use of the antitoxin. antitoxin is absolutely harmless when given to a patient who has no diphtheria. every case of tonsilitis should be quarantined when there are other children in the house. the local condition of the throat helps in the diagnosis: in tonsilitis (as the name implies) the disease is limited to the tonsils and on the tonsils (one or both) do we find the spots or patches. in diphtheria, on the other hand, the membrane is not limited to the tonsils, but may cover every part of the throat and extend into the nose and mouth. in tonsilitis it is spots or patches we see in the throat. in diphtheria it is membrane we see always. the difficulty here again is that if we wait till the diphtheritic membrane covers the whole throat, antitoxin will not be of much use. in diphtheria we have a characteristic odor, in tonsilitis we have no characteristic odor. the practical lesson to be learned from this uncertainty is, immediately to get a physician as soon as you find spots in the throat of your sick child, unless you are absolutely sure that the condition is not diphtheria and you are willing to take that chance. treatment of an acute attack of tonsilitis.--put the child in bed at once and keep him on a light diet during the fever. give him all the cool boiled water he wants to drink. if the fever is very high it can be controlled by sponging the body with cool water. if the patient is an infant the food should be reduced to one-half strength. tonsilitis is a disease that runs a certain course and gets better, or the patient develops some other more serious conditions as a result of neglect or carelessness. we therefore try to make the patient comfortable and let the disease take care of itself. the throat can be gargled or sprayed with any mild antiseptic liquid, or it can be painted with tincture of iodine or per cent. solution of silver nitrate. as a rule the gargles do not aid in the cure of the disease, though they contribute to the comfort of the patient. a cold compress made of half a dozen thicknesses of cloth, such as a table napkin, and put under the jaw (not round the neck), and covered with oiled silk and held in place with a bandage that meets and is tied on the top of the head, is of distinct usefulness. when it is known that the child is rheumatic, the heart must be carefully watched during the fever and anti-rheumatic remedies depended upon to effect a cure. summary:-- tonsilitis, because of its likeness to diphtheria, must be promptly and carefully diagnosed. a physician only is capable of making a diagnosis. any sore throat in a child with spots or membrane is deserving of serious and immediate attention. a mistake may mean death. don't take a chance. bronchitis bronchitis is one of the commonest diseases of childhood. it is the cause of many deaths. exposure during inclement weather is as a rule the cause of it. it occurs in all classes and conditions of children. poorly nourished and badly clothed children are more liable to get it than are others. it is more dangerous in young children and infants than in older children. a young child or an infant will get bronchitis quicker than those older and stronger under the same conditions. bronchitis is often present while children are suffering from other diseases, measles, influenza, scarlet fever, typhoid fever, pneumonia, diphtheria, whooping-cough, for example. it may accompany any disease of childhood, however. symptoms.--in infants bronchitis usually follows a "cold in the head," with running nose and a cough. the child is indisposed and peevish because of the cold. in a few days the cough becomes worse, fever develops, the breathing is quicker, and the baby looks and acts sick. the cough may be constant and severe; sometimes the cough does not seem to bother the baby, although this is exceptional. the breathing is quite rapid and is accompanied with a moist, rattling sound in the chest. the baby is restless and if the cough is severe it becomes exhausted. vomiting or diarrhea may be present. bronchitis in older children.--bronchitis in older children comes on abruptly, with fever and cough. the child may complain of headache and pains in the chest or other parts of the body. it may begin with a chill or chilly feelings. these children "raise" with the cough. the expectoration may be quite profuse; at first it is a white, frothy mucus, then yellow, and later a yellowish green; it may be slightly tinged with blood. there is a mild form of bronchitis in these older children where the serious symptoms are absent. the children are not sick enough to go to bed, but they appear to have a "heavy cold" with, at first, a tight, hard cough, which is usually worse at night. later the cough turns loose and the same expectoration occurs as in the severe type. it is these cases of mild bronchitis which do not receive the proper care and treatment that develop into the so-called "winter cough," which lasts for months. treatment.--(see page under heading, "catching colds.") children who acquire bronchitis easily and frequently, should be built up. cod liver oil should be given all winter. the sleeping apartment of these children should not be too cold, but it should be well aired through the day and well ventilated throughout the night. flannel night clothes should be worn and the feet should be kept warm always. mild attacks of "cold in the head" should be treated vigorously and not neglected. the following "don'ts" may be profitably studied when your child or baby has bronchitis:-- don't keep the windows tightly closed; fresh air and good ventilation are absolutely necessary to the patient. don't use a cotton jacket or oil silk. don't wrap the child up in blankets and shawls. don't carry the child around; keep it in bed. don't dose the child with syrupy cough mixtures. don't overheat the room. don't let friends bother or annoy the baby. don't reduce the diet unnecessarily. the child should be put to bed. the temperature of the room should be degrees f. all the time. the windows should be opened top and bottom according to the weather, and the room should be well aired every day, the patient being taken to another room while it is being done. the child should have its usual night clothes on, nothing more. if the child is not very sick and insists on sitting up, a bath robe can be worn but it should be always removed when it sleeps. it is advisable to change the position of the baby from time to time. have it rest on one side, then on the other, as well as on the back. give a dose of castor oil at the beginning of the sickness and keep the bowels open during the disease. diet.--the diet will depend upon the severity of the disease. if the fever is high and the cough persistent, the strength of the food of nursing infants should be reduced. we can reduce the strength of the food by giving the child a drink of cool boiled water before each feeding and shortening the length of each feeding. older children may be given toast, milk with lime water, cocoa with milk, broths, gruels, custards, cereals and fruit juices. inhalations.--the value of inhalations in bronchitis is very great. the ordinary croup kettle, which can be bought in any good drug store, is the best method of giving them. full directions come with each kettle as to the best way to use it. the best drug to use in the kettle is creosote (beechwood). ten drops are added to one quart of boiling water and the steaming continued for thirty minutes. the interval between steaming is two hours and a half in bad cases day and night. in mild cases the night treatments can be dispensed with. sheets rigged up over the top and sides of the crib, in the form of a tent, is the most desirable way to give the inhalations. external applications.--counter-irritation by means of mustard pastes are the best applications. they should be put back and front--one on back and one on the chest, overlapping at the sides beneath the arms. they should cover the entire body from the waist line to the neck. these pastes are made as follows:--mix the mustard (english) and the flour in the following proportions, using a quantity according to the size of child and area to be covered; one tablespoonful mustard to three tablespoonfuls of flour. mix with lukewarm water until a paste is formed, not too thick and not too thin. spread on a cloth (put plenty on) and cover with one layer of cheesecloth and place the cheesecloth side next the skin. in order to guard against burning the skin it is advisable to rub the skin with vaseline, before and after putting on the paste. the paste should be left on until the skin is uniformly red. it may be applied from two to four times in the twenty-four hours according to the severity of the case. mustard pastes are most effective during the first two or three days of the disease. drugs.--drugs are of very little value in the treatment of bronchitis. in the first stage of the disease, when the cough is hard and dry, small doses of castor oil and syrup of ipecac may be given to good advantage. the following dosage should be followed closely: st year, drops castor oil, drops syrup of ipecac, every two hours; rd year, drops castor oil, drops syrup of ipecac, every two hours; over years, drops castor oil, drops syrup of ipecac, every two hours. the benefits from this treatment will be obtained in the first two or three days, when it should be discontinued. the cough under this treatment and the use of the mustard paste and inhalations of creosote will be soft and loose in two or three days and the fever will be distinctly on the mend. the disease lasts from five to ten days. it may, however, last much longer according to the condition of the child, etc. there are other drugs that can be given, with good effect, but when other remedies are indicated a physician should be called to prescribe them according to indications. summary:-- bronchitis is one of the commonest diseases of childhood. it is the cause of many deaths. a large number of children have a tendency to bronchitis. these children need careful attention and "building up." do not neglect a "little" cold. it means trouble. chronic or recurrent bronchitis.--bronchitis becomes chronic when the treatment of an acute attack fails to cure the condition. the failure usually is dependent upon the condition of the child. it may be suffering with some disease resulting from poor nourishment or poor sanitary and hygienic surroundings or both. the bronchitis, in other words, is dependent upon some other condition, and will not get wholly better until the cause is cured. these children should lead an active outdoor life when the weather is favorable. their sleeping-room should be well aired and ventilated. red meats are allowed twice a week only. sugar is cut down to the lowest limit. skimmed milk only should be taken--the cream being too rich for them. they can eat freely of fruits in season, green vegetables and cereals. the bowels must move freely every day. patients must be given a lukewarm bath, followed by a brief spray of cold water, daily. the cold spray should not be too cold; about degrees f. is the suitable temperature of the water. an absolute change of climate, to a warmer inland atmosphere, is imperative before some of these patients will begin to improve. summary:-- a child with chronic bronchitis, or with frequent attacks of bronchitis (or chronic colds), is usually suffering from some other diseased condition. the bronchitis, or the cold, will not get better until you find out what that "other diseased condition" is. it takes a physician to find that out. having found the cause, cure it, and the bronchitis will disappear and the general health of the child will immediately improve. pneumonia pneumonia is a very common disease in childhood. it is the most frequent complication of the various acute infectious diseases. pneumonia is an exceedingly important factor in the mortality of infancy. there are two kinds of pneumonia:-- . broncho-pneumonia. . lobar-pneumonia. acute broncho-pneumonia.--up to the fourth year this is the form of pneumonia always present. it is the form that always complicates other diseases all through childhood. it is most apt to occur during the spring and winter months. it affects all classes, but especially those whose hygienic surroundings are poor. catching cold is the exciting cause in a large percentage of primary pneumonias. symptoms.--broncho-pneumonia has no regular course. it may or it may not follow a cold or an attack of bronchitis. as a rule it begins suddenly with a high fever, frequently accompanied by vomiting, rapid respiration, cough, and prostration. the child does not maintain a high fever continuously; it varies considerably throughout each twenty-four hours. it lasts from one to three weeks, and subsides gradually. the respirations vary between and per minute, though they may be much more frequent than this. the child breathes with apparent difficulty, the soft parts of the cheeks and nose rising and falling as it breathes. the prostration becomes, as the disease progresses, more and more marked, until the child looks profoundly sick. cough is a constant and incessant symptom. it disturbs rest and sleep and may cause frequent vomiting. there is no expectoration. a strong cough is a good symptom; if it stops it is a bad symptom. pain is seldom present. blueness of the skin is a bad sign and indicates failure of respiration and suggests constant and careful watching. delirium may be present during the disease. it is not necessarily a bad sign. accompanying stomach troubles are frequent if the patient is very young, and are very important. the bowels may be loose; they may be green in color and contain much mucus. large quantities of gas may accumulate in the intestines and may cause much distress and convulsions. death may occur at any time or the process may be arrested and recovery take place at any stage of the disease. broncho-pneumonia is not necessarily a fatal disease in a fairly healthy child. it is, however, always a serious disease. various complications may occur in the course of the disease. the most frequent are: pleurisy, emphysema, abscess of the lung, meningitis, heart disease, stomach troubles, thrush, intestinal disease. how to tell when a child has broncho-pneumonia.--if a child develops a high fever, breathes rapidly, coughs, and is content to lie in bed because of the degree of prostration, broncho-pneumonia is almost certain to be the disease present. if in addition to these symptoms there is any blueness of the fingers or around the mouth it is more strongly suggestive of pneumonia. if the child has been suffering with bronchitis it is sometimes difficult to tell just when the pneumonia begins. the child will appear more profoundly sick, the fever will go higher, and the respiration will be more frequent when pneumonia sets in on top of bronchitis. treatment.--the nursing of a little patient with pneumonia is the most important part. he must get plenty of fresh air; consequently he should be kept in a well-ventilated room. it is an excellent plan to change the patient twice daily from the sick room into another which has previously been thoroughly aired. while he is in this room the sick room should be as thoroughly aired as is possible. keep this plan up all through the disease; change the position of the patient in bed every two hours. he should never be allowed to lie on his back for hours at a time. in this way the different parts of the lungs get a chance to air themselves,--the air cells expand and the oxygen in the air and the fresh blood tend to heal the parts more quickly. it would be distinctly wrong to go into the detailed symptomatic treatment of broncho-pneumonia in a book of this character. inasmuch as this is one of the most serious diseases of infancy, no mother should attempt to treat it alone. a physician is absolutely necessary and the most the mother can hope to do is to follow out his directions to the letter. he may direct the use of mustard pastes but it is essential to know where to apply them. if he should request the use of the cotton jacket, the height and character of the fever must regulate its use. stimulants are always necessary, whisky and strychnine being given in every case, but if given at the wrong time they may do more harm than good. cough mixtures may be necessary, but frequently they are contra-indicated. drugs and cold sponging may be used to reduce the fever, but they are dangerous if used when conditions do not justify their use. complications must be diagnosed when they occur, and the correct methods of treatment promptly instituted. a competent physician alone can assume the responsibility of these various phases of the disease. every mother should appreciate, however, that pneumonia is frequently the result of carelessness. it is a well-known fact that pneumonia is an infrequent disease among children of the well-to-do, because the hygienic surroundings of these children are better and because they receive competent attention if suffering with colds and bronchitis. bronchitis is quite common in all classes of children, but in the lower walks of life it is the custom to allow children to run around while they give every sign of having a heavy cold, and a beginning bronchitis. these children should receive treatment and should be kept indoors and in bed if they have even a slight fever, as pneumonia is frequently the inevitable outcome. they should be carefully fed, and all signs of stomach or intestinal troubles attended to at once. [illustration: by permission of henry h. goddard a grim result isaac is , although mentally . he is a high-grade moron. this is one of those all too frequent instances[a] "of a feeble-minded woman with a husband who is alcoholic and the offspring either feeble-minded or miscarriages." "isaac is exceedingly dangerous. he is a potential criminal or bad man, or under the best conditions would at least marry and probably become the father of defectives like himself." this and the succeeding pictures in this volume contrast vividly with the frontispiece. terrible are the results when we disregard the inevitable laws of nature, and so mate ourselves that our children will be parasites on society.] [a] "feeble-mindedness; its causes and consequences", goddard, the macmillan company. the after-treatment of pneumonia is important, and every detail has a distinct bearing on the ultimate recovery and establishment of good health. careful feeding, a good tonic, and the proper attention to exercise, fresh air and bathing are requisite. a change of air after the fever is gone is more important than all other measures put together. a dry, warm climate where patients can be kept in the open air is preferable. the danger of allowing a slow, long drawn-out convalescence after pneumonia is the development of tuberculosis. adenoids adenoids are very common, almost popular, in childhood. the condition is one that causes more real trouble and discomfort than any other childhood affliction. adenoids are associated with, and are responsible for, many of the ailments of childhood. they may be associated with enlarged tonsils or they may be independent of them. they may be present at birth or develop any time thereafter, though they are more frequent between the ages of two and six years. children who have adenoids invariably suffer from chronic "head-colds" with a discharge from the nose. these chronic colds are caused by the adenoids. nearly every disease, and every diseased, or abnormal, condition of the nose, throat, larynx, and lungs can be directly caused by the presence of adenoids. they are also responsible for numerous other conditions of very grave importance in the growing child. the accompanying "head-colds" may develop into a bronchitis which may keep the child indoors for a long period. adenoids always interfere with respiration, thereby depriving the child of a normal quantity of oxygen, thus rendering the blood less pure, and, as a consequence, seriously interfering with the nourishment and general health. the impaired nourishment and poor health thus produced, as a direct result of adenoids, renders the child more liable to disease; he may thus acquire ailments that may affect his whole subsequent life. the mental side of a child's development is also affected by the presence of adenoids, so much so that actual statistics prove that these children cannot keep up with their classes in the public school. we must therefore regard the presence of adenoids as a serious menace to the health and comfort of the patient. it has already been pointed out in discussing other diseases that before a cure of these diseases could be permanently accomplished it would be absolutely necessary to remove the adenoids, which were, no doubt, the actual cause, or an important contributing cause, of the disease. such conditions as catarrhal laryngitis, croup, chronic recurring winter coughs, acute catarrhal rhinitis, "snuffles", "cold in the head", chronic catarrh, bronchial asthma, incontinence of urine, "bed-wetting", "nose-bleeding", headaches in growing children, anemia, deafness, night terrors, defective speech, diphtheria, consumption, are frequently caused by the presence of adenoids. these patients contract certain diseases easier than other children, and when they do, they have them more severely; such diseases are diphtheria, tuberculosis, scarlet fever, measles, and whooping cough. adenoid children are, as a rule, in better health during the warm, equable, summer weather than during the changeable, uncertain weather we have in the winter months. if the case is neglected, and if the adenoids have existed for a long time, the growth of the child is impaired. he remains small and stunted, and the expression of the face is dull and stupid. the temperament and disposition are affected also; such children are languid, listless and depressed. how to tell when a child has adenoids.--children with well-developed adenoids are "mouth-breathers." instead of breathing through the nose they breathe with the mouth open, especially when sound asleep. if a child has a discharge from its nose and a chronic cough, both of which resist treatment, and if in addition it is a mouth-breather, it is safe to investigate the naso-pharynx for adenoids. if a child with these symptoms is not in good health, is listless and depressed, looks stupid, snores at night, has difficulty in breathing and cannot blow its nose satisfactorily, is troubled occasionally with "nose bleeds" and headaches, we may be satisfied that the child has adenoids, as no other condition could produce such a picture. adenoids, like enlarged tonsils, are dangerous, apart from the physical distress and disease which they cause, owing to the fact that they harbor deadly bacteria, and from these bacteria, which find a lodgment in the adenoids and tonsils, a fatal attack of diphtheria or consumption may have its beginning. treatment of adenoids.--absolute removal is the only justifiable treatment. this is rendered imperative for so many reasons that it is unnecessary to go into details in justification of the procedure. the physical well-being, the mental development, the life of the child depend upon it. any parent who would wittingly interpose an objection to the removal of his or her child's adenoids, after they have been demonstrated to exist, would be guilty of a grave crime. the operation itself is not at all dangerous. it is over in a few moments and the child is well in an hour or two, so far as any pain or suffering is concerned. physicians are frequently asked if adenoids "grow" again after removal. the answer is, "yes," they sometimes do. in a very small percentage of the cases they do return. the older the child is when they are removed the less chance there is of a recurrence. a child operated on before it is two years of age is more liable to a recurrence than a child operated on at six years of age. this must not, however, be construed as an excuse for putting an operation off, because if a child needs an operation at two years and it is postponed till later, its health will be permanently injured before it is four years of age. summary:-- . adenoids cause more trouble and more actual disease than any other condition during childhood. . it is a crime for a parent to refuse operation if the presence of adenoids has been proved. . removal is the only treatment and it should be done in every case as soon as possible. . the operation is a trivial one and is free from danger. nasal hemorrhage--"nose bleeds" a hemorrhage from the nose may occur at any time from birth on. it depends upon the rupture of one or more blood vessels. the great majority of "nose-bleeds" are caused by adenoids, or by a small ulcer in the nose, or by an injury, such as a blow or fall. a nasal hemorrhage, however, may be caused by other, more serious conditions, and for that reason may justify a careful inquiry into the cause, especially if bleeding should occur a number of times, or be of a serious character the first time. of the more common causes as given above, the adenoids should be removed, and the chronic catarrh which is invariably the cause of the ulcer should be cured. treatment of an acute attack.--have the patient sit erect; loosen all tight clothing around neck; fold the hands over the head; apply cold to the back of the neck and the nose. pieces of ice can be put into the nostril and the ice bag to the nape of the neck, or a piece of ice can be put into a folded napkin and held on the back of the neck. taking a long breath and holding it as long as possible and repeating it while the ice is being applied is an aid. placing the feet in hot mustard water is of decided use. another excellent expedient is to wrap absorbent cotton round a smooth probe (piece of whalebone, for example), dip the cotton in an alum-water mixture (half teaspoonful powdered alum in a half cupful of water), and then push it into the bleeding nostril as far as you can with gentle force. a valuable remedy is peroxide of hydrogen used full strength and freely dropped into the nostril. if these measures fail, send for a physician at once. summary:-- st. nose bleeds may be caused by some serious condition. nd. if they occur a number of times have the child examined. rd. if the treatment outlined above does not stop the bleeding in a few moments send immediately for a physician. quinsy quinsy is not common in childhood. it usually follows tonsilitis when it is seen. the child complains of pain in the neck, extreme pain and difficulty upon swallowing, and inability to open the mouth as much as usual. there is a tendency to hold the head to one side. the treatment is to open the abscess at the earliest moment after pus is present. hiccough hiccough is, in most cases, in infancy and childhood caused by some irritation of the stomach, may be over-filled with food or gas. in these cases it is an unimportant incident and may be quickly relieved by giving the child an enema of soap-water and a laxative of rhubarb and soda. infrequently hiccough may be the result of cold feet, or a surface chill. simple methods of relief are, to hold the breath, to expire, or blow the breath out as long as possible before taking the next breath; to sip water from a cup held by another person while the tips of the two fore-fingers are in the ears. hiccough is quite frequent in hysteria in girls, but it is of no consequence. when hiccoughs set in during the course of any serious disease it is a very unfavorable sign. sore mouth: stomatitis stomatitis is an inflammation of the mucous membrane (inner lining) of the mouth. the gums and the inner surface of the lips and cheeks may be red and angry-looking. there may be small grayish spots on any part of the mouth. if the case is very bad or if it has lasted some time and has been neglected, these spots grow larger and join together forming irregular grayish plaques. a large percentage of the cases never go further than this because the proper care and attention is given them. it is possible, however, for any case to progress further and become ulcerative. this will be observed first as a faint yellow line at the margin of the teeth and gum. ulceration never takes place unless the child has teeth. the quantity of saliva is very greatly increased, so much so that it flows out of the mouth soiling the clothes. the saliva is intensely acid and it consequently irritates the skin, causing more or less eczema. the mouth is painful and hot. there is slight fever, but seldom any marked prostration. if, however, the ulceration should be severe, the fever may be quite high. there is one feature of these cases that sometimes proves vexatious and annoying. because of the soreness of the mouth, the child cannot draw strongly enough on the nipple to get a normal feeding, and as a result the nutrition of the child is poor. these children are hungry and when offered the nipple grasp it greedily, draw a few mouthfuls then stop because of the pain and begin to cry. if the ulceration is extensive, there is usually an odor and the gums bleed easily. sometimes the teeth fall out or have to be drawn out. strong, well-fed children are as likely to develop stomatitis as are those who are weakly and ill fed. the disease is caused by infection and is contagious. just what the infection is we do not know; we do, however, know that children whose mouths are carefully cleaned after each feeding do not have sore mouths of this character. when cleaning the mouth care must be observed not to injure the tender mucous membrane. treatment.--as soon as the condition is observed mouth-washing should be systematically and thoroughly carried out. after each feeding the mouth should be washed with a saturated solution of boric acid in boiled water. (see page .) it is not necessary to use any further treatment, as a rule. patients recover in four to eight days. strict attention to cleanliness, however, is imperative. the feeding bottle and nipple, or the mother's nipple, if breast fed, must be kept scrupulously clean. the feeding of these children is sometimes a problem for a day or two, because, as stated above, of the soreness of the mouth. this is best overcome by feeding the baby with a spoon. if breast fed, it is necessary to pump the milk and then feed with the spoon. children will take the milk better if it is fed cold. cold boiled water is largely taken and is good for them at this time. treatment for ulcers in mouth.--the ulcers should be touched with a camel's-hair brush which has been dipped into finely powdered burnt alum. if a stronger caustic is necessary, the solid stick of nitrate of silver may be used. a mouth wash may also be used in the ulcerative cases, composed of the peroxide of hydrogen diluted with two parts of water. if this is used wash the mouth out afterward with plain, cool, boiled water. the peroxide mouth wash can be used four or five times daily. in addition to the mouth washing in the ulcerative cases it is advisable to use internally chlorate of potash. the druggist should be requested to make a two-ounce saturated solution, and of this you can give one-half teaspoonful, largely diluted with cool water, every hour during the day for the first twenty-four hours, then every two hours until marked improvement is shown, when it can be further reduced by lengthening the interval between doses. sprue--thrush sprue is a form of sore mouth. it is seen only during the first six months of life, as a rule. it affects the mucous membrane of the mouth; it appears in the form of small white spots that look like drops of curdled milk. they are on the inner surface of the cheek and may be all over the mouth, and on the tongue. the spots are firmly attached, and if forcibly removed the mucous membrane will bleed. the disease is caused by infection through lack of cleanliness and it invariably affects poorly nourished children, especially those who are bottle-fed. there are no symptoms other than those of the mouth; the child frequently refuses to nurse because of evident pain and distress while nursing. the condition is not contagious. it may be cured in from six to eight days without difficulty. treatment.--mouth irrigations of boracic acid are all that are necessary. they are given in the following way: place the child on its side, roll around the index finger a piece of absorbent cotton, dip this in a saturated solution of boracic acid, and put into the mouth of the child. let the cotton take up as much of the solution as it will hold, so that when it is lightly pressed on the tongue and cheeks it will flow out of the mouth, thus "irrigating the mouth." repeat this a number of times, pressing the cotton to a different part each time. this should be gone through from four to six times daily. if the child is a bottle-fed baby, care should be taken in cleaning the nipples and bottles as directed on page . if the patient is breast-fed, care must be taken to note that the mother's nipples are clean. they should be washed with the same solution of boracic acid and not handled. if the child cannot nurse it is necessary to feed it with a spoon. in obstinate cases the parts may be touched with a one per cent. solution of formalin. mothers should particularly note not to use honey and borax, as is often recommended by women who know no better, in any disease of the mouth in children. * * * * * chapter xxxv diseases of the stomach and gastro-intestinal canal inflammation of the stomach--acute gastritis--persistent vomiting--acute gastric indigestion--iced champagne in persistent vomiting--acute intestinal diseases of children--conditions under which they exist and suggestions as to remedial measures--acute intestinal indigestion--symptoms of acute intestinal indigestion--treatment of acute intestinal indigestion--children with whom milk does not agree--chronic or persistent intestinal indigestion--acute ileo-colitis--dysentery--enteritis--entero-colitis--inflammatory diarrhea--chronic ileo-colitis--chronic colitis--summer diarrhea--cholera infantum--gastro-enteritis--acute gastro-enteric infection--gastro-enteric intoxication--colic appendicitis--jaundice in infants--jaundice in older children--catarrhal jaundice--gastro-duodenitis--intestinal worms--worms, thread, pin and tape--rupture acute gastric indigestion acute inflammation of the stomach--acute gastritis--persistent vomiting an infant seldom has real inflammation of the stomach. gastric, or stomach, indigestion is the better name, because it actually signifies the true condition. it is indigestion that causes a child to vomit, though it is possible to have a true inflammation caused by the taking of irritant or corrosive drugs. gastric indigestion causes sudden, repeated vomiting, with prostration and occasional fever. it is caused by unsuitable food, the wrong quantity of food, irregular feeding, and food the quality of which is not good. treatment.--the stomach should be immediately washed out. until the physician arrives the mother can encourage the child to drink a large quantity of cool boiled water. this will be vomited and it will wash out the stomach at the same time. no further treatment may be necessary, as the vomiting may stop. all food should be withheld for at least twenty-four hours. a high rectal irrigation should now be given. it is essential to know that the bowel is absolutely clean in all vomiting cases. the normal salt solution is the best agent to use for a high enema in infants. (see page .) after twelve or twenty-four hours' abstinence from food, the child can be given teaspoonful doses every twenty minutes of cooled boiled water, or barley or albumen water, weak tea, or chicken broth. cold liquids are better retained and more readily taken than those that are heated. if the liquid feedings are vomited, another twelve hours must elapse before trying stomach feedings. in these cases we must try to satisfy the thirst by giving cold colon flushings. if the case becomes protracted and we find it impossible to nourish the child by the mouth, we must wash the stomach out once every day with a five per cent. solution of bicarbonate of soda, and feed the child by the rectum. sometimes we can feed through the stomach tube. liquids will frequently be retained when put into the stomach through a tube when they will be vomited if swallowed. the best food by the rectum is plain peptonized milk. drugs are absolutely useless. if the vomiting persists, despite the above efforts to stop it, there is nothing to be gained by experimenting. you will not only render the condition worse but you will weaken the child. morphine given hypodermatically is the only remedy. given in appropriate doses, according to age, it is absolutely harmless. it will not only stop the vomiting, but it will give the child a much-needed rest, by allowing it to go to sleep. when it wakes up it will be stronger and its stomach will most likely retain small doses of nourishment. great care must be exercised, in getting the child back on a normal diet, not to try to go too fast. in cases of persistent vomiting in children i have found it advisable to use teaspoonful doses of ice-cold champagne. these children will sometimes keep this down when all other liquids will be vomited. it is absolutely necessary to keep the child lying down. if he is restless or sits up, the vomiting may begin all over again. the champagne not only is excellent nourishment for the child, but it quiets the stomach, allays irritability, and frequently favors sleep, during which time a cure very often results. the champagne must be drawn through a champagne siphon (procured in the drug store), and the bottle must be kept on ice with the mouth downward; otherwise it will get stale very quickly and be of no use. if kept as advised it will remain good to the end. summary:-- st. persistent vomiting in a child means acute gastritis. stop all food for twenty-four hours. nd. encourage the child to drink large quantities of slightly warm water; this will wash the stomach out and frequently stops the vomiting. rd. when the child is quiet wash out the bowels. th. if vomiting persists, use iced champagne as directed. acute intestinal diseases of children the large infant mortality that results from intestinal diseases during the summer months is deserving of the most careful consideration, both of the physician and the parent. apart from the excessive heat of the summer, there is no doubt that an unfavorable environment, which means bad hygienic surroundings, bad sanitary conditions, bad food and home influences, contributes largely to the enormous number of these serious cases. education, while it may be expected to influence favorably the sanitary and other conditions in the home, cannot change the home location. the child must continue to live in the same environment. it is in this class of cases that these summer diseases are so very fatal. children in better circumstances can take advantage of conditions which are denied to the tenement child. the diseases must therefore be faced and treated under these existing conditions. in addition to the climate and the environment, there are certain factors that occur in all classes which result in intestinal derangement. if the stomach or bowels are not performing their function properly, or if the food or method of feeding is wrong, these, plus very hot, humid weather, invariably result in serious intestinal disease. the mother must be taught to interpret properly the meaning of a green, loose stool in the summertime; she must appreciate that it is the danger signal and must be regarded seriously. the very best preventive against summer diseases of the intestine is to guard particularly against any trouble with the child's stomach at all seasons of the year. a healthy stomach and bowel will resist disease, even in very hot weather. the most important food product which has a direct relationship to this class of diseases is milk. in a large city like new york it will remain impossible to solve the milk problem, despite the splendid efforts of the health department and the members of the medical profession, until the city itself shall establish milk depots and ice stations where safe milk, and ice to keep it safe, may be obtained at a nominal cost, or free, if the parents cannot afford to buy it. we, therefore, must recognize that the vast majority of children to-day are taking milk that is not suited to them, that is really not fit as a food for children. the mothers do not know this and no steps are taken to render the milk more safe for them to feed to their children. these mothers are willing to do what is essential in the interest of their children, but they do not know what should be done. these people cannot afford a physician or a nurse to teach them, nor do they even know that their methods are wrong or that they need any instruction. we must carry the information and the explanation to them. we must show them the need for a change of methods. this is the work for those charitably disposed women who desire some worthy purpose in life, who really wish to do some real good. all the equipment they need is good common sense. they will tell these mothers why it is necessary to pasteurize the milk before feeding it to the baby. they will show how to keep the nursing bottles clean, and the nipples sweet and fresh. they will instruct them how to dress the baby in the hot weather and impress them with the need of giving it all the cool, fresh air possible. in short, they will gain the confidence and the good will of these mothers in a tactful and diplomatic way, and they will tell them all they know in language which they will understand regarding the care of the baby. in every city in the country this work is needed and is waiting for the missionaries who will volunteer. to teach mothers the need for boiled water as a necessary drink for baby and older children is alone a worthy avocation. to impress upon one of these willing but ignorant mothers the absolute necessity for washing her hands before she prepares her baby's food, that she must keep a covered vessel in which the soiled napkins are placed until washed, that she should frequently sponge her baby in the hot weather, and explain thoroughly why these are important details, is a work of true religious charity. they should be specially taught to immediately discontinue milk at the first sign of intestinal trouble, to give a suitable dose of castor oil and to put the child on barley water as a food until the danger is passed. they should be taught to know the significance of a green, watery stool, they should know that is the one danger signal in the summer time that no mother can ignore without wilfully risking the life of her baby. they should be taught to prepare special articles of diet when they are needed. if every mother were educated to the extent as indicated in the above outline the appalling infant mortality would fall into insignificance. it is not a difficult task nor would it take a long time to carry it out; it is the work for willing women who have time and who perhaps spend that time in less desirable but more dramatic ways. it is the knowledge that aids in catching disease in its inception that counts. the worst infections begin as a mild condition and prompt treatment robs them of their sting. when treatment is delayed and the child is fed for twenty-four hours too long on milk, the condition which in the beginning could have been stopped promptly has developed and it becomes a fight for life. it will be seen from the above that all we need is education. education of the mother primarily, but education of the missionary, the nurse, the physician, the municipality, and the state, each co-operating, each willing to work in the interest of a great cause, for the benefit of the human race and for the brotherhood of man. acute intestinal indigestion causes.--overfeeding, unsuitable and improper food, irregular and indiscriminate feeding, sudden change from one food to another, as at weaning time, a change from a poor quality to a rich food, or vice versa. conditions affecting the health of the child, especially the nervous system, such as hot weather, extreme cold, fatigue, or at the beginning of any of the acute diseases. children sometimes are predisposed to attacks of intestinal indigestion; these children are delicate in health and have weak digestive ability. the slightest irregularity or error in diet will cause an attack in these children. symptoms.--the attack may come on suddenly or it may develop slowly. the important constitutional symptoms are fever, prostration, and a general nervous irritability. the child is seized with pain in the abdomen. the pain is referred to the region around the navel. it is sharp, colicky, and severe, causing the child to cry out and draw up its legs in an effort to lessen its severity. the child is exceedingly restless and acts as if it were on the verge of a dangerous illness. gas in the bowel is not present as a rule as frequently as it is in infants under the same circumstances. in a few hours diarrhea sets in, the stools may number from four to twelve or more in twenty-four hours. the stools are acid, sour, and the odor may be very foul. they are thinner than usual and frothy from the presence of gas. in very young infants suffering from a sudden attack of intestinal indigestion, the stomach, as well as the bowels, is invariably upset. if the indigestion is the result of a slower process, the stomach does not participate in the process. the color of the stools in infancy is yellow, then yellowish-green, and later grass-green. undigested food is always present and in infants the curdled casein of the milk appears as white specks or lumps in the movements. the fever is high in the sudden cases and lower in the cases of gradual onset. the prostration is more severe when the onset is sudden and in infants may be very marked. the termination of the disease depends upon the cause, the treatment, and the previous health of the child. in healthy children promptly and properly treated it may be all over in a week. in delicate, poorly nourished children, and especially in the summer time, it may be the beginning of trouble that may eventuate in death. treatment.--there is no condition in the whole realm of diseases of childhood where the knowledge of the mother may have such important results as this condition. the most effective time to treat these cases of intestinal indigestion is before the physician is called. there are few diseases in which time is so valuable, so far as final results are concerned, as it is here. every mother should know the significance of a loose, green stool. she should be taught that it means danger and consequently demands prompt treatment. the first indication is to empty, thoroughly, the bowel. the best means for this purpose, if it is immediately procurable, is calomel. if calomel is not procurable at once give castor oil, two teaspoonfuls to an infant, one tablespoonful to an older child. calomel should be given in one-eighth-grain doses, repeated every three-quarters of an hour for eight or twelve doses, until the bowel is thoroughly cleaned out. don't be afraid of a few extra movements at the beginning. better clean out thoroughly at the start than to be compelled to do it all over again after the child is weak and suffering from the poison of the disease. the next important thing to do is to stop milk at once. the thirst is usually intense and if vomiting is not present it can be moderately relieved by giving small quantities frequently of cool boiled water or mineral water or strained albumen or barley water. we quite often have to stop all food and liquids by the mouth for twenty-four hours. if the prostration is very great and the child looks as though it might collapse, it can be given brandy in cracked ice from time to time. after the bowels have been thoroughly cleaned out, never before, some medicinal agent may be given to stop the unnecessary diarrhea. in a very large number of promptly and properly treated cases this is not needed. if it is thought best to use it the physician will select the agent according to the conditions present and prescribe it. breast-fed infants rarely have intestinal diseases of a severe type. if they should develop diarrhea they must be taken off the mother's milk for twenty-four hours. they should be given a dose of castor oil or calomel and fed on barley water in the interval. the feedings should be reduced in quantity and the interval doubled. the two-hour interval will become a four-hour feeding: the three or four ounces at each feeding can be reduced to two ounces. the intention is to simply give as little as possible while the diarrhea is under way. the mother's breasts must be pumped at the regular feeding time in order to preserve the flow, release the pressure, and keep the milk fresh. it is sometimes a problem to renew feedings of milk without exciting a relapse of the diarrhea. it should not be tried until the stools are normal in color and consistency. this may not be for three or four days. in resuming the milk it should be given in smaller amounts and diluted with lime water or barley water for the first day. gruels may be given to which skimmed milk may be added: later add the ordinary milk. if it is well digested and does not cause any return of the diarrhea, the quantity of milk can be slowly increased until the former feedings are resumed. it is often of very great advantage to boil the milk for some time. peptonized milk is safe and can be used in bottle-fed infants after diarrhea. in older children, meat, broths, eggs, boiled milk, and dry toast bread may be used sparingly for some time. cereals, vegetables, fruits, should be withheld for a considerable time and watched carefully when resumed. kumyss, buttermilk, matzoon, bacillac, and other fermented milks are better borne than plain milk. all of these children need rest, fresh air, change of air, frequent bathing, and tonics, as an attack of this kind leaves them depressed, weak, languid, and anemic. summary:-- st. when a child complains of sharp, colicky, severe pains in the abdomen, around navel, which are shortly followed by foul, sour, frothy diarrhea,--greenish in color, it has acute intestinal indigestion. nd. every mother should know that a green stool means danger. she should know to give at once a cathartic,--castor oil is good, but give a good large dose--then stop all food for twenty-four hours. if she learns this lesson she will have time to wait for the doctor; meantime, she may have saved her child's life. children with whom milk does not agree contrary to the general belief, there are quite a large number of children in whom milk seems to act as a poison. these children are not necessarily constipated. they suffer, however, from a slow, continuous intestinal toxemia or poison. the symptoms of this condition are headache, disorders of speech, habitual sleep-talking, sleep-walking, and general nervous irritability without cause: they are listless, languid, and constantly tired. they may be bright in the morning and sleepy in the afternoon. they are irritable and cross and touchy. treatment.--milk must be wholly discontinued. eggs must be restricted to one every second day, and meat but once daily. the use of green vegetables is particularly suitable and should be given daily. cereals and fruit also are good. malted milk, kumyss, or matzoon may be given in place of milk. if constipation is present, rhubarb and soda mixture is an excellent laxative in these cases. a tonic should be prescribed for all these children. dysentery--enteritis--entero-colitis--inflammatory diarrhea cause.--any cause which has been mentioned as a cause of ordinary diarrhea may result in this disease. it may occur at any time of the year and at any age. it may follow the infectious diseases. it may follow any other disease of the intestines. symptoms.--it may begin like an ordinary attack of acute intestinal indigestion. there is usually vomiting, fever, pain, and frequent yellow or green stools. the passages may be blood-stained and there may be little or much mucus. the stools at the beginning have no odor as a rule. the bowels move very frequently, often with little or nothing to pass. there may be pain with each movement. the blood may disappear in a few days, but the mucus remains, often in large quantity in each stool. at the beginning the fever is high, but it soon falls and remains low during the attack. the child loses weight, is irritable, has no appetite, and looks and acts sick. when the attack is over these children do not gain their strength as readily as we would like; recovery is slow. the acute symptoms usually last about one week, after this time the child begins to recover, but the process is a tedious one and one in which much care has to be exercised. it is an encouraging sign to note the disappearance of the blood in the stools and the return of the movements to the normal brown color. when these favorable signs are wanting the bowel is probably ulcerated and it will take a much longer time to return to normal and to be free from blood and mucus. the above is the ordinary form of this disease and it ends in recovery as a rule. there is a more severe form, however, which differs from the above in the following way: the fever is high and remains high; the stools are more frequent and there is more blood and more mucus in them; the child is much more irritable and is more profoundly sick. death may occur at any time from the second day. if the little patient survives, the return to health is a very slow process; it often takes months and frequently years before a reasonable degree of strength is regained. relapses are common, and they are very difficult to treat and care for. in some cases the child never wholly regains its former strength. there are children who have been the victims of other intestinal diseases or conditions who develop colitis. the colitis in these cases may come on suddenly with vomiting and high fever, or it begins slowly, with no vomiting and with little fever. their appetite is poor, their digestion is feeble, their prostration is pronounced. they lose flesh rapidly and may be emaciated to a remarkable degree. very few of these cases recover completely. serious and sometimes fatal relapses may take place. the feeding of these children is a difficult task and the greatest care must be constantly taken; a very little mistake may cost the life of the child. treatment.--all diseases of the intestine in childhood should be promptly and efficiently treated. if any form of diarrhea is neglected, it may result in the development of ileo-colitis with all its risks and uncertainty. when a child is seized with sudden bowel trouble, no matter what variety it is, it should be treated with the greatest care because "sudden" bowel trouble usually means plenty of trouble if it is neglected. fresh air is essential in all these cases. a change of air is of decided value as soon as the immediate symptoms have abated. the diet is the same as for children who have gastro-enteric intoxication. later, much difficulty will be met because these patients have absolutely no appetite,--peptonized skimmed milk is always good, beef broths are often well borne, liquid beef peptonoids may be tried. the food should be given every three hours. boiled water and stimulants may be given between the feedings. later in older children, raw beef, eggs, boiled milk, kumyss, or matzoon and gruels may be given. great care has to be taken for months after an attack; relapses may be caused by changes of temperature, by fatigue, and, of course, by improper feeding. these children should avoid potatoes, tomatoes, fruits, corn, oatmeal, and a great many other things which an intelligent mother would not give any sick child, as candy, cakes, pastries, etc. cases which begin with free vomiting, thin stools; and fever should be treated at once. the bowels must be thoroughly cleaned out, the colon should be thoroughly irrigated, and all food should be stopped. when there are bloody stools with mucus and pain we must depend upon castor oil, irrigations of the colon, and opium and bismuth by the mouth. a good big dose of oil at the beginning is always necessary. if, however, the stomach is irritable and will not tolerate castor oil, we may substitute calomel in one-fourth-grain doses every hour for six doses, to be followed by citrate of magnesium. irrigation of the colon in these cases is one of the essential means of successful treatment; it should be done twice a day during the first few days of the disease. stimulants are needed in all the cases. they help the heart, act as a food, and tend to quiet the general nervousness by favoring sleep. good brandy given in boiled cool water is the best stimulant. after the child is over the worst of the acute symptoms all medicine should be withdrawn and the proper kind of food given. tonics will aid in restoring the strength. cod liver oil during the following winter is a very good plan to aid in building up the vitality of the weakened bowel, but it must not be given too soon. chronic ileo-colitis--chronic colitis chronic ileo-colitis fellows the acute variety. cases which are unusually severe or which have been badly managed are likely to become chronic. a child suffering from this disease presents the following picture: the patient is emaciated, the abdomen is usually enlarged with gas, the feet are cold, the circulation of the blood is poor, the fever is low or absent altogether except when the child is having a relapse, when it jumps up suddenly. the bowels are loose and contain mucus, frequently in large quantities. the mucus may stop for a few days; then it appears again with a rise of temperature accompanied with loose stools with foul odor. these children are exceedingly nervous and irritable and are very poor sleepers. parents should be told it will be impossible to effect a rapid cure of these cases. it often takes months to get them started on the safe road. the slightest mistake or change in the weather will upset the progress of the cure and it will be necessary to begin all over again. the entire hope of cure rests with the mother. she must be faithful, patient, and must carry out the physician's instructions implicitly. the management consists in diet, change of climate, and such other treatment as the physician finds necessary in each individual case. treatment.--in children under one year of age the only hope is breast milk, which must be given in small quantities. they do not do well on any starch food for a considerable period. where breast milk is not available the whites of two or three eggs may be given daily. they may be beaten up and given in skimmed milk, or in plain water with a little salt added. zwieback or bread crumbs may be given in small quantities. they should be fed at four-hour intervals. older children may take skimmed milk, raw scraped beef, junket, and coddled white of egg or raw egg, bread crumbs, toasted, or zwieback. a rectal enema must be given every twenty-four hours if the bowels have not moved. if constipation is the habit a laxative should be given; the aromatic fluid extract of cascara sagrada or magnesia are suitable. at least one free movement every day is essential to success. colon irrigations are only to be used when there is a rise of temperature, irrespective of whether the bowels have moved or not. when convalescence is established these children should be given a maximum of fresh air and should be treated as recommended in cases of malnutrition. summer diarrhea as the name implies, this is the form of diarrhea that is so common, especially in cities, in summer. it is always preceded by some milder condition which paves the way for the more serious diarrhea. acute indigestion is, as a general rule, the forerunner of cholera infantum. the influence of hot weather must always be kept in mind as the underlying factor which no doubt conduces to gastro-intestinal disease of infancy and childhood. the depression incident to a spell of hot and possibly humid weather tends to interfere with the digestive process of babies and children. when this function is carried on imperfectly, the strength and vitality of the child fails, and if immediate steps are not taken to check the process, diarrhea makes its appearance. if these children are improperly fed, or if their surroundings are not sanitary; if they are not getting fresh air enough, or if they suffer because of lack of attention, and have at the same time a little indigestion, it is only a step further to develop a full-fledged cholera infantum. the outcome of any case of summer diarrhea is questionable. it is not safe to make any promise. an apparently mild attack may prove quickly fatal. much depends upon the previous history of the child. if it has been a strong, healthy child it has a very good chance if treated energetically and correctly. if it has previously suffered from bad nutrition, is not robust, has had trouble with its stomach, etc., the chances are against it. the one lesson to be learned by all mothers is, as stated above, to act quickly; to be on the watch all through the summer months for any trouble with the baby's stomach or bowels. it is much easier to treat and cure a little trouble than to battle against an established gastro-enteric intoxication. overfeeding and indiscriminate feeding must be religiously avoided,--they are the two most prolific causes of stomach and intestinal troubles in childhood. symptoms.--the onset is sudden and pronounced. the child begins to vomit and continues vomiting and retching persistently. the bowels are loose, and large, watery, greenish stools are frequent. the prostration is very marked, the child looks seriously sick, respiration is quick and shallow, the eyes sunken, the skin becomes ashen gray in color, and the pulse is soft and very rapid. the fever may be very high or it may remain low. the low febrile cases are the worst. if taken in hand quickly and if the treatment is energetic and if the child reacts, the case may go rapidly on to recovery and the child be wholly well in a few days; or it may not react, but be overwhelmed by the poison and sink and die in twenty-four hours. treatment.--in the treatment of cholera infantum it must not be forgotten that the dangerous element is the poisoning of the system that is constantly going on. it is difficult for the non-medical mind to estimate the importance of this element. it is, of course, caused by the bacteria present in the gastro-intestinal canal. there are numberless millions of bacteria in the normal healthy bowel. a very large percentage of those germs are good for us, are there for a beneficent purpose, and can and do protect us from other germs which occasionally find their way into the bowel and whose purpose is not a peaceful one. when the bowel condition changes, as during an attack of summer diarrhea, it is invaded by multitudes of evil-intentioned germs. these germs find conditions in the diseased bowel exceedingly favorable to them, so they begin work in an active, energetic way. the result of their activity is highly poisonous, and, as the good germs are virtually out of business and are consequently not working in our interest, we are absolutely in the hands of the enemy. there is soon manufactured, by these invading germs, enough poison to poison the entire system of the child. it is this feature that we must combat in summer diarrhea. it is absolutely essential to keep these cases as much in the open fresh air as possible. no matter how sick they may be, this rule must be observed. light clothing is advisable. if it is a city child that is affected and it does not show decided improvement in three or four days, it should, if possible, be sent to the country. there is always distinct danger of a relapse in every case, so the little victim should be given a change of air as soon as convalescence permits. the seashore is preferable to the mountains in all intestinal cases. in the care of these patients cleanliness is an important factor and counts much in the ultimate cure. the child, as well as the clothing, should be kept scrupulously clean. napkins as soon as soiled should be removed and put into a disinfecting solution. the buttocks should be well powdered after each movement to prevent sores developing. feeding must be stopped at once. no food of any kind should be given for at least twenty-four hours, or until the tendency to vomit subsides. the thirst must be allayed, however, so we give frequently small quantities of thin barley water or albumen water or cold boiled water. if these are vomited we must stop giving them altogether for twenty-four hours. if the fever is high and the skin dry, the child should be given a cool pack, ° to ° f., which can be moistened every half hour with water at this temperature; this will often control the fever satisfactorily. hot-water bottles should be placed at the feet if they are cold. if, on the other hand, the fever is very low (below normal), the child's circulation poor, the skin blue and cold, a hot-water bath at ° f., for five minutes (rubbing the surface of the body while in the bath), will be of very great service. the bath may be repeated at half-hour intervals. if the patient is a breast-fed infant it can be allowed to nurse after the twenty-four-hour rest. the length of time it is permitted to stay at the breast should be about one-quarter of the time it was allowed before the attack began. if it does not vomit, the nursing can be repeated every four hours. as the case progresses toward recovery the interval between feedings can be shortened. care, however, must be taken not to shorten the interval too rapidly. if the patient is artificially fed and is not over four months old, a substitute for the milk must be found. the best substitutes are rice or barley water, either plain or dextrinized, the malted foods, chicken or beef broths, liquid peptonoids or bovinine. water (boiled and cooled) may be allowed at all times if not vomited. older children are treated in the same way. all food is withheld while there is any vomiting. when vomiting stops begin with small quantities of beef broth, or chicken, or veal broth. later kumyss or matzoon can be tried, and finally thin gruels made with milk. if vomiting persists the stomach must be washed out; this can be done by giving the infant or child a large drink of cool boiled water. this will be immediately vomited and it will clean the stomach at the same time. the stomach-pump may be used to better advantage. one washing is usually sufficient. the vomiting will stop after the stomach has been washed out and the patient may then be given, frequently, small quantities of cold albumen water or barley water. the bowel should be thoroughly cleaned out at the beginning of every summer diarrhea. castor oil or calomel are the two best cathartics for this purpose. if the stomach is not upset use castor oil. if the stomach is upset use calomel; one-fourth of a grain every hour for eight doses will be sufficient. give enough, however,--there is no danger at the beginning of the attack of too free movements of the bowel. whatever cathartic is given, it should produce green, watery stools. irrigation of the bowel is an exceedingly effective way of cleaning out the poison-laden large intestine. it should be done in every instance unless the movements are watery and of such frequency as to render irrigation unnecessary. once or twice daily will be sufficient in even the worst cases. the irrigation should be given at the temperature of ° f, and should be the normal saline solution; a long rectal tube is used to give the irrigation. summary:-- st. cholera infantum is one of the most dangerous, one of the most treacherous, and one of the quickest acting diseases of childhood. nd. don't temporize, don't delay, don't regard lightly any diarrhea during the summer time. rd. give a large dose of castor oil and withhold all nourishment until the doctor sees the little patient in every case of diarrhea during the warm weather. th. keep the child in a cool, quiet place and don't handle or annoy it. th. follow, your doctor's directions implicitly. the fight may be short, sharp, and decisive. don't pave the way for regrets afterward. do everything while you have the chance. colic colic is a common condition in infancy. very few children escape more or less colic during the first few months of life. it does not seem to injure permanently some infants; they go on growing according to standard, eat and sleep, and seem contented and happy despite occasional severe attacks of colic. other children suffer seriously; the degree of indigestion is considerable, and the nutrition of the child is interfered with. colic is much more frequent in bottle-fed infants than in those fed on breast milk. cow's milk, no matter how skillfully it is prepared for their use, is at best an unsuitable diet and taxes the digestive ability of robust children. it is quite natural for an infant whose digestive organs are not strong to develop colic and intestinal indigestion if put on artificial food. any condition that causes indigestion may likewise cause colic. those children who are always overfeeding,--taking too much milk, too strong milk, or who are fed irregularly,--are the colicky babies. constipation is frequently associated with colic and may be the actual cause. a daily movement of the bowel does not necessarily mean that the bowels are emptying themselves satisfactorily. despite the daily movement, there may be considerable fecal matter left in the bowel which undergoes decomposition. this results in the evolution of large quantities of gas and severe attacks of colic. indigestion is very often caused by conditions which effect the stability of the child's nervous organism; such conditions are fright, anger, fatigue, exhaustion, excitement. the origin of the colic in breast-fed children is very often caused by some nervous condition of the mother that affects her milk. constipation in the mother may cause colic in the child. symptoms.--a baby having an attack of colic will cry loudly from time to time and whine during the interval; it will pull up its legs and bear down. its abdomen is tense and hard and distended with gas. with the expulsion of the gas the pain ceases and the child falls asleep. if the attack is very severe the prostration and exhaustion is marked; the feet are cold and the body is bathed in perspiration. if the colic is constant the child may be fretful and restless most of the time, being seemingly comfortable for only an hour or two in the twenty-four. in older children who cry because of severe pain in the abdomen the possibility of appendicitis must not be forgotten. treatment.--find out the cause of the colic if possible. if the cause is located in the mother, the remedy naturally must affect her. regulation of her bowel, restriction of her diet, and proper exercise, may be sufficient to effect a cure of the colic in the infant. the object of treatment is to help the child get rid of the gas. the best and quickest means to effect this is to apply massage or give a rectal injection. an injection of two ounces of cold water in which a half or one teaspoonful of glycerine has been put, will act quickly. dry heat applied to the abdomen in the form of the hot-water bottle or woolen cloths will aid in the expulsion of the gas. the feet should be kept warm. in cases of habitual colic in breast-fed babies the cause may be in the quality of the mother's milk. it should be examined and if found too strong should be diluted. this can be done by giving the child an ounce of plain boiled water or barley water before each feeding. if the child gets an ounce of liquid before each feeding he will not want as much of the breast milk; so we shall have the same total quantity, but a reduced quality, which may cure the colic at once. it is necessary, in order to cure colic, that the bowels move every day in a satisfactory manner. if any aid is needed, milk of magnesia is the best laxative. it may be given in teaspoonful doses in water previous to a feeding. aromatic cascara sagrada in from ten to thirty-drop doses is a very good laxative, if a stronger remedy is needed. to relieve the acute attack, three drops of hoffman's anodyne may be given in two teaspoonfuls of warm water and repeated in ten-minute intervals until relieved, to a baby under one year of age. from five to ten drops of gin, given in three teaspoonfuls of warm water, and repeated in fifteen minutes, is also satisfactory and harmless. a very good remedy which may be used with the above for quick relief, and to stop the child from crying, is the following: fold a piece of flannel cloth (two thicknesses) the size of the baby's abdomen; wring out of very hot water and drop ten drops of turpentine over the surface,--at different spots,--of the flannel and lay on abdomen,--turpentine side next skin. cover this with another piece of flannel,--two or three thicknesses, that has been dry-heated and allow to remain in place for about ten minutes. colic, as a rule, disappears completely about the third month. appendicitis appendicitis is mentioned here merely to acquaint mothers with its prominent symptoms. when a child has what seems to be an attack of indigestion, but complains of pain and tenderness in the abdomen, vomits, and develops a fever, and is constipated, appendicitis may be suspected. the pain and tenderness are not referred to the region of the appendix but are more centrally located. if, however, the finger point is pressed over the appendix, distinct tenderness will be elicited in inflammation of that region. constipation is the rule in appendicitis, but diarrhea occasionally accompanies it. the abdominal muscles may be rigid, that is, the abdomen does not feel soft as is usual; there is a feeling if they are pressed, as if they were hard and unyielding. treatment.--put the child in bed and send for the family physician at once. the condition is too serious and too uncertain to delay, or for a parent to make any effort at treatment. appendicitis is a much more serious condition in infancy and childhood than it is in an adult. jaundice in infants there are two types of jaundice in infants that deserve brief consideration. st. there is a form of jaundice caused by a defect in the development of the bile or gall tubes. these infants develop jaundice a day or two after birth and become intensely jaundiced within a very brief time. they lose flesh and strength to a marked degree and die in a few weeks. it is not possible to affect this condition favorably by any method of treatment. this type of jaundice is not very common. nd. there is a type of jaundice that appears between the second and fifth day of life that is very common. it lasts from one to two weeks and then disappears. it is never fatal and is not serious. it requires no treatment. jaundice in older children--catarrhal jaundice--gastro duodenitis symptoms.--this form of jaundice begins like an attack of ordinary indigestion. there are, as a rule, pain, fever, vomiting, and prostration. the pain is located in the upper part of the abdomen and may be quite severe. the vomiting may continue for a number of days. the bowels are usually constipated. after a few days the jaundice sets in and may be quite intense. after the jaundice is established the stools are gray or white in color and there is much gas in the bowel. the urine is very dark and may be yellow or yellowish-green in color. the child complains of headache, is dull and listless, and appears sick and weak. the condition lasts about two weeks, but the jaundice may last much longer. it is not a serious disease. treatment.--the diet should be cut down in quantity and should consist of rare meat, fruit, and a small quantity of milk. if vomiting continues the milk may diluted with lime water or vichy water. the child should drink water or vichy water freely. no starchy foods, or fats, or sugars should be allowed. the bowels should be kept open with calomel, one-tenth of a grain every hour until ten are taken, to be followed by citrate of magnesia every morning. if the pain is severe it may be relieved by a mustard paste or a turpentine poultice. the child should be given acid hydrochloric diluted, eight drops in one-half glass of water, ten minutes before each meal--and kept on it for at least one month. intestinal worms there are three types of intestinal worms; they are known as the round-worm, the thread-worm, and the tape worm. round-worm.--the round-worm is usually found in children of the run-about age. it is never seen in infancy. it occupies the small or upper intestine, and is from four to ten inches long. if there are round-worms in the bowel, there are usually a number of them and there may be hundreds. symptoms.--round-worms give no definite symptoms. the only possible way to tell if they are present is actually to see them in the stools of the child. they are of a light gray color. it is reasonable to expect that a child suffering from worms will have symptoms of abdominal distress from time to time; indigestion with colic and much gas may be present; children lose their appetites and are nervous and restless; sleep is disturbed; they may grind their teeth and talk in their sleep, and they may pick their noses unnecessarily during the day. these symptoms may, however, accompany other conditions when no worms are present in the bowel. my observation has been that in children in whom worms were present the nervous symptoms were distinctly accentuated. they are unreliable children; they seem well to-day and peevish to-morrow; they complain of headaches, dizziness, and chilly feelings. they are hysterical, noisy, uncontrollable. a child with these symptoms should be suspected of having worms and if no cause can be found to explain his temperamental vagaries he should be treated for worms. i have cured a number of children of excessive nervousness by giving them medicine for worms when no worms were present. such results can only be explained on the assumption that these children were suffering from intestinal auto-toxemia or self-poisoning, and the thorough disinfection of the bowel apparently stopped the process by ridding the child's system of a mass of bacteria, which were undoubtedly causing the auto-toxemia and consequent nervousness. treatment.--the most efficient remedy for removing round-worms is santonin. the quantity necessary for the various ages is as follows: two to four years grains. four to six years grains. six to ten years - / grains. the best way to give it is in divided doses, with an equal quantity of sugar of milk. for a child of six years the formula would therefore be, - / grains of santonin, mixed with the same quantity of sugar of milk divided into three powders. these powders are given four hours apart in the following way. the child is given a light supper the evening before and one-half glass citrate of magnesia the following morning and the first powder one-half hour later; no breakfast being given. a light lunch, of milk and crackers, may be taken about noon. the second powder is given four hours after the first, and the third four hours after the second. half an hour after the last powder, a dose of castor oil (one tablespoonful) is given. in a few moments the bowels will move; usually there are no worms in this movement. a little later they will move freely again and if worms are present they will be discharged in this movement. thread-worm, or pin-worm.--a thread-worm looks just like a little piece of white thread. they are found in the lower part of the bowel and in the rectum. they are usually present, if present at all, in large numbers. symptoms.--the chief symptom is itching. it may be limited to the anus or it may involve the neighboring parts. thread-worms may find their way out of the anus and in female children may find their way into the vagina. in these instances the child is tormented with itching of the privates and may establish the habit of self-abuse as a result of the constant itching and scratching. the itching is more intense at night soon after the child goes to bed. as a result of the local irritation in the lower part of the bowel and rectum there is set up a catarrh of the bowel which produces large quantities of mucus. treatment.--the only medication by the mouth that is of any use is turpentine in one drop doses after meals, given in a teaspoonful of sugar. the best treatment, and in most cases the only treatment that is effective, is the use of rectal injections. the procedure is as follows:--the child first gets a cleaning injection of two quarts of warm water into which a teaspoonful of borax has been put. this will wash away any mucus or fecal matter that may have collected. this injection is best given with a no. rectal catheter which is pushed into the rectum for about inches, the water being allowed to run away as it enters. from six to eight ounces of the infusion of quassia is then passed, as high up as the catheter will reach. it is intended that the quassia will remain in as long as possible, for at least half an hour. in order to assure this there are two features that should be kept in mind: first, the water should be allowed to flow in slowly, consequently hold the bag low, not higher than two feet above the level of the bed on which the patient lies; second, after the water is all in remove the catheter very slowly and keep the child absolutely quiet. this treatment is repeated every second night for a week, then twice a week for four weeks. a solution of garlic is a very effective remedy and may be tried if the quassia fails, which is not likely if the treatment is carried out effectively and if the parts are kept scrupulously clean. tape worms.--tape worms are obtained from eating raw meat, pork or sausage, rarely from fish, and from playing with cats and dogs. symptoms.--no definite symptoms accompany the presence of tape worm. the children may have pains in the abdomen, diarrhea, a capricious appetite, foul breath, and they may suffer from anemia, sometimes quite severely. the only positive symptoms is the presence of links of the worm in the stools. treatment.--give a dose of castor oil at bed time. two hours after breakfast next morning give one-half dram of the oleoresin of male-fern in emulsion or capsule. very light nourishment should be taken during the day, composed of gruels and soups. when the worm is passed it should be examined to find if the head is present; if not, the treatment should be repeated in twenty-four hours. rupture rupture of any description is not a condition that any mother should attempt to treat. a physician should be called in every case. any misdirected effort at manipulation or pressure may result in irreparable injury to the parts. external applications are useless and may be injurious. all ordinary forms of rupture in infancy and early childhood are curable if properly treated. * * * * * chapter xxxvi diseases of children, continued mastitis or inflammation of the breasts in infancy--mastitis in young girls--let your ears alone--never box a child's ears--do not pick the ears--earache--inflammation of the ear--acute otitis--swollen glands--acute adenitis--swollen glands in the groin--boils--hives--nettle rash--prickly heat--ringworm in the scalp--eczema--poor blood--simple anemia--chlorosis--severe anemia--pernicious anemia mastitis, or inflammation of the breasts in infancy there are a few drops of a milky secretion in the breasts of infants when born. occasionally the amount will be in excess of the normal quantity, and the breasts, around the nipple, may be swollen and slightly inflamed. should this condition persist, it may be relieved by painting the parts with the tincture of belladonna. under no circumstances should the breasts be manipulated or rubbed, as this is very apt to cause an inflammatory condition, and to result in mastitis. mastitis begins, as a rule, during the second week of life. the breast becomes red, swollen, painful, and shows inflammatory changes. it may terminate without the formation of an abscess, or it may go on to suppuration. the child becomes extremely restless and irritable, it is disinclined to nurse, and suffers from loss of sleep and nourishment. it is possible for such a condition, in the female, to injure the breast to the extent of arresting its development and to render it useless in the future. if the suppuration is extensive the process may terminate fatally. mastitis in infants is caused by unnecessary interference and manipulation and by want of cleanliness. when it occurs the parts should be kept absolutely clean and should not be handled in any way. ichthyol per cent., zinc oxide ointment, enough to make one ounce, spread upon old, clean, soft linen, and laid over the parts and changed every six hours, is an excellent healing application. a piece of oiled silk may be put outside the linen to prevent the ointment staining the clothing, and over this a layer of absorbent cotton and a binder, applied without pressure. if an abscess develops in spite of treatment, it must be freely opened and freely drained, and the general health of the patient supported by regular nourishment and tonics. mastitis in young girls.--pain and swelling of the breasts are sometimes complained of by girls between the twelfth and fifteenth years, though it may occur at an earlier or later date. if left alone the condition will invariably subside without treatment. should bacteria find an entrance through the nipple at this time, an abscess may result. the whole breast is involved and it will be exceedingly painful and much swollen. there may be moderate fever, headache, and a pronounced feeling of indisposition. these patients should be given a laxative,--citrate of magnesia, or pluto water, and kept on a very light diet. an ice-bag should be kept constantly at the breast during the day, and a moist dressing of : bichloride of mercury during the night. it may take a week before recovery takes place. let your ears alone never box a child's ears.--a single blow may make a child deaf; repeated blows on their ears will certainly injure children's hearing. thomas a. edison, our greatest inventor, was made deaf when a lad by a surly brakeman, who soundly boxed his ears for some trivial or fancied offense. boxing a child's ears is but one of a great many things you should never do to the ears. in fact, there are far more things you should not do to safeguard the hearing, than there are things you can do to benefit your ears. do not pick the ears.--do not put cotton in the ears unless ordered to do so by a reputable physician. do not syringe the ears without the doctor's orders. put no poultices in the ears. do not put drops of any kind in the ears unless prescribed by a doctor. above all, do not use the advertised ear cures, as most of them are harmful. never blow into a child's ear, never douche the nose without the doctor's orders, as this may wash germs into the tubes leading to the ears and bring about a serious condition. riding in tunnels, especially in tunnels under water where the air pressure varies, has, through some recent investigation, been found to be injurious to the ears of a great many people. conductors and other trainmen who run through many tunnels are apt to have ear trouble, as are the men who work underground a great depth where they are in motion, such as miners running underground trains. if you have an earache that continues for any length of time, take no chances, but consult a physician. and remember to care for the throat and nose, as ill conditions in those places result in ear troubles. do not blow your nose too hard; it merely injures the inner sides of the ear drums. adenoids in children frequently bring about a bad ear trouble. even seasickness is due in a great measure to ear disturbances. if you have a running ear, attend to it at once by visiting a doctor. so serious is this that life insurance companies will not insure people in that condition. earache.--when a child complains of earache its ear should be examined. in nearly every case of earache it is necessary to treat the throat, as this is, as a rule, the seat of the trouble. an antiseptic gargle of equal parts of borolyptol and warm water is an excellent mixture. it should be used freely every two hours. children suffering from earache should be kept indoors. if the examination should show that it is not necessary to lance the ear drum, some local measure may be adopted to allay the pain. putting the child in bed with the head resting on a hot-water bottle may be all that will be necessary. the following procedure may be carried out, but only after a physician has made an examination and according to his directions: a hot water douche, given by means of a douche bag, is quite effective. the water should be ° f.; the bag should be held about two feet above the level of the child's head, and the irrigating point should not be pushed into the ear, but held so that the water will find its own way into the ear. when the earache does not respond to the above methods the ear should be closely watched and examined at intervals so that it may be opened at the right moment. this is very essential because, if it is neglected, the pus may find its way into the mastoid cells and set up the dangerous disease, mastoiditis. this disease may cause abscess of the brain and death. the moment a child develops fever in the course of an earache the ear should be examined and opened at once, if found necessary. inflammation of the ear. acute otitis.--inflammation of the ear seldom occurs in childhood, unless as a complication, or as a result of some infectious disease. any disease which affects the throat in any way may be the cause of the inflammation of the ear. such diseases are, "cold in the head," tonsilitis, grippe, "sore throat," or pharyngitis, measles, scarlet fever. it is much more common in children than in adults. the younger the child, the more liable it is to develop ear trouble when suffering from any of the above diseases. the presence of adenoids favors the development of ear complications. symptoms.--there is one symptom present in all cases of inflammation of the ear; that is, fever. pain may or may not be present; it is present in a majority of the cases. children with inflammation of the ear are exceedingly restless and do not sleep long at a time nor do they sleep soundly. treatment.--the treatment is to open the drum membrane, at the right time, which of course will always be done by a physician who has had some experience in this work. after treatment.--the after treatment consists of washing or syringing the ear every three hours with eight or twelve ounces of a : , solution of corrosive sublimate. this will be kept up for four days; then the intervals between the washing will be extended to five hours, and kept up until the drum membrane closes. if the corrosive sublimate solution should cause any eruption around the ear, a normal salt solution (see page ) may be used in the same way, and in the same quantity as above. a running ear will run for from three to six weeks. it may heal up at any time after ten days. if the discharge should suddenly stop and the fever rise, it indicates that the opening has become plugged or healed too quickly. in either case it will have to be opened again. as soon as the ear begins running again the symptoms will disappear. after syringing the ear it should be dried thoroughly with pieces of sterile absorbent cotton. the best syringe to use for washing out the ear is a one-ounce hard-rubber ear syringe with a soft rubber tip. an ordinary douche bag will do if a syringe of the above character cannot be obtained. the douche bag should not be held higher than two feet above the patient's head. the double-current ear irrigator is an excellent device for this purpose. the child should be on its back on a table. its arms should be fastened down by its side. a basin can be placed under its ear and the irrigating done without causing any pain or discomfort. any child addicted to disease of the ear should be closely watched and examined for tuberculosis. scrofula may accompany this condition. these children need careful attention in every little detail, they need good nourishment, fresh air night and day, and they should not be pushed at school. during the winter they should be protected from "catching colds;" it is a good plan to put them on a cod-liver-oil mixture for the entire cold season. during the summer they should have a radical change of climate. summary: st. inflammation of the ear is frequently a complication of or follows some other disease which affects the throat. nd. if a child with one of these diseases becomes restless, sleepless and feverish, be on the look-out for ear trouble. rd. the ear must be lanced immediately when necessary. th. the after treatment is very important, because the hearing of the child depends upon it. swollen glands. acute adenitis swollen glands in infancy and childhood are usually seen below and behind the ear, less frequently in the groin. their cause is, as a rule, local disturbance in the mouth or throat, as decayed teeth, enlarged tonsils, cold in the head, catarrh, adenoids, or some form of infection of the mouth, or throat, or scalp. they occasionally accompany scarlet fever, diphtheria, measles, and influenza. they seldom suppurate. symptoms.--a swelling is noticed just below the angle of the jaw; it does not grow rapidly. there is a slight temperature and the child is more or less irritable. if the patient is an infant, the fever may be quite high and there may be considerable prostration. the trouble lasts from four to eight weeks. treatment.--an ice-bag constantly applied is the best treatment. this not only relieves pain, but it prevents the possibility of the gland breaking down and suppurating. it is sometimes difficult to keep an ice-bag on an infant, in which case cold compresses should be applied. these are made by taking several layers of old linen or cheese cloth and laying them on ice. they should be applied frequently to the swollen gland. the following ointment may be applied, though the ice-bag is the better and more certain treatment: ichthyol per cent., adeps lanae one ounce. this is applied on cloth and renewed every six hours. this ointment is black and stains the clothing. for that reason it is advised to use oiled silk over the cloth to avoid staining the pillow or clothing. children suffering from adenitis should use a spray of dobell's solution in the nose and throat three or four times daily. if the cause of the swollen glands is known, treatment for its cure should be promptly instituted. in the event of pus forming the gland must be opened and drained. swollen glands in the groin of a child are caused most frequently by some inflammatory condition of the privates, which should be discovered and treated. boils in some delicate children and in some children who do not seem to be delicate, repeated crops of boils may appear from time to time. it is necessary to open them as soon as pus is present. they should be pressed out and a gauze dressing, wet with a saturated solution of boric acid, bound over them. the dressing should be kept moist. i have in a number of instances successfully rid a child of the tendency to boils by the use of the following formula, which i can recommend highly as one of the best tonics i have ever used in the treatment of delicate and poorly nourished children: tinct. nux vomica drops, acid phosphoric dilute drops, syrup hypophosphites, teaspoonful. make a two-ounce mixture and give to children over four years of age one teaspoonful after each meal; to younger children, one-half teaspoonful after each meal. it is necessary in these cases to keep the bowels open daily. hives. nettle-rash cause.--contact with different plants, bites of insects, irritation from clothing, use of certain drugs. certain articles of food, such as tomatoes, strawberries, oatmeal, buckwheat, have all been said to cause hives. dentition during warm weather and the presence of worms and chronic malarial poisoning have been known to cause hives. it is most frequently caused, however, in childhood by some disturbance in the stomach or bowels. it causes severe itching and loss of sleep and as a result of these the general health suffers. treatment.--if caused by any external irritant, remove it. if it is caused by any special article of diet, prohibit its use. if no cause is apparent, give the child one tablespoonful of castor oil, and put it on the mildest diet possible of soups, broths, and dried stale bread. give no milk. use the following treatment on the erupted parts: menthol, ten grains in one ounce of cold cream. keep the bowels open. it is sometimes necessary to advise a change of air before complete cure results. prickly heat this is a very common complaint in children during the summer months. it is so common that it is well known and easily recognized. it consists of a bright red eruption, composed of little papules, close together. the rash comes out quickly, so much so that mothers may be surprised and frightened by observing an angry looking rash on their baby some morning when none was there the night before. it most frequently appears upon the neck, back, chest, and forehead. it is exceedingly itchy and a child may scratch itself and cause extensive harm. eczema, of a very obstinate type, frequently results from scratching. the rash of prickly heat is easily diagnosed from other rashes because it is accompanied by no other symptom, such as fever, which would suggest a more serious disease. the rash of prickly heat resembles the rash of scarlet fever more than any other rash, but it is quickly noted that when a child has scarlet fever it has every symptom of being profoundly sick, while prickly heat has no symptom other than the itch and discomfort. it is caused by overfeeding, being overclothed, and sweating in hot weather. treatment.--steps should be taken to prevent prickly heat in an infant. use light, seasonable clothing, bathe frequently, and use plenty of good toilet powder. when the child actually has an attack, open its bowels freely with citrate of magnesia, and give some sweet spirits of niter, according to age. protect the skin from the irritating underwear by interposing a soft piece of linen. in order to reduce the inflammation and cure the condition apply equal parts of starch and boric acid powder freely. keep the patient on a light fluid diet. the bran bath is advisable if the little patient is addicted to these skin eruptions. ringworm of the scalp children of all ages are liable to "catch" ringworm of the scalp. it particularly affects those who are untidy, dirty, and badly cared for, though any child is apt to get it while attending the public schools. if a mother discovers scaly patches in the scalp, with loss of hair, ringworm should be immediately suspected. it is not, however, always easy to diagnose the condition, especially if the case is a mild one. if it is a severe attack, there is, as a rule, quite a little inflammation, and this may render the condition obscure for some time. the disease may be mistaken for dandruff, but dandruff covers a large area of the scalp, while ringworm is limited and sharply defined. dandruff may cause a loss of hair; if it does, the hairs come out clean, while in ringworm they break off near the scalp. treatment.--ringworm is always curable, provided the patient is watched and treatment carried out thoroughly. it is always absolutely necessary to treat the condition, because it will not get better of itself, and the longer it is permitted to last, the worse it gets, and the more difficult it is to cure. if treatment is begun at once, it may take two months to cure it. if the case has lasted for some time, or if it has been neglected and not treated thoroughly, it will take from six months to one year to cure it. these facts are stated so that parents may not become discouraged. the first thing to do is to cut the hair as close to the scalp as possible, wherever the ringworm is, and for about an inch outside, and all around it. the entire scalp should be thoroughly washed three times a week. the scales should be kept soft by the use of carbolic soap. the hair should not be brushed at all, because brushing the hair may spread the disease to other parts of the scalp. every child with ringworm of the scalp should wear a cap of muslin or one lined with paper, so that others may not be infected. these caps can be burned when dirty and new ones made. one of the best remedies to apply to the affected area is the following: bichloride of mercury, grains; olive oil, teaspoonfuls; kerosene, teaspoonfuls. this is rubbed in every day until the parts are sore and tender. it is a good plan to apply this mixture to the entire scalp every fourth day, to guard against other parts becoming infected. it is not necessary to rub it in when using it where there is no ringworm. when the scalp becomes sore from the application it can be stopped for a day or two, or until better; then begin again and repeat the treatment right along. if the kerosene in the above mixture is objected to, a very good mixture is bichloride of mercury, grains, and tincture of iodine, ounce. this may be rubbed vigorously enough to produce a rash. if the disease shows a tendency to spread under this treatment it is best to apply the latter mixture to the entire scalp. ringworm on any other part of the body is effectually treated by applying tincture of iodine. it should be painted on every day until the skin begins to peel, when the ringworm will disappear with the skin. eczema eczema is the most important skin disease of babyhood. it is probably the most frequent skin disease of infancy. any baby may develop eczema. there are, however, some babies who seem to be very susceptible to it. the reason of this susceptibility seems to be due to the natural tenderness, or delicacy, of the skin. these children, because of the extreme sensitiveness of the skin, develop an eczema from a very slight degree of external irritation, or a trifling disturbance of digestion. children of rheumatic or gouty parents are more liable to be victims of eczema than are others. eczema of the face is quite common in children who are apparently healthy and fat. it does not seem to matter whether they are breast-fed or bottle-fed. the following conditions may be regarded as contributory to eczema: exposure to winds; cold, dry air; heat; the use of hard water or strong soaps; lack of cleanliness, and the irritation of clothing. it frequently accompanies chronic constipation, indigestion, and other conditions of the intestinal canal; overfeeding; too early or too excessive use of starchy foods. eczema of the face:--eczema rubrum.--this is the most frequent form. it affects the cheeks, scalp, forehead, and sometimes the ears and the neck. it begins on the cheeks as small red papules. these join together and form a mass of moist, exuding crusts. they dry in time and may be so thick as to form a mask on the face. the skin may be much swollen. when the crusts are removed the face looks red and angry and bleeds easily. it is exceedingly itchy. it causes restlessness, loss of sleep, and it may affect the appetite, though, as a rule, the health remains good. eczema of the face is exceedingly chronic; it improves from time to time, but it is cured with great difficulty only. infants suffering with eczema of the face begin to improve about the middle of the second year and may be entirely cured about this time. the reason of this is the greater amount of exercise the child is getting at this period. if the disease continues longer it is because of the unnecessary amount of fat that the child has. treatment.--eczema is a notoriously tedious disease. there is very little tendency for it to improve, if left to itself. the age, the severity, and just how much you can rely upon the mother, or nurse, faithfully to carry out directions--upon these its cure depends. at best, the treatment may have to be carried out for months. if the eczema is accompanied with constipation and indigestion in infancy, very little can be done with the eczema until these conditions are removed. there exists in the minds of the laity, and in some physicians also, an idea that it is wrong, or dangerous, to cure, or "dry up," an eczema. it is never dangerous, but highly desirable, to cure an eczema, whenever possible. it is always wise, because it is always necessary, to get the child in perfect condition before you treat the eczema. cure the constipation, or indigestion, or cold, or whatever is the matter with the child; then treat the eczema. this is the only plan that offers any success. it is not a simple matter to find out why a nursing child is having indigestion. the most minute care must be exercised to find out the element in the milk that is causing the eczema. it would, however, be foolish, and a waste of time, to apply pastes, etc., to an eczema of the face, while the real cause that produced it was still in existence. it will frequently be found necessary to change the food entirely. strict attention to the bowels is essential, both in infants and in older children. sometimes to cure the constipation means an immediate cure of the eczema. if the child is anemic, poorly nourished, and flabby, tonics are advisable. cod liver oil is of use in quite a number of these cases. eczematous children should not be taken out when the weather is very cold or when there are high winds. they should not be washed with plain water, or with castile soap and water. when washing is necessary, do it with milk and water, to which one teaspoonful of borax is added. the clothing must not be too heavy. in eczema of the face, the child must either wear a mask or heavy woolen gloves, so that he will not scratch the parts. frequently these fail, and it will be necessary to restrain the child from scratching the face by the use of some mechanical device. a piece of strong pasteboard bandaged on the elbows, so as to prevent the child from bending them, is all that is necessary. if the child cannot bend the elbows he cannot scratch his face, yet he has the free use of his hands. the use of external remedies is imperative, as frequently the cause is mostly external, and in other cases it must be used in addition to the general treatment. before external treatment is instituted, the crusts should be softened by applying olive oil to them for twenty-four hours, after which they can be removed with soap and water. if there is much inflammation, or if the face looks angry, a very good application is lassar's paste. later, when the inflammation has subsided and the itching is severe, a mixture of tar ointment, teaspoonfuls; zinc oxide, - / teaspoonfuls; rose water ointment, teaspoonfuls has proved to be one of the very best. when the eczema on the face is of the weeping, or moist, variety, the application of bassorin paste gives splendid results. when an external remedy is applied to any eczematous surface it is necessary to apply it on a cloth. simply to smear it on will do no good. in the treatment of eczema, when the children are breast-fed, it is well to remember that the real cause of the eczema may be in the mother. if the mother is constipated, or if her diet is too liberal, if she is drinking beer, or an excess of coffee, or is not taking exercise, the eczema may be caused by one or other or all of these. for eczema of the scalp the remedy to use is white-precipitate ointment, part; vaseline, parts. mix together and apply. poor blood. simple anemia causes.--there is what may be termed an unnatural tendency toward poor blood during infancy and childhood. the explanation of this anomalous condition is, that the tax or strain put upon the blood to provide for the growth of the child is severe, and is in addition to the great demands made upon it in the exercise of its regular duties. we must, therefore, always take this special duty into consideration, when the question of recuperation, convalescence, feeding, and the administration of blood foods and tonics comes up. it is not necessary to specify the diseases from which a child may suffer and recover, in an anemic condition. any disease may leave a child with temporarily poor blood. the conditions which most frequently produce anemia in childhood are improper feeding and unhealthy surroundings. it is not fully appreciated how seriously these conditions can affect the health of growing children. there is one condition that every mother should be warned against, namely, the possibility of unduly prolonging breast-feeding. children should be weaned at the end of the tenth month. by prolonging the breast-feeding a mother can undermine the vitality and strength of her baby and so impoverish its blood as to invite disease. a bottle-fed baby should be put upon a mixed diet at the same time. to continue feeding a child exclusively on milk for a year or two after weaning, simply because "it will not take anything else," is criminal. any woman guilty of such stupidity should never have become a mother. once again it must be emphasized that every child must have an abundance of fresh air, must not be confined in close, hot, unsanitary rooms, and must have a daily, satisfactory movement of the bowels to be a healthy child with good blood in its body. symptoms.--children suffering from poor blood are flabby, constipated, hungry, weak specimens of childhood. they are under weight, complain of headache, pains, disturbed sleep, are nervous and irritable. they tire quickly, are short of breath, and may have a tendency to faint easily. the hands and feet are cold, the pulse is small and irregular. they may have attacks of nose-bleeding and of bed-wetting. chlorosis.--chlorosis is that form of anemia, of poor blood, which occurs in young girls about the time their sickness begins. it is most frequently seen between the fourteenth and seventeenth years, and more often in blondes than in brunettes. the cause is not known. it is thought to be due to constipation. any occupation which is deleterious to health has a distinct influence on the condition. employment in factories, confinement in badly ventilated rooms, bad or insufficient food, great grief, care, or a bad fright, mental strain, overstudy, may all produce, or contribute to the production of chlorosis. symptoms.--the symptoms of chlorosis resemble those of simple anemia. children suffering from anemia are pale; girls with chlorosis have a peculiar greenish yellow tint in the skin. they are short of breath, they have vertigo, palpitation, disturbances of digestion, constipation, cold hands and feet, and scanty or arrested monthly periods. they have various nervous disturbances, such as headache, pains in various parts of the body, neuralgia, especially over the eyes, hysterical attacks, and sometimes cholera. ulcer of the stomach is sometimes seen in this condition. the disease lasts for a year or longer; it frequently lasts a number of years. relapses are frequent. [illustration: by permission of henry h. goddard "a misfortune at birth"] warren is feeble-minded. his family said it was due to "a serious fall of the mother." [a]"the family history is, however, exceedingly interesting. "the paternal grandfather, whom we have called nick, was of good family, although he himself was totally different from the rest. he was weak in every way, and to be considered feeble-minded. he married into a family that was much lower socially than his own, although we have no proof that it was a defective family. the children of this couple were all mentally defective and low-grade, morally as well as intellectually. "warren's father, jake, a thoroughly disgraceful character, married sal, a woman somewhat older than he. "the immorality of this family beggars description. a girl named moll was fifteen years old when jake brought her into his home: his wife, sal, was so feeble-minded that she allowed the illicit relations between these two. moll's child was born in the hospital after the mother had been sent away from one home because of her horrible syphilitic condition--from which she finally died. "our boy warren's sister liz with whom the father lived in incestuous relations, was also allowed to live illicitly with a man who worked for her father. she was so simple that she talked openly about her relations with her father and with this man. when a child was to be born the man married her. "this is not all, but enough: and sufficient to show what feeble-mindedness leads to when it takes the direction of sexual abuses." [a] "feeble-mindedness: its causes and consequences, goddard, the macmillan company. severe anemia: pernicious anemia.--this is the most severe form of anemia, or the condition in which we have the poorest blood. while this condition frequently results in death the others rarely ever do. this condition is not common in childhood. symptoms.--there is intense weakness and prostration. the skin is very pale, the mucous membranes are bluish white. the breath is markedly short and there is often dropsy of the limbs and feet. fever is often present and quite high. the disease lasts a number of months; the patient often feels better for a time, then relapses into a more serious condition than before. treatment of the various forms of anemia simple anemia.--find the cause and stop it. in infancy special attention should be given to diet and hygiene, giving the child plenty of fresh air, and a change of air to the country or seashore if necessary. the general treatment is more important than any benefit that may be derived from drugs. the rules laid down in the articles on "malnutrition" must be closely followed in these children. chlorosis.--in this form of anemia, or poor blood, it is best to give iron. change of air and change of scene are of special importance in these cases and will frequently cure. the general condition of course must not be overlooked. the diet, exercise, bowels, habits, should receive careful attention. iron should be continued for a number of months after all traces of the anemia have disappeared. pernicious anemia.--for this condition arsenic is the one remedy needful. in all conditions of poor blood the most careful attention should be given to the general health. colds must be guarded against. the patients should never get their feet or their clothes wet. muscular exercise, because of the weak condition of the heart, should be moderate, and only given on the advice of a physician. it is frequently necessary to stop all forms of exercise and in many instances we get the best results by directing complete rest in bed for a considerable part of the day or for all day if the case demands it. * * * * * chapter xxxvii diseases of children, continued rheumatism--malaria--rashes of childhood--pimples--acne-- blackheads--convulsions--fits--spasms--bed-wetting--enuresis-- incontinence--sleeplessness--disturbed sleep--nightmare--night terrors-- headache--thumb-sucking--biting the finger nails--colon irrigation-- how to wash out the bowels--a high enema--enema--methods of reducing fever--ice cap--cold sponging--cold pack--the cold bath--various baths-- mustard baths--hot pack--hot bath--hot air, or vapor bath--bran bath-- tepid bath--cold sponge--shower bath--poultices--hot fomentations--how to make and how to apply a mustard paste--how to prepare and use the mustard pack--turpentine stupes--oiled silk, what it is and why it is used. rheumatism this is a rather common disease of childhood. it occurs most frequently between the ages of nine and thirteen years. children can have it, however, at any age. the symptoms of rheumatism in children are much the same, though somewhat milder, as when the disease is present in an adult. children are not quite as sick, nor is the fever as high, nor is the pain as great as in a grown person. in children the disease does not last as long, as a rule. sometimes it will jump from one joint to another, and may, as a consequence, become chronic. when a child has once had rheumatism, it has the same disposition to recur that it has in adults. the principal danger of rheumatism in children is its tendency to attack the heart. even mild attacks of the disease can do serious damage to the heart. children who have the rheumatic tendency invariably suffer from inflammatory conditions of the upper respiratory tract. they are prone to have recurring colds, tonsilitis, and sore throats. treatment of conditions without regard to the underlying rheumatism is never satisfactory. these children complain of indefinite pains, now in one place, now in another. these pains are commonly known as "growing-pains" and, inasmuch as they are rheumatic and not "growing pains," they should be regarded seriously because of the heart damage they might do if ignored, and especially so since the mildest attacks of rheumatism, without any joint symptoms even, frequently leave the heart in very bad shape. as a general rule it will be found that when a child has had a number of attacks of bronchitis or asthma it is rheumatic and should receive treatment for the rheumatic tendency. children with the tendency to rheumatism invariably eat too much red meats and sugar,--the latter in the form of candy or as an excess in the food. treatment of an acute attack.--the child should be put in bed and kept warm. the bowels should be freely opened with citrate of magnesia. the diet should be very light: milk and lime water or milk and vichy water, with a piece of dry toast or zwieback, is all the child needs until the fever is relieved. when a single joint is affected local measures may be taken for its relief. wraping the joints up with flannel cloths which have been wrung out of true oil of wintergreen, and outside of this oiled silk snugly bandaged on, is an excellent external application. the flannel cloths should be kept moist by adding a little of the wintergreen from time to time as it dries in. this can be done without removing the bandage. this application is kept in place for twenty-four hours and renewed if necessary. such an external application will aid in the actual cure of the disease and will quickly relieve the patient of the pain. the oil of wintergreen used in this way should be the "true" oil, and should be so specified when bought in the drug store. because of the great tendency to attack the heart a physician should take charge of every case of acute rheumatism in a child. to treat the tendency to rheumatism.--exclude red meats and sugar in all forms as much as is possible. give green vegetables freely, potatoes boiled with the skins on, fish, eggs, and poultry. cereals with milk, especially well cooked scotch oatmeal, are exceedingly good for these children. by keeping up this diet after the acute attack has passed for a considerable time, it is possible to cure the various other complaints with which the child is afflicted,--tonsilitis, sore-throats, winter coughs, head-colds, bronchitis, asthma, etc. these children should wear woolen underwear all the year round. they should be encouraged to drink water or vichy freely between meals. in the treatment of an acute attack as given above it will be observed that no drugs are mentioned. this is intentional because it would be unjust to encourage the home treatment of a disease that is so treacherous, even in its mildest forms. because of its tendency to recur and with each recurrence the danger of the heart being affected, it is advisable to put these children on cod liver oil or iron or some other good tonic. every precaution should be taken to prevent these children from getting their feet wet or being out in the rain. summary:-- rheumatism is a dangerous disease in children. in its mildest forms it can affect the heart badly. it has a distinct tendency to recur. rheumatic children are afflicted with a number of diseased conditions which do not respond to treatment unless the rheumatism is treated. acute rheumatism should never be treated except by a physician because of its treacherous character. malaria. intermittent fever malaria occurs quite often in infants and children. as a rule the child gives evidence of gastro-intestinal disturbance for a short period before the malarial symptoms appear. the chilly stage is often absent. sometimes the hands and feet are cold and may be slightly blue and the child may appear to be in collapse. this stage may last for an hour or longer. the chilly stage may, however, be replaced by nervous symptoms,--restlessness, dizziness, irritability, nausea, etc.,--or a convulsion may take place. in the second stage the temperature may rise quite high, the pulse may be quite rapid; the child is flushed, restless, and cries. this period may last from half an hour to two hours. the sweating stage is not as a rule well marked in a child. it may be very slight or not at all. between the attacks some children may be entirely well; others remain restless, have little appetite and poor digestion. malaria in children does not always follow a typical course. we often see children suffering from spasms, fainting spells, neuralgias, diarrhea, vomiting, and skin eruptions, all due to the malarial condition. this often leads to a mistake in diagnosis. intermittent fever is often mistaken for pneumonia. malaria is not a favorable disease for an infant to have. it rapidly weakens the child and great debility and anemia follows. treatment.--the treatment for malaria in children is by the administration of quinine as in adults. it must, however, be given with care and intelligence; for this reason no mother should begin dosing her child with it without consulting a physician. regarding mosquitoes the following is an extract from a circular in relation to the causation and prevention of malaria and the life history and extermination of mosquitoes issued by the department of health, city of new york: extermination and prevention of mosquitoes.--mosquitoes require for their development standing water. they cannot arise in any other way. a single crop soon dies and disappears unless the females find water on which their eggs may be laid. in order to prevent mosquitoes, therefore, the requirement is simple. no standing water.--pools of rain water, duck ponds, ice ponds, and temporary accumulations due to building; marshes, both of salt and fresh water, and road-side drains; pots, kettles, tubs, springs, barrels of water, and other back-yard collections, should be drained, filled with earth, or emptied. running streams should have their margins carefully cleaned and covered with gravel to prevent weeds and grass at the water's edge. lily ponds and fountain pools should, if possible, be abolished; if not, the margins should be cemented or carefully graveled, a good stock of minnows put in the water, and green slime (algæ) regularly cleaned out, as it collects. where tanks, cisterns, wells or springs are necessary to supply water, the openings to them should be closely covered with wire gauze (galvanized to prevent rusting), not the smallest aperture being left. when neither drainage nor covering is practicable, the surface of the standing water should be covered with a film of light fuel oil (or kerosene) which chokes and kills the larvæ. the oil may be poured on from a can or from a sprinkler. it will spread itself. one ounce of oil is sufficient to cover square feet of water. the oil should be renewed once a week during warm weather. particular attention should be paid to cess-pools. these pools when uncovered breed mosquitoes in vast numbers; if not tightly closed by a cemented top or by wire-gauze, they should be treated once a week with an excess of kerosene or light fuel oil. certain simple precautions suffice to protect persons living in malarial districts from infection: first: proper screening of the house to prevent the entrance of the mosquitoes (after careful search for and destruction of all those already present in the house), and screening of the bed at night. the chief danger of infection is at night (the anopheles bite mostly at this time). second: the screening of persons in malarial districts who are suffering from malarial fever, so that mosquitoes may not bite them and thus become infected. third: the administration of quinine in full doses to malarial patients to destroy the malarial organisms in the blood. fourth: the destruction of mosquitoes by one or more of the methods already described. these measures, if properly carried out, will greatly restrict the prevalence of the disease, and will prevent the occurrence of new malarial infections. it must be remembered that when a person is once infected, the organisms may remain in the body for many years, producing from time to time relapses of the fever. a case of malarial infection in a house (whether the person is actively ill or the infection is latent) in a locality where anophele mosquitoes are present, is a constant source of danger, not only to the inmates of the house, but to the immediate neighborhood, if proper precautions are not taken. it should be noted in this connection that the mosquitoes may remain in a house through an entire winter and probably infect the inmates in the spring upon the return of the warm weather. malarial fever is prevalent in certain boroughs of new york city, and in view of the presence of standing water resulting from the extensive excavations taking place in various parts of these boroughs, is likely to extend, if means are not taken for its prevention. regulations of the board of health, new york city, in aid of mosquito extermination and the prevention of malarial fever (in force from march to october .) . no rain-water barrel, cistern, or other receptacle for rain-water, shall be maintained without being tightly screened by netting, or so absolutely covered that no mosquito can enter. . no cans, pails, or anything capable of holding water, shall be thrown out or allowed to remain unburied on or about any premises. . every uncovered cesspool or tank shall be kept in such condition that oil may be freely distributed so as to flow over the surface of the water. covered cess-pools must have perfectly tight covers, and all openings must be screened. . no waste or other water shall be thrown out or allowed to stand on or near premises. information is requested as to the presence of standing water anywhere, so that the premises may be inspected and the legal remedies against the same be applied. the prompt coöperation of all persons in the enforcement of the above regulations is earnestly desired, and they are assured that in this way the breeding of mosquitoes on their premises may be prevented. mosquitoes are, so far as known, the only means of conveying malaria. "rashes" of childhood the following table gives all the characteristics of the rashes that accompany the eruptive fevers. the term "incubation" means the period of time which elapses between the time when the child was exposed to, or caught the disease, and the time when the child is taken sick. it is sometimes interesting to know where a child could have caught a disease; so if we know the incubation period we can tell exactly where the child was on the day, or days, when it was infected. -----------+------------+-----------+-----------------+----------+---------+ name | incubation |day of rash|character of rash|rash fades|duration -----------+------------+-----------+-----------------+----------+---------+ measles | - days | th day |small red like |on the | - | | |spots resembling | th day |days | | |flea bites, first|of fever | | | |appearing on face| | | | |and forehead, | | | | |forming blotches | | | | |with semi-lunar | | | | |borders. | | -----------+------------+-----------+-----------------+----------+---------+ scarlet | - days | d day of |bright scarlet, |on th | - days fever |occasionally| fever |rapidly diffused,|day of | | longer | |first on chest |fever | | | |and upper | | | | |extremities. | | -----------+------------+-----------+-----------------+----------+---------+ chicken-pox| - days | d day |small rose |slight | - days | | |vesicles, which |scab of | | | |do not become |short | | | |pustular |duration | -----------+------------+-----------+-----------------+----------+---------+ typhoid | - days | - days |rose colored | |from fever | | |papules elevated,| | - | | |few in number, | |days | | |limited to trunk,| | | | |disappear on | | | | |pressure. | | -----------+------------+-----------+-----------------+----------+---------+ smallpox | - days | d day of |small, round, | th day | - (variola) | | fever |red, hard, |scabs |days | | |papules forming |form and | | | |vesicles then |about | | | |pustules, first | th day | | | |appearing on face|fall off | | | |and wrists. | | -----------+------------+-----------+-----------------+----------+---------+ other rashes.--there are so-called "stomach" rashes which are a source of much worry to mothers. these rashes may appear at any time and they may be limited to certain parts or may cover most of the body. they may be bright red, or they may be simply a general discoloration. they may appear as blotches or they may spread all over, like the rash of scarlet fever when at its height. these rashes are of no importance, except that they indicate some derangement of the gastro-intestinal tract. as a rule they indicate indiscriminate feeding or overfeeding. children who have had too much candy or pastries, or who have been fed things which are unsuited to their age, frequently develop rashes. such children should have a thorough cleaning out; a dose of castor oil is probably the best cathartic to give them. the mother may readily learn to know the difference between a rash that is unimportant and one that indicates one of the eruptive diseases, if she gives the matter a little careful thought. in the first place a child who is about to become the victim of one of the eruptive diseases will be sick, and will have a fever for two or three days before any rash appears; while on the other hand a child may go to bed in good health and may next morning be covered with a general rash, or with large blotches, without any fever and without any evidence of ill-health, except the skin condition. in the second place, if the mother gives the child a cathartic and restricts the diet for a day the rash will disappear, and good spirits and good health will be maintained; on the other hand, the giving of a cathartic to a child who is the victim of an eruptive disease will not tend to diminish the rash, but may accentuate it. pimples: blackheads (acne).--this eruption is situated chiefly on the face. it may appear, however, on the back, shoulders, and on the chest. it is mostly seen in young men and women about the age of puberty. it appears as conical elevations of the size of a pea; they are red and tender on pressure, and have a tendency to form matter, or pus, in their center. in from four to ten days the matter is discharged but the red spots continue for some time longer. "blackheads" appear as slightly elevated spots of a black color out of which a small worm-like substance may be pressed. pimples and blackheads are due to inflammation of the glands of the skin. the mouths of these glands become filled with dust which acts as a plug causing the retention of the oily matter of the gland which becomes inflamed and hence the pimples and blackheads. certain constitutional conditions favor the development of these skin blemishes. constipation, indigestion, bad blood from unsanitary and bad hygienic surroundings, self-abuse and bad sexual habits favor the appearance of these skin affections. treatment.--the patient must avoid tea, coffee, tobacco, alcohol, veal, pork, fats, candy, pastries, cheese, and all edibles that are known to disagree with the digestion of the patient. constipation must be avoided; if necessary, laxatives may be taken to keep the bowel open. the blackheads must be squeezed out with an instrument made for the purpose, not with the finger nails. pimples must be opened with a sterile needle. the parts should be washed three times a day with hot water and green soap, and the following mixture applied at night:-- zinc oxide ounces / powdered calamine ounces / lime water ounces mix and shake before applying to the skin. convulsions. fits. spasms convulsions are quite common in children, especially those under three years of age. a convulsion in an infant immediately, or within three months, after its birth is the result of injury, either at birth or later (a fall for example) which seriously affects the brain itself. after the third month the cause of fits or convulsions is, in a very large percentage of the cases, to be found in errors of diet resulting in disturbances in the stomach or bowels--eating of articles of food difficult to digest, as green or overripe fruit, salads, fresh bread, pickles, cheese, etc. children of a nervous temperament are more liable to convulsions than are others. females are more frequently victims of fits than are male children. in infants convulsions often result from changes in the mother's milk. mental excitement, deep emotion, anger, frights, severe affliction and distress will so affect a woman's milk that it will cause convulsions in her child if she nurses it while under the influence of any of these conditions. convulsions may result from any condition that disturbs the nutrition of the child, as, for example,--exhaustion, anemia, intestinal indigestion, blood poison, and general weakness resulting from some severe sickness, especially those of the digestive organs. various forms of brain disease cause spasms and fits; the most common are meningitis, tumors, hemorrhage, abscesses and injuries. convulsions may accompany certain conditions, as, the presence of worms, teething, severe burns, foreign bodies in the ear, whooping cough, pneumonia scarlet fever, malaria, sometimes measles, typhoid fever, and diphtheria. children who are badly nourished and who live constantly in unsanitary surroundings are more apt to have convulsions than those who are well nourished and who live hygienically. one attack renders the patient more liable to another, and when the "habit" is established any trivial cause may incite a convulsion; persistent and systematic efforts should therefore be taken to prevent the attacks. the best preventives are: st. to regulate the diet and the bowels. nd. remove adenoids and worms, if they exist. rd. avoid the use of alcohol, coffee, tea, fresh bread, pastries, candies and all improper foods. th. guard the child against catching cold, infectious diseases and all fevers. in other words, save the child from the cause and the convulsion will not take place. by regulating the bowels we mean that everything the child eats must be seen by the mother, must be with the mother's permission, and must be suited to the child's age. if there is any question about the latter it will be advisable to have a physician write out a list of articles suitable to the child. it is generally necessary to eliminate meats, pastries, candies, sugar to a large extent, gravies, salads, sauces, and all the extras of the table, as pickles, mustard, relish, etc., as well as coffee, tea, cocoa, and alcohol. the child should live in the open air as much as possible; a daily warm bath, followed by a quick, cold sponge, is a necessity. children subject to fits are possessed of a highly nervous temperament. they are difficult to manage unless managed with firmness and tact. it is not necessary to be harsh, but it is imperative to be firm and decided. they must be made to realize that they are not "the master," that their will is not supreme, and the mother must exact this condition; otherwise these children will become dictators and selfish despots--ruining the discipline of the home, spoiling their own chance of physical health, and rendering unhappy everyone around them. the parents, therefore, have a definite duty to perform and it is not an easy one. the food should be so regulated that each day a natural movement of the bowels will take place. (see article on constipation, page .) if a day should pass without a movement the child should be given a hot rectal enema as described on page . the adenoids can be easily demonstrated to either exist or be absent. (see page .) if worms are known to be present in the child they should be at once removed. if they are simply suspected, the child should receive treatment for them, just the same. (see page .) by going a long time without a convulsion the nervous system will recuperate itself, and become so strong and healthy that what once would cause a fit will make no impression in its new strengthened state; therefore, if you "save the child from the cause," the convulsions will cure themselves, as it were. there are some cases of convulsions for which no satisfactory explanation can be found. treatment.--when a child has a convulsion, remove its clothing and put it into a mustard bath. the temperature of the bath should be ° f. every part of the child should be under the water except the head, which is supported in the palm of the hand. while it is in the bath its body, and especially its arms and legs, should be briskly rubbed by the hands of an assistant in order to keep the circulation active. a rectal injection of soap suds or plain salt and water (see page ) should be given while the child is in the bath, because, as explained above, a large percentage of these cases are caused by gastro-intestinal derangements. the rectal injection will likely remove the cause. an ordinary convulsion lasts from five to ten minutes. when the child is removed from the bath it should be placed in a warm, comfortable bed and kept absolutely quiet. a hot-water bottle may be put near its feet and an ice-bag or cold cloths should be kept on its head. it should be given a full dose of castor oil and allowed to go to sleep. its diet should consist of light broths for two or three days and during this time it should not be disturbed or annoyed by too much attention. this is as far as it is wise or safe for any mother to go in the treatment of convulsions. a physician should be called in every instance, because a convulsion should never be regarded lightly. many children have become idiots, others have been afflicted with paralysis, because of inattention at the proper time. summary:-- st. convulsions must always be regarded as serious. nd. convulsions demand prompt treatment. rd. every mother should know that an english mustard bath--hot--is the first resort in convulsions. th. while this is being done she can read the home treatment in this book and carry it out before the doctor comes. th. if the fit is not caused by some stomach or intestinal trouble, have the physician find out the cause and tell you what to do, and do it faithfully, because if you neglect the proper treatment the child may become idiotic or paralyzed. bed wetting. enuresis--incontinence enuresis, or incontinence of urine, is customary in infancy. just when urination becomes a voluntary act depends upon the development and training of the individual child. as a rule children can be taught to control this function during the day, or while awake, about the tenth month. it is not under control during sleep until a much later period, usually by the end of the second year, but lack of control should not be regarded as abnormal until the child has entered the fourth year. if the child fails to control the act of urination during the day at the end of the second year, and is addicted to habitual bed-wetting, some measures should be adopted to cure the condition. boys under twelve years of age seem to be affected more frequently than girls. it is wrong to assume that it is caused by negligence or laziness, as some parents do. it has generally a special cause, and the cause usually can be found if it is carefully sought for. it may be the result of bad habits: exposure to cold in the night; lying on the back; drinking too much liquid in the afternoon or at bedtime. it may be due to too much acid in the urine, and if so it will be found necessary to reduce meats and eggs the child is eating. worms, stone in the bladder, some anatomical abnormality or deficiency, may be responsible for it. the diet may be at fault; adenoids are supposed by some physicians to be the cause. no matter what the actual cause may be, it must be found and remedied before we can hope for a permanent cure. a very large majority of these cases are due to nervousness. these children are of a nervous temperament. they are not necessarily sickly children; they are simply of a nervous type. they are well-nourished, active, and lively. incontinence of urine during the day and long-continued bed-wetting does not at all affect the health of the child. if they are in poor health, it is essential to treat their general condition before trying to cure the incontinence. it is absolutely wrong to punish or to crush the spirit of these children. constant nagging and taunting, even if done in the hope of shaming the child into a cure, will simply make a coward of him and will not aid in improving matters, but will be distinctly detrimental. scrupulous cleanliness must be constantly practiced or these children, if neglected, may develop ulcers and sores of a very obstinate character. the odor is also bad for the health of the child. treatment.--find and remove the cause if possible. if due to general poor health, give tonics, obtain a change of air, and build the child up. reduce the total quantity of liquids, if in excess, and be very careful not to give any liquids near bedtime. don't cover these children too much; they should never be "too warm"; they should sleep in a well-aired room, and they should receive a quick, cool sponge bath every morning. they should be taught to sleep on their sides, never on their backs. their diet should be light but nourishing. when bed-wetting is established it will continue, if untreated, until the child is eight or ten years of age, and it frequently lasts much longer. when treatment is undertaken it should be distinctly understood by the mother that it will take many months to cure; and during these months she must give her constant attention to the child. if she does not undertake to do this, or if she fails to do it, the treatment should not be begun at all, as it will not succeed. various plans should be tried to keep the child from sleeping on its back. the reason of this is because it has been found that the child wets the bed only when sleeping on its back and never when sleeping on its side. the simplest method, of tying a towel or cloth around the child with a knot over the spinal column, so that it will hurt and waken it, if it turns on its back, is a very good one and should be carefully tried for some time. the nervous system of these children should never be overtaxed at home or at school. early hours and plenty of sleep are desirable. certain articles of diet of a stimulating character should be entirely avoided,--for example, coffee, tea, beer, candies, sugars, and pickles. the best diet for these children is one composed exclusively of milk, vegetables, fruits, meats, and cereals. meats, however, should be given only once every two days. it is a good plan to teach the child to hold his water during the day, as long as he can, to accustom the bladder to being full. adenoid growths, which contribute to the nervousness of a naturally nervous child, should be removed. it is a good plan to take the child up when the parents go in bed and let him urinate. this often cures the condition in itself. sometimes moral measures, such as the promise of a reward, will strengthen the will so that the child may overcome the tendency. find out what the child most desires in the way of a toy, and promise it if he goes so long without wetting the bed. aid and encourage him to make efforts to win the reward. if drugs have to be resorted to, it is necessary to call the family physician, as the only drugs that are of any use are very powerful and have to be given with great care and caution. it is the experience of most physicians and specialists, however, that in a large majority of cases the treatment, along the lines as given above, will be effective, without drugs, if faithfully persisted in by the mother. these children should be examined by a physician. the cause of the bed-wetting is frequently discovered to be produced by anatomical abnormalities which render circumcision imperative. in these cases no method of treatment will succeed until circumcision is performed. sleeplessness. disturbed sleep causes.--in babies, disturbed sleep is most frequently due to hunger or to indigestion. the latter is the result of overfeeding or improper feeding. rocking the child to sleep, or feeding it during the night will cause sleeplessness. teething, colic, or any pain will result in disturbed sleep. nervous children are frequently poor sleepers. in older children, some digestive disturbance is, as a rule, the cause. chronic intestinal indigestion, worms, adenoid growths, enlarged tonsils, lack of fresh air in the bedroom, cold feet, may, however, be the cause. overstudy in school, poor blood, poor nourishment are always accompanied by inability to sleep soundly. too strenuous play, exciting stories read before bedtime, may cause sleeplessness. treatment.--the removal of the cause is absolutely necessary. in order to discover the cause it is sometimes essential to study the child's whole routine in order to be able to tell exactly just what is causing the apparent insomnia. it may be necessary to change the method of feeding, to regulate the studies and the exercises, and to suggest changes regarding the sanitary and hygienic environment of the child's life. mothers must be warned against using drugs in the form of soothing syrups or teething mixtures. they are dangerous and absolutely forbidden under the above conditions. the nervous disposition of the child must be taken into consideration and treated if necessary. if bad habits exist they must be stopped. poor blood and poor nutrition must receive the treatment suggested under these headings. nightmare. night terrors in a nightmare a child wakes suddenly in a state of fright and will inform you that it has had a bad dream. his mind seems clear and he recognizes those about him. he is not easily calmed and may cry for some time; finally he goes to sleep again. the next day he will remember the dream and most of the incidents of the night before. such cases are quite frequent. they are to be treated in the same way as cases of disturbed sleep, as they really have the same cause. they are mostly due to digestive disturbances and errors of diet. night-terrors.--cases under this heading form a distinct group by themselves. they are not frequent, but the condition is much more serious. the cause seems to be wholly nervous and may indicate an important nervous derangement. it seems to have some indefinite relation to such conditions as migraine, hysteria, epilepsy, and even insanity. the child wakes suddenly during the night and sits up, evidently in terror; he does not apparently regain his full consciousness. he talks of being scared, calls for his mother, trembles and shakes, cannot answer questions intelligently, and after a time goes to sleep. next day he remembers nothing of the attack and does not seem to suffer in any way as a result of it. i am disposed to believe that all of these attacks are not due to a nervous condition. a number of them of exactly this type have been cured by absolutely withdrawing milk from the diet. it is a good plan to restrict the possibility of excessive play in these children. they are of the type whose play is work, and too much of it is too exhausting. some person should sleep in the same room with these patients or in an adjoining room with the door open. if the condition occurs frequently the child should be subjected to a thorough physical examination, because it may be one evidence of a serious ailment. sometimes these little patients have to be taken out of school and sent to the country, where they should remain for many months. it is far better to regard the condition as indicating an abnormality,--even though it may not have any deeper significance than that the digestive apparatus of the child is not quite right,--and make every effort to cure it, than to permit the child to go on under what really are unjust and unfavorable conditions. headache headaches are not common in little children. the most frequent ones are caused by: . chronic indigestion and constipation. . anemia and malnutrition. . nervous disorders. . diseases of the eye, nose, throat. . rheumatism and gout. . disturbances of the genital tract. those arising from anemia and poor nutrition are most frequently present in girls from ten to fifteen years of age. they may result from overcrowding of school work, which results in loss of appetite and poor sleep. nervous headaches may be hereditary or acquired through unhygienic surroundings. hysteria, epilepsy, disease of the brain, neuralgia from carious teeth, may result in nervous headaches. headaches from disturbances of the genital tract may afflict girls about the time of puberty. treatment.--to remove the cause is the only plan that promises any result. each one must be investigated by itself and dealt with accordingly. for the headache itself a hot foot bath, cold to the head, and small doses of phenacetine (one grain every hour for four doses) are perhaps the most certain of all methods of treatment. thumb-sucking the habit of sucking the thumb may be corrected by wearing a pair of white mittens, or gloves tied at the wrist. should children attempt to suck the thumb with gloves on, as some do, it will be necessary to saturate the thumb and fingers of the gloves with tincture of aloes, or a solution of the bisulphate of quinine, one dram to two ounces of water. biting the finger nails biting the finger nails may be stopped by the use of the same bitter remedies as are used in thumb-sucking. how to wash out the bowels colon irrigation. a high enema procure a soft rubber catheter,--no. american is about right. it is not advisable to get too soft rubber for the reason that it will buckle when the child strains and it will be impossible to wash out the bowel. fill half full an ordinary two-quart douche bag with water that is warm, but not too hot. dissolve a heaping teaspoonful of table salt in a glass of hot water and add this to the water in the bag. hang the bag about two feet above the level of the child, so that the water will not flow in with too strong a stream; otherwise the child will immediately try to eject it. if the water flows in gently, the child may not object to it to the extent of making strenuous efforts to force the catheter out. use the small sized nozzle that comes with the douche bag. place the rubber catheter over this nozzle, lubricate the catheter, place the child on its back over a douche pan, insert the catheter about two inches, let the water run and as it runs in push the catheter up gently until it is all in the bowel except the end on the douche tip. the object of letting the water run while pushing in the catheter is because it floats up with the water as it distends the bowel; there is no risk then of pushing the end into the intestinal wall or hurting the child. while the water is flowing into the bowel it is a good plan to compress the buttocks together to aid in holding the water, as the child is very apt to let it run out as soon as it feels uncomfortable. the temperature of the water for the ordinary rectal injection should be ° f. when the child is exhausted or very weak, or when the circulation is poor, the temperature of the water may be as high as ° f. when, on the other hand, the fever is very high, the water may be much cooler; as low as ° f. has been given with good results on the fever. if the irrigation is given with the intention of reducing the fever, it is best to begin with water around ° f., and reduce it to ° f., gradually. indications for irrigation of the colon.--when it is desired to cleanse the bowel of any collection of matter a colon irrigation is indicated. this matter may be mucus, fecal substance, undigested food, or the decomposing waste products which may remain there as a result of disease or other conditions. when it is desired to medicate by putting fluids into the bowel we adopt the colon infusion. every diseased condition of the bowel does not, however, indicate irrigation. if a child is having frequent loose movements every half-hour it is safe to assume that the bowel is being cleaned out sufficiently without any artificial aid. to irrigate in these cases would only irritate and would not accomplish anything. the cases which are benefited are those in which we have a fever with four or five green stools in the twenty-four hours, or where we have a high fever with no movement at all. to irrigate in these cases we not only get rid of the products of decomposition, but we prevent further decomposition and we reduce the fever, thereby contributing to the general welfare of the child. when the child is convalescing and when there is only mucus in the stools, with no fever--as in cases of chronic ileo-colitis--the colon irrigations should be stopped, as they tend to keep up the discharge of mucus in these cases. if, however, there is a relapse with fever, which would indicate a fresh infection with more discharging mucus and possibly green stools, the irrigation must be used until the fever subsides. colon irrigations should always be given in every case of convulsions in infancy, first to clean out the bowel to prevent putrefaction, and second to empty the bowel on general principles because an overloaded bowel is very frequently the cause of convulsions in children. when irrigation of the bowel is given at all it must be given thoroughly. enough water must pass into the bowel to wash it all out. for this reason it is essential that the catheter should be all in and in the bowel--not doubled on itself two or three inches in the bowel. if it is a serious case and the mother nervous, someone else should give the washing--preferably the physician himself. if the child objects strenuously, as often happens, it must be done with greater care to be successful. remember that a colon irrigation is never given unless it is absolutely necessary and as a consequence it is given to accomplish a certain purpose; it must, therefore, be done thoroughly. if it is not, your child may miss the chance it has of getting over some immediate difficulty and if the moment of the "chance" is wasted or lost, that moment will not return. be thorough, therefore. enema.--some physicians talk about a high enema and a low enema. a high enema is really an irrigation as described above. the following remarks apply to low enemas only. a so-called low enema is given to clean out the rectum of constipated matter, or for the introduction of food or medicine by rectum, when for various reasons it is necessary to spare the stomach. it may be given with the fountain syringe or with the ordinary bulb (baby) syringe. a catheter may be put on the tip of the syringe if it is thought best to inject higher up than in the rectum. when an enema is used in infants or older children for the relief of constipation, the best medium to use is glycerine. for an infant, one teaspoonful to an ounce of water is sufficient; for older children, one tablespoonful to two ounces of water, given with the bulb syringe, will give prompt results. if the constipation is pronounced, the fecal mass very hard, an enema of sweet oil, allowed to remain in for ten minutes, will soften it and permit a movement. soap suds are often used. they are good but not as reliable as the glycerine or oil; if, however, neither of these two are at hand the soap suds may be given. enemas should be carefully given and the liquid slowly injected. if the fountain syringe is used care must be exercised in not having the bag too high. if it is too high the liquid will flow in too strongly, either injuring the bowel wall or causing the child to strain immediately and pass out the injection before it has an opportunity of accomplishing its work. the temperature of the enema should be warm--not hot, and not cold, simply body heat. methods of reducing fever during the course of acute illness it is frequently necessary to reduce the fever, if possible, without the use of drugs. the following means are often adopted. it is desirable that the mother should know just how to carry out these methods: ice-cap.--an ice-cap is used to protect the brain when a child or adult is running a very high fever. it is put on when the fever is above ° f. it may be used in other conditions--brain disease, or disease of the meninges or cord--in which case the physician will be in attendance and will direct what should be done. ice-bags are procured in the drug stores. the best one is the flat french ice-bag. fill it three-quarters full of finely chopped ice, put the ice-bag in a towel, and place on the patient's head. there should be only one thickness of the towel between the ice-bag and the head. it will be necessary to keep a record of the fever so that the ice-bag may be withdrawn when it falls below ° f. when the ice melts the bag must be at once refilled. this is often overlooked by careless mothers. cold sponging.--cold sponging is used to reduce fever or to allay nervous irritability. equal parts of alcohol and water or vinegar and water are used. the temperature of the water should be ° to ° f. infants to be sponged should be completely undressed and laid upon a blanket. the sponging should be done for about fifteen or twenty minutes, after which the child is wrapped in a dry blanket without further clothing except the diaper. to be effective it must be done frequently. cold pack.--the cold pack is used to reduce fever. it is one of the simplest and one of the best means we have. the child is undressed completely, and laid upon a blanket. it is completely covered with a small blanket (except its head) wrung out of water at ° f. outside of this the child is rubbed with a piece of ice, front and back, for a sufficiently long time to render the surface cool, but not cold. children take kindly to this means of reducing fever; there is no shock and they are quieted by it. just how long one will rub with the ice depends upon circumstances. from five to thirty minutes may be employed. the head should be sponged with cold water while this is being done and it is a good plan to have a hot-water bottle at the child's feet. the cold bath.--to reduce fever the cold bath is used in the following way: water at a temperature of ° f. is put into the bath and the child is first put into this water, then the water is reduced by putting into it shaved ice until it reaches ° f. the child's body is well rubbed while it is in the bath and cold water is applied to its head. the bath is continued for five minutes, or sometimes with a robust child to ten minutes. on removal the child should be put into a warm blanket after being thoroughly dried. rectal irrigations.--these are sometimes given to reduce fever. they are very useful and very successful if they are given properly and without exciting the child too much. it is best to give water of an ordinary temperature at first and gradually reduce it to ° f. it should be continued for ten minutes or longer. it may be repeated every three hours. (see page .) various baths every mother should know how to give any bath that may be directed by the physician. the mustard bath.--take from three to four tablespoonfuls of english mustard; mix thoroughly in about one gallon of warm water. add to this about five gallons of plain water at a temperature of ° f. if it is necessary to raise the temperature of the water higher it may be done by adding water until the temperature reaches ° or ° f. the mustard bath is exceedingly effective in cases of shock, great sudden depression, collapse, heart failure, or in sudden congestion of the lungs or brain. the special use of the mustard bath is in the treatment of convulsions; it is also useful for nervous children who sleep badly. two or three minutes in the mustard bath, followed by a quick rubbing, will induce refreshing sleep in these children. it is not necessary to have more than one tablespoonful of mustard in these cases. the hot bath.--a bath is prepared of water at a temperature of ° f. after the child is in the bath the temperature of the water is raised to °, or to ° f. it is not safe to go above this point. the body of the child should be well rubbed while it is in the bath. in most cases it is advisable to apply cold water to the head while the child is in the bath. a bath thermometer should be kept in the water to see that it does not rise above the temperature desired. the hot bath, like the mustard bath, is used to promote reaction in cases of shock, collapse, etc., and in convulsions. the hot pack.--remove all clothing from the baby and envelop the body in a sheet wrung out of water at a temperature of ° f., to ° f., after which the body should be rolled in a thick blanket. those hot applications may be changed every twenty minutes until free perspiration is produced. this condition may be kept up as long as is necessary. the hot pack is used mainly in disease of the kidney. the hot-air or vapor bath.--the child is put in bed wholly undressed with the bed clothing raised about twelve inches, and held in that position by a wicker support. the child's head is of course outside the bed clothing. beneath the bed clothing hot air or vapor from a croup kettle is introduced. this will cause free perspiration in twenty minutes. it may be continued from twenty to thirty minutes at a time. the vapor bath is used in diseases of the kidney, as a rule. the bran bath.--in five gallons of water place a bag in which is put one quart of ordinary wheat bran. the bag is made of cheese cloth. squeeze and manipulate the bran bag until the water resembles a thin porridge. the temperature of the water is usually about ° f., though it may be given with any temperature of water. the bran bath is of great value in eczema, or in rashes about the buttocks, or in delicate skin conditions when plain water would irritate. the tepid bath.--this bath may be given at a temperature of °, or ° f. it is of distinct advantage in extremely nervous children. to induce sleep it is often better than drugs. the cold sponge or shower bath.--this bath should be given in the morning in a warm room. a tub should be provided with enough water in it to cover the child's feet. this water should be warm because when the feet are in warm water it prevents the shock which frequently comes when cold water is applied to any other part of the body. a large sponge is filled with water at a temperature of from ° to ° f. this is squeezed a number of times over the child's chest, shoulders, and back. while the cold water is being applied the body should be well rubbed with the free hand of the mother. the bath should not last longer than half a minute. when finished take the child out quickly and stand him on a bath towel and give him a brisk rubbing with a bath towel until the skin reacts. this is an exceedingly valuable tonic for a delicate child. it should not be used on younger children than eighteen months of age. in younger children a cold plunge is preferable. for the cold plunge water at a temperature of ° f. is prepared. the child is lifted into this and given a single dip up to the neck. he is then briskly rubbed off as above. there are a very few children who do not take kindly to either the cold sponge or plunge. these children do not react; they remain pale or blue and pinched for some time after. it may be necessary to discontinue the procedure or to use water of a higher temperature. poultices poultices are useful in inflammation and for the relief of pain. to be of any value they should be applied frequently--every ten or twenty minutes--and they should be applied hot. ground flaxseed is the best material for poultices. it should be mixed with boiling water until the proper thickness is reached. it may be kept simmering on a fire. when one poultice is taken off it can be scraped into the pot and heated over if there is no discharge. each poultice should be put into clean muslin, put on the part and covered with oiled silk. this will help to retain the heat and prevent the clothing or bed sheet from becoming wet. hot fomentations a hot fomentation is simply a clean poultice. several thicknesses of flannel are taken, wrung out of very hot water, covered with cotton batting, and then with oiled silk. how to make and how to apply a mustard paste.--for infants: take one part english mustard to six parts flour, mix with lukewarm water, and spread between two layers of cheesecloth. for older children and adults: take one tablespoonful english mustard to three or four tablespoonfuls of flour, and mix as above. mustard pastes should be made big enough. you can accomplish a great deal more by putting on a sufficiently large mustard paste than by simply putting on one the size of the palm of your hand. it should be left on until the skin is distinctly red. the length of time will depend, of course, upon the strength of the mustard. mustard pastes may be put on every three hours, if necessary, and they may be used for a week at this interval if the conditions demand it. if they are used in pneumonia or other pulmonary diseases, they should be used large enough to go around the whole chest. if they are used in heart failure, they should be big enough to cover the whole trunk. when made with the white of an egg they will not blister. or if the part is rubbed with white vaseline before applying, it will not blister and it will be just as effective. when a mustard paste is removed the red area should be rubbed with white vaseline and covered with a clean piece of flannel. how to prepare and use the mustard pack.--the child is stripped and laid upon a blanket, and the trunk is surrounded by a large towel or sheet saturated with mustard water. this is prepared as follows: take one tablespoonful of english mustard and dissolve it in one quart of water, slightly warmed. saturate a towel in this mixture and apply to the body of the child while it is dripping. the patient is then rolled in a blanket. keep the child in this pack for ten or fifteen minutes. the mustard pack is not as good as the mustard bath, but it is all that is necessary in a number of various conditions. the physician will, of course, decide these matters. it is simply the duty of the mother to know how to carry out the physician's instructions. the turpentine stupe.--take a piece of flannel, big enough to cover the area which it is desired to affect, wring it out of as hot water as it is possible. upon this sprinkle twenty drops of spirits of turpentine. place the stupe wherever it is desired and cover with a piece of oiled silk or dry flannel. the turpentine stupe is mostly used in pain of the abdominal cavity. in colic from acute indigestion it is a very convenient means of quieting the child by allaying the pain. care should be taken not to allow this form of application to remain on too long. take it off when the skin is red. for continuous use it is not as good as the mustard paste. oiled silk. what it is, and why it is used oiled silk is sold in the drug stores by the yard. it is one yard wide. it is used to cover any local application to prevent evaporation into the air or to prevent the clothing from absorbing the medicament. if a liniment is applied on cloth to effect a certain result, it may take some time to do its work. if the wet cloth is covered with the clothing, the clothing will absorb the medicine quicker than the body will and thereby defeat the object in view, in addition to rendering the clothing wet and nasty. if the application is covered with oiled silk it cannot escape into the clothing, because the oiled silk is impervious. the body will be compelled to absorb the medicine and consequently results will be quicker and more certain. many liniments are expensive; to permit them to be absorbed by the clothing is needless waste it is therefore economical to apply the oiled silk. diseases of children [illustration: by permission of henry h. goddard.] the first blight this is one of those truly unfortunate cases which, so far as present knowledge goes, cannot be guarded against. eunice, age , mentally , is a low-grade imbecile. there is not in the whole family, for generations back, a single case of feeble-mindedness, nor of disease that would undermine the nervous organization. close scrutiny does not reveal a single assignable cause. she came, as an accident, to blight an otherwise normal family. such cases are few, but unfortunately they do occur. it is for eugenics to materially reduce the possibility of such occurrences. * * * * * chapter xxxviii infectious or contagious diseases rules to be observed in the treatment of contagious diseases--what isolation means--the contagious sick room--conduct and dress of the nurse--feeding the patient and nurse--how to disinfect the clothing and linen--how to disinfect the urine and feces--how to disinfect the hands--disinfection of the room necessary--how to disinfect the mouth and nose--how to disinfect the throat--receptacle for the sputum--care of the skin in contagious diseases--convalescence after a contagious disease--disinfecting the sick chamber--the after treatment of a disinfected room--how to disinfect the bed clothing and clothes--mumps--epidemic parotitis--chicken pox--varicella--la grippe--influenza--diphtheria--whooping cough--pertussis--measles--koplik's spots--department of health rules in measles--scarlet fever--scarlatina--typhoid fever--various solutions--boracic acid solution--normal salt solution--carron oil--thiersch's solution--solution of bichloride of mercury--how to make various solutions. rules to be observed in the treatment of contagious diseases every mother should know the elementary principles involved in the treatment of contagious diseases. they are contagious because they may be conveyed from one individual to another or because a person nursing a victim of a contagious disease may carry that disease to another person without having the disease herself. for this reason, certain rules have been established by the medical profession, which experience has taught are necessary in order to preserve the health of the community when such diseases are prevalent. the very first rule to which the physician will direct the mother's attention, when there is a contagious disease, will be that the child must be "isolated." what isolation means.--isolation means the complete seclusion of the patient in a room by himself, so that no one will see him or come in contact with him except the physician and the nurse or mother who will tend him during the entire course of the disease. isolation implies more than it would seem to mean. it implies that every article used during the sickness will be thoroughly disinfected before it leaves the room in which the patient himself is isolated. mothers must always remember that every article used by the patient may carry the germs of the disease to some other member of the family or to some other individual. these articles are the clothing of the child, the bedclothes, napkins, handkerchiefs, towels, dishes, knives and spoons, rags, the various discharges--sputum, urine, and bowel passages--and, we may add to this list, flies, insects, and domestic animals. every precaution must, therefore, be taken to safeguard any dissemination of the disease by means of these articles. thorough isolation also implies that the nurse shall frequently bathe and disinfect her person and her clothing, and that the sick-room itself shall be carefully dusted with a moist cloth and disinfected from time to time. the contagious sick-room.--the contagious sick-room will be prepared in exactly the same way as the ordinary sick-room which has been previously described. in addition, however, it will be safeguarded in the following manner. a wet sheet will be hung up outside the door. this sheet will be kept constantly moistened with a solution of chloride of lime. one-half pound to an ordinary house-pail of water is the strength of the solution to use. every window must be effectively screened to prevent the ingress and egress of flies and other insects. conduct and dress of the nurse.--she will remain in the sick-room all the time unless when she takes outdoor exercise. her dress will consist of a long gown which will entirely cover her person from the neck to the shoes and will be of plain, white, easily washed material, without tucks or ruffles or adornment of any kind. she should wear an ordinary pair of house slippers made of light leather. her cap will be large enough to cover and include her hair and head. when she leaves the room, she will remove her cap, gown, and slippers, disinfect her hands in a disinfecting solution and wash her face, neck, and hands in soap and water. she should go directly out and in, without coming in contact with any occupant of the home. feeding the patient and nurse.--the meals for the patient and nurse should be left on a table outside the door of the sick-room, from which place the nurse will then take them into the room. the utensils used for these meals should not be used by other members of the family during the entire sickness. after the patient and nurse have eaten, the utensils should be placed in a chloride of lime solution for disinfection. if any of the food is left over it should be put into a jar in which it may be disinfected and rendered harmless before being disposed of. how to disinfect the clothing and linen.--all bed and body linen, towels, handkerchiefs, napkins, etc., should be immediately put into a large receptacle--a wash boiler, or tub, will answer the purpose admirably--containing a five per cent. solution of carbolic acid in which an adequate quantity of soft soap has been dissolved. they should remain in this mixture for two hours, after which they may be wrung out and taken to the laundry. how to disinfect the urine and feces.--the urine and the stools should be passed into vessels containing a solution of four ounces of carbolic acid to the gallon of water. this vessel should be covered and the mixture allowed to stand for one hour, after which time it may be thrown out. how to disinfect the hands.--any of the following solutions may be used for disinfection of the nurse's hands: creolin, one teaspoonful to the quart of water; chloride of lime, one-half pound to a pail of water; formalin, thirty-two drops to a quart of water. a basin containing one of the above solutions should be constantly kept standing for the frequent disinfection of the nurse's hands. after disinfection, the hands should be washed in plain water and soap. disinfection of room necessary.--the room in which a contagious patient is confined requires systematic attention on the part of the nurse. every other day all flat or projecting surfaces should be disinfected. mantels, window-sills, door knobs, picture moldings, furniture, chairs, and bed-railings, should be wiped with cloths moistened in a disinfecting solution. a suitable solution for this purpose is one containing one ounce of carbolic acid to the quart of water. how to disinfect the mouth and nose.--in the course of all contagious diseases the mouth and throat of the patient and nurse should be thoroughly disinfected as a matter of routine. it should be done at least twice daily unless more frequent disinfection is called for because of the nature of the disease. in measles and diphtheria, for example, the nasal and throat conditions will undoubtedly call for more frequent and more thorough disinfection than twice daily. this may also apply to scarlet fever if the throat is involved as is often the case. pocket handkerchiefs should never be used by a patient suffering from a contagious disease. the nose and mouth should be wiped with pieces of gauze or cheesecloth, cut into small squares for this purpose. these should be immediately burned after being used. to disinfect the throat, a solution of formalin, six drops to six ounces of water, is effective. to disinfect the nose, a solution of glyco-thymoline is suitable. these applications should be made by means of an atomizer, a different atomizer being used for the patient and nurse. receptacle for the sputum.--a cuspidor, or basin, should be constantly kept at the side of the bed in which the patient may conveniently expectorate. this utensil should contain the chloride of lime solution previously mentioned. care of the skin in contagious diseases.--as in all other sick conditions, the skin of the patient should be bathed frequently with an alcoholic solution. in the later stages of measles and scarlet fever it is essential to anoint the skin while the patient is scaling. this may be done with carbolated vaseline. mothers should understand why this is necessary. these diseases have a distinct rash or eruption. this eruption practically kills the skin cells and at a certain period these cells are cast off by the new growth of skin underneath. this process is called scaling. in measles the scales are small, and are cast off in the form of bran like dust. in scarlet fever, the cells adhere together and are cast off in large scales. these scales are contagious. they are very light and will float in the air if dry. the movement of the patient, changing the bed clothing, etc., will waft a multitude of these contagious scales into the air of the room and infect every article they may land on. this would make the disinfection of the room difficult and tedious. in order to obviate this tendency experience has taught us that much of the difficulty and nearly all of the risk of contagion may be overcome by rubbing some oily or sticky substance on the skin. by this method the dust and scales are rendered heavier than the air, stick together and will not float. during the scaling period there is a constant itch present which irritates the little patient. by using carbolated vaseline to anoint the skin we accomplish two purposes. the carbolic acid in the vaseline relieves the itch, and the vaseline itself greases the skin so that the scales remain in the bed. each day the nurse changes the bed-sheet, gathers the scales in the sheet and puts all in the disinfecting solution. convalescence after a contagious disease.--complete isolation must be kept up until all danger from contagion is passed. in diphtheria this period is not reached until the examination of the throat contents under the microscope is returned negative. in diseases which have a rash this period is not reached until all scaling is completed. even then, and for a number of days or weeks, the patient may be taken out for exercise daily, but must not be allowed to play with other children until his strength justifies active exercise. it takes a much longer period to rid the system of the poison of a contagious disease than most mothers appreciate. many children have died from heart failure after they were considered well simply because the active exercise overtaxed the heart before the system was wholly free from the poison of the disease. before the child is removed from the sick-room for the first time he should have a disinfecting bath. this bath should be in a solution of bichloride of mercury, the strength of which should be one part to five thousand parts of water. the towels used to dry the patient after the bath should be fresh and should not have been in the sick-room. he should then be dressed in clothing which has never been in the sick-room. disinfecting the sick-chamber how to disinfect a room.--the most efficient way to disinfect a room is by means of formaldehyde gas. this, however, requires a special apparatus which can only be used by one familiar with the process. in all large cities the department of health usually undertakes the disinfection of rooms after any contagious disease. the next best method is by sulphur. when sulphur is employed it should be used in the form of powder or in small pieces. this is placed in a shallow iron pan set on a couple of boards in a tub partly filled with water. the sulphur is moistened with alcohol before it is set on fire. it is always necessary, of course, before disinfecting by any process to make the room as nearly air tight as is possible. to accomplish this the windows must be tightly closed, the doors locked, and the cracks and keyhole sealed with pieces of paper or adhesive paper. the room should remain closed for six or eight hours, after which it should be thoroughly aired for several days. the after treatment of a disinfected room.--the walls, ceiling, and all flat surfaces, such as mantels, window-sills, etc., should be washed with a fresh chloride of lime solution. the floor should be scrubbed with a four per cent. soda solution. all carpets and curtains, if any, should be removed, taken to a vacant lot and thoroughly beaten and then exposed to direct sunlight for a number of hours. the room should then be well aired again for a couple of days before it is again occupied. how to disinfect the bed clothing and clothes.--the surest way is to boil them for half an hour; otherwise they may be left in the room while it is being disinfected. spraying the clothes with a spray of formaldehyde is an effective way of disinfecting them. mumps: epidemic parotitis mumps is a contagious disease. it is most common between the fourth and sixth years. infants are rarely affected. the disease is not very contagious, direct contact being necessary to communicate it. every case should be isolated for a period of three weeks from the beginning of the disease. the seat of the affection is the parotid gland which is located in front of and on a level with the ear. one or both glands may be affected at the same time or one may follow the other in succumbing. the duration of the disease from the time the swelling becomes noticeable is about ten days. it is contagious for a week after the swelling subsides. the period of incubation is from one to three weeks. symptoms.--in the majority of cases the first symptom is the swelling and the discomfort which it causes. in more severe cases the child feels sick and is listless for from twenty-four to forty-eight hours. there may be a headache, vomiting, pains in the back and limbs, and fever. there is pain in the swelling which is increased by movement of the jaws and by pressure. the degree of the swelling varies with the severity of the attack. it may be very little or it may be so great as to completely distort, and render unrecognizable, the face. it must be remembered that, though mumps is not regarded as an important or dangerous disease, it may assume dangerous characteristics. we sometimes see distressing complications with mumps. in boys, orchitis, or inflammation of the testicles, occasionally occur. in girls, ovaritis, or inflammation of the ovaries may be present. these complications may be avoided by keeping the patients in bed. treatment.--keep the child in bed until the fever is gone. keep him in the house for one week after the swelling has entirely subsided. he should be put on a liquid diet while the fever lasts. the bowels should move each day. the mouth should be kept clean by an antiseptic mouth wash. if there is much pain in the swollen gland, warm, wet dressings give the best results. sometimes it is advisable to paint the gland with belladonna ointment. if it is not very painful, the most comfortable way to dress the gland is simply to place over it a large pad of absorbent cotton held in place by a broad strip of flannel cloth. chicken pox. varicella chicken pox is an affection almost entirely special to children, in whom it may be observed from their first year, although it is especially frequent from the ages of two to six. it appears often in the epidemical form and spreads by contagion. some doctors are inclined to regard varicella as a very attenuated form of smallpox, hence the name "chicken pox," by which it is popularly known. this opinion is based merely on the analogy between the two types of skin eruptions and the coincidence sometimes observed between two epidemics of smallpox and chicken pox. but the theory falls on considering that, on the one hand, chicken pox offers no safeguard against infection by smallpox and does not prevent the effects of vaccination, and, on the other hand the disease may occur in children who have been vaccinated or who have had smallpox. chicken pox, too, differs essentially from smallpox in the course of its development. after a period of incubation, extending over a fortnight, chicken pox becomes apparent by such symptoms as slight shivering, extreme fatigue and a general but not very intense condition of fever. in less than twenty-four hours small pink spots will appear on the skin, and these after a few hours are topped by a vesicle, and the next day the whole rash shows a vesiculous appearance. the vesicles are sometimes small and pointed, sometimes more voluminous and globular in form. they are filled with a limpid or a slightly yellowish liquid. their base is sometimes surrounded by an inflammatory ring. by the third day the contents of the vesicle has become thicker and tends to become purulent. on the fourth day desiccation commences, and the vesicles shrivel and shrink in and form small brownish scabs, which fall about the eighth day. frequently the child will scratch them off with the finger nails before they are entirely desiccated. the vesicles leave small reddish spots, which generally disappear gradually, almost always without a scar. an eruption of chicken pox does not burst out all over the body at once, but appears in successive rashes. it is not confined to any special parts of the body. it may begin and spread at the same time from the face, the trunk of the body or the limbs. a dozen pimples may be seen the first day, while three or even ten times as many may be visible the next day, and so on for several days in succession. sometimes the vesicles appear on mucous membrane at different parts--the mouth, tongue, soft palate and tonsils--and may also invade the conjunctiva and cornea, or the larynx, where they will set up laryngitis. owing to the very contagious nature of chicken pox, the first thing to be done is to provide for the complete isolation during a period of twelve to fifteen days of all patients attacked by the disease. the treatment of the disease is solely a matter of hygiene. the more severe the fever the stricter the diet should be, and in the case of great fever, the diet should be restricted to broth and milk. if there is no fever the child need not be placed on any special diet. if the intestines are sluggish, they may be stimulated by administering a dose of castor oil. it is advisable to make the patient rinse his mouth two or three times a day with a mouth wash. it is also well to apply a lotion around the eyes and face, consisting of two per cent. boracic acid solution with the chill taken off. finally, in order to prevent the child scratching the sores and the consequent danger of inoculation by the finger nails, it is a good practice to rub a small amount of carbolated vaseline over the itching parts. it is frequently found necessary to have the little patient wear white woolen gloves to prevent scratching and infecting the sores. if a child scratches the sores on the face it will leave an unsightly mark which will stay for the rest of its life. the child, of course, should not be allowed to rejoin his playmates without having had a good bath, and having had his clothes completely disinfected. influenza: la grippe the most important feature with reference to influenza in children is its very active tendency to develop complications. these complications generally affect the respiratory tract. so we find in children suffering from grippe an easy disposition to get bronchitis or broncho-pneumonia. the younger the child the greater the danger. the disease itself, so long as it remains an uncomplicated influenza, is not of much importance or severity. the lesson to be learned, therefore, is to treat the disease with respect and take every precaution to avoid the possibility of developing a complication. la grippe is a highly contagious disease. it prevails epidemically, and after an active epidemic it may remain in the vicinity for a number of years. it is more frequently seen in the late winter months and early spring. the poison of the disease clings to clothing and apartments as well as to railroad and street cars. the germ is found in the sputum and in the nasal secretions. sneezing is one of its symptoms and it is one of the ways by which the disease is spread around. children should never be brought near an adult suffering from influenza. one attack does not render the patient immune to a subsequent attack as is the case with most of the contagious diseases. the reverse is the rule with la grippe because one attack favors the development of another attack. it is a common experience for many people to have influenza every winter or spring. symptoms.--if a child "catches" grippe, it becomes quite sick abruptly. there is usually chilliness, pains in the muscles all over the body, more or less fever, sometimes nausea and vomiting. if the attack is a more severe one, the prostration is more marked, the temperature higher and the signs of shock and poisoning of the system are more in evidence. a child a few months old can get influenza so severely as to cause collapse and death in thirty-six hours. as a rule the type of grippe most common in infancy is of a very mild character. it lasts about a week. children may be a little slow in convalescing and it may be three or four weeks before they regain their health. complications.--as has been intimated, the most frequent complication is bronchitis and the most fatal one is broncho-pneumonia. a congestion of the entire mucous membrane of the respiratory tract, producing a nasal discharge, a sore and inflamed throat, pains and a feeling of compression, with a cough in the chest, may accompany the disease. gastric symptoms, with vomiting, intestinal disturbance, diarrhea, with or without mucus and blood, are quite common in some epidemics. not infrequently we have numerous cases in which the ear seems to be the vulnerable part. as a consequence running ears have to receive most of our attention. when the ears are affected, the glands of the neck become inflamed. they swell up and add considerable to the discomfort of the little patient. treatment.--cases of influenza should be isolated. children should be put in a room by themselves and the other children of the family should not be permitted to see them. the rooms should be disinfected after the case is over. as complications are the dangerous element in grippe, we should try to prevent them. this can be best done by promptly putting the child in bed, making him comfortable, opening his bowels by castor oil or calomel. he should be made to drink hot lemonade. he should be kept on a light diet from which meat and vegetables are excluded. the above treatment will usually suffice in the ordinary uncomplicated grippe. if complications arise they must be treated according to the conditions. it is well to remember that the degree of prostration following a rather severe attack of grippe is out of all proportion to the extent of the disease. these little patients sometimes suffer considerably and do not regain their strength promptly. experience has taught us that the best thing to do is to send them away. a change of climate will do wonders for them, more quickly and more thoroughly than all the medicine we can give them at home. the seashore is particularly good for them. diphtheria diphtheria is an acute, specific, infectious, communicable disease. it affects the tonsils, throat, nose, or larynx. it is most frequently seen in children between the ages of two and five years, though it may appear at any time during life. the two sexes are equally liable to it. the same person may have the disease twice or more times at different ages. children suffering from disease of the nose or throat are more likely to get it than are others. such diseases are cold in the head with running nose, catarrh of the nose and throat, inflammation of the mucous membranes of the nose or throat. diphtheria may occur at any time of the year, though it is more frequent during the cold months. the incubation, or the length of time between exposure to the disease and the development of the symptoms, is between two and five days. in its mild form the disease may be present without giving any constitutional symptoms. in its severe form, however, it is one of the most dangerous diseases of childhood. in large cities it is present all the year round with more or less frequent outbreaks in the form of local epidemics. in the country it is only seen in its epidemic form. it does not arise without a cause, that is, there is always a preceding case from which an epidemic springs, though it is not always easy to trace the connection. the child inhales the bacilli which cause the disease with the air it breathes. the bacilli may lodge on toys or other articles from which the child gets them. direct infection is usually the mode of communication through which a child obtains the disease. the saliva and mucus from the nose contain the bacilli in large quantities and if a patient coughs or sneezes they are expelled in this way and infect others. frequently a child suffering from a mild form of diphtheria may attend school and infect others without it being known that the child has the disease. symptoms.--the symptoms vary with the severity of the attack. there are mild cases, as has been stated, that give no constitutional symptoms. there may be a small amount of local disturbance in the throat or nose and there may be some membrane present, but, for some reason, there does not seem to be any absorption of the poison into the system and the child escapes the systemic disturbance. even as a local condition these cases vary. there is always a fever at the beginning, but the child never seems sick enough to go to bed. if the throat is examined it will be found to be red and slightly inflamed, there may be spots on the tonsils, or there may be a gray film over them. there is no discharge from the nose and the child does not complain of an excess of mucus from the throat. the spots may last for a week and then disappear. these cases are difficult to diagnose without making a culture, and if the physician insists upon keeping the child confined to bed while apparently well the family as a rule object, though it is absolutely necessary. these are the cases that do great harm in school, and no mother should object if the physician insists in taking preventative measures to stop an epidemic if the bacilli have been found in the child's throat. she should rather feel thankful that the child escaped so easily. since the introduction of antitoxin we do not see the severe cases now, so that a description of them would not be of any use in a book of this character. mothers should, however, know that it is absolutely criminal to take any chances with a "sore throat." antitoxin is a prompt and an absolute remedy if used soon after the onset of the disease. it is more sure if used the first or second day, still reliable the third day, but its efficacy diminishes the longer we postpone its use from the date of the onset of the disease. when, therefore, a child complains of being sick and states that its throat hurts, medical aid should be at once sought. the disease may develop in one of two ways. it may begin as a slight indisposition for a day or two, and perhaps some soreness of the throat. the fever may be slight. the child will continue to be sick despite any treatment given and will get slowly worse until the fourth or fifth day, when it will be impossible to mistake the condition. at other times the disease begins abruptly. the child complains of being sick. it may vomit, or suffer from headache, chilly feelings, and a fever. the glands in the neck may swell and cause considerable disturbance. there is, as a rule, an abundant discharge from the nose and there is an excess of mucus in the throat. membrane is seen in the throat. it may cover the tonsils and spread over the entire throat cavity, or it may extend up into the nose and over the roof of the mouth. all the parts are much swollen and breathing is interfered with, sometimes seriously. if the attack is very severe there is an active absorption of poison going on from the throat which soon renders the little patient intensely sick. there is marked weakness and prostration, the circulation becomes poor, the pulse rapid and the child falls into a stupor. the physician will, of course, have taken complete charge of the case before the patient has gone thus far. the nursing of the case, which may fall to the mother if no trained nurse is present, is most important. she should preserve absolute cleanliness of herself and of the sick room. she should never eat or sleep in the same room with the patient, and should use a gargle, which the physician should prescribe, frequently during the day. she should dress simply, so that whatever is worn can be changed often and washed easily. every article of furniture must be taken out of the sick room that is not absolutely essential in the care of the case. if toys are allowed they should be burned as soon as the child is tired of them, never left around the house after the case is over. the room should be a large one and it should be thoroughly aired each day. the floor should be washed each day with a solution of bichloride of mercury, and all dusting should be done with a wet cloth. the bed linen and any rags or handkerchiefs used should be treated as in scarlet fever. all vessels in which the patient expectorates should have an antiseptic in them. the room must be disinfected after the case is over. the patient must be kept in bed during the entire attack. he must not be allowed to even sit up in bed until the physician gives him permission. this is a very important essential in the treatment of this disease, and the nurse must be held responsible for the conduct of the patient in this respect. because of the character of the poison, there is a tendency to paralysis of the heart, and frequently children have been allowed to sit up too soon only to fall back dead in bed. the same thing has occurred later in the disease when children have been allowed to play too heartily before the poison had an opportunity to completely eliminate itself. nursing children should be fed on breast milk pumped from the mother, but they must not nurse it themselves. older children can take milk and should depend upon it mostly. the physician will give any other special directions that he may think necessary, the duty of the mother being to see that they are faithfully carried out. whooping-cough whooping-cough is usually seen in young children. it may, however, affect a person at any age. it is contagious. during infancy it is one of the most fatal diseases. during adult life it is a dangerous condition, while in childhood it is simply regarded as a mildly contagious disease. it is most contagious during the catarrhal stage,--the first ten days. children suffering from whooping-cough should not be allowed to mix or play with other children for two months. after an exposure to the disease it takes about fourteen days for a case to develop. the danger of whooping-cough is the tendency to develop pneumonia or bronchitis. symptoms.--during the first ten days the child acts as if suffering from an ordinary catarrhal cold with cough. this is called the catarrhal stage. there is no way of telling that whooping-cough is present until the child whoops. most children do not whoop until the expiration of the catarrhal stage, though a very few do from the beginning of the disease. if a child is treated for an ordinary cold with cough and does not respond to treatment, and whooping-cough is epidemic, it is fair to assume that whooping-cough has been contracted. when the cough shows a distinct tendency to be worse at night it is further proof of this assumption. when they begin to cough in paroxysms, and whoop, the second, or spasmodic stage begins. these fits of paroxysmal coughing are much more severe than spells of ordinary coughing. these may only be three or four attacks daily, or the child may have from forty to fifty such attacks. when children feel these attacks coming on they seek support, holding on to chairs or they stand by the mother's knee. the coughing is explosive, rapid, and forceful, the child fails to catch its breath and is compelled to take a deep inspiration, which is the whoop; it then goes on coughing more. the face may become purple, the eyes protrude, and the veins of the face swell up. near the end of the attack the child raises, or vomits a mass of stringy, glutinous mucus. after it is over the child is exhausted, there is a more or less profuse perspiration, and he may be quite dazed. these attacks are, as a rule, more frequent and more severe during the night. this stage lasts about one month and is then followed by the stage of decline, during which the disease subsides into what appears as an ordinary bronchial cold. it is quite common for these children to get relapses, especially during inclement winter weather, and go on whooping for two or three months longer. their vitality suffers because their sleep and nourishment is interfered with, and they become nervous and difficult to manage. treatment.--inasmuch as there is no remedy known that will cure whooping-cough, the best we can do is to render the patient physically efficient to stand the severe strain of coughing, which is the worst feature of the disease. experience has taught us that those children do best who spend their entire time out of doors. we, therefore, advise parents to encourage their children to play in the open air. there is no exception to this rule, even in winter weather, unless it is particularly inclement. if the weather is wet or raw, or if the child has bronchitis, or is running a fever, it would be more safe to keep the child indoors, in a well-aired room, until the temporary conditions pass over, when they could again resume the open-air treatment. naturally delicate children if under two years of age should not risk staying out of doors too much in very cold or raw weather, even if not suffering from any of the above complications. the bedrooms of children suffering from whooping-cough should be large and thoroughly aired day and night. the nourishment in these cases is of great importance. they should be carefully fed, and if they vomit with the paroxysms of coughing, they should be fed small quantities frequently. any form of digestive disturbance is very apt to accentuate the frequency of coughing. a fluid diet of milk is the best. milk punches aid in keeping up the strength; malted milk and eggs beaten in milk are nutritious and easily digested. so far as internal medication is concerned, i have found pertussin to be the most efficacious remedy. if it is begun early and in sufficient dosage, it not only favors an early termination of the disease, but it lessens the frequency and the severity of the paroxysms. if it is suspected that the child has been exposed to whooping-cough, pertussin may be given during the catarrhal stage with the advantage that it will render the whole course of the disease milder. if it is given during the course of an ordinary catarrhal cold, it will in most cases be as effectual as any ordinary cough remedy. the dosage should be large enough to produce results. i have found a teaspoonful every two hours to a child of three years to be the average dose. in older children i give two teaspoonfuls every three hours. it is necessary to continue its use throughout the disease. the taste of pertussin is pleasant and young children take it willingly. when the disease is inclined to a protracted course, or when the cough does not subside, especially during unfavorable weather, it is of great importance to send the child away. a change of climate, preferably to the seashore, even for a short time, will act like a charm, and will cure the cough of whooping-cough quicker than any other possible measure. measles measles is the most widely prevalent, eruptive, contagious disease. with few exceptions, every human being "gets" measles. as an uncomplicated disease it is never fatal, and is not even regarded as dangerous. because of this characteristic, however, parents are neglectful and complications occur, and these frequently prove fatal. one attack renders the patient immune. it is very highly contagious and spreads with great rapidity among those who have never had it. it is not possible to carry the disease any great distance by a third person or by means of living objects. it does not, however, cling to clothing or other objects as long as scarlet fever. its period of incubation is from eleven to fourteen days. symptoms.--the symptoms develop gradually. a severe cold in the head is the first and most characteristic symptom of the disease. there is a discharge from the nose, swollen and watery eyes, sneezing and a hoarse, harsh cough. the patient may complain of the throat being painful and examination will reveal a general congestion of the parts. there are also headache, lassitude, pains in the back, and there may be vomiting and diarrhea. children in the early stages of measles are tired and sleepy. koplik's spots.--three or four days, in rare cases somewhat longer, before the appearance of the rash there appears on the mucous membrane of the cheeks small, bluish white, or yellowish white points, the size of a small pin head. these points are surrounded with reddened areas which give the appearance of a general rash with fine white points upon it. these points resemble milk particles. they adhere firmly to the mucous membrane and when an effort is made to remove them it is found that the underlying surface is ulcerated and excoriated. the koplik spots are not of much value to the mother other than that they may be relied upon to indicate the coming disease with which they child is affected. physicians look for them as an aid in diagnosis before the rash would of itself indicate the disease. the rash appears on the third, fourth, or fifth day of the disease. from the day of the infection to the outbreak of the rash about thirteen days intervene. it is seen first at the roots of the hair on the forehead, behind the ears or on the neck. it may be seen first on the cheeks. the beginning rash appears as small, dark red, dull spots. at first there are only a few, but they soon become more numerous, they join together, and soon the surface looks inflamed as if entirely covered with the rash. the rash covers the entire body, including the soles and palms. in twenty-four hours it is at its height on the face. it spreads downward like a wave, first the face, then the neck and chest, then the abdomen and later the legs. by the time it invades the legs it has begun to fade on the face. it fades slowly in the order of its appearance. its duration is about four days. the skin is swollen; it burns and itches. the eyes are swollen and red and intensely sensitive to light. there is usually a muco-pus discharge from them. the cough is invariably an annoying feature. the fever is high and reaches its highest point when the rash is at its height. as the rash fades the fever subsides. when the rash fades, the patient begins to "scale." the scales of measles are fine, like bran, never in large patches like the scales of scarlet fever. the amount of the scaling varies. it may be quite considerable or it may be so small as to be overlooked. complications.--the most important and by far the most frequent complication of measles is broncho-pneumonia. there may be various conditions affecting the stomach, bowels, throat, ears, bronchi, and the nervous system, which may accompany the disease but are seldom of a serious or important character. treatment.--measles runs a certain course and will run that course, no matter what we may or may not do. we cannot stop it, or shorten it, or lessen its severity. we can only hope to make the patient comfortable and to prevent the development of complications. the child should be put in bed and kept comfortably warm but not too warm. the room should be kept at the ordinary temperature of the sick room, ° to ° f. it should be darkened but not dark. the food should be fluid and given regularly. the child may be given all the cool,--not cold,--water it wants to drink. the bowels should be kept open daily. if constipation occurs an enema may be given. the eyes must be carefully watched and washed every hour or two during the day with a boracic acid solution. if the cough is distressing, it may be rendered less distressing, though we cannot hope to stop it until the disease has run its course. the restlessness, headache and general discomfort can be much modified by suitable remedies. if the itching is acute, the body can be rubbed with carbolated vaseline. when the rash subsides and the patient is free from fever a daily warm bath should be given in order to facilitate scaling. should complications arise they should be promptly cared for by the attending physician. summary:-- . measles is the most prevalent infectious disease of childhood. . the danger of measles has been and is underestimated. because of its prevalency many mothers treat it with less respect than they should, with the result that fatal complications occur, or the future health of the child is permanently injured. . children with measles should be put in bed and kept in bed and treated as directed above. the following rules have been formulated by the department of health of new york city, with reference to measles, and embody precautions that should find general observance: . all children in the family must be promptly excluded from school attendance. . careful and continued isolation of the patient must be enforced until the case is terminated and fumigation has been ordered by the medical inspector of the department. . all secondary cases must be reported even if the first case is still under surveillance of the department of health. . suspected cases must be treated as contagious cases until a sufficiently long observation has shown that the patient has a non-contagious disease. all cases will be considered as measles, if so reported. any change in the original diagnosis must be made in writing to the department of health and must be confirmed by a diagnostician. . physicians must not order the removal of patients to the contagious disease hospital, or elsewhere, in cabs or other vehicles, but must notify the department of health and the removal will be effected by a coupé or ambulance of the department. . whenever there is a case of measles in rooms in the rear of, or communicating with, a store, the inspector is required to have the store closed at once, or to report the case for immediate removal to the hospital. . a case of measles must not be removed from one house to another, or even to a different apartment in the same house, without the permission of the department. such removal is in direct violation of the provisions of the sanitary code. . no case of measles shall be discharged from observation until the department has been notified, the case examined by an inspector to see if desquamation is entirely completed, and the premises ordered fumigated. this examination by the inspector is necessary because the department of health must have official information as to the completion of desquamation before a child is dismissed from observation. other people with children demand this protection. at no other time is the inspector allowed to examine the patient. in any case, however, where isolation has not been maintained and it becomes necessary to remove the patient to the hospital, a diagnostician will make an examination. it is recommended that physicians provide a special washable gown for each case of measles. this gown should be put on before entering the sick-room and taken off outside the sick-room as soon as the visit is completed. the gown should be kept in a closet or suitable place, separate from all other clothing, and the gown, and the closet should be fumigated after the termination of the case. . in private houses only fumigation may be performed under the supervision of the attending physician; provided he follow accurately the directions given in the following rules and regulations. upon request a blank will be provided upon which he must state the manner and extent of the work performed under his orders and supervision. if satisfactory to the department, this will be accepted in place of fumigation by the department. it is essential, however, that he should know that the disinfection has been efficiently carried out. in every case of fumigation the following regulations must be complied with: all cracks or crevices in rooms to be fumigated must be sealed or calked, to prevent the escape of the disinfectant, and one of the following disinfectants used in the quantities named: a. sulphur, lbs., for every , cubic feet of air space, hours' exposure. b. formaline, oz. for every , cubic feet of air space, hours' exposure. c. paraform, , grains for every , cubic feet of air space, hours' exposure. the following disinfecting solutions may be used for goods, which are afterwards to be washed: a. carbolic acid, to per cent. b. bichloride of mercury, - , . scarlet fever. scarlatina. scarlet fever is an acute, contagious disease. it begins abruptly. the child may have a severe attack and be quite sick from the beginning, or he may have a mild attack and not be very sick. usually the fever rises rapidly, the child vomits and complains of a sore throat. if the attack is very mild the throat symptoms may not cause any distress. frequently, about the third day, there are patches on the tonsils. prostration may be profound if the fever is very high. convulsions and diarrhea are sometimes present in very young patients. it takes from two to six days to develop scarlet fever from the time the child is exposed to it. the disease may be caught at any time, but it is most contagious during the time the patient is scaling. it is not as contagious as measles. some children seem to escape even though directly exposed to it. it is more frequent in the fall and during the winter, and it is more severe during the latter months. eruption.--the eruption appears at any time after twelve hours. it may not, however, appear before the third or fourth day. it lasts from three to seven days, and only takes a few hours to cover the whole body after it is first seen. the rash is first seen on the neck or chest; it appears as a red, uniform blush, but, when examined closely, small reddish spots may be seen all over it. if the rash is very faint and of a doubtful character a hot bath may bring it out. a bright red, well-developed rash is a sign of good heart action. in the event of heart failure, the rash fades quickly. itching is a constant symptom after the rash is fully out. about the eighth day the rash begins to scale or desquamate. it begins on the neck and chest. it takes from one to three weeks to scale completely, from the time it begins to peel. the hands and feet are the last spots to scale. it must always be kept in mind that mild cases are just as contagious as severe cases, and that a mild case may cause in another person a very severe attack. the throat may be mildly affected or it may be the most troublesome feature of the case. it is red and swollen and the child complains of pain during the act of swallowing. patches may be seen on the tonsils on the third day. there is usually a discharge from the nose and this discharge may be contagious. while the fever is high, the child is restless, complains of thirst, and may be slightly delirious. one attack is usually all a child has during life, though there are exceptions to this rule. complications are quite frequent with scarlet fever. inflammation of the ears and kidneys is most often met. measures to be taken to prevent spread of disease.--every case, no matter how mild, should be isolated for four weeks. many cases must be isolated longer,--until scaling is complete. children should not play or sleep with other children for three or four weeks after all symptoms have been absent. other children in the family, who have not been exposed, should be sent away. all clothing should be changed and washed in soap and water and then boiled in a carbolic solution. the nurse should not mix freely with other members of the family. the sick room should be kept clean, and well aired. it should be dusted with a wet cloth, and this should afterwards be burned. there should be no furniture, or hangings, or pictures in the room other than are absolutely necessary. the room should not be used after the case is over until it is thoroughly and completely disinfected. during the period of scaling the patient should be rubbed all over with carbolated vaseline. this allays itching and prevents the scales flying around. the bed sheet can be taken off daily with the scales in it, and immediately put in carbolic water and boiled. treatment.--inasmuch as scarlet fever is one of the most dangerous and one of the most treacherous diseases of childhood, we cannot afford to take any chances with it. every child with scarlet fever should be put in bed, and kept there during the entire illness,--that is, from four to six weeks. light, and the free circulation of fresh air are absolutely necessary for the proper care of a scarlet fever case. the child should be clothed only with the usual night gown and a light undershirt. no extra wraps or blankets are required. the diet should be reduced in quantity and strength. the bowels should move daily. if anything is necessary to accomplish this, citrate of magnesia is quite satisfactory. there is no special medicine for the treatment of this disease. often it is not necessary to give any. good nursing is more essential, and with proper attention to the bowels, diet, fresh air, clothing, sleep, and quiet, all will, as a rule, result favorably. quiet is essential. consequently, two persons at a time should never be allowed in the room with the little patient. the family physician will prescribe whatever medicine is necessary in his judgment, and will meet any complication as it arises. typhoid fever typhoid fever is an acute infectious disease. it is rare in infancy. after the fifth year it is more common. it is caused by drinking infected water or milk. it is not a serious disease in childhood, rarely being fatal. symptoms.--it may begin suddenly or it may come on slowly. if suddenly, the child develops what appears to be an attack of indigestion, has fever, vomiting, and is prostrated. in cases developing slowly the child complains of being tired, has a headache, nausea, and fever. vomiting is the suggestive and important symptom. diarrhea is usually present. constipation, however, may accompany the entire illness. children may not complain of an excess of gas as do adults. the abdomen is tender. the typhoid eruption is rarely seen in children. they lose flesh steadily and then strength diminishes rapidly. headache and delirium at night are quite common, and the child is dull and indifferent, and often in a state of semi-stupor. in order to tell definitely whether the child has typhoid, it is necessary to make a blood examination. there are so many intestinal conditions in children that simulate typhoid, that a blood examination is imperative. treatment.--the patient should remain in bed during the time fever is present and for a few days after. a fluid diet, preferably milk, is the most suitable means of nourishing the child. it may be diluted or given plain according to the age of the patient. water is essential and should be given freely. the discharges of the patient should be thoroughly disinfected in a solution of carbolic acid, - . all clothing and bed linen should be boiled for two hours. if the fever remains high cold sponging is advisable. the attending physician should instruct regarding this feature, as some children do not stand cold applications well. the average duration of the disease is about six weeks. how to keep from getting and spreading typhoid fever.--typhoid fever is a communicable disease, but, if certain precautions are taken, its contraction and spread can almost certainly be prevented. the disease is caused by a specific germ known as the typhoid bacillus. these germs are found in the excreta (stools and urine) of persons ill with typhoid fever. failure to properly disinfect these excreta and carelessness in the care of persons ill with typhoid fever lead to the transmission of the disease from the sick to the well by the infection of water, milk or food with the typhoid bacillus or by direct contact. the disease is contracted by taking into the mouth in some form the discharges from some previous case. there is no other way. it is, therefore, a disease of filth and someone is at fault somewhere for every case of typhoid fever that occurs. bad sanitary conditions, such as lack of drainage, open cess-pools, sewer gas, decaying vegetable matter, etc., may favor the contraction of the disease, but cannot cause it unless the specific germ, the typhoid bacillus, is present. the water supply of a community becomes infected by the entrance into it of the excreta (stools and urine) of persons suffering from typhoid fever. milk (in which typhoid bacilli grow and multiply very rapidly) usually becomes infected by washing out milk cans with water in which these bacilli are present, or from the presence of the bacilli on the hands or persons of those handling milk. oysters spread the disease when they have been "freshed" in water rich in sewage and containing the typhoid bacillus. flies, whose bodies have become foul with typhoid excreta, may infect food, milk, etc. those who take care of typhoid patients may contract the disease if they do not at once disinfect their hands after handling the patient, or clothing or bedding which has become soiled with the discharges. how to keep from getting typhoid fever.--if the chance of infection is to be reduced to a minimum, all drinking water, concerning the character of which there may be the slightest doubt, should be boiled, and all milk, the handling and care of which is not absolutely beyond suspicion, should be pasteurized or boiled. all food supplies (meat, milk, vegetables, etc.), should be carefully protected against flies, and flies should not be permitted access to the sick-room, the kitchen nor to the room in which the meals are eaten. bathing at all beaches which have sewers emptying in their immediate vicinity should be strictly avoided. in the majority of cases it is probable that the system must be slightly below par in order that the disease may be contracted; therefore, all indigestible food, green fruit, etc., which may set up indigestion or diarrhea, and so render the system more susceptible to infection, should be avoided. in addition, the elementary rules of cleanliness and hygiene, both as to the house and person, should be most strictly observed. no member of a household in which a case of typhoid fever occurs should take food in any form without previously washing the hands. typhoid bacilli enter the body only through the mouth. if sufficient care be taken to prevent their entrance, the contraction of the disease can be absolutely prevented. how to keep from spreading the disease.--in order to protect themselves and others in the household, persons caring for or in any way coming into contact with a case of typhoid fever must constantly bear in mind that the secretions and excretions (urine, stools, etc.), of the patient contain typhoid bacilli and are capable of transmitting the disease to others. the person who nurses the patient should not do the cooking for the family. the bedding used by the patient should be washed separately from that used by others. special dishes, plates, knives, forks, etc., should be kept for the use of the patient alone, and should be washed separately and thoroughly. particular attention should be paid to immediate disinfection of the stools and urine of the patients until the restoration of health is complete. the urine is especially dangerous. it may look entirely normal and yet contain typhoid bacilli for some time after recovery is apparently complete. in a few instances the typhoid bacilli may persist in the stools for weeks or months after recovery. such persons are called "typhoid carriers," and constitute a grave menace to the health of the community. the best disinfectants are carbolic acid and freshly slacked lime; both are effectual, cheap and easily obtained. urine or stools to which has been added one-third of their volume of a solution of one part of carbolic acid to twenty parts of water are, as a rule, sufficiently disinfected in half an hour, provided the mass of the stool is broken up and thoroughly mixed with the solutions. the best method is to keep the urinal of bed-pan partly filled with the disinfecting solution at all times. in this way any germs present in the urine or stools are almost instantly destroyed. stools and urine should never be thrown out on the ground. if no system of drainage is at hand, they should be very thoroughly disinfected and emptied into a hole in the ground and covered with earth. all persons nursing or handling the patient in any way should be careful to wash their hands very thoroughly with soap and water before leaving the sick-room. they should never, while in the sick-room, touch any article of food or put their hands to their mouths. careful observation of the above suggestions and precautions will almost certainly prevent contraction of typhoid fever or the spread of the disease. various solutions boracic acid solution.--in the previous pages mothers are frequently told to use "a saturated solution of boracic acid." a saturated solution means that the water in the solution has dissolved all of the product that is put into it that it is capable of dissolving. when boracic acid is put into water, the water will dissolve it up to a certain point; if you add more the boracic acid will not dissolve; it will float if it is in the form of powder, or it will remain at the bottom of the glass if it is crystal--in other words the water is saturated to its limit and the solution is known as a saturated solution. the strength of a saturated solution of boracic acid is as follows:-- boracic acid ounces - / hot sterile water pints which means that pints of hot water will completely dissolve - / ounces of boracic acid. if any more boracic acid is added the water will not dissolve it because it is already "saturated." inasmuch, however, as boracic acid is harmless, it is perfectly safe to use the liquid part of a solution which contains some undissolved acid. a saturated solution is used in the eyes after it is strained. normal salt solution.--a normal salt solution is made in the following proportions:-- sodium chloride (ordinary table salt) grains sterile water pints normal salt solution is much used in irrigating the bowel. a mother may safely use it in the proportion of one heaping teaspoonful to two quarts of water--two quarts being the size of the ordinary fountain syringe. carron oil.--lime water and raw linseed oil, equal parts. this mixture is much used in burns. it should be made fresh. thiersch's solution:-- salicylic acid drams / boracic acid drams sterile water pints thiersch's solution is a good, mild antiseptic solution, or wash. solution of bichloride of mercury ( to ):-- bichloride of mercury grains common salt grains sterile water pints bichloride of mercury is one of the most powerful and poisonous drugs. solutions made from it should never be used without special directions from a physician. in much weaker solutions than the above it is one of the best antiseptic washes known. it is used to disinfect wounds, for douches, and for various other purposes, but always by special direction of a physician. other solutions.--frequently mothers are directed to use solutions in the proportion of to , or to . this means that there will be one part of the drug, or of the liquid medicine, to , or parts of water. for example if you were asked to make up a solution of bichloride of mercury in the strength of to , you would use one ounce of bichloride of mercury to four thousand ounces of water, or one grain of the mercury to four thousand drops of water,--one grain being equivalent to one drop. sometimes solutions are made up on the percentage basis. for example, a five per cent. solution of carbolic acid. in this case it would be necessary to take five ounces of carbolic to one hundred ounces of water, or five drops of carbolic to one hundred drops of water. * * * * * chapter xxxix accidents and emergencies accidents and emergencies--contents of the family medicine chest--foreign bodies in the eye--foreign bodies in the ear--foreign bodies in the nose--foreign bodies in the throat--a bruise or contusion--wounds--arrest of hemorrhage--removal of foreign bodies from a wound--cleansing a wound--closing and dressing wounds--the condition of shock--dog bites--sprains--dislocations--wounds of the scalp--run-around--felon--whitlow--burns and scalds contents of the family medicine chest.--the family medicine cabinet should contain the following articles: a graduate, medicine droppers, hot water bags, a flat ice bag, a fountain syringe, a davidson's syringe, a baby syringe, sterile gauze, absorbent cotton, gauze bandages of various widths, a yard of oiled silk, one roll of one inch "z o" adhesive plaster, a bottle of pearson's creolin, hydrogen peroxide (fresh), one ounce tincture of iodine in an air-tight bottle, a can of colman's mustard, two ounces of syrup of ipecac, a bottle of castor oil (fresh), one pound of boracic acid powder, one pound of boracic acid crystal, a bottle of glycerine, a bottle of white vaseline, a bath thermometer, some good whisky or brandy, aromatic spirits of ammonia, smelling salts, pure sodium bicarbonate, oil of cloves for an aching gum or toothache, a bottle of alkolol for mouth wash and gargle, and one ounce of the following ointment for use in the various emergencies which occur in all homes,-- bismuth subnitrate dram one zinc oxide dram one phenol ( %) drops twelve resinol ointment to make ounce one this ointment may be applied to all cuts, bruises, skin eruptions, chafings and sores of minor importance. it is one of the best applications for chafing of the skin in babies. the medicine chest should also contain a small jar of unguentine for burns; one-tenth grain calomel tablets for a cathartic for baby to be used as explained in the text of the book, or as advised by the physician. it may also contain tablets for colds and for other purposes as suggested by the family physician. it should never contain medicines the use of which is not thoroughly understood by the mother. it is a wrong practice for mothers to keep medicines to use for the same ailment at a subsequent time. the ailment may not be the same and frequently the medicine itself deteriorates, or it may get stronger with age. many medicines are made with alcohol in them. if kept for some time the alcohol evaporates and leaves a concentrated mixture which, if given in the dose meant for the fresh preparation, may poison a child. such cases of poisoning are on record. the same argument applies to powders. certain drugs lose their strength, some absorb moisture, others change their chemical strength if kept mixed with other chemicals. they should be thrown away after the case is over if they have not been used. it is a dangerous practice to keep medicines around if there are children in the family. foreign bodies in the eye.--particles which accidentally lodge in the eye are usually located on the under surface of the upper lid. they are sometimes, however, found on the ball of the eye or on the inner aspect of the lower lid. foreign bodies which are propelled into the eye with great force, as iron specks which railroad men frequently get sometimes imbed themselves into the eye-ball and have to be cut out or dug out. the entrance of the foreign particle is always accompanied by a flow of tears which is nature's way of removing them. the offending object may escape through the tear duct into the nose, or it may be simply washed out with the flow of tears. rubbing the well eye will cause a flow of tears in both eyes and may facilitate removal of the foreign matter. blowing the nose may force the particle into the tear duct. the use of the eye cup may help in ridding the eye of the body. the same object may be accomplished if the eyes are immersed in a basin of water and opened wide. then by moving the eyes around the particle may be washed out. if the particle is located on the under surface of the upper lid it may be promptly removed by pulling the upper lid forcibly down and over the lower lid. the eyelashes of the lower lid act as a brush and as a rule quickly remove the irritant if the procedure is carried out adroitly. everting the upper lid is a means of locating the body and in making possible its removal by a small camel's hair brush or corner of a handkerchief. to evert the upper lid it is necessary to employ a guide. a match stem may be used in an emergency. this is laid across the middle of the upper lid, the eye lashes are grasped with the fingers of the other hand and the lid is bent over the match stem and turned up thus everting or turning inside out the entire upper lid. the procedure may be facilitated if the patient is instructed to look down while the operator is drawing the eye-lid upward. if the particle cannot be easily removed by any of the above methods it is not safe for an uninstructed individual to go any further. the eye is an exceedingly delicate organ and may be permanently injured by unnecessary irritation. it is always safer and it may be cheaper in the long run to consult a competent oculist in such cases. after the removal of any object from the eye, it is desirable to frequently wash it out with a saturated solution of boracic acid. this mixture will allay any inflammation and will tend to restore the normal condition more quickly and more satisfactorily than if the eye were left to heal itself. foreign bodies in the ear.--when a foreign body gets into the ear mothers are unnecessarily alarmed because of a failure to appreciate that the ear is a closed passage. it is impossible for any object to get into the ear itself; the depth of the external passage is only about one inch in an adult. at this point the passage is completely closed by the drum membrane. most of the harm is done by ignorant meddling, not by the object itself. children frequently put foreign bodies in the ear, as, buttons, pebbles, beans, cherry stones, coffee, etc. the very first thing for the mother to do when she learns that her child has put "something" in its ear is to keep cool, and try to find out what the something is. it is essential to know what the article is because different articles are treated differently. for example if we try to remove a bean or pea with a syringe, the liquid will cause the pea or bean to swell and result in wedging it in so firmly that it will be impossible to dislodge it in this way. if the object is hard, as a marble, button, pebble, bead, the greatest care must be exercised. try to make the object fall out. to effect this, turn the child's head downward with the injured ear toward the floor. then pull the lobe of the ear outward and backward so as to straighten the canal. a teaspoonful of olive oil poured into the ear will aid in its expulsion. if after the oil is poured in, the head is suddenly turned as above described the object will fall out. a very effective way to remove a hard object is to take a small camel's hair brush and coat the end with glue, or any other adhesive substance, then place it in contact with the object and permit it to remain long enough to become firmly attached after which it may be gently pulled out with the object attached. never employ an instrument in the ear to remove a foreign body. when a live insect or fly enters the ear a number of safe methods may be developed. if the ear is immediately turned to a bright light the insect may come out of its own accord. it may be floated out with salt water, or it may be smothered with sweet oil or castor oil after which it may be floated or syringed out. if it is necessary to employ a syringe this should be used gently. a foreign body may remain in the ear for days or weeks without doing any harm. this suggests that any unnecessary poking or prying should not be undertaken, because this may wedge it in tighter and to injure the drum membrane. foreign bodies in the nose.--children may put any of these articles into the nose. very often they do, and do not know enough to tell. if such is the case the first symptom calling attention to the fact that something is wrong is the appearance of a thick foul discharge from one nostril or some obstruction to breathing on the same side. when the foreign body may be seen the child should be made to blow the nose, first closing the well side with the finger. if this does not expel the object the child should be made to sneeze by tickling the free nostril with a feather or by taking snuff. the mother should never permit the use of instruments by one unskilled in an effort to rid the nose of an obstruction. there is great danger of seriously injuring the delicate structure of the nose in this way or of pushing the object so far in that it may necessitate an operation to extract it. it is much safer to seek medical aid before any damage is effected. it seldom does harm to wait until the right assistance is at hand; it often does serious harm to be too smart in these little matters. foreign bodies in the throat.--if the foreign body is in the upper part of the throat and can be seen it may be removed with any instrument that can grasp it. the child may be immediately held up by its feet when the article may be shaken out. if it is further back or in the air passages the child should be made to vomit by tickling the throat with a feather or with the finger held in the throat till it does vomit. when the object interferes with breathing a physician should be sent for in a hurry. in the meantime the family may try to dislodge it by having the child bend forward or by holding it with the head downward and, while in this position, sharply striking the back with each cough. striking the chest when in this position may effect the same purpose. if no success follows this procedure try the reverse position. have the child bend backward over the arm of a sofa, for example, or put him in bed with the body hanging out of the bed face upward. if none of these effect relief you must depend upon the skill of the physician. a bruise or contusion.--a bruise or contusion is an injury to the tissues underneath the skin, but this does not imply that the skin itself is opened or damaged. in every bruise the small blood vessels are ruptured, and the blood collects in the tissues causing distention, swelling and pain. the blood is held in the tissues, it is stagnant, becomes dark in color and so produces the bluish discoloration that we see in all bruises. the color varies according to the extent of the collected blood. at first it is red and inflamed looking, then purple, then black, then greenish and finally citron. the so-called "black-eye" is a typical example of this degree of bruise. after a bruise the parts swell from the collection of blood and from the accompanying inflammation. this causes pain which persists for a day although the spot may be sore and tender for a week or more. in all mild varieties home remedies may suffice, but in the more serious and extensive bruises it is advisable to seek medical assistance. it is essential to completely put the part to rest and to elevate it. this will relieve the pain and favor the absorption of the exuded blood. if the bruise is on the foot, the leg should be elevated until the foot is higher than the hip. if, on the hand, it should be so held that it will be higher than the elbow and it may frequently be held higher than the shoulder to relieve the throbbing and the pain. as a rule, cold should be applied as soon after the injury as possible, cloths wrung out of ice water, or a piece of ice may be bound on the part for a short time. the object of the cold is to stop the internal bleeding. if the injury is slight, as are most of the injuries of the household, the mother may apply repeated cloths wrung out of very hot water. this procedure tends to aid the immediate absorption of the blood and prevents a discoloration of the part. if there is great pain relief may be afforded by applying a firm bandage saturated in the lead-water and laudanum mixture which may be obtained in the drug store under the name of lead and opium wash. the bruised part should be massaged every day and a simple ointment may be applied to soften the inflamed area. if any complication arises in the treatment of a bruise, it will be necessary to consult a physician. wounds.--a wound implies an injury to the skin in addition to injury to the underlying parts to a lesser or greater extent. the skin may be opened by cutting, or stabbing wounds; or it may be punctured, torn, contused, or bruised open. these injuries are effected in various ways. we speak of machinery or mechanical wounds, or gunshot wounds, bites, cuts, stabs and other varieties of wounds. it is very important to know exactly how a wound is produced and the nature of the instrument which opened the skin. we try to obtain this information in order to estimate the probable degree of poison that may or may not have entered into the wound. the first thing to do in treating wounds is to stop the bleeding. if the patient is suffering from shock he should be given active treatment for this condition as described elsewhere. if the wound contains any foreign bodies these should be removed. the wound should then be cleansed, closed and dressed and kept at rest. if the wound is poisoned, or if there is any fear that lockjaw may arise, or if the wound has been caused by a mad dog it will require special treatment. it is far better not to interfere if you do not know what to do than to do harm. one should offer no advice if they are not qualified to give advice. much harm has resulted from doing the wrong thing in these cases. the instruction in the following pages is given so that the average mother may know what to do in emergency but not with the intention that she may regard her knowledge as sufficient to dispense with the aid of the physician. arrest of hemorrhage.--when there is a wound there is always bleeding; this means that some blood vessels have been cut or torn open allowing blood to escape. the character of the hemorrhage will determine the nature of the treatment to be employed. on general principles, the first thing to do in the presence of bleeding is to elevate the part, if that is possible. if there is simply a general oozing of blood, it may be controlled and arrested by pressure. this pressure should be steady and prolonged. it is best accomplished by wetting a clean handkerchief or a pad of gauze in ice cold water, placing this on the part and binding it on firmly with a bandage. if the discharge of blood flows in a steady stream and is rather dark the hemorrhage is coming from a vein. we know that veins carry blood toward the heart so that any pressure or constriction employed to stop a venous hemorrhage should be tied on the side of the wound further removed from the heart. inasmuch as veins have soft walls the right kind of pressure will in most instances stop the bleeding. the part should be elevated after the pad is adjusted in place. any tight band on the limb as a garter or sleeve band should be removed as they tend to interrupt the return circulation. if the hemorrhage is from an artery the blood is bright red. it spurts out forcibly, is difficult to control and demands immediate attention. arteries carry the blood from the heart to the extremities. they beat with every pulsation of the heart so that blood coming from an artery spurts with every pulse beat. even a small artery may be responsible for a very considerable hemorrhage in a very short time. whatever is done must be done quickly. the parts should be freed from all clothing and if possible elevated. pressure may be tried, if it succeeds it must be strong and steady pressure. the point to press must be on the heart side of the bleeding artery since the blood stream is coming that way--this the mother will note is the reverse from treating bleeding from a vein as previously explained. the artery at this point may be felt beating. it is frequently necessary to clamp the whole limb to stop an arterial hemorrhage. this may be done in the following manner. take a strong piece of cloth or bandage and tie above the bleeding point. insert a short piece of stick between the bandage and the limb and twist around until the bleeding stops. this should not be kept on longer than one hour. a tourniquet of this character shuts off all the blood in the limb and if kept on too long the parts may mortify. the best means to stop a hemorrhage of this character is by means of a rubber bandage sold for the purpose. it is applied by stretching at every turn. it exerts uniform pressure and in this way does no injury to the parts. all these measures are, of course, only temporary expedients as the artery will finally have to be caught and tied by a physician. removal of foreign bodies from a wound.--when the foreign bodies are large enough to be seen they may be picked out with the fingers after the hands have been rendered sterile. smaller bodies may be picked up with forceps, or they may be washed out with water that has been boiled and cooled slightly, or a bichloride of mercury solution in the strength of to may be used; or a normal salt solution may be used. as a general rule the physician should be allowed to undertake this procedure so that you may not be blamed for something that may come up later. cleansing a wound.--the simplest way, and the most effective, to cleanse a wound, no matter how caused, is to procure a brush and paint it thoroughly with tincture of iodine. the iodine should be painted right into the raw wound, it is then bound up and left if it is small and does not need any stitching. when the physician comes he can attend to any further procedure that may be necessary. closing and dressing wounds.--if the wound is small, its edges may be drawn together with narrow strips of adhesive bandage after it has been painted with iodine. it is then bound up and kept at rest. it should be inspected the following day to see if it is healing properly. if the wound is large or torn, it should be seen by a physician and dressed and closed by him. all wounds do better if they are kept at rest. the condition of shock.--when a person suffers a serious injury, loses a large quantity of blood, or is subjected to a profound emotion, it affects the vital powers to such an extent that the individual is said to be suffering from shock. shock expresses itself in varying degrees of apathy. the patient may or may not be conscious. if conscious he gives no evidence of feeling, he is silent and motionless although he will respond to directions and may answer questions. the eyes are dull and listless, the face pale and pinched, and the general expression is apathetic. the skin is cold and there may be perspiration; the pulse is feeble and irregular, and the breathing is shallow. the whole attitude of the victim is one of indifference and apparent inability to appreciate the seriousness of the situation and a seeming immunity to pain or discomfort. when this condition exists it must always be regarded as serious because the patient may die as a direct result of the condition of shock. the various symptoms depend upon a temporary paralysis of the blood vessels which deprives the brain of blood. there is always a certain degree of shock with all injuries. mothers should know what to do in these cases before the physician comes. the general treatment in all cases is to keep the patient warm and quiet, and to use stimulants carefully. the patient should be put in bed or on a flat surface with the feet higher than the head. if raising the feet should cause the face to become blue it will be advisable to restore the patient to the horizontal posture. artificial heat must be applied to the patient's body and extremities by means of hot water bags, bottles, bricks, plates, or any other handy device. blankets should be put around the patient and every possible means resorted to, to maintain body heat. mustard plasters may be put to the heart, spine and shins. stimulants are necessary, such as hot black coffee if possible or hot water, in which a small portion of brandy may be put. if brandy is not obtainable the patient may take aromatic spirits of ammonia in hot water every twenty minutes for a number of doses. in every case of shock a physician should be sent for immediately. dog bites.--when a child is bit by a dog every effort should be made to get the dog. it should be kept in a safe place for a week so that it may be definitely known whether it is sick or not. if the dog dies within a few days after biting anyone it may be assumed that he had rabies. its head should be sent to the local health authorities who can tell after examination if it was mad. if there is any reason to assume that the dog was infected, the child should receive the pasteur treatment. this treatment will, if conducted under favorable circumstances, absolutely prevent hydrophobia. the mother should sterilize the wound as thoroughly as possible. this may be done by using pure hydrogen peroxide. a little piece of absorbent cotton is wound round the end of a tooth-pick or match, dipped in the peroxide and the incision thoroughly rubbed clean. this may be done a number of times to ensure thorough cleansing. no effort should be made to cauterize the wound. it is not considered proper to employ this method with dog bites. when the physician examines the wound he may or may not open it further for more extensive inspection and sterilization. mothers should remember that there are thousands of bites by dogs that never cause any trouble, and if it is known that the dog is healthy no worry need trouble the family. it is also wrong to inform the child of the probability of hydrophobia. the child may worry himself sick with fear and if the mother is nervous and excitable he is apt to be made sick with the dread of what may follow. it is better, therefore, to remain quiet, to keep cool, and not to excite the little patient at all. sprains.--every joint is held together by ligaments which are attached to the bones forming the joint. if these ligaments are subjected to a sudden twist in a direction in which the joint is not constructed to move, the resulting injury is known as a sprain. the ligaments are stretched, though they may be torn apart and even small pieces of the bone may be split off if the wrench is great enough. the injury is an exceedingly painful one and frequently renders the limb useless for some time. it is always accompanied with some degree of swelling and more or less inflammation. a sprained joint should be immediately put at absolute rest. the best dressing is the lead and opium wash. two pints of it may be obtained at the drug store. pour into a large bowl, saturate a large piece of thick absorbent cotton, wrap around the joint and bind in place. this dressing may be repeated as often as the cotton becomes dry. when the swelling has disappeared and the pain is gone, it is desirable to have the joint supported with strips of adhesive bandage. these must be put on in a certain way in order to properly support the joint. consequently a physician should put them on. if a sprain is not attended to effectively there is danger of the joint being more or less incapacitated for life. dislocations.--a dislocated joint is one that has been put out of place. it is best to allow a physician to treat a dislocation. unskilled handling of a dislocated joint may not only increase the damage but it may permanently put the joint out of business. until the physician arrives the part should be kept absolutely at rest. wounds of the scalp.--children frequently get injuries of the scalp. these wounds bleed freely and as a rule they occasion a great deal of unnecessary worry and apprehension. usually they are not of much importance. we must keep in mind, however, the probability of fracture as a consequence of severe injury. the first thing to do when there is bleeding from the scalp is to cut or shave away the hair surrounding the wound. this should be done for an inch around the wound so that thorough disinfection may be possible. the wound should now be cleansed as previously instructed and an effort made to stop the bleeding. the best method is to first apply pads of gauze wrung out of very hot water. when success is evident a pad made of boiled cotton should be placed on the wound and held tightly in place for some time. if the wound is of such a character as to demand stitches a physician should of course put them in. run-around: felon: whitlow.--when pus germs enter around a finger nail and lodge in the soft tissue a "run-around" is the result. it is accompanied with pain, swelling, redness and inflammation. the loss of the nail may follow. a felon or whitlow is a more extensive and a more serious condition. it is not always possible to trace the cause of a felon. the fact that germs gain an entrance, however, is soon established. sometimes a bruise, or scratch, or a wound is the primary cause. the last joint of any of the fingers may be the seat of a felon. a end of the finger becomes hot, tense, swollen and very painful; the pain is intense if the hand is held down. the surface may or may not be red. there is as a rule some fever. if the felon is on the little finger or thumb the condition is worse than on the others as a rule,--the inflammation extending to the hand and often into the arm. the condition affects the palmar surface of the fingers. if the felon results in the "death" of the bone, the last joint will have to be taken off and the hand may be distorted, crippled, and rendered permanently disabled. blood poison may set in and death is possible as a result of this complication. treatment.--every effort should be made to abort a felon. continuous application of equal parts of alcohol and water night and day may abort it. tincture of iodine applied to the entire end of the finger may be effective. the hand must be at rest, carried in a sling during the day and slung over the head to the bed-board at night. if these efforts are not successful after twenty-four hours hot poultices should be resorted to, but they must be changed every twenty minutes. if, at the end of another twenty-four hours, there is no improvement the finger must be freely cut open by a surgeon and the poultices continued. treatment of "run-around."--apply iodine freely, cold applications, and if the inflammation persists use poultices. it is frequently necessary to incise the run-around. patients suffering from either of these conditions need general tonic treatment and should be under the care of a physician. burns and scalds.--burns result from undue exposure to dry heat. scalds are produced by the action of hot liquids and steam. there are always produced two results from a burn or a scald. first the local effect, and, second, the general effect. the general effect may produce shock, the symptoms of which have been described in the previous pages. the degree of shock depends upon the extent of the local injury and may be severe enough to result in death. if the local injury covers more than two-thirds of the body death as a rule takes place within two days. how to extinguish burning clothing.--the thought to keep in mind is to smother the flames effectively. if we deprive the flame of all air or oxygen it will immediately subside. this may be done quickly by wrapping the burning part in a carpet, rug, blanket, overcoat or any large woolen material at hand. if none of these articles are at hand the victim may roll on the floor and try to smother the flame by pressure, aided by the hands. it is a good plan to throw water on the patient immediately after the fire has been put out, so as to extinguish the smoldering fire. when a person is scalded by steam or boiling water or other liquid, it is advisable to pour cold water freely over the wound. how to remove the clothing.--when it is necessary to remove the clothing it is essential to be gentle in order not to do greater injury. the clothing must not be pulled. the garment should be cut so that they fall off. if any part sticks to the skin, it must be left, not torn away. later, it may be removed by moistening it with salt water. treatment of scalds and burns.--all slight burns or scalds may be effectively treated with unguentine. this substance may be obtained in any drug store. it is spread on a cloth and applied directly to the injured part, bound securely on and renewed every day until the wound is healed. if unguentine is not readily obtainable the part may be covered with any of the following mixtures or oils: carbolated vaseline, equal parts of linseed oil and lime water, olive oil, castor oil or kerosene, cloths soaked in a solution of baking soda, or a solution of phenol sodique. in severe burns or scalds the mother should not attempt to treat the child. a physician should be summoned at once. the child may be given a little whisky or brandy in warm water, and if the pain is great a dose of laudanum may be given. the dose of laudanum is one drop for each year of life. if the child has a chill he may be put into a warm bath of °f. it is not wise to cut a burn blister. the water may be let out by puncturing with a sterile needle, but the skin must be left intact until the new skin is grown. the treatment of burns must be done with the greatest cleanliness because if infected with germs they may prove serious. * * * * * miscellaneous chapter xl miscellaneous the dangerous house fly--diseases transmitted by flies--homes should be carefully screened and protected--the breeding places of flies--special care should be given to stables, privy vaults, garbage, vacant lots, foodstuffs, water fronts, drains--precautions to be observed--how to kill flies--moths--what physicians are doing--radium--x-ray treatment and x-ray diagnosis--aseptic surgery--new anesthetics--vaccine in typhoid fever--" "--transplanting the organs of dead men into the living--bacteria that make soil barren or productive--anti-meningitis serum--a serum for malaria in sight. the dangerous house fly mothers should become thoroughly acquainted with the grave consequences which may result from fly-infected foods, and from the possible carriage of disease by means of flies, even where foods are carefully protected. the transmission of the following diseases by means of flies has been conclusively proven: typhoid fever, tuberculosis, cholera, oriental plague, inflammation of the eyelids, serious infection of wounds. summer diarrhea of children is also transmitted in this way. typhoid fever and summer diarrhea of children in this country, and cholera and oriental plague in the countries in which those diseases exist, may be transmitted through the various foods that are eaten in an uncooked state, if infected by flies, through cooked foods infected by flies after the process of cooking, through drinking water which has been infected by flies, and through milk similarly infected. fruits are especially likely to be infected by the small fruit fly commonly found around markets and stands. fish may be infected by flies, and in consequence will undergo rapid decomposition. decomposition caused in this way has resulted in many cases of diarrhea and dysentery. what is commonly known as fly speck is the excreta of the fly, and frequently contains virulent disease germs. these specks are often found on foodstuffs that have not been properly protected. transmission of disease may also occur by the infection of open wounds through contact with infected flies. this is true of all pus formation in wounds. the simple contact of a fly infected with the disease may cause oriental plague, sore eyes, and possibly granular eyelids. a fly infected with dysentery or typhoid fever may cause either of these diseases by simply coming in contact with the lips of susceptible persons. the fly in the house should be relentlessly pursued and destroyed. the house which is carefully screened and protected from flies is infinitely safer than one not so protected. in the spring of the year the house fly begins to take on life. eggs which were laid the preceding fall begin to hatch. at first the fly is only a little worm wriggling in some pile of filth. the eggs are usually laid and the grub developed in a manure pile or some mass of garbage or other filth. before the grub develops into the fly it is easily destroyed. if everything in and about the house were kept scrupulously clean, and if every manure pile were kept carefully screened or covered so as to protect it from flies, there would be no difficulty in preventing the fly nuisance. the most effective way to accomplish this is to destroy the breeding places. the importance of this may be seen when it is considered that one fly produces one hundred and twenty-five millions or more of its kind in one season. stables.--manure is by far the commonest material in which the fly lays her eggs. all stables should be kept scrupulously clean. no manure should be allowed to accumulate where it will be exposed to flies for even a few minutes. immediately after it is dropped by an animal, it should be removed and covered. manure may be treated with considerable quantities of lime without interfering with its fertilizing value, and in this way the development of the eggs laid in it by the flies can be practically prevented. the floors of stables should be thoroughly flushed with water at least once in every twenty-four hours. privy vaults.--human excrement also affords an excellent breeding place for flies. in army camps the latrines are the points from which much infection is transmitted to troops, and thousands of the men have lost their lives by contracting typhoid fever transmitted in this manner. during the summer time all open vaults and dry closets should be treated continuously with lime, crude creolin or crude carbolic acid, and they should be carefully cleaned out at frequent intervals. garbage.--as a medium for the development of flies, garbage may be considered next in importance to excreta. the eggs of the fly hatch in about twenty-four hours, and garbage which is retained in the kitchen for that length of time may contain flies in the grub stage. to prevent this development, all garbage should be covered and pails should be emptied as often as possible. in country districts garbage should be burned in the kitchen or buried in the garden at frequent intervals, twenty-four hours being the maximum time it should be retained. vacant lots.--vacant lots frequently contain appreciable quantities of organic matter in a state of decomposition, affording favorable breeding places for flies. these vacant areas should be maintained in a state of scrupulous cleanliness. foodstuffs.--in order to prevent contamination of foodstuffs, all foods that are eaten in the raw state and all foods that are exposed for sale after having been cooked should be carefully protected from contact with flies, by screens or covers. a point where rapid development of flies takes place is along the city's water front. this is due to the fact that many of the sewers do not discharge below the level of the water. all open drains should be eliminated, whether they be sewers, private house drains or drains from cess-pools. precautions to be observed.--keep the house free from flies. every fly should be considered a possible disease carrier and should be destroyed. keep the windows of the house, especially the kitchen windows, carefully screened during the spring, summer and autumn. protect children from exposure to flies, particularly children who are ill, and do not allow nursing bottles to be exposed to flies. protect milk and other foodstuffs from contact with flies. keep the garbage outside of the house, carefully covered. abolish open drains near dwelling places. stable manure should be frequently sprinkled with lime and kept covered. earth closets and privy vaults should be treated with lime, crude creolin or crude carbolic acid at frequent intervals. earth closets and privy vaults should be cleaned frequently in order to prevent excrement accumulating to an undue extent. to kill flies.--dissolve one dram of bichromate of potash in two ounces of water, add a little sugar to this solution and put some of it in shallow dishes and place about the house. sticky fly paper and fly traps may also be used. to clean the room where there are many flies, burn pyrethrum powder (persian insect powder). this stupefies the flies and in this condition they may be swept up and burned. probably the best and simplest fly killer is a weak solution of formaldehyde in water (two teaspoonfuls to the pint). this solution should be placed in plates or saucers throughout the house. ten cents' worth of formaldehyde, obtained in the drug store, will last an ordinary family all summer. don't smell formaldehyde in the pure state; it is very pungent and strong. in the solution of the strength used for flies it has no offensive smell. it is fatal to disease organisms, and is practically non-poisonous except to insects. flies will not stay in the house when this solution is around. moths.--late spring and early summer is the time to guard against moths and beetles. many of these fabric-destroying insects are brought into the house on flowers. may and june are especially bad months, as both moths and beetles are only dangerous to fabrics in their young or grub stage. these insects will destroy almost anything from coarse rugs to the finest of ball gowns and dress suits. carpets that are rarely swept and garments that are seldom disturbed are most liable to damage. the substitution of the frequently removed and easily cleaned rugs for carpets will greatly lessen the danger from the destructive moth and beetle grubs. carpets laid on tight floors are much less liable to injury than where numerous cracks furnish safe retreats for the insects. tarred paper under a carpet is an excellent preventive. all clothes presses should be thoroughly cleaned at frequent intervals. the garments should be removed, aired and vigorously brushed. any larvæ which are not dislodged in this way should be destroyed. it is a bad plan to keep odds and ends of woolen or other materials in attics where these pests can breed and thus spread to more valuable articles. spraying with benzine two or three times during hot weather is a good way of preventing injury to furniture or carriage upholstery and other articles which are in storage or not in use for a long time. if you are certain that woolens and furs are free from the pests they may be stored in safety by placing them in tight paste board boxes and sealing the covers firmly with gummed paper. both moths and carpet beetles are harmless at a temperature of degrees fahrenheit--a fact very well known to advantage by the large fur storage companies. they cannot survive furthermore a temperature of decrees if subjected to it for about twenty minutes. what physicians are doing.--it is desirable that the ordinary non-medical individual should know what the science of medicine is doing and what it is accomplishing. during the past fifteen years the art of curing and preventing disease has taken on giant strides. the man or woman most ready to question the accomplishments and the ability of the humble family physician or the motive of the science of medicine, is the one who appreciates least that it is due to the skill and intelligence of the medical men of to-day that he owes his comfort, his health, and his freedom from pestilence, plague and disease. unthinking people laud and praise some upstart whose ability lies in his faculty to fool the gullible, or they will rush to seek the false aid of some nondescript science, because it is popular and well advertised, while they pass by or ignore the men whose labors have made the world what it is, and who alone possess the ability to intelligently wage the battle in the interest of humanity against disease. the medical profession has repeatedly pointed out that there are, on an average, six hundred thousand lives lost every year in the united states from preventable disease and accidents. six hundred thousand lives which medical science has at hand the remedy to save, but which the medical profession sacrificed because of inadequate legislation. few people can comprehend just what six hundred thousand lives mean. let us put it in another way. there are destroyed by preventable disease and accidents every day american lives equal in number to the crews of two battle ships, equal in three months to more than the total combined numbers of the army and navy of the united states; equal in one year to more than the total number of lives lost in all our wars since the declaration of independence. the titanic disaster shocked the public for a moment, and seemed to impress them as though it was a terrible and unheard of waste of good human lives. yet in the loss of life due to preventable causes we have in this country every day in the year a destruction of our citizens exceeding in magnitude that which occurred when the titanic sank. think of it! a titanic disaster a day, and yet the public does not rise up and demand in a spirit of anger and determination that steps be taken at once to put an end to this appalling and unnecessary waste of lives. under modern hygienic conditions, the average length of existence for an individual in great britain has increased ten years in the last half century. among all the enlightened and advanced nations, the expectation of the individual for long survival is greater. since the appearance of uncheckable and epidemic disorders is less frequent and the percentage of cures is greater. since quarantine has been regularly established and the sewage system made efficient in large cities, and since the sanitary plumbing laws have been made compulsory, the general death rate has decreased enormously. these regulations have been the product of regularly educated medical or sanitary experts. no 'ism or 'ology has ever established any scientific principle which has contributed to the general welfare of the people. we no longer fear the plague, or typhus or yellow fever, cholera, diphtheria, typhoid, consumption, and other diseases which once were a constant menace to the race. the plague, for example, is practically limited to the far east, where modern methods cannot evidently be introduced efficiently. at one time it periodically devastated europe, where it cannot now get a foothold because of the introduction of sanitary systems and hygienic principles. tetanus or lockjaw and hydrophobia are now amenable to cure while formerly all cases were practically fatal. the mortality of diphtheria has been reduced more than fifty per cent. antiseptic precautions in surgical cases, first introduced by the famous surgeon, lord lister, have made possible and successful operations that formerly could not be undertaken, thus broadening the whole field of surgical possibilities. the boer war and the war with spain proved this truth in a way that could not be denied. smallpox is almost a medical curiosity in new york city, where it once was a scourge. the mortality of childbirth has been reduced to about one-fifth of what it was by the introduction of antiseptics and anesthetics. the new methods of making and preparing drugs, the sterilization and inspection of milk, the methods devised for the care of and preparation of infant foods have all enormously contributed to checking disease, to preventing disease, and to increasing the length of life and its happiness. these are all facts which may be proved by any one, no matter how incompetent they may be. if we were to give up all these hard earned victories, cease to investigate or experiment, deny the existence of disease, and depend upon the questionable methods of hysterical emotionalists we would soon find ourselves facing all the horrors of the past. can we afford to lose the priceless benefits we have achieved and are attaining? can we sit still and permit the profession of medicine, which has always contained the best of the race in its membership, the best intellects, the most sympathetic and unselfish characters, the noblest and most steadfast souls, to be maligned and assailed, to have its means of well-doing assaulted and threatened, when we know that it should be supported and protected for the sake of all it has done in the past in the interest of humanity? every mother should be acquainted with these facts so that she may lend her influence in behalf of honest effort and honest inquiry. the following summary comprises a brief review of what medicine has been doing in the recent past: radium.--this element was discovered about fifteen years ago by professor and mme. curie. it possesses the wonderful property of giving out inexhaustible stores of energy. it virtually possesses the property of perpetual motion. professor becquerel was the first one to suggest that it might possess therapeutic or healing powers. the suggestion came to him in a curious way. he carried a tube of radium in his vest pocket and was severely burnt as a consequence. the incident suggested to him that, if radium could attack healthy tissue in such a short time, it should be able to similarly attack diseased tissue. experiments were soon instituted, and are still being conducted to exactly define its curative value and scope. it was hailed as a cure for cancer and other serious conditions, but we have found that it is not a cure for these ailments. it is, however, exceedingly valuable in the treatment of certain skin diseases. in lupus, epithelial tumors, ulcers, papillomata, angiomata and pruritus, it is being widely and successfully used. it was later discovered that it can quickly kill disease-producing bacteria. it is also well known that it will efficiently purify water. x-ray treatment and x-ray diagnosis.--professor roentgen gave to the world an exceedingly valuable discovery in the x-ray. he discovered that a certain form of electrical energy, when applied in a certain way, would produce shadows that differentiated between a certain degrees of opacity. for example, it would, if directed upon the human hand, produce shadows that clearly indicated whether the substance through which the rays passed was bone or muscle. the chief value of the x-rays has been found to be this property rather than any healing value which has been attributed to them. the fact that these shadows can be photographed has rendered them of supreme value in surgery and medicine. previously it was essential that the surgeon should depend upon his own diagnosis, upon what he could learn from his sense of touch and from surrounding conditions. with the x-rays at his disposal he can quite eliminate the personal equation. his pictures are precise and mathematically accurate; he can prove the truth of his diagnosis before he cuts. we can take pictures of fractured bones and from what we learn we can immediately tell how they should be set to attain the very best results. we can actually tell if there is a stone in the kidney before we subject the patient to a serious operation. we can actually take pictures of the stomach at various stages of digestion and tell what disease affects the individual with a degree of precision that was not possible before the x-rays were introduced. these examples only suggest its use. there are a multiplicity of uses for these as yet unknown rays which have greatly aided in diagnosis and consequently in successful treatment. aseptic surgery.--the utility of the aseptic principle in surgery was demonstrated by the japanese army surgeons during the war with russia in - . their success in preventing deaths from suppurating wounds amazed the world. their method was to discard the use of antiseptics and to depend upon absolutely clean instruments, dressings and hands. the most terrible wounds healed under this method without festering. this is, of course, the method in vogue to-day all over the civilized world. the japanese did not discover aseptic surgery, but they were the first to put it to actual test in a large way. the old method was to depend upon drugs to kill the germs which might find their way into wounds and operations. to-day we prevent the germs from getting into the wound and depend upon nature to do the rest. new anesthetics.--several important advances have been made in methods of giving anesthetics and in the nature of the products used. temporary unconsciousness with electricity was induced in by dr. stephane leduc. stovaine was invented by dr. jonnesco, of bucharest. he injected it into the spinal cord after the method made famous by biers with cocaine in . dr. w. s. schley invented novocaine for the same purpose. temporary unconsciousness was accomplished by the use of epsom salts injected into the spinal cord by dr. samuel j. meltzer. all of these efforts to discover a harmless anesthetic by spinal injection were made possible by investigations and experiments of dr. j. leonard corning, of new york, who worked along this line as far back as . the most revolutionary discovery, however, was that of dr. s. j. meltzer at the rockefeller institute, new york, when he inserted a tube into the windpipe, through which he pumped the anesthetic into the lungs. while doing this he at the same time pumped oxygen to aerate the blood, thus ensuring the patient against possible accident during the course of difficult and tedious operations on the lungs and heart. vaccine in typhoid fever.--inasmuch as typhoid fever has played an important part in the conduct of all wars, it has always been a source of much careful study by military and naval surgeons in every civilized country in the world. we had not, however, reached a stage when it was possible to hope for its extermination until medical science began to appreciate the possibilities of vaccine therapy. the cuban, boer and russian wars, because of the terrible experiences of the soldiers with typhoid in each of them, stimulated inquiry along the line of discovering a serum of vaccine that would be effectual against it. american, british, french and japanese military and naval surgeons instituted experiments simultaneously to discover an anti-typhoid vaccine. in the fall of , american army surgeons were experimenting with a serum at washington and on governor's island with success, but the first public announcement of an absolutely successful vaccine was made by captain vincent of the french navy on june th, , before the académie de medicine in paris. the final success of the anti-typhoid serum has been conclusively proved by elaborate tests upon soldiers and sailors in many nations. it is difficult for the ordinary individual to appreciate the significance and importance of a discovery of this character and magnitude. when one thinks calmly of the thousands and thousands of men who have lost their lives during wars because of typhoid epidemics, and of the thousands of others who have returned home practically invalided for life from the same cause, it is possible to, at least, conceive of the benefit to the race such a discovery promises. and when we learn that the discovery is a product of the same principle or method which gave to the world a cure for smallpox, diphtheria and syphilis, we must begin to believe that the medical profession is on the path which is unlimited in its field of promise so far as efficient treatment is concerned. yet to-day we have people who do not believe in vaccination or in anti-diphtheritic serum. we may not live to see the time, but it is not far distant in the opinion of men qualified to speak with authority, when every disease will be amenable to the serum therapy, and when drugs will virtually be discarded by the human race. " ."--one of the most important discoveries in the history of medicine was recently given to the world by dr. paul ehrlich. he called it " ," because it was the th experiment he had made with the same end in view. it was designed with the purpose of curing the most terrible disease known to man, syphilis. the name of the remedy is salvarsan. that it will do all that was first claimed for it is still doubtful, but salvarsan and its improvements, neosalvarsan, etc., are accepted by the profession as by far the best treatment yet devised for this dread disease. it points the way for improvement along the same line to an ultimate specific. transplanting the organs of dead men into living men.--to take from a recently dead individual a kidney, or a bone, or an artery, and by immersing them in certain fluids thereby keeping them alive indefinitely, and later transplanting them in the body of a living individual so that they will continue to live and perform their function in the new environment, is a revolutionary and a seemingly incredible performance. yet dr. alexis carrel of the rockefeller institute, new york, has accomplished this wonderful task. the smallest imagination can picture the possibilities of this kind of surgery, but, inasmuch as the discovery is so recent and the opportunities for testing it upon human beings are so relatively few, that time alone can tell how far it may be possible to go. anti-meningitis serum.--another important discovery that has emanated from the rockefeller institute is the anti-meningitis serum. the death rate from spinal meningitis, before the introduction of the serum, was per cent., the use of the serum has reduced this percentage to . we owe this important contribution to dr. simon flexner. a serum for malaria now possible.--dr. c. c. bass, of tulane university, has succeeded in extracting malaria-producing parasites from human blood and keeping them alive in test tubes. this feat had been long attempted but never before with success. the significance of this achievement is that it is the first step toward preparing a serum that will give immunity to malaria. none none this file was produced from images generously made available by the canadian institute for historical microreproductions. advice to a mother on the management of her children and on the treatment on the moment of some of their more pressing illnesses and accidents by pye henry chavasse, fellow of the royal college of surgeons of england, fellow of the obstetrical society of london, formerly president of queen's college medico-chirurgical society, birmingham. "lo, children and the fruit of the womb are an heritage and gift that cometh of the lord." preface. this book has been translated into french, into german, into polish, and into tamil (one of the languages of india); it has been extensively published in america; and is well-known wherever the english language is spoken. the twelfth edition--consisting of twenty thousand copies--being exhausted in less than three years, the thirteenth edition is now published. one or two fresh questions have been asked and answered, and two or three new paragraphs have i been added. pye henry chavasse. , hagley road, edgbaston, birmingham, _june_, . contents. part i--infancy. preliminary conversation ablution management of the navel navel rupture--groin rupture clothing diet vaccination and re-vaccination dentition exercise sleep the bladder and the bowels ailments, disease, etc. concluding remarks on infancy part ii--childhood ablution clothing diet the nursery exercise amusements education sleep second dentition disease, etc. warm baths warm external applications accidents part iii--boyhood and girlhood ablution, etc. management of the hair clothing diet air and exercise amusements education household work for girls choice of profession or trade sleep on the teeth and gums prevention of disease, etc. concluding remarks index advice to a mother. part i.--infancy _infant and suckling._--i. samuel _a rose with all its sweetest leaves yet folded._--byron. _man's breathing miniature!_--coleridge. preliminary conversation . _i wish to consult you on many subjects appertaining to the management and the care of children; will you favour me with your advice and counsel_? i shall be happy to accede to your request, and to give you the fruits of my experience in the clearest manner i am able, and in the simplest language i can command--freed from all technicalities. i will endeavour to guide you in the management of the health of your offspring;--i will describe to you the _symptoms_ of the diseases of children;--i will warn you of approaching danger, in order that you may promptly apply for medical assistance before disease has gained too firm a footing;--i will give you the _treatment_ on the moment; of some of their more pressing illnesses--when medical aid cannot at once be procured, and where delay may be death;--i will instruct you, in case of accidents, on the _immediate_ employment of remedies--where procrastination may be dangerous;--i will tell you how a sick child should be nursed, and how a sick-room ought to be managed;--i i will use my best energy to banish injurious practices from the nursery;--i will treat of the means to prevent disease where it be possible;--i will show you the way to preserve the health of the healthy,--and how to strengthen the delicate;--and will strive to make a medical man's task more agreeable to himself,--and more beneficial to his patient,--by dispelling errors and prejudices, and by proving the importance of your _strictly_ adhering to his rules. if i can accomplish any of these objects, i shall be amply repaid by the pleasing satisfaction that i have been of some little service to the rising generation. . _then you consider it important that i should be made acquainted with, and be well informed upon, the subjects you have just named_? certainly! i deem it to be your imperative duty to _study_ the subjects well. the proper management of children is a vital question,--a mother's question,--and the most important that can be brought under the consideration of a parent; and, strange to say, it is one that has been more neglected than any other. how many mothers undertake--the responsible management of children without previous instruction, or without forethought; they undertake it, as though it may be learned either by intuition or by instinct, or by affection. the consequence is, that frequently they are in a sea of trouble and uncertainty, tossing about without either rule or compass; until, too often, their hopes and treasures are shipwrecked and lost. the care and management, and consequently the health and future well-doing of the child, principally devolve upon the mother, "for it is the mother after all that has most to do with the making or marring of the man." [footnote: _good words_, dr w. lindsay alexander, march .] dr guthrie justly remarks that--"moses might have never been the man he was unless he had been nursed by his own mother. how many celebrated men have owed their greatness and their goodness to a mother's training!" napoleon owed much to his mother. "'the fate of a child,' said napoleon, 'is always the work of his mother;' and this extraordinary man took pleasure in repeating, that to his mother he owed his elevation. all history confirms this opinion..." the character of the mother influences the children more than that of the father, because it is more exposed to their daily, hourly observation.--_woman's mission_. i am not overstating the importance of the subject in hand when i say, that a child is the most valuable treasure in the world, that "he is the precious gift of god," that he is the source of a mother's greatest and purest enjoyment, that he is the strongest bond of affection between her and her husband, and that "a babe in a house is a well-spring of pleasure, a messenger of peace and love."--_tupper_, i have, in the writing of the following pages, had one object constantly in view--namely, health-- "that salt of life, which does to all a relish give, its standing pleasure, and intrinsic wealth, the body's virtue, and the soul's good fortune--health." if the following pages insist on the importance of one of a mother's duties more than another it is this,--_that the mother herself look well into everything appertaining to the management of her own child_. blessed is that mother among mothers of whom it can be said, that "she hath done what she could" for her child--for his welfare, for his happiness, for his health! for if a mother hath not "done what she could for her child"--mentally, morally, and physically--woe betide the unfortunate little creature;--better had it been for him had he never been born! ablution . _is a new-born infant, for the first time, to be washed in warm or in cold water_? it is not an uncommon plan to use _cold_ water from the first, under the impression of its strengthening the child. this appears to be a cruel and barbarous practice, and is likely to have a contrary tendency. moreover, it frequently produces either inflammation of the eyes, or stuffing of the nose, or inflammation of the lungs, or looseness of the bowels. although i do not approve of _cold_ water, we ought not to run into an opposite extreme, as _hot_ water would weaken and enervate the babe, and thus would predispose him to disease. luke warm _rain_ water will be the best to wash him with. this, if it be summer, should have its temperature gradually lowered, until it be quite cold, if it be winter, a _dash_ of warm water ought still to be added, to take oft the chill [footnote: a nursery basin (wedgwoode make is considered the best), holding either six or eight quarts of water, and which will be sufficiently large to hold the whole body of the child. the baton is generally fitted into a wooden frame which will raise it to a convenient height for the washing of the baby.] (by thermometer = to degrees.) it will be necessary to use soap--castile soap being the best for the purpose--it being less irritating to the skin than the ordinary soap. care should be taken that it does not get into the eyes, as it may produce either inflammation or smarting of those organs. if the skin be delicate, or if there be any excoriation or "breaking-out" on the skin, then glycerine soap, instead of the castile soap, ought to be used. . _at what age do you recommend a mother to commence washing her infant either in the tub, or in the nursery basin_? as soon as the navel string comes away [footnote: sir charles locock strongly recommends that an infant should be washed _in a tub_ from the very commencement. he says,--"all those that i superintend _begin_ with a tub."--_letter to the author_.] do not be afraid of water,--and that in plenty,--as it is one of the best strengtheners to a child's constitution. how many infants suffer, for the want of water from excoriation! . _which do you prefer--flannel or sponge--to wash a child with_? a piece of flannel is, for the first part of the washing very useful--that is to say, to use with the soap, and to loosen the dirt and the perspiration; but for the finishing-up process, a sponge--a large sponge--is superior to flannel, to wash all away, and to complete the bathing. a sponge cleanses and gets into all the nooks, corners, and crevices of the skin. besides, sponge, to finish up with, is softer and more agreeable to the tender skin of a babe than flannel. moreover, a sponge holds more water than flannel, and thus enables you to stream the water more effectually over him. a large sponge will act like a miniature shower bath, and will thus brace and strengthen him. . _to prevent a new-born babe from catching cold, is it necessary to wash his head with brandy_? it is _not necessary_. the idea that it will prevent cold is erroneous, as the rapid evaporation of heat which the brandy causes is more likely to give than to prevent cold. . _ought that tenacious, paste like substance, adhering to the skin of a new-born babe, to be washed off at the first dressing_? it should, provided it be done with a soft sponge and with care. if there be any difficulty in removing the substance, gently rub it, by means of a flannel, [footnote: mrs baines (who has written so much and so well on the management of children), in a _letter_ to the author, recommends flannel to be used in the _first_ washing of an infant, which flannel ought afterwards to be burned; and that the sponge should be only used to complete the process, to clear off what the flannel had already loosened. she also recommends that every child should have his own sponge, each of which should have a particular distinguishing mark upon it, as she considers the promiscuous use of the same sponge to be a frequent cause of _ophthalmia_ (inflammation of the eyes). the sponges cannot be kept too clean.] either with a little lard, or fresh butter, or sweet-oil. after the parts have been well smeared and gently rubbed with the lard, or oil, or butter, let all be washed off together, and be thoroughly cleansed away, by means of a sponge and soap and warm water, and then, to complete the process, gently put him in for a minute or two in his tub. if this paste like substance be allowed to remain on the skin, it might produce either an excoriation, or a "breaking-out" besides, it is impossible, if that tenacious substance be allowed to remain on it, for the skin to perform its proper functions. . _have you any general observations to make on the washing of a new-born infant_? a babe ought, every morning of his life, to be thoroughly washed from head to foot, and this can only be properly done by putting him bodily either into a tub or into a bath, or into a large nursery basin, half filled with water. the head, before placing him in the bath, should be first wetted (but not dried), then immediately put him into the water, and, with a piece of flannel well soaked, cleanse his whole body, particularly his arm pits, between his thighs, his groins, and his hams, then take a large sponge in hand, and allow the water from it, well filled, to stream all over the body, particularly over his back and loins. let this advice be well observed, and you will find the plan most strengthening to your child. the skin must, after every bath, be thoroughly but quickly dried with warm, dry, soft towels, first enveloping the child in one, and then gently absorbing the moisture with the towel, not roughly scrubbing and rubbing his tender skin as though a horse were being rubbed down. the ears must, after each ablution, be carefully and well dried with a soft dry napkin, inattention to this advice has sometimes caused a gathering in the ear--a painful and distressing complaint, and at other times it has produced deafness. directly after the infant is dried, all the parts that are at all likely to be chafed ought to be well powdered. after he is well dried and powdered, the chest, the back, the bowels, and the limbs should be gently rubbed, taking care not to expose him unnecessarily during such friction. he ought to be partially washed every evening, indeed it may be necessary to use a sponge and a little warm water frequently during the day, namely, each time after the bowels have been relieved. _cleanliness is one of the grand incentives to health_, and therefore cannot be too strongly insisted upon. if more attention were paid to this subject, children would be more exempt from chafings, "breakings-out," and consequent suffering, than they at present are. after the second month, if the babe be delicate, the addition of two handfuls of table-salt to the water he is washed with in the morning will tend to brace and strengthen him. with regard to the best powder to dust an infant with, there is nothing better for general use than starch--the old fashioned starch _made of wheaten flour_--reduced by means of a pestle and mortar to a fine powder, or violet powder, which is nothing more than finely powdered starch scented, and which may be procured of any respectable chemist. some others are in the habit of using white lead, but as this is a poison, it ought _on no account_ to be resorted to. . _if the parts about the groin and fundament be excoriated, what is then the best application_? after sponging the parts with tepid _rain water_, holding him over his tub, and allowing the water from a well filled sponge to stream over the parts, and then drying them with a soft napkin (not rubbing, but gently dabbing with the napkin), there is nothing better than dusting the parts frequently with finely powdered native carbonate of zinc-calamine powder. the best way of using this powder is, tying up a little of it in a piece of muslin, and then gently dabbing the parts with it. remember excoriations are generally owing to the want of water,--to the want of an abundance of water. an infant who is every morning well soused and well swilled with water seldom suffers either from excoriations, or from any other of the numerous skin diseases. cleanliness, then, is the grand preventative of, and the best remedy for excoriations. naaman the syrian was ordered "to wash and be clean," and he was healed, "and his flesh came again like unto the flesh of a little child and he was clean." this was, of course, a miracle; but how often does water, without any special intervention, act miraculously both in preventing and in curing skin diseases! an infant's clothes, napkins especially, ought never to be washed with soda; the washing of napkins with soda is apt to produce excoriations and breakings-out. "as washerwomen often deny that they use soda, it can be easily detected by simply soaking a clean white napkin in fresh water and then tasting the water; if it be brackish and salt, soda has been employed." [footnote: communicated by sir charles locock to the author.] . _who is the proper person to wash and dress the babe_? the monthly nurse, as long as she is in attendance; but afterwards the mother, unless she should happen to have an experienced, sensible, thoughtful nurse, which, unfortunately, is seldom the case. [footnote: "the princess of wales might have been seen on thursday taking an airing in a brougham in hyde park with her baby--the future king of england--on her lap, without a nurse, and accompanied only by mrs brace. the princess seems a very pattern of mothers, and it is whispered among the ladies of the court that every evening the mother of this young gentleman may be seen in a flannel dress, in order that she may properly wash and put on baby's night clothes, and see him safely in bed. it is a pretty subject for a picture."--_pall mall gazette_.] . _what is the best kind of apron for a mother, or for a nurse, to wear, while washing the infant_? flannel--a good, thick, soft flannel, usually called bathcoating--apron, made long and full, and which of course ought to be well dried every time before it is used. . _perhaps you will kindly recapitulate, and give me further advice on the subject of the ablution of my babe_. let him by all means, then, as soon as the navel-string has separated from the body, be bathed either in his tub, or in his bath, or in his large nursery-basin, for if he is to be strong and hearty, in the water every morning he must go. the water ought to be slightly warmer than new milk. it us dangerous for him to remain for a long period in his bath, this, of course, holds good in a ten fold degree if the child have either a cold or pain in his bowels. take care that, immediately after he comes out of his tub, he is well dried with warm towels. it is well to let him have his bath the first thing in the morning, and before he has been put to the breast, let him be washed before he has his breakfast, it will refresh him and give him an appetite. besides, he ought to have his morning ablution on an empty stomach, or it may interfere with digestion, and might produce sickness and pain. in putting him in his tub, let his head be the first part washed. we all know, that in bathing in the sea, now much better we can bear the water if we first wet our head, if we do not do so, we feel shivering and starved and miserable. let there be no dawdling in the washing, let it be quickly over. when he is thoroughly dried with warm _dry_ towels, let him be well rubbed with the warm hand of the mother or of the nurse. as i previously recommended, while drying him and while rubbing him, let him repose and kick and stretch either on the warm flannel apron, or else on a small blanket placed on the lap. one bathing in the tub, and that in the morning, is sufficient, and better than night and morning. during the day, as i before observed, he may, after the action either of his bowels or of his bladder, require several spongings of lukewarm water, _for cleanliness is a grand incentive to health and comeliness_. remember it is absolutely necessary to every child from his earliest babyhood to have a bath, to be immersed every morning of his life in the water. this advice, unless in cases of severe illness, admits of no exception. water to the body--to the whole body--is a necessity of life, of health, and of happiness, it wards off disease, it brace? the nerves, it hardens the frame, it is the finest tonic in the world. oh, if every mother would follow to the very letter this counsel how much misery, how much ill-health might then be averted! management of the navel. . _should the navel-string be wrapped in singed rag_? there is nothing better than a piece of fine old linen rag, _unsinged_; when singed, it frequently irritates the infant's skin. . _how ought the navel-string to be wrapped in the rag_? take a piece of soft linen rag, about three inches wide and four inches long, and wrap it neatly round the navel string, in the same manner you would around a cut finger, and then, to keep on the rag, tie it with a few rounds of whity-brown thread. the navel-string thus covered should, pointing upwards, be placed on the belly of the child, and must be secured in its place by means of a flannel belly-band. . _if after the navel-string has been secured, bleeding should (in the absence of the medical man) occur, how must it be restrained_? the nurse or the attendant ought immediately to take off the rag, and tightly, with a ligature composed of four or five whity-brown threads, retie the navel-string; and to make assurance doubly sure, after once tying it, she should pass the threads a second time around the navel-string, and tie it again; and after carefully ascertaining that it no longer bleeds, fasten it up in the rag as before. bleeding of the navel-string rarely occurs, yet, if it should do so--the medical man not being at hand--the child's after-health, or even his life, may, if the above directions be not adopted, be endangered. . _when does the navel-string separate from the child_? from five days to a week after birth; in some cases not until ten days or a fortnight, or even, in rare cases, not until three weeks. . _if the navel-string does not at the end of a week came away, ought any means to be used to cause the separation_? certainly not, it ought always to be allowed to drop off, which, when in a fit state, it will readily do. meddling with the navel string has frequently cost the babe a great deal of suffering, and in some cases even his life. . _the navel is sometimes a little sore, after the navel-string comes away, what ought then to be done_? a little simple cerate should be spread on lint, and be applied every morning to the part affected, and a white-bread poultice, every night, until it is quite healed. navel rupture--groin rupture. . _what are the causes of a rupture of the navel? what ought to be done? can it be cured_? ( ) a rupture of the navel is sometimes occasioned by a meddlesome nurse. she is very anxious to cause the navel-string to separate from the infant's body, more especially when it is longer in coming away than usual. she, therefore, before it is in a fit state to drop off, forces it away. ( ) the rapture, at another time, is occasioned by the child incessantly crying. a mother, then, should always bear in mind, that a rupture of the navel is often caused by much crying, and that it occasions much crying, indeed, it is a frequent cause of incessant crying. a child, therefore, who, without any assignable cause, is constantly crying, should have his navel carefully examined. a rupture of the navel ought always to be treated early--the earlier the better. ruptures of the navel can only be _cured_ in infancy and in childhood. if it be allowed to run on until adult age, a _cure_ is impossible. palliative means can then only be adopted. the best treatment is a burgundy pitch plaster, spread on a soft piece of wash leather, about the size of the top of a tumbler, with a properly-adjusted pad (made from the plaster) fastened on the centre of the plaster, which will effectually keep up the rupture, and in a few weeks will cure it. it will be necessary, from time to time, to renew the plaster until the cure be effected. these plasters will be found both more efficacious and pleasant than either truss or bandage; which latter appliances sometimes gall, and do more harm than they do good. . _if an infant have a groin-rupture (an inguinal rupture), can that also be cured_? certainly, if, soon after birth, it be properly attended to. consult a medical man, and he will supply you with a well-fitting truss, _which will eventually cure him_. if the truss be properly made (under the direction of an experienced surgeon) by a skilful surgical-instrument maker, a beautiful, nicely-fitting truss will be supplied, which will take the proper and exact curve of the lower part of the infant's belly, and will thus keep on without using any under-strap whatever--a great desideratum, as these under-straps are so constantly wetted and soiled as to endanger the patient constantly catching cold. but if this under-strap is to be superseded, the truss must be made exactly to fit the child--to fit him like a ribbon; which is a difficult thing to accomplish unless it be fashioned by a skilful workman. it is only lately that these trusses have been made without under-straps. formerly the under-straps were indispensable necessaries. these groin-ruptures require great attention and supervision, as the rupture (the bowel) must, before putting on the truss be cautiously and thoroughly returned into the belly; and much care should be used to prevent the chafing and galling of the tender skin of the babe, which an ill-fitting truss would be sure to occasion. but if care and skill be bestowed on the case, a perfect cure might in due time be ensured. the truss must not be discontinued, until a _perfect_ cure be effected. let me strongly urge you to see that my advice is carried out to the very letter, as a groin-rupture can only be _cured_ in infancy and in childhood. if it be allowed to ran on, unattended to, until adult age, he will be obliged to wear a truss _all his life_, which would be a great annoyance and a perpetual irritation to him. clothing. . _is it necessary to have a flannel cap in readiness to put on as soon as the babe is born_? sir charles locock considers that a flannel cap is _not_ necessary, and asserts that all his best nurses have long discarded flannel caps. sir charles states that since the discontinuance of flannel caps infants have not been more liable to inflammation of the eyes. such authority is, in my opinion, conclusive. my advice, therefore, to you is, discontinue by all means the use of flannel caps. . _what kind of a belly-band do you recommend--a flannel or a calico one_? i prefer flannel, for two reasons--first, on account of its keeping the child's bowels comfortably warm; and secondly, because of its not chilling him (and thus endangering cold, &c.) when he wets himself. the belly-band ought to be moderately, but not tightly applied, as, if tightly applied, it would interfere with the necessary movement of the bowels. . _when should the belly-band be discontinued_? when the child is two or three months old. the best way of leaving it off is to tear a strip off daily for a few mornings, and then to leave it off altogether. "nurses who take charge of an infant when the monthly nurse leaves, are frequently in the habit of at once leaving off the belly-band, which often leads to ruptures when the child cries or strains. it is far wiser to retain it too long than too short a time; and when a child catches whooping-cough, whilst still very young, it is safer to resume the belly-band." [footnote: communicated by sir charles locock to the author.] . _have you any remarks to make on the clothing of on infant_? a babe's clothing ought to be light, warm, loose, and free from pins. ( .) _it should be light_, without being too airy. many infant's clothes are both too long and too cumbersome. it is really painful to see how some poor little babies are weighed down with a weight of clothes. they may be said to "bear the burden," and that a heavy one, from the very commencement of their lives! how absurd, too, the practice of making them wear _long_ clothes. clothes to cover a child's feet, and even a little beyond, may be desirable; but for clothes, when the infant is carried about, to reach to the ground, is foolish and cruel in the extreme. i have seen a delicate baby almost ready to faint under the infliction. ( .) _it should be warm_, without being too warm. the parts that ought to be kept warm are the chest, the bowels, and the feet. if the infant be delicate, especially if he be subject to inflammation of the lungs, he ought to wear a fine flannel, instead of his usual shirts, which should be changed as frequently. ( .) _the dress should be loose_, so as to prevent any pressure upon the blood-vessels, which would otherwise impede the circulation, and thus hinder a proper development of the parts. it ought to be loose about the chest and waist, so that the lungs and the heart may have free play. it should be loose about the stomach, so that digestion may not be impeded; it ought to be loose about the bowels, in order that the spiral motion of the intestines may not be interfered with--hence the importance of putting on a belly-band moderately slack; it should be loose about the sleeves, so that the blood may course, without let or hindrance, through the arteries and veins; it ought to be loose, then, everywhere, for nature delights in freedom from restraint, and will resent, sooner or later, any interference. oh, that a mother would take common sense, and not custom, as her guide! ( .) _as few pins_ should be used in the dressing of a baby as possible. inattention to this advice has caused many a little sufferer to be thrown into convulsions. the generality of mothers use no pins in the dressing of their children; they tack every part that requires fastening with a needle and thread. they do not even use pins to fasten the baby's diapers. they make the diapers with loops and tapes, and thus altogether supersede the use of pins in the dressing of an infant. the plan is a good one, takes very little extra time, and deserves to be universally adopted. if pins be used for the diapers, they ought to be the patent safety pins. . _is there any necessity for a nurse being particular in airing an infant's clothes before they are put on? if she were less particular, would it not make him more hardy_? a nurse cannot be too particular on this head. a babe's clothes ought to be well aired the day before they are put on, as they should _not_ be put on warm from the fire. it is well, where it can be done, to let him have clean clothes daily. where this cannot be afforded, the clothes, as soon as they are taken off at night, ought to be well aired, so as to free them from the perspiration, and that they may be ready to put on the following morning. it is truly nonsensical to endeavour to harden a child, or any one else, by putting on damp clothes! . _what is your opinion of caps for an infant_? the head ought to be kept cool; caps, therefore, are unnecessary. if caps be used at all, they should only be worn for the first month in summer, or for the first two or three months in winter. if a babe take to caps, it requires care in leaving them off, or he will catch cold. when you are about discontinuing them, put a thinner and a thinner one on, every time they are changed, until you leave them off altogether. but remember, my opinion is, that a child is better _without_ caps; they only heat his head, cause undue perspiration, and thus make him more liable to catch cold. if a babe does not wear a cap in the day, it is not at all necessary that he should wear one at night. he will sleep more comfortably without one, and it will be better for his health. moreover, night-caps injure both the thickness and beauty of the hair. . _have you any remarks to make on the clothing of an infant, when, in the winter time, he is sent out for exercise_? be sure that he is well wrapped up. he ought to have under his cloak a knitted worsted spencer, which should button behind, and if the weather be very cold, a shawl over all, and, provided it be dry above, and the wind be not in the east or in the north-east, he may then brave the weather. he will then come from his walk refreshed and strengthened, for cold air is an invigorating tonic. in a subsequent conversation i will indicate the proper age at which a child should be first sent out to take exercise in the open air. . _at what age ought an infant "to be shortened?"_ this, of course, will depend upon the season. in the summer, the right time "for shortening a babe," as it is called, is at the end of two months, in the winter, at the end of three months. but if the right time for "shortening" a child should happen to be in the spring, let it be deferred until the end of may. the english springs are very trying and treacherous, and sometimes, in april the weather is almost as cold, and the wind as biting as in winter. it is treacherous, for the sun is hot, and the wind, which is at this time of the year frequently easterly, is keen and cutting i should far prefer "to shorten" a child in the winter than in the early spring. diet . _are you an advocate for putting a baby to the breast soon after birth, or for waiting, as many do, until the third day_? the infant ought to be put to the bosom soon after birth, the interest, both of the mother and of the child demands it. it will be advisable to wait three or four hours, that the mother may recover from her fatigue, and, then, the babe must be put to the breast. if this be done, he will generally take the nipple with avidity. it might be said, at so early a period that there is no milk in the bosom; but such is not usually the case. there generally is a _little_ from the very beginning, which acts on the baby's bowels like a dose of purgative medicine, and appears to be intended by nature to cleanse the system. but, provided there be no milk at first, the very act of sucking not only gives the child a notion, but, at the same time, causes a draught (as it is usually called) in the breast, and enables the milk to flow easily. of course, if there be no milk in the bosom--the babe having been applied once or twice to determine the fact--then you must wait for a few hours before applying him again to the nipple, that is to say, until the milk be secreted. an infant, who, for two or three days, is kept from the breast, and who is fed upon gruel, generally becomes feeble, and frequently, at the end of that time, will not take the nipple at all. besides, there is a thick cream (similar to the biestings of a cow), which, if not drawn out by the child, may cause inflammation and gathering of the bosom, and, consequently, great suffering to the mother. moreover, placing him _early_ to the breast, moderates the severity of the mother's after pains, and lessens the risk of her flooding. a new-born babe must _not_ have gruel given to him, as it disorders the bowels, causes a disinclination to suck, and thus makes him feeble. . _if an infant show any disinclination to suck, or if he appear unable to apply his tongue to the nipple, what ought to be done_? immediately call the attention of the medical man to the fact, in order that he may ascertain whether he be tongue-tied. if he be, the simple operation of dividing the bridle of the tongue will remedy the defect, and will cause him to take the nipple with ease and comfort. . _provided there be not milk at first, what ought then to be done_? wait with patience; the child (if the mother have no milk) will not, for at least twelve hours, require artificial food. in the generality of instances, then, artificial food is not at all necessary; but if it should be needed, one-third of new milk and two-thirds of warm water, slightly sweetened with loaf sugar (or with brown sugar, if the babe's bowels have not been opened), should be given, in small quantities at a time, every four hours, until the milk be secreted, and then it must be discontinued. the infant ought to be put to the nipple every four hours, but not oftener, until he be able to find nourishment. if after the application of the child for a few times, he is unable to find nourishment, then it will be necessary to wait until the milk be secreted. as soon as it is secreted, he must be applied with great regularity, _alternately_ to each breast. i say _alternately_ to each breast. _this is most important advice_. sometimes a child, for some inexplicable reason, prefers one breast to the other, and the mother, to save a little contention, concedes the point, and allows him to have his own way. and what is frequently the consequence?--a gathered breast! we frequently hear of a babe having no notion of sucking. this "no notion" may generally be traced to bad management, to stuffing him with food, and thus giving him a disinclination to take the nipple at all. . _how often should a mother suckle her infant_? a mother generally suckles her baby too often, having him almost constantly at the breast. this practice is injurious both to parent and to child. the stomach requires repose as much as any other part of the body; and how can it have if it be constantly loaded with breast-milk? for the first month, he ought to be suckled, about every hour and a half; for the second month, every two hours,--gradually increasing, as he becomes older, the distance of time between, until at length he has it about every four hours. if a baby were suckled at stated periods, he would only look for the bosom at those times, and be satisfied. a mother is frequently in the habit of giving the child the breast every time he cries, regardless of the cause. the cause too frequently is that he has been too often suckled--his stomach has been overloaded, the little fellow is consequently in pain, and he gives utterance to it by cries. how absurd is such a practice! we may as well endeavour to put out a fire by feeding it with fuel. an infant ought to be accustomed to regularity in everything, in times for sucking, for sleeping, &c. no children thrive so well as those who are thus early taught. . _where the mother is moderately strong, do you advise that the infant should have any other food than the breast_? artificial food must not, for the first five or six months, be given, if the parent be _moderately_ strong, of course, if she be feeble, a _little_ food will be necessary. many delicate women enjoy better health whilst ambling than at any other period of their lives. it may be well, where artificial food, in addition to the mother's own milk, is needed, and before giving any farinaceous food whatever (for farinaceous food until a child is six or seven months old is injurious), to give, through a feeding bottle, every night and morning, in addition to the mother's breast of milk, the following _milk-water-and sugar-of milk food_-- fresh milk, from one cow, warm water, of each a quarter of a pint, sugar of milk one tea spoonful the sugar of milk should first be dissolved in the warm water, and then the fresh milk _unboiled_ should be mixed with it. the sweetening of the above food with sugar-of-milk, instead of with lump sugar, makes the food more to resemble the mother's own milk. the infant will not, probably, at first take more than half of the above quantity at a time, even if he does so much as that but still the above are the proper proportions, and as he grows older, he will require the whole of it at a meal. . _what food, when a babe is six or seven months old, is the best substitute for a mother's milk?_ the food that suits one infant will not agree with another. ( ) the one that i have found the most generally useful, is made as follows--boil the crumb of bread for two hours in water, taking particular care that it does not burn, then add only a _little_ lump-sugar (or _brown_ sugar, if the bowels be costive), to make it palatable. when he is six or seven months old, mix a little new milk--the milk of one cow--with it gradually as he becomes older, increasing the quantity until it be nearly all milk, there being only enough water to boil the bread, the milk should be poured boiling hot on the bread. sometimes the two milks--the mother's and the cow's milk--do not agree, when such is the case, let the milk be left out, both in this and in the foods following, and let the food be made with water, instead of with milk and water. in other respects, until the child is weaned, let it be made as above directed, when he is weaned, good fresh cow's milk must, as previously recommended, be used. ( ) or cut thin slices of bread into a basin, cover the bread with _cold_ water, place it in an oven for two hours to bake, take it out, beat the bread up with a fork, and then slightly sweeten it. this is an excellent food. ( ) if the above should not agree with the infant (although, if properly made, they almost invariably do), "tous les-mois" may be given. [footnote: "tous les mois" is the starch obtained from the tuberous roots of various species of _canna_, and is imported from the west indies. it is very similar to arrow root. i suppose it is called "tous les-mois," as it is good to be eaten all the year round.]( ) or robb's biscuits, as it is "among the best bread compounds made out of wheat-flour, and is almost always readily digested."--_routh_. ( ) another good food is the following--take about a pound of flour put it in a cloth, tie it up tightly, place it a saucepanful of water, and let it boil for four or five hours, then take it out, peel off the outer rind, and the inside will be found quite dry, which grate. ( ) another way of preparing an infant's food, is to bake flour--biscuit flour--in a slow oven, until it be of a light fawn colour. baked flour ought after it is baked, to be reduced, by means of a rolling pin, to a fine powder, and should then be kept in a covered tin, ready for use. ( ) an excellent food for a baby is baked crumbs of bread. the manner of preparing it is as follows--crumb some bread on a plate, put it a little distance from the fire to dry. when dry, rub the crumbs in a mortar, and reduce them to a fine powder, then pass them through a sieve. having done which, put the crumbs of bread into a slow oven, and let them bake until they be of a light fawn colour. a small quantity either of the boiled, or of the baked flour, or of the baked crumb of bread, ought to be made into food, in the same way as gruel is made, and should then be slightly sweetened, according to the state of the bowels, either with lump or with brown sugar. ( ) baked flour sometimes produces constipation, when such is the case, mr. appleton, of budleigh salterton, devon, wisely recommends a mixture of baked flour, and prepared oatmeal, [footnote: if there is any difficulty in obtaining _prepared_ oatmeal, robinson's scotch oatmeal will answer equally as well.] in the proportion of two of the former and one of the latter. he says--"to avoid the constipating effects, i have always had mixed, before baking, one part of prepared oatmeal with two parts of flour, this compound i have found both nourishing, and regulating to the bowels. one table-spoonful of it, mixed with a quarter of a pint of milk, or milk and water, when well boiled, flavoured and sweetened with white sugar, produces a thick, nourishing, and delicious food for infants or invalids." he goes on to remark--"i know of no food, after repeated trials, that can be so strongly recommended by the profession to all mothers in the rearing of their infants, without or with the aid of the breasts, at the same time relieving them of much draining and dragging whilst nursing with an insufficiency of milk, as baked flour and oatmeal." [footnote: _british medical journal_, dec , ] ( ) a ninth food may be made with "farinaceous food for infants, prepared by hards of dartford". if hard's farinaceous food produces costiveness--as it sometimes does--let it be mixed either with equal parts or with one third of robinson's scotch oatmeal. the mixture of the two together makes a splendid food for a baby. ( ) a tenth, and an excellent one, may be made with rusks, boiled for an hour in water, which ought then to be well beaten up, by means of a fork, and slightly sweetened with lump sugar. great care should be taken to select good rusks, as few articles vary so much in quality. ( ) an eleventh is--the top crust of a baker's loaf, boiled for an hour in water, and then moderately sweetened with lump sugar. if, at any time, the child's bowels should be costive, _raw_ must be substituted for _lump_ sugar. ( ) another capital food for an infant is that made by lemann's biscuit powder. [footnote: lemann's biscuit powder cannot be too strongly recommended--it is of the finest quality, and may be obtained of lemann, threadneedle street, london. an extended and an extensive experience confirms me still more in the good opinion i have of this food.] ( ) or, brown and polson's patent corn flour will be found suitable. francatelli, the queen's cook, in his recent valuable work, gives the following formula for making it--"to one dessert-spoonful of brown and polson, mixed with a wineglassful of cold water, add half a pint of boiling water, stir over the fire for five minutes, sweeten lightly, and feed the baby, but if the infant is being brought up by the hand, this food should then be mixed with milk--not otherwise." ( ) a fourteenth is neaves' farinaceous food for infants, which is a really good article of diet for a babe, it is not so binding to the bowels as many of the farinaceous foods are, which is a great recommendation. ( ) the following is a good and nourishing food for a baby:--soak for an hour, some _best_ rice in cold water; strain, and add fresh water to the rice; then let it simmer till it will pulp through a sieve; put the pulp and the water in a saucepan, with a lump or two of sugar, and again let it simmer for a quarter of an hour; a portion of this should be mixed with one-third of fresh milk, so as to make it of the consistence of good cream. this is an excellent food for weak bowels. when the baby is six or seven months old, new milk should be added to any of the above articles of food, in a similar way to that recommended for boiled bread. ( .) for a delicate infant, lentil powder, better known as du barry's "ravalenta arabica," is invaluable. it ought to be made into food, with new milk, in the same way that arrow-root is made, and should be moderately sweetened with loaf-sugar. whatever food is selected ought to be given by means of a nursing bottle. if a child's bowels be relaxed and weak, or if the motions be offensive, the milk _must_ be boiled, but not otherwise. the following ( ) is a good food when an infant's bowels are weak and relaxed:--"into five large spoonfuls of the purest water, rub smooth one dessert-spoonful of fine flour. set over the fire five spoonfuls of new milk, and put two bits of sugar into it; the moment it boils, pour it into the flour and water, and stir it over a slow fire twenty minutes." where there is much emaciation, i have found ( ) genuine arrow-root [footnote: genuine arrow-root, of first-rate quality, and at a reasonable price, may be obtained of h. m. plumbe, arrow-root merchant, alie place. great alie street. aldgate, london, e.] a very valuable article of food for an infant, as it contains a great deal of starch, which starch helps to form fat and to evolve caloric (heat)--both of which a poor emaciated chilly child stands so much in need of. it must be made with equal parts of water and of good fresh milk, and ought to be slightly sweetened with loaf sugar; a small pinch of table salt should be added to it. arrow-root will not, as milk will, give bone and muscle; but it will give--what is very needful to a delicate child--fat and warmth. arrow-root, as it is principally composed of starch, comes under the same category as cream, butter, sugar, oil, and fat. arrowroot, then, should always be given with new milk (mixed with one-half of water); it will then fulfil, to perfection, the exigencies of nourishing, of warming, and fattening the child's body. new milk, composed in due proportions as it is, of cream and of skim milk--the very acme of perfection--is the only food, _which of itself alone,_ will nourish and warm and fatten. it is, for a child, _par excellence,_ the food of foods! arrow-root, and all other farinaceous foods are, for a child, only supplemental to milk--new milk being, for the young, the staple food of all other kinds of foods whatever. but bear in mind, _and let there be no mistake about it,_ that farinaceous food, be it what it may, until the child be six or seven months old, until, indeed, he _begin_ to cut his teeth, is not suitable for a child; until then, _the milk-water-salt-and-sugar food_ (see page ) is usually, if he be a dry-nursed child, the best artificial food for him. i have given you a large and well-tried infant's dietary to chose from, as it is sometimes difficult to fix on one that will suit; but, remember, if you find one of the above to agree, keep to it, as a babe requires a simplicity in food--a child a greater variety. let me, in this place, insist upon the necessity of great care and attention being observed in the preparation of any of the above articles of diet. a babe's stomach is very delicate, and will revolt at either ill-made, or lumpy, or burnt food. great care ought to be observed as to the cleanliness of the cooking utensils. the above directions require the strict supervision of the mother. broths have been recommended, but, for my own part, i think that, for a _young_ infant, they are objectionable; they are apt to turn acid on the stomach, and to cause flatulence and sickness, they, sometimes, disorder the bowels and induce griping and purging. whatever artificial food is used ought to be given by means of a bottle, not only as it is a more natural way than any other of feeding a baby, as it causes him to suck as though he were drawing it from the mother's breasts, but as the act of sucking causes the salivary glands to press out their contents, which materially assist digestion. moreover, it seems to satisfy and comfort him more than it otherwise would do. one of the best, if not _the best_ feeding bottle i have yet seen, is that made by morgan brothers, bow lane, london. it is called "the anglo-french feeding bottle" s maw, of aldersgate street, london, has also brought out an excellent one--"the fountain infant's feeding bottle" another good one is "mather's infant's feeding bottle" either of these three will answer the purpose admirably. i cannot speak in terms too highly of these valuable inventions. the food ought to be of the consistence of good cream, and should be made fresh and fresh. it ought to be given milk warm. attention must be paid to the cleanliness of the vessel, and care should be taken that the milk be that of one cow, [footnote: i consider it to be of immense importance to the infant, that the milk be had from one cow. a writer in the _medical times and gazette_ speaking on this subject, makes the following sensible remarks--"i do not know if a practice common among french ladies when they do not nurse, has obtained the attention among ourselves which it seems to me to deserve. when the infant is to be fed with cow milk that from various cows is submitted to examination by the medical man and if possible, tried on some child, and when the milk of any cow has been chosen, no other milk is ever suffered to enter the child's lips for a french lady would as soon offer to her infant's mouth the breasts of half a dozen wet-nurses in the day, as mix together the milk of various cows, which must differ, even as the animals themselves, in its constituent qualities. great attention is also paid to the pasture, or other food of the cow thus appropriated."] and that it be new and of good quality, for if not it will turn acid and sour, and disorder the stomach, and will thus cause either flatulence or looseness of the bowels, or perhaps convulsions. the only way to be sure of having it from _one_ cow, is (if you have not a cow of your own), to have the milk from a _respectable_ cow keeper, and to have it brought to your house in a can of your own (the london milk cans being the best for the purpose). the better plan is to have two cans, and to have the milk fresh and fresh every night and morning. the cans, after each time of using, ought to be scalded out, and, once a week the can should be filled with _cold_ water, and the water should be allowed to remain in it until the can be again required. very little sugar should be used in the food, as much sugar weakens the digestion. a small pinch of table-salt ought to be added to whatever food is given, as "the best savour is salt." salt is most wholesome--it strengthens and assists digestion, prevents the formation of worms, and, in small quantities, may with advantage be given (if artificial food be used) to the youngest baby. . _where it is found to be absolutely necessary to give an infant artificial food_ whilst suckling, _how often ought he to be fed_? not oftener than twice during the twenty four hours, and then only in _small_ quantities at a time, as the stomach requires rest, and at the same time, can manage to digest a little food better than it can a great deal. let me again urge upon you the importance, if it be at all practicable, of keeping the child _entirely_ to the breast for the first five or six months of his existence. remember there is no _real_ substitute for a mother's milk, there is no food so well adapted to his stomach, there is no diet equal to it in developing muscle, in making bone, or in producing that beautiful plump rounded contour of the limbs, there is nothing like a mother's milk _alone_ in making a child contented and happy, in laying the foundation of a healthy constitution, in preparing the body for a long life, in giving him tone to resist disease, or in causing him to cut his teeth easily and well, in short, _the mothers milk is the greatest temporal blessing an infant can possess_. as a general rule, therefore, when the child and the mother are tolerably strong, he is better _without artificial_ food until he have attained the age of three or four months, then, it will usually be necessary to feed him with _the milk-water-and-sugar-of milk food_ (see p ) twice a day, so as gradually to prepare him to be weaned (if possible) at the end of nine months. the food mentioned in the foregoing conversation will, when he is six or seven months old, be the best for him. . _when the mother is not able to suckle her infant herself, what ought to be done_? it must first be ascertained, _beyond all doubt_, that a mother is not able to suckle her own child many delicate ladies do suckle their infants with advantage, not only to their offspring, but to themselves. "i will maintain," says steele, "that the mother grows stronger by it, and will have her health better than she would have otherwise she will find it the greatest cure, and preservative for the vapours [nervousness] and future miscarriages, much beyond any other remedy whatsoever her children will be like giants, whereas otherwise they are but living shadows, and like unripe fruit, and certainly if a woman is strong enough to bring forth a child, she is beyond all doubt strong enough to nurse it afterwards." many mothers are never so well as when they are nursing, besides, suckling prevents a lady from becoming pregnant so frequently as she otherwise would. this, if she be delicate, is an important consideration, and more especially if she be subject to miscarry. the effects of miscarriage are far more weakening than those of suckling. a hireling, let her be ever so well inclined, can never have the affection and unceasing assiduity of a mother, and, therefore, cannot perform the duties of suckling with equal advantage to the baby. the number of children who die under five years of age is enormous--many of them from the want of the mother's milk. there is a regular "parental baby-slaughter"--"a massacre of the innocents"-- constantly going on in england, in consequence of infants being thus deprived of their proper nutriment and just dues! the mortality from this cause is frightful, chiefly occurring among rich people who are either too grand, or, from luxury, too delicate to perform such duties; poor married women, as a rule, nurse their own children, and, in consequence reap their reward. if it be ascertained, _past all doubt_, that a mother cannot suckle her child, then, if the circumstances of the parents will allow--and they ought to strain a point to accomplish it--a healthy wet-nurse should be procured, as, of course, the food which nature has supplied is far, very far superior to any invented by art. never bring up a baby, then, if you can possibly avoid it, on _artificial_ food. remember, as i proved in a former conversation, there is in early infancy no _real_ substitute for either a mother's or a wet-nurse's milk. it is impossible to imitate the admirable and subtle chemistry of nature. the law of nature is, that a baby, for the first few months of his existence, shall be brought up by the breast, and nature's law cannot be broken with impunity. [footnote: for further reasons why artificial food is not desirable, at an early period of infancy, see answer to th question, page .] it will be imperatively necessary then-- "to give to nature what is nature's due." again, in case of a severe illness occurring during the first nine months of a child's life, what a comfort either the mother's or the wet-nurse's milk is to him! it often determines whether he shall live or die. but if a wet-nurse cannot fill the place of a mother, then asses' milk will be found the best substitute, as it approaches nearer, in composition, than any other animal's, to human milk; but it is both difficult and expensive to obtain. the next best substitute is goats' milk. either the one or the other ought to be milked fresh and fresh, when wanted, and should be given by means of a feeding-bottle. asses' milk is more suitable for a _delicate_ infant, and goats' milk for a _strong_ one. if neither asses' milk nor goats' milk can be procured, then the following _milk-water-salt-and-sugar food_, from the very commencement, should be given; and as i was the author of the formula, [footnote: it first appeared in print in the th edition of _advice to a mother_, .] i beg to designate it as--_rye chavasse's milk food_:-- new milk, the produce of one _healthy_ cow; warm water, of each, equal parts; table salt, a few grains--a small pinch; lump sugar, a sufficient quantity, to slightly sweeten it. the milk itself ought not to be heated over the fire, [footnote: it now and then happens that if the milk be not boiled, the motions of an infant are offensive; _when such is the case_, let the milk be boiled, but not otherwise.] but should, as above directed, be warmed by the water; it must, morning and evening, be had fresh and fresh. the milk and water should be of the same temperature as the mother's milk, that is to say, at about ninety degrees fahrenheit. it ought to be given by means of either morgan's, or maw's, or mather's feeding-bottle, [footnote: see answer to question , page .] and care must be taken to _scald_ the bottle out twice a day, for if attention be not paid to this point, the delicate stomach of an infant is soon disordered. the milk should, as he grows older, be gradually increased and the water decreased, until two-thirds of milk and one-third of water be used; but remember, that either _much_ or _little_ water must _always_ be given with the milk. the above is my old form, and which i have for many years used with great success. where the above food does not agree (and no food except a healthy mother's own milk does _invariably_ agree) i occasionally substitute sugar-of milt for the lump sugar, in the proportion of a tea spoonful of sugar-of milk to every half pint of food. if your child bring up his food, and if the ejected matter be sour-smelling, i should advise you to leave out the sugar-of milk altogether, and simply to let the child live, for a few days, on milk and water alone, the milk being of _one_ cow, and in the proportion of two-thirds to one-third of _warm_ water--not _hot_ water, the milk should not be scalded with _hot_ water, as it injures its properties, besides, it is only necessary to give the child his food with the chill just off. the above food, where the stomach is disordered, is an admirable one, and will often set the child to rights without giving him any medicine whatever. moreover, there is plenty of nourishment in it to make the babe thrive, for after all it is the milk that is the important ingredient in all the foods of infants, they can live on it, and on it alone, and thrive amazingly. mothers sometimes say to me, that farinaceous food makes their babes flatulent, and that my food (_pye chavasse's milk food_) has not that effect. the reason of farinaceous food making babes, until they have _commenced_ cutting their teeth, "windy" is, that the starch of the farinaceous food (and all farinaceous foods contain more or less of starch) is not digested, and is not, as it ought to be, converted by the saliva into sugar [footnote: see pye chavasse's _counsel to a mother_, d edition.] hence "wind" is generated, and pain and convulsions often follow in the train. the great desideratum, in devising an infant's formula for food, is to make it, until he be nine months old, to resemble as much as possible, a mother's own milk, and which my formula, as nearly as is practicable, does resemble hence its success and popularity. as soon as a child begins to cut his teeth the case is altered, and _farinaceous food, with milk and with water_, becomes an absolute necessity. i wish, then, to call your especial attention to the following-facts, for they are facts--farinaceous foods, _of all kinds_, before a child _commences_ cutting his teeth (which is when he is about six or seven months old) are worse than useless--they are, positively, injurious, they are, during the early period of infant life, perfectly indigestible, and may bring on--which they frequently do-- convulsions. a babe fed on farinaceous food alone would certainly die of starvation, for, "up to six or seven months of age, infants have not the power of digesting farinaceous or fibrinous substances"--dr letheby on _food_. a babe's salivary glands, until he be six or seven months old, does not secrete its proper fluid--namely, ptyalin, and consequently the starch of the farinaceous food--and all farinaceous food contains starch--is not converted into dextrine and grape-sugar, and is, therefore, perfectly indigestible and useless--nay, injurious to an infant, and may bring on pain and convulsions, and even death, hence, the giving of farinaceous food, until a child be six or seven months old, is one and the principal cause of the frightful infant mortality at the present time existing in england, and which is a disgrace to any civilized land! in passing, allow me to urge you never to stuff a babe--never to overload his little stomach with food, it is far more desirable to give him a little not enough, than to give him a little too much. many a poor child has been, like a young bird, killed with stuffing. if a child be at the breast, and at the breast alone, there is no fear of his taking too much, but if he be brought up on artificial food, there is great fear of his over loading his stomach. stuffing a child brings on vomiting and bowel-complaints, and a host of other diseases which now it would be tedious to enumerate. let me, then, urge you on no account, to over load the stomach of a little child. there will, then, in many cases, be quite sufficient nourishment in the above. i have known some robust infants brought up on it, and on it along, without a particle of farinaceous food, or of any other food, in any shape or form whatever. but if it should not agree with the child, or if there should not be sufficient nourishment in it, then the food recommended in answer to no. question ought to be given, with this only difference--a little new milk must from the beginning be added, and should be gradually increased, until nearly all milk be used. the milk, as a general rule, ought to be _unboiled_; but if it purge violently, or if it cause offensive motions--which it sometimes does--then it must be boiled. the moment the milk boils up, it should be taken off the fire. food ought for the first month to be given about every two hours; for the second month, about every three hours; lengthening the space of time as the baby advances in age. a mother must be careful not to over-feed a child, as over-feeding is a prolific source of disease. let it be thoroughly understood, and let there be no mistake about it, that a babe during the first nine months of his life, must have--it is absolutely necessary for his very existence--milk of some kind, as the staple and principal article of his diet, either mother's, wet-nurse's, or asses', or goats', or cow's milk. . _how would you choose a wet-nurse_? i would inquire particularly into the state of her health; whether she be of a healthy family, of a consumptive habit, or if she or any of her family have laboured under "king's evil;" ascertaining if there be any seams or swellings about her neck; any eruptions or blotches upon her skin; if she has a plentiful breast of milk, and if it be of good quality [footnote: "it should be thin, and of a bluish-white colour, sweet to the taste, and when allowed to stand, should throw up a considerable quantity of cream,"--_maxell and evenson on the diseases of children_.] (which may readily be ascertained by milking a little into a glass); if she has good nipples, sufficiently long for the baby to hold; that they be not sore; and if her own child be of the same, or nearly of the same age, as the one you wish her to nurse. ascertain, whether she menstruate during suckling; if she does, the milk is not so good and nourishing, and you had better decline taking her. [footnote: sir charles locock considers that a woman who menstruates during lactation is objectionable as a wet-nurse, and "that as a mother with her first child is more liable to that objection, that a second or third child's mother is more eligible than a first"--_letter to the author_.] assure yourself that her own babe is strong and healthy that he be free from a sore mouth, and from a "breaking-out" of the skin. indeed, if it be possible to procure such a wet-nurse, she ought to be from the country, of ruddy complexion, of clear skin, and of between twenty and five-and-twenty years of age, an the milk will then be fresh, pure, and nourishing. i consider it to be of great importance that the infant of the wet-nurse should be, as nearly as possible, of the same age as your own, as the milk varies in quality according to the age of the child. for instance, during the commencement of suckling, the milk is thick and creamy, similar to the biestings of a cow, which, if given to a babe of a few months old, would cause derangement of the stomach and bowels. after the first few days, the appearance of the milk changes; it becomes of a bluish-white colour, and contains less nourishment. the milk gradually becomes more and more nourishing as the infant becomes older and requires more support. in selecting a wet-nurse for a very small and feeble babe, you must carefully ascertain that the nipples of the wet-nurse are good and soft, and yet not very large. if they be very large, the child's mouth being very small, he may not be able to hold them. you must note, too, whether the milk flows readily from the nipple into the child's mouth; if it does not, he may not have strength to draw it, and he would soon die of starvation. the only way of ascertaining whether the infant really draws the milk from the nipple, can be done by examining the mouth of the child _immediately_ after his taking the breast, and seeing for yourself whether there be actually milk, or not, in his mouth. very feeble new-born babes sometimes cannot take the bosom, be the nipples and the breasts ever so good, and although maw's nipple-shield and glass tube had been tried. in such a case, cow's milk-water-sugar-and-salt, as recommended at page , must be given in small quantities at a time--from two to four tea-spoonfuls--but frequently; if the child be awake, every hour, or every half hour, both night and day, until he be able to take the breast. if, then, a puny, feeble babe is only able to take but little at a time, and that little by tea-spoonfuls, he must have little and often, in order that "many a little might make a mickle." i have known many puny, delicate children who had not strength to hold the nipple in their mouths, but who could take milk and water (as above recommended) by tea-spoonfuls only at a time, with steady perseverance, and giving it every half hour or hour (according to the quantity swallowed), at length be able to take the breast, and eventually become strong and hearty children; but such cases require unwearied watching, perseverance, and care. bear in mind, then, that the smaller the quantity of the milk and water given at a time, the oftener must it be administered, as, of course, the babe must have a certain quantity of food to sustain life. . _what ought to be the diet either of a wet-nurse, or of a mother, who is suckling_? it is a common practice to cram a wet-nurse with food, and to give her strong ale to drink, to make good nourishment and plentiful milk! this practice is absurd; for it either, by making the nurse feverish, makes the milk more sparing than usual, or it causes the milk to be gross and unwholesome. on the other hand, we must not run into an opposite extreme. the mother, or the wet-nurse, by using those means most conducive to her own health, will best advance the interest of her little charge. a wet-nurse, ought to live somewhat in the following way:--let her for breakfast have black tea, with one or two slices of cold meat, if her appetite demand it, but not otherwise. it is customary for a wet-nurse to make a hearty luncheon; of this i do not approve. if she feel either faint or low at eleven o'clock, let her have either a tumbler of porter, or of mild fresh ale, with a piece of dry toast soaked in it. she ought not to dine later than half-past one or two o'clock; she should eat, for dinner, either mutton or beef, with either mealy potatoes, or asparagus, or french beans, or secale, or turnips, or broccoli, or cauliflower, and stale bread. rich pastry, soups, gravies, high-seasoned dishes, salted meats, greens, and cabbage, must one and all be carefully avoided; as they only tend to disorder the stomach, and thus to deteriorate the milk. it is a common remark, that "a mother who is suckling may eat anything." i do not agree with this opinion. can impure or improper food make pure and proper milk, or can impure and improper milk make good blood for an infant, and thus good health? the wet-nurse ought to take with her dinner a moderate quantity of either sound porter, or of mild (but not old or strong) ale. tea should be taken at half past five or six o'clock; supper at nine, which should consist either of a slice or two of cold meat, or of cheese if she prefer it, with half a pint of porter or of mild ale; occasionally a basin of gruel may with advantage be substituted. hot and late suppers are prejudicial to the mother, or to the wet-nurse, and, consequently, to the child. the wet-nurse ought to be in bed every night by ten o'clock. it might be said, that i have been too minute and particular in my rules for a wet-nurse; but when it is considered of what importance good milk is to the well-doing of an infant, in making him strong and robust, not only now, but as he grows up to manhood, i shall, i trust, be excused for my prolixity. . _have you any more hints to offer with regard to the management of a wet-nurse_? a wet-nurse is frequently allowed to remain in bed until a late hour in the morning, and during the day to continue in the house, as if she were a fixture! how is it possible that any one, under such treatment, can continue healthy! a wet nurse ought to rise early, and, if the weather and season will permit, take a walk, which will give her an appetite for breakfast, and will make a good meal for her little charge. this, of course, cannot, during the winter mouths, be done; but even then, she ought, some part of the day, to take every opportunity of walking out; indeed, in the summer time she should live half the day in the open air. she ought strictly to avoid crowded rooms; her mind should be kept calm and unruffled, as nothing disorders the milk so much as passion, and other violent emotions of the mind; a fretful temper is very injurious, on which account you should, in choosing your wet-nurse, endeavour to procure one of a mild, calm, and placid disposition. [footnote: "'the child is poisoned.' 'poisoned! by whom?' 'by you. you have been fretting.' 'nay, indeed, mother. how can i help fretting!' 'don't tell me, margaret. a nursing mother has no business to fret. she must turn her mind away from her grief to the comfort that lies in her lap. know you not that the child pines if the mother vexes herself?'"--_the cloister and the hearth_. by charles reade.] a wet-nurse ought never to be allowed to dose her little charge either with godfrey's cordial, or with dalby's carminative, or with syrup of white poppies, or with medicine of any kind whatever. let her thoroughly understand this, and let there be no mistake in the matter. do not for one moment allow your children's health to be tampered and trifled with. a baby's health is too precious to be doctored, to be experimented upon, and to be ruined by an ignorant person. . _have the goodness to state at what age a child ought to be weaned_? this, of course, must depend both upon the strength of the child, and upon the health of the parent; on an average, nine months is the proper time. if the mother be delicate, it may be found necessary to wean the infant at six months; or if he be weak, or labouring under any disease, it may be well to continue suckling him for twelve months; but after that time, the breast will do him more harm than good, and will, moreover, injure the mother's health, and may, if she be so predisposed, excite consumption. . _how would you recommend a mother to act when, she weans her child_? she ought, as the word signifies, do it gradually--that is to say, she should, by degrees, give him less and less of the breast, and more and more of artificial food; at length, she must only suckle him at night; and lastly, it would be well for the mother either to send him away, or to leave him at home, and, for a few days, to go away herself. a good plan is, for the nurse-maid to have a half-pint bottle of new milk--which has been previously boiled [footnote: the previous boiling of the milk will prevent the warmth of the bed turning the milk sour, which it otherwise would do.]--in the bed, so as to give a little to him in lieu of the breast. the warmth of the body will keep the milk of a proper temperature, and will supersede the use of lamps, of candle-frames, and of other troublesome contrivances. . _while a mother is weaning her infant, and after she have weaned him, what ought to be his diet_? any one of the foods recommended in answer to question . . _if a child be suffering severely from "wind," is there any objection to the addition of a small quantity either of gin or of peppermint to his food to disperse it_? it is a murderous practice to add either gin or peppermint of the shops (which is oil of peppermint dissolved in spirits) to his food. many children have, by such a practice, been made puny and delicate, and have gradually dropped into an untimely grave. an infant who is kept, for the first five or six months, _entirely_ to the breast--more especially if the mother be careful in her own diet--seldom suffers from "wind;" those, on the contrary, who have much or improper food, [footnote: for the first five or six months never, if you can possibly avoid it, give artificial food to an infant who is sucking. there is nothing, in the generality of cases, that agrees, for the first few months, like the mother's milk _alone_.] suffer severely. care in feeding, then, is the grand preventative of "wind;" but if, notwithstanding all your precautions, the child be troubled with flatulence, the remedies recommended under the head of flatulence will generally answer the purpose. . _have you any remarks to make on sugar for sweetening a baby's food_? a _small_ quantity of sugar in an infant's food is requisite, sugar being nourishing and fattening, and making cow's milk to resemble somewhat, in its properties human milk; but, bear in mind, _it must be used sparingly._ _much_ sugar cloys the stomach, weakens the digestion, produces acidity, sour belchings, and wind:-- "things sweet to taste, prove in digestion sour." _shakspeare._ if a babe's bowels be either regular or relaxed, _lump_ sugar is the best for the purpose of sweetening his food; if his bowels are inclined to be costive, _raw_ sugar ought to be substituted for lump sugar, as _raw_ sugar acts on a young babe as an aperient, and, in the generality of cases, is far preferable to physicking him with opening medicine. an infant's bowels, whenever it be practicable (and it generally is), ought to be regulated by a judicious dietary rather than by physic. vaccination and re-vaccination. . _are you an advocate for vaccination_? certainly. i consider it to be one of the greatest blessings ever conferred upon mankind. small-pox, before vaccination was adopted, ravaged the country like a plague, and carried off thousands annually; and those who did escape with their lives were frequently made loathsome and disgusting objects by it. even inoculation (which is cutting for the small-pox) was attended with danger, more especially to the unprotected--as it caused the disease to spread like wildfire, and thus it carried off immense numbers. vaccination is one, and an important cause of our increasing population; small-pox, in olden times, decimated the country. . _but vaccination does not always protect a child from, small-pox_? i grant you that it does not _always_ protect him, _neither does inoculation_; but when he is vaccinated, if he take the infection, he is seldom pitted, and very rarely dies, and the disease assumes a comparatively mild form. there are a few, very few fatal cases recorded after vaccination, and these may be considered as only exceptions to the general rule; and, possibly, some of these may be traced to the arm, when the child was vaccinated, not having taken proper effect. if children, and adults were _re-vaccinated_,--say every seven years after the first vaccination,--depend upon it, even these rare cases would not occur, and in a short time small-pox would be known only by name. . _do you consider it, then, the imperative duty of a mother, in every case, to have, after the lapse of every seven years, her children re-vaccinated_? i decidedly do: it would be an excellent plan for _every_ person, once every seven years to be re-vaccinated, and even oftener, if small-pox be rife in the neighbourhood. vaccination, however frequently performed, can never do the slightest harm, and might do inestimable good. small-pox is both a pest and a disgrace, and ought to be constantly fought and battled with, until it be banished (which it may readily be) the kingdom. i say that small-pox is a pest; it is worse than the plague, for if not kept in subjection, it is more general--sparing neither young nor old, rich nor poor, and commits greater ravages than the plague ever did. small-pox is a disgrace: it is a disgrace to any civilised land, as there is no necessity for its presence, if cow-pox were properly and frequently performed, small-pox would be unknown. cow-pox is a weapon to conquer small-pox and to drive it ignominiously from the field. my firm belief, then, is, that if _every_ person were, _every seven years_, duly and properly vaccinated, small-pox might be utterly exterminated; but as long as there are such lax notions on the subject, and such gross negligence, the disease will always be rampant, for the poison of small-pox never slumbers nor sleeps, but requires the utmost diligence to eradicate it. the great dr jenner, the discoverer of cow-pox as a preventative of small-pox, strongly advocated the absolute necessity of _every_ person being re-vaccinated once every seven years, or even, oftener, if there was an epidemic of small-pox in the neighbourhood. . _are you not likely to catch not only the cow-pox, but any other disease that the child has from whom the matter is taken_? the same objection holds good in cutting for small pox (inoculation)--only in a ten-fold degree--small-pox being such a disgusting complaint. inoculated small-pox frequently produced and left behind inveterate "breakings-out," scars, cicatrices, and indentations of the skin, sore eyes, blindness, loss of eyelashes, scrofula, deafness--indeed, a long catalogue of loathsome diseases. a medical man, of course, will be careful to take the cow-pox matter from a healthy child. . _would it not be well to take the matter direct from the cow_? if a doctor be careful--which, of course, he will be--to take the matter from a healthy child, and from a well-formed vesicle, i consider it better than taking it _direct_ from the cow, for the following reasons:--the cow-pox lymph, taken direct from the cow, produces much more violent symptoms than after it has passed through several persons; indeed, in some cases, it has produced effects as severe as cutting for the small-pox, besides, it has caused, in many cases, violent inflammation and even sloughing of the arm. there are also several kinds of _spurious_ cow-pox to which the cow is subject, and which would be likely to be mistaken for the _real_ lymph. again, if even the _genuine_ matter were not taken from the cow _exactly_ at the proper time, it would he deprived of its protecting power. . _at what age do you recommend an infant to be first vaccinated_? when he is two months old, as the sooner he is protected the better. moreover, the older he is the greater will be the difficulty in making him submit to the operation, and in preventing his arm from being rubbed, thus endangering the breaking of the vesicles, and thereby interfering with its effects. if small-pox be prevalent in the neighbourhood, he may, with perfect safety, be vaccinated at the month's end; indeed if the small-pox be near at hand, he _must_ be vaccinated, regardless of his age, and regardless of everything else, for small-pox spares neither the young nor the old, and if a new-born babe should unfortunately catch the disease, he will most likely die, as at his tender age he would not have strength to battle with such a formidable enemy. "a case, in the general lying-in-hospital, lambeth, of small-pox occurred in a woman a few days after her admission, and the birth of her child. her own child was vaccinated when only four days old, and all the other infants in the house varying from one day to a fortnight and more. all took the vaccination; and the woman's own child, which suckled her and slept with her; and all escaped the small pox." [footnote: communicated by sir charles locock to the author.] . _do you consider that taking of matter from a child's arm weakens the effect of vaccination on the system_? certainly not, provided it has taken effect in more than one place. the arm is frequently much inflamed, and vaccinating other children from it abates the inflammation, and thus affords relief. _it is always well to leave one vesicle undisturbed_. . _if the infant have any "breaking out" upon the skin, ought that to be a reason for deferring the vaccination_? it should, as two skin diseases cannot well go on together; hence the cow-pox might not take, or, if it did, might not have its proper effect in preventing small-pox. "it is essential that the vaccine bud or germ have a congenial soil, uncontaminated by another poison, which, like a weed, might choke its healthy growth."--_dendy_. the moment the skin be free from the breaking-out, he must be vaccinated. a trifling skin affection, like red gum, unless it be severe, ought not, at the proper age to prevent vaccination. if small-pox be rife in the neighbourhood, the child _must_ be vaccinated, regardless of any "breaking-out" on the skin. . _does vaccination make a child poorly_? at about the fifth day after vaccination, and for three or four days, he is generally a little feverish; the mouth is slightly hot, and he delights to have the nipple in his mouth. he does not rest so well at night; he is rather cross and irritable; and, sometimes, has a slight bowel-complaint. the arm, about the ninth or tenth day, is usually much inflamed--that is to say it is, for an inch or two or more around the vesicles, red, hot, swollen, and continues in this state for a day or two, at the end of which time the inflammation gradually subsides. it might be well to state that the above slight symptoms are desirable, as it proves that the vaccination has had a proper effect on his system, and that, consequently, he is more likely to be thoroughly protected from any risk of catching small-pox. . _do you approve, either during or after vaccination, of giving medicine, more especially if he be a little feverish_? no, as it would be likely to work off some of its effects, and thus would rob the cow-pox of its efficacy on the system. i do not like to interfere with vaccination _in any way whatever_ (except, at the proper time, to take a little matter from the arm), but to allow the pock to have full power upon his constitution. what do you give the medicine for? if the matter that is put into the arm be healthy, what need is there of physic! and if the matter be not of good quality, i am quite sure that no physic will make it so! look, therefore, at the case in whatever way you like, physic after vaccination is _not_ necessary; but, on the contrary, hurtful. if the vaccination produce slight feverish attack, it will, without the administration of a particle of medicine, subside in two or three days. . _have you any directions to give respecting the arm after vaccination_? the only precaution necessary is to take care that the arm be not rubbed; otherwise the vesicles may be prematurely broken, and the efficacy of the vaccination may be lessened. the sleeve, in vaccination, ought to be large and soft, and should not be tied up. the tying up of a sleeve makes it hard, and is much more likely to rub the vesicles than if it were put on the usual way. . _if the arm, after vaccination, be much inflamed, what ought to be done_? smear frequently, by means of a feather or a camel's hair brush, a little cream on the inflamed part. this simple remedy will afford great comfort and relief. . _have the goodness to describe the proper appearance, after the falling-off of the scab of the arm_? it might be well to remark, that the scabs ought always to be allowed to fall off of themselves. they must not, on any account, be picked or meddled with. with regard to the proper appearance of the arm, after the falling-off of the scab, "a perfect vaccine scar should be of small size, circular, and marked with radiations and indentations."-- _gregory_. dentition . _at what time does dentition commence_? the period at which it commences is uncertain. it may, as a rule, be said that a babe begins to cut his teeth at seven months old. some have cut teeth at three months; indeed, there are instances on record of infants having been born with teeth. king richard the third is said to have been an example. shakspeare notices it thus:-- "york.--marry, they say my uncle grew so fast, that he could gnaw a crust at two hours old. 'twas full two years ere i could get a tooth, grandam, this would have been a biting jest." when a babe is born with teeth, they generally drop out. on the other hand, teething, in some children does not commence until they are a year and a half or two years old, and, in rare cases, not until they are three years old. there are cases recorded of adults who have never cut any teeth. an instance of the kind came under my own observation. dentition has been known to occur in old age. a case is recorded by m. carre, in the _gazette medicale de paris_ (sept , ), of an old lady, aged eighty-five, who cut several teeth after attaining that age! . _what is the number of the first set of teeth, and in what order do they generally appear_? the first or temporary set consists of twenty. the first set of teeth are usually cut in pairs. "i may say that nearly invariably the order is-- st, the lower front incissors [cutting teeth], then the upper front, then the _upper_ two lateral incissors, and that not uncommonly a double tooth is cut before the two _lower_ laterals; but at all events the lower laterals come th and th, and, not th and th, as nearly all books on the subject testify." [footnote: sir charles locock in a _letter_ to the author.] then the first grinders, in the lower jaw, afterwards the first upper grinders, then the lower corner-pointed or canine teeth, after which the upper corner or eye-teeth, then the second grinders in the lower jaw, and lastly, the second grinders of the upper jaw. they do not, of course, always appear in this rotation. nothing is more uncertain than the order of teething. a child seldom cuts his second grinders until after he is two years old. _he is, usually, from the time they first appear, two years in cutting the first set of teeth_. as a rule, therefore, a child of two years old has sixteen, and one of two years and a half old, twenty teeth. . _if an infant be feverish or irritable, or otherwise poorly, and if the gums be hot, swollen, and tender, are you an advocate for their being lanced_? certainly; by doing so he will, in the generality of instances, be almost instantly relieved. . _but it has been stated that lancing the gums hardens them_? this is a mistake--it has a contrary effect. it is a well-known fact, that a part which has been divided gives way much more readily than one which has not been cut. again, the tooth is bound down by a tight membrane, which, if not released by lancing, frequently brings on convulsions. if the symptoms be urgent, it may be necessary from time to time to repeat the lancing. it would, of course, be the height of folly to lance the gums unless they be hot and swollen, and unless the tooth, or the teeth, be near at hand. it is not to be considered a panacea for every baby's ill, although, in those cases where the lancing of the gums is indicated, the beneficial effect is sometimes almost magical. . _how ought the lancing of a child's gums to be performed_? the proper person, of course, to lance his gums is a medical man. but if, perchance, you should be miles away and be out of the reach of one, it would be well for you to know how the operation ought to be performed. well, then, let him lie on the nurse's lap upon his back, and let the nurse take hold of his hands in order that he may not interfere with the operation. then, _if it be the upper gum_ that requires lancing, you ought to go to the head of the child, looking over, as it were, and into his mouth, and should steady the gum with the index finger of your left hand; then, you should take hold of the gum-lancet with your right hand--holding as if it were a table-knife at dinner--and cut firmly along the inflamed and swollen gum and down to the tooth, until the edge of the gum-lancet grates on the tooth. each incision ought to extend along the ridge of the gum to about the extent of each expected tooth. _if it be the lower gum_ that requires lancing, you must go to the side of the child, and should steady the outside of the jaw with the fingers of the left hand, and the gum with the left thumb, and then you should perform the operation as before directed. although the lancing of the gums, to make it intelligible to a non-professional person, requires a long description, it is, in point of fact, a simple affair, is soon performed, and gives but little pain. . _if teething cause convulsions, what ought to be done_? the first thing to be done (after sending for a medical man) is to freely dash water upon the face, and to sponge the head with cold water, and as soon as warm water can be procured, to put him into a warm bath [footnote: for the precautions to be used in putting a child into a warm bath, see the answer to question on "warm baths."] of degrees fahrenheit. if a thermometer be not at hand, [footnote: no family, where there are young children, should be without fahrenheit's thermometer.] you must plunge your own elbow into the water: a comfortable heat for your elbow will be the proper heat for the infant. he must remain in the bath for a quarter of an hour, or until the fit be at an end. the body must, after coming out of the bath, be wiped with warm and dry and coarse towels; he ought then to be placed in a warm blanket. the gums must be lanced, and cold water should be applied to the head. an enema, composed of table salt, of olive oil, and warm oatmeal gruel--in the proportion of one table-spoonful of salt, of one of oil, and a tea-cupful of gruel--ought then to be administered, and should, until the bowels have been well opened, be repeated every quarter of an hour; as soon as he comes to himself a dose of aperient medicine ought to be given. it may be well, for the comfort of a mother, to state that a child in convulsions is perfectly insensible to all pain whatever; indeed, a return to consciousness speedily puts convulsions to the rout. . _a nurse is in the habit of giving a child, who is teething, either coral, or ivory, to bite: do you approve of the plan_? i think it a bad practice to give him any hard, unyielding substance, as it tends to harden the gums, and, by so doing, causes the teeth to come through with greater difficulty. i have found softer substances, such as either a piece of wax taper, or an india-rubber ring, or a piece of the best bridle leather, or a crust of bread, of great service. if a piece of crust be given as a gum-stick, he must, while biting it, be well watched, or by accident he might loosen a large piece of it, which might choke him. the pressure of any of these excites a more rapid absorption of the gum, and thus causes the tooth to come through more easily and quickly. . _have you any objection to my baby, when he is cutting his teeth, sucking his thumb_? certainly not: the thumb is the best gum-stick in the world:--it is convenient; it is handy (in every sense of the word): it is of the right size, and of the proper consistence, neither too hard nor too soft; there is no danger, as of some artificial gum-sticks, of its being swallowed, and thus of its choking the child. the sucking of the thumb causes the salivary glands to pour out their contents, and thus not only to moisten the dry mouth, but assist the digestion; the pressure of the thumb eases, while the teeth are "breeding," the pain and irritation of the gums, and helps, when the teeth are sufficiently advanced, to bring them through the gums. sucking of the thumb will often make a cross infant contended and happy, and will frequently induce a restless babe to fall into a sweet refreshing sleep. truly may the thumb be called a baby's comfort. by all means, then, let your child suck his thumb whenever he likes, and as long as he chooses to do so. there is a charming, bewitching little picture of a babe sucking his thumb in kingsley's _water babies_, which i heartily commend to your favourable notice and study. . _but if an infant be allowed to suck his thumb, will it not be likely to become a habit, and stick to him for years--until, indeed, he become a big boy_? after he have cut the whole of his first set of teeth, that is to say, when he is about two years and a half old, he might, if it be likely to become a habit, be readily cured by the following method, namely, by making a paste of aloes and water, and smearing it upon his thumb. one or two dressings will suffice as after just tasting the bitter aloes he will take a disgust to his former enjoyment, and the habit will at once be broken. many persons i know have an objection to children sucking their thumbs, as for instance,-- "perhaps it's as well to keep children from plums, and from pears in the season, and sucking their thumbs." [footnote: _ingoldsby legends_.] my reply is,-- p'rhaps 'tis as well to keep children from pears; the pain they might cause, is oft follow'd by tears; 'tis certainly well to keep them from plums; but certainly not from sucking their thumbs! if a babe suck his thumb 'tis an ease to his gum; a comfort; a boon; a calmer of grief; a friend in his need--affording relief; a solace; a good; a soother of pain; a composer to sleep; a charm; and a gain. 'tis handy, at once, to his sweet mouth to glide; when done with, drops gently down by his side; 'tis fix'd, like an anchor, while the babe sleeps. and the mother, with joy, her still vigil keeps. . _a child who is teething dribbles, and thereby wets his chest, which frequently causes him to catch cold; what had better be done_? have in readiness to put on several _flannel_ dribbling bibs, so that they may be changed as often as they become wet; or, if he dribble _very much_, the oiled silk dribbling-bibs, instead of the flannel ones, may be used, and which may be procured at any baby-linen ware house. . _do you approve of giving a child, during teething, much fruit_? no; unless it be a few ripe strawberries or raspberries, or a roasted apple, or the juice of five or six grapes--taking care that he does not swallow either the seeds or the skin--or the insides of ripe gooseberries, or an orange. such fruits, if the bowels be in a costive state, will be particularly useful. all stone fruit, _raw_ apples or pears, ought to be carefully avoided, as they not only disorder the stomach and the bowels,--causing convulsions, gripings, &c.,--but they have the effect of weakening the bowels, and thus of engendering worms. . _is a child, during teething, more subject to disease, and, if so, to what complaints, and in what manner may they be prevented_? the teeth are a fruitful source of suffering and of disease; and are, with truth, styled "our first and our last plagues." dentition is the most important period of a child's life, and is the exciting cause of many infantile diseases; during this period, therefore, he requires constant and careful watching. when we consider how the teeth elongate and enlarge in his gums, pressing on the nerves and on the surrounding parts, and thus how frequently they produce pain, irritation, and inflammation; when we further contemplate what sympathy there is in the nervous system, and how susceptible the young are to pain, no surprise can be felt, at the immense disturbance, and the consequent suffering and danger frequently experienced by children while cutting their _first_ set of teeth. the complaints or the diseases induced by dentition are numberless, affecting almost every organ of the body,--the _brain_, occasioning convulsions, water on the brain, &c.; the _lungs_, producing congestion, inflammation, cough, &c.; the _stomach_, exciting sickness, flatulence, acidity, &c,; the _bowels_, inducing griping, at one time costiveness, and at another time purging; the _skin_, causing "breakings-out." to prevent these diseases, means ought to be used to invigorate a child's constitution by plain, wholesome food, as recommended under the article of diet; by exercise and fresh air; [footnote: the young of animals seldom suffer from cutting their teeth--and what is the reason? because they live in the open air, and take plenty of exercise; while children are frequently cooped up in close rooms, and are not allowed the free use of their limbs. the value of fresh air is well exemplified in the registrar-general's report for ; he says that in , , deaths, from all diseases, occur in the town from teething while only take place in the country from the same cause.] by allowing him, weather permitting, to be out of doors a great part of every day; by lancing the gums when they get red, hot, and swollen; by attention to the bowels, and if he suffer more than usual, by keeping them rather in a relaxed state by any simple aperient, such as either castor oil, or magnesia and rhubarb, &c.; and, let me add, by attention to his temper: many children are made feverish and ill by petting and spoiling them. on this subject i cannot do better than refer you to an excellent little work entitled abbot's _mother of home_, wherein the author proves the great importance of _early_ training. . _have the goodness to describe the symptoms and the treatment of painful dentition_? painful dentition may be divided into two forms--( ) the mild; and ( ) the severe. in the _mild_ form the child is peevish and fretful, and puts his fingers, and everything within reach, to his mouth, he likes to have his gums rubbed, and takes the breast with avidity, indeed it seems a greater comfort to him than ever. there is generally a considerable flow of saliva, and he has frequently a more loose state of bowels than is his wont. now, with regard to the more _severe_ form of painful dentition--the gums are red, swollen, and hot, and he cannot without expressing pain bear to have them touched, hence, if he be at the breast, he is constantly loosing the nipple. there is dryness of the mouth, although before there had been a great flow of saliva. he is feverish, restless, and starts in his sleep. his face is flashed. his head is heavy and hot. he is sometimes convulsed. [footnote: see answer to question .] he is frequently violently griped and purged, and suffers severely from flatulence. he is predisposed to many and severe diseases. the _treatment,_ of the _mild_ form, consists of friction, of the gum with the finger, with a little "soothing syrup," as recommended by sir charles locock, [footnote: soothing syrup--some of them probably contain opiates, but a perfectly safe and useful one is a little nitrate of potass in syrup of roses--one scruple to half an ounce.--_communicated by sir charles locock to the author._ this 'soothing syrup' is not intended to be given us a mixture but to be used as an application to rub the gums with. it may be well to state that it is a perfectly harmless remedy even if a little of it were swallowed by mistake.] a tepid bath of about degrees fahrenheit, every night at bed time, attention to diet and to bowels, fresh air and exercise. for the mild form, the above plan will usually be all that is required. if he dribble, and the bowels be relaxed, so much the better. the flow of saliva and the increased action of the bowels afford relief, and therefore must not be interfered with. in the _mild_ form, lancing of the gums is not desirable. the gums ought not to be lanced, unless the teeth be near at hand, and unless the gums be red, hot, and swollen. in the _severe_ form a medical man should be consulted early, as more energetic remedies will be demanded; that is to say, the gums will require to be freely lanced, warm baths to be used, and medicines to be given, to ward off mischief from the head, from the chest, and from the stomach. if you are living in the town, and your baby suffers much from teething, take him into the country. it is wonderful what change of air to the country will often do, in relieving a child who is painfully cutting his teeth. the number of deaths in london, from teething, is frightful; it is in the country comparatively trifling. . _should an infant be purged during teething or indeed, during any other time, do you approve of either absorbent or astringent medicines to restrain it_? certainly not. i should look upon, the relaxation as an effort of nature to relieve itself. a child is never purged without a cause; that cause, in the generality of instances, is the presence of either some undigested food, or acidity, or depraved motions, that want a vent. the better plan is, in such a case, to give a dose of aperient medicine, such as either castor oil, or magnesia and rhubarb; and thus work it off. if we lock up the bowels, we confine the enemy, and thus produce mischief. [footnote: i should put this in capitals, it is so important and is often mistaken.--c. locock.] if he be purged more than usual, attention should be paid to the diet--if it be absolutely necessary to give him artificial food while suckling--and care must be taken not to overload the stomach. . _a child is subject to a slight cough during dentition--called by nurses "tooth-cough"--which a parent would not consider of sufficient importance to consult a doctor about: pray tell me, is there any objection to a mother giving her child a small quantity either of syrup of white poppies, or of paregoric, to ease it_? a cough is an effort of nature to bring up any secretion from the lining membrane of the lungs, or from the bronchial tubes, hence it ought not to be interfered with. i have known the administration of syrup of white poppies, or of paregoric, to stop the cough, and thereby to prevent the expulsion of the phlegm, and thus to produce either inflammation of the lungs, or bronchitis. moreover, both paregoric and syrup of white poppies are, for a young child, dangerous medicines (unless administered by a judicious medical man), and _ought never to be given by a mother_. in the month of april , i was sent for, in great haste, to an infant, aged seventeen months, who was labouring under convulsions and extreme drowsiness, from the injudicious administration of paregoric, which had been given to him to ease a cough. by the prompt administration of an emetic he was saved. . _a child, who is teething, is subject to a "breaking-out," more especially behind the ears--which is most disfiguring, and frequently very annoying what would you recommend_? i would apply no external application to cure it, as i should look upon it as an effort of the constitution to relieve itself, and should expect, if the "breaking-out" were repelled, that either convulsions, or bronchitis, or inflammation of the lungs, or water on the brain, would be the consequence. the only plan i should adopt would be, to be more careful in his diet, to give him less meat (if he be old enough to eat animal food), and to give him, once or twice a week, a few doses of mild aperient medicine, and, if the irritation from the "breaking-out" be great, to bathe it, occasionally, either with a little warm milk and water, or with rose water. exercise. . _do you recommend exercise in the open air for a baby? and if so, how soon after birth_? i am a great advocate for his having exercise in the open air. "the infant in arms makes known its desire for fresh air, by restlessness, it cries, for it cannot speak its wants, is taken abroad and is quiet." the age at which he ought to commence taking exercise will, of course, depend upon the season and upon the weather. if it be summer, and the weather be fine, he should he carried in the open air, a week or a fortnight after birth, but if it be winter, he ought not on any account to be taken out under the month, and not even then, unless the weather be mild for the season, and it be the middle of the day. at the end of two months he should breathe the open air more frequently. and after the expiration of three months, he ought to be carried out _every day_, even if it be wet under foot, provided it be fine above, and the wind be neither in an easterly nor in a north-easterly direction. by doing so we shall make him strong and hearty, and give the skin that mottled appearance which is so characteristic of health. he must, of course, be well clothed. i cannot help expressing my disapprobation of the practice of smothering up an infant's face with a handkerchief, with a veil or with any other covering, when he is taken out into the air. if his face be so muffled up, he may as well remain at home, as under such circumstances, it is impossible for him to receive any benefit from the invigorating effects of the fresh air. . _can you devise any method to induce a babe himself to take exercise_? he must be encouraged to use muscular exertion, and, for this purpose, he ought to be frequently laid either upon a rug, or carpet, or the floor. he will then stretch his limbs and kick about with perfect glee. it is a pretty sight, to see a little fellow kicking and sprawling on the floor. he crows with delight and thoroughly enjoys himself. it strengthens his back, it enables him to stretch his limbs, and to use his muscles, and is one of the best kinds of exercise a very young child can take. while going through his performances his diaper, if he wear one, should be unfastened, in order that he might go through his exercises untrammelled. by adopting the above plan, the babe quietly enjoys himself--his brain is not over excited by it; this is an important consideration, for both mothers and nurses are apt to rouse, and excite very young children to their manifest detriment. a babe requires rest, and not excitement. how wrong it is, then, for either a mother or a nurse to be exciting and rousing a new born babe. it is most injurious and weakening to his brain. in the early period of his existence his time ought to be almost entirely spent in sleeping and in sucking! . _do you approve of tossing an infant much about_? i have seen, a child tossed nearly to the ceiling! can anything be more cruel or absurd! violent tossing of a young babe ought never to be allowed, it only frightens him, and has been known to bring on convulsions. he should be gently moved up and down (not tossed), such exercises causes a proper circulation of the blood, promotes digestion, and soothes to sleep. he must always be kept quiet immediately after taking the breast, if he be tossed _directly_ afterwards, it interferes with his digestion, and is likely to produce sickness. sleep . _ought the infant's sleeping apartment to be kept warm_? the lying-in room is generally kept too warm, its heat being, in many instances, more that of an oven than of a room. such a place is most unhealthy, and is fraught with danger both to the mother and the baby. we are not, of course, to run into an opposite extreme, but are to keep the chamber at a moderate and comfortable temperature. the door ought occasionally to be left ajar, in order the more effectually to change the air and thus to make it more pure and sweet. a new born babe, then, ought to be kept comfortably warm, but not very warm. it is folly in the extreme to attempt to harden a very young child either by allowing him, in the winter time, to be in a bedroom without a fire, or by dipping him in _cold_ water, or by keeping him with scant clothing on his bed. the temperature of a bedroom, in the winter time, should be, as nearly as possible, at deg. fahr. although the room should be comfortably warm, it ought from time to time to be properly ventilated. an unventilated room soon becomes foul, and, therefore, unhealthy. how many in this world, both children and adults, are "poisoned with their own breaths!" an infant should not be allowed to look at the glare either of a fire or of a lighted candle, as the glare tends to weaken the sight, and sometimes brings on an inflammation of the eyes. in speaking to, and in noticing a baby, you ought always to stand _before_, and not _behind_ him, or it might make him squint. . _ought a babe to lie alone from the first_? certainly not: at first--say, for the first few months--he requires the warmth of another person's body, especially in the winter; but care must be taken not to overlay him, as many infants, from carelessness in this particular, have lost their lives. after the first few months he had better lie alone, on a horse-hair mattress. . _do you approve of rocking an infant to sleep_? i do not. if the rules of health be observed, he will sleep both soundly and sweetly without rocking; if they be not, the rocking might cause him to fall into a feverish, disturbed slumber, but not into a refreshing, calm sleep. besides, if you once take to that habit, he will not go to sleep without it. . _then don't you approve of a rocking-chair, and of rockers to the cradle_? certainly not: a rocking-chair, or rockers to the cradle, may be useful to a lazy nurse or mother, and may induce a child to sleep, but that restlessly, when he does not need sleep, or when he is wet and uncomfortable, and requires "changing;" but will not cause him to have that sweet and gentle and exquisite slumber so characteristic of a baby who has no artificial appliances to make him sleep. no! rockers are perfectly unnecessary, and the sooner they are banished the nursery the better will it be for the infant community. i do not know a more wearisome and monotonous sound than the everlasting rockings to and fro in some nurseries, they are often accompanied by a dolorous lullaby from the nurse, which adds much to the misery and depressing influence of the performance. . _while the infant is asleep, do you advise the head of the crib to be covered with a handkerchief, to shade his eyes from the light, and, if it be summer time, to keep off the flies_? if the head of the crib be covered, the babe cannot breathe freely, the air within the crib becomes contaminated, and thus the lungs cannot properly perform their functions. if his sleep is to be refreshing, he must breathe pure air. i do not even approve of a head to a crib. a child is frequently allowed to sleep on a bed with the curtains drawn completely close, as though it were dangerous for a breath of air to blow upon him [footnote: i have somewhere read that if a cage containing a canary, be suspended at night within a bed where a person is sleeping, and the curtains be drawn closely around, that the bird will, in the morning, in all probability, be found dead!] this practice is most injurious. an infant must have the full benefit of the air of the room, indeed, the bed room door ought to be frequently left ajar, so that the air of the apartment may be changed, taking care, of course, not to expose him to a draught. if the flies, while he is asleep, annoy him, let a net veil be thrown over his face, as he can readily breathe through net, but not through a handkerchief. . _have you any suggestions to offer as to the way a babe should be dressed when he is put down to sleep_? whenever he be put down to sleep, be more than usually particular that his dress be loose in every part, be careful that there be neither strings nor bands, to cramp him. let him, then, during repose, be more than ordinarily free and unrestrained-- "if, whilst in cradled rest your infant sleeps. your watchful eyes unceasing vigil keeps lest cramping bonds his pliant limbs constrain, and cause defects that manhood may retain." . _is it a good sign for a young child to sleep much_? a babe who sleeps a great deal thrives much more than one who does not. i have known many children, who were born [footnote: it may be interesting to a mother to know the average weight of new born infants. there is a paper on the subject in the _medical circular_ (april , ) and which has been abridged in _braithwaite's retrospect of medicine_ (july and december ). the following are extracts--"dr. e. von siebold presents a table of the weights of infants ( male and female) weighed immediately after birth. from this table (for which we have not space) it results that by far the greater number of the children, weighed between and lbs. from / to lbs. the number rose from to , and from to / lbs. they fell from to , and never rose again at any weight to . from / to / lbs. they sank from to , rising however at / lbs. to . only six weighed lbs., one / lbs. and two lbs. the author has never but once met with a child weighing lbs. the most frequent weight in the was lbs, numbering . it is a remarkable fact, that until the weight of lbs the female infants exceeded the males in number, the latter thenceforward predominating. from these statements, and those of various other authors here quoted, the conclusion may be drawn that the normal weight of a mature new born infant is not less than six nor more than lbs., the average weight being / or lbs., the smaller number referring to female and the higher to male infants."] small and delicate, but who slept the greatest part of their time, become strong and healthy. on the other hand, i have known those who were born large and strong, yet who slept but little, become weak and unhealthy. the common practice of a nurse allowing a baby to sleep upon her lap is a bad one, and ought never to be countenanced. he sleeps cooler, more comfortably, and soundly in his crib. the younger an infant is the more he generally sleeps, so that during the early months he is seldom awake, and then only to take the breast. . _how is it that much sleep causes a young child to thrive so well_? if there be pain in any part of the body, or if any of the functions be not properly performed, he sleeps but little. on the contrary, if there be exemption from pain, and if there be a due performance of all the functions, he sleeps a great deal, and thus the body becomes refreshed and invigorated. . _as much sleep is of such advantage, if an infant sleep but little, would you advise composing medicine to be given to him_? certainly not. the practice of giving composing medicine to a young child cannot he too strongly reprobated. if he does not sleep enough, the mother ought to ascertain if the bowels be in a proper state, whether they be sufficiently opened, that the motions be of a good colour--namely, a bright yellow, inclining to orange colour--and free from slime or from bad smell. an occasional dose of rhubarb and magnesia is frequently the best composing medicine he can take. . _we often hear of coroner's inquests upon infants who have been found dead in bed--accidentally overlaid what is usually the cause_? suffocation, produced either by ignorance, or by carelessness. from _ignorance_ in mothers, in their not knowing the common laws of life, and the vital importance of free and unrestricted respiration, not only when babies are up and about, but when they are in bed and asleep. from _carelessness_, in their allowing young and thoughtless servants to have the charge of infants at night, more especially as young girls are usually heavy sleepers, and are thus too much overpowered with sleep to attend to their necessary duties. a foolish mother sometimes goes to sleep while allowing her child to continue sucking. the unconscious babe, after a tune, looses the nipple, and buries his head in the bed-clothes. she awakes in the morning, finding, to her horror, a corpse by her side, with his nose flattened, and a frothy fluid, tinged with, blood, exuding from his lips. a mother ought, therefore, never to go to sleep until her child have finished sucking. _the following are a few rules to prevent an infant from being accidentally overlaid_--( .) let your baby while asleep have plenty of room in the bed. ( .) do not allow him to be too near to you; or if he he unavoidably near you (from the small size of the bed), let his face be turned to the opposite side. ( .) let him lie fairly either on his side, or on his back. ( .) be careful to ascertain that his mouth be not covered with the bed-clothes; and, ( .) do not smother his face with clothes, as a plentiful supply of pure air is as necessary when he is awake, or even more so, than when he is asleep. ( .) never let him lie low in the bed. ( .) let there be _no_ pillow near the one his head is resting on, lest he roll to it, and thus bury his head in it remember, a young child has neither the strength nor the sense to get out of danger; and, if he unfortunately either turn on his face, or bury his head in a pillow that is near, the chances are that he will be suffocated, more especially as these accidents usually occur at night, when the mother, or the nurse, is fast asleep. ( .) never intrust him at night to a young and thoughtless servant. the bladder and the bowels of an infant. . _have you any hints to offer respecting the bowels and the bladder of an infant during the first three months of his existence_? a mother ought daily to satisfy herself as to the state of the bladder and the bowels of her child. she herself should inspect the motions, and see that they are of a proper colour (bright-yellow, inclining to orange), and consistence (that of thick gruel), that they are neither slimy, nor curdled, nor green; if they should be either the one or the other, it is a proof that she herself has, in all probability, been imprudent in her diet, and that it will be necessary for the future that she be more careful both in what she eats and in what she drinks. she ought, moreover, to satisfy herself that the urine does not smell strongly, that it does not stain the diapers, and that he makes a sufficient quantity. a frequent cause of a child crying is, he is wet, and uncomfortable, and wants drying and changing, and the only way he has of informing his mother of the fact is by crying lustily, and thus telling her in most expressive language of her thoughtlessness and carelessness. . _how soon may an infant dispense with diapers_? a babe of three months and upwards, ought to be held out, at least, a dozen times during the twenty-four hours; if such a plan were adopted, diapers might at the end of three months be dispensed with--a great _desideratum_-and he would be inducted into clean habits--a blessing to himself, and a comfort to all around, and a great saving of dresses and of furniture. "teach your children to be clean. a dirty child is the mother's disgrace," [footnote: hints on household management, by mrs c. l. balfour.] truer words were never written,--a dirty child is the mother's disgrace. ailments, disease, etc. . _a new born babe frequently has a collection of mucus in the air passages, causing him to wheeze: is it a dangerous symptom_? no, not if it occur _immediately_ after birth; as soon as the bowels have been opened, it generally leaves him, or even before, if he give a good cry, which as soon as he is born he usually does. if there be any mucus either within or about the mouth, impeding breathing, it must with a soft handkerchief be removed. . _is it advisable, as soon as an infant is born, to give him medicine_? it is now proved that the giving of medicine to a babe _immediately_ after birth is unnecessary, nay, that it is hurtful--that is, provided he be early put to the breast, as the mother's _first_ milk is generally sufficient to open the bowels. sir charles locock [footnote: in a _letter_ to the author.] makes the following sensible remarks on this subject:--"i used to limit any aperient to a new-born infant to those which had not the first milk, and who had wet nurses, whose milk was, of course, some weeks old, but for many years i have never allowed any aperient at all to any new born infant, and i am satisfied it is the safest and the wisest plan." the advice of sir charles locock--_to give no aperient to a new-born infant_--is most valuable, and ought to be strictly followed. by adopting his recommendation, much after misery might be averted. if a new born babe's bowels be costive, rather than give him an aperient, try the effect of a little moist sugar, dissolved in a little water, that is to say, dissolve half a tea-spoonful of pure unadulterated _raw_ sugar in a tea-spoonful of warm water and administer it to him, if in four hours it should not operate, repeat the dose. butter and raw sugar is a popular remedy, and is sometimes used by a nurse to open the bowels of a new born babe, and where there is costiveness, answers the purpose exceedingly well, and is far superior to castor oil. try by all means to do, if possible, without a particle of opening medicine. if you once begin to give aperients, you will have frequently to repeat them. opening physic leads to opening physic, until at length his stomach and bowels will become a physic shop! let me, then, emphatically say, avoid, if possible, giving a new born babe a drop or a gram of opening medicine. if from the first you refrain from giving an aperient, he seldom requires one afterwards. it is the _first_ step, in this as in all other things, that is so important to take. if a new-born babe have _not_ for twelve hours made water, the medical man ought to be informed of it, in order that he may inquire into the matter, and apply the proper remedies. be particular in attending to these directions, or evil consequences will inevitably ensue. . _some persons say, that new-born female infants have milk in their bosoms, and that it is necessary to squeeze them, and apply plasters to disperse the milk_. the idea of there being real milk in a baby's breast is doubtful, the squeezing of the bosom is barbarous, and the application of plasters is useless. "without actually saying," says sir charles locock, "there is milk secreted in the breasts of infants, there is undoubtedly not rarely considerable swelling of the breasts both in _female_ and _male_ infants, and on squeezing them a serous fluid oozes out. i agree with you that the nurses should never be allowed to squeeze them, but be ordered to leave them alone." [footnote: _letter_ to the author.] . _have the goodness to mention the slight ailments which are not of sufficient importance to demand the assistance of a medical man_? i deem it well to make the distinction between _serious_ and _slight_ ailments, i am addressing a mother. with regard to serious ailments, i do not think myself justified, except in certain _urgent_ cases, in instructing a parent to deal with them. it might be well to make a mother acquainted with the _symptoms_, but not with the _treatment_, in order that she might lose no time in calling in medical aid. this i hope to have the pleasure of doing in future conversations. _serious diseases, with a few exceptions_, and which i will indicate in subsequent conversations, ought never to be treated by a parent, not even in the _early_ stages, for it is in the early stages that the most good can generally be done. it is utterly impossible for any one who is not trained to the medical profession to understand a _serious_ disease in all its bearings, and thereby to treat it satisfactorily. there are some exceptions to these remarks. it will be seen in future conversations that sir charles locock considers that a mother ought to be made acquainted with the _treatment_ of _some_ of the more _serious_ diseases, where delay in obtaining _immediate_ medical assistance might be death. i bow to his superior judgment, and have supplied the deficiency in subsequent conversations. the ailments and the diseases of infants, such as may, in the absence of the doctor, be treated by a parent, are the following:--chafings, convulsions, costivenesa, flatulence, gripings, hiccup, looseness of the bowels (diarrhoea), dysentery, nettle-rash, red-gum, stuffing of the nose, sickness, thrush. in all these complaints i will tell you--_what to do_, and--_what not to do_. . _what are the causes and the treatment of chafing_? the want of water: inattention and want of cleanliness are the usual causes of chafing. _what to do._--the chafed parts ought to be well and thoroughly sponged with tepid _rain_ water--allowing the water from a well-filled sponge to stream over them,--and, afterwards, they should be thoroughly, but tenderly, dried with a soft towel, and then be dusted, either with finely-powdered starch, made of wheaten flour, or with violet powder, or with finely-powdered native carbonate of zinc, or they should be bathed with finely-powdered fuller's-earth and tepid water. if, in a few days, the parts be not healed discontinue the above treatment, and use the following application:--beat up well together the whites of two eggs, then add, drop by drop, two table-spoonfuls of brandy. when well mixed, put it into a bottle and cork it up. before using it let the excoriated parts be gently bathed with luke-warm rain water, and, with a soft napkin, be tenderly dried; then, by means of a camel's hair brush, apply the above liniment, having first shaken the bottle. but bear in mind, after all that can be said and done, _that there is nothing in these cases like water_--there is nothing like keeping the parts clean, and the only way of thoroughly effecting this object is _by putting him every morning into his tub_. _what not to do_.--do not apply white lead, as it is a poison. do not be afraid of using _plenty_ of water, as cleanliness is one of the most important items of the treatment. . _what are the causes of convulsions of an infant_? stuffing him, in the early months of his existence, _with food_, the mother having plenty of breast milk the while, the constant physicking of child by his own mother, teething, hooping-cough, when attacking a very young baby. i never knew a case of convulsions occur--say for the first four months--(except in very young infants labouring under hooping-cough), where children lived on the breast-milk alone, and where they were _not_ frequently quacked by their mothers. for the treatment of the convulsions from teething, see page . _what to do_ in a case of convulsions which has been caused by feeding an infant either with too much or with _artificial_ food. give him, every ten minutes, a tea-spoonful of ipecacuanha wine, until free vomiting be excited then put him into a warm bath (see warm baths), and when he comes out of it administer to him a tea-spoonful of castor oil, and repeat it every four hours, until the bowels be well opened. _what not to do_--do not for at least a month after the fit, give him artificial food, but keep him entirely to the breast. do not apply leeches to the head. _what to do in a case of convulsions from hooping cough_--there is nothing better than dashing cold water on the face, and immersing him in a warm bath of degrees fahr. if he be about his teeth, and they be plaguing him, let the gums be both freely and frequently lanced. convulsions seldom occur in hooping-cough, unless the child be either very young or exceedingly delicate. convulsions attending an attack of hooping-cough make it a _serious_ complication, and requires the assiduous and skilful attention of a judicious medical man. _what not to do in such a case_--do not apply leeches, the babe requires additional strength, and not to be robbed of it, and do not attempt to treat the case yourself. . _what are the best remedies for the costiveness of an infant_? i strongly object to the frequent administration of opening medicine, as the repetition of it increases the mischief to a tenfold degree. _what to do_.--if a babe, after the first few months, were held out, and if, at regular intervals, he were put upon his chair, costiveness would not so much prevail. it is wonderful how soon the bowels, in the generality of cases, by this simple plan, may be brought into a regular state. besides, it inducts an infant into clean habits, i know many careful mothers who have accustomed their children, after the first three months, to do without diapers altogether. it causes at first a little trouble, but that trouble is amply repaid by the good consequences that ensue; among which must be named the dispensing with such encumbrances as diapers. diapers frequently chafe, irritate, and gall the tender skin of a baby. but they cannot of course, at an early age be dispensed with, unless a mother have great judgment, sense, tact, and perseverance, to bring her little charge into the habit of having his bowels relieved and his bladder emptied every time he is either held out or put upon his chair. before giving an infant a particle of aperient medicine, try, if the bowels are costive, the effect of a little _raw_ sugar and water, either half a tea-spoonful of raw sugar dissolved in a tea-spoonful or two of water, or give him, out of your fingers, half a tea-spoonful of raw sugar to eat. i mean by _raw_ sugar, not the white, but the pure and unadulterated sugar, and which you can only procure from a respectable grocer. if you are wise, you will defer as long as you can giving an aperient. if you once begin, and continue it for a while, opening medicine becomes a dire necessity, and then woe betide the poor unfortunate child. or, give a third of a tea-spoonful of honey, early in the morning, occasionally. or administer a warm water enema--a tablespoonful, or more, by means of a oz. india rubber enema bottle. _what not to do_.--there are two preparations of mercury i wish to warn you against administering of your own accord, viz.--( ) calomel, and a milder preparation called ( ) grey-powder (mercury with chalk). it is a common practice in this country to give calomel, on account of the readiness with which it can be administered it being small in quantity, and nearly tasteless. grey powder also, is, with many mothers, a favourite in the nursery. it is a medicine of immense power--either for good or for evil, in certain cases it is very valuable, but in others, and in the great majority, it is very detrimental. this practice, then, of a mother giving mercury, whether in the form either of calomel or of grey powder, cannot be too strongly reprobated, as the frequent administration either of the one or of the other weakens the body, predisposes it to cold, and frequently excites king's-evil--a disease too common in this country. calomel and grey-powder, then, ought never to be administered unless ordered by a medical man. syrup of buckthorn and jalap are also frequently given, but they are griping medicines for a baby, and ought to be banished from the nursery. the frequent repetition of opening medicines, then, in any shape or form, very much interferes with digestion, they must, therefore, be given as seldom as possible. let me, at the risk of wearying you, again urge the importance of your avoiding, as much as possible, giving a babe purgative medicines. they irritate beyond measure the tender bowels of an infant, and only make him more costive afterwards, they interfere with his digestion, and are liable to give him cold. a mother who is always, of her own accord, quacking her child with opening physic, is laying up for her unfortunate offspring a debilitated constitution--a miserable existence. for further information on this important subject see the d edition of _counsel to a mother (being the companion volume of advice to a mother)_, on the great importance of desisting from irritating, from injuring, and from making still more costive, the obstinate bowels of a costive child,--by the administration of opening medicine,--however gentle and well-selected the aperients might be. oh, that the above advice could be heard, and be acted upon, through the length and the breadth of the land, how much misery and mischief would then be averted! . _are there any means of preventing the costiveness of an infant_? if greater care were paid to the rules of health, such as attention to diet, exercise in the open air, thorough ablution of the _whole_ body--more especially when he is being washed--causing the water, from a large and well-filled sponge, to stream over the lower part of his bowels; the regular habit of causing him, at stated periods, to be held out, whether he want or not, that he may solicit a stool. if all these rules were observed, costiveness would not so frequently prevail, and one of the miseries of the nursery would be done away with. some mothers are frequently dosing their poor unfortunate babes either with magnesia to cool them, or with castor oil to heal their bowels! oh, the folly of such practices! the frequent repetition of magnesia, instead of cooling an infant, makes him feverish and irritable. the constant administration of castor oil, instead of healing the bowels, wounds them beyond measure. no! it would be a blessed thing if a babe could be brought up without giving ham a particle of opening medicine; his bowels would then act naturally and well: but then, as i have just now remarked, a mother, must be particular in attending to nature's medicines--to fresh air, to exercise, to diet, to thorough ablution, &c. until that time comes, poor unfortunate babies must be, occasionally, dosed with an aperient. . _what are the causes of, and remedies for, flatulence_? flatulence most frequently occurs in those infants who live on _artificial_ food, especially if they be over-fed. i therefore beg to refer you to the precautions i have given, when speaking of the importance of keeping a child for the first five or six months _entirely_ to the breast; and, if that be not practicable, of the times of feeding, and of the _best_ kinds of artificial food, and of those which are least likely to cause "wind." _what to do._--notwithstanding these precautions, if the babe should still suffer, "one of the best and safest remedies for flatulence is sal volatile,--a tea-spoonful of a solution of one drachm to an ounce and a half of water" [footnote: sir charles locock, in a _letter_ to the author since sir charles did me the honour of sending me, for publication, the above prescription for flatulence, a new "british pharmacopoeia" has been published in which the sal volatile is much increased in strength it is therefore necessary to lessen the sal volatile in the above prescription one half--that is to say, a tea spoonful of the solution of _half_ a drachm to an ounce and a half of water.] or, a little dill or aniseed may be added to the food--half a tea-spoonful of dill water or, take twelve drops of oil of dill, and two lumps of sugar, rub them well in a mortar together, then add, drop by drop, three table-spoonfuls of spring water, let it be preserved in a bottle for use. a tea-spoonful of this, first shaking the vial, may be added to each quantity of food. or, three tea-spoonfuls of bruised caraway-seeds may be boiled for ten minutes in a tea-cupful of water, and then strained. one or two tea-spoonfuls of the caraway tea may be added to each quantity of his food, or a dose of rhubarb and magnesia may occasionally be given. opodeldoc, or warm olive oil, well rubbed, for a quarter of an hour at a time, by means of the warm hand, over the bowels, will frequently give relief. turning the child over on his bowels, so that they may press on the nurses' lap, will often afford great comfort. a warm bath (where he is suffering severely) generally gives _immediate_ ease in flatulence, it acts as a fomentation to the bowels. but after all, a dose of mild aperient medicine, when the babe is suffering severely, is often the best remedy for "wind." remember, at all times, prevention, whenever it be--and how frequently it is--possible, is better than cure. _what not to do_--"godfrey's cordial," "infants' preservative," and "dalby's carminative," are sometimes given in flatulence, but as most of these quack medicines contain, in one form or another, either opium or poppy, and as opium and poppy are both dangerous remedies for children, all quack medicines must be banished the nursery. syrup of poppies is another remedy which is often given by a nurse to afford relief for flatulence; but let me urge upon you the importance for banishing it from the nursery. it has (when given by unprofessional persons) caused the untimely end of thousands of children. the medical journals and the newspapers teem with cases of deaths from mothers incautiously giving syrup of poppies to ease pain and to procure sleep. . _what are the symptoms, the causes, and the treatment of "gripings" of an infant_? _the symptoms._--the child draws up his legs; screams violently; if put to the nipple to comfort him, he turns away from it and cries bitterly; he strains, as though he were having a stool; if he have a motion, it will be slimy, curdled, and perhaps green. if, in addition to the above symptoms, he pass a large quantity of watery fluid from his bowels, the case becomes one of _watery gripes_, and requires the immediate attention of a doctor. the _causes_ of "gripings" or "gripes" may proceed either from the infant or from the mother. if from the child, it is generally owing either to improper food or to over-feeding; if from the mother, it may be traced to her having taken either greens, or port, or tart beer, or sour porter, or pickles, or drastic purgatives. _what to do._--the _treatment_, of course, must depend upon the cause. if it arise from over-feeding, i would advise a dose of castor oil to be given, and warm fomentations to be applied to the bowels, and the mother, or the nurse, to be more careful for the future. if it proceed from improper food, a dose or two of magnesia and rhubarb in a little dill water, made palatable with simple syrup. [footnote: take of--powdered turkey rhubarb, half a scruple; carbonate of magnesia, one scruple; simple syrup, three drachms; dill water, eight drachms; make a mixture, one or two tea-spoonfuls (according to the age of the child) to be taken every four boors, until relief be obtained--first shaking the bottle.) if it arise from a mother's imprudence in eating trash, or from her taking violent medicine, a warm bath, a warm bath, indeed, let the cause of "griping" be what it may, usually affords instant relief. another excellent remedy is the following--soak a piece of new flannel, folded into two or three thicknesses, in warm water, wring it tolerably dry, and apply as hot as the child can comfortably bear it to the bowels, then wrap him in a warm, dry blanket, and keep him, for at least half an hour, enveloped in it. under the above treatment, he will generally soon fall into a sweet sleep, and awake quite refreshed. _what not to do_--do not give opiates, astringents, chalk, or any quack medicine whatever. if a child suffer from a mother's folly in her eating improper food, it will be cruel in the extreme for him a _second_ time to be tormented from the same cause. . _what occasions hiccup, and what is its treatment_? hiccup is of such a trifling nature as hardly to require interference. it may generally be traced to over feeding. should it be severe, four or five grains of calcined magnesia, with a little syrup and aniseed water, and attention to feeding are all that will be necessary. . _will you describe the symptoms of infantile diarrhoea_? infantile diarrhoea, or _cholera infantum_, is one of the most frequent and serious of infantile diseases, and carries off, during the year, more children than any other complaint whatever a knowledge of the symptoms, therefore, is quite necessary for a mother to know, in order that she may, at the proper tune, call in efficient medical aid. it will be well, before describing the symptoms, to tell you how many motions a young infant ought to have a day, their colour, consistence, and smell. well, then, he should have from three to six motions in the twenty four hours, the colour ought to be a bright yellow, inclining to orange, the consistence should be that of thick gruel; indeed, his motion, if healthy, ought to be somewhat of the colour (but a little more orange-tinted) and of the consistence of mustard made for the table; it should be nearly, if not quite, devoid of smell; it ought to have a faint and peculiar, but not a strong disagreeable odour. if it have a strong and disagreeable smell, the child is not well, and the case should be investigated, more especially if there be either curds or lumps in the motions; these latter symptoms denote that the food has not been properly digested. now, suppose a child should have a slight bowel complaint--that is to say, that he has six or eight motions during the twenty-four hours,--and that the stools are of a thinner consistence than what i have described,--provided, at the same time, that he be not griped, that he have no pain, and have not lost his desire for the breast:--what ought to be done?_nothing_. a slight looseness of the bowels should _never_ be interfered with,--it is often an effort of nature to relieve itself of some vitiated motion that wanted a vent--or to act as a diversion, by relieving the irritation of the gums. even if he be not cutting his teeth, he may be "breeding" them--that is to say, the teeth may be forming in his gums, and may cause almost as much, irritation as though he were actually cutting them. hence, you see the immense good a slight "looseness of the bowels" may cause. i think that i have now proved to you the danger of interfering in such a case, and that i have shown you, the folly and the mischief of at once giving astringents--such as godfrey's cordial, dalby's carminative, &c.--to relieve a _slight_ relaxation. a moderate "looseness of the bowels," then, is often a safety-valve, and you may, with as much propriety, close the safety-valve of a steam engine, as stop a moderate "looseness of the bowels!" now, if the infant, instead of having from three to six motions, should have more than double the latter number; if they be more watery; if they become slimy and green, or green in part and curdled; if they should have an unpleasant smell; if he be sick, cross, restless, fidgety, and poorly; if every time he have a motion he be griped and in pain, we should then say that he is labouring under diarrhoea; then, it will be necessary to give a little medicine, which i will indicate in a subsequent conversation. should there be both blood and slime mixed with the stool, the case becomes more serious; still, with proper care, relief can generally be quickly obtained. if the evacuations--instead of being stool--are merely blood and slime, and the child strain frequently and violently, endeavouring thus, but in vain, to relieve himself, crying at each effort, the case assumes the character of dysentery. [footnote: see symptoms and treatment of dysentery.] if there be a mixture of blood, slime, and stool from the bowels, the case would be called dysenteric-diarrhoea. the latter case requires great skill and judgment on the part of a medical men, and great attention and implicit obedience from the mother and the nurse. i merely mention these diseases in order to warn you of their importance, and of the necessity of strictly attending to a doctor's orders. . _what are the causes of diarrhoea--"looseness of the bowels?"_ improper food; overfeeding; teething; cold; the mother's milk from various causes disagreeing, namely, from her being out of health, from her eating unsuitable food, from her taking improper and drastic purgatives, or from her suckling her child when she is pregnant. of course, if any of these causes are in operation, they ought, if possible, to be remedied, or medicine to the babe will be of little avail. . _what is the treatment of diarrhoea_? _what to do._--if the case be _slight_, and has lasted two or three days (do not interfere by giving medicine at first), and if the cause, as it probably is, be some acidity or vitiated stool that wants a vent, and thus endeavours to obtain one by purging, the best treatment is, to assist nature by giving either a dose of castor oil, or a moderate one of rhubarb and magnesia, [footnote: for a rhubarb and magnesia mixture prescription, see page (_note_).] and thus to work off the enemy. after the enemy has been worked off, either by the castor oil, or by the magnesia and rhubarb, the purging will, in all probability, cease; but if the relaxation still continue, that is to say, for three or four days--then, if medical advice cannot be procured, the following mixture should be given:-- take of--aromatic powder of chalk and opium, ten grains; oil of dill, five drops; simple syrup, three drachms; water, nine drachms; make a mixture, [footnote: let the mixture be made by a chemist.] half a tea-spoonful to be given to an infant of six months and under, and one tea-spoonful to a child above that age, every four hours--first shaking the bottle. if the babe be at the breast, he ought, for a few days, to be kept _entirely_ to it. the mother should be most particular in her own diet. _what not to do._--the mother must neither take greens, nor cabbage, nor raw fruit, nor pastry, nor beer; indeed, while the diarrhoea of her babe continues, she had better abstain from wine, as well as from fermented liquors. the child, if at the breast, ought _not_, while the diarrhoea continues, to have any artificial food. he must neither be dosed with grey-powder (a favourite, but highly improper remedy, in these cases), nor with any quack medicines, such as dalby's carminative or godfrey's cordial. . _what are the symptoms of dysentery_? dysentery frequently arises from a neglected diarrhoea. it is more dangerous than diarrhoea, as it is of an inflammatory character; and as, unfortunately, it frequently attacks a delicate child, requires skilful handling; hence the care and experience required in treating a case of dysentery. well, then, what are the symptoms? the infant, in all probability, has had an attack of diarrhoea--bowel complaint as it is called--for several days; he having had a dozen or two of motions, many of them slimy and frothy, like "frog-spawn," during the twenty-four hours. suddenly the character of the motion changes,--from being principally stool, it becomes almost entirely blood and mucus; he is dreadfully griped, which causes him to strain violently, as though his inside would come away every time he has a motion,--screaming and twisting about, evidently being in the greatest pain, drawing his legs up to his belly and writhing in agony. sickness and vomiting are always present, which still more robs him of his little remaining strength, and prevents the repair of his system. now, look at his face! it is the very picture of distress. suppose he has been a plump, healthy little fellow, you will see his face, in a few days, become old-looking, care-worn, haggard, and pinched. day and night the enemy tracks him (unless proper remedies be administered); no sleep, or if he sleep, he is, every few minutes, roused. it is heart-rending to have to attend a bad case of dysentery in a child,--the writhing, the screaming, the frequent vomiting, the pitiful look, the rapid wasting and exhaustion, make it more distressing to witness than almost any other disease a doctor attends. . _can anything be done to relieve such a case_? yes. a judicious medical man will do a great deal. but, suppose that yon are not able to procure one, i will tell you _what to do_ and _what not to do_. _what to do_.--if the child be at the breast, keep him to it, and let him have nothing else for dysentery is frequently caused by improper feeding. if your milk be not good, or it be scanty, _instantly_ procure a healthy wet-nurse. _lose not a moment;_ for in dysentery, moments are precious. but, suppose that you have no milk, and that no wet-nurse can be procured: what then? feed him entirely on cow's milk--the milk of _one_ healthy cow; let the milk be unboiled, and be fresh from the cow. give it in small quantities at a time, and frequently, so that it may be retained on the stomach. if a table-spoonful of the milk make him sick, give him a dessert-spoonful; if a dessert-spoonful cause sickness, let him only have a tea-spoonful at a time, and let it be repeated every quarter of an hour. but, remember, in such a case the breast milk--the breast milk alone--is incomparably superior to any other milk or to any other food whatever. if he be a year old, and weaned, then feed him, as above recommended, on the cow's milk. if there be extreme exhaustion and debility, let fifteen drops of brandy be added to each table-spoonful of new milk, and let it be given every half hour. now with regard to medicine. i approach this part of the treatment with some degree of reluctance,--for dysentery is a case requiring opium--and opium i never like a mother of her own accord to administer. but suppose a medical man cannot be procured in time, the mother must then prescribe, or the child will die! _what then is to be done?_ sir charles locock considers "that, in severe dysentery, especially where there is sickness, there is no remedy equal to pure calomel, in a full dose without opium." [footnote: communicated by sir charles locock to the author.] therefore, at the very _onset_ of the disease, let from three to five grains (according to the age of the patient) of calomel, mixed with an equal quantity of powdered white sugar, be put dry on the tongue. in three hours after let the following mixture be administered:-- take of--compound powder of ipecacuanha, five grains; ipecacuanha wine, one drachm; simple syrup, three drachms; cinnamon water, nine drachms; to make a mixture, a tea-spoonful to be given every three or four hours, first _well_ shaking the bottle. supposing he cannot retain the mixture--the stomach rejecting it as soon as swallowed--what then? give the opium, mixed with small doses of mercury with chalk and sugar, in the form of powder, and put one of the powders _dry_ on the tongue, every three hours:-- take of--powdered opium, half a grain; mercury with chalk, nine grains; sugar of milk, twenty-four grains; mix well in a mortar, and divide into twelve powders. now, suppose the dysentery has for several days persisted, and that, during that time, nothing but mucus and blood--that no real stool--has come from the bowels, then a combination of castor oil and opium [footnote: my friend, the late dr baly, who had made dysentery his particular study, considered the combination of opium and castor oil very valuable in dysentery.] ought, instead of the medicine recommended above, to be given:-- take of--mucilage of gum acacia, three drachms; simple syrup, three drachms; tincture of opium, ten drops (_not_ minims); castor oil, two drachms; cinnamon water, four drachms: make a mixture. a tea spoonful to be taken every four hours, first _well_ shaking the bottle. a warm bath, at the commencement of the disease, is very efficacious; but it must be given at the _commencement_. if he has had dysentery for a day or two, he will be too weak to have a warm bath; then, instead of the bath, try the following:--wrap him in a blanket, which has been previously wrung out of hot water; over which envelope him in a _dry_ blanket. keep him in this hot, damp blanket for half an hour; then take him out, put on his nightgown and place him in bed, which has been, if it be winter time, previously warmed. the above "blanket treatment" will frequently give great relief, and will sometimes cause him to fall into a sweet sleep. a flannel bag, filled with hot powdered table salt, made hot in the oven, applied to the bowels, will afford much comfort. _what not to do_.--do not give aperients unless it be, as before advised, the castor oil guarded with the opium; do not stuff him with artificial food; do not fail to send for a judicious and an experienced medical man; for, remember, it requires a skilful doctor to treat a case of dysentery, more especially in a child. . _what are the symptoms, the causes and the treatment of nettle-rash_? nettle-rash consists of several irregular, raised wheals, red at the base, and white on the summit, on different parts of the body; _but it seldom attacks the face_. it is not contagious, and it may occur at all ages and many times. it comes and goes, remaining only a short time in a place. it puts on very much the appearance of the child having been stung by nettles--hence its name. it produces great heat, itching, and irritation, sometimes to such a degree as to make him feverish, sick, and fretful. he is generally worse when he is warm in bed, or when the surface of his body is suddenly exposed to the air. rubbing the skin, too, always aggravates the itching and the tingling, and brings out a fresh crop. the _cause_ of nettle-rash may commonly be traced to improper feeding; although, occasionally, it proceeds from teething. _what to do_.--it is a complaint of no danger, and readily gives way to a mild aperient, and to attention to diet. there is nothing better to relieve the irritation of the skin than a warm bath. if it be a severe attack of nettle-rash, by all means call in a medical man. _what not to do_.--do not apply cold applications to his skin, and do not wash him (while the rash is out) in quite _cold_ water. do not allow him to be in a draught, but let him be in a well-ventilated room. if he be old enough to eat meat, keep it from him for a few days, and let him live on milk and farinaceous diet. avoid strong purgatives, and calomel, and grey-powder. . _what are the symptoms and the treatment of red-gum_? red-gum, tooth-rash, red-gown, is usually owing to irritation from teething; not always from the cutting but from the evolution--the "breeding," of the teeth. it is also sometimes owing to unhealthy stools irritating the bowels, and showing itself, by sympathy, on the skin. red-gum consists of several small papulae, or pimples, about the size of pins' heads, and may be known from measles--the only disease for which it is at all likely to be mistaken--by its being unattended by symptoms of cold, such as sneezing, running, and redness of the eyes, &c., and by the patches _not_ assuming a crescentic--half-moon shape; red-gum, in short, may readily he known by the child's health being unaffected, unless, indeed, there be a great crop of pimples; then there will be slight feverishness. _what to do_.--little need be done. if there be a good deal of irritation, a mild aperient should be given. the child ought to be kept moderately, but not very warm. _what not to do_.--draughts of air, or cold should be carefully avoided; as, by sending the eruption suddenly in, either convulsions or disordered bowels might be produced. do not dose him with grey-powder. . _how would you prevent "stuffing of the nose" in a new-born babe_? rubbing a little tallow on the bridge of the nose is the old-fashioned remedy, and answers the purpose. it ought to be applied every evening just before putting him to bed. if the "stuffing" be severe, dip a sponge in hot water, as hot as he can comfortably bear; ascertain that it be not too hot, by previously applying it to your own face, and then put it for a few minutes to the bridge of his nose. as soon as the hard mucus is within reach, it should be carefully removed. . _do you consider sickness injurious to an infant_? many thriving babies are, after taking the breast, frequently sick; still we cannot look upon sickness otherwise than as an index of either a disordered or of an overloaded stomach. if the child be sick, and yet be thriving, it is a proof that he overloads his stomach. a mother, then, must not allow him to suck so much, at a time. she should, until he retain all he takes, lessen the quantity of milk. if he be sick and does _not_ thrive, the mother should notice if the milk he throws up has a sour smell; if it have, she must first of all look to her own health; she ought to ascertain if her own stomach be out of order; for if such be the case, it is impossible for her to make good milk. she should observe whether in the morning her own tongue be furred and dry; whether she have a disagreeable taste in her mouth, or pains at her stomach, or heart-burn, or flatulence. if she have all, or any of these symptoms, the mystery is explained why he is sick and does not thrive. she ought then to seek advice, and a medical man will soon put her stomach into good order; and, by so doing, will, at the same time, benefit her child. but if the mother be in the enjoyment of good health, she must then look to the babe himself, and ascertain if he be cutting his teeth; if the gums require lancing; if the secretions from the bowels be proper both in quantity and in quality; and, if he have had _artificial_ food--it being absolutely necessary to give such food--whether it agree with him. _what to do_.--in the first place, if the gums be red, hot, and swollen, let them be lanced; in the second, if the secretion from the bowels be either unhealthy or scanty, give him a dose of aperient medicine, such as caster oil, or the following:--take two or three grains of powdered turkey rhubarb, three grains of pure carbonate of magnesia, and one grain of aromatic powder--mix. the powder to be taken at bed-time, mixed in a tea-spoonful of sugar and water, and which should, if necessary, be repeated the following night. in the third place, if the food he be taking does not agree with him, change it (_vide_ answer to question ). give it in smaller quantities at a time, and not so frequently; or what will be better still, if it be possible, keep him, for a while, entirely to the breast. _what not to do_.--do not let him overload his stomach either with breast milk, or with _artificial food_. let the mother avoid, until his sickness be relieved, greens, cabbage, and all other green vegetables. . _what are the causes, the symptoms, the prevention, and the cure of thrush_? the thrush is a frequent disease of an infant, and is often brought on either by stuffing or by giving him improper food. a child brought up _entirely_, for the first three or four months, on the breast, seldom suffers from this complaint. the thrush consists of several irregular, roundish, white specks on the lips, the tongue, the inside and the angles of the mouth, giving the parts affected the appearance of curds and whey having been smeared upon them. the mouth is hot and painful, and he is afraid to suck; the moment the nipple is put to his mouth he begins to cry. the thrush, sometimes, although but rarely, runs through the whole of the alimentary canal. it should be borne in mind that nearly every child, who is sucking, has his or her tongue white or "frosted," as it is sometimes called. the thrush may be mild or very severe. now with regard to what to do.--as the thrush is generally owing to improper and to artificial feeding, _if the child be at the breast_, keep him, for a time, entirely to it. do not let him be always sucking, as that will not only fret his month, but will likewise irritate and make sore the mother's nipple. _if he be not at the breast_, but has been weaned, then keep him for a few days entirely to a milk diet--to the milk of one cow--either boiled, if it be hot weather, to keep it sweet; or unboiled, in cool weather--fresh as it comes from the cow, mixed with warm water. the best medicine is the old-fashioned one of borax, a combination of powdered lump-sugar and borax being a good one for the purpose: the powdered lump-sugar increases the efficacy, and the cleansing properties of the borax; it tends, moreover, to make it more palatable.-- take of--borax, half a drachm; lump sugar, two scruples; to be well mixed together, and made into twelve powders. one of the powders to be put dry on the tongue every four hours. the best _local_ remedy is honey of borax, which ought to be smeared frequently, by means of the finger, on the parts affected. thorough ventilation of the apartment must be observed; and great cleanliness of the vessels containing the milk should be insisted upon. in a bad case of thrush, change of air to the country is most desirable; the effect is sometimes, in such cases, truly magical. if the thrush be brought on either by too much or by improper food; in the first case of course, a mother must lessen the quantity; and, in the second, she should be more careful in her selection. _what not to do_.--do not use either a calf's teat or wash leather for the feeding-bottle; fortunately, since the invention of india-rubber teats, they are now nearly exploded; they were, in olden times, fruitful causes of thrush. do not mind the trouble of ascertaining that the cooking-vessels connected with the baby's food are perfectly clean and sweet. do not leave the purity and the goodness of the cow's milk (it being absolutely necessary to feed him on artificial food) to be judged either by the milk-man, or by the nurse, but taste and prove it yourself. do not keep the milk in a warm place, but either in the dairy or in the cellar; and, if it be summer time, let the jug holding the milk be put in a crock containing lumps of ice. do not use milk that has been milked longer than twelve hours, but if practicable, have it milked direct from the cow, and use it _immediately_--let it be really and truly fresh and genuine milk. when the disease is _severe_, it may require more active treatment--such as a dose of calomel; _which medicine must never be given unless it be either under the direction of a medical man, or unless it be in an extreme case,--such as dysentery_; [footnote: see the treatment of dysentery.] therefore, the mother had better seek advice. in a _severe_ case of thrush, where the complaint has been brought on by _artificial_ feeding--the babe not having the advantage of the mother's milk--it is really surprising how rapidly a wet-nurse--if the case has not been too long deferred--will effect a cure, where all other means have been tried and have failed. the effect has been truly magical! in a severe case of thrush pure air and thorough ventilation are essential to recovery. . _is anything to be learned from the cry of an infant_? a babe can only express his wants and his necessities by a cry; he can only tell his aches and his pains by a cry; it is the only language of babyhood; it is the most ancient of all languages; it is the language known by our earliest progenitors; it is, if listened to aright, a very expressive language, although it is only but the language of a cry-- "soft infancy, that nothing canst but cry."--_shakspeare_. there is, then, a language in the cry of an infant, which to a mother is the most interesting of all languages, and which a thoughtful medical man can well interpret. the cry of a child, to an experienced doctor, is, each and all, a distract sound, and is as expressive as the notes of the gamut. the cry of passion, for instance, is a furious cry; the cry of sleepiness is a drowsy cry; the cry of grief is a sobbing cry; the cry of an infant when roused from sleep is a shrill cry; the cry of hunger is very characteristic,--it is unaccompanied with tears, and is a wailing cry; the cry of teething is a fretful cry; the cry of pain tells to the practised ear the part of pain; the cry of ear-ache is short, sharp, piercing, and decisive, the head being moved about from side to side, and the little hand being often put up to the affected side of the head; the cry of bowel-ache is also expressive,--the cry is not so piercing as from ear-ache, and is an interrupted, straining cry, accompanied with a drawing-up of the legs to the belly; the cry of bronchitis is a gruff and phlegmatic cry; the cry of inflammation of the lungs is more a moan than a cry; the cry of croup is hoarse, and rough, and ringing, and is so characteristic that it may truly be called "the croupy cry;" the cry of inflammation of the membranes of the brain is a piercing shriek--a danger signal--most painful to hear; the cry of a child recovering from a severe illness is a cross, and wayward, and tearful cry; he may truly be said to be in a quarrelsome mood; he bursts out, without rhyme or reason, into a passionate flood of tears--into "a tempest of tears:" tears are always, in a severe illness, to be looked upon as a good omen, as a "the tears that heal and bless"--_h. bonar_. tears, when a child is dangerously ill, are rarely, if ever, seen; a cry, at night, for light--a frequent cause of a babe crying--is a restless cry:-- "an infant--crying in the night; an infant crying for the light: and with no language hat a cry."--_tennyson_. . _if an infant be delicate, have you any objection to his having either veal or mutton broth, to strengthen him_? broths seldom agree with a babe at the breast i have known them produce sickness, disorder the bowels, and create fever. i recommend you, therefore, not to make the attempt. although broth and beef-tea, when taken by the mouth, will seldom agree with an infant at the breast, yet, when used as an enema, and in small quantities, so that they may be retained, i have frequently found them to be of great benefit, they have in some instances appeared to have snatched delicate children from the brink of the grave. . _my baby's ankles are very weak: what do you advise to strengthen them_? if his ankles be weak, let them every morning be bathed, after the completion of his morning's ablution, for fire minutes each time, with bay-salt and water, a small handful of bay-salt dissolved in a quart of rain water (with the chill of the water off in the winter, and of its proper temperature in the summer time); then let them be dried; after the drying, let the ankles he well rubbed with the following liniment:-- take of--oil of rosemary, three drachms; liniment of camphor, thirteen drachms: to make a liniment do not let him be put on his feet early; but allow him to crawl, and sprawl, and kick about the floor, until his body and his ankles become strong. do not, on any account, without having competent advice on the subject, use iron instruments, or mechanical supports of any kind: the ankles are generally, by such artificial supports, made worse, in consequence of the pressure causing a further dwindling away and enfeebling of the ligaments of the ankles, already wasted and weakened. let him wear shoes with straps over the insteps to keep them on, and not boots: boots will only, by wasting the ligaments, increase the weakness of the ankles. . _sometimes there is a difficulty in restraining the bleeding of leech bites. what is the best method_? the difficulty in these cases generally arises from the improper method of performing it. for example--a mother endeavours to stop the haemorrhage by loading the part with rag; the more the bites discharge, the more rag she applies. at the same time, the child probably is in a room with a, large fire, with two or three candles, with the doors closed, and with perhaps a dozen people in the apartment, whom the mother has, in her fright, sent for. this practice is strongly reprehensible. if the bleeding cannot be stopped,--in the first place, the fire most be extinguished, the door and windows should be thrown open, and the room ought to be cleared of persons, with the exception of one, or, at the most, two; and every rag should be removed. "stopping of leech bites.--the simplest and most certain way, till the proper assistance is obtained, is the pressure of the finger, with nothing intervening. it _cannot_ bleed through that." [footnote: sir charles locock, in a _letter_ to the author.] many babies, by excessive loss of blood from leech bites, have lost their lives from a mother not knowing how to act, and also from the medical man either living at a distance, or not being at hand. fortunately for the infantile community, leeches are now very seldom ordered by doctors. . _supposing a baby to be poorly, have you any advice to give to his mother as to her own management_? she must endeavour to calm her feelings or her milk will be disordered, and she will thus materially increase his illness. if he be labouring under any inflammatory disorder, she ought to refrain from the taking of beer, wine, and spirits, and from all stimulating food; otherwise, she will feed his disease. before concluding the first part of my subject--the management of infancy--let me again urge upon you the importance--the paramount importance--if you wish your babe to be strong and hearty,--of giving him as little opening physic as possible. the best physic for him is nature's physic--fresh air, and exercise, and simplicity of living. a mother who is herself always drugging her child, can only do good to two persons--the doctor and the druggist! if an infant from his birth be properly managed,--if he have an abundance of fresh air for his lungs,--if he have plenty of exercise for his muscles (by allowing him to kick and sprawl on the floor),--if he have a good swilling and sousing of water for his skin,--if, during the _early_ months of his life, he have nothing but the mother's milk for his stomach,--he will require very little medicine--the less the better! he does not want his stomach to be made into a doctor's shop! the grand thing is not to take every opportunity of administering physic, but of using every means of with-holding it! and if physic be necessary, not to doctor him yourself, unless it be in extreme and urgent cases (which in preceding and succeeding conversations i either have or will indicate), but to employ an experienced medical man. a babe who is always, without rhyme or reason, being physicked, is sure to be puny, delicate, and unhealthy, and is ready at any moment to drop into an untimely grave! i will maintain that a healthy child _never_ requires drugging with opening physic, and that costiveness is brought on by bad management. aperient medicines to a healthy child are so much poison! _let me impress the above remarks on every mother's mind;_ for it is a subject of vital importance. never, then, give a purgative to a healthy child; for, if he be properly managed, he will never require one. if you once begin to give aperients, you will find a difficulty discontinuing them. finally, i will only say with _punch_,--"don't" concluding remarks on infancy. . in concluding the first part of our subject--infancy--i beg to remark: there are four things essentially necessary to a babe's well-doing, namely, ( ) plenty of water for his skin; ( ) plenty of fresh genuine milk mixed with water for his stomach (of course, giving him only his mother's milk during the first six, eight, or nine months of his existence); ( ) plenty of pure air for his lungs; ( ) plenty of sleep for his brain: these are the four grand essentials for an infant; without an abundance of one and all of them, perfect health is utterly impossible! perfect health! the greatest earthly blessing, and more to be coveted than ought else beside! there is not a more charming sight in the universe than the beaming face of a perfectly healthy babe,-- "his are the joys of nature, his the smile, the cherub smile, of innocence and health."--_knox._ part ii. childhood. _the child is father of the man_.--wordsworth. _bairns are blessings_--shakespeare. _these are my jewels!_--cornella. ablution. . _at twelve months old, do you still recommend a child to be_ put in his tub _to be washed_? certainly i do, as i have previously recommended at page , in order that his skin may be well and thoroughly cleansed. if it be summer time, the water should be used cold; if it be winter, a dash of warm must be added, so that it may be of the temperature of new milk: but do not, on any account use _very warm_ water. the head must be washed (but not dried) before he be placed in a tub, then, putting him in the tub (containing the necessary quantity of water, and washing him as previously recommended), [footnote: see infancy-ablution, page .] a large sponge should be filled with the water and squeezed over his head, so that the water may stream over the whole surface of his body. a jugful of water should, just before taking him out of his bath, be poured over and down his loins; all this ought rapidly to be done, and he must be quickly dried with soft towels, and then expeditiously dressed. for the washing of your child i would recommend you to use castile soap in preference to any other; it is more pure, and less irritating, and hence does not injure the texture of the skin. take care that the soap does not get into his eyes, or it might produce irritation and smarting. . _some mothers object to a child's standing in the water._ if the head be wetted before he be placed in the tub, and if he be washed as above directed, there can be no valid objection to it. he must not be allowed to remain in his tab more than five minutes. . _does not washing the child's head, every morning, make him more liable to catch cold, and does it not tend to weaken his sight_? it does neither the one nor the other; on the contrary, it prevents cold, and strengthens his sight; it cleanses his scalp, prevents scurf, and, by that means, causes a more beautiful bead of hair. the head, after each washing, ought, with a soft brush, to be well brushed, but should not be combed. the brushing causes a healthy circulation of the scalp; but combing the hair makes the head scurfy, and pulls out the hair by the roots. . _if the head, notwithstanding the washing, be scurfy, what should be done_? after the head has been well dried, let a little cocoa-nut oil be well rubbed, for five minutes each time, into the roots of the hair, and, afterwards, let the head be well brushed, but not combed. the fine-tooth comb will cause a greater accumulation of scurf, and will scratch and injure the scalp. . _do you recommend a child to be washed_ in his tub _every night and morning_? no; once a day is quite sufficient; in the morning in preference to the evening; unless he be poorly, then, evening instead of morning; as, immediately after he has been washed and dried, he can be put to bed. . _ought a child to be placed in his tub whilst he is in a state of perspiration_? not whilst he is perspiring _violently,_ or the perspiration might he checked suddenly, and ill consequences would ensue; _nor ought he to be put in his tub when he is cold,_ or his blood would be chilled, and would be sent from the skin to some internal vital part, and thus would be likely to light up inflammation--probably of the lungs. his skin, when he is placed in his bath, ought to be moderately and comfortably warm; neither too hot nor too cold. . _when the child is a year old, do you recommend cold or warm water to be used_? if it be winter, a little warm water ought to be added, so as to raise the temperature to that of new milk. as the summer advances, less and less warm water is required, so that, at length, none is needed. . _if a child be delicate, do you recommend anything to be added to the water which may tend to brace and strengthen him_? either a handful of table-salt, or half a handful of bay-salt, or of tidman's sea-salt, should be previously dissolved in a quart jug of _cold_ water; then, just before taking the child out of his morning bath, let the above be poured over and down the back and loins of the child--holding the jug, while pouring its contents on the back, a foot distant from the child, in order that it might act as a kind of douche bath. . _do you recommend the child, after he has been dried with the towel, to be rubbed with the hand_? i do; as friction encourages the cutaneous circulation, and causes the skin to perform its functions properly, thus preventing the perspiration (which is one of the impurities of the body) from being sent inwardly either to the lungs or to other parts. the back, the chest, the bowels, and the limbs are the parts that ought to be well rubbed. clothing . _have you any remarks to make on the clothing of a child_? children, boys and girls, especially if they be delicate, ought always to wear high dresses up to their necks. the exposure of the upper part of the chest (if the child be weakly) is dangerous. it is in the _upper_ part of the lungs, in the region of the collar bones, that consumption first shows itself. the clothing of a child, more especially about the chest, should be large and full in every part, and be free from tight strings, so that the circulation of the blood may not be impeded, and that there may be plenty of room for the fall development of the rapidly-growing body. his frock, or tonic, ought to be of woollen material--warm, light, and porous, in order that the perspiration may rapidly evaporate. the practice of some mothers in allowing their children to wear tight bands round their waists, and tight clothes, is truly reprehensible. _tight_ bands or _tight_ belts around the waist of a child are very injurious to health; they crib in the chest, and thus interfere with the rising and the falling of the ribs--so essential to breathing. _tight_ hats ought never to be worn; by interfering with the circulation they cause headaches. nature delights in freedom, and resents interference! . _what parts of the body in particular ought to be kept warm_? the chest, the bowels, and the feet, should be kept comfortably warm. we must guard against an opposite extreme, and not keep them too hot. the head alone should be kept cool, on which account i do not approve either of night or of day caps. . _what are the best kinds of hat for a child_? the best covering for the head, when he is out and about, is a loose-fitting straw hat, which will allow the perspiration to escape. it should have a broad rim, to screen the eyes. a sun-shade, that is to say, a sea-side hat--a hat made of cotton--with a wide brim to keep off the sun, is also an excellent hat for a child; it is very light, and allows a free escape of the perspiration. it can be bought, ready made, at a baby-linen warehouse. a knitted or crocheted woollen hat, with woollen rosettes to keep the ears warm, and which may be procured at any baby-linen warehouse, makes a nice and comfortable winter's hat for a child. it is also a good hat for him to wear while performing a long journey. the colour chosen is generally scarlet and white, which, in cold weather, gives it a warm and comfortable appearance. it is an abominable practice to cover a child's head with beaver or with felt, or with any thick impervious material it is a well-ascertained fact, that beaver and silk hats cause men to suffer from headache, and to lose their hair--the reason being, that the perspiration cannot possibly escape through them. now, if the perspiration cannot escape, dangerous, or at all events injurious, consequences must ensue, as it is well known that the skin is a breathing apparatus, and that it will not with impunity bear interference. neither a child nor any one else should be permitted to be in the glare of the son without his hat. if he be allowed, he is likely to have a sun-stroke, which might either at once kill him, or might make him an idiot for the remainder of his life; which latter would be the worse alternative of the two. . _have you, any remarks to make on keeping a child's hands and legs warm when in the winter time he it carried out_? when a child either walks or is carried out in wintry weather, be sure and see that both his hands and legs are well protected from the cold. there is nothing for this purpose like woollen gloves, and woollen stockings coming up over the knees. . _do you approve of a child wearing a flannel nightgown_? he frequently throws the clothes off him, and has occasion to be taken up in the night, and if he have not a flannel gown on, is likely to catch cold; on which account i recommend it to be worn. the usual calico night-gown should be worn _under_ it. . _do you advise a child to be lightly clad, in order that he may be hardened thereby_? i should fear that such a plan, instead of hardening, would be likely to produce a contrary effect. it is an ascertained fact that more children of the poor, who are thus lightly clad, die, than of those who are properly defended from the cold. again, what holds good with a young plant is equally applicable to a young child; and we all know that it is ridiculous to think of unnecessarily exposing a tender plant to harden it. if it were thus exposed, it would wither and die. . _if a child be delicate, if he have a cold body, or a languid circulation, or if he be predisposed to inflammation of the lungs, do you approve of his wearing flannel instead of linen shirts_? i do; as flannel tends to keep the body at an equal temperature, thus obviating the effects of the sudden changes of the weather, and promotes by gentle friction the cutaneous circulation, thus warming the cold body, and giving an impetus to the languid circulation, and preventing an undue quantity of blood from being sent to the lungs, either to light up or to feed inflammation _fine_ flannel, of course, ought to be worn, which should be changed as frequently as the usual shirts. if a child have had an attack either of bronchitis or of inflammation of the lungs, or if he have just recovered from scarlet fever, by all means, if he have not previously worn flannel, _instantly_ let him begin to do so, and let him, _next_ to the skin, wear a flannel waistcoat. _this is important advice, and ought not to be disregarded_. _scarlet_ flannel is now much used instead of _white_ flannel; and as scarlet flannel has a more comfortable appearance, and does not shrink so much in washing, it may be substituted for the white. . _have you any remarks to make on the shoes and stockings of a child? and on the right way of cutting the toe-nails_? he ought, daring the winter, to wear lamb's wool stockings that will reach _above_ the knees, and _thick_ calico drawers that will reach a few inches _below_ the knees; as it is of the utmost importance to keep the lower extremities comfortably warm. it is really painful to see how many mothers expose the bare legs of their little ones to the frosty air, even in the depths of winter. be sure and see that the boots and shoes of your child be sound and whole; for if they be not so, they will let in the damp, and if the damp, disease and perhaps death. "if the poor would take better care of their children's feet half the infantile mortality would disappear. it only costs twopence to put a piece of thick felt or cork into the bottom of a boot or shoe, and the difference is often between that and a doctors bill, with, perhaps, the undertaker's besides."--_daily telegraph_, garters ought not to be worn, as they impede the circulation, waste the muscles, and interfere with walking. the stocking may be secured in its place by means of a loop and tape, which should be fastened to a part of the dress. let me urge upon you the importance of not allowing your child to wear _tight_ shoes; they cripple the feet, causing the joints of the toes, which ought to have free play, and which should assist in walking, to be, in a manner, useless; they produce corns and bunions, and interfere with the proper circulation of the foot. a shoe ought to be made according to the shape of the foot--rights and lefts are therefore desirable. the toe-part of the shoe must be made broad, so as to allow plenty of room for the toes to expand, and that one toe cannot overlap another. be sure, then, that there be no pinching and no pressure. in the article of shoes you ought to be particular and liberal; pay attention to having nicely fitting ones, and let them be made of soft leather, and throw them on one side the moment they are too small. it is poor economy, indeed, because a pair of shoes be not worn out, to run the risk of incurring the above evil consequences. _shoes are far preferable to boots:_ boots weaken instead of strengthen the ankle. the ankle and instep require free play, and ought not to be hampered by boots. moreover, boots, by undue pressure, decidedly waste away the ligaments of the ankle. boots act on the ankles in a similar way that stays do on the waist--they do mischief by pressure. boots waste away the ligaments of the ankle; stays waste away the muscles of the back and chest; and thus, in both cases, do irreparable mischief. a shoe for a child ought to be made with a narrow strap over the instep, and with button and button-hole; if it be not made in this way, the shoe will not keep on the foot. it is a grievous state of things, that in the nineteenth century there are but few shoemakers who know how to make a shoe! the shoe is made not to fit a real foot, but a fashionable imaginary one! the poor unfortunate toes are in consequence screwed up as in a vice! let me strongly urge you to be particular that the sock, or stocking, fits nicely--that it is neither too small nor too large; if it be too small, it binds up the toes unmercifully, and makes one toe to ride over the other, and thus renders the toes perfectly useless in walking; if it be too large, it is necessary to lap a portion of the sock, or stocking, either under or over the toes, which thus presses unduly upon them, and gives pain and annoyance. it should be borne in mind, that if the toes have full play, they, as it were, grasp the ground, and greatly assist in locomotion--which, of course, if they are cramped up, they cannot possibly do. be careful, too, that the toe-part of the sock, or stocking, be not pointed; let it be made square in order to give room to the toes. "at this helpless period of life, the delicately feeble, outspreading toes are wedged into a narrow-toed stocking, often so short as to double in the toes, diminishing the length of the rapidly growing foot! it is next, perhaps, tightly laced into a boot of less interior dimensions than itself; when the poor little creature is left to sprawl about with a limping, stumping gait, thus learning to walk as it best can, under circumstances the most cruel and torturing imaginable." [footnote: _the foot and its covering_, second edition. by james dowie. london: . i beg to call a mother's especial attention to this valuable little book: it is written by an earnest intelligent man, by one who has studied the subject in all its bearings, and by one who is himself a shoemaker.] it is impossible for either a stocking, or a shoe, to fit nicely unless the toe-nails be kept in proper order. now, in cutting the toe-nails, there is, as in everything else, a right and a wrong way. the _right_ way of cutting a toe-nail is to cut it straight--in a straight line. the _wrong_ way is to cut the corners of the nail--to round the nail as it is called. this cutting the corners of the nails often makes work for the surgeon, as i myself can testify; it frequently produces "growing-in" of the nail, which sometimes necessitates the removal of either the nail, or a portion of it. . _at what time of the year should a child leave off his winter clothing_? a mother ought not to leave off her children's winter clothing until the spring be far advanced: it is far better to be on the safe side, and to allow the winter clothes to be worn until the end of may. the old adage is very good, and should be borne in mind:-- "button to chin till may be in; ne'er cast a clout till may be out." . _have you any general remarks to make on the present fashion of dressing children_? the present fashion is absurd. children are frequently dressed like mountebanks, with feathers and furbelows and finery; the boys go bare-legged; the little girls are dressed like women, with their stuck-out petticoats, crinolines, and low dresses! their poor little waists are drawn in tight, so that they can scarcely breathe; their dresses are very low and short, the consequence is, that a great part of the chest is exposed to our variable climate; their legs are bare down to their thin socks, or if they be clothed, they are only covered with gossamer drawers; while their feet are encased in tight shoes of paper thickness! dress! dress! dress! is made with them, at a tender age, and when first impressions are the strongest, a most important consideration. they are thus rendered vain and frivolous, and are taught to consider dress "as the one thing needful" and if they live to be women--which the present fashion is likely frequently to prevent--what are they? silly, simpering, delicate, lack-a-daisical nonentities; dress being their amusement, their occupation, their conversation, their everything, their thoughts by day and their dreams by night! truly they are melancholy objects to behold! let children be dressed as children, not as men and women. let them be taught that dress is quite a secondary consideration. let health, and not fashion, be the first, and we shall then have, with god's blessing, blooming children, who will, in time, be the pride and strength of dear old england! diet. . _at twelve months old, have you any objection to a child having any other food besides that you mentioned in answer to the th question_? there is no objection to his _occasionally_ having, for dinner, either a mealy, _mashed_ potato and gravy, or a few crumbs of bread and gravy. rice-pudding or batter-pudding may, for a change, be given; but remember, the food recommended in a former conversation is what, until he be eighteen months old, must be principally taken. during the early months of infancy--say, for the first six or seven--if artificial food be given at all, it should be administered by means of a feeding-bottle. after that time, either a spoon, or a nursing boat, will be preferable. the food as he becomes older, ought to be made more solid. . _at_ eighteen _months old, have you any objection to a child having meat_? he ought not to have meat until he have several teeth to chew it with. if he has most of his teeth--which he very likely at this age will have--there is no objection to his taking a small slice either of mutton, or occasionally of roast beef, which should be well cut into very small pieces, and mixed with a mealy _mashed_ potato, and a few crumbs of bread and gravy; either _every_ day, if he be delicate, or every _other_ day, if he be a gross or a fast-feeding child. it may be well, in the generality of cases, for the first few months to give him meat _every other_ day, and either potato or gravy, or rice or suet-pudding or batter-pudding on the alternate days; indeed, i think so highly of rice, of suet, and of batter-puddings, and of other farinaceous puddings, that i should advise you to let him have either the one or the other even on those days that he has meat--giving it him _after_ his meat. but remember, if he have meat _and_ pudding, the meat ought to be given sparingly. if he be gorged with food, it makes him irritable, cross, and stupid; at one time, clogging up his bowels, and producing constipation; at another, disordering his liver, and causing either clay-coloured stools--denoting a _deficiency_ of bile, or dark and offensive motions--telling of _vitiated_ bile; while, in a third case, cramming him with food might bring on convulsions. . _as you are to partial to puddings for a child, which do you consider the best for him_? he ought, every day, to have a pudding for his dinner--either rice, arrow-root, sago, tapioca, suet-pudding, batter-pudding, or yorkshire-pudding, mixed with crumbs of bread and gravy--free from grease. a well boiled suet-pudding, with plenty of suet in it, is one of the best puddings he can have; it is, in point of fact, meat and farinaceous food combined, and is equal to, and will oftentimes prevent the giving of, cod-liver oil; before cod-liver oil came into vogue, suet boiled in milk was _the_ remedy for a delicate child. he may, occasionally, have fruit-pudding, provided the pastry be both plain and light. the objection to fruit pies and puddings is, that the pastry is often too rich for the delicate stomach of a child; there is so objection, certainly not, to the fruit--cooked fruit being, for a child, most wholesome; if, therefore, fruit puddings and pies be eaten, the pastry part ought to be quite plain. there is, in "murray's modern cookery book," an excellent suggestion, which i will take the liberty of quoting, and of strongly urging my fair reader to carry into practice:--"_to prepare fruit for children, a far more wholesome way than in pies and puddings_, is to put apples sliced, or plums, currants, gooseberries, &c., into a stone jar; and sprinkle among them as much lisbon sugar as necessary. set the jar on an oven or on a hearth, with a tea-cupful of water to prevent the fruit from burning; or put the jar into a saucepan of water, till its contents be perfectly done. slices of bread or some rice may be put into the jar, to eat with the fruit." _jam_--such as strawberry, raspberry, gooseberry--_is most wholesome for a child_, and ought occasionally to be given, in lieu of sugar, with the rice, with the batter, and with the other puddings. marmalade, too, is very wholesome. puddings ought to be given _after_ and not _before_ his meat and vegetables; if you give him pudding before his meat, he might refuse to eat meat altogether. by adopting the plan of giving puddings _every_ day, your child will require _less_ animal food; _much_ meat is injurious to a young child. but do not run into an opposite extreme: a _little_ meat ought, every day, to be given, _provided he has cut the whole of his first set of teeth_; until then, meat every _other_ day will be often enough. . _as soon as a child has cut the whole of his first set of teeth, what ought to be his diet?--what should be his breakfast_? he can, then, have nothing better, where it agrees, than scalding hot new milk poured on sliced bread, with a slice or two of bread and butter to eat with it. butter, in moderation, is nourishing, fattening, and wholesome. moreover, butter tends to keep the bowels regular. these facts should be borne in mind, as some mothers foolishly keep their children from butter, declaring it to be too rich for their children's stomachs! new milk should be used in preference either to cream or to skim-milk. cream, as a rule, is too rich for the delicate stomach of a child, and skim-milk is too poor when robbed of the butter which the cream contains. but give cream and water, where new milk (as is _occasionally_ the case) does not agree; but never give skim-milk. _skim_-milk (among other evils) produces costiveness, and necessitates the frequent administration of aperients. cream, on the other hand, regulates and tends to open the bowels. although i am not, as a rule, so partial to cream as i am to good genuine fresh milk, yet i have found, in cases of great debility, more especially where a child is much exhausted by some inflammatory disease, such as inflammation of the lungs, the following food most serviceable:--beat up, by means of a fork, the yolk of an egg, then mix, little by little, half a tea-cupful of very weak _black_ tea, sweeten with one lump of sugar, and add a table-spoonful of cream. let the above, by tea-spoonfuls at a time be frequently given. the above food is only to be administered until the exhaustion be removed, and is not to supersede the milk diet, which must, at stated periods, be given, as i have recommended in answers to previous and subsequent questions. when a child has costive bowels, there is nothing better for his breakfast than well-made and well-boiled oatmeal stir-about, which ought to be eaten with milk fresh from the cow. scotch children scarcely take anything else, and a finer race is not in existence; and, as for physic, many of them do not even know either the taste or the smell of it! you win find robinson's pure scotch oatmeal (sold in packets) to be very pure, and sweet, and good. stir-about is truly said to be-- "the halesome parritch, chief of scotia's food."--_burns._ cadbury's cocoa essence, made with equal parts of boiling water and fresh milk, slightly sweetened with lump sugar, is an admirable food for a delicate child. bread and butter should be eaten with it. . _have you any remarks to make on cow's milk as an article of food_? cow's milk is a valuable, indeed, an indispensable article of diet, for the young; it is most nourishing, wholesome, and digestible. the finest and the healthiest children are those who, for the first four or five years of their lives, are fed _principally_ upon it. milk ought then to be their staple food. no child, as a rule, can live, or, if he live, can be healthy, unless milk be the staple article of his diet. there is no substitute for milk. to prove the fattening and strengthening qualities of milk, look only at a young calf who lives on milk, and on milk alone! he is a samson in strength, and is "as fat as butter;" and all young things if they are in health are fat! milk, then, contains every ingredient to build up the body, which is more than can be said of any other known substance besides. a child may live entirely, and grow, and become both healthy and strong, on milk and on milk alone, as it contains every constituent of the human body. a child cannot "live by bread alone," but he might on milk alone! milk is animal and vegetable--it is meat and bread--it is food and drink--it is a fluid, but as soon as it reaches the stomach it becomes a solid [footnote: how is milk in the making of cheese, converted into curds? by rennet. what is rennet? the juice of a calf's maw or stomach. the moment the milk enters the human maw or stomach, the juice of the stomach converts it into curds--into solid food, just as readily as when it enters a calfs maw or stomach, and much more readily than by rennet, as the _fresh_ juice is stronger than the _stale_. an ignorant mother often complains that because, when her child is sick, the milk curdles, that it is a proof that it does not agree with him! if, at those times, it did _not_ curdle, it would, indeed, prove that his stomach was in a wretchedly weak state; she would then have abundant cause to be anxious.]--solid food; it is the most important and valuable article of diet for a child in existence. it is a glorious food for the young, and must never, on any account whatever, in any case be dispensed with. "considering that milk contains in itself most of the constituents of a perfect diet, and is capable of maintaining life in infancy without the aid of any other substance, it is marvellous that the consumption of it is practically limited to so small a class; and not only so, but that in sick-rooms, where the patient is surrounded with every luxury, arrow-root, and other compounds containing much less nutriment, should so often be preferred to it."--_the times._ do not let me be misunderstood. i do not mean to say, but that the mixing of farinaceous food--such as lemann's biscuit powder, robb's biscuit, hard's farinaceous food, brown and polson's corn flour, and the like, with the milk, is an improvement, in some cases--a great improvement; but still i maintain that a child might live and thrive, and that for a lengthened period, on milk--and on milk alone! a dog will live and fatten for six weeks on milk alone; while he will starve and die in a shorter period on strong beef-tea alone! it is a grievous sin for a milkman to adulterate milk. how many a poor infant has fallen a victim to that crime!--for crime it may be truly called. it is folly in the extreme for a mother to bate a milkman down in the price of his milk; if she does, the milk is sure to be either of inferior quality, or adulterated, or diluted with water; and woe betide the poor unfortunate child if it be either the one or the other! the only way to insure good milk is, to go to a respectable cow-keeper, and let him be made to thoroughly understand the importance of your child having _genuine_ milk, and that you are then willing to pay a fair remunerative price for it. rest assured, that if you have to pay one penny or even twopence a quart more for _genuine_ milk, it is one of the best investments that you ever have made, or that you are ever likely to make in this world! cheap and inferior milk might well be called cheap and nasty; for inferior or adulterated milk is the very essence, the conglomeration of nastiness; and, moreover, is very poisonous to a child's stomach. one and the principal reason why so many children are rickety and scrofulous, is the horrid stuff called milk that is usually given to them. it is a crying evil, and demands a thorough investigation and reformation, and the individual interference of every parent. limited liability companies are the order of the day; it would really be not a bad speculation if one were formed in every large town, in order to insure good, genuine, and undiluted milk. _young_ children, as a rule, are allowed to eat too much meat. it is a mistaken notion of a mother that they require so much animal food. if more milk were given and less meat, they would he healthier, and would not be so predisposed to disease, especially to diseases of debility, and to skin-disease. i should strongly recommend you, then, to be extravagant in your milk score. each child ought, in the twenty-four hours, to take at least a quart of good, fresh, new milk. it should, of course, be given in various ways,--as bread and milk, rice-puddings, milk and differents kinds of farinaceous food, stir-about, plain milk, cold milk, hot milk, any way, and every way, that will please his palate, and that will induce him to take an abundant supply of it. the "advice" i have just given you is of paramount importance, and demands your most earnest attention. there would be very few rickety children in the world if my "counsel" were followed out to the very letter. . _but suppose my child will not take milk, he having an aversion to it, what ought then to be done_? boil the milk, and sweeten it to suit his palate. after he has been accustomed to it for a while, he will then, probably, like milk. gradually reduce the sugar, until at length it be dispensed with. a child will often take milk this way, whereas he will not otherwise touch it. if a child will not drink milk, he _must_ eat meat; it is absolutely necessary that he should have either the one or the other; and, if he have cut nearly all his teeth, he ought to have both meat and milk--the former in moderation, the latter in abundance. . _supposing milk should not agree with my child, what must then be done_? milk, either boiled or unboiled, almost always agrees with a child. if it does not, it must be looked upon as the exception, and not as the rule. i would, in such a case, advise one-eighth of lime water to be added to seven-eighths of new milk--that is to say, two table-spoonfuls of lime water should be mixed with half a pint of new milk. . _can you tell me of a way to prevent milk, in hot weather, from turning sour_? let the jug of milk be put into a crock, containing ice--wenham lake is the best--either in the dairy or in the cellar. the ice may at any time, be procured of a respectable fishmonger, and should be kept, wrapped either in flannel or in blanket, in a cool place, until it be wanted. . _can you tell me why the children of the rich suffer so much more from costiveness than do the children of the poor_? the principal reason is that the children of the rich drink milk without water, while the children of the poor drink water without, or with very little, milk--milk being binding, and water opening to the bowels. be sure then, and bear in mind, _as this is most important advice_, to see that water is mixed with all the milk that is given to your child. the combination of milk and water for a child is a glorious compound--strengthening, fattening, refreshing, and regulating to the bowels, and thus doing away with that disgraceful proceeding so common in nurseries, of everlastingly physicking, irritating and irreparably injuring the tender bowels of a child. my opinion is, that aperients, as a rule, are quite unnecessary, and should only be given in severe illness, and under the direction of a judicious medical man. how much misery, and injury, might be averted if milk were always given to a child in combination with water! aperients, by repetition, unlike water, increase the mischief tenfold, and cork them up most effectually; so that the bowels, in time, will not act without them! a mother before she gives an aperient to her child should ponder well upon what i have said upon the subject, it being a vital question, affecting, as it does, the well-being and the well-doing of her child. . _but, if a child's bowels be very costive, what is to be done to relieve them_? do not give him a grain or a drop of opening medicine, but in lieu thereof, administer, by means of a oz. india-rubber enema bottle, half a tea-cup or a tea-cupful, according to the age of the child, [footnote: for a babe, from birth until he be two years old, one, two, or three table-spoonfuls of warm water will be sufficient, and a oz. enema bottle will be the proper size for the purpose of administering it.] of warm water; now this will effectually open the bowels, without confining them afterwards, which opening physic would most assuredly do! . _is it necessary to give a child luncheon_? if he want anything to eat between breakfast and dinner let him have a piece of dry bread; and if he have eaten very heartily at dinner, and, like oliver twist, "asks for more!" give him, to satisfy his craving, a piece of _dry_ bread. he will never eat more of that than will do him good, and yet he will take sufficient to satisfy his hunger, which is very important. . _what ought now to be his dinner_? he should now have meat, either mutton or beef, daily, which must be cut up very small, and should be mixed with mealy, _mashed_ potato and gravy. he ought _always_ to be accustomed to eat salt with his dinner. let a mother see that this advice is followed, or evil consequences will inevitably ensue. let him be closely watched, to ascertain that he well masticates his food, and that he does not eat too quickly; for young children are apt to bolt their food. . _have you any objection to pork for a change_? i have a great objection to it for the young. it is a rich, gross, and therefore unwholesome food for the delicate stomach of a child. i have known it, in several instances, produce violent pain, sickness, purging, and convulsions. if a child be fed much, upon such meat, it will be likely to produce "breakings-out" on the skin. in fine, his blood will put on the same character as the food he is fed with. moreover, pork might be considered a _strong meat_, and "_strong_ meat and _strong_ drink can only be taken by _strong_ men." . _do you approve of veal for a child_? my objection to pork was, that it was rich and gross; this does not apply to veal; but the objection to it is, that it is more difficult of digestion that either mutton or beef; indeed, all young meats are harder of digestion than meats of maturity; thus mutton is more digestible than lamb, and beef than veal. . _do you disapprove of salted and boiled beef for a child_? if beef be _much_ salted it is hard of digestion, and therefore ought not to be given to him; but if it have been but _slightly_ salted, then for a change there will be no objection to a little. there is no necessity in the _winter_ time to _salt_ meat intended for boiling; then boiled _unsalted_ meat makes a nice change for a child's dinner. salt, of course, _must_ with the unsalted meat be eaten. . _but suppose there is nothing on the table that a child may with impunity eat_? he should then have either a grilled mutton chop, or a lightly-boiled egg; indeed, the latter, at any time, makes an excellent change. there is great nourishment in an egg; it will not only strengthen the frame, but it will give animal heat as well: these two qualities of an egg are most valuable; indeed, essential for the due performance of health: many articles of food contain the one qualification, but not the other: hence the egg is admirably suitable for a child's _occasional_ dinner. . _are potatoes an unwholesome food for a child_? new ones are; but old potatoes well cooked and mealy, are the best vegetable he can have. they ought to be _well mashed_, as i have known lumps of potatoes cause convulsions. . _do you approve of any other vegetables for a child_? occasionally: either asparagus or broccoli, or cauliflower, or turnips, or french beans, which latter should be cut up fine, may with advantage be given. green peas may occasionally be given, provided they be thoroughly well boiled, and mashed with the knife on the plate. underdone and unmashed peas are not fit for a child's stomach: there is nothing more difficult of digestion than underdone peas. it is important, too, to mash them, even if they be well done, as a child generally bolts peas whole; and they pass through the alimentary canal without being in the least digested. . _might not a mother be too particular in dieting her child_? certainly not. if blood can be too pure and too good she might! when we take into account that the food we eat is converted into blood; that if the food be good the blood is good; and that if the food be improper or impure, the blood is impure likewise; and, moreover, when we know that every part of the body is built up by the blood, we cannot be considered to be too particular in making our selection of food. besides if indigestible or improper food be taken into the stomach, the blood will not only be made impure, but the stomach and the bowels will be disordered. do not let me be misunderstood: i am no advocate for a child having the same food one day as another-- certainly not. let there be variety, but let it be _wholesome_ variety. variety in a child's (not in infant's) food is necessary. if he were fed, day after day, on mutton, his stomach would, at length be brought into that state, that in time it would not properly digest any other meat, and a miserable existence would be the result. . _what ought a child to drink with his dinner_? toast and water, or, if he prefer it, plain spring water. let him have as much as he likes. if you give him water to drink, there is no fear of his taking too much; nature will tell him when he has had enough. be careful of the quality of the water, and the source from which you procure it. if the water be _hard_--provided it be free from organic matter--so much the better. [footnote: see the _third_ edition of _counsel to a mother_, under the head of "hard or soft water as a beverage!"] spring water from a moderately deep well is the best. if it come from a land spring, it is apt, indeed, is almost sure to be contaminated by drains, &c.; which is a frequent cause of fevers, of diphtheria, of asiatic cholera, and of other blood poisons. guard against the drinking water being contaminated with lead; never, therefore, allow the water to be collected in leaden cisterns, as it sometimes is if the water be obtained from water-works companies. lead pumps, for the same reason, ought never to be used for drinking purposes. paralysis, constipation, lead colic, dropping of the wrist, wasting of the ball of the thumb, loss of memory, and broken and ruined health, might result from neglect of this advice. the drinking fountains are a great boon to poor children, as water and plenty of it, is one of the chief necessaries of their existence; and, unfortunately, at their own homes they are not, oftentimes, able to obtain a sufficient supply. moreover, drinking fountains are the best advocates for temperance. some parents are in the habit of giving their children beer with their dinners--making them live as they live themselves! this practice is truly absurd, and fraught with great danger! not only so, but it is inducing a child to be fond of that which in after life might be his bane and curse! no good end can be obtained by it; it will _not_ strengthen so young a child; it will on the contrary, create fever, and will thereby weaken him; it will act injuriously upon his delicate, nervous, and vascular systems, and by means of producing inflammation either of the brain or of its membranes, might thus cause water on the brain (a disease to which young children are subject), or it might induce inflammation of the lungs. . _what ought a child who has cut his teeth to have for his supper_? the same that he has for breakfast. he should sup at six o'clock. . _have you any general remarks to make on a child's meals_? i recommended a great sameness in an _infant's_ diet; but a _child's_ meals, his dinners especially, ought to be much varied. for instance, do not let him have day after day mutton; but ring the changes on mutton, beef, poultry, game, and even occasionally fish--sole or cod. not only let there be a change of meat, but let there be a change in the manner of cooking it; let the meat sometimes be roasted; let it at other times be boiled. i have known a mother who has prided herself as being experienced in these matters, feed her child, day after day, on mutton chops! such a proceeding is most injurious to him, as after a while his unfortunate stomach will digest nothing but mutton chops, and, in time, not even those! with regard to vegetables, potatoes--_mashed_ potatoes--ought to be his staple vegetable; but, every now and then, cauliflower, asparagus, turnips, and french beans, should be given. with respect to puddings, vary them; rice, one day; suet, another; batter, a third; tapioca, a fourth; or, even occasionally, he might have either apple or gooseberry or rhubarb pudding--provided the pastry be plain and light. it is an excellent plan, as i have before remarked, to let her child eat jam--such as strawberry, raspberry, or gooseberry--and that without stint, either with rice or with batter puddings. _variety of diet_, then, is _good for a child:_ it will give him muscle, bone, and sinew; and, what is very important, it will tend to regulate his bowels, and it will thus prevent the necessity of giving him aperients. but do not stuff a child--do not press him, as is the wont of some mothers, to eat more than he feels inclined. on the contrary, if you think that he is eating too much--that he is overloading his stomach--and if he should ask for more, then, instead of giving him either more meat or more pudding, give him a piece of dry bread. by doing so, you may rest assured that he will not eat more than is absolutely good for him. . _if a child be delicate, is there any objection to a little wine, such as cowslip or tent, to strengthen him_? wine ought not to be given to a child unless it be ordered by a medical man; it is even more injurious than beer. wine, beer, and spirits, principally owe their strength to the alcohol they contain; indeed, nearly _all_ wines are _fortified_ (as it is called) with brandy. brandy contains a large quantity of alcohol, more than any other liquor, namely . per cent. if, therefore, you give wine, it is, in point of fact, giving diluted brandy--diluted alcohol; and alcohol acts, unless it be used as a medicine, and under skilful medical advice, as a poison to a child. . _suppose a child suddenly to lose his appetite? is any notice to be taken of it_? if he cannot eat well, depend upon it, there is something wrong about the system. if he be teething, let a mother look well to his gums, and satisfy herself that they do not require lancing. if they be red, hot, and swollen, send for a medical man, that he may scarify them. if his gums be not inflamed, and no tooth appears near, let her look well to the state of his bowels; let her ascertain that they be sufficiently opened, and that the stools be of a proper consistence, colour, and smell. if they be neither the one nor the other, give a dose of aperient medicine, which will generally put all to rights. if the gums be cool, and the bowels be right, and his appetite continue bad, call in medical aid. a child asking for something to eat, is frequently, in a severe illness, the first favourable symptom; we may generally then prognosticate that all will soon be well again. if a child refuse his food, neither coax nor tempt him to eat: as food without an appetite will do him more harm than it will do him good; it may produce either sickness, bowel-complaint, or fever. depend upon it, there is always a cause for a want of appetite;--perhaps his stomach has been over-worked, and requires repose; or his bowels are loaded, and nature wishes to take time to use up the old material;--there might be fever lurking in his system; nature stops the supplies, and thus endeavours, by not giving it food to work with, to nip it in the bud;--there might be inflammation; food would then be improper, as it would only add fuel to the fire; let, therefore, the cause be either an overworked stomach, over-loaded bowels, fever, or inflammation, food would be injurious. kind nature if we will but listen to her voice, will tell us when to eat, and when to refrain. . _when a child is four or five years old, have you any objection to his drinking tea_? some parents are in the habit of giving their children strong (and frequently green) tea. this practice is most hurtful. it acts injuriously upon their delicate, nervous system, and thus weakens their whole frame. if milk does not agree, a cup of very weak tea, that is to say, water with a dash of _black_ tea in it, with a table-spoonful of cream, may be substituted for milk; but a mother must never give tea where milk agrees. . _have you any objection to a child occasionally having either cakes or sweetmeats_? i consider them as so much slow poison. such things both cloy and weaken the stomach, and thereby take away the appetite, and thus debilitate the frame. moreover "sweetmeats are coloured with poisonous pigments." a mother, surely, is not aware, that when she is giving her child sugar confectionery she is, in many cases, administering a deadly poison to him? "we beg to direct the attention of our readers to the report of the analytical sanitary commission, contained in the _lancet_ of the present week (dec. , ), on the pigments employed in colouring articles of sugar confectionery. from this report it appears that metallic pigments of a highly dangerous and even poisonous character, containing chromic acid, lead, copper, mercury, and arsenic, are commonly used in the colouring of such articles." if a child be never allowed to eat cakes and sweetmeats, he will consider a piece of dry bread a luxury, and will eat it with the greatest relish. . _is bakers' or is home-made bread the most wholesome for a child_? bakers' bread is certainly the lightest; and, if we could depend upon its being unadulterated, would, from its lightness, be the most wholesome; but as we cannot always depend upon bakers' bread, home-made bread, as a rule should be preferred. if it be at all heavy, a child must not be allowed to partake of it; a baker's loaf ought then to be sent for, and continued to be eaten until light home-made bread can be procured. heavy bread is most indigestible. he must not be allowed to eat bread until it be two or three days old. if it be a week old, in cold weather, it will be the more wholesome. . _do you approve either of caraway seeds or of currants in bread or in cakes--the former to disperse wind, the latter to open the bowels_? there is nothing better than plain bread: the caraway-seeds generally pass through the bowels undigested, and thus might irritate, and might produce, instead of disperse wind. [footnote: although caraway seeds _whole_ are unwholesome, yet caraway tea, made as recommended in a previous conversation, is an excellent remedy to disperse wind.] some mothers put currants in cakes, with a view of opening the bowels of their children; but they only open them by disordering them. . _my child has an antipathy to certain articles of diet: what would you advise to be done_? a child's antipathy to certain articles of diet should be respected: it is a sin and a shame to force him to eat what he has a great dislike to: a child, for instance, sometimes dislikes the fat of meat, underdone meat, the skin off boiled milk and off rice-pudding. why should he not have his likes and dislikes as well as "children of a larger growth?" besides, there is an idiosyncrasy--a peculiarity of the constitution in some children--and nature oftentimes especially points out what is good and what is bad for them individually, and we are not to fly in the face of nature. "what is one man's meat is another man's poison." if a child be forced to eat what he dislikes, it will most likely not only make him sick, but will disorder his stomach and bowels; food, if it is really to do him good, must be eaten by him with a relish, and not with disgust and aversion. some mothers, who are strict disciplinarians, pride themselves on compelling their children to eat whatever they choose to give them! such children are to be pitied! . _when ought a child to commence to dine with his parents_? as soon as he be old enough to sit up at the table, provided the father and mother either dine or lunch in the middle of the day. "i always prefer having children about me at meal tines. i think it makes them little gentlemen and gentlewomen in a manner that nothing else will."--_christian's mistake_. the nursery. . _save you any remarks to make on the selection, the ventilation, the warming, the temperature, and the arrangements of a nursery? and have you any further observations to offer conducive to the well-doing of my child_? the nursery ought to be the largest and the most airy room in the house. in the town, if it be in the topmost story (provided the apartment be large and airy) so much the better, as the air will then be purer. the architect, in the building of a house, ought to be particularly directed to pay attention to the space, the loftiness, the ventilation, the light, the warming, and the conveniences of a nursery. a bath-room attached to it will be of great importance and benefit to the health of a child. it will be advantageous to have a water-closet near at hand, which should be well supplied with water, be well drained, and be well ventilated. if this be not practicable, the evacuations ought to be removed as soon as they are passed. it is a filthy and an idle habit of a nurse-maid to allow a motion to remain for any length of time in the room. the ventilation of a nursery is of paramount importance. there ought to be a constant supply of fresh pure air in the apartment. but how few nurseries have fresh, pure air! many nurseries are nearly hermetically sealed--the windows are seldom, if ever, opened; the doors are religiously closed; and, in summer time, the chimneys are carefully stuffed up, so that a breath of air is not allowed to enter! the consequences are, the poor unfortunate children "are poisoned by their own breaths," and are made so delicate that they are constantly catching cold; indeed, it might be said that they are labouring under chronic catarrhs, all arising from nature's laws being set at defiance. the windows ought to be large, and should be made to freely open both top and bottom. whenever the child is out of the nursery, the windows ought to be thrown wide open; indeed, when he is in it, if the weather be fine, the upper sash should be a little lowered. a child should be encouraged to change the room, frequently, in order that it may be freely ventilated; for good air is as necessary to his health as wholesome food, and air cannot be good if it be not frequently changed. if you wish to have a strong and healthy child, ponder over and follow this advice. i have to enter my protest against the use of a stove in a nursery. i consider a gas stove _without a chimney_ to be an abomination, most destructive to human life. there is nothing like the old-fashioned open fire-place with a good-sized chimney, so that it may not only carry off the smoke, but also the impure air of the room. be strict in not allowing your child either to touch or to play with fire; frightful accidents have occurred from mothers and nurses being on these points lax. the nursery ought to have a large fire-guard, to go all round the hearth, and which should be sufficiently high to prevent a child from climbing over. not only must the nursery have a guard, but every room where he is allowed to go should he furnished with one on the bars. moreover, it will be advisable to have a guard in every room where a fire is burning, to prevent ladies from being burned. fortunately for them, preposterous crinolines are out of fashion: when they were in fashion, death from burning was of every-day occurrence; indeed, lady-burning was then to be considered one of the institutions of our land! a nursery is usually kept too hot; the temperature in the winter time ought _not to exceed_ degrees fahrenheit a _good_ thermometer should be considered an indispensable requisite to a nursery. a child in a hot, close nursery is bathed in perspiration; if he leave the room to go to one of lower temperature, the pores of his skin are suddenly closed, and either a severe cold or an inflammation of the lungs, or an attack of bronchitis, is likely to ensue. moreover, the child is both weakened and enervated by the heat, and thus readily falls a prey to disease. a child ought never to be permitted to sit with his back to the fire; if he be allowed, it weakens the spine, and thus his whole frame; it causes a rash of blood to the head and face, and predisposes him to catch cold. let a nurse make a point of opening the nursery window every time that she and her little charge leave the nursery, if her absence be only for half an hour. the mother herself ought to see that this advice is followed, pure air is so essential to the well-being of a child. pure air and pure water, and let me add, pure milk, are for a child the grand and principal requirements of health. look well to the drainage of your house and neighbourhood. a child is very susceptible to the influence of bad drainage. bad drains are fruitful sources of scarlet fever, of diphtheria, of diarrhoea, &c. "it is sad to be reminded that, whatever evils threaten the health of population, whether from pollutions of water or of air,--whether from bad drainage or overcrowding, they fall heaviest upon the most innocent victims--upon children of tender years. their delicate frames are infinitely more sensitive than the hardened constitutions of adults, and the breath of poison, or the chill of hardships, easily blights their tender life."--_the times._ a nursery floor ought not to be _washed_ oftener than once a week; and then the child or children should, until it be dry, be sent into another room. during the drying of the floor, the windows must, of course, be thrown _wide_ open. the constant _wetting_ of a nursery is a frequent source of illness among children. the floor ought, of course, to be kept clean; but this may be done by the servant thoroughly sweeping the room out every morning before her little charge makes his appearance. do not have your nursery wall covered with green paper-hangings. green paper-hangings contain large quantities of arsenic--arsenite of copper (scheele's green)--which, i need scarcely say, is a virulent poison, and which flies about the room in the form of powder. there is frequently enough poison on the walls of a room to destroy a whole neigbourhood. there is another great objection to having your nursery walls covered with _green_ paper-hangings; if any of the paper should become loose from the walls, a little child is very apt to play with it, and to put it, as he does every thing else, to his mouth. this is not an imaginary state of things, as four children in one family have just lost their lives from sucking green paper-hangings. green dresses, as they are coloured with a preparation of arsenic, are equally as dangerous as green paper-hangings; a child ought, therefore, never to wear a green dress. "it may be interesting to some of our readers," says _land and water_, "to know that the new green, so fashionable for ladies' dresses, is just as dangerous in its nature as the green wall-paper, about which so much was written some time since. it is prepared with a large quantity of arsenic; and we have been assured by several of the leading dressmakers, that the workwomen employed in making up dresses of this colour are seriously affected with all the symptoms of arsenical poisoning. let our lady friends take care." children's toys are frequently painted of a green colour with arsenite of copper, and are consequently, highly dangerous for him to play with. the best toy for a child is a box of _unpainted_ wooden bricks, which is a constant source of amusement to him. if you have your nursery walls hung with paintings and engravings, let them be of good quality. the horrid daubs and bad engravings that usually disfigure nursery walls, are enough to ruin the taste of a child, and to make him take a disgust to drawing, which would be a misfortune. a fine engraving and a good painting expand and elevate his mind. we all know that first impressions are the most vivid and the most lasting. a taste in early life for everything refined and beautiful purifies his mind, cultivates his intellect, keeps him from low company, and makes him grow up a gentleman! lucifer matches, in case of sudden illness, should, both in the nursery and in the bedroom, be always in readiness; but they must be carefully placed out of the reach of children, as lucifer matches are a deadly poison. many inquests have been held on children who have, from having sucked them, been poisoned by them. . _have you any observation to make on the light of a nursery_? let the window, or what is better, the windows, of a nursery be very large, so as to thoroughly light up every nook and corner of the room, as there is nothing more conducive to the health of a child than an abundance of light in the dwelling. a room cannot, then, be too light. the windows of a nursery are generally too small. a child requires as much light as a plant. gardeners are well aware of the great importance of light in the construction of their greenhouses, and yet a child, who requires it as much, and is of much greater importance, is cooped up in dark rooms! the windows of a nursery ought not only to be frequently opened to let in fresh air, but should be _frequently cleaned_, to let in plenty of light and of sunshine, as nothing is so cheering and beneficial to a child as an abundance of light and sunshine! _with regard to the best artificial light for a nursery._--the air of a nursery cannot be too pure; i therefore do not advise you to have gas in it, as gas in burning gives off quantities of carbonic acid and sulphuretted hydrogen, which vitiate the air. the paraffine lamp, too, makes a room very hot and close. there is no better light for a nursery than either price's patent candles or the old-fashioned tallow-candle. let a child's _home_ he the happiest _house_ to him in the world; and to be happy he must be merry, and all around him should be merry and cheerful; and he ought to have an abundance of playthings, to help on the merriment. if he have a dismal nurse, and a dismal home, he may as well be incarcerated in a prison, and be attended by a gaoler. it is sad enough to see dismal, doleful men and women, but it is a truly lamentable and unnatural sight to see a doleful child! the young ought to be as playful and as full of innocent mischief as a kitten. there will be quite time enough in after years for sorrow and for sadness. bright colours, plenty of light, _clean_ windows (mind this, if you please), an abundance of _good_-coloured prints, and toys without number, are the proper furnishings of a nursery. nursery! why, the very name tells you what it ought to be--the home of childhood--the most important room in the house,--a room that will greatly tend to stamp the character of your child for the remainder of his life. . _have you any more hints to offer conducive to the well-doing of my child_? you cannot be too particular in the choice of those who are in constant attendance upon him. you yourself, of course, must be his _head-nurse_--you only require some one to take the drudgery off your hands! you ought to be particularly careful in the selection of his nurse. she should be steady, lively, truthful, and good tempered; and must be free from any natural imperfection, such as squinting, stammering, &c., for a child is such an imitative creature that he is likely to acquire that defect, which in the nurse is natural. "children, like babies, are quick at 'taking notice.' what they see they mark, and what they mark they are very prone to copy."--_the times_. she ought not to be very young, or she may be thoughtless, careless, and giggling. you have no right to set a child to mind a child; it would be like the blind leading the blind. no! a child is too precious a treasure to be entrusted to the care and keeping of a young girl. many a child has been ruined for life by a careless young nurse dropping him and injuring his spine. a nurse ought to be both strong and active, in order that her little charge may have plenty of good nursing; for it requires great strength in the arms to carry a heavy child for the space of an hour or two at a stretch, in the open air; and such is absolutely necessary, and is the only way to make him strong, and to cause him to cut his teeth easily, and at the same time to regulate his bowels; a noise, therefore, most be strong and active, and not mind hard, work, for hard work it is; but, after she is accustomed to it, pleasant notwithstanding. never should a nurse be allowed to wear a mask, nor to dress up and paint herself as a ghost, or as any other frightful object. a child is naturally timid and full of fears, and what would not make the slightest impression upon a grown-up person might throw a child into fits-- "the sleeping, and the dead, are but as pictures: 'tis the age of childhood that fears a painted devil."--_shakspeare_. never should she be permitted to tell her little charge frightful stories of ghosts and hobgoblins; if this be allowed, the child's disposition will become timid and wavering, and may continue so for the remainder of his life. if a little fellow were not terrified by such stories, the darkness would not frighten him more than the light. moreover, the mind thus filled with fear, acts upon the body, and injures the health. a child must never be placed in a dark cellar, nor frightened by tales of rats, &c. instances are related of fear thus induced impairing the intellect for life; and there are numerous examples of sudden fright causing a dangerous and even a fatal illness. _night-terrors_.--this frightening of a child by a silly nurse frequently brings on night-terrors. he wakes up suddenly, soon after going to sleep, frightened and terrified; screaming violently, and declaring that he has seen either some ghost, or thief, or some object that the silly nurse had been previously in the day describing, who is come for him to take him away. the little fellow is the very picture of terror and alarm; he hides his face in his mother's bosom, the perspiration streams down him, and it is some time before he can be pacified--when, at length, he falls into a troubled feverish slumber, to awake in the morning unrefreshed. night after night these terrors harass him, until his health materially suffers, and his young life becomes miserable looking forward with dread to the approach of darkness. _treatment of night terrors_.--if they have been brought on by the folly of the nurse, discharge her at once, and be careful to select a more discreet one. when the child retires to rest, leave a candle burning, and let it burn all night, sit with him until he be asleep, and take care, in case he should rouse up in one of his night-terrors, that either yourself or some kind person be near at hand. do not scold him for being frightened--he cannot help it, but soothe him, calm him, fondle him, take him into your arms and let him feel that he has some one to rest upon, to defend and to protect him. it is frequently in these cases necessary before he can be cared to let him have change of air and change of scene. let him live, in the day time, a great part of the day in the open air. a nurse maid should never, on any account whatever, be allowed to whip a child. "does ever any man or woman remember the feeling of being 'whipped' as a child, the fierce anger, the insupportable ignominy, the longing for revenge, which blotted out all thought of contrition for the fault or rebellion against the punishment? with this recollection on their own parts, i can hardly suppose any parents venturing to inflict it, much less allowing its infliction by another under any circumstances whatever. a nurse-maid or domestic of any sort, once discovered to have lifted up her hand against a child, ought to meet instant severe rebuke, and on a repetition of the offence instant dismissal." [footnote: _a woman's thoughts about women_.] i have seen in the winter tune a lazy nurse sit before the fire with a child on her lap, rubbing his cold feet just before putting him to his bed. now, this is not the way to warm his feet. the right method is to let him romp and run either about the room, or the landing, or the hall--this will effectually warm them, but, of course, it will entail a little extra trouble on the nurse, as she will have to use a little exertion to induce him to do so, and this extra trouble a lazy nurse will not relish. warming the feet before the fire will give the little fellow chilblains, and will make him when he is in bed more chilly. the only way for him to have a good romp before he goes to bed, is for the mother to join in the game. she may rest assured, that if she does so, her child will not be the only one to benefit by it. she herself will find it of marvellous benefit to her own health; it will warm her own feet, it will be almost sure to insure her a good night, and will make her feel so light and buoyant as almost to fancy that she is a girl again! well, then, let every child, before going to bed, hold a high court of revelry, let him have an hour--the children's hour--devoted to romp, to dance, to shout, to sing, to riot, and to play, and let him be the master of the revels-- "between the dark and the daylight, when the night is beginning to lower, comes a pause in the day's occupation, which is known as the children's hour." _longfellow_. let a child be employed--take an interest in his employment, let him fancy that he is useful--_and he is useful_, he is laying in a stock of health. he is much more usefully employed than many other grown-up children are! a child should be happy; he must, in every way, be made happy; everything ought to be done to conduce to his happiness, to give him joy, gladness, and pleasure. happy he should be, as happy as the day is long. kindness should be lavished upon him. make a child understand that you love him; prove it in your actions--these are better than words; look after his little pleasures--join in his little sports; let him never hear a morose word--it would rankle in his breast, take deep root, and in due time bring forth bitter fruit. love! let love be his pole-star; let it be the guide and the rule of all you do and all you say unto him. let your face, as well as your tongue speak love. let your hands be ever ready to minister to his pleasures and to his play. "blessed be the hand that prepares a pleasure for a child, for there is no saying when and where it may again bloom forth. does not almost everybody remember some kind-hearted man who showed him a kindness in the dulcet days of childhood? the writer of this recollects himself, at this moment, a bare-footed lad, standing at the wooden fence of a poor little garden in his native village, while, with longing eyes, he gazed on the flowers which were blooming there quietly in the brightness of the sabbath morning. the possessor came from his little cottage. he was a wood-cutter by trade, and spent the whole week at work in the woods. he had come into the garden to gather flowers to stick in his coat when he went to church. he saw the boy, and breaking off the most beautiful of his carnations (it was streaked with red and white), he gave it to him. neither the giver nor the receiver spoke a word, and with bounding steps the hoy ran home. and now, here, at a vast distance from that home, after so many events of so many years, the feeling of gratitude which agitated the breast of the boy, expressed itself on paper. the carnation has long since faded, but it now bloometh afresh."--_douglas jerrold_. the hearty ringing laugh of a child is sweet music to the ear. there are three most joyous sounds in nature--the hum of a bee, the purr of a cat, and the laugh of a child. they tell of peace, of happiness, and of contentment, and make one for a while forget that there is so much misery in the world. a man who dislikes children is unnatural, he has no "milk of human kindness" in him; he should be shunned. give me, for a friend, a man-- "who takes the children on his knee, and winds their curls, about his hand."--_tennyson_. . _if a child be peevish, and apparently in good health, have you any plan to propose to allay his irritability_? a child's troubles are soon over--his tears are soon dried; "nothing dries sooner than a tear"--if not prolonged by improper management-- "the tear down childhood's check that flows is like the dew-drop on the rose; when next the summer breeze comes by, and waves the bush, the flower is dry."--_scott_. never allow a child to be teased; it spoils his temper. if he be in a cross humour take no notice of it, but divert his attention to some pleasing object. this may be done without spoiling him. do not combat bad temper with bad temper--noise with noise. be firm, be kind, be gentle, [footnote: "but we were gentle among you, even as a women cherisheth her children."-- thess. ii. .] be loving, speak quietly, smile tenderly, and embrace him fondly, but _insist upon implicit obedience_, and you will have, with god's blessing, a happy child-- "when a little child is weak from fever passing by, or wearied out with restlessness don't scold him if he cry. tell him some pretty story-- don't read it from a book; he likes to watch you while you speak, and take in every look. or sometimes singing gently-- a little song may please, with quiet and amusing words, and tune that flows with ease. or if he is impatient, perhaps from time to time a simple hymn may suit the best, in short and easy rhyme. the measured verses flowing in accents clear and mild, may blend into his troubled thought, and soothe the little child. but let the words be simple, and suited to his mind, and loving, that his weary heart a resting-place may find."--_household verses_. speak, _gently_ to a child; speak _gently_ to all; but more especially speak _gently_ to a child. "a gentle voice is an excellent thing in a woman," and is a jewel of great price, and is one of the concomitants of _perfect_ lady. let the hinges of your disposition be well oiled. "'i have a dear friend. he was one of those well-oiled dispositions which turn upon the hinges of the world without creaking.' would to heaven there were more of them! how many there are who never turn upon the hinges of this world without a grinding that sets the teeth of a whole household on edge! and somehow or other it has been the evil fate of many of the best spirits to be so circumstanced; both men and women, to whom life is 'sweet habitude of being,' which has gone far to reconcile them to solitude as far less intolerable! to these especially the creakings of those said rough hinges of the world is one continued torture, for they are all too finely strung; and the oft-recurring grind jars the whole sentient frame, mars the beautiful lyre, and makes cruel discord in a soul of music. how much of sadness there is in such thoughts! seems there not a past in some lives, to which it is impossible ever to become reconciled!"--_life's problems_. pleasant words ought always to be spoken to a child; there must be neither snarling, nor snapping, nor snubbing, nor loud contention towards him. if there be it will ruin his temper and disposition, and will make him hard and harsh, morose and disagreeable. do not always be telling your child how wicked he is; what a naughty boy he is; that god will never love him, and all the rest of such twaddle and blatant inanity! do not, in point of fact, bully him, as many poor little fellows are bullied! it will ruin him if you do; it will make him in after years either a coward or a tyrant. such conversations, like constant droppings of water, will make an impression, and will cause him to feel that it is of no use to try to be good--that he is hopelessly wicked! instead of such language, give him confidence in himself; rather find out his good points and dwell upon them; praise him where and whenever you can; and make him feel that, by perseverance and god's blessing, he will make a good man. speak truthfully to your child; if you once deceive him, he will not believe you for the future. not only so, but if you are truthful yourself you are likely to make him truthful--like begets like. there is something beautiful in truth! a lying child is an abomination! sir walter scott says "that he taught his son to ride, to shoot, and to tell the truth" archdeacon hare asserts "that purity is the feminine, truth the masculine of honour." as soon as a child can speak he should be made to lisp the noble words of truth, and to love it, and to abhor a lie! what a beautiful character he will then make! blessed is the child that can say,-- "parental cares watched o'er my growing youth, and early stamped it with the love of truth." _leadbeater papers._ have no favourites, show no partiality; for the young are very jealous, sharp-sighted, and quick-witted, and take a dislike to the petted one. do not rouse the old adam in them. let children be taught to be "kindly affectioned one to another with brotherly love;" let them be encouraged to share each other's toys and playthings, and to banish selfishness. attend to a child's _little_ pleasures. it is the _little_ pleasures of a child that constitute his happiness. great pleasures to him and to us all (as a favourite author remarks) come but seldom, and are the exceptions, and not the rule. let a child he nurtured in love. "it will be seen," says the author of _john halifax_, "that i hold this law of kindness as the alpha and omega of education. i once asked one, in his own house, a father in everything but the name, his authority unquestioned, his least word held in reverence, his smallest wish obeyed--'how did you ever manage to bring up these children?' he said: '_by love_.'" let every word and action prove that you love your children. enter into all their little pursuits and pleasures. join them in their play, and be a "child again!" if they are curious, do not check their curiosity; but rather encourage it; for they have a great deal--as we all have--to learn, and how can they know if they are not taught? you may depend upon it the knowledge they obtain from observation is far superior to that obtained from books. let all you teach them, let all you do, and let all you say bear the stamp of love. "endeavour, from first to last, in your intercourse with your children, to let it bear the impress of _love_. it is not enough that you _feel_ affection towards your children--that you are devoted to their interests; you must show in your manner the fondness of your hearts towards them. young minds cannot appreciate great sacrifices made for them; they judge their parents by the words and deeds of every-day life. they are won by _little_ kindnesses, and alienated by _little_ acts of neglect or impatience. one complaint unnoticed, one appeal unheeded, one lawful request arbitrarily refused, will be remembered by your little ones more than a thousand acts of the most devoted affection."--_the protoplast_. a placid, well-regulated temper is very conducive to health. a disordered, or an over-loaded stomach, is a frequent cause of peevishness. appropriate treatment in such a case will, of course, be necessary. . _my child stammers: can you tell me the cause, and can you suggest a remedy_? a child who stammers is generally "nervous," quick, and impulsive. his ideas flow too rapidly for speech. he is "nervous;" hence, when he is alone, and with those he loves, he oftentimes speaks fluently and well; he stammers more both when he is tired and when he is out of health--when the nerves are either weak or exhausted. he is emotional: when he is either in a passion or in excitement, either of joy or of grief, he can scarcely speak--"he stammers all over." he is impulsive: he often stammers in consequence. he is in too great a hurry to bring out his words; they do not flow in proper sequence: hence his words are broken and disjointed. stammering, of course, might be owing either to some organic defect, such as from defective palate, or from defective brain, then nothing will cure him; or it might be owing to "nervous" causes--to "irregular nervous action," then a cure might, with care and perseverance, be usually effected. in all cases of stammering of a child, let both the palate of his mouth and the bridle of his tongue be carefully examined, to see that neither the palate be defective, nor the bridle of the tongue be too short--that he be not tongue-tied. _now, with regard to treatment._--make him speak slowly and deliberately: let him form each word, without clipping or chopping; let him be made, when you are alone with him, to exercise himself in elocution. if he speak quickly, stop him in his mid-career, and make him, quietly and deliberately, go through the sentence again and again, until he has mastered the difficulty; teach him to collect his thoughts, and to weigh each word ere he give it utterance; practise him in singing little hymns and songs for children; this you will find a valuable help in the cure. a stammerer seldom stutters when he sings. when he sings, he has a full knowledge of the words, and is obliged to keep in time--to sing neither too fast nor too slow. besides, he sings in a different key to his speaking voice. many professors for the treatment of stammering cure their patients by practising lessons of a sing-song character. never jeer him for stammering, nor turn him to ridicule; if you do, it will make him ten times worse; but be patient and gentle with him, and endeavour to give him confidence, and encourage him to speak to you as quietly, as gently, and deliberately as you speak to him; tell him not to speak, until he has arranged his thoughts and chosen his words; let him do nothing in a hurry. demosthenes was said, in his youth, to have stammered fearfully, and to have cured himself by his own prescription, namely, by putting a pebble in his mouth, and declaiming, frequently, slowly quietly, and deliberately, on the sea-shore--the fishes alone being his audience,-- until at length he cured himself, and charmed the world with his eloquence and with his elocution. he is held up, to this very day, as the personification and as the model of an orator. his patience, perseverance, and practice ought, by all who either are, or are, interested in a stammerer, to be borne in mind and followed. . _do you approve of a carpet in a nursery_? no, unless it be a small piece for a child to roll upon. a carpet harbours dirt and dust, which dust is constantly floating about the atmosphere, and thus making it impure for him to breathe. the truth of this may be easily ascertained by entering a darkened room, where a ray of sunshine is struggling through a crevice in the shutters. if the floor of a nursery must be covered, let drugget be laid down, and this may every morning be taken up and shaken. the less furniture a nursery contains the better, for much furniture obstructs the free circulation of the air, and, moreover, prevents a child from taking proper play and exercise in the room--an abundance of which are absolutely necessary for his health. . _supposing there is not a fire in the nursery grate, ought the chimney to be stopped to prevent a draught in the room_? certainly not. i consider the use of a chimney to be two-fold--first, to carry off the smoke, and secondly (which is of quite as much importance), to ventilate the room, by carrying off the impure air, loaded as it is with carbonic acid gas--the refuse of respiration. the chimney, therefore, should never, either winter or summer, be allowed for one moment to be stopped. this is important advice, and requires the strict supervision of every mother, as servants will, if they have the chance, stop all chimneys that have no fires in the grates. exercise. . _do you approve, during the summer months, of sending a child out before breakfast_? i do, when the weather will permit, and provided the wind be neither in an easterly nor in a north-easterly direction; indeed, _he can scarcely be too much in the open air_. he must not be allowed to stand about draughts or about entries, and the only way to prevent him doing so is for the mother herself to accompany the nurse. she will then kill two birds with one stone, as she will, by doing so, benefit her own as well as her child's health. . _ought a child to be early put on his feet to walk_? no: let him learn to walk himself. he ought to be put upon a carpet; and it will be found that when he is strong enough, he will hold by a chair, and will stand alone: when he can do so, and attempts to walk, he should then be supported. you must, on first putting him upon his feet, be guided by his own wishes. he will, as soon as he is strong enough to walk, have the inclination to do so. when he has the inclination and the strength it will be folly to restrain him; if he have neither the inclination nor the strength, it will be absurd to urge him on. rely, therefore, to a certain extent, upon the inclination of the child himself. self-reliance cannot be too early taught him, and, indeed, every one else. in the generality of instances, however, a child is put on his feet too soon, and the bones, at that tender age, being very flexible, bend, causing bowed and bandy-legs; and the knees, being weak, approximate too closely together, and thus they become knock-kneed. this advice of _not_ putting a child _early_ on his feet, i must strongly insist on, as many mothers are so ridiculously ambitious that their young ones should walk early--that they should walk before other children of their acquaintance have attempted--that they have frequently caused the above lamentable deformities; which is a standing reproach to them during the rest of their lives. . _do you approve of perambulators_? i do not, for two reasons:--first, because when a child is strong enough, he had better walk as much as he will; and, secondly, the motion is not so good, and the muscles are not so much put into action, and consequently cannot be so well developed, as when he is earned. a perambulator is very apt to make a child stoop, and to make him both crooked and round-shouldered. he is cramped by being so long in one position. it is painful to notice a babe of a few months old in one of these newfangled carriages. his little head is bobbing about first on one side and then on the other--at one moment it is dropping on his chest, the next it is forcibly jolted behind: he looks, and doubtless feels, wretched and uncomfortable. again, these perambulators are dangerous in crowded thoroughfares. they are a public nuisance, inasmuch as they are wheeled against and between people's legs, and are a fruitful source of the breaking of shins, of the spraining of ankles, of the crushing of corns, and of the ruffling of the tempers of the foot-passengers who unfortunately come within their reach; while, in all probability, the gaping nurses are staring another way, and every way indeed but the right, more especially if there be a redcoat in the path! besides, in very cold weather, or in a very young infant, the warmth of the nurse's body, while he is being carried, helps to keep him warm, he himself being naturally cold. in point of fact, the child, while being borne in the nurse's arms, reposes on the nurse, warm and supported, as though he were in a nest! while, on the other hand, if he be in a perambulator, he is cold and unsupported, looking the very picture of misery, seeking everywhere for test and comfort, and finding none! a nurse's arm, then, is the only proper carriage for a _young_ child to take exercise on. she ought to change about, first carrying frim on the one arm, and then on the other. nursing him on one arm only might give his body a twist on one side, and thus might cause deformity. when he is old enough to walk, and is able properly to support the weight of his own neck and back, then there will be no objection, provided it be not in a crowded thoroughfare, to his riding occasionally in a perambulator; but when he is older still, and can sit either a donkey or a pony, such exercise will be far more beneficial, and will afford him much greater pleasure. . _supposing it to be wet under foot, but dry above, do you then approve of sending a child out_? if the wind be neither in the east nor the north-east, and if the air be not damp, let him be well wrapped up and be sent out. if he be labouring under an inflammation of the lungs, however slight, or if he be just recovering from one, it would, of coarse, be highly improper. in the management of a child, we must take care neither to coddle nor to expose him unnecessarily, as both are dangerous. never send a child out to walk in a fog; he will, if you do, be almost sure to catch cold. it would be much safer to send him out in rain than in fog, though neither the one nor the other would be desirable. . _how many times a day in fine weather ought a child to be sent out_? let him be sent out as often as it be possible. if a child lived more in the open air than he is wont to do, he would neither be so susceptible of disease, nor would he suffer so much from teething, nor from catching cold. . _supposing the day to be wet, what exercise would you then recommend_? the child ought to run either about a large room, or about the hall; and if it does not rain violently, you should put on his hat and throw up the window, taking care while the window is open that he does not stand still. a wet day is the day for him to hold his high court of revelry, and "to make him as happy as the day is long." do not on any account allow him to sit any length of time at a table, amusing himself with books, &c.; let him be active and stirring, that his blood may freely circulate as it ought to do, and that his muscles may be well developed. i would rather see him actively engaged in mischief than sitting still, doing nothing! he ought to be put on the carpet, and should then be tumbled and rolled about, to make the blood bound merrily through, the, vessels, to stir up the liver, to promote digestion, and to open the bowels. the misfortune of it is, the present race of nurses are so encumbered with long dresses, and so screwed in with tight stays (aping their betters), that they are not able to stoop properly, and thus to have a good game of romps with their little charges. "doing nothing is doing ill" is as true a saying as was ever spoken. . _supposing it to be winter, and the weather to be very cold, would you still send a child out_? decidedly, provided he be well wrapped up. the cold will brace and strengthen him. cold weather is the finest tonic in the world. in frosty weather, the roads being slippery, when you send him out to walk, put a pair of large old woollen stockings over his boots or shoes. this will not only keep his feet and his legs warm, but it will prevent him from falling down and hurting himself. while thus equipped, he may even walk on a slide of ice without falling down! a child, in the winter time, requires, to keep him warm, plenty of flannel and plenty of food, plenty of fresh and genuine milk, and plenty of water in his tub to wash and bathe him in a morning, plenty of exercise and plenty of play, and then he may brave the frosty air. it is the coddled, the half-washed, and the half-starved child (half-washed and half-starved from either the mother's ignorance or from the mother's timidity), that is the chilly starveling,--catching cold at every breath of wind, and every time he either walks or is carried out,--a puny, skinny, scraggy, scare-crow, more dead than alive, and more fit for his grave than for the rough world he will have to struggle in! if the above advice be strictly followed, a child may be sent out in the coldest weather, even-- "when icicles hang by the wall, and dick, the shepherd, blows his nail; and tom bears logs into the hall, and milk comes frozen home in pail." _shakspeare_. amusements. . _have you any remarks to make on the amusements of a child_? let the amusements of a child be as much as possible out of doors; let him spend the greater part of every day in the open air; let him exert himself as much as he please, his feelings will tell him when to rest and when to begin again; let him be what nature intended mm to be--a happy, laughing, joyous child. do not let him be always poring over books:-- "books! 'tis a dull and endless strife, come, hear the woodland linnet! how sweet his music! on my life, there's more of wisdom in it. and hark! how blithe the throstle sings! he, too, is no mean preacher: come forth into the light of things,-- let nature be your teacher. she has a world of ready wealth, our minds and hearts to bless,-- spontaneous wisdom breathed by health, truth breathed by cheerfulness. one impulse from a vernal wood may teach you more of man, of moral evil and of good, than, all the sagea can."--_wordsworth._ he ought to be encouraged to engage in those sports wherein the greatest number of muscles are brought into play. for instance, to play at ball, or hoop, or football, to play at horses, to run to certain distances and back; and, if a girl, to amuse herself with a skipping rope, such, being excellent exercise-- "by sports like these are all their cares beguiled, the sports of children satisfy the child."--_goldsmith._ every child, where it be practicable, should have a small plot of ground to cultivate, that he may dig and delve in, and make dirt-pies if he choose. children now-a-days, unfortunately, are not allowed to soil their hands and their fine clothes. for my own part, i dislike such model children; let a child be natural--let him, as far as is possible, choose his own sports. do not be always interfering with his pursuits, and be finding fault with him. remember, what may be amusing to you may be distasteful to him. i do not, of course, mean but that you should constantly have a watchful eye over him; yet do not let him see that he is under restraint or surveillance; if you do, you will never discover his true character and inclinations. not only so, but do not dim the bright sunshine of his early life by constantly checking and thwarting him, tupper beautifully says-- "and check not a child in his merriment,-- should not his morning be sunny?" when, therefore, he is either in the nursery or in the play-ground, let him shout and riot and romp about as much as he please. his lungs and his muscles want developing, and his nerves require strengthening; and how can such be accomplished unless you allow them to be developed and strengthened by natural means? the nursery is a child's own domain; it is his castle, and he should be lord paramount therein. if he choose to blow a whistle, or to spring a rattle, or to make any other hideous noise, which to him is sweet music, he should be allowed, without let or hindrance, to do so. if any members of the family have weak nerves, let them keep at a respectful distance. a child who never gets into mischief must be either sly, or delicate, or idiotic; indeed, the system of many persons, in bringing up children, is likely to make them either the one or the other. the present plan of training children is nearly all work (books), and very little play. play, and plenty of it, is necessary to the very existence of a child. a boy not partial to mischief, innocent mischief, and play, is unnatural; he is a man before his time, he is a nuisance, he is disagreeable to himself and to every one around. he is generally a sneak, and a little humbug. girls, at the present time, are made clever simpletons; their brains are worked with useless knowledge, which totally unfits them for every-day duties. their muscles are allowed to be idle, which makes them limp and flabby. the want of proper exercise ruins the complexion, and their faces become of the colour of a tallow candle! and precious wives and mothers they make when they do grow up! grow up, did i say? they grow all manner of ways, and are as crooked as crooked sticks! what an unnatural thing it is to confine a child several hours a day to his lessons; why, you might as well put a colt in harness, and make him work for his living! a child is made for play; his roguish little eye, his lithe figure, his antics, and his drollery, all point out that he is cut out for play--that it is as necessary to his existence as the food he eats, and as the air he breathes! a child ought not to be allowed to have playthings with which he can injure either himself or others, such as toy-swords, toy-cannons, toy-paint-boxes, knives, bows and arrows, hammers, chisels, saws, &c. he will not only be likely to injure himself and others, but will make sad havoc on furniture, house, and other property. fun, frolic, and play ought, in all innocent ways, to be encouraged; but wilful mischief and dangerous games ought, by every means, to be discountenanced. this advice is frequently much needed, as children prefer to have and delight in dangerous toys, and often coax and persuade weak and indulgent mothers to gratify their wishes. _painted_ toys are, many of them, highly dangerous, those painted _green_ especially, as the colour generally consists of scheele's green--arsenite of copper. children's paint-boxes are very dangerous toys for a child to play with; many of the paints are poisonous, containing arsenic, lead, gamboge, &c, and a child, when painting, is apt to put the brush into his mouth, to absorb the superabundant fluid. of all the colours, the _green_ paint is the most dangerous, as it is frequently composed of arsenite of copper--arsenic and copper--two deadly poisons. there are some paint-boxes warranted not to contain a particle of poison of any kind these ought, for a child, to be chosen by a mother. but, remember, although he ought not to be allowed to have poison paint-boxes and poison painted toys, _he must have an abundance of toys,_ such as the white wood toys--brewers' drays, millers' waggons, boxes of wooden bricks, &c. the noah's ark is one of the most amusing and instructive toys for a child. "those fashioned out of brown, unpainted pine-wood by the clever carvers of nuremberg or the black forest are the best, i think, not only because they are the most spirited, but because they will survive a good deal of knocking about and can be sucked with impunity from the first dawn of recollection, children are thus familiarised with the forms of natural objects, and may be well up in natural history before they have mastered the abc" [footnote: from an excellent article _about toys,_ by j hamilton fyfe in _good words_ for december .] parents often make sunday a day of gloom; to this i much object. of all the days in the week, sunday should be the most cheerful and pleasant. it is considered by our church a festival, and a glorious festival it ought to be made, and one on which our heavenly father wishes to see all his children happy and full of innocent joy. let sunday, then, be made a cheerful, joyous, innocently happy day, and not, as it frequently is, the most miserable and dismal in the week. it is my firm conviction that many men have been made irreligious by the ridiculously strict and dismal way they were compelled, as children, to spend their sundays. you can no more make a child religious by gloomy asceticism, than yon can make people good by act of parliament. one of the great follies of the present age is, children's parties, where they are allowed to be dressed up like grown-up women, stuck out in petticoats, and encouraged to eat rich cake and pastry, and to drink wine, and to sit up late at night! there is something disgusting and demoralising in all this. their pure minds are blighted by it. do not let me be misunderstood: there is not the least objection, but, on the contrary, great advantage, for friends' children to meet friends' children; but then let them be treated as children, and not as men and women! . _do you approve of public play-grounds for children_? it would be well, in every village, and in the outskirts of every town, if a large plot of ground were set apart for children to play in, and to go through regular gymnastic exercises. play is absolutely necessary to a child's very existence, as much as food and sleep; but in many parts of england where is he to have it? playgrounds and play are the best schools we have; they teach a great deal not taught elsewhere; they give lessons in health, which is the grandest wealth that can be bestowed--"for health is wealth;" they prepare the soil for the future schoolmaster; they clear the brain, and thus the intellect, they strengthen the muscles; they make the blood course merrily through the arteries; they bestow healthy food for the lungs; they give an appetite; they make a child, in due time, become every inch a man! play-grounds and play are one of the finest institutions we possess. what would our large public schools be without their play and cricket grounds? they would be shorn of half their splendour and their usefulness! there is so much talk now-a-days about _useful_ knowledge, that the importance of play and play-grounds is likely to be forgotten. i cannot help thinking however, that a better state of things is dawning. "it seems to be found out that in our zeal for useful knowledge, that knowledge is found to be not the least useful which treat boys as active, stirring, aspiring, and ready." [footnote: _the saturday review_, december , .] . _do you approve of infant schools_? i do, if the arrangements be such that health is preferred before learning. [footnote: "according to aristotle, more care should be taken of the body than of the mind for the first seven years; strict attention to diet be enforced, &c. . . . . . the eye and ear of the child should be most watchfully and severely guarded against contamination of every kind, and unrestrained communication with servants be strictly prevented. even his amusements should be under due regulation, and rendered as interesting and intellectual as possible."--the rev john williams, in his _life and actions of alexander the great_] let children be only confined for three or four hours a day, and let what little they learn be taught as an amusement rather than as a labour. a play-ground ought to be attached to an infant school; where, in fine weather, for every half-hour they spend in-doors, they should spend one in the open air; and, in wet weather, they ought to have, in lieu of the play-ground, a large room to romp, and shout, and riot in. to develop the different organs, muscles, and other parts of the body, children require fresh air, a free use of their lungs, active exercise, and their bodies to be thrown into all manner of attitudes. let a child mope in a corner, and he will become stupid and sickly. the march of intellect, as it is called, or rather the double quick march of intellect, as it should be called, has stolen a march upon health. only allow the march of intellect and the march of health to take equal strides, and then we shall have "_mens sana in corpore sano_" (a sound mind in a sound body). in the education of a young child, it is better to instruct him by illustration, by pictures, and by encouraging observation on things around and about him, than by books. it is surprising how much, without endangering his health, may be taught in this way. in educating your child, be careful to instil and to form good habits--they will then stick to him for life. children at the present day are too highly educated--their brains are over-taxed, and thus weakened. the consequence is, that as they grow up to manhood, if they grow up at all, they become fools! _children_ are now taught what formerly _youths_ were taught. the chord of a child's life is ofttimes snapped asunder in consequence of over education:-- "screw not the cord too sharply, lest it snap"--_tennyson_. you should treat a child as you would a young colt. think only at first of strengthening his body. let him have a perfectly free, happy life, plenty of food to eat, abundance of air to breathe, and no work to do; there is plenty of time to think of his learning--of giving him brain work. it will come sadly too soon; but do not make him old before his time. . _at what age do you advise my child to begin his course of education--to have his regular lessons_? in the name of the prophet,--figs! fiddlesticks! about courses of education and regular lessons for a child! you may as well ask me when he, a child, is to begin hebrew, the sanscrit, and mathematics! let him have a course of education in play; let him go through regular lessons in foot-ball, bandy, playing at tic, hares and hounds, and such like excellent and really useful and health-giving lessons. begin his lessons! begin brain work, and make an idiot of him! oh! for shame, ye mothers! you who pretend to love your children so much, and to tax, otherwise to injure, irreparably to injure their brains, and thus their intellects and their health, and to shorten their very days. and all for what? to make prodigies of them! forsooth! to make fools of them in the end, . _well, then, as you have such a great objection to a child commencing his education early in life, at what age may he, with safety, commence his lessons? and which do you prefer--home or school education_? home is far preferable to a school education. he is, if at home, under your own _immediate_ observation, and is not liable to be contaminated by naughty children; for, in every school, there is necessarily a great mixture of the good and of the bad; and a child, unfortunately, is more likely to be led by the bad than by the good. moreover, if he be educated at home, the mother can see that his brain is not over-worked. at school the brain is apt to be over-worked, and the stomach and the muscles to be under-worked. remember, as above stated, _the brain must have but very little work until the child be seven years old;_ impress this advice upon your memory, and let no foolish ambition to make your child a clever child allow you, for one moment, to swerve from this advice. build up a strong, healthy body, and in due time the brain will bear a _moderate_ amount of intellectual labour. as i have given _you_ so much advice, permit me, for one moment, to address a word to the father of your child:-- let me advise you, then, mr. _pater familias_, to be careful how you converse, what language you use, while in the company of your child. bear in mind, a child is very observant, and thinks much, weighs well, and seldom forgets all you say and all you do! let no hasty word, then, and more especially no oath, or no impious language, ever pass your lips, if your child be within hearing. it is, of course, at all times wicked to swear; but it is heinously and unpardonably sinful to swear in the presence of your child! "childhood is like a mirror, catching and reflecting images. one impious or profane thought, uttered by a parent's lip, may operate upon the young heart like a careless spray of water thrown upon polished steel, staining it with rust, which no after scouring can efface." never talk secrete before a child--"little pitchers have long ears;" if you do, and he disclose your secrets--as most likely he will--and thus make mischief, it will be cruel to scold him; you will, for your imprudence, have yourself only to blame. be most careful, then, in the presence of your child, of what you say, and of whom you speak. this advice, if followed, might save a great deal of annoyance and vexation. . _are you an advocate for a child being taught singing?_ i am: i consider singing a part of his education. singing expands the walls of his chest, strengthens and invigorates his lungs, gives sweetness to his voice, improves his pronunciation, and is a great pleasure and amusement to him. sleep. . _do you approve of a child sleeping on a_ feather _bed_? a _feather_ bed enervates his body, and, if he be so predisposed, causes rickets, and makes him crooked. a horse-hair mattress is the best for a child to lie on. the pillow, too, should be made of horse-hair. a _feather_ pillow often causes the bead to be bathed in perspiration, thus enervating the child, and making him liable to catch cold. if he be at all rickety, if he be weak in the neck, if he be inclined to stoop, or if he be at all crooked, let him, by all means, lie without a pillow. . _do you recommend a child, in the middle of the day, to be put to sleep_? let him be put on his mattress _awake_, that he may sleep for a couple of hours before dinner, then he will rise both refreshed and strengthened for the remainder of the day. i said, let him be put down _awake_. he might, for the first few times, cry, but, by perseverance, he will without any difficulty fall to sleep. the practice of sleeping before dinner ought to be continued until he be three years old, and, if he can be prevailed upon, even longer. for if he do not have sleep in the middle of the day, he will all the afternoon and the evening be cross; and when he does go to bed, he will probably be too tired to sleep, or his nerves having been exhausted by the long wakefulness, he will fall into a troubled, broken slumber, and not into that sweet, soft, gentle repose, so characteristic of healthy, happy childhood! . _at what hour ought a child to be put to bed in the evening_? at six in the winter, and at seven o'clock in the summer. _regularity_ ought to be observed, _as regularity is very conducive to health._ it is a reprehensible practice to keep a child up until nine or ten o'clock at night. if this be done, he will, before his time, become old, and the seeds of disease will be sown, as soon as he can run, let him be encouraged, for half an hour before he goes to bed, to race either about the hall, or the landing, or a large room, which will be the best means of warming his feet, of preventing chilblains, and of making him sleep soundly. . _have you any directions to give me at to the placing of my child in his bed_? if a child lie alone, place him fairly on his aide in the middle of the bed; if it be winter time, see that his arms and hands be covered with the bed-clothes; if it be summer, his hands might be allowed to be outside the clothes. in putting him down to sleep, you should ascertain that his face be not covered with the bedclothes; if it be, he will he poisoned with his own breath--the breath constantly giving off carbonic acid gas; which gas must, if his face be smothered in the clothes; be breathed--carbonic acid gas being highly poisonous. you can readily prove the existence of carbonic and gas in the breathing, by simply breathing into a little lime-water; after breathing for a few seconds into it, a white film will form on the top; the carbonic acid gas from the breath unites with the lime of the lime-water and the product of the white film is carbonate of lime. . _do you advise a bedroom to be darkened at night_? certainly: a child sleeps sounder and sweeter in a dark than in a light room. there is nothing better for the purpose of darkening a bedroom, than venetian blinds. remember, then, a well-ventilated, but a darkened, chamber at night. the cot or the crib ought _not_ to face the window, "as the light is best behind." [footnote: sir charles locock in a letter to the author. ] . _which is the beat position for a child when sleeping--on his back, or on his side_? his side: he ought to be accustomed to change about on the right side one night, on the left another; and occasionally, for a change, he should lie on his back. by adopting this plan, you will not only improve his figure, but likewise his health. lying, night after night, in one position, would be likely to make him crooked. . _do you advise, in the winter time, that there should be a fire in the night nursery_? certainly not, unless the weather be intensely cold. i dislike fires in bedrooms, especially for children; they are very enervating, and make a child liable to catch cold. cold weather is very bracing, particularly at night "generally speaking," says the _siecle_, "during winter, apartments are too much heated. the temperature in them ought not to exceed deg. centigrade ( deg. fahrenheit); and even in periods of great cold scientific men declare that deg. or deg. had better not be exceeded. in the wards of hospitals, and in the chambers of the sick, care is taken not to have greater heat than deg.. clerks in offices, and other persons of sedentary occupations, when rooms in which they sit are too much heated, are liable to cerebral [brain] congestion and to pulmonary [lung] complaints. in bedrooms, and particularly those of children, the temperature ought to be maintained rather low; it is even prudent only rarely to make fires in them, especially during the night" if "a cold stable make a healthy horse," i am quite sure that a moderately cold and well-ventilated bedroom helps to make a healthy child. but, still, in the winter time, if the weather be biting cold, a _little_ fire in the bedroom grate is desirable. in bringing up children, we must never run into extremes--the coddling system and the hardening system are both to be deprecated; the coddling system will make the strong child weakly, while the hardening system will probably kill a delicate one. a child's bed ought, of course, to be comfortably clothed with blankets--i say blankets, as they are much superior to coverlids; the perspiration will more readily pass through a blanket than a coverlid. a _thick_ coverlid ought never to be used; there is nothing better, for a child's bed, than the old-fashioned patchwork coverlid, as the perspiration will easily escape through it. . _should a child be washed and dressed_ as soon as he awake _in the morning_? he ought, if he awake in anything like reasonable time; for if he doze after he be once awake, such slumber does him more harm than good. he should be up every morning as soon as it is light if, as a child, he be taught to rise early, it will make him an early riser for life, and will tend greatly to prolong both his existence and his happiness. _never awake a child from his sleep_ to dress him, to give him medicine, or for any other purpose; _let him always sleep as long as he can;_ but the moment he awakes let him be held out, and then let him be washed and dressed, and do not wait, as many a silly nurse does, until he have wet his bed, until his blood be chilled, and until he be cross, miserable, and uncomfortable! how many babes are made ill by such foolish practices! the moment he leaves his bed, turn back to the fullest extent the clothes, in order that they may be thoroughly ventilated and sweetened. they ought to be exposed to the air for at least an hour before the bed be made. as soon as he leaves his room, be it winter or summer, throw open the windows. . _ought a child to lie alone_? he should, after he is weaned. he will rest more comfortably, and his sleep will be more refreshing. . _supposing a child should not sleep well, what ought to be done? would you give him a dose of composing medicine_? certainly not. try the effects of exercise. exercise in the open air is the best composing medicine in the world. let the little fellow be well tired out, and there will be little fear of his not sleeping. . _have you any further observations to make on the subject of sleep_? send a child joyful to bed. do not, if you can possibly help it, let him go to bed crying. let the last impressions he has at night be of his happy home, and of his loving father and mother and let his last thoughts be those of joy and gladness. he will sleep all the sounder if he be sent to bed in such a frame of mind, and he will be more refreshed and nourished in the morning by his sleep. . _what are the usual causes of a child walking in his sleep, and what measures during such times, ought to be adopted to prevent his injuring himself_? a disordered stomach, in a child of nervous temperament, or worms, are usually the causes. the means to be adopted to prevent his throwing himself out of the window, are to have bars to his chamber present, and if that be not practicable, to have either nails or screws driven into the window sash to allow the window to open only for a sufficient space for ventilation, and to have a screw window fastening, in order that he cannot, without difficulty, open the window, to have a trusty person to sleep in his room, who should have directions given not to rouse him from his sleep, but to gently lead him back to his bed, which may frequently be done without awaking him, and to consult a medical man, who will adopt means to destroy the worms, to put his stomach into order, to brace his nerves, and to strengthen his general system. a trip to the coast and sea bathing, in such a case, is often of great service. second dentition. . _when does a child commence to cut his second set of teeth_? generally at seven years old. he _begins to cut_ them at about that time: but it should be borne in mind (so wonderful are the works of god) that the _second_ crop of teeth, _in embryo_, is actually bred and formed from the very commencement of his life, _under_ the first tier of teeth, but which remain in abeyance for years, and do not come into play until the _first_ teeth, having done their duty, loosen and fall out, and thus make room for the more numerous, larger, stronger, and more permanent teeth, which latter have to last for the remainder of his existence. the _first_ set is sometimes cut with a great deal of difficulty, and produces various diseases; the _second_, or permanent teeth, come easily, and are unaccompanied with any disorder. the following is the process:--one after another of the _first_ set gradually loosen, and either drop out, or with little pain are readily pulled out; under these, the _second_--the permanent--teeth make their appearance, and fill up the vacant spaces. the fang of the tooth that has dropped out is nearly all absorbed or eaten away, leaving little more than the crown. the _first_ set consists of twenty; the _second_ (including the wise-teeth, which are not, generally cut until after the the age of twenty-seven) consists of thirty-two. i would recommend you to pay particular attention to the teeth of your children; for, besides their being ornamental, their regularity and soundness are of great importance to the present as well as to the future health of your offspring. if there be any irregularity in the appearance of the _second_ set, lose no time in consulting an experienced and respectable dentist. on disease, etc. . _do you think it important that i should be made acquainted with the symptoms of the serious diseases of children_? certainly i am not advocating the doctrine of a mother _treating serious_ diseases; far from it, it is not her province, except in certain cases of extreme urgency, where a medical man cannot be procured, and where delay might be death; but i do insist upon the necessity of her knowing the _symptoms_ of disease. my belief is, that if parents were better informed on such subjects, many children's lives might be saved, much suffering averted, and sorrow spared. the fact is, the knowledge of the symptoms of disease is, to a mother, almost a sealed book. if she were better acquainted with these matters, how much more useful would she be in a sick-room, and how much more readily would she enter into the plans and views of the medical man! by her knowledge of the symptoms, and by having his advice in time, she would nip disease in the bud, and the fight might end in favour of life, for "sickness is just a fight between life and death."--_geo. m'donald._ it is really lamentable to contemplate the amount of ignorance that still exists among mothers in all that appertains to the diseases of children; although, fortunately, they are beginning to see and to feel the importance of gaining instruction on such subjects; but the light is only dawning. a writer of the _medical times and gazette_ makes the following remarks, which somewhat bear on the subject in question. he observes--"in spite of the knowledge and clear views possessed by the profession on all that concerns the management of children, no fact is more palpable than that the most grievous ignorance and incompetency prevail respecting it among the public. we want some means of making popular the knowledge which is now almost restricted to medical men, or, at most, to the well-educated classes." in the earlier editions of this work i did not give the _treatment_ of any serious diseases, however urgent. in the eight last editions, i have been induced, for reasons i will presently state, to give the _treatment_ of some of the more urgent _serious_ diseases, when a medical man cannot instantly be procured, and where delay might be death. sir charles locock, who has taken a kind interest in this little work, has given me valid reasons why a mother should be so enlightened. the following extracts are from a letter which i received from sir charles on the subject, and which he has courteously allowed me to publish. he says,--"as an old physician of some experience in complaints of infants and children, i may perhaps be allowed to suggest that in a future edition you should add a few words on the actual treatment of some of the more urgent infantile diseases. it is very right to caution parents against superseding the doctor, and attempting to manage serious illness themselves, but your advice, with very small exceptions, always being 'to lose no tune in sending for a medical man,' much valuable and often irremediable time may be lost _when a medical man is not to be had_. take, for instance, a case of croup there are no directions given at all, except to send for a medical man, and always to keep medicines in the house which he may have directed. but how can this apply to a first attack? you state that a first attack is generally the worst. but why is it so? simply because it often occurs when the parents do not recognise it, and it is allowed to get a worse point than in subsequent attacks, when they are thoroughly alive to it. as the very best remedy, and often the only essential one, if given early, is a full emetic, surely it is better that you should give some directions as to this in a future edition, and i can speak from my own experience when i say that an emetic, _given in time_, and repeated to free vomiting, will cut short _any_ case of croup. in nine cases out of ten the attack takes place in the evening or early night, and when vomiting is effected the dinner of that day is brought up nearly undigested, and the seventy of the symptoms at once cut short. whenever any remedy is valuable, the more by its being administered _in time_, it is surely wiser to give directions as to its use, although, as a general rule, it is much better to advise the sending for medical advice." the above reasons, coming from such a learned and experienced physician as sir charles locock, are conclusive, and have decided me to comply with his advice, to enlighten a mother on the _treatment_ of some of the more urgent diseases of infants and of children. in a subsequent letter addressed to myself, sir charles has given me the names of those _urgent_ diseases, which he considers may be treated by a mother "where a medical man cannot be procured quickly, or not at all." they are croup: inflammation of the lungs; diptheria; dysentry; diarrhoea; hooping cough, in its various stages; and shivering fit. sir charles sums up his letter to me by saying, "such a book ought to be made as complete as possible, and the objections to medical treatment being so explained as to induce mothers to try to avoid medical men is not so serious as that of leaving them without any guide in those instances where every delay is dangerous, and yet where medical assistance is not to be obtained or not to be had quickly." in addition to the above i shall give you the _treatment_ of bronchitis, measles, and scarlet fever. bronchitis is one of the most common diseases incidental to childhood, and, with judicious treatment, is, in the absence of the medical man, readily managed by a sensible mother. measles is very submissive to treatment. scarlet fever, _if it be not malignant_, and, _if it be not complicated with diphtheric-croup_, and if certain rules be strictly followed, is also equally amenable to treatment. i have been fortunate in treating scarlet fever, and i therefore think it desirable to enter fully into the _treatment_ of a disease which is looked upon by many parents, and, according to the usual mode of treatment, with just cause, with great consternation and dread. by giving my plan of treatment, fully and simply, and without the slightest reservation, i am fully persuaded, through god's blessing, that i may be the humble means of saving the lives of numbers of children. the diseases that might be treated by a mother, in the absence of a medical man, will form the subject of future conversations. i think it right to promise that in all the prescriptions for a child i have for the use of a mother given, i have endeavoured to make them as simple as possible, and have, whenever practicable, avoided to recommend powerful drugs. complicated prescriptions and powerful medicines might, as a rule, to be seldom given; and when they are, should only be administered by a judicious medical man: a child requiring much more care and gentleness in his treatment than an adult: indeed, i often think it would be better to leave a child to nature rather than to give him powerful and large doses of medicines. a remedy--calomel, for instance--has frequently done more mischief than the disease itself; and the misfortune of it is, the mischief from that drug has oftentimes been permanent, while the complaint might, if left alone, have only been temporary. . _at what age does water in the brain usually occur, and how is a mother to know that her child is about to labour under that disease_? water on the brain is, as a rule, a disease of childhood: after a child is seven years old it is comparatively rare. it more frequently attacks delicate children--children who have been dry nursed (especially if they have been improperly fed), or who have been suckled too long, or who have had consumptive mothers, or who have suffered severely from toothing, or who are naturally of a feeble constitution. water on the brain sometimes follows an attack of inflammation of the lungs, more especially if depressing measures (such as excessive leeching and the administration of emetic tartar) have been adopted. it occasionally follows in the train of contagious eruptive diseases, such as either small-pox or scarlatina. we may divide the symptoms of water on the brain into two stages. the first--the premonitory stage--which lasts for or five days, in which medical aid might be of great avail: the second--the stage of drowsiness and of coma--which usually ends in death. i shall dwell on the first--the premonitory stage--in order that a mother may see the importance without loss of time of calling in a medical man:-- if her child be feverish and irritable, if his stomach be disordered, if he have urgent vomitings, if he have a foul breath, if his appetite be capricious and bad, if his nights be disturbed (screaming out in his sleep), if his bowels be disordered, more especially if they be constipated, if he be more than usually excited, if his eye gleam with unusual brilliancy, if his tongue run faster than it is wont, if his cheek be flushed and his head be hot, and if he be constantly putting his hand to his head; there is cause for suspicion. if to these symptoms be added, a more than usual carelessness in tumbling about, in hitching his foot in the carpet, or in dragging one foot after the other; if, too, he has complained of darting, shooting, lancinating pains in his head, it may then be known that the _first_ stage of inflammation (the forerunner of water on the brain) either has taken, or is about taking place. remember no time ought to be lost in obtaining medical aid; for the _commencement_ of the disease is the golden opportunity, when life might probably be saved. . _at what age, and in what neighbourhood, is a child most liable to croup, and when is a mother to know that it is about to take place_? it is unusual for a child until he be twelve months old to have croup: but, from that time until the age of two years, he is more liable to it than at any other period. the liability after two years, gradually, until he be ten years old, lessens, after which time it is rare. a child is more liable to croup in a low and damp, than in a high and dry neighbourhood; indeed, in some situations, croup is almost an unknown disease; while in others it is only too well understood. croup is more likely to prevail when the wind is either easterly or north-easterly. there is no disease that requires more prompt treatment than croup, and none that creeps on more insidiously. the child at first seems to be labouring under a slight cold, and is troubled with a little _dry_ cough, he is hot and fretful, and hoarse when he cries. hoarseness is one of the earliest symptoms of croup, and it should be borne in mind that a young child, unless he be going to have croup, is seldom hoarse, if, therefore, your child be hoarse, he should be carefully watched, in order that, as soon as croup be detected, not a moment be lost in applying the proper remedies. his voice at length becomes gruff, he breathes as though it were through muslin, and the cough becomes crowing. these three symptoms prove that the disease is now fully formed. these latter symptoms sometimes come on without any previous warning, the little fellow going to bed apparently quite well, until the mother is awakened, perplexed and frightened, in the middle of the night, by finding him labouring under the characteristic cough and the other symptoms of croup. if she delay either to send for assistance, _or if proper medicines be not instantly given_, in a few hours it will probably be of no avail, and in a day or two the little sufferer will be a corpse. when once a child has had croup the after attacks are generally milder. if he has once had an attack of croup, i should advise you always to have in the house medicine--a oz. bottle of ipecacuanha wine, to fly to at a moments notice, [footnote: in case of a sudden attack of croup, _instantly_ give a teaspoonful of ipecacuanha wine, and repeat it every fire minutes natal free vomiting be excited.] but never omit, where practicable, in a case of croup, whether the case be severe or mild to send _immediately_ for medical aid. there is no disease in which time is more precious than in croup, and where the delay of an hour may decide either for life or for death. . _but suppose a medical man is not immediately to be procured, what then am i to do? more especially, as you say, that delay might be death_? _what to do_.--i never, in my life, lost a child with croup with catarrhal croup where i was called in at the _commencement_ of the disease, and where my plans were carried out to the very letter. let me begin by saying, look well to the goodness and purity of the medicine, for the life of your child may depend upon the medicine being genuine. what medicine! _ipecacuanha wine!_ at the earliest dawn of the disease give a few spoonful of ipecacuanha wine every five minutes, until free vomiting be exerted. in croup, then, before he be safe, free vomiting _must_ be established, and that without loss of time. if, _after_ the expiration of an hour, the ipecacuanha wine (having given during that hour one or two tea-spoonfuls of it every five minutes) be not sufficiently powerful for the purpose--although it generally is so--(_if the ipecacuanha wine be good_)--then let the following mixture be substituted-- take of--powdered ipecacuanha, one scruple, wine of ipecacuanha, one ounce and a half make a mixture. one or two tea spoonfuls to be given every five minutes, until free vomiting be excited, first well shaking the bottle. after the vomiting, place the child for a quarter of an hour in a warm bath. [footnote: see "warm baths"--directions and precautions to be observed.] when out of the bath give him small doses of ipecacuanha wine every two or three hours. the following is a palatable form for the mixture-- take of--wine of ipecacuanha, three drachms; simple syrup, three drachms, water, six drachms make a mixture. a tea-spoonful to be taken every two or three hours. but remember the emetic which is given at _first_ is _pure ipecacuanha wine, without a drop of either water or of syrup._ a large sponge dipped out of very hot water, and applied to the throat, and frequently renewed, oftentimes affords great relief in croup, and ought during the time the emetic is being administered in all cases to be adopted. if it be a _severe_ case of croup, and does not in the course of two hours yield to the free exhibition of the ipecacuanha emetic, apply a narrow strip of _smith's tela vesicularia_ to the throat, prepared in the same way as for a case of inflammation of the lungs (see the conversation on the _treatment_ of inflammation of the lungs). with this only difference, let it be a narrower strip, only one-half the width there recommended, and apply it to the throat instead of to the chest. if a child has a very short, fat neck, there may not be room for the _tela_, then you ought to apply it to the _upper_ part of the chest--just under the collar-bones. let it be understood, the the _tela vesicularia_ is not a severe remedy, that the _tela_ produces very little pain--not nearly so much as the application of leeches; although, in its action, it is much more beneficial, and is not nearly so weakening to the system. keep the child from all stimulants; let him live on a low diet, such as milk and water, toast and water, arrowroot, &c.; and let the room be, if practicable, at a temperate heat-- deg. fahrenheit, and be well ventilated. so you see that the _treatment_ of croup is very simple, and the the plan might be carried out by an intelligent mother. notwithstanding which, it is your duty, where practicable, to send, at the very _onset_ of the disease, for a medical man. let me again reiterate that, if your child is to be saved, the _ipecacuanha wine must be genuine and good_. this can only be effected by having the medicine from a highly respectable chemist. again, if ever your child has had croup, let me again urge you _always_ to have in the house a oz. bottle of ipecacuanha wine, that you may resort to at a moment's notice, in case there be the slightest return of the disease. ipecacuanha wine, unfortunately, is not a medicine that keeps well, therefore, every three or four months a fresh bottle ought to be procured, either from a medical man or from a chemist. as long as the ipecacuanha wine remains _clear_, it is good; but as soon as it becomes _turbid_, it is bad, and ought to be replaced by a fresh supply. an intelligent correspondent of mine makes the following valuable remarks on the preservation of ipecacuanha wine:--"now, i know that there are some medicines and chemical preparations which, though they spoil rapidly when at all exposed to the air, yet will keep perfectly good for an indefinite time if hermetically sealed up in a _perfectly full_ bottle. if so, would it not be a valuable suggestion if the apothecaries' hall, or some other london firm of _undoubted_ reliability, would put up oz. phials of ipecacuanha wine of guaranteed purity, sealed up so as to keep good so long as unopened, and sent out in sealed packages, with the guarantee of their name. by their keeping a few such ounce bottles in an unopened state in one's house, one might rely in being ready for any emergency. if you think this suggestion worth notice, and could induce some first-rate house to carry it out, and mention the fact in a subsequent edition of your book, you would, i think, be adding another most valuable item to an already invaluable book." the above suggestion of preserving ipecacuanha wine in ounce bottles, quite full, and hermetically sealed, is a very good one. the best way of hermetically sealing the bottle would be, to cut the cork level with the lip of the bottle, and to cover the cork with sealing-wax, in the same manner wine merchants serve some kinds of their wines, and then to lay the bottles on their sides in sawdust in the cellar. i have no doubt, if such a plan were adopted, the ipecacuanha wine would for a length of time keep good. of course, if the wine of ipecacuanha be procured from the apothecaries' hall company, london (as suggested by my correspondent), there can be no question as to the genuineness of the article. _what not to do_--do not give emetic tartar, do not apply leeches, do not keep the room very warm, do not give stimulants, do not omit to have always in the house either a oz. bottle, or three or four oz. bottles, of ipecacuanha wine. . _i have heard child crowing mentioned as a formidable disease, would you describe the symptoms_? child-crowing, or spasm of the glottis, or _spurious croup_, as it is sometimes called, is occasionally mistaken for _genuine croup_. it is a more frequent disorder than the latter, and requires a different plan of treatment child crowing is a disease that invariably occurs only during dentition, and is _most perilous_, indeed, painful dentition is _the_ cause--_the_ only cause--of child crowing. but, if a child labouring under it can fortunately escape suffocation until he have cut the whole of his first set of teeth--twenty--he is then safe. child-crowing comes on in paroxysms. the breathing during the intervals is quite natural--indeed, the child appears perfectly well, hence, the dangerous nature of the disease is either overlooked, or is lightly thought of, until perhaps a paroxysm worse than common takes place, and the little patient dies of suffocation, overwhelming the mother with terror, with confusion, and dismay. the _symptoms_ in a paroxysm of child-crowing are as follows--the child suddenly loses and fights for his breath, and in doing so, makes a noise very much like that of crowing, hence the name child-crowing. the face during the paroxysm becomes bluish or livid. in a favourable case, after either a few seconds, or even, in some instances, a minute, and a frightful straggle to breathe, he regains his breath, and is, until another paroxysm occurs, perfectly well. in an unfavourable case, the upper part (chink) of the windpipe--the glottis--remains for a minute or two closed, and the child, not being able to breathe, drops a corpse in his nurse's arms! many children, who are said, to have died of fits, hare really died of child-crowing. child-crowing is very apt to cause convulsions, which complication, of course, adds very much to the danger. such a complication requires the constant supervision of an experienced and skilful medical man. i have entered thus rather fully into the subject, as nearly every life might be saved, if a mother knew the nature and the treatment of the complaint, and of the _great necessity during the paroxysm of prompt and proper measures_. for, too frequently, before a medical man has had time to arrive, the child has breathed his last, the parent himself being perfectly ignorant of the necessary treatment; hence the vital importance of the subject, and the paramount necessity of imparting such information, in a _popular_ style, in conversations of this kind. . _what treatment, then, during a paroxysm of child-crowing should you advise_? the first thing, of course, to be done, is to send _immediately_ for a medical man. have a plentiful supply of cold and of hot water always at hand, ready at a moment's notice for use. the instant the paroxysm is upon the child, plentifully and perseveringly dash _cold_ water upon his head and face. put his foot and legs in _hot_ salt, mustard, and water; and, if necessary, place him up to his neck in a hot bath, still dashing water upon his face and head. if he does not quickly come round, sharply smack his back and buttocks. in every severe paroxysm of child-crowing, put your fore-finger down the throat of the child, and pull his tongue forward. this plan of pulling the tongue forward opens the epiglottis (the lid of the glottis), and thus admits air (which is so sorely needed) into the glottis and into the lungs, and thus staves off impending suffocation. if this plan were generally known and adopted, many precious lives might be saved. [footnote: an intelligent correspondent first drew my attention to the efficacy of pulling forward the tongue in every severe paroxysm of child-crowing.] there is nothing more frightfully agonising to a mother's feelings than to see her child strangled,--as it were,--before her eyes, by a paroxysm of child crowing. as soon as a medical man arrives, he will lose no time in thoroughly lancing the gums, and in applying other appropriate remedies. great care and attention ought, during the intervals, to be paid to his diet. if the child be breathing a smoky, close atmosphere, he should be immediately removed to a pure one. in this disease, indeed, there is no remedy equal to a change of air--to a dry, bracing neighbourhood. change of air, even if it be winter, is the best remedy, either to the coast or to a healthy mountainous district. i am indebted to mr roberton of manchester (who has paid great attention to this disease, and who has written a valuable essay on the subject [footnote: see the end of the volume of "physiology and diseases of women," &c. churchill, .]) for the knowledge of this fact. where, in a case of this kind, it is not practicable to send a child _from_ home, then let him be sent out of doors the greater part of every day; let him, in point of fact, almost live in the open air. i am quite sure, from an extensive experience, that in this disease, fresh air, and plenty of it, is the best and principal remedy. cold sponging of the body too is useful. mr roberton, who, at my request, has kindly given me the benefit of his extensive experience in child-crowing, considers that there is no remedy, in this complaint, equal to fresh air--to dry cold winds--that the little patient ought, in fact, nearly to live, during the day, out of doors, whether the wind be in the east or in the north-east, whether it be biting cold or otherwise, provided it be dry and bracing, for "if the air be dry, the colder the better,"--taking care, of course, that he be well wrapped up. mr roberton, moreover, advises that the child should be sent away at once from home, either to a bracing sea-side place, such as blackpool or fleetwood; or to a mountainous district, such as buxton. as the subject is so important, let me recapitulate: the gums ought, from time to time, to be well lanced, in order to remove the irritation of painful dentition--painful dentition being the real cause of the disease. cold sponging should be used twice or thrice daily. the diet should be carefully attended to (see dietary of child); and everything conducive to health should (as recommended in these conversations) be observed. but, remember, after all that can be said about the treatment, there is nothing like change of air, of fresh air, of cold, dry pure air, and of plenty of it--the more the little fellow can inhale, during the day, the better it will be for him, it will be far better than any drug contained in the pharmacopoeia. i have dwelt on this subject at some length--it being a most important one--as, if the above advice were more generally known and followed, nearly every child, labouring under this complaint, would be saved; while now, as coroners' inquests abundantly testify, the disease carries off yearly an immense number of victims. . _when is a mother to know that a cough is not a "tooth cough" but one of the symptoms of inflammation of the lungs_? if the child has had a shivering fit; if his skin be very hot and very dry; if his lips be parched; if there be great thirst; if his cheeks be flushed; if he be dull and heavy, wishing to be quiet in his cot or crib; if his appetite be diminished; if his tongue be furred; if his mouth be _burning_ hot and dry; [footnote: if you put your finger into the mouth of a child labouring under inflammation of the lungs, it is like putting your finger into a hot apple pie, the heat is so great.] if his urine be scanty and high-coloured, staining the napkin or the linen; _if his breathing be short, panting, hurried, and oppressed; if there be a hard dry cough, and if his skin be burning hot;_--then there is no doubt that inflammation of the lungs has taken place. no time should be lost in sending for medical aid; indeed, the _hot, dry mouth and skin, and short, hurried breathing_ would be sufficient cause for your procuring _immediate_ assistance. if inflammation of the lungs were properly treated at the _onset_, a child would scarcely ever be lost by that disease. i say this advisedly, for in my own practice, _provided i am called in early, and if my plans are strictly carried out_, i scarcely ever lose a child from inflammation of the lungs. you may ask--what are your plans? i will tell you, in case _you cannot promptly obtain medical advice,_ as delay might be death! _the treatment of inflammation of the lungs, what to do._--keep the child to one room, to his bedroom, and to his bed. let the chamber be properly ventilated. if the weather be cool, let a small fire be in the grate; otherwise, he is better without a fire. let him live on low diet, such as weak black tea, milk and water (in equal quantities), and toast and water, thin oatmeal gruel, arrow-root, and such like simple beverages, and give him the following mixture:-- take of--wine of ipecacuanha, three drachms; simple syrup, three drachms; water, six drachms; make a mixture. a tea-spoonful of the mixture to be taken every four hours. be careful that you go to a respectable chemist, in order _that the totality of the ipecacuanha wine may be good, as the child's life may depend upon it._ if the medicine produce sickness, so much the better; continue it regularly until the short, oppressed, and hurried breathing has subsided, and has become natural. if the attack be very severe, in addition to the above medicine, at once apply a blister, not the common blister, but _smith's tela vesicatoria_ [footnote: manufactured by t. & h. smith, chemists, edinburgh, and may be procured of southalls, chemists, birmingham.]--a quarter of a sheet. if the child be a year old, the blister ought to be kept on for three hours, and then a piece of dry, soft linen rag should be applied for another three hours. at the end of which time--six hours--there will be a beautiful blister, which must then, with a pair of scissors, be cut, to let out the water, and then let the blister be dressed, night and morning, with simple cerate spread on lint. if the little patient be more than one year, say two years old, let the tela remain on for five hours, and the dry linen rag for five hours more, before the blister, as above recommended, be cut and dressed. if in a day or two the inflammation still continue violent, let another tela vesicatoria be applied, not over the old blister, but let a narrow strip of it be applied on each side of the old blister, and managed in the same manner as before directed. _i cannot speak too highly of smith's tela vesicatoria._ it has, in my hands, through god's blessing, saved the lives of scores of children. it is far, very far, superior to the old fashioned blistering plaster. it seldom, if the above rules be strictly observed, fails to rise, it gives much less pain than the common blister, when it has had the desired effect, it readily heals, which cannot always be said of the common fly blister, more especially with children. my sheet anchors, then, in the inflammation of the lungs of children are, ipecacuanha wine and smith's _tela vesicatoria_. let the greatest care, as i before advised, be observed in obtaining the ipecacuanha wine genuine and good. this can be only depended upon by having the medicine from a highly respectable chemist, ipecacuanha wine, when genuine and good, is, in many children's diseases, is one of the most valuable of medincies. _what, in a case of inflammation of the lungs, not to do_--do not, on any account, apply leeches. they draw out the life of the child, but not his disease. avoid--_emphatically let me say so_--giving emetic tartar it is one of the most lowering and death-dealing medicines that can be administered either to an infant or to a child! if you wish to try the effect of it, take a dose yourself, and i am quite sure that you will then never be inclined to poison a child with such an abominable preparation! in olden times--many, many years ago--i myself gave it in inflammation of the lungs, and lost many children! since leaving it off, the recoveries of patients by the ipecacuanha treatment, combined with the external application of smith's _tela vesicatoria_, have been in many cases marvellous. avoid broths and wine, and all stimulants. do _not_ put the child into a warm bath, it only oppresses the already oppressed breathing. moreover, after he is out of the bath, it causes a larger quantity of blood to rush back to the lungs and to the bronchial tubes, and thus feeds the inflammation. do not, by a large fire, keep the temperature of the room high. a small fire, in the winter time, encourages ventilation, and in such a case does good. when the little patient is on the mother's or on the nurse's lap, do not burden him either with a _heavy_ blanket or with a _thick_ shawl. either a _thin_ child's blanket, or a _thin_ woollen shawl, in addition to his usual nightgown, is all the clothing necessary. . _is bronchitis a more frequent disease than inflammation of the lungs? which is the most dangerous? what are the symptoms of bronchitis_? bronchitis is a much more frequent disease than inflammation of the lungs, indeed, it is one of the most common complaints both of infants and of children, while inflammation of the lungs is comparatively a rare disease. bronchitis is not nearly such a dangerous disease as inflammation of the lungs. _the symptoms_--the child for the first few days labours under symptoms of a heavy cold, he has not his usual spirits. in two or three days, instead of the cold leaving him, it becomes more confirmed, he is now really poorly, fretful, and feverish, his breathing becomes rather hurried and oppressed, his cough is hard and dry, and loud, he wheezes, and if you put your ear to his naked back, between his shoulder blades, you will hear the wheezing more distinctly. if at the breast, he does not suck with his usual avidity; the cough, notwithstanding the breast is a great comfort to him, compels him frequently to loose the nipple; his urine is scanty, and rather high-coloured, staining the napkin, and smelling strongly. he is generally worse at night. well, then, remember if the child be feverish, if he have symptoms of a heavy cold, if he have an oppression of breathing, if he wheeze, and if he have a tight, dry, noisy cough, you may be satisfied that he has an attack of bronchitis. . _how can i distinguish between bronchitis and inflammation of the lungs_? in bronchitis the skin is warm, but moist; in inflammation of the lungs it is hot and dry: in bronchitis the mouth is warmer than usual, but moist; in inflammation of the lungs it is burning hot: in bronchitis the breathing is rather hurried, and attended with wheezing; in inflammation of the lungs it is very short and panting, and is unaccompanied with wheezing, although occasionally a very slight crackling sound might be heard: in bronchitis the cough is long and noisy; in inflammation of the lungs it is short and feeble: in bronchitis the child is cross and fretful; in inflammation of the lungs he is dull and heavy, and his countenance denotes distress. we have sometimes a combination of bronchitis and of inflammation of the lungs, an attack of the latter following the former. then the symptoms will be modified, and will partake of the character of the two diseases. . _how would you treat a case of bronchitis_? if a medical man cannot be procured, i will tell you _what to do_: confine the child to his bedroom, and if very ill, to his bed. if it be winter time, have a little fire in the grate, but be sure that the temperature of the chamber be not above degrees fahrenheit, and let the room be properly ventilated, which may be effected by occasionally leaving the door a little ajar. let him lie either _outside_ the bed or on a sofa, if he be very ill, _inside_ the bed, with a sheet and a blanket only to cover him, but no thick coverlid. if he be allowed to be on the lap, it only heats him and makes him restless. if he will not lie on the bed, let him rest on a pillow placed on the lap, the pillow will cause him to lie cooler, and will more comfortably rest his weaned body. if he be at the breast, keep him to it, let him have no artificial food, unless, if he be thirsty a little toast and water. if he be weaned, let him have either milk and water, arrow root made with equal parts of milk and water, toast and water, barley water, or weak black tea, with plenty of new milk in it, &c., but, until the inflammation have subsided, neither broth nor beef tea. now, with regard to medicine, the best medicine is ipecacuanha wine, given in large doses, so as to produce constant nausea. the ipecacuanha abates fever, acts on the skin, loosens the cough, and, in point of fact, in the majority of cases, will rapidly effect a cure. i have in a preceding conversation given you a prescription for the ipecacuanha wine mixture. let a tea-spoonful of the mixture be taken every four hours. if in a day or two he be no better, but worse, by all means continue the mixture, whether it produce sickness or otherwise, and put on the chest a _tela vesicatoria_, a quarter of a sheet. the ipecacuanha wine and the tela vesicatoria are my sheet anchors in the bronchitis, both of infants and of children. they rarely, even in very severe cases, fail to effect a cure, provided the tela vesicatorina be properly applied, and the ipecacuanha wine be genuine and of good quality. if there be any difficulty in procuring _good_ ipecacuanha wine, the ipecacuanha may be given in powder instead of the wine the following is a pleasant form-- take of--powder of ipecacuanha, twelve grains white sugar thirty six grains mix well together and divide into twelve powders. one of the powders to be put dry on the tongue every four hours. the ipecacuanha powder will keep better than the wine--an important consideration to those living in country places, nevertheless, if the wine can be procured fresh and good, i far prefer the wine to the powder. when the bronchitis has disappeared, the diet ought gradually to be improved--rice, sago, tapioca, and light batter-pudding, &c.; and, in a few days, either a little chicken or a mutton chop, mixed with a well-mashed potato and crumb of bread, should be given. but let the improvement in his diet be gradual, or the inflammation might return. _what not to do_.--do not apply leeches. do not give either emetic tartar or antimonial wine, which is emetic tartar dissolved in wine. do not administer either paregoric or syrup of poppies, either of which would stop the cough, and would thus prevent the expulsion of the phlegm. any fool can stop a cough, but it requires a wise man to rectify the mischief. a cough is an effort of nature to bring up the phlegm, which would otherwise accumulate, and in the end cause death. again, therefore, let me urge upon you the immense importance of _not_ stopping the cough of a child. the ipecacuanha wine will, by loosening the phlegm, loosen the cough, which is the only right way to get rid of a cough. let what i have now said be impressed deeply upon your memory, as thousands of children in england are annually destroyed by having their coughs stopped. avoid, until the bronchitis be relieved, giving him broths, and meat, and stimulants of all kinds. for further observations on _what not to do_ in bronchitis, i beg to refer you to a previous conversation we had on _what not to do_ in inflammation of the lungs. that which is injurious in the one case is equally so in the other. . _what are the symptoms of diphtheria, or, as it is sometimes called, boulogne sore-throat_? this terrible disease, although by many considered to be a new complaint, is, in point of fact, of very ancient origin. homer, and hippocrates, the father of physic, have both described it. diphtheria first appeared in england in the beginning of the year , since which time it has never totally left our shores. _the symptoms_--the little patient, before the disease really shows itself, feels poorly, and is "out of sorts." a shivering fit, though not severe, may generally be noticed. there is heaviness, and slight headache, principally over the eyes. sometimes, but not always, there is a mild attack of delirium at night the next day he complains of slight difficulty of swallowing. if old enough, he will complain of constriction about the swallow. on examining the throat, the tonsils will be found to be swollen and redder--more darkly red than usual. slight specks will be noticed on the tonsils. in a day or two an exudation will cover them, the back of the swallow, the palate, the tongue, and sometimes the inside of the cheeks and of the nostrils. this exudation of lymph gradually increases until it becomes a regular membrane, which puts on the appearance of leather, hence its name diphtheria. this membrane peels off in pieces, and if the child be old and strong enough he will sometimes spit it up in quantities, the membrane again and again rapidly forming as before. the discharges from the throat are occasionally, but not always, offensive. there is danger of croup from the extension of the membrane into the wind pipe. the glands about the neck and under the jaw are generally much swollen, the skin is rather cold and clammy, the urine is scanty and usually pale, the bowels at first are frequently relaxed. this diarrhoea may, or may not, cease as the disease advances. the child is now in a perilous condition, and it becomes a battle between his constitution and the disease. if, unfortunately, as is too often the case--diphtheria being more likely to attack the weakly--the child be very delicate, there is but slight hope of recovery. the danger of the disease is not always to be measured by the state of the throat. sometimes, when the patient appears to be getting well, a sudden change for the worse rapidly carries him off. hence the importance of great caution, in such cases, in giving an opinion as to ultimate recovery. i have said enough to prove the terrible nature of the disease, and to show the necessity of calling in, at the earliest period of the symptoms, an experienced and skilful medical man. . _is diphtheria contagious_? _decidedly_. therefore, when practicable, the rest of the children ought instantly to be removed to a distance. i say _children_, for it is emphatically a disease of childhood. when adults have it, it is the exception and not the rule: "thus it will be seen, in the account given of the boulogne epidemic, that of deaths from this cause, occurred amongst children under ten years of age. in the lincolnshire epidemic, in the autumn of , all the deaths at horncastle, in number, occurred amongst children under twelve years of age." [footnote: _diphtheria_: by ernest hart. a valuable pamphlet on the subject. dr wade of birmingham has also written an interesting and useful monograph on diphtheria. i am indebted to the above authors for much valuable information.] . _what are the causes of diphtheria_? bad and imperfect drainage; [footnote: "now all my carefully conducted inquiries induce me to believe that the disease comes from drain-poison. all the cases into which i could fully inquire, have brought conviction to my mind that there is a direct law of sequence in some peculiar conditions of atmosphere between diphtheria and bad drainage; and, if this be proved by subsequent investigations, we may be able to prevent a disease which, in too many cases, our known remedies cannot cure."--w. carr, esq., blackheath, _british medical journal_, december , .] want of ventilation; overflowing privies; low neighbourhoods in the vicinity of rivers; stagnant waters; indeed, everything that vitiates the air, and thus depresses the system, more especially if the weather be close and muggy; poor and, improper food; and last, though not least, contagion. bear in mind, too, that a delicate child is much more predisposed to the disease than a strong one. . _what is the treatment of diptheria_? _what to do_--examine well into the ventilation, for as diphtheria is frequently caused by deficient ventilation, the best remedy is thorough ventilation. look well both to the drains and to the privies, and see that the drains from the water-closets and from the privies do not in any way contaminate the pump-water. if the drains be defective or the privies be full, the disease in your child will be generated, fed, and fostered. not only so, but the disease will spread in your family and all around you. keep the child to his bedroom and to his bed. for the first two or three days, while the fever runs high, put him on a low diet, such as milk, tea, arrow root, &c. apply to his throat every four hours a warm barm and oatmeal poultice. if he be old enough to have the knowledge to use a gargle, the following will be found serviceable-- take of--permanganate of potash, pure, four grams, water eight ounces to make a gargle or, take of--powdered alum, one drachm, simple syrup one ounce, water, seven ounces to make a gargle the best medicine for the first few days of the attack, is the following mixture-- take of--chlorate of potash two drachms, boiling water seven ounces syrup of red poppy one ounce to make a mixture. a table spoonful to be taken every four hours. or the chlorate of potash might be given in the form of powder-- take of--chlorate of potash two scruples, lump sugar one drachm mix and divide into eight powders. one to be put into a dry tea spoon and then placed on the tongue every three hours, these powders are very useful in diphtheria; they are very cleansing to the tongue and throat. if they produce much smarting as where the mouth is very sore they sometimes do, let the patient, after taking one, drink plentifully of milk, indeed i have known these powders induce a patient to take nourishment, in the form of milk, which he otherwise would not have done, and thus to have saved him from dying of starvation, which, before taking the powders, there was every probability of his doing. an extensive experience has demonstrated to me the great value of these powders in diphtheria, but they must be put on the tongue dry. as soon as the skin has lost its preternatural heat, beef tea and chicken broth ought to be given. or if great prostration should supervene, in addition to the beef tea, port wine, a table spoonful every four hours, should be administered. if the child be cold, and there be great sinking of the vital powers, brandy and water should be substituted for the port wine. remember, in ordinary cases, port wine and brandy are not necessary, _but in cases of extreme exhaustion_ they are most valuable. as soon as the great heat of the skin has abated and the debility has set in, one of the following mixtures will be found useful-- take of--wine of iron, one ounce and a half, sample syrup, one ounce, water, three ounces and a half to make a mixture. a table spoonful to be taken every four hours. or, take of--tincture of perchloride of iron, one drachm simple syrup, one ounce, water, three ounces to make a mixture. a table spoonful to be taken three times a day. if the disease should travel downwards, it will cause all the symptoms of croup, then it must be treated as croup, with this only difference, that a blister (_tela vesicatoria_) must _not_ be applied, or the blistered surface may be attacked by the membrane of diphtheria, which may either cause death or hasten that catastrophe. in every other respect treat the case as croup, by giving an emetic, a tea spoonful of ipecacuanha wine every five minutes, until free vomiting be excited, and then administer smaller doses of ipecacuanha wine every two or three hours, as i recommended when conversing with you on the treatment of croup. _what not to do_--do not, on any account, apply either leeches or a blister. if the latter be applied, it is almost sure to be covered with the membrane of diphtheria, similar to that inside of the mouth and of the throat, which would be a serious complication. do not give either calomel or emetic tartar. do not depress the system by aperients, for diphtheria is an awfully depressing complaint of itself, the patient, in point of fact, is labouring under the depressing effects of poison, for the blood has been poisoned either by the drinking water being contaminated by faecal matter from either a privy or from a water-closet, by some horrid drain, by proximity to a pig-sty, by an overflowing privy, especially if vegetable matter be rotting at the same time in it, by bad ventilation, or by contagion. diphtheria may generally be traced either to the one or to the other of the above causes, therefore let me urgently entreat you to look well into all these matters, and thus to stay the pestilence! diphtheria might long remain in a neighbourhood if active measures be not used to exterminate it. . _have the goodness to describe the symptoms of measles_? measles commences with symptoms of a common cold, the patient is at first chilly, then hot and feverish, he has a running at the nose, sneezing, watering, and redness of the eyes, headache, drowsiness, a hoarse and peculiar ringing cough, which nurses call "measle-cough," and difficulty of breathing. these symptoms usually last three days before the eruption appears, on the fourth it (the eruption) generally makes its appearance, and continues for four days and then disappears, lasting altogether, from the commencement of the symptoms of cold to the decline of the eruption, seven days. it is important to bear in mind that the eruption consists of _crescent-shaped--half moon-shaped--patches_, that they usually appear first about the face and the neck, in which places they are the best marked; then on the body and on the arms; and, lastly, on the legs, and that they are slightly raised above the surface of the skin. the face is swollen, more especially the eye-lids which are sometimes for a few days closed. well, then, remember, _the running at the nose, the, sneezing, the peculiar hoarse cough, and the half-moon-shaped patches_, are the leading features of the disease, and point out for a certainty that it is measles. . _what constitutes the principal danger in measles_? the affection of the chest. the mucous or lining membrane of the bronchial tubes is always more or less inflamed, and the lungs themselves are sometimes affected. . _do you recommend "surfeit water" and saffron tea to throw out the eruption in measles_? certainly not. the only way to throw out the eruption, as it is called, is to keep the body comfortably warm, and to give the beverages ordered by the medical man, with the chill off. "surfeit water," saffron tea, and remedies of that class, are hot and stimulating. the only effect they can have, will be to increase the fever and the inflammation--to add fuel to the fire. . _what is the treatment of measles_? _what to do_.--the child ought to be confined both to his room and to his bed, the room being kept comfortably warm; therefore, if it be winter time, there should be a small fire in the grate; in the summer time, a fire would be improper. the child must not be exposed to draughts; notwithstanding, from time to time, the door ought to be left a little ajar in order to change the air of the apartment; for proper ventilation, let the disease be what it may, is absolutely necessary. let the child, for the first few days, be kept on a low diet, such as on milk and water, arrow-root, bread and butter, &c. if the attack be mild, that is to say, if the breathing be not much affected (for in measles it always is more or less affected), and if there be not much wheezing, the acidulated infusion of roses' mixture [footnote: see page ] will be all that is necessary. but suppose that the breathing is short, and that there is a great wheezing, then instead of giving him the mixture just advised, give him a tea-spoonful of a mixture composed of ipecacuanha wine, syrup, and water, [footnote: see page ] every four hours. and if, on the following day, the breathing and the wheezing be not relieved in addition to the ipecacuanha mixture, apply a tola vesicatoria, as advised under the head of inflammation of the lungs. when the child is convalescing, batter puddings, rice, and sago puddings, in addition to the milk, bread and butter, &c, should be given, and, a few days later, chicken, mutton chops, &c. the child ought not, even in a mild case of measles, and in favourable weather to be allowed to leave the house under a fortnight, or it might bring on an attack of bronchitis. _what not to do_--do not give either "surfeit water" or wine. do not apply leeches to the chest. do not expose the child to the cold air. do not keep the bed room very hot, but comfortably warm. do not let the child leave the house, even under favourable circumstances, under a fortnight. do not, while the eruption is out, give aperients. do not, "to ease the cough," administer either emetic tartar or paregoric--the former drug is awfully depressing, the latter will stop the cough, and will thus prevent the expulsion of the phlegm. . _what is the difference between scarlatina and scarlet fever_? they are indeed one and the same disease, scarlatina being the latin for scarlet fever. but, in a _popular_ sense, when the disease is mild, it is usually called scarlatina. the latter term does not sound so formidable to the ears either of patients or of parents. . _will you describe the symptoms of scarlet fever_? the patient is generally chilly, languid, drowsy, feverish, and poorly for two days before the eruption appears. at the end of the second day, the characteristic, bright scarlet efflorescence, somewhat similar to the colour of a boiled lobster, usually first shows itself. the scarlet appearance is not confined to the skin; but the tongue, the throat, and the whites of the eyes put on the same appearance; with this only difference, that on the tongue and on the throat the scarlet is much darker; and, as dr elliotson accurately describes it,--"the tongue looks as if it had been slightly sprinkled with cayenne pepper;" the tongue, at other times, looks like a strawberry; when it does, it is called "the strawberry tongue." the eruption usually declines on the fifth, and is generally indistinct on the sixth day; on the seventh it has completely faded away. there is usually, after the first few days, great itching on the surface of the body. the skin, at the end of the week, begins to peel and to dust off, making it look as though meal had been sprinkled upon it. there are three forms of scarlet fever;--the one where the throat is little, if at all, affected, and this is a mild form of the disease; the second, which is generally, especially at night, attended with delirium, where the throat is _much_ affected, being often greatly inflamed and ulcerated; and the third (which is, except in certain unhealthy districts, comparatively rare, and which is very dangerous), the malignant form. . _would it be well to give a little cooling, opening physic as soon as a child begins to sicken for scarlet fever_? _on no account whatever._ aperient medicines are, in my opinion, highly improper and dangerous both before and during the period of the eruption. it is my firm conviction, that the administration of opening medicine, at such times, is one of the principal causes of scarlet fever being so frequently fatal. this is, of course, more applicable to the poor, and to those who are unable to procure a skilful medical man. . _what constitutes the principal danger in scarlet fever_? the affection of the throat, the administration of opening medicine during the first ten days, and a peculiar disease of the kidneys ending in _anasarca_ (dropsy), on which account, the medical man ought, when practicable, to be sent for at the onset, that no time may be lost in applying _proper_ remedies. when scarlet fever is complicated--as it sometimes is--with diphtheria, the diphtheric membrane is very apt to travel into the wind-pipe, and thus to cause diphtheric croup, it is almost sure, when such is the case, to end in death. when a child dies from such a complication, the death might truly be said to be owing to the diphtheric croup, and not to the scarlet fever, for if the diphtheric croup had not occurred, the child would, in all probability, have been saved. the deaths from diphtheria are generally from diphtheric croup, if there be no croup, there is, as a rule, frequent recovery. . _how would you distinguish between scarlet fever and measles_? measles commences with symptoms of a common cold, scarlet fever does not. measles has a _peculiar hoarse_ cough, scarlet fever has not. the eruption of measles is in patches of a half moon shape, and is slightly raised above the skin, the eruption of scarlet fever is _not_ raised above the skin at all, and is one continued mass. the colour of the eruption is much more vivid in scarlet fever than in measles. the chest is the part principally affected in measles, and the throat in scarlet fever. there is an excellent method of determining, for a certainty, whether the eruption be that of scarlatina or otherwise. i myself have, in several instances, ascertained the truth of it--"for several years m bouchut has remarked in the eruptions of scarlatina a curious phenomenon, which serves to distinguish this eruption from that of measles, erythema, erysipelas &c., a phenomenon essentially vital, and which is connected with the excessive contractability of the capillaries. the phenomenon in question is a _white line_, which can be produced at pleasure by drawing the back of the nail along the skin where the eruption, is situated. on drawing the nail, or the extremity of a hard body (such as a pen-holder), along the eruption, the skin is observed to grow pale, and to present a white trace, which remains for one or two minutes, or longer, and then disappears. in this way the diagnosis of the disease may be very distinctly written on the skin; the word 'scarlatina' disappears as the eruption regains its uniform tint."--_edinburgh medical journal._ . _is it of so much importance, then, to distinguish between scarlet fever and measles_? it is of great importance, as in measles the patient ought to be kept _moderately_ warm, and the drinks should be given with the chill off; while in scarlet fever the patient ought to be kept cool--indeed, for the first few days, _cold_--and the beverages, such as spring-water, toast and water, &c., should be administered quite cold. . _do you believe in "hybrid" scarlet fever--that is to say, in a cross between scarlet fever and measles_? i never in my life saw a case of "hybrid" scarlet fever--nor do i believe in it. scarlet fever and measles are both blood poisons, each one being perfectly separate and distinct from the other. "hybrid" scarlet fever is, in my opinion, an utter impossibility. in olden times, when the symptoms of diseases were not so well and carefully distinguished as now, scarlet fever and measles were constantly confounded one with the other, and was frequently said to be "hybrid"--a cross between measles and scarlet fever--to the patient's great detriment and danger, the two diseases being as distinct and separate as their treatment-and management ought to be. . _what is the treatment of scarlet fever?_ [footnote: on the th of march , i had the honour to read a _paper on the treatment of scarlet fever_ before the members of queens college medico-chirugical society, birmingham--which _paper_ was afterwards published in the _association journal_ (march ) and in braithwaite's _retrospect of medicine_ (january--june, ) and in rankings _half yearly abstract of the medical sciences_ (july--december, ), besides in other publications. moreover the _paper_ was translated into german, and published in _canstatts jahresbericht_, iv , ] _what to do_--pray pay attention to my rules, and carry out my directions to the letter--i can then promise, _that if the scarlet fever be neither malignant nor complicated with diphtheria_, the plan i am about to advise will, with god's blessing, be usually successful. what is the first thing to be done? send the child to bed, throw open the windows, be it winter or summer, and have a thorough ventilation, for the bedroom must be kept cool, i may say cold. do not be afraid of fresh air, for fresh air, for the first few days, is essential to recovery. _fresh air, and plenty of it, in scarlet fever, is the best doctor_ a child can have let these words be written legibly on your mind. [footnote: in the _times_ of sept , , is the following copied from the _bridgewater mercury_-- gross superstition--in one of the streets of taunton, there resides a man and his wife who have the care of a child this child was attacked with scarlatina, and to all appearance death was inevitable. a jury of matrons was as it were empanelled, and to prevent the child 'dying hard' all the doors in the house all the drawers, all the boxes all the cupboards were thrown wide open, the keys taken out and the body of the child placed under a beam, whereby a sure, certain, and easy passage into eternity could be secured. watchers held their vigils throughout the weary night, and in the morning the child, to the surprise of all, did not die, and is now gradually recovering. these old women--this jury of matrons--stumbled on the right remedy, "all the doors in the house....were thrown vide open," and thus they thoroughly ventilated the apartment. what was the consequence? the child who, just before the opening of the doors, had all the appearances "that death was inevitable," as soon as fresh air was let in showed symptoms of recovery, "and in the morning the child, to the surprise of all, did not die, and is now gradually recovering." there is nothing wonderful--there is nothing surprising to my mind--in all this. ventilation--thorough ventilation--is the grand remedy for scarlatina! oh, that there were in scarlet fever cases a good many such old women's--such a "jury of matrons'"--remedies! we should not then be horrified, as we now are, at the fearful records of death, which the returns of the registrar general disclose!] if the weather be either intensely cold, or very damp, there is no objection to a small fire in the grate provided there be, at the same time, air--an abundance of fresh air--admitted into the room. take down the curtains of the bed, remove the valances. if it be summer time, let the child be only covered with a sheet. if it be winter time, in addition to the sheet, he should have one blanket over him. now for the throat--the best _external_ application is a barm and oatmeal poultice how ought it to be made, and how applied? put half a tea-cupful of barm into a saucepan, put it on the fire to boil; as soon as it boils, take it off the fire, and stir oatmeal into it, until it be of the consistence of a nice soft poultice; then place it on a rag, and apply it to the throat, carefully fasten it on with a bandage, two or three turns of the bandage going round the throat, and two or three over the crown of the head, so as nicely to apply the poultice where it is wanted--that is to say, to cover the tonsils. tack the bandage: do not pin it. let the poultice be changed three times a day. the best medicine is the acidulated infusion of roses, sweetened with syrup:-- take of--dilated sulphuric acid, half a drachm; simple syrup, one ounce and a half; acid infusion of roses, four ounces and a half: to make a mixture. a table-spoonful to be taken every four hours. it is grateful and refreshing, it is pleasant to take, it abates fever and thirst, it cleanses the throat and tongue of mucus, and is peculiarly efficacious in scarlet fever; as soon as the fever is abated it gives an appetite. my belief is that the sulphuric acid in the mixture is a specific in scarlet fever, as much as quinine is in ague, and sulphur in itch. i have reason to say so, for, in numerous cases i have seen its immense value. now, with regard to food.--if the child be at the breast, keep him entirely to it. if he be weaned, and under two years old, give him milk and water, and cold water to drink. if he be older, give him toast and water, and plain water from the pump, as much as he chooses; let it be quite cold--the colder the better. weak black tea, or thin gruel, may be given, but not caring, unless he be an infant at the breast, if he take nothing but _cold_ water. if the child be two years old and upwards, roasted apples with sugar, and grapes, will be very refreshing, and will tend to cleanse both the mouth and the throat avoid broths and stimulants. when the appetite returns, you may consider the patient to be safe. the diet ought now to be gradually improved. bread and butter, milk and water, and arrowroot made with equal parts of new milk and water, should for the first two or three days be given. then a light batter or rice pudding may be added, and in a few days, either a little chicken or a mutton chop. the essential remedies, then, in scarlet fever, are, for the first few days--( ) plenty of fresh air and ventilation, ( ) plenty of cold water to drink, ( ) barm poultices to the throat, and ( ) the acidulated infusion of roses mixture as a medicine. now, then, comes very important advice. after the first few days, probably five or six, sometimes as early as the fourth day--_watch carefully and warily, and note the time, the skin will suddenly become cool_, the child will say that he feels chilly; then is the time you must now change your tactics--_instantly close the windows and put extra clothing_, a blanket or two, on his bed. a flannel nightgown should, until the dead skin have peeled off, be now worn next to the skin, when the flannel nightgown should be discontinued. the patient ought ever after to wear, in the day time, a flannel waistcoat. [footnote: on the importance--the vital importance--of the wearing of flannel next to the skin, see "flannel waistcoats."] his drinks must now be given with the chill off; he ought to have a warm cup of tea, and gradually his diet should, as i have previously advised, be improved. there is one important caution i wish to impress upon you,--_do not give opening medicine during the time the eruption is out_. in all probability the bowels will be opened: if so, all well and good; but do not, on any account, for the first ten days, use artificial means to open them. it is my firm conviction that the administration of purgatives in scarlet fever is a fruitful source of dropsy, of disease, and death. when we take into consideration the sympathy there is between the skin and the mucous membrane, i think that we should pause before giving irritating medicines, such as purgatives. the irritation of aperients on the mucous membrane may cause the poison of the skin disease (for scarlet fever is a blood-poison) to be driven internally to the kidneys, to the throat, to the pericardium (bag of the heart), or to the brain. you may say, do you not purge if the bowels be not open for a week? i say emphatically, no! i consider my great success in the treatment of scarlet fever to be partly owing to my avoidance of aperients during the first ten days of the child's illness. if the bowels, after the ten days, be not properly opened, a dose or two of syrup of senna should be given: that is to say, one or two tea-spoonfuls should be administered early in the morning, and should, if the first dose does not operate, be repeated in four hours. in a subsequent conversation, i shall strongly urge you not to allow your child, when convalescent, to leave the house under at least a month from the commencement of the illness; i, therefore, beg to refer you to that conversation, and hope that you will give it your best and earnest consideration! during the last twenty years i have never had dropsy from scarlet fever, and i attribute it entirely to the plan i have just recommended, and in not allowing my patients to leave the house under the month--until, in fact, the skin that had peeled off has been renewed. let me now sum up the plan i adopt, and which i beg leave to designate as--pye chavasse's fresh air treatment of scarlet fever:-- . thorough ventilation, a cool room, and scant clothes on the bed, for the first five or six days. . a change of temperature of the skin to be carefully regarded. as soon as the skin is cool, closing the windows, and putting additional clothing on the bed. . the acidulated infusion of hoses with syrup is _the_ medicine for scarlet fever. . purgatives to be religiously avoided for the first ten days at least, and even afterwards, unless there be absolute necessity. . leeches, blisters, emetics, cold and tepid spongings, and painting the tonsils with caustic, inadmissible in scarlet fever. . a strict antiphlogistic (low) diet for the first few days, during which time cold water to be given _ad libitum_. . the patient not to leave the house in the summer under the month; in the winter, under six weeks. _what not to do._--do not, then, apply either leeches or blisters to the throat; do not paint the tonsils with caustic; do not give aperients; do not, on any account, give either calomel or emetic tartar; do not, for the first few days of the illness, be afraid of _cold air_ to the skin, and of cold water as a beverage; do not, emphatically let me say, _do not_ let the child leave the house for at least a month from the commencement of the illness. my firm conviction is, that purgatives, emetics, and blisters, by depressing the patient, sometimes cause ordinary scarlet fever to degenerate into malignant scarlet fever. i am aware that some of our first authorities advocate a different plan to mine. they recommend purgatives, which i may say, in scarlet fever, are my dread and abhorrence. they advise cold and tepid spongings--a plan which i think dangerous, as it will probably drive the disease internally. blisters, too, have been prescribed; these i consider weakening, injurious, and barbarous, and likely still more to inflame the already inflamed skin. they recommend leeches to the throat, which i am convinced, by depressing the patient, will lessen the chance of his battling against the disease, and will increase the ulceration of the tonsils. again, the patient has not too much blood; the blood is only poisoned. i look upon scarlet fever as a specific poison of the blood, and one which will be eliminated from the system, _not_ by bleeding, _not_ by purgatives, _not_ by emetics but by a constant supply of fresh and cool air, by the acid treatment, by cold water as a beverage, and for the first few days by a strict antiphlogistic (low) diet. sydenham says that scarlet fever is oftentimes "fatal through the officiousness of the doctor." i conscientiously believe that a truer remark was never made; and that, under a different system to the usual one adopted, scarlet fever would not be so much dreaded. [footnote: if any of my medical brethren should do me the honour to read these pages, let me entreat them to try my plan of treating scarlet fever, as my success has been great. i have given full and minute particulars, in order that they and mothers (if mothers cannot obtain medical advice) may give my plan a fair and impartial trial. my only stipulations are that they must _begin_ with my treatment, and _not mix_ any other with it, and carry out my plan to the very letter. i then, with god's blessing, provided the cases be neither malignant nor complicated with diphtheria, shall not fear the result. if any of my _confreres_ have tried my plan of treatment of scarlet fever--and i have reason to know that many have--i should feel grateful to them if they would favour me with their opinion as to its efficacy. address--"pye chavasse, hagley road, birmingham."] dr budd, of bristol, recommends, in the _british medical journal_, that the body, including the scalp, of a scarlet fever patient, should, after about the fourth day, be anointed, every night and morning, with camphorated oil; this anointing to be continued until the patient is able to take a warm bath and use disinfectant soap: this application will not only be very agreeable to the patient's feelings, as there is usually great irritation and itching of the skin, but it will, likewise, be an important means of preventing the dead skin, which is highly infectious, and which comes off partly in flakes and partly floats about the air as dust, from infecting other persons. the plan is an excellent one, and cannot be too strongly recommended. if the case be a combination of scarlet fever and of diphtheria, as it unfortunately now frequently is, let it be treated as a case of diphtheria. . _i have heard of a case of scarlet fever, where the child, before the eruption showed itself, was suddenly struck prostrate, cold, and almost pulseless: what, in such a case, are the symptoms, and what immediate treatment do you advise_? there is an _exceptional_ case of scarlet fever, which now and then occurs, and which requires _exceptional_ and prompt treatment, or death will quickly ensue. we will suppose a case: one of the number, where nearly all the other children of a family are labouring under scarlet fever, is quite well, when suddenly--in a few hours, or even, in some cases, in an hour--utter prostration sets in, he is very cold, and is almost pulseless, and is nearly insensible--comatose. having sent instantly for a judicious medical man, apply, until he arrives, hot bottles, hot bricks, hot bags of salt to the patient's feet and legs and back, wrap him in hot blankets, close the window, and give him hot brandy and water--a tablespoonful of brandy to half a tumblerful of hot water--give it him by teaspoonfuls, continuously--to keep him alive; when he is warm and restored to consciousness, the eruption will probably show itself, and he will become hot and feverish; then your tactics must, at once, be changed, and my fresh air treatment, and the rest of the plan i have before advised must in all its integrity, be carried out. we sometimes hear of a child, before the eruption comes out and within twenty-four hours of the attack, dying of scarlet fever. when such be the case it is probably owing to low vitality of the system--to utter prostration--he is struck down, as though for death, and if the plan be not adopted of, for a few hours, keeping him alive by heat, and by stimulants, until, indeed, the eruption comes out, he will never rally again, but will die from scarlet fever poisoning and from utter exhaustion. these cases are comparatively rare, but they do, from time to time, occur, and, when they do, they demand exceptional and prompt and energetic means to save them from ending in almost immediate and certain death. "to be forewarned is to be forearmed." [footnote: i have been reminded of this _exceptional_ case of scarlet fever by a most intelligent and valued patient of mine, who had a child afflicted as above described, and whose child was saved from almost certain death, by a somewhat similar plan of treatment as advised in the text.] . _how soon ought a child to be allowed to leave the house after an attack of scarlet fever_? he must not be allowed to go out for at least a month from the commencement of the attack, in the summer, and six weeks in the winter; and not even then without the express permission of a medical man. it might be said that this is an unreasonable recommendation: but when it is considered that the whole of the skin generally desquamates, or peels off, and consequently leaves the surface of the body exposed to cold, which cold flies to the kidneys, producing a peculiar and serious disease in them, ending in dropsy, this warning will not be deemed unreasonable. scarlet fever dropsy, which is really a _formidable disease, generally arises from, the carelessness, the ignorance, and the thoughtlessness of parents in allowing a child to leave the house before the new skin be properly formed and hardened._ prevention is always better than cure. thus far with regard to the danger to the child himself. now, if you please, let me show you the risk of contagion that you inflict upon families, in allowing your child to mix with others before a month at least has elapsed. bear in mind, a case is quite as contagious, if not more so, while the skin is peeling off, as it was before. thus, in ten days or a fortnight, there is as much risk of contagion as at the _beginning_ of the disease, and when the fever is at its height. at the conclusion of the month, the old skin has generally all peeled off, and the new skin has taken its place; consequently there will then be less fear of contagion to others. but the contagion of scarlet fever is so subtle and so uncertain in its duration, that it is impossible to fix the exact time when it ceases. let me most earnestly implore you to ponder well on the above important facts. if these remarks should be the means of saving only one child from death, or from broken health, my labour will not have been in vain. . _what means do you advise to purify a house, clothes, and furniture, from the contagion of scarlet fever_? let every room in the house, together with its contents, and clothing and dresses that cannot be washed, be well fumigated with sulphur--taking care the while to close both windows and door; let every room be _lime-washed_ and then be white-washed; if the contagion have been virulent, let every bedroom be freshly papered (the walls having been previously stripped of the old paper and then lime-washed); let the bed, the holsters, the pillows, and the mattresses be cleansed and purified; let the blankets and coverlids be thoroughly washed, and then let them be exposed to the open air--if taken into a field so much the better; let the rooms be well scoured; let the windows, top and bottom, be thrown wide open; let the drains be carefully examined; let the pump water be scrutinised, to see that it be not contaminated by faecal matter, either from the water-closet, from the privy, from the pig-stye, or from the stable; let privies be emptied of their contents--_remember this is most important advice_--then put, into the empty places, either lime and powdered charcoal or carbolic acid, for it is a well ascertained fact that it is frequently impossible to rid a house of the infection of scarlet fever without adopting such a course. "in st george's, southwark, the medical officer reports that scarlatina 'has raged fatally, almost exclusively where privy or drain, smells are to be perceived in the houses.'" [footnote: _quarterly report of the board of health_ upon sickness in the metropolis.] let the children, who have not had, or who do not appear to be sickening for scarlet fever, be sent away from home--if to a farm house so much the better. indeed, leave no stone unturned, no means untried, to exterminate the disease from the house and from the neighbourhood. remember the young are more prone to catch contagious diseases than adults; for "in the morn and liquid dew of youth contagious blastments are most imminent."--_shakspeare_. . _have you any further observations to offer on the precautions to be taken against the spread of scarlet fever_? great care should be taken to separate the healthy from the infected. the nurses selected for attending scarlet fever patients should be those who have previously had scarlet fever themselves. dirty linen should be removed at once, and be put into boiling water. very little furniture should be in the room of a scarlet fever patient--the less the better--it only obstructs the circulation of the air, and harbours the scarlet fever poison. the most scrupulous attention to cleanliness should, in these cases, be observed. a patient who has recovered from scarlet fever, and before he mixes with healthy people, should, for three or four consecutive mornings, have a warm bath, and well wash himself, while in the bath, with soap; he will, by adopting this plan, get rid of the dead skin, and thus remove the infected particles of the disease. if scarlet fever should appear in a school, the school must for a time be broken up, in order that the disease might be stamped out there must be no half measures where such a fearful disease is in question. a house containing scarlet fever patients should, by parents, be avoided as the plague; it is a folly at any time to put one's head into the lion's mouth! chloralum and carbolic acid, and chloride of lime, and condy's fluid, are each and all good disinfectants; but not one is to be compared to perfect cleanliness and to an abundance of fresh and pure air--the last of which may truly _par excellence_ be called god's disinfectant! either a table-spoonful of chloralum, or two tea-spoonfuls of carbolic acid, or two tea-spoonfuls of condy's fluid, or a tea-spoonful of chloride of lime in a pint of water, are useful to sprinkle the soiled handkerchiefs as soon as they be done with, and before the be washed, to put in the _pot-de-chambre_, and to keep in saucers about the room; but, remember, as i have said before, and cannot repeat too often, there is no preventative like the air of heaven, which should be allowed to permeate and circulate freely through the apartment and through the house: air, air, air is the best disinfectant, curative, and preventative of scarlet fever in the world! i could only wish that my _treatment of scarlet fever_ were, in all its integrity, more generally adopted; if it were, i am quite sure that thousands of children would annually be saved from broken health and from death. time still further convinces me that my treatment is based on truth as i have every year additional proofs of its value and of its success; but error and prejudice are unfortunately ever at work, striving all they can to defeat truth and common sense. one of my principal remedies in the treatment of scarlet fever is an abundance of fresh air; but many people prefer their own miserable complicated inventions to god's grand and yet simple remedies--they pretend that they know better than the mighty framer of the universe! . _will you describe the symptoms of chicken pox_? it is occasionally, but not always, ushered in with a slight shivering fit; the eruption shows itself in about twenty-four hours from the child first appearing poorly. it is a vesicular [footnote: _vesicles_. small elevations of the cuticle, covering a fluid which is generally clear and colourless at first, but afterwards whitish and opaque, or pearly.--_watson_.] disease. the eruption comes out in the form of small pimples, and principally attacks the scalp, the neck, the back, the chest, and the shoulders, but rarely the face; while in small-pox the face is generally the part most affected. the next day these pimples fill with water, and thus become vesicles; on the third day they are at maturity. the vesicles are quite separate and distinct from each other. there is a slight redness around each of them. fresh ones, whilst the others are dying away, make their appearance. chicken-pox is usually attended with a slight itching of the skin; when the vesicles are scratched the fluid escapes, and leaves hard pearl-like substances, which, in a few days, disappear. chicken-pox never leaves pit marks behind. it is a child's complaint; adults scarcely, if ever, have it. . _is there any danger in chicken-pox; and what treatment do you advise_? it is not at all a dangerous, but, on the contrary, a trivial complaint. it lasts only a few days, and requires but little medicine. the patient ought, for three or four days, to keep the house, and should abstain from animal food. on the sixth day, but not until then, a dose or two of a mild aperient is all that will be required. . _is chicken-pox infectious_? there is a diversity of opinion on this head, but one thing is certain--it cannot be communicated by inoculation. . _what are the symptoms of modified small-pox_? the modified small-pox--that is to say, small-pox that has been robbed of its virulence by the patient having been either already vaccinated, or by his having had a previous attack of small-pox--is ushered in with severe symptoms, with symptoms almost as severe as though the patient had not been already somewhat protected either by vaccination or by the previous attack of small-pox--that is to say, he has a shivering fit, great depression of spirits and debility, _malaise_, sickness, headache, and occasionally delirium. after the above symptoms have lasted about three days, the eruption shows itself. the immense value of the previous vaccination, or the previous attack of small-pox, now comes into play. in a case of _unprotected_ small-pox, the appearance of the eruption _aggravates_ all the above symptoms, and the danger begins; while in the _modified_ small-pox, the moment the eruption shows itself the patient feels better, and, as a rule, rapidly recovers. the eruption, of _modified_ small-pox varies materially from the eruption of the _unprotected_ small-pox. the former eruption assumes a varied character, and is composed, first, of vesicles (containing water); and, secondly, of pustules (containing matter), each of which pustules has a depression in the centre; and, thirdly, of several red pimples without either water or matter in them, and which sometimes assume a livid appearance. these "breakings-out" generally show themselves more upon the wrist, and sometimes up one or both of the nostrils. while in the latter disease--the _unprotected_ small-pox--the "breaking-out" is composed entirely of pustules containing matter, and which pustules are more on the face than on any other part of the body. there is generally a peculiar smell in both diseases--an odour once smelt never to be forgotten. now, there is one most important remark i have to make,--the _modified small-pox is contagious_. this ought to be borne in mind, as a person labouring under the disease must, if there be children in the house, either be sent away himself, or else the children ought to be banished both the house and the neighbourhood. another important piece of advice is,--let _all_ in the house--children and adults, one and all--be vaccinated, even if any or all have been previously vaccinated. _treatment_.--let the patient keep his room, and if he be very ill, his bed. let the chamber be well ventilated. if it be winter time, a small fire in the grate will encourage ventilation. if it be summer, a fire is out of the question; indeed, in such a case, the window-sash ought to be opened, as thorough ventilation is an important requisite of cure, both in small-pox and in _modified_ small-pox. while the eruption is out, do not on any account give aperient medicine. in ten days from the commencement of the illness a mild aperient may be given. the best medicine in these cases is, the sweetened acidulated infusion of roses, [footnote: see page ] which ought to be given from the commencement of the disease, and should be continued until the fever be abated. for the first few days, as long as the fever lasts, the patient ought not to be allowed either meat or broth, but should be kept on a low diet, such as on gruel, arrow-root, milk-puddings, &c. as soon as the fever is abated he ought gradually to resume his usual diet. when he is convalescent, it is well, where practicable, that he should have change of air for a month. . _how would you distinguish between modified small-pox and chicken-pox_? modified small-pox may readily be distinguished from chicken-pox, by the former disease being, notwithstanding its modification, much more severe and the fever much more intense before the eruption shows itself than chicken-pox; indeed, in chicken-pox there is little or no fever either before or after the eruption; by the former disease--the modified small-pox--consisting _partly_ of pustules (containing matter), each pustule having a depression in the centre, and the favourite localities of the pustules being the wrists and the inside of the nostrils; while, in the chicken-pox, the eruption consists of vesicles (containing water), and _not_ pustules (containing matter), and the vesicles having neither a depression in the centre, nor having any particular partiality to attack either the wrists or the inside of the nose. in modified small-pox each pustule is, as in unprotected small-pox, inflamed at the base; while in chicken-pox there is only very slight redness around each vesicle. the vesicles in chicken-pox are small--much smaller than the pustules in modified small-pox. . _is hooping-cough an inflammatory disease_? hooping-cough in itself is not inflammatory, it is purely spasmodic; but it is generally accompanied with more or less of bronchitis-- inflammation of the mucous membrane of the bronchial tubes--on which account it is necessary, _in all cases_ of hooping-cough, to consult a medical man, that he may watch the progress of the disease and nip inflammation in the bud. . _will you have the goodness to give the symptoms, and a brief history of, hooping-cough_? hooping-cough is emphatically a disease of the young; it is rare for adults to have it; if they do, they usually suffer more severely than children. a child seldom has it but once in his life. it is highly contagious, and therefore frequently runs through a whole family of children, giving much annoyance, anxiety, and trouble to the mother and the nurses; hence hooping-cough is much dreaded by them. it is amenable to treatment. spring and summer are the best seasons of the year for the disease to occur. this complaint usually lasts from six to twelve weeks--sometimes for a much longer period, more especially if proper means are not employed to relieve it. hooping-cough commences as a common cold and cough. the cough, for ten days or a fortnight, increases in intensity; at about which time it puts on the characteristic "hoop." the attack of cough comes on in paroxysms. in a paroxysm, the child coughs so long and so violently, and _expires_ so much air from the lungs without _inspiring_ any, that at times he appears nearly suffocated and exhausted; the veins of his neck swell; his face is nearly purple; his eyes, with the tremendous exertion, almost seem to start from their sockets; at length there is a sudden _inspiration_ of air through the contracted chink of the upper part of the wind-pipe--the glottis--causing the peculiar "hoop;" and after a little more coughing, he brings up some glairy mucus from the chest; and sometimes, by vomiting, food from the stomach; he is at once relieved, until the next paroxysm occur, when the same process is repeated, the child during the intervals, in a favourable case, appearing quite well, and after the cough is over, instantly returning either to his play or to his food. generally, after a paroxysm he is hungry, unless, indeed, there be severe inflammation either of the chest or of the lungs. sickness, as i before remarked, frequently accompanies hooping-cough; when it does, it might be looked upon as a good sign. the child usually knows when an attack is coming on; he dreads it, and therefore tries to prevent it; he sometimes partially succeeds; but, if he does, it only makes the attack, when it does come, more severe. all causes of irritation and excitement ought, as much as possible, to be avoided, as passion is apt to bring on a severe paroxysm. a new-born babe--an infant of one or two months old--commonly escapes the infection; but if, at that tender age, he unfortunately catch hooping-cough, it is likely to fare harder with him than if he were older--the younger the child, the greater the risk. but still, in such a case, do not despair, as i have known numerous instances of new-born infants, with judicious care, recover perfectly from the attack, and thrive after it as though nothing of the kind had ever happened. a new-born babe, labouring under hooping-cough, is liable to convulsions, which is in this disease one, indeed the great, source of danger. a child, too, who is teething, and labouring under the disease, is also liable to convulsions. when the patient is convalescing, care ought to be taken that he does not catch cold, or the "hoop" might return. hooping-cough may either precede, attend, or follow an attack of measle. . _what is the treatment of hooping-cough_? we will divide the hooping-cough into three stages, and treat each stage separately, _what to do.--in the first stage_, the commencement of hooping-cough: for the first ten days give the ipecacuanha wine mixture, [footnote: for the prescription of the ipecacuanha wine mixture, see page .] a tea-spoonful three times a day. if the child be not weaned, keep him entirely to the breast, if he be weaned, to a milk and farinaceous diet. confine him for the first ten days to the house, more especially if the hooping-cough be attended, as it usually is, with more or less bronchitis. but take care that the rooms be well ventilated; for good air is essential to the cure. if the bronchitis attending the hooping-cough be severe, confine him to his bed, and treat him as though it were simply a case of bronchitis. [footnote: for the treatment of bronchitis, see answer to th question.] _in the second stage_, discontinue the ipecacuanha mixture, and give dr gibb's remedy--namely, nitric acid--which i have found to be an efficacious and valuable one in hooping-cough:-- take of--diluted nitric acid, two drachms; compound tincture of cardamons, half a drachm; simple syrup, three ounces; water, two ounces and a half: make a mixture. one or two tea-spoonfuls, or a table-spoonful, according to the age of the child--one tea-spoonful for an infant of six months, and two tea-spoonfuls for a child of twelve months, and one table-spoonful for a child of two years, every four hours, first shaking the bottle. let the spine and the chest be well rubbed every night and morning either with roche's embrocation, or with the following stimulating liniment (first shaking the bottle):-- take of--oil of cloves, one drachm; oil of amber, two drachms; camphorated oil, nine drachms: make a liniment. let him wear a broad band of new flannel, which should extend round from his chest to his back, and which ought to be changed every night and morning, in order that it may be dried before putting on again. to keep it in its place it should be fastened by means of tapes and with shoulder-straps. the diet ought now to be improved--he should gradually return to his usual food; and, weather permitting, should almost live in the open air--fresh air being, in such a case, one of the finest medicines. _in the third stage_, that is to say, when the complaint has lasted a month, if by that time the child is not well, there is nothing like change of air to a high, dry, healthy, country place. continue the nitric acid mixture, and either the embrocation or the liniment to the back and the chest, and let him continue to almost live in the open air, and be sure that he does not discontinue wearing the flannel until he be quite cured, and then let it be left off by degrees. if the hooping-cough have caused debility, give him cod-liver oil--a tea-spoonful twice or three times a day, giving it him on a full stomach, after his meals. but, remember, after the first three or four weeks, change of air, and plenty of it, is for hooping-cough the grand remedy. _what not to do_.--"do not apply leeches to the chest, for i would rather put blood into a child labouring under hooping-cough than take it out of him--hooping-cough is quite weakening enough to the system of itself without robbing him of his life's blood; do not, on any account whatever, administer either emetic tartar or antimonial wine; do not give either paregoric or syrup of white poppies; do not drug him either with calomel or with grey-powder; do not dose him with quack medicine; do not give him stimulants, but rather give him plenty of nourishment, such as milk and farinaceous food, but _no_ stimulants; do not be afraid, after the first week or two, of his having fresh air, and plenty of it--for fresh, pure air is the grand remedy, after all that can be said and done, in hooping-cough. although occasionally we find that, if the child to labouring under hooping-cough, and is breathing a pure country air, and is not getting well so rapidly as we could wish, change of air to a smoky gas-laden town will sometimes quickly effect a cure; indeed, some persons go so far as to say that the _best_ remedy for an _obstinate_ case of hooping-cough is, for the child to live, the great part of every day, in gas-works!" . _what is to be done during a paroxysm of hooping-cough_? if the child be old enough, let him stand up; but if he be either too young or too feeble, raise his head, and bend his body a little forward; then support his back with one hand, and the forehead with the other. let the mucus, the moment it be within reach, be wiped with a soft handkerchief out of his mouth. . _in an obstinate case of hooping-cough, what is the best remedy_? change of air, provided there be no active inflammation, to any healthy spot. a farm-house, in a high, dry, and salubrious neighbourhood, is as good a place as can be chosen. if, in a short time, he be not quite well, take him to the sea-side: the sea breezes will often, as if by magic, drive away the disease. . _suppose my child should have a shivering fit, is it to be looked upon as an important symptom_? certainly. nearly all _serious_ illnesses commence with a shivering fit: severe colds, influenza, inflammations of different organs, scarlet fever, measles, small-pox, and very many other diseases, begin in this way. if, therefore, your child should ever have a shivering fit, _instantly_ send for a medical man, as delay might be dangerous. a few hours of judicious treatment, at the commencement of an illness, is frequently of more avail than days and weeks, nay months, of treatment, when disease has gained a firm footing. a _serious_ disease often steals on insidiously, and we have perhaps only the shivering fit, which might be but a _slight_ one, to tell us of its approach. a _trifling_ ailment, too, by neglecting the premonitory symptom, which, at first might only be indicated by a _slight_ shivering fit, will sometimes become a mortal disorder:-- "the little rift within the lute, that by-and-by will make the music mute, and ever widening slowly silence all." [footnote: the above extract from tennyson is, in my humble opinion, one of the most beautiful pieces of poetry in the english language. it is a perfect gem, and a volume in itself, so truthful, so exquisite, so full of the most valuable reflections; for instance--( .) "the little rift within the lute,"--the little tubercle within the lung "that by-and-by will make the music mute, and ever widening slowly silence all," and the patient eventually dies of consumption. ( .) the little rent--the little rift of a very minute vessel in the brain, produces an attack of apoplexy, and the patient dies. ( .) each and all of us, in one form or another, sooner or later, will have "the little rift within the lute." but why give more illustrations?--a little reflection will bring numerous examples to my fair reader's memory.] . _in case of a shivering fit, perhaps you will tell me what to do_? _instantly_ have the bed warmed, and put the child to bed. apply either a hot bottle or a hot brick, wrapped in flannel, to the soles of his feet. put an extra blanket on his bed, and give him a cup of hot tea. as soon as the shivering fit is over, and he has become hot, gradually lessen the _extra_ quantity of clothes on his bed, and take away the hot bottle or the hot brick from his feet. _what not to do_.--do not give either brandy or wine, as inflammation of some organ might be about taking place. do not administer opening medicine, as there might be some "breaking out" cooling out on the skin, and an aperient might check it. . _my child, apparently otherwise healthy, screams out in the night violently in his sleep, and nothing for a time will pacify him: what is likely to be the cause, and what is the treatment_? the causes of these violent screamings in the night are various. at one time, they proceed from teething; at another, from worms; sometimes, from night-mare; occasionally, from either disordered stomach or bowels. each of the above causes will, of course, require a different plan of procedure; it will, therefore, be necessary to consult a medical man on the subject, who will soon, with appropriate treatment, be able to relieve him. . _have the goodness to describe the complaint of children called mumps_. the mumps, inflammation of the "parotid" gland, is commonly ushered in with a slight feverish attack. after a short time, a swelling, of stony hardness, is noticed before and under the ear, which swelling extends along the neck towards the chin. this lump is exceedingly painful, and continues painful and swollen for four or five days. at the end of which time it gradually disappears, leaving not a trace behind. the swelling of mumps never gathers. it may affect one or both sides of the face. it seldom occurs but once in a lifetime. it is contagious, and has been known to run through a whole family or school; but it is not dangerous, unless, which is rarely the case, it leaves the "parotid" gland, and migrates either to the head, to the breast, or to the testicle. . _what is the treatment of mumps_? foment the swelling, four or five times a day, with a flannel wrung out of hot camomile and poppy-head decoction; [footnote: four poppy-heads and four ounces of camomile blows to be boiled in four pints of water for half an hour, and then strained to make the decoction.] and apply, every night, a barm and oatmeal poultice to the swollen gland or glands. debar, for a few days, the little patient from taking meat and broth, and let him live on bread and milk, light puddings, and arrow-root. keep him in a well-ventilated room, and shut him out from the company of his brothers, his sisters, and young companions. give him a little mild, aperient medicine. of course, if there be the slightest symptom of migration to any other part or parts, instantly call in a medical man. . _what is the treatment of a boil_? one of the best applications is a burgundy-pitch plaster spread on a soft piece of wash leather. let a chemist spread a plaster, about the size of the hand; and, from this piece, cut small plasters, the size of a shilling or a florin (according to the dimensions of the boil), which snip around and apply to the part. put a fresh one on daily. this plaster will soon cause the boil to break; when it does break, squeeze out the contents--the core and the matter--and then apply one of the plasters as before, which, until the boil be well, renew every day. the old-fashioned remedy for a boil--namely, common yellow soap and brown-sugar, is a capital one for the purpose. it is made with equal parts of brown sugar and of shredded yellow soap, and mixed by means of a table-knife on a plate, with a few drops of water, until it be all well blended together, and of the consistence of thick paste; it should then be spread either on a piece of wash-leather, or on thick linen, and applied to the boil, and kept in its place by means either of a bandage or of a folded handkerchief; and should he removed once or twice a day. this is an excellent application for a boil--soothing, comforting, and drawing--and will soon effect a cure. a paste of honey and flour, spread on linen rag, is another popular and good application for a boil. _if the boils should arise from the child being in a delicate state of health_, give him cod-liver oil, meat once a day, and an abundance of milk and farinaceous food. let him have plenty of fresh air, exercise, and play. _if the boil should arise from gross and improper feeding_, then keep him for a time from meat, and let him live principally on a milk and farinaceous diet. _if the child be fat and gross_, cod-liver oil would he improper; a mild aperient, such as rhubarb and magnesia, would then be the best medicine. . _what are the symptoms of ear-ache_? a young child screaming shrilly, violently, and continuously, is oftentimes owing to ear-ache; carefully, therefore, examine each ear, and ascertain if there be any discharge; if there be, the mystery is explained. screaming from ear-ache may be distinguished from the screaming from bowel-ache by the former (ear-ache) being more continuous--indeed, being one continued scream, and from the child putting his hand to his head; while, in the latter (bowel-ache), the pain is more of a coming and of a going character, and he draws up his legs to his bowels. again, in the former (ear-ache), the secretions from the bowels are natural; while, in the latter (bowel-ache), the secretions from the bowels are usually depraved, and probably offensive. but a careful examination of the ear will generally at once decide the nature of the case. . _what is the best remedy for ear-ache_? apply to the ear a small flannel bag, filled with hot salt--as hot as can be comfortably borne, or foment the ear with a flannel wrung out of hot camomile and poppy head decoction. a roasted onion, inclosed in muslin applied to the ear, is an old-fashioned and favourite remedy, and may, if the bag of hot salt, or if the hot fomentation do not relieve, be tried. put into the ear, but not very far, a small piece of cotton wool, moistened with warm olive oil. taking care that the wool is always removed before a fresh piece be substituted, as if it be allowed to remain in any length of time, it may produce a discharge from the ear. avoid all _cold_ applications. if the ear-ache be severe, keep the little fellow at home, in a room of equal temperature, but well-ventilated, and give him, for a day or two, no meat. if a discharge from the ear should either accompany or follow the ear-ache, _more especially if the discharge be offensive_, instantly call in a medical man, or deafness for life may be the result. a knitted or crotcheted hat, with woollen rosettes over the ears, is, in the winter time, an excellent hat for a child subject to ear-ache. the hat may be procured at any baby-linen warehouse. . _what are the causes and the treatment of discharges from the ear_? cold, measles, scarlet fever, healing up of "breakings out" behind the ear; pellets of cotton wool, which had been put in the ear, and had been forgotten to be removed, are the usual causes of discharges from the ear. it generally commences with ear-ache. the _treatment_ consists in keeping the parts clean, by syringing the ear every morning with warm water, by attention to food--keeping the child principally upon a milk and a farmaceous diet, and by change of air--more especially to the coast. if change of air be not practicable, great attention should be paid to ventilation. as i have before advised, in all cases of discharge from the ear call in a medical man, as a little judicious medicine is advisable--indeed, essential; and it may be necessary to syringe the ear with lotions, instead of with warm water; and, of course, it is only a doctor who has actually seen the patient who can decide these matters, and what is best to be done in each case. . _what is the treatment of a "stye" on the eye-lid_? bathe the eye frequently with warm milk and water, and apply, every night at bedtime, a warm white-bread poultice. no medicine is required; but, if the child be gross, keep him for a few days from meat, and let him live on bread and milk and farinaceous puddings. . _if a child have large bowels, what would you recommend as likely to reduce their size_? it ought to be borne in mind, that the bowels of a child are larger in proportion than those of an adult. but, if they be actually larger than they ought to be, let them be well rubbed for a quarter of an hour at a time night and morning, with soap liniment, and then apply a broad flannel belt. "a broad flannel belt worn night and day, firm but not tight, is very serviceable." [footnote: sir charles locock, in a _letter_ to the author.] the child ought to be prevented from drinking as much as he has been in the habit of doing; let him be encouraged to exercise himself well in the open air; and let strict regard be paid to his diet. . _what are the best aperients for a child_? if it be _actually_ necessary to give him opening medicine, one or two tea-spoonfuls of syrup of senna, repeated, if necessary, in four hours, will generally answer the purpose; or, for a change, one or two tea-spoonfuls of castor oil may be substituted. lenitive electuary (compound confection of senna) is another excellent aperient for the young, it being mild in its operation, and pleasant to take; a child fancying it is nothing more than jam, and which it much resembles both in appearance and in taste. the dose is half or one tea-spoonful early in the morning occasionally. senna is an admirable aperient for a child, and is a safe one, which is more than can be said of many others. it is worthy of note that "the taste of senna may be concealed by sweeting the infusion, [footnote: infusion of senna may be procured of any respectable druggist. it will take about one or two table-spoonfuls, or even more, of the infusion (according to the age of the child, and the obstinacy of the bowels), to act as an aperient. of course, you yourself will be able, from time to time, as the need arises, to add the milk and the sugar, and thus to make it palatable. it ought to be given warm, so as the more to resemble tea.] adding milk, and drinking as ordinary tea, which, when thus prepared, it much resembles" [footnote: _waring's manual of practical therapeutics._] honey, too, is a nice aperient for a child--a tea-spoonful ought to be given either by itself, or spread on a slice of bread. some mothers are in the habit of giving their children jalap gingerbread. i do not approve of it, as jalap is a drastic, griping purgative; besides, jalap is very nasty to take--nothing will make it palatable. fluid magnesia--solution of carbonate of magnesia--is a good aperient for a child; and, as it has very little taste, is readily given, more especially if made palatable by the addition either of a little syrup or of brown sugar. the advantages which it has over the old solid form are, that it is colourless and nearly tasteless, and never forms concretions in the bowels, as the _solid_ magnesia, if persevered in for any length of time, sometimes does. a child of two or three years old may take one or two table-spoonfuls of the fluid; either by itself or in his food, repeating it every four hours until the bowels be open. when the child is old enough to drink the draught off _immediately_, the addition of one or two tea-spoonfuls of lemon juice to each dose of the fluid magnesia, makes a pleasant effervescing draught, and increases its efficacy as an aperient. bran-bread [footnote: one-part of bran to three parts of flour, mixed together and made into bread.] and _treacle_ will frequently open the bowels; and as treacle is wholesome, it may be substituted for butter when the bowels are inclined to be costive. a roasted apple, eaten with _raw_ sugar, is another excellent mild aperient for a child. milk gruel--that is to say, milk thickened with oatmeal--forms an excellent food for him, and often keeps his bowels regular, and thus (_which is a very important consideration_) supersedes the necessity of giving him an aperient. an orange (taking care he does not eat the peel or the pulp), or a fig after dinner, or a few muscatel raisins, will frequently regulate the bowels. stewed prunes is another admirable remedy for the costiveness of a child. the manner of stewing them is as follows:--put a pound of prunes in a brown jar, add two table-spoonfuls of _raw_ sugar, then cover the prunes and the sugar with cold water; place them in the oven, and let them stew for four hours. a child should every morning eat half a dozen or a dozen of them, until the bowels be relieved, taking care that he does not swallow the stones. stewed prunes may be given in treacle--treacle increasing the aperient properties of the prunes. a suppository is a mild and ready way of opening the bowels of a child. when he is two or three years old and upwards, a _candle_ suppository is better than a _soap_ suppository. the way of preparing it is as follows:--cut a piece of dip-tallow candle--the length of three inches--and insert it as you would a clyster pipe, about two inches up the fundament, allowing the remaining inch to be in sight, and there let the suppository remain until the bowels be opened. another excellent method of opening a child's bowels is by means of an enema of warm water,--from half a tea-cupful to a tea-cupful, or even more, according to the age of the child. i cannot speak too highly of this plan as a remedy for costiveness, as it entirely, in the generality of cases, prevents the necessity of administering a particle of aperient medicine by the mouth. the fact of its doing so stamps it as a most valuable remedy--opening physic being, as a rule, most objectionable, and injurious to a child's bowels. bear this fact--for it is a fact--in mind and let it be always remembered. . _what are the most frequent causes of protrusion of the lower-bowel_? the too common and reprehensible practice of a parent administering frequent aperients, especially calomel and jalap, to her child. another cause, is allowing him to remain for a quarter of an hour or more at a time on his chair; this induces him to strain, and to force the gut down. . _what are the remedies_? if the protrusion of the bowel have been brought on by the abase of aperients, abstain, for the future from giving them; but if medicine be absolutely required, give the mildest--such as either syrup of senna or castor oil--_and the less of those the better._ if the _external_ application of a purgative will have the desired effects it will in such cases, be better than the _internal_ administration of aperients. castor oil used as a liniment is a good one for the purpose. let the bowels be well rubbed, every night and morning, for five minutes at a time with the oil. a wet compress to the bowels will frequently open them, and will thus do away with the necessity of giving an aperient--_a most important consideration_. fold a napkin in six thicknesses, soak it in _cold_ water, and apply it to the bowels; over which put either a thin covering or sheet of gutta-percha, or a piece of oiled-silk; keep it in its place with a broad flannel roller; and let it remain on the bowels for three or four hours, or until they be opened. try what diet will do, as opening the bowels by a regulated diet is far preferable to the giving of aperients. let him have either bran-bread or robinson's patent groats, or robinson's pure scotch oatmeal made into gruel with new milk, or du barry's arabica revalenta, or a slice of huntly and palmer's lump gingerbread. let him eat stewed prunes, stewed rhubarb, roasted apples, strawberries, raspberries, the inside of grapes and gooseberries, figs, &c. give him early every morning a draught of _cold_ water. let me, again, urge you _not_ to give aperients in these cases, or in any case, unless you are absolutely compelled. by following my advice you will save yourself an immense deal of trouble, and your child a long catalogue of misery. again, i say, look well into the matter, and whenever it be practicable avoid purgatives. now, with regard to the best manner of returning the bowel, lay the child upon the bed on his face and bowels, with his hips a little raised; then smear lard on the forefinger of your right hand (taking care that the nail be cut close), and gently with, your fore-finger press the bowel into its proper place. remember, if the above methods be observed, you cannot do the slightest injury to the bowel; and the sooner it be returned, the better it will be for the child; for if the bowel be allowed to remain long down, it may slough or mortify, and death may ensue. the nurse, every time he has a motion, must see that the bowel does not come down, and if it does, she ought instantly to return it. moreover, the nurse should be careful _not_ to allow the child to remain on his chair more than two or three minutes at a time. another excellent remedy for the protrusion of the lower bowel, is to use every morning a cold salt and water sitz bath. there need not be more than a depth of three inches of water in the bath; a small handful of table salt should be dissolved in the water; a dash of warm water in the winter time must be added, to take off the extreme chill; and the child ought not to be allowed to sit in the bath for more than one minute, or whilst the mother can count a hundred; taking care, the while, to throw either a square of flannel or a small shawl over his shoulders. the sitz bath ought to be continued for months, or until the complaint be removed. i cannot speak in too high praise of these baths. . _do you advise me, every spring and fall, to give my child brimstone to purify and sweeten his blood, and as a preventive medicine_? certainly not; if you wish to take away his appetite, and to weaken and depress him, give brimstone! brimstone is not a remedy fit for a child's stomach. the principal use and value of brimstone is as an external application in itch, and as an internal remedy, mixed with other laxatives, in piles--piles being a complaint of adults. in olden times poor unfortunate children were dosed, every spring and fall, with brimstone and treacle to sweeten their blood! fortunately for the present race, there is not so much of that folly practised, but still there is room for improvement. to dose a _healthy_ child with physic is the grossest absurdity. no, the less physic a delicate child has the better it will be for him, but physic to a healthy child is downright poison! and brimstone of all medicines! it is both weakening and depressing to the system, and by opening the pores of the skin and by relaxing the bowels, is likely to give cold, and thus to make a healthy, a sickly child. sweeten his blood! it is more likely to weaken his blood, and thus to make his blood impure! blood is not made pure by drugs, but by nature's medicine; by exercise, by pure air, by wholesome diet, by sleep in a well-ventilated apartment, by regular and thorough ablution. brimstone a preventive medicine! preventive medicine--and brimstone especially in the guise of a preventive medicine--is "a mockery, a delusion, and a snare." . _when a child is delicate, and his body, without any assignable cause, is gradually wasting away, and the stomach rejects all food that is taken, what plan can be adopted likely to support his strength, and thus probably be the means of saving his life_? i have seen, in such a case, great benefit to arise from half a tea-cupful of either strong mutton-broth or of strong beef-tea, used as an enema every four hours. [footnote: an enema apparatus is an important requisite in every nursery; it may be procured of any respectable surgical instrument maker. the india-rubber enema bottle is, for a child's use, a great improvement on the old syringe, as it is not so likely to get out of order, and, moreover, is more easily used.] it should be administered slowly, in order that it may remain in the bowel. if the child be sinking, either a dessert-spoonful of brandy, or half a wine-glassful of port wine, ought to be added to each enema. the above plan ought only to be adopted if there be _no_ diarrhoea. if there be diarrhoea, an enema must _not_ be used. then, provided there be great wasting away, and extreme exhaustion, and other remedies having failed, it would be advisable to give, by the mouth, _raw_ beef of the finest quality, which ought to be taken from the hip bone, and should be shredded very fine. all fat and skin must be carefully removed. one or two tea-spoonfuls (according to the age of the child) ought to be given every four hours. the giving of _raw_ meat to children in exhaustive diseases, such as excessive long-standing diarrhoea, was introduced into practice by a russian physician, a professor wiesse of st petersburg. it certainly is, in these cases, a most valuable remedy, and has frequently been the means of snatching such patients from the jaws of death. children usually take raw meat with avidity and with a relish. . _if a child be naturally delicate, what plan would you recommend to strengthen him_? i should advise strict attention to the rules above mentioned, and _change of air_--more especially, if it be possible, to the coast. change of air, sometimes, upon a delicate child, acts like magic, and may restore him to health when all other means have failed. if a girl be delicate, "carry her off to the farm, there to undergo the discipline of new milk, brown bread, early hours, no lessons, and romps in the hay-field."--_blackwood_. this advice is, of course, equally applicable for a delicate boy, as delicate boys and delicate girls ought to be treated alike. unfortunately in these very enlightened days there is too great a distinction made in the respective management and treatment of boys and girls. the best medicines for a delicate child will be the wine of iron and cod-liver oil. give them combined in the manner i shall advise when speaking of the treatment of rickets. in diseases of long standing, and that resist the usual remedies, there is nothing like _change of air_. hippocrates, the father of medicine, says-- "in longis morbis solum mutare." (in tedious diseases to change the place of residence.) a child who, in the winter, is always catching cold, whose life during half of the year is one continued catarrh, who is in consequence, likely, if he grow up at all, to grow up a confirmed invalid, ought, during the winter months, to seek another clime; and if the parents can afford the expense, they should at the beginning of october, cause him to bend his steps to the south of europe--mentone being as good a place as they could probably fix upon. . _do you approve of sea bathing for a delicate young child_? no: he is frequently so frightened by it that the alarm would do him more harm than the bathing would do him good. the better plan would be to have him every morning well sponged, especially his back and loins, with sea water; and to have him as much as possible carried on the beach, in order that he may inhale the sea breezes. when he be older, and is not frightened at being dipped, sea bathing will be very beneficial to him. if bathing is to do good, either to an adult or to a child, it must be anticipated with pleasure, and neither with dread nor with distaste. . _what is the best method for administering medicine to a child_? if he be old enough, appeal to his reason; for, if a mother endeavour to deceive her child, and he detect her, he will for the future suspect her. if he be too young to be reasoned with, then, if he will not take his medicine, he must be compelled. lay him across your knees, let both his hands and his nose be tightly held, and then, by means of the patent medicine-spoon, or, if that be not at hand, by either a tea or a dessert-spoon, pour the medicine down his throat, and he will be obliged to swallow it. it may be said that this is a cruel procedure; but it is the only way to compel an unruly child to take physic, and is much less cruel than running the risk of his dying from the medicine not having been administered. [footnote: if any of my medical brethren should perchance read these conversations, i respectfully and earnestly recommend them to take more pains in making medicines for children pleasant and palatable. i am convinced that, in the generality of instances, provided a little more care and thought were bestowed on the subject, it may be done; and what an amount of both trouble and annoyance it would save! it is really painful to witness the struggles and cries of a child when _nauseous_ medicine is to be given; the passion and excitement often do more harm than the medicine does good.] . _ought a sick child to be roused from his sleep to give him physic, when it is time for him to take it_? on no account, as sleep, being a natural restorative, must not be interfered with. a mother cannot be too particular in administering the medicine, at stated periods, whilst he is awake. . _have you any remarks to make on the management of a sick-room, and have you any directions to give on the nursing of a child_? in sickness select a large and lofty room; if in the town, the back of the house will be preferable--in order to keep the patient free from noise and bustle--as a sick-chamber cannot be kept too quiet. be sure that there be a chimney in the room--as there ought to be in _every_ room in the house--and that it be not stopped, as it will help to carry off the impure air of the apartment. keep the chamber _well ventilated_, by, from time to time, opening the window. the air of the apartment cannot be too pure; therefore, let the evacuations from the bowels be instantly removed, either to a distant part of the house, or to an out-house or to the cellar, as it might be necessary to keep them for the medical man's inspection. before using either the night-commode, or the _pot-de-chambre_, let a little water, to the depth of one or two inches, be put in the pan, or _pot_; in order to sweeten the motion, and to prevent the faecal matter from adhering to the vessel. let there be frequent change of linen, as in sickness it is even more necessary than in health, more especially if the complaint be fever. in an attack of fever, clean sheets ought, every other day, to be put on the bed; clean body-linen every day. a frequent change of linen in sickness is most refreshing. if the complaint be fever, a fire in the grate will not be necessary. should it be a case either of inflammation of the lungs or of the chest, a small fire in the winter time is desirable, keeping the temperature of the room as nearly as possible at degrees fahrenheit. bear in mind that a large fire in a sick-room cannot be too strongly condemned; for if there be fever--and there are scarcely any complaints without--a large fire only increases it. small fires, in cases either of inflammation of the lungs or of the chest, in the winter time, encourage ventilation of the apartment, and thus carry off impure air. if it be summer time, of course fires would be improper. a thermometer is an indispensable requisite in a sick-room. in fever, free and thorough ventilation is of vital importance, more especially in scarlet fever; then a patient cannot have too much air; in scarlet fever, for the first few days the windows, be it winter or summer, must to the widest extent be opened. the fear of the patient catching cold by doing so is one of the numerous prejudices and baseless fears that haunt the nursery, and the sooner it is exploded the better it will he for human life. the valances and bed-curtains ought to be removed, and there should be as little furniture in the room as possible. if it be a case of measles, it will be necessary to adopt a different course; then the windows ought not to be opened, but the door must from time to time be left ajar. in a case of measles, if it be winter time, a _small_ fire in the room will be necessary. in inflammation of the lungs or of the chest, the windows should not be opened, but the door ought occasionally to be left unfastened, in order to change the air and to make it pure. remember, then, that ventilation, either by open window or by open door, is in all diseases most necessary. ventilation is one of the best friends a doctor has. in fever, do not load the bed with clothes; in the summer a sheet is sufficient, in winter a sheet and a blanket. in fever, do not be afraid of allowing the patient plenty either of cold water or of cold toast and water; nature will tell him when he has had enough. in measles, let the chill be taken off the toast and water. in _croup_, have always ready a plentiful supply of hot water, in case a warm bath might he required. in _child-crowing_, have always in the sick-room a supply of cold water, ready at a moment's notice to dash upon the face. in fever, do not let the little patient lie on the lap; he will rest more comfortably on a horse-hair mattress in his crib or cot. if he have pain in the bowels, the lap is most agreeable to him; the warmth of the body, either of the mother or of the nurse, soothes him; besides, if he be on the lap, he can be turned on his stomach and on his bowels, which, often affords him great relief and comfort. if he be much emaciated, when he is nursed, place a pillow upon the lap and let him lie upon it. in _head affections_, darken the room with a _green_ calico blind; keep the chamber more than usually quiet; let what little talking is necessary be carried on in whispers, but the less of that the better; and in _head affections_, never allow smelling salts to be applied to the nose, as they only increase the flow of blood to the head, and consequently do harm. it is often a good sign for a child, who is seriously ill, to suddenly become cross. it is then he begins to feel his weakness and to give vent to his feelings. "children are almost always cross when recovering from an illness, however patient they may have been during its severest moments, and the phenomenon is not by any means confined to children."--geo. mcdonald. a sick child must _not_ be stuffed with _much_ food at a time. he will take either a table-spoonful of new milk or a table-spoonful of chicken broth every half hour with greater advantage than a tea-cupful of either the one or the other every four hours, which large quantity would very probably be rejected from his stomach, and may cause the unfortunately treated child to die of starvation! if a sick child be peevish, attract his attention either by a toy or by an ornament; if he be cross, win him over to good humour by love, affection, and caresses, but let it be done gently and without noise. do not let visitors see him; they will only excite, distract, and irritate him, and help to consume the oxygen of the atmosphere, and thus rob the air of its exhilarating health-giving qualities and purity; a sick-room, therefore, is not a proper place, either for visitors or for gossips. in selecting a sick-nurse, let her be gentle, patient, cheerful, quiet, and kind, but firm withal; she ought to be neither old nor young: if she be old she is often garrulous and prejudiced, and thinks too much of her trouble; if she he young, she is frequently thoughtless and noisy; therefore choose a middle-aged woman. do not let there be in the sick-room more than, besides the mother, one efficient nurse; a greater number can he of no service--they will only be in each other's way, and will distract the patient. let stillness, especially if the head be the part affected, reign in a sick-room. creaking shoes [footnote: nurses at these times ought to wear slippers, and not shoes. the best slippers in sick-rooms are those manufactured by the north british rubber company, edinburgh; they enable nurses to walk in them about the room without causing the slightest noise; indeed, they might truly be called "the noiseless slipper," a great desideratum in such cases, more especially in all head affections of children. if the above slippers cannot readily be obtained, then list slippers--soles and all bring made of list--will answer the purpose equally as well.] and rustling silk dresses ought not to be worn in sick-chambers--they are quite out of place there. if the child be asleep, or if he be dozing, perfect stillness must he enjoined, not even a whisper should be heard:-- "in the sick-room be calm, more gently and with care. lest any jar or sudden noise, come sharply unaware. you cannot tell the harm. the mischief it may bring, to wake the sick one suddenly, besides the suffering. the broken sleep excites fresh pain, increased distress; the quiet slumber undisturb'd soothes pain and restlessness. sleep is the gift of god: oh! bear these words at heart, 'he giveth his beloved sleep,' and gently do thy part." [footnote: _household verses on health and happiness._ london: jarrold and sons. a most delightful little volume.] if there be other children, let them be removed to a distant part of the house; or, if the disease be of an infectious nature, let them be sent away from home altogether. in all illnesses--and bear in mind the following is most important advice--a child must be encouraged to try and make water, whether he ask or not, at least four times during the twenty-four hours; and at any other time, if he express the slightest inclination to do so. i have known a little fellow to hold his water, to his great detriment, for twelve hours, because either the mother bad in her trouble forgotten to inquire, or the child himself was either too ill or too indolent to make the attempt. see that the medical man's directions are, to the very letter, carried out. do not fancy that you know better than he does, otherwise you have no business to employ him. let him, then, have your implicit confidence and your exact obedience. what _you_ may consider to be a trifling matter, may frequently be of the utmost importance, and may sometimes decide whether the case shall end either in life or death! _lice_.--it is not very poetical, as many of the grim facts of every-day life are not, but, unlike a great deal of poetry, it is unfortunately too true that after a severe and dangerous illness, especially after a bad attack of fever, a child's head frequently becomes infested with vermin--with lice. it therefore behoves a mother herself to thoroughly examine, by means of a fine-tooth comb, [footnote: which fine-tooth comb ought not to be used at any other time except for the purpose of examination, as the constant use of a fine-tooth comb would scratch the scalp, and would encourage a quantity of scurf to accumulate.] her child's head, in order to satisfy her mind that there be no vermin there. as soon as he be well enough, he ought to resume his regular ablutions--that is to say, that he must go again regularly into his tub, and have his head every morning thoroughly washed with soap and water. a mother ought to be particular in seeing that the nurse washes the hair-brush at least once every week; if she does not do so, the dirty brush which had during the illness been used, might contain the "nits"--the eggs of the lice--and would thus propagate the vermin, as they will, when on the head of the child, soon hatch. if there be already lice on the head, in addition to the regular washing every morning with the soap and water, and after the head has been thoroughly dried, let the hair be well and plentifully dressed with camphorated oil--the oil being allowed to remain on until the next washing on the following morning. lice cannot live in oil (more especially if, as in camphorated oil, camphor be dissolved in it), and as the camphorated oil will not, in the slightest degree, injure the hair, it is the best application that can be used. but as soon as the vermin have disappeared, let the oil be discontinued, as the _natural oil_ of the hair is, at other times, the only oil that is required on the head. the "nit"--the egg of the louse--might be distinguished from scurf (although to the _naked_ eye it is very much like it in appearance) by the former fastening firmly on one of the hairs as a barnacle would on a rock, and by it not being readily brushed off as scurf would, which latter (scurf) is always loose. . _my child, in the summer time, is much tormented with fleas: what are the best remedies_? a small muslin bag, filled with camphor, placed in the cot or bed, will drive fleas away. each flea-bite should, from time to time, be dressed by means of a camel's hair brush, with a drop or two of spirit of camphor; an ounce bottle of which ought, for the purpose, to be procured from a chemist. camphor is also an excellent remedy to prevent bugs from biting. bugs and fleas have a horror of camphor; and well they might, for it is death to them! there is a famous remedy for the destruction of fleas manufactured in france, entitled "_la poudre insecticide,_" which, although perfectly harmless to the human economy, is utterly destructive to fleas. bugs are best destroyed either by creosote or by oil of turpentine: the places they do love to congregate in should be well saturated by means of a brush, with the creosote or with the oil of turpentine. a few dressings will effectually destroy both them and their young ones. . _is not the pulse a great sign either of health or of disease_? it is, and every mother should have a general idea of what the pulse of children of different ages should be both in health and in disease. "every person should know how to ascertain the state of the pulse in health; then, by comparing it with what it is when he is ailing, he may have some idea of the urgency of his case. parents should know the healthy pulse of each child, since now and then a person is born with a peculiarly slow or fast pulse, and the very case in hand may be of such peculiarity. an infant's pulse is , a child of seven about , and from to years it is beats a minute, declining to at fourscore. a healthful grown person beats times in a minute, declining to at fourscore. at , if the pulse always exceeds , there is a disease; the machine working itself out, there is a fever or inflammation somewhere, and the body is feeding on itself, as in consumption, when the pulse is quick." . _suppose a child to have had an attack either of inflammation of the lungs or of bronchitis, and to be much predisposed to a return: what precautions would you take to prevent either the one or the other for the future_? i would recommend him to wear fine flannel instead of lawn shirts; to wear good lamb's-wool stockings _above the knees_, and good, strong, dry shoes to his feet; to live, weather permitting, a great part of every day in the open air; to strengthen his system by good nourishing food--by an abundance of both milk and meat (the former especially); to send him, in the autumn, for a couple of months, to the sea-side; to administer to him, from time to time, cod-liver oil; in short, to think only of his health, and to let learning, until he be stronger, be left alone. i also advise either table salt or bay salt, or tidman's sea salt, to be added to the water in which the child is washed with in the morning, in a similar manner as recommended in answer to a previous question. . _then do you not advise such a child to be confined within doors_? if any inflammation be present, or if he have but just recovered from one, it would be improper to send him into the open air, but not otherwise, as the fresh air would be a likely means of strengthening the lungs, and thereby of preventing an attack of inflammation for the future. besides, the more a child is coddled within doors, the more likely will he be to catch cold, and to renew the inflammation. if the weather be cold, yet neither wet nor damp, he ought to be sent out, but let him be well clothed; and the nurse should have strict injunctions _not_ to stand about entries or in any draughts--indeed, not to stand about at all, but to keep walking about all the time she is in the open air. unless you have a trustworthy nurse, it will be well for you either to accompany her in her walk with your child, or merely to allow her to walk with him in the garden, as you can then keep your eye upon both of them. . _if a child be either chicken-breasted, or if he be narrow-chested, are there any means of expanding and of strengthening his chest_? learning ought to be put out of the question, attention must be paid to his health alone, or consumption will probably mark him as its own! let him live as much as possible in the open air; if it be country, so much the better. let him rise early in the morning, and let him go to bed betimes; and if he be old enough to use the dumb-bells, or what is better, an india-rubber chest-expander, he should do so daily. he ought also to be encouraged to use two short sticks, similar to, but heavier than, a policeman's staff, and to go, every morning, through regular exercises with them. as soon as he is old enough, let him have lessons from a drill-sergeant and from a dancing master. let him be made both to walk and to sit upright, and let him be kept as much as possible upon a milk diet, [footnote: where milk does not agree, it may generally be made to do so by the addition of one part of lime water to seven parts of new milk. moreover, the lime will be of service in hardening his bones, and, in these cases, the bones require hardening.] and give him as much as he can eat of fresh meat every day. cod liver oil, a tea-spoonful or a dessert-spoonful, according to his age, twice a day, is serviceable in these cases. stimulants ought to be carefully avoided. in short, let every means be used to nourish, to strengthen, and invigorate the system, without, at the same time, creating fever. such a child should be a child of nature, he ought almost to live in the open air, and throw his books to the winds. of what use is learning without health? in such a case as this you cannot have both. . _if a child be round-shouldered, or if either of his shoulder-blades have "grown out," what had better be done_? many children have either round shoulders, or have their shoulder blades grown out, or have their spines twisted, from growing too fast, from being allowed to slouch in their gait, and from not having sufficient nourishing food, such as meat and milk, to support them while the rapid growth of childhood is going on. if your child be affected as above described, nourish him well on milk and on farinaceous food, and on meat once a day, but let milk be his staple diet; he ought, during the twenty four hours, to take two or three pints of new milk. he should almost live in the open air, and must have plenty of play. if you can so contrive it, let him live in the country. when tired, let him lie, for half an hour, two or three times daily, flat on his back on the carpet. let him rest at night on a horse-hair mattress, and not on a feather bed. let him have every morning, if it be summer, a thorough cold water ablution, if it be winter, let the water be made tepid. let either two handfuls of table salt or a handful of bay salt be dissolved in the water. let the salt and water stream well over his shoulders and down his back and loins. let him be well dried with a moderately coarse towel, and then let his back be well rubbed, and his shoulders be thrown back-exercising them much in the same manner as in skipping, for five or ten minutes at a time. skipping, by-the-by, is of great use in these cases, whether the child be either a boy or a girl-using, of course, the rope backwards, and not forwards. let books be utterly discarded until his shoulders have become strong, and thus no longer round, and his shoulder-blades have become straight. it is a painful sight to see a child stoop like an old man. let him have, twice daily, a tea-spoonful or a dessert-spoonful (according to his age) of cod-liver oil, giving it him on a full and not on an empty stomach. when he is old enough, let the drill-sergeant give him regular lessons, and let the dancing-master be put in requisition. let him go through regular gymnastic exercises, provided they are not of a violent character. but, bear in mind, let there be in these cases no mechanical restraints--no shoulder-straps, no abominable stays. make him straight by natural means--by making him strong. mechanical means would only, by weakening and wasting the muscles, increase the mischief, and thus the deformity. in this world of ours there is too much reliance placed on artificial, and too little on natural means of cure. . _what are the causes of bow legs in a child; and what is the treatment_? weakness of constitution, poor and insufficient nourishment, and putting a child, more especially a fat and heavy one, on his legs too early. _treatment._--nourishing food, such as an abundance of milk, and, if he be old enough, of meat; iron medicines; cod-liver-oil; thorough ablution, every morning of the whole body; an abundance of exercise, either on pony, or on donkey, or in carriage, but not, until his legs be stronger, on foot. if they are much bowed, it will be necessary to consult an experienced surgeon. . _if a child, while asleep, "wet his bed" is there any method of preventing him from doing so_? let him be held out just before he himself goes to bed, and again when the family retires to rest. if, at the time, he be asleep, he will become so accustomed to it, that he will, without awaking, make water. he ought to be made to lie on his side; for, if he be put on his back, the urine will rest upon an irritable part of the bladder, and, if he be inclined to wet his bed, he will not be able to avoid doing so. he must not be allowed to drink much with his meals, especially with his supper. wetting the bed is an infirmity with some children--they cannot help it. it is, therefore, cruel to scold and chastise them for it. occasionally, however, wetting the bed arises from idleness; in which case, of course, a little wholesome correction might be necessary. water-proof bed-sheeting--one yard by three-quarters of a yard--will effectually preserve the bed from being wetted, and ought always, on these occasions, to be used. a mother ought, every morning, to ascertain for herself, whether a child have wet his bed; if he have, and if, unfortunately, the water-proof cloth have not been used, the mattress, sheets, and blankets must be instantly taken to the kitchen fire and be properly dried. inattention to the above has frequently caused a child to suffer either from cold, from a fever, or from an inflammation; not only so, but, if they be not dried, he is wallowing in filth and in an offensive effluvium. if both mother and nurse were more attentive to their duties--in frequently holding a child out, whether he ask or not--a child wetting his bed would be the exception, and not, as it frequently is, the rule. if a child be dirty, you may depend upon it, the right persons to blame are the mother and the nurse, and not the child! . _if a child should catch small-pox, what are the best means to prevent pitting_? he ought to be desired neither to pick nor to rub the pustules. if he be too young to attend to these directions, his hands must be secured in bags (just large enough to hold them), which bags should he fastened round the wrists. the nails must be cut very close. cream smeared, by means of a feather, frequently in the day, on the pustules, affords great comfort and benefit. tripe liquor (without salt) has, for the same purpose, been strongly recommended. i myself, in several cases, have tried it, and with the happiest results. it is most soothing, comforting, and healing to the skin. . _can you, tell me of any plan to prevent chilblaine, or, if a child be suffering from them, to cure them_? _first, then, the way to prevent them._--let a child, who is subject to them, wear, in the winter time, a square piece of wash-leather over the toes, a pair of warm lamb's-wool stockings, and good shoes; but, above all, let him be encouraged to run about the house as much as possible, especially before going to bed; and on no account allow him either to warm has feet before the fire, or to bathe them in hot water. if the feet be cold, and the child be too young to take exercise, then let them be well rubbed with the warm hand. if adults suffer from chilblains, i have found friction, night and morning, with horse-hail flesh-gloves, the best means of preventing them. _secondly, the way to cure them._--if they be unbroken: the old-fashioned remedy of onion and salt is one of the best of remedies. cut an onion in two; take one-half of it, dip it in table salt and well rub, for two or three minutes, the chilblain with it. the onion and salt is a famous remedy to relieve that intolerable itching which sometimes accompanies chilblains: then let them be covered with a piece of lint, over which a piece of wash-leather should be placed. _if they be broken_, let a piece of lint be spread with spermaceti-cerate, and be applied, every morning, to the part, and let a white-bread poultice be used every night. . _during the winter time my child's hands, legs, &c., chap very much; what ought i to do_? let a tea-cupful of bran be tied up in a muslin bag, and be put, over the night, into either a large water-can or jug of _rain_ water; [footnote: _rain_ water ought _always_ to be used in the washing of a child; pump water is likely to chap the skin, and to make it both rough and irritable.] and let this water from the can or jug be the water he is to be washed with on the following morning, and every morning until the chaps be cured. as often as water is withdrawn, either from the water-can or from the jog, let fresh rain water take its place, in order that the bran may be constantly soaking in it. the bran in the bag should be renewed about twice a week. take particular care to dry the skin well every time he be washed; then, after each ablution, as well as every night at bed-time, rub a piece of deer's suet over the parts affected: a few dressings will perform a cure. the deer's suet may be bought at any of the shops where venison is sold. another excellent remedy is glycerine, [footnote: glycerine prepared by price's patent candle company is by far the best. sometimes, if the child's skin be very irritable, the glycerine requires diluting with water--say, two ounces of glycerine to be mixed in a bottle with four ounces of rain water--the bottle to be well shaken just before using it.] which should be smeared, by means of the finger or by a camel's hair brush, on the parts affected, two or three times a day. if the child be very young, it might be necessary to dilute the glycerine with rose-water; fill a small bottle one-third with glycerine, and fill up the remaining two-thuds of the bottle with rose-water--shaking the bottle every time just before using it. the best soap to use for chapped hands is the glycerine soap: no other being required. . _what is the best remedy for chapped lips_? cold-cream (which may be procured of any respectable chemist) is an excellent application for _chapped lips_. it ought, by means of the finger, to be frequently smeared on the parts affected. . _have the goodness to inform me of the different varieties of worms that infest a child's bowels_? principally three-- , the tape-worm; , the long round-worm; and , the most frequent of all, the common thread or maw-worm. the tape-worm infests the whole course of the bowels, both small and large: the long round-worm, principally the small bowels, occasionally the stomach; it sometimes crawls out of the child's mouth, causing alarm to the mother; there is, of course, no danger in its doing so: the common thread-worm or maw-worm infests the rectum or fundament. . _what are the causes of worms_? the causes of worms are: weak bowels; bad and improper food, such as unripe, unsound, or uncooked fruit, and much green vegetables; pork, especially underdone pork; [footnote: one frequent, if not the most frequent, cause of tape-worm is the eating of pork, more especially if it be underdone. _underdone_ pork is the most unwholesome food that can he eaten, and is the most frequent cause of tape-worm known. _underdone_ beef also gives tape-worm; let the meat, therefore, be well and properly cooked. these facts ought to be borne in mind, as prevention is always better than cure.] an abundance of sweets; the neglecting of giving salt in the food. . _what are the symptoms and the treatment of worms_? _the symptoms_ of worms are--emaciation; itching and picking of the nose; a dark mark under the eyes; grating, during sleep, of the teeth; starting in the sleep; foul breath; furred tongue; uncertain appetite--sometimes voracious, at other times bad, the little patient sitting down very hungry to his dinner, and before scarcely tasting a mouthful, the appetite vanishing; large bowels; colicky pains of the bowels; slimy motions; itching of the fundament. tape-worm and round-worm, more especially the former, are apt, in children, to produce convulsions. tape-worm is very weakening to the constitution, and usually causes great emaciation and general ill-health; the sooner, therefore, it is expelled from the bowels the better it will be for the patient. many of the obscure diseases of children arise from worms. in all doubtful cases, therefore, this fact should be borne in mind, in order that a thorough investigation may be instituted. with regard to _treatment_, a medical man ought, of course, to be consulted. he will soon use means both to dislodge them, and to prevent a future recurrence of them. let me caution a mother never to give her child patent medicines for the destruction of worms. there is one favourite quack powder, which is composed principally of large doses of calomel, and which is quite as likely to destroy the patient as the worms! no, if your child have worms, put him under the care of a judicious medical man, who will soon expel them, without, at the same tune, injuring health or constitution! . _how may worms be prevented from infesting a child's bowels_? worms generally infest _weak_ bowels; hence, the moment a child becomes strong worms cease to exist. the reason why a child is so subject to them is owing to the improper food which is usually given to him. when he be stuffed with unsound and with unripe fruits, with much sweets, with rich puddings, and with pastry, and when he is oftentimes allowed to eat his meat _without_ salt, and to _bolt_ his food without chewing it, is there any wonder that he should suffer from worms? the way to prevent them is to avoid such things, and, at the same time, to give him plenty of salt to his _fresh_ and well-cooked meat. salt strengthens and assists digestion, and is absolutely necessary to the human economy. salt is emphatically a worm destroyer. the truth of this statement may be readily tested by sprinkling a little salt on the common earth-worm. "what a comfort and real requisite to human life is salt! it enters into the constituents of the human blood, and to do without it is wholly impossible."--_the grocer_. to do without it is wholly impossible! these are true words. look well to it, therefore, ye mothers, and beware of the consequences of neglecting such advice, and see for yourselves that your children regularly eat salt with their food. if they neglect eating salt with their food, they _must of necessity have worms_, and worms that will eventually injure them, and make them miserable. all food, then, should be "flavoured with salt;" _flavoured_, that is to say, salt should be used in each and every kind of food--_not in excess, but in moderation_. . _you have a great objection to the frequent administration of aperient medicines to a child: can you advise any method to prevent their use_? although we can scarcely call constipation a disease, yet it sometimes leads to disease. the frequent giving of aperients only adds to the stubbornness of the bowels. i have generally found a draught, early every morning, of _cold_ pump water, the eating either of huntley and palmer's loaf ginger-bread, or of oatmeal gingerbread, a variety of animal and vegetable food, ripe sound fruit, muscatel raisins, a fig, or an orange after dinner, and, when he be old enough, _coffee_ and milk instead of _tea_ and milk, to have the desired effect, more especially if, for a time, aperients be studiously avoided. . _have you any remarks to make on rickets_? rickets is owing to a want of a sufficient quantity of earthy matter in the bones; hence the bones bend and twist, and lose their shape, causing deformity. rickets generally begins to show itself between the first and second years of a child's life. such children are generally late in cutting their teeth, and when the teeth do come they are bad, deficient of enamel, discoloured, and readily decay. a rickety child is generally stunted in stature; he has a large head, with overhanging forehead, or what nurses call a watery-head-shaped forehead. the fontanelles, or openings of the head, as they are called, are a long time in closing. a rickety child is usually talented; his brain seems to thrive at the expense of his general health. his breast-bone projects out, and the sides of his chest are flattened; hence he becomes what is called chicken-breasted or pigeon-breasted; his spine is usually twisted, so that he is quite awry, and, in a bad case, he is hump-backed; the ribs, from the twisted spine, on one side bulge out; he is round-shouldered; the long bones of his body, being soft, bend; he is bow-legged, knock-kneed, and weak-ankled. rickets are of various degrees of intensity, the humpbacked being among the worst there are many mild forms of rickets; weak ankles, knocked-knees, bowed-legs, chicken-breasts, being among the latter number. many a child, who is not exactly hump-backed, is very round-shouldered, which latter is also a mild species of rickets. show me a child that is rickety, and i can generally prove that it is owing to poor living, more especially to poor milk. if milk were always genuine, and if a child had an abundance of it, my belief is that rickets would be a very rare disease. the importance of genuine milk is of national importance. we cannot have a race of strong men and women unless, as children, they have had a good and plentiful supply of milk. it is utterly impossible. milk might well be considered one of the necessaries of a child's existence. genuine, fresh milk, then, is one of the grand preventatives, as well as one of the best remedies, for rickets. many a child would not now have to swallow quantities of cod-liver oil if previously he had imbibed quantities of good genuine milk. an insufficient and a poor supply of milk in childhood sows the seeds of many diseases, and death often gathers the fruit. can it be wondered at, when there is so much poor and nasty milk in england, that rickets in one shape or another is so prevalent? when will mothers arouse from their slumbers, rub their eyes, and see clearly the importance of the subject? when will they know that all the symptoms of rickets i have just enumerated _usually_ proceed from the want of nourishment, more especially from the want of genuine, and of an abundance of, milk? there are, of, course, other means of warding off rickets besides an abundance of nourishing food, such as thorough ablution, plenty of air, exercise, play, and sunshine; but of all these splendid remedies, nourishment stands at the top of the list. i do not mean to say that rickets _always_ proceeds from poorness of living--from poor milk. it sometimes arises from scrofula, and is an inheritance of one or of both the parents. rickety children, if not both carefully watched and managed, frequently, when they become youths, die of consumption. a mother, who has for some time neglected the advice i have just given, will often find, to her grievous cost, that the mischief has, past remedy, been done, and that it is now "too late!--too late!" . _how may a child be prevented from becoming rickety? or, if he be rickety, how ought he to be treated_? if a child be predisposed to be rickety, or if he be actually rickety, attend to the following rules:-- let him live well, on good nourishing diet, such as on tender rump-steaks, cut very fine, and mixed with mashed potatoes, crumb of bread, and with the gravy of the meat. let him have, as i have before advised, an abundance of good new milk--a quart or three pints during every twenty-four hours. let him have milk in every form--as milk gruel, du barry's arabica revalenta made with milk, batter and rice puddings, suet puddings, bread and milk, etc. _to harden the bones_, let lime water be added to the milk (a table-spoonful to each tea-cupful of milk.) let him have a good supply of fresh, pure, dry air. he must almost live in the open air--the country, if practicable, in preference to the town, and the coast in summer and autumn. sea bathing and sea breezes are often, in these cases, of inestimable value. he ought not, at an early age, to be allowed to bear his weight upon his legs. he must sleep on a horse-hair mattress, and not on a feather bed. he should use every morning cold baths in the summer and tepid baths in the winter, with bay salt (a handful) dissolved in the water. friction with the hand must, for half an hour at a time, every night and morning, be sedulously applied to the back and to the limbs. it is wonderful how much good in these cases friction does. strict attention ought to be paid to the rules of health as laid down in these conversations. whatever is conducive to the general health is preventive and curative of rickets. books, if he be old enough to read them, should be thrown aside; health, and health alone, must be the one grand object. the best medicines in these cases are a combination of cod-liver oil and the wine of iron, given in the following manner:--put a tea-spoonful of wine of iron into a wine-glass, half fill the glass with water, sweeten it with a lump or two of sugar, then let a tea-spoonful of cod-liver oil swim on the top; let the child drink it all down together, twice or three times a day. an hour after a meal is the _best_ time to give the medicine, as both iron and cod-liver oil sit better on a _full_ than on an _empty_ stomach. the child in a short time will become fond of the above medicine, and will be sorry when it is discontinued. a case of rickets requires great patience and steady perseverance; let, therefore, the above plan have a fair and long-continued trial, and i can then promise that there will be every probability that great benefit will be derived from it. . _if a child be subject to a scabby eruption about the mouth, what is the best local application_? leave it to nature. do not, on any account, apply any local application to heal it; if you do, you may produce injury; you may either bring on an attack of inflammation, or you may throw him into convulsions. no! this "breaking-out" is frequently a safety-valve, and must not therefore be needlessly interfered with. should the eruption be severe, reduce the child's diet; keep him from butter, from gravy, and from fat meat, or, indeed, for a few days from meat altogether; and give him mild aperient medicine; but, above all things, do not quack him either with calomel or with grey-powder. . _will you have the goodness to describe the eruption on the face and on the head of a young child, called milk-crust or running scall_? milk-crust is a complaint of very young children--of those who are cutting their teeth--and, as it is a nasty looking complaint, and frequently gives a mother a great deal of trouble, of anxiety, and annoyance, it will be well that you should know its symptoms, its causes, and its probable duration. _symptoms_.--when a child is about nine months or a year old, small pimples are apt to break out around the ears, on the forehead, and on the head. these pimples at length become vesicles (that is to say, they contain water), which run into one large one, break, and form a nasty dirty-looking yellowish, and sometimes greenish, scab, which scab is moist, indeed, sometimes quite wet, and gives out a disagreeable odour, and which is sometimes so large on the head as actually to form a skullcap, and so extensive on the face as to form a mask. these, i am happy to say, are rare cases. the child's beauty is, of, course, for a time completely destroyed, and not only his beauty, but his good temper; for as the eruption causes great irritation and itching, he is constantly clawing himself, and crying with annoyance the great part of the day, and sometimes also of the night--the eruption preventing him from sleeping. it is not contagious, and soon after he has cut the whole of his first set of teeth it will get well, provided it has not been improperly interfered with. _causes_.--irritation from teething; stuffing him with overmuch meat, thus producing a humour, which nature tries to get rid of by throwing it out on the surface of the body; the safest place she could fix on for the purpose; hence the folly and danger of giving medicines and applying _external_ applications to drive the eruption in. "diseased nature oftentimes breaks forth in strange eruptions," and cures herself in this way, if she be not too much interfered with, and if the eruption be not driven in by injudicious treatment. i have known in such cases disastrous consequences to follow over-officiousness and meddlesomeness. nature is trying all she can to drive the humour out, while some wiseacres are doing all they can to drive the humour in. _duration_.--as milk-crust is a tedious affair, and will require a variety of treatment, it will be necessary to consult an experienced medical man; and although he will be able to afford great relief, the child will not, in all probability, be quite free from the eruption until he have cut the whole of his first set of teeth--until he be upwards of two years and a half old--when, with judicious and careful treatment, it will gradually disappear, and eventually leave not a trace behind. it will be far better to leave the case alone--to get well of itself--rather than to try to cure the complaint either by outward applications or by strong internal medicines; "the remedy is often worse than the disease," of this i am quite convinced. . _have you any advice to give me as to my conduct towards my medical man_? give him your entire confidence. be truthful and be candid with him. tell him the truth, the whole truth, and nothing but the truth. have no reservations; give him, as near as you can, a plain, unvarnished statement of the symptoms of the disease. do not magnify, and do not make too light of any of them. be prepared to state the exact time the child first showed symptoms of illness. if he have had a shivering fit, however slight, do not fail to tell your medical man of it. note the state of the skin; if there be a "breaking-out"--be it ever so trifling--let it be pointed out to him. make yourself acquainted with the quantity and with the appearance of the urine, taking care to have a little of it saved, in case the doctor may wish to see and examine it. take notice of the state of the motions--their number during the twenty-four hours, their colour, their smell, and their consistence, keeping one for his inspection. never leave any of these questions to be answered by a servant; a mother is the proper person to give the necessary and truthful answers, which answers frequently decide the fate of the patient. bear in mind, then, a mother's untiring care and love, attention and truthfulness, frequently decide whether, in a serious illness, the little fellow shall live or die! fearful responsibility! a medical man has arduous duties to perform; smooth, therefore, his path as much as you can, and you will be amply repaid by the increased good he will be able to do your child. strictly obey a doctor's orders--in diet, in medicine, in everything. never throw obstacles in his way. never omit any of his suggestions; for, depend upon it that if he be a sensible man, directions, however slight, ought never to be neglected; bear in mind, with a judicious medical man, "that nothing walks with aimless feet."--_tennyson_. if the case be severe, requiring a second opinion, never of your own accord call in a physician, without first consulting and advising with your own medical man. it would be an act of great discourtesy to do so. inattention to the foregoing advice has frequently caused injury to the patient, and heart-burnings and ill-will among doctors. speak, in the presence of your child, with respect and kindness of your medical man, so that the former may look upon the latter as a friend--as one who will strive, with god's blessing, to relieve his pain and suffering. remember the increased power of doing good the doctor will have if the child be induced to like, instead of dislike, him. not only be careful that you yourself speak before your child, respectfully and kindly of the medical man, but see that your domestics do so likewise; and take care that they are never allowed to frighten your child, as many silly servants do, by saying that they will send for the doctor, who will either give him nasty medicine, or will perform some cruel operation upon him. a nurse-maid should, then, never for one moment be permitted to make a doctor an object of terror or of dislike to a child. send, whenever it be practicable, for your doctor _early_ in the morning, as he will then make his arrangements accordingly, and can by daylight better ascertain the nature of the complaint, more especially if it be a skin disease. it is utterly impossible for him to form a correct opinion of the nature of a "breaking-out" either by gas or by candle light. if the illness come on at night, particularly if it be ushered in either with a severe shivering, or with any other urgent symptom, no time should be lost, be it night or day, in sending for him, "a little fire is quietly trodden out, which, being sufier'd, rivers cannot quench." _shakespeare_. warm baths . _have the goodness to mention the complaints of a child for which warm baths are useful_. . convulsions; . pains in the bowels, known by, the child drawing up his legs, screaming violently, etc.; . restlessness from teething; . flatulence. the warm bath acts as a fomentation to the stomach and the bowels, and gives ease where the usual remedies do not rapidly relieve. . _will you mention the precautions, and the rules to be observed in gutting a child info a warm bath_? carefully ascertain before he be immersed in the bath that the water be neither too hot nor too cold. carelessness, or over-anxiety to put him in the water as quickly as possible, has frequently, from his being immersed in the bath when the water was too hot, caused him great pain and suffering. from to degrees of fahrenheit is the proper temperature of a warm bath. if it be necessary to add fresh warm water, let him be either removed the while, or let it not be put in when very hot; for if boiling water be added to increase the heat of the bath, it naturally ascends, and may scald him. again, let the fresh water be put in at as great a distance from him as possible. the usual time for him to remain in a bath is a quarter of an hour or twenty minutes. let the chest and the bowels be rubbed with the hand while he is in the bath. let him be immersed in the bath as high up as the neck, taking care that he be the while supported under the armpits, and that his head be also rested. as soon as he comes out of the bath, he ought to be carefully but quickly rubbed dry; and if it be necessary to keep up the action on the skin, he should be put to bed, between the blankets; or if the desired relief has been obtained, between the sheets, which ought to have been previously warmed, where, most likely, he will fall into a sweet refreshing sleep. warm external applications. . _in case of a child suffering pain either in his stomach or in his bowels, or in case he has a feverish cold, can you tell me of the best way of applying heat to them_? in pain either of the stomach or of the bowels, there is nothing usually affords greater or speedier relief than the _external_ application of heat the following are four different methods of applying heat:-- . a bag of hot salt--that is to say, powdered table-salt--put either into the oven or into a frying-pan over the fire, and thus made hot, and placed in a flannel bag, and then applied, as the case may be, either to the stomach or to the bowels. hot salt is an excellent remedy for these pains. . an india-robber hot-water bottle, [footnote: every house where there are children ought to have one of these india-rubber hot-water bottles. it may be procured at any respectable vulcanised india-rubber warehouse.] half filled with hot water--it need not be boiling--applied to the stomach or to the bowels, will afford great comfort . another and an excellent remedy for these cases is a hot bran poultice. the way to make it is as follows:--stir bran into a vessel containing either a pint or a quart (according to size of poultice required) of boiling water, until it be the consistence of a nice soft poultice, then put into a flannel bag and apply it to the part affected. when cool, dip it from time to time in _hot_ water. . in case a child has a feverish cold, especially if it be attended, as it sometimes is, with pains in the bowels, the following is a good external application.--take a yard of flannel, fold it in three widths, then dip it in very hot water, wring it out tolerably dry, and apply it evenly and neatly round and round the bowels; over this, and to keep it in its place, and to keep in the moisture, put on a _dry_ flannel bandage, four yards long and four inches wide. if it be put on at bed-time, it ought to remain on all night. where there are children, it is desirable to have the yard of flannel and the flannel bandage in readiness, and then a mother will be prepared for emergencies. either the one or the other, then, of the above applications will usually, in pains of the stomach and bowels, afford great relief. there is one great advantage of the _external_ application of heat--it can never do harm; if there be inflammation, it will do good; if there be either cramps or spasms of the stomach, it will be serviceable; if there be colic, it will be one of the best remedies that can be used; if it be a feverish cold, by throwing the child into a perspiration, it will be beneficial. it is well for a mother to know how to make a white bread poultice; and as the celebrated abernethy was noted for his poultices, i will give you his directions, and in his very words:--"scald out a basin, for you can never make a good poultice unless you have perfectly boiling water, then, having put in some hot water, throw in coarsely crumbled bread, and cover it with a plate. when the bread has soaked up as much water as it will imbibe, drain off the remaining water, and there will be left a light pulp. spread it a third of an inch thick on folded linen, and apply it when of the temperature of a warm bath. it may be said that this poultice will be very inconvenient if there be no lard in it, for it will soon get dry; but this is the very thing you want, and it can easily be moistened by dropping warm water on it, whilst a greasy poultice will be moist, but not wet."--_south's household surgery_. accidents. . _supposing a child to cut his finger, what is the best application_? there is nothing better than tying it up with rag in its blood, as nothing is more healing than blood. do not wash the blood away, but apply the rag at once, taking care that no foreign substance be left in the wound. if there be either glass or dirt in it, it will of course be necessary to bathe the cut in warm water, to get rid of it before the rag be applied. some mothers use either salt or fryar's balsam, or turpentine, to a fresh wound; these plans are cruel and unnecessary, and frequently make the cut difficult to heal. if it bleed immoderately, sponge the wound freely with cold water. if it be a severe cut, surgical aid, of course, will be required. . _if a child receive a blow, causing a bruise, what had better be done_? immediately smear a small lump of _fresh_ butter on the part affected, and renew it every few minutes for two or three hours; this is an old-fashioned, but a very good remedy. olive oil may--if _fresh_ butter be not at hand--be used, or soak a piece of brown-paper in one third of french brandy and two-thirds of water, and immediately apply it to the part; when dry renew it. either of these simple plans--the butter plan is the best--will generally prevent both swelling and disfiguration. a "_black eye_."--if a child, or indeed any one else, receive a blow over the eye, which is likely to cause a "black eye," there is no remedy superior to, nor more likely to prevent one, than well buttering the parts for two or three inches around the eye with fresh butter, renewing it every few minutes for the space of an hour or two; if such be well and perseveringly done, the disagreeable appearance of a "black eye" will in all probability be prevented. a capital remedy for a "black eye" is the arnica lotion,-- take of--tincture of arnica, one ounce; water, seven ounces; to make a lotion. the eye to be bathed by means of a soft piece of linen rag, with this lotion frequently; and, between times, let a piece of linen rag, wetted in the lotion, be applied: to the eye, and be fastened in its place by means of a bandage. the white lily leaf, soaked in brandy, is another excellent remedy for the bruises of a child. gather the white lily blossoms when in full bloom, and put them in a wide-mouthed bottle of brandy, cork the bottle, and it will then always be ready for use. apply a leaf to the part affected, and bind it on either with a bandage or with a handkerchief. the white lily root sliced is another valuable external application for bruises. . _if a child fall upon his head and be stunned, what ought to be done_? if he fall upon his head and be stunned, he will look deadly pale, very much as if he had fainted. he will in a few minutes, in all probability, regain his consciousness. sickness frequently supervenes, which makes the case more serious, it being a proof that injury, more or less severe, has been done to the brain; send, therefore, instantly for a medical man. in the meantime, loosen both his collar and neckerchief, lay him flat on his back, sprinkle cold water upon his face, open the windows so as to admit plenty of fresh air, and do not let people crowd round him, nor shout at him, as some do, to make him speak. while he is in an unconscious state, do not on any account whatever allow a drop of blood to be taken from him, either by leeches or from the arm-venesection; if you do, he will probably never rally, but will most likely "sleep the sleep that knows not breaking." . _a nurse sometimes drops an infant and injures his back; what ought to be done_? instantly send for a surgeon; omitting to have proper advice in such a case has frequently made a child a cripple for life. a nurse frequently, when she has dropped her little charge, is afraid to tell her mistress; the consequences might then be deplorable. if ever a child scream violently without any assignable cause, and the mother is not able for some time to pacify him, the safer plan is that she send for a doctor, in order that he might strip and carefully examine him; much after misery might often be averted if this plan were more frequently followed. . _have you any remarks to make and directions to give on accidental poisoning by lotions, by liniments, etc_? it is a culpable practice of either a mother or nurse to leave _external_ applications within the reach of a child. it is also highly improper to put a mixture and an _external_ application (such as a lotion or a liniment) on the same tray or on the same mantel-piece. many liniments contain large quantities of opium, a tea-spoonful of which would be likely to cause the death of a child. "hartshorn and oil," too, has frequently been swallowed by children, and in several instances has caused death. many lotions contain sugar of lead, which is also poisonous. there is not, fortunately, generally sufficient lead in the lotion to cause death; but if there be not enough to cause death, there may be more than enough to make the child very poorly. all these accidents occur from disgraceful carelessness. a mother or a nurse ought _always_, before administering a dose of medicine to a child, to read the label on the bottle; by adopting this simple plan many serious accidents and much after misery might be averted. again, i say, let every lotion, every liniment, and indeed everything for external use, be either locked up or be put out of the way, and far away from all medicine that is given by the mouth. this advice admits of no exception. if your child have swallowed a portion of a liniment containing opium, instantly send for a medical man. in the meantime force a strong mustard emetic (composed of two tea-spoonfuls of flour of mustard, mixed in half a tea-cupful of warm water) down his throat. encourage the vomiting by afterwards forcing him to swallow warm water. tickle the throat either with your finger or with a feather. souse him alternately in hot and then in a cold bath. dash cold water on his head and face. throw open the windows. walk him about in the open air. rouse him by slapping him, by pinching him, and by shouting to him; rouse him, indeed, by every means in your power, for if you allow him to go to sleep, it will, in all probability, be the sleep that knows no waking! if a child have swallowed "hartshorn and oil," force him to drink vinegar and water, lemon-juice and water sweetened with sugar, barley water, and thin gruel. if he have swallowed a lead lotion, give him a mustard emetic, and then vinegar and water, sweetened either with honey or with sugar, to drink. . _are not lucifer matches poisonous_? certainly, they are very poisonous; it is, therefore, desirable that they should be put out of the reach of children. a mother ought to be very strict with servants on this head. moreover, lucifer matches are not only poisonous but dangerous, as a child might set himself on fire with them. a case bearing on the subject has just come under my own observation. a little boy three years old, was left alone for two or three minutes, during which time he obtained possession of a lucifer match, and struck a light by striking the match against the wall. instantly there was a blaze. fortunately for him, in his fright, he threw the match on the floor. his mother at this moment entered the room. if his clothes had taken fire, which they might have done, had he not have thrown the match away, or if his mother had not been so near at hand, he would, in all probability, have either been severely burned or have been burned to death. . _if a child's clothes take fire, what ought to be done to extinguished them_? lay him on the floor, then roll him either in the rug, or in the carpet, or in the door-mat, or in any thick article of dress you may either have on, or have at hand--if it be woollen, so much the better; or, throw him down, and roll him over and over on the floor, as, by excluding the atmospheric air, the flame will go out:--hence the importance of a mother cultivating presence of mind. if parents were better prepared for such emergencies, such horrid disfigurations and frightful deaths would be less frequent. you ought to have a proper fire-guard before the nursery grate, and should be strict in not allowing your child to play with fire. if he still persevere in playing with it, when he has been repeatedly cautioned not to do so, he should be punished for his temerity. if anything would justify corporal chastisement, it would surely be such an act of disobedience. there are only two acts of disobedience that i would flog a child for--namely, the playing with fire and the telling of a lie! if after various warnings and wholesome corrections he still persist, it would be well to let him slightly taste the pain of his doing so, either by holding his hand for a moment very near the fire, or by allowing him to slightly touch either the hot bar of the grate or the flame of the candle. take my word for it the above plan, will effectually cure him--he will never do it again. it would be well for the children of the poor to have pinafores made either of woollen or of stuff materials. the dreadful deaths from burning, which so often occur in winter, too frequently arise from _cotton_ pinafores first taking fire. [footnote: it has been computed that upwards of children are annually burned to death by accident in england.] if all dresses after being washed, and just before being dried, were, for a short time, soaked in a solution of tungstate of soda, such clothes, when dried, would, be perfectly fire-proof. tangstate of soda may be used either with or without starch; but full directions for the using of it will, at the time of purchase, be given by the chemist. . _is a burn more dangerous than a scald_? a burn is generally more serious than a scald. burns and scalds are more dangerous on the body, especially on the chest, than either on the face or on the extremities. the younger the child, the greater the danger. scalds both of the mouth and the throat, from a child drinking boiling water from the spout of a tea-kettle, are most dangerous. a poor person's child is, from the unavoidable absence of the mother, sometimes shut up in the kitchen by himself, and being very thirsty, and no other water being at hand, he is tempted, in his ignorance, to drink from the tea-kettle: if the water be unfortunately boiling, it will most likely prove to him to be a fatal draught! . _what are the best immediate applications to a scald or to a burn_? there is nothing more efficacious than flour. it ought to be thickly applied over the part affected, and should be kept in its place either with a rag and a bandage, or with, strips of old linen. if this be done, almost instantaneous relief will be experienced, and the burn or the scald, if superficial, will soon be well. the advantage of flour as a remedy, is this, that it is always at hand. i have seen some extensive bums and scalds cured by the above simple plan. another excellent remedy is, cottonwool of superior quality, purposely made for surgeons. the burn or the scald ought to be enveloped in it; layer after layer should be applied until it be several inches thick. the cotton-wool must not be removed for several days. these two remedies, flour and cotton-wool, may be used in conjunction; that is to say, the flour may be thickly applied to the scald or to the burn, and the cotton wool over all. prepared lard--that is to say, lard without salt [footnote: if there be no other lard in the house but lard _with_ salt, the salt may be readily removed by washing the lard in cold water. prepared lard--that is to say, lard _without_ salt--can, at any moment, be procured from the nearest druggist in the neighbourhood]--is an admirable remedy for burns and for scalds. the advantages of lard are,--( .) it is almost always at hand; ( .) it is very cooling, soothing, and unirritating to the part, and it gives almost immediate freedom from pain; ( .) it effectually protects and sheathes the burn or the scald from the air; ( .) it is readily and easily applied: all that has to be done is to spread the lard either on pieces of old linen rag, or on lint, and then to apply them smoothly to the parts affected, keeping them in their places by means of bandages--which bandages may be readily made from either old linen or calico shirts. dr john packard, of philadelphia, was the first to bring this remedy for burns and scalds before the public--he having tried it in numerous instances, and with the happiest results. i myself have, for many years been in the habit of prescribing lard as a dressing for blisters, and with the best effects. i generally advise equal parts of prepared lard and of spermaceti-cerate to be blended together to make an ointment. the spermaceti-cerate gives a little more consistence to the lard, which, in warm weather especially, is a great advantage. another valuable remedy for burns is "carron-oil;" which is made by mixing equal parts of linseed-oil and lime-water in a bottle, and shaking it up before using it. cold applications, such as cold water, cold vinegar and water, and cold lotions, are most injurious, and, in many cases, even dangerous. scraped potatoes, sliced cucumber, salt, and spirits of turpentine, have all been recommended; but, in my practice, nothing has been so efficacious as the remedies above enumerated. do not wash the wound, and do not dress it more frequently than every _other_ day. if there be much discharge, let it be gently sopped up with soft old linen rag; but do not, _on any_ account, let the burn be rubbed or roughly handled. i am convinced that, in the majority of cases, wounds are too frequently dressed, and that the washing of wounds prevents the healing of them. "it is a great mistake," said ambrose pare, "to dress ulcers too often, and to wipe their surfaces clean, for thereby we not only remove the useless excrement, which is the mud or sanies of ulcers, but also the matter which forms the flesh. consequently, for these reasons, ulcers should not be dressed too often." it is nature, and not the surgeon, that really cures the wound, and it is done, like all nature's works, principally in secret, by degrees, and by patience, and resents much interference. the seldom-dressing of a wound and patience are, then, two of the best remedies for effecting a cure. shakspeare, who seemed to know surgery, as he did almost everything else beside was quite cognisant of the fact:-- "how poor are they, that have not patience what wound did ever heal, but by degrees" the burn or the scald may, after the first two days, if severe, require different dressings; but, if it be severe, the child ought of course to be immediately placed under the care of a surgeon. if the scald be either on the leg or on the foot, a common practice is to take the shoe and the stocking off; in this operation the skin is also at the same time very apt to be removed. now, both the shoe and the stocking ought to be slit up, and thus be taken off, so that neither unnecessary pain nor mischief may be caused. . _if a bit of quick-lime should accidentally enter the eye of my child, what ought to be done_? instantly, but tenderly remove, either by means of a camel's hair brush, or by a small spill of paper, any bit of lime that may adhere to the ball of the eye, or that may be within the eye or on the eye-lashes; then well bathe the eye (allowing a portion to enter it) with vinegar and water-one part of vinegar to three parts of water, that is to say, a quarter fill a clean half-pint medicine bottle with vinegar, and then fill it up with spring water, and it will be ready for use. let the eye be bathed for at least a quarter of an hour with, it the vinegar will neutralise the lime, and will rob it of its burning properties. having bathed the eye with vinegar and water for a quarter of an hour, bathe it for another quarter of an hour simply with a little warm water, after which, drop into the eye two or three drops of the best sweet-oil, put on an eye-shade made of three thicknesses of linen rag, covered with green silk, and then do nothing more until the doctor arrive. if the above rules be not _promptly_ and _properly_ followed out, the child may irreparably lose his eyesight; hence the necessity of conversations of this kind, to tell a mother, provided _immediate_ assistance cannot be obtained, what ought _instantly_ to be done; for moments, in such a case, are precious. while doing all that i have just recommended, let a surgeon be sent for, as a smart attack of inflammation, of the eye is very apt to follow the burn of lime; but which inflammation will, provided the _previous_ directions have been _promptly_ and _efficiently_ followed out, with appropriate treatment, soon subside. the above accident is apt to occur to a child who is standing near a building when the slacking of quicklime is going on, and where portions of lime in the form of powder are flying about the air. it would be well not to allow a child to stand about such places, as prevention is always better than cure. _quicklime_ is sometimes called _caustic-lime_--it well deserves its name, for it is a _burning-lime_, and if proper means be not promptly used, will soon burn away the sight. . _if any other foreign substance should enter the eye, what is the best method of removing it_? if there be grit, or sand, or dust, or particle of coal, or gnat, or a hair, or an eye-lash in the eye, it ought to be tenderly removed by a small tightly-folded paper spill, holding down the lower lid with the fore-finger of the left hand the while; and the eye, if inflamed, should be frequently bathed with warm milk and water; but generally as soon as the cause is removed the effect will cease, and after treatment will be unnecessary. if a particle of metal be sticking on the cornea of the eye, as it sometimes does, it will require the skilled hand of a surgeon to remove it. any foreign substance, however minute, in the eye, is very painful; but a piece of burning lime is excruciating. shakspeare gives a graphic description of the pain from the presence of any foreign substance, however small, in the eye:-- "oh heaven!--that there were but a mote in yours, a grain, a dust, a gnat, a wand'ring hair, any annoyance in that precious sense! then, feeling what small things are boist'rous there, your vile intent must needs seem horrible." . _what ought to be done in a case of choking_? how often does a hungry little child, if not carefully watched, fill his mouth so full, and swallow lumps of food in such hot haste, as to choke himself-- "with eager feeding, food doth choke the feeder" _shakespeare._ _treatment_.-instantly put your finger into the throat and feel if the substance be within reach; if it be food, force it down, and thus liberate the breathing; should it be a hard substance, endeavour to hook it out; if you cannot reach it, give a good smart blow or two with the flat of the hand on the back; or, as recommended by contributor to the _lancet_, on the chest, taking care to "seize the little patient, and place him between your knees side ways, and in this or some other manner to _compress the abdomen_ [the belly], otherwise the power of the blow will be lost by the yielding of the abdominal parieties [walls of the belly], and the respiratory effort will not be produced." if that does not have the desired effect, tickle the throat with your finger, so as to ensure immediate vomiting, and the subsequent ejection of the offending substance. . _should my child be bitten by a dog supposed to be mad, what ought to be done_? instantly well rub for the space of five or ten _seconds_--seconds, _not_ minutes--a stick of nitrate of silver (lunar-caustic) into the wound. the stick of lunar-caustic should be pointed, like a cedar pencil for writing, in order the more thoroughly to enter the wound. [footnote: a stick of pointed nitrate of silver, in a case, ready for use, may be procured of any respectable chemist.] this, if properly done directly after the bite, will effectually prevent hydrophobia. the nitrate of silver acts not only as a caustic to the part, but it appears effectually to neutralise the poison, and thus, by making the virus perfectly innocuous, is a complete antidote. if it be either the lip, or the parts near the eye, or the wrist, that have been bitten, it is far preferable to apply the caustic than to cut the part out; as the former is neither so formidable, nor so dangerous, nor so disfiguring as the latter, and yet it is equally as efficacious. i am indebted to the late mr youatt, the celebrated veterinary surgeon, for this valuable antidote or remedy for the _prevention_ of the most horrible, heart-rending, and incurable disease known. mr youatt had an immense practice among, dogs as well as among horses. he was a keen observer of disease, and a dear lover of his profession, and he had paid great attention to rabies-- dog-madness. he and his assistants had been repeatedly bitten by rabid dogs; but knowing that he was in possession of an infallible preventive remedy, he never dreaded the wounds inflicted either upon himself or upon his assistants. mr youatt never knew lunar-caustic, if properly and _immediately_ applied, to fail. it is, of course, only a preventive. if hydrophobia be once developed in the human system, no antidote has ever yet, for this fell and intractable disease, been found. while walking the london hospitals, upwards of forty years ago, i received an invitation from mr youatt to attend a lecture on rabies--dog-madness. he had, during the lecture, a dog present labouring under _incipient_ madness. in a day or two after the lecture, he requested me and other students to call at his infirmary and see the dog, as the disease was at that time fully developed. we did so, and found the poor animal raving mad--frothing at the mouth, and snapping at the iron bars of his prison. i was particularly struck with a peculiar brilliancy and wildness of the dog's eyes. he seemed as though, with affright and consternation, he beheld objects unseen by all around. it was pitiful to witness his frightened and anxious countenance. death soon closed the scene! i have thought it my duty to bring the value of lunar-caustic as a preventive of hydrophobia prominently before your notice, and to pay a tribute of respect to the memory of mr youatt--a man of talent and of genius. never kill a dog supposed to be mad who has bitten either a child, or any one else, until it has, past all doubt, been ascertained whether he be really mad or not. he ought, of course, to be tied up; and be carefully watched, and be prevented the while from biting any one else. the dog by all means should be allowed to live at least for some weeks, as the fact of his remaining well will be the best guarantee that there is no fear of the bitten child having caught hydrophobia. there is a foolish prejudice abroad, that a dog, be he mad or not, who has bitten a person ought to be _immediately_ destroyed; that although the dog be not at the time mad, but should at a future period become so, the person who had been bitten when the dog was _not_ mad, would, when the dog became mad, have hydrophobia! it seems almost absurd to bring the subject forward; but the opinion is so very general and deep-rooted, that i think it well to declare that there is not the slightest foundation of truth in it, but that it is a ridiculous fallacy! a cat sometimes goes mad, and its bite may cause hydrophobia; indeed, the bite of a mad cat is more dangerous than the bite of a mad dog. a bite from a mad cat ought to be treated precisely in the same manner-namely, with the lunar-caustic--as for a mad dog. hydrophobia was by our forefathers graphically called _water-fright_: it was well named, for the horror of swallowing water is, by an hydrophobic patient, most intense, and is _the_ leading symptom of this fell and incurable disease. a bite either from a dog or from a cat _who is not mad_, from a cat especially, is often venomous and difficult to heal. the best application is, _immediately_ to apply a large hot white bread poultice to the part, and to renew it every four hours; and, if there be much pain in the wound, to well foment the part, every time before applying the poultice, with a hot camomile and poppy-head fomentation. scratches of a cat are best treated by smearing, and that freely and continuously for an hour, and then afterwards at longer intervals, fresh butter on the part affected. if fresh butter be not at hand, fresh lard--that is to say, lard _without_ salt--will answer the purpose. if the pain of the scratch be very intense, foment the part affected with hot water, and then apply a hot white bread poultice, which should be frequently renewed. . _what are the best remedies in ease of a sting from either a bee or a wasp_? extract the sting, if it have been left behind, either by means of the pair of dressing forceps, or by the pressure of the hollow of a small key--a watch-key will answer the purpose; then, the blue-bag (which is used in washing) moistened with water, should be applied to the part; or a few drops of solution of potash, [footnote: which may be instantly procured of a druggist.] or "apply moist snuff or tobacco, rubbing it well in," [footnote: a bee-master. _the times_, july , .] and renew from time to time either of them: if either of these be not at hand, either honey, or treacle, or fresh butter, will answer the purpose. should there be much swelling or inflammation, foment the part with hot water, and then apply hot bread poultice, and renew it frequently. in eating apricots, or peaches, or other fruit, they ought beforehand to be carefully examined, in order to ascertain that no wasp is lurking in them; otherwise, it may sting the throat, and serious consequences will ensue. . _if a child receive a fall, causing the skin to be grazed, can you tell me of a good application_? you will find gummed paper an excellent remedy: the way of preparing it is as follows:--apply evenly, by means of a small brush, thick mucilage of gum-arabic to cap-paper; hang it up to dry, and keep it ready for use. when wanted, cut a portion as large as may be requisite, then moisten it with your tongue, in the same manner you would a postage stamp, and apply it to the grazed part. it may be removed when necessary by simply wetting it with water. the part in two or three days will be well. there is usually a margin of gummed paper sold with postage stamps; this will answer the purpose equally well. if the gummed paper be not at hand, then frequently, for the space of an hour or two, smear the part affected with fresh butter. . _in case of a child swallowing by mistake either laudanum, or paregoric, or godfrey's cordial, or any other preparation of opium, what ought to be done_? give, as _quickly as possible_, a strong mustard emetic; that is to say, mix two tea-spoonfuls of flour of mustard in half a tea-cupful of water, and force it down his throat. if free vomiting be not induced, tickle the upper part of the swallow with a feather, drench the little patient's stomach with large quantities of warm water. as soon as it can be obtained from the druggist, give him the following emetic draught-- take of--sulphate of zinc, one scruple; simple syrup, one drachm. distilled water, seven drachms; to make a draught. smack his buttocks and his back, walk him, or lead him, or carry him about in the fresh air, shake him by the shoulders, pat his hair, tickle his nostrils, shout and holler in his ears, plunge him into a warm bath and then into a cold bath alternately. well sponge his head and face with cold water, dash cold water on his head, face, and neck, and do not, on any account, until the effects of the opiate are gone off, allow him to go to sleep, if you do, he will never wake again! while doing all those things, of course, you ought to lose no time in sending for a medical man. . _have you any observation to make on parent's allowing the deadly nightshade (atropa belladonna) to grow in their gardens_? i wish to caution you not on any account to allow the belladonna--the deadly nightshade--to grow in your garden. the whole plant--root, leaves, and berries--is poisonous and the berries, being attractive to the eye, are very alluring to children. . _what is the treatment of poisoning by belladonna_? instantly send for a medical man, but, in the mean time, give an emetic-a mustard emetic--mix two teaspoonfuls of flour of mustard in half a tea-cupful of warm water, and force it down the child's throat then drench him with warm water, and tickle the upper part of his swallow either with a feather or with the finger, to make him sick as the grand remedy is an emetic to bring up the offending cause. if the emetic has not acted sufficiently, the medical man when he arrives may deem it necessary to use the stomach pump, but remember not a moment must be lost, for moments are precious in a case of belladonna poisoning, in giving a mustard emetic, and repeating it again and again until the enemy be dislodged. dash cold water upon his head and face; the best way of doing which is by means of a large sponge, holding his head and his face over a wash-hand basin, half filled with cold water, and filling the sponge from the basin, and squeezing it over his head and face, allowing the water to continuously stream over them for an hour or two, or until the effects of the poison have passed away. this sponging of the head and face is very useful in poisoning by opium, as well as in poisoning by belladonna; indeed, the treatment of poisoning by the one is very similar to the treatment of poisoning by the other. i, therefore, for the further treatment of poisoning by belladonna, beg to refer you to a previous conversation, on the treatment of poisoning by opium. . _should a child put either a pea or a bead, or any other foreign substance, up the nose, what ought to be done_? do not attempt to extract it yourself, or you might push it further in, but send instantly for a surgeon, who will readily remove it, either with a pair of forceps, or by means of a bent probe, or with a director. if it be a pea, and it be allowed for any length of time to remain in, it will swell, and will thus become difficult to extract, and may produce great irritation and inflammation. a child ought not to be allowed to play with peas or with beads (unless the beads are on a string), as he is apt, for amusement, to push them up his nose. . _if a child have put either a pea, a bean, a bead, a cherry-stone, or any other smooth substance, into his ear, what ought to be done to remove it_? turn his head on one side, in order to let the ear with the pea or the bead in it be undermost, then give with the flat of your hand two or three sharp, sudden slaps or boxes on the other, or _upper_most ear, and most likely the offending substance will drop out. poking at the ear will, in the majority of cases, only send the substance further in, and will make it more difficult (if the above simple plan does not succeed) for the medical man to remove. the surgeon will, in all probability, syringe the ear; therefore have a supply of warm water in readiness for him, in order that no time may be lost. . _if an earwig or any other living thing, should get into the ear of a child, what ought to be done_? lay the child on his side, the affected ear being uppermost, and fill the ear, from a tea-spoon, with either water or sweet oil. the water or oil will carry the living thing, whatever it be, out of the ear, and the child is at once relieved. . _if a child swallow a piece of broken glass, what ought to be done_? avoid purgatives, as the free action on the bowels would be likely to force the spiculae of glass into the mucous membrane of the bowels, and thus would wound them, and might cause ulceration, and even death. "the object of treatment will be to allow them to pass through the intestines well enveloped by the other contents of the tube, and for this purpose a solid, farinaceous diet should be ordered, and purgatives scrupulously avoided."--_shaw's medical remembrancer_, by hutchinson. . _if a child swallow a pin, what should be done_? treat him as for broken glass. give him no aperients, or it might, in action, force the pin into the bowel. i have known more than one instance where a child, after swallowing a pin, to have, voided it in his motion. . _if a child swallow a coin of any kind, is danger likely, to ensue, and what ought to be done_? there is, as a rule, no danger. a dose or two of castor oil will be all that is usually necessary. the evacuations ought to be carefully examined until the coin be discovered. i once knew a child swallow a pennypiece, and pass it in his stool. . _if a child, while playing with a small coin (such as either a threepenny or a fourpenny piece), or any other substance, should toss it into his mouth, and inadvertently allow it to enter the windpipe, what ought to be done_? take hold of him by the legs, allowing his head to hang downwards; then give him with the palm of your hand several sharp blows on his back, and you may have the good fortune to see the coin coughed out of his mouth. of course, if this plan does not succeed, send instantly, for a medical man. . _how can a mother prevent her child from having an accident_? by strict supervision over frim on her own part, and by not permitting her child to be left to the tender mercies of servants; by not allowing him to play with fire, to swing over banisters, and to have knives and playthings of a dangerous character; to keep all poisonous articles and cutting instruments out of his reach; and, above all and before all, insisting, lovingly, affectionately, but firmly, upon implicit obedience. accidents generally arise from one of three causes, namely, either from wilful disobedience, or from gross carelessness, or from downright folly. i quite agree with davenant, that they do not arise from chance-- "if we consider accident, and how, repugnant unto sense, it pays desert with bad event, we shall disparage providence." part iii. boyhood and girlhood. _just at the age 'twixt boy and youth when thought is speech and speech is truth_--scott _'tis with him e'en standing water. between man and boy_--shakespeare _standing with reluctant feet, where the brook and river meet, womanhood and childhood fleet_--longfellow ablution, etc. . _have you any remarks to make on the ablution of boys and girls_? how is it that a mother thinks it absolutely necessary (which it really is) that her babe's _whole_ body should, every morning, be washed; and yet who does not deem it needful that her girl or boy, of twelve years old, should go through the process of daily and _thorough_ ablution? if the one case be necessary, sure i am that the other is equally if not more needful. thorough ablution of the body every morning at least is essential to health. i maintain that no one can be in the enjoyment of perfect health who does not keep his skin--the whole of his skin--clean. in the absence of cleanliness, a pellicle forms on the skin which engenders disease. moreover, a person who does not keep his skin clean is more susceptible of contracting contagious disease, such as small-pox, typhus fever, cholera, diphtheria, scarlet fever, etc. thorough ablution of the body is a grand requisite of i maintain that no one can be perfectly healthy unless he thoroughly wash his body--the whole of his body; if filth accumulate which, if not washed off, it is sure to do, disease must, as a matter of course, follow. besides, ablution is a delightful process; it makes one feel fresh and sweet, and young and healthy; it makes the young look handsome, and the old look young! thorough ablution might truly be said both to renovate and to rejuvenise! a scrupulously clean skin is one of the grand distinctive characteristics both of a lady and of a gentleman, dirty people are not only a nuisance to themselves, but to all around; they are not only a nuisance but a danger, as their dirty bodies are apt to carry from place to place contagious diseases. it is important that parts that are covered should be kept cleaner than parts exposed to the air, as dirt is more apt to fester in dark places; besides, parts exposed to the air have the advantage of the air's sweetening properties; air acts as a bath, and purifies the skin amazingly. it is desirable to commence a complete system of washing early in life, as it then becomes a second nature, and cannot afterwards be dispensed with. one accustomed to the luxury of his morning ablution, if anything prevented him from taking it, would feel most uncomfortable; he would as soon think of dispensing with his breakfast as with his bath. every boy, every girl, and every adult, ought each to have either a room or a dressing-room to himself or to herself, in order that he or she might strip to the skin and thoroughly wash themselves; no one can wash properly and effectually without doing so. now, for the paraphernalia required for the process--( .) a large nursery basin, one that will hold six or eight quarts of water (wedgwood's make being considered the best); ( .) a piece of coarse flannel, a yard long and half a yard wide; ( .) a large sponge; ( .) a tablet either of the best yellow or of curd soap; ( .) two towels-one being a diaper, and the other a turkish rubber. now, as to the manner of performing ablution. you ought to fill the basin three parts full with _rain_ water, then, having well-soaped and cleansed your hands, re-soap them, dip your head and face into the water, then with the soaped hands well rub and wash your head, face, neck, chest, and armpits; having done which, take the wetted sponge, and go over all the parts previously travelled over by the soaped hands; then fold the flannel, as you would a neck-kerchief, and dip it in the water, then throw it, as you would a skipping-rope, over your shoulders and move it a few times from right to left and from left to right, and up and down, and then across the back and loins; having done which, dip the sponge in the water, and holding your head over the water, let the water stream from the sponge a time or two over your head, neck, and face. dip your head and face in the water, then put your hands and arms (as far as they will go) into the water, holding them there while you can count thirty. having reduced the quantity of water to a third of a basinful, place the basin on the floor, and sit (while you can count fifty) in the water; then put one foot at a time in the water, and quickly rub, with soaped hands, up and down your leg, over the foot, and pass your thumb between each toe (this latter procedure tends to keep away soft corns); then take the sponge, filled with water, and squeeze it over your leg and foot, from the knee downwards,--then serve your other leg and foot in the same way. by adopting the above plan, the whole of the body will, every morning, be thoroughly washed. a little warm water might at first, and during the winter time, be added, to take off the chill; but the sooner quite cold water is used the better. the body ought to be quickly dried (taking care to wipe between each toe), first with the diaper, and then with the turkish rubber. in drying your back and loins, you ought to throw as you would a skipping-rope, the turkish rubber over your shoulders, and move it a few times front side to side, until the parts be dry. although the above description is necessarily prolix, the washing itself ought to be very expeditiously performed; there should be no dawdling over it, otherwise the body will become chilled, and harm instead of good will be the result. if due dispatch be used, the whole of the body might, according to the above method, be thoroughly washed and dried in the space of ten minutes. a boy ought to wash his head, as above directed, every morning, a girl, who has much hair, once a week, with soap and water, with flannel and sponge. the hair, if not frequently washed, is very dirty, and nothing is more repulsive than a dirty head! it might be said, "why do you go into particulars? why dwell so much upon minutiae? every one, without being told, knows how to wash himself!" i reply, "that very few people do know how to wash themselves properly; it is a misfortune that they do not--they would be healthier and happier and sweeter if they did!" . _have you any remarks to make on boys and girls learning to swim_? let me strongly urge you to let your sons and daughters be _early_ taught to swim. swimming is a glorious exercise--one of the best that can be taken; it expands the chest; it promotes digestion; it develops the muscles, and brings into action some muscles that in any other form of exercise are but seldom brought into play; it strengthens and braces the whole frame, and thus makes the swimmer resist the liability of catching cold; it gives both boys and girls courage, energy, and self-reliance,--splendid qualities in this rough world of ours. swimming is oftentimes the means of saving human life; this of itself would be a great recommendation of its value. it is a delightful amusement; to breast the waves is as exhilarating to the spirits as clearing on horse-back a five-barred gate. the art of learning to swim is quite as necessary to be learned by a girl as by a boy; the former has similar muscles, lungs, and other organs to develop as the latter. it is very desirable that in large towns swimming-baths for ladies should be instituted. swimming ought, then, to be a part and parcel of the education of every boy and of every girl. swimming does not always agree. this sometimes arises from a person being quite cold before he plunges into the water. many people have an idea that they ought to go into the water while their bodies are in a cool state. now this is a mistaken notion, and is likely to produce dangerous consequences. the skin ought to be comfortably warm, neither very hot nor very cold, and then the bather will receive every advantage that cold bathing can produce, if he go into the bath whilst the body is cold, the blood becomes chilled, and is driven to internal parts, and thus mischief is frequently produced. a boy, after using cold bathing, ought, if it _agree_ with him, to experience a pleasing glow over the whole surface of his body, his spirits and appetite should be increased, and he ought to feel stronger; but if it _disagree_ with him, a chilliness and coldness, a lassitude and a depression of spirits, will be the result; the face will be pale and the features will be pinched, and, in some instances, the lips and the nails will become blue; all these are signs that _cold_ bathing is injurious, and, therefore, that it ought on no account to be persevered in, unless these symptoms have hitherto proceeded from his going into the bath whilst he was quite cold. he may, previously to entering the bath, warm himself by walking briskly for a few minutes. where cold, sea water bathing does not agree, _warm_ sea bathing should be substituted. . _which do you prefer--sea bathing or fresh water bathing_? sea bathing. sea bathing is incomparably superior to fresh water bathing; the salt water is far more refreshing and invigorating; the battling with the waves is more exciting; the sea breezes, blowing on the nude body, breathes (for the skin is a breathing apparatus) health and strength into the frame, and comeliness into the face; the sea water and the sea breezes are splendid cosmetics; the salt water is one of the finest applications, both for strengthening the roots and brightening the colour of the hair, provided grease and pomatum have not been previously used. . _have you any directions to give as to the time and the seasons, and the best mode of sea bathing_? summer and autumn are the best seasons of the year for cold sea bathing--august and september being the best months. to prepare the skin for the cold sea bathing, it would be well, before taking a dip in the sea, to have on the previous day a warm salt water bath. it is injurious, and even dangerous, to bathe _immediately_ after a _full_ meal; the best time to bathe is about two hours after breakfast-that is to say, at about eleven or twelve o'clock in the forenoon. the bather as soon as he enters the water, ought _instantly_ to wet his head; this may be done either by his jumping at once from the machine into the water, or, if he have not the courage to do so, by plunging his head without loss of time _completely_ under the water. he should remain in the water about a quarter of an hour, but never longer than half an hour. many bathers by remaining a long time in the water do themselves great injury. if sea bathing be found to be invigorating-- and how often to the delicate it has proved to be truly magical--a patient may bathe once every day, but on no account oftener. if he be not strong, he had better, at first, bathe only every other day, or even only twice a week. the bather, after leaving the machine, ought for half an hour to take a brisk walk in order to promote a reaction, and thus to cause a free circulation of the blood. . _do you think a tepid bath [footnote: a tepid bath from to degrees of, fahrenheit.] may be more safely used_? a tepid bath may be taken at almost any time, and a bather may remain longer in one, with safety, than in a cold bath. . _do you approve of warm bathing_? a warm, bath [footnote: a warm bath from to degrees of fahrenheit] may with advantage be occasionally used--say, once a week. a warm bath cleanses the skin more effectually than either a cold or a tepid bath; but, as it is more relaxing, ought not to be employed so often as either of them. a person should not continue longer than ten minutes in a warm bath. once a week, as a rule is quite often enough for a warm bath; and it would be an excellent plan if every boy and girl and adult would make a practice of having one regularly every week, unless any special reason should arise to forbid its use. . _but does not warm bathing, by relaxing the pores of the skin, cause a person to catch cold if he expose himself to the air immediately afterwards_? there is, on this point, a great deal of misconception and unnecessary fear. a person, _immediately_ after using a warm bath, should take proper precautions--that is to say, he must not expose himself to draughts, neither ought he to wash himself in _cold_ water, nor should he, _immediately_ after taking one, drink _cold_ water. but he may follow his usual exercise or employment, provided the weather be fine, and the wind be neither in the east nor the north-east. every house of any pretension ought to have a bathroom. nothing would be more conducive to health than regular systematic bathing. a hot and cold bath, a sitz bath, and a shower bath--each and all in their turn--are grand requisites to preserve and procure health. if the house cannot boast of a bath-room, then the corporation baths (which nearly every large town possesses) ought to be liberally patronised. management of the hair . _what is the best application for the hair_? a sponge and _cold_ water, and two good hair-brushes. avoid grease, pomatum, bandoline, and all abominations of that kind. there is a natural oil of the hair, which is far superior to either rowland's macassar oil or any other oil! the best scent for the hair is an occasional dressing of soap and water; the best beautifier of the hair is a downright thorough good brushing with two good hair brushes! again, i say, _avoid grease of all kinds to the hair_. "and as for woman's hair, don't plaster it with scented and sour grease, or with any grease; it has an oil of its own. and don't tie up your hair tight, and make it like a cap of iron over your skull. and why are your ears covered? you hear all the worse, and they are not the cleaner. besides, the ear is beautiful in itself, and plays its own part in the concert of the features." [footnote: _health._ by john brown, m.d.] if the hair cannot, without some application, be kept tidy, then a little castor oil, scented, might, by means of an old tooth-brush, be used to smooth it; castor oil is, for the purpose, one of the most simple and harmless of dressings; but, as i said before, the hair's own natural oil cannot be equalled, far less surpassed! if the hair fall off, the castor oil, scented with a few drops either of otto of roses or of essence of bergamot, is a good remedy to prevent its doing so; a little of it ought, night and morning, to be well rubbed into the roots of the hair. cocoa-nut oil is another excellent application for the falling off of the hair, and can never do harm, which is more than can be said of many vaunted remedies for the hair! clothing. . _do you approve of a boy wearing flannel next to the skin?_ england is so variable a climate, and the changes from heat to cold, and from dryness to moisture of the atmosphere, are so sudden, that some means are required to guard against their effects. flannel, as it is a bad conductor of heat, prevents the sudden changes from affecting the body, and thus is a great preservative against cold. flannel is as necessary in the summer as in the winter time; indeed, we are more likely both to sit and to stand in draughts in the summer than in the winter; and thus we are more liable to become chilled and to catch cold. woollen shirts are now much worn; they are very comfortable and beneficial to health. moreover, they simplify the dress, as they supersede the necessity of wearing either both flannel and linen, or flannel and calico shirts. . _flannel sometimes produces great irritation of the skin: what ought to be done to prevent it_? have a moderately fine flannel, and persevere in its use; the skin in a few days will bear it comfortably. the angola and wove-silk waistcoats have been recommended as substitutes, but there is nothing equal to the old-fashioned welsh flannel. . _if a boy have delicate lungs, do you approve of his wearing a prepared hare-skin over the chest_? i do not: the chest may be kept too warm as well as too cold. the hare-skin heats the chest too much, and thereby promotes a violent perspiration; which, by his going into the cold air, may become suddenly checked, and may thus produce mischief. if the chest be delicate, there is nothing like flannel to ward off colds. . _after an attack of rheumatic fever, what extra clothing do you advise_? in the case of a boy, or a girl, just recovering from a severe attack of rheumatic fever, flannel next the skin ought always, winter and summer, to be worn--flannel drawers as well as a flannel vest. . _have you any remarks to make on boys' waistcoats_? fashion in this, as in most other instances, is at direct variance with common sense. it would seem that fashion was intended to make work for the doctor, and to swell the bills of mortality! it might be asked, what part of the chest, in particular, ought to be kept warm? the upper part needs it most. it is in the _upper_ part of the lungs that tubercles (consumption) usually first make their appearance; and is it not preposterous to have such parts, in particular, kept cool? double-breasted waistcoats cannot be too strongly recommended for _delicate_ youths, and for all men who have _weak_ chests. . _have you any directions to give respecting the shoes and the stockings_? the shoes for winter should be moderately thick and waterproof. if boys and girls be delicate, they ought to have double soles to their shoes, with a piece of bladder between each sole, or the inner sole may be made of cork; either of the above plans will make the soles of boots and shoes completely water-proof. in wet or dirty weather india-rubber over-shoes are useful, as they keep the _upper_ as well as the _under_ leathers perfectly dry. the socks, or stockings, for winter, ought to be either lambs-wool or worsted; it is absurd to wear _cotton_ socks or stockings all the year round. i should advise a boy to wear socks not stockings, as he will then be able to dispense with garters. garters, as i have remarked in a previous conversation, are injurious--they not only interfere with the circulation of the blood, but also, by pressure, injure the bones, and thus the shape of the legs. boys and girls cannot be too particular in keeping their feet warm and dry, as cold wet feet are one of the most frequent exciting causes of bronchitis, of sore throats, and of consumption. . _when should a girl begin to wear stays_? she ought never to wear them. . _do not stays strengthen the body_? no; on the contrary, they weaken it ( .) _they, weaken the muscles_. the pressure upon them causes them to waste; so that, in the end, a girl cannot do without them, as the stays are then obliged to perform the duty of the wasted muscles. ( .) _they weaken the lungs_ by interfering with their functions. every inspiration is accompanied by a movement of the ribs. if this movement be impeded, the functions of the lungs are impeded likewise, and, consequently, disease is likely to follow, and either difficulty of breathing, or cough, or consumption, may ensue. ( ) _they weaken the heart's action_, and thus frequently produce palpitation, and, perhaps, eventually, organic or incurable disease of the heart ( ) _they weaken the digestion_, by pushing down the stomach and the liver, and by compressing the latter, and thus induce indigestion, flatulence, and liver-disease. [footnote: several years ago, while prosecuting my anatomical studies in london university college dissecting rooms, on opening a young women, i discovered an immense indentation of the liver large enough to admit a rolling pin, produced by tight lacing!] ( ) _they weaken the bowels_, by impeding their proper peristaltic (spiral) motion, and thus might produce either constipation or a rupture. is it not presumptuous to imagine that man can improve upon god's works, and that if more support had been required, the almighty would not have given it?-- "god never made his work for man to mend"--_dryden._ . _have you any remarks to make on female dress_? there is a perfect disregard of health in everything appertaining to fashion. parts that ought to be kept warm, remain unclothed, the _upper_ portion of the chest, most prone to tubercles (consumption), is completely exposed, the feet, great inlets to cold, are covered with thin stockings, and with shoes as thin as paper. parts that should have full play are cramped and hampered, the chest is cribbed in with stays, the feet with _tight_ shoes,--hence causing deformity, and preventing a free circulation of blood. the mind, that ought to be calm and unruffled, is kept in a constant state of excitement by balls, and concerts, and plays. mind and body sympathise with each other, and disease is the consequence. night is turned into day, and a delicate girl leaves the heated ball room, decked out in her airy finery, to breathe the damp and cold air of night. she goes to bed, but, for the first few hours, she is too much excited to sleep, towards morning, when the air is pure and invigorating, and, when to breathe it, would be to inhale health and life, she falls into a feverish slumber, and wakes not until noon-day. oh, that a mother should be so blinded and so infatuated! . _have you any observations to make on a girl wearing a green dress_? it is injurious to wear a green dress, if the colour have been imparted to it by means of _scheele's green_, which is arsenite of copper--a deadly poison. i have known the arsenic to fly off from a _green_ dress in the form of powder, and to produce, in consequence, ill-health. gas-light green is a lovely green, and free from all danger, and is fortunately superseding the scheele's green both in dresses and in worsted work. i should advise my fair reader, when she selects green as her colour, always to choose the gas-light green, and to wear and to use for worsted work no other green besides, unless it be imperial green. diet. . _which is the more wholesome, coffee or tea, where milk does not agree, for a youth's breakfast_? coffee, provided it be made properly, and provided the boy or the girl take a great deal of out-door exercise; if a youth be much confined within doors, black tea is preferable to coffee. the usual practice of making coffee is to boil it, to get out the strength! but the fact is, the process of boiling boils the strength away; it drives off that aromatic, grateful principle, so wholesome to the stomach, and so exhilarating to the spirits; and, in lieu of which, extracts its dregs and impurities, which are both heavy and difficult of digestion. the coffee ought, if practicable, to be _freshly_ ground every morning, in order that you may be quite sure that it be perfectly genuine, and that none of the aroma of the coffee has flown off from long exposure to the atmosphere. if a youth's bowels be inclined to be costive, coffee is preferable to tea for breakfast, as coffee tends to keep the bowels regular. fresh milk ought always to be added to the coffee in the proportion of half coffee and half new milk. if coffee does not agree, then _black_ tea should be substituted, which ought to be taken with plenty of fresh milk in it. milk may be frequently given in tea, when it otherwise would disagree. when a youth is delicate, it is an excellent plan to give him, every morning before he leaves his bed, a tumblerful of _new_ milk. the draught of milk, of course, is not in any way to interfere with his regular breakfast. . _do you approve of a boy eating meat with his breakfast_? this will depend upon the exercise he uses. if he have had a good walk or run before breakfast, or if he intend, after breakfast, to take plenty of athletic out-door exercise, meat, or a rasher or two of bacon, may, with advantage, be eaten; but not otherwise. . _what is the best dinner for a youth_? fresh mutton or beef, a variety of vegetables, and a farinaceous pudding. it is a bad practice to allow him to dine, exclusively, either on a fruit pudding, or on any other pudding, or on pastry. unless he be ill, he must, if he is to be healthy, strong, and courageous, eat meat every day of his life. "all courageous animals are carnivorous, and greater courage is to be expected in a people, such as the english, whose food is strong and hearty, than in the half-starved commonalty of other countries."--sir w. temple. let him be debarred from rich soups and from high-seasoned dishes, which only disorder the stomach and inflame the blood. it is a mistake to give a boy or a girl broth or soup, in lieu of meat for dinner; the stomach takes such slops in a discontented way, and is not at all satisfied. it may be well, occasionally, to give a youth with his dinner, _in addition to his meat_, either good soup or good broth not highly seasoned, made of good _meat_ stock. but after all that can be said on the subject, a plain joint of meat, either roast or boiled, is far superior for health and strength than either soup or broth, let it be ever so good or so well made. he should be desired to take plenty of time over his dinner, so that he may be able to chew his food well, and thus that it may be reduced to an impalpable mass, and be well mixed with the saliva,--which the action of the jaws will cause to be secreted--before it passes into the stomach. if such were usually the case, the stomach would not have double duty to perform, and a boy would not so frequently lay the foundation of indigestion, etc., which may embitter, and even make miserable, his after-life. meat, plain pudding, vegetables, bread, and hunger for sauce (which exercise will readily give), is the best, and, indeed, should be, as a rule, the only dinner he should have. a youth ought not to dine later than two o'clock. . _do you consider broths and soups wholesome_? the stomach can digest solid much more readily than it can liquid food; on which account the dinner, specified above, is far preferable to one either of broth or of soup. fluids in large quantities too much dilute the gastric juice, and over-distend the stomach, and hence weaken it, and thus produce indigestion: indeed, it might truly be said that the stomach often takes broths and soups in a grumbling way! . _do you approve of a boy drinking beer with his dinner_? there is no objection to a little good, mild table-beer, but _strong_ ale ought never to be allowed. it is, indeed, questionable whether a boy, unless he take unusual exercise, requires anything but water with his meals. . _do you approve of a youth, more especially if he be weakly, having a glass or two of wine after dinner_? i disapprove of it: his young blood does not require to be inflamed, and his sensitive nerves excited, with wine; and, if he he delicate, i should be sorry to endeavour to strengthen him by giving him such an inflammable fluid. if he be weakly, he is more predisposed to put on either fever or inflammation of some organ; and, being thus predisposed, wine would be likely to excite either the one or the other of them into action. "wine and youth are fire upon fire."--_fielding._ a parent ought on no account to allow a boy to touch spirits, however much diluted; they are, to the young, still more deadly in their effects than wine. . _have you any objection to a youth drinking tea_? not at all, provided it be not _green_ tea, that it be not made strong, and that it have plenty of milk in it. green tea is apt to make people nervous, and boys and girls ought not even to know what it is to be nervous. . _do you object to supper for a youth_? meat suppers are highly prejudicial. if he be hungry (and if he have been much in the open air, he is almost sure to be), a piece of bread and cheese, or of bread and butter, with a draught either of new milk or of table beer, will form the best supper he can have. he ought not to sup later than eight o'clock. . _do you approve of a boy having anything between meals_? i do not; let him have four meals a day, and he will require nothing in the intervals. it is a mistaken notion that "little and often is best," the stomach requires rest as much as, or perhaps more than (for it is frequently sadly over-worked) any other part of the body. i do not mean that he is to have "_much_ and seldom:" moderation, in everything, is to be observed. give him as much as a growing boy requires (_and that is a great deal_), but do not let him eat gluttonously, as many indulgent parents encourage their children to do. intemperance in eating cannot be too strongly condemned. . _have you any objection to a boy having pocket money_? it is a bad practice to allow a boy _much_ pocket money; if he be so allowed, he will be loading his stomach with sweets, fruit, and pastry, and thus his stomach will become cloyed and disordered, and the keen appetite, so characteristic of youth, will be blunted, and ill-health will ensue. "in a public education, boys early learn intemperance, and if the parents and friends would give them less money upon their usual visits, it would be much to their advantage, since it may justly be said that a great part of their disorders arise from surfeit, '_plus occidit gula quam gladius_' (gluttony kills more than the sword)."--_goldsmith._ how true is the saying that "many people dig their graves with their teeth." you may depend upon it that more die from stuffing than from starvation! there would be little for doctors to do if there were not so much stuffing and imbibing of strong drinks going on in the world! air and exercise. . _have you any remarks to make on fresh air and exercise for boys and girls_? girls and boys, especially the former, are too much confined within doors. it is imperatively necessary, if you wish them to be strong and healthy, that they should have plenty of fresh air and exercise; remember, i mean fresh air--country air, not the close air of a town. by exercise, i mean the free unrestrained use of their limbs. girls, in this respect, are unfortunately worse off than boys, although they have similar muscles to develop, similar lungs that require fresh air, and similar nerves to be braced and strengthened. it is not considered lady-like to be natural--all then: movements must be measured by rule and compass! the reason why so many young girls of the present day are so sallow, under-sized, and ill-shaped, is for the want of air and exercise. after a time the want of air and exercise, by causing ill health, makes them slothful and indolent-it is a trouble for them to move from their chairs! respiration, digestion, and a proper action of the bowels, imperatively demand fresh air and exercise. ill health will inevitably ensue if boys and girls are cooped up a great part of the day in a close room. a distinguished writer of the present day says: "the children of the very poor are always out and about. in this respect they are an example to those careful mammas who keep their children, the whole day long, in their chairs, reading, writing, ciphering, drawing, practising music lessons, doing crotchet work, or anything, in fact, except running about in spite of the sunshine always peeping in and inviting them out of doors; and who, in the due course of time, are surprised to find their children growing up with incurable heart, head, lung, or stomach complaints." . _what is the lest exercise for a youth_? walking or running: provided either of them be not carried to fatigue,--the slightest approach to it should warn a youth to desist from carrying it further. walking exercise is not sufficiently insisted upon. a boy or a girl, to be in the enjoyment of good health, ought to walk at least ten miles every day. i do not mean ten miles at a stretch, but at different times of the day. some young ladies think it an awfully long walk if they manage a couple of miles! how can they, with such exercise, expect to be well? how can their muscles be developed? how can their nerves be braced? how can their spines be strengthened and be straight? how can their blood course merrily through their blood-vessels? how can their chests expand and be strong? why, it is impossible! ill health must be the penalty of such indolence, for nature will not be trifled with! walking exercise, then, is the finest exercise that can be taken, and must be taken, and that without stint, if boys and girls are to be strong and well! the advantage of our climate is, that there is not a day in the whole year that walking exercise cannot be enjoyed. i use the term enjoyed advisedly. the roads may, of course, be dirty; but what of that a good thick pair of boots will be the remedy. do then, let me entreat you, insist upon your--girls and boys taking plenty of exercise; let them almost live in the open air! do not coddle them; this is a rough; world of ours, and they must rough it; they must be knocked about a great deal, and the knocks will do them, good. poor youths who are, as it were, tied to their mother's apron strings, are much to be pitied; they are usually puny and delicate, and effeminate, and utterly deficient of self-reliance. . _do you approve of--horse or pony exercise for boys and girls_? most certainly i do; but still it ought not to supersede walking. horse or pony exercise is very beneficial, and cannot be too strongly recommended. one great advantage for those living in towns, which it has over walking, is, that a person may go further into the country, and thus be enabled to breathe a purer and more healthy atmosphere. again, it is a much more amusing exercise than walking, and this, for the young, is a great consideration indeed. horse exercise is for both boys and girls a splendid exercise; it improves the figure, it gives grace to the movements, it strengthens the chest, it braces the muscles, and gives to the character energy and courage. both boys and girls ought to be early taught to ride. there is nothing that gives more pleasure to the young than riding either on a pony or on a horse, and for younger children, even on that despised, although useful animal, a donkey. exercise, taken with pleasure, is doubly beneficial. if girls were to ride more on horseback than they now do, we should hear less of crooked spines and of round shoulders, of chlorosis and of hysteria, and of other numerous diseases of that class, owing, generally, to debility and to mismanagement. those ladies who "affect the saddle" are usually much healthier, stronger, and straighter than those who either never or but seldom ride on horseback. siding on horseback is both an exercise and an amusement, and is peculiarly suitable for the fair sex, more especially as their modes of exercise are somewhat limited, ladies being excluded from following many games, such as cricket, and foot-ball, both of which are practised, with such zest and benefit, by the rougher sex. . _do you approve of carriage exercise_? there is no muscular exertion in carriage exercise; its principal advantage is, that it enables a person to have a change of air, which may be purer than the one he is in the habit of breathing. but, whether it be so or not, change of air frequently does good, even, if the air be not so pure. carriage exercise, therefore, does only partial good, and ought never to supersede either walking or horse exercise. . _what is the best time of the day, for the taking of exercise_? in the summer time, early in the morning and before breakfast, as "cool morning air exhilarates young blood like wine." if a boy cannot take exercise upon an empty stomach, let him have a slice of bread and a draught of milk. when he returns home he will be able to do justice to his breakfast. in fine weather he cannot take too much exercise, provided it be not carried to fatigue. . _what is the best time for him to keep quiet_? he ought not to take exercise immediately after--say for half an hour after--a hearty meal, or it will be likely to interfere with his digestion. amusements. . _what amusements do you recommend for a boy as being most beneficial to health_? manly games--such as rowing, skating, cricket, quoits, foot-ball, rackets, single-stick, bandy, bowls, skittles, and all gymnastic exercises. such games bring the muscles into proper action, and thus cause them to be fully developed. they expand and strengthen the chest; they cause a due circulation of the blood, making it to bound merrily through the blood-vessels, and thus to diffuse health and happiness in its course. another excellent amusement for boys, is the brandishing of clubs. they ought to be made in the form of a constable's staff, but should be much larger and heavier. the manner of handling them is so graphically described by addison that i cannot do better than transcribe it--"when i was some years younger than i am at present, i used to employ myself in a more laborious diversion, which i learned from a latin treatise of exercises that is written with great erudition; it is there called the [greek: skiomachia] or the fighting with a man's own shadow, and consists in the brandishing of two short sticks grasped in each hand, and loaded with plugs of lead at either end. this opens the chest, exercises the limbs, and gives a man all the pleasure of boxing without the blows. i could wish that several learned men would lay out that time which they employ in controversies and disputes about nothing, in this method of fighting with their own shadows. it might conduce very much to evaporate the spleen which makes them uneasy to the public as well as to themselves." another capital, healthful game is single-stick, which makes a boy "to gain an upright and elastic carriage, and to learn the use of his limbs."--_h. kingsley_. single-stick may be taught by any drill-sergeant in the neighbourhood. do everything to make a boy strong. remember, "the glory of young men is their strength." if games were more patronised in youth, so many miserable, nervous, useless creatures would not abound. let a boy or girl, then, have plenty of play; let half of his or her time be spent in play. there ought to be a gymnasium established in every town of the kingdom. the gymnasium, the cricket ground, and the swimming bath, are among our finest establishments, and should be patronised accordingly. first of all, by an abundance of exercise and fresh air make your boys and girls strong, and then, in due time, they will be ready and be able to have their minds properly cultivated. unfortunately, in this enlightened age, we commence at the wrong end--we put the cart before the horse--we begin by cultivating the mind, and we leave the body to be taken care of afterwards; the results are, broken health, precocious, stunted, crooked, and deformed youths, and premature decay. one great advantage of gymnastic exercise is, it makes the chest expand, it fills the lungs with air, and by doing so strengthens them amazingly, and wards off many diseases. the lungs are not sufficiently exercised and expanded; boys and girls, girls especially, do not as a rule half fill their lungs with air; now air to the lungs is food to the lungs, and portions of the lungs have not half their proper food, and in consequence suffer. it is very desirable that every boy and girl should, every day of his or her life, and for a quarter of an hour at least each time, go through a regular _breathing exercise_--that is to say, should be made to stand upright, throw back the shoulders, and the while alternately and regularly fully fill and fully empty the lungs of air. if this plan were daily followed, the chest and lungs would be wonderfully invigorated, and the whole body benefited. . _is playing the flute, blowing the bugle, or any other wind instrument, injurious to health_? decidedly so: the lungs and the windpipe are brought into unnatural action by them. if a boy be of a consumptive habit, this will, of course, hold good with tenfold force. if a youth must be musical let him be taught singing, as that, provided the lungs be not diseased, will be beneficial. . _what amusements do you recommend for a girl_? archery, skipping, horse exercise, croquet, the hand-swing, the fly-pole, skating, and dancing, are among the best. archery expands the chest, throws back the shoulders, thus improving the figure, and develops the muscles. skipping is exceedingly good exercise for a girl, every part of the body being put into action by it horse exercise is splendid for a girl; it improves the figure amazingly--it is most exhilarating and amusing; moreover, it gives her courage and makes her self-reliant croquet develops and improves the muscles of the arms, beautifies the complexion, strengthens the back, and throws out the chest. croquet is for girls and women what cricket is for boys and men--a glorious game. croquet has improved both the health and the happiness of womankind more than any game ever before invented. croquet, in the bright sunshine, with the winds of heaven blowing about the players, is not like a ball in a stifling hot ball-room, with gas-lights poisoning the air. croquet is a more sensible amusement than dancing; it brings the intellect as well as the muscles into play. the man who invented croquet has deserved greater glory, and has done more good to his species, than many philosophers whose names are emblazoned in story. hand-swing is a capital exercise for a girl, the whole of the body is thrown into action by it, and the spine, the shoulders, and the shoulder-blades, are especially benefited. the fly-pole, too, is good exercise for the whole of the muscles of the body, especially of the legs and the arms. skating is for a girl excellent exercise, and is as exhilarating as a glass of champagne, but will do her far more good! skating improves the figure, and makes a girl balance and carry herself upright and well; it is a most becoming exercise for her, and is much in every way to be commended. moreover, skating gives a girl courage and self-reliance. dancing, followed as a rational amusement, causes a free circulation of the blood, and provided it does not induce her to sit up late at night, is most beneficial. . _if dancing be so beneficial why are balls such fruitful sources of coughs, of cold, and consumptions_? on many accounts. they induce young ladies to sit up late at night; they cause them to dress more lightly than they are accustomed to do; and thus thinly clad, they leave their homes while the weather is perhaps piercingly cold, to plunge into a suffocating, hot ballroom, made doubly injurious by the immense number of lights, which consume the oxygen intended for the due performance of the healthy functions of the lungs. their partners, the brilliancy of the scene, and the music, excite their nerves to undue and thus to unnatural, action, and what is the consequence? fatigue, weakness, hysterics, and extreme depression follow. they leave the heated ball-room when the morning has far advanced, to breathe the bitterly cold and frequently damp air of a winter's night, and what is the result? hundreds die of consumption, who might otherwise have lived. ought there not, then, to be a distinction between a ball at midnight and a dance in the evening? . _but still, would you have a girl brought up to forego the pleasure of a ball_? if a parent prefer her so-called pleasures to her health, certainly not; to such a mother i do not address myself. . _have you any remarks to make on singing, or on reading aloud_? before a mother allows her daughter to take lessons in singing, she should ascertain that there be no actual disease of the lungs, for if there be, it will probably excite it into action; but if no disease exist, singing or reading aloud is very conducive to health. public singers are seldom known to die of consumption. singing expands the chest, improves the pronunciation, enriches the voice for conversation, strengthens the lungs, and wards off many of their diseases. . _do you approve of corporal punishments in schools_? i do not. i consider it to be decidedly injurious both to body and mind. is it not painful to witness the pale cheeks and the dejected looks of those boys who are often flogged? if their tempers are mild, their spirits are broken; if their dispositions are at all obstinate, they become hardened and wilful, and are made little better than brutes. [footnote: "i would have given him, captain fleming, had he been my son," quoth old pearson the elder, "such's good sound drubbing as he never would have forgotten--never!" "pooh! pooh! my good sir. don't tell me. never saw flogging in the navy do good. kept down brutes; never made a man yet."--dr norman macleod in _good words_, may .] a boy who is often flogged loses that noble ingenuousness and fine sensibility so characteristic of youth. he looks upon his school as his prison, and his master as his gaoler, and as he grows up to manhood, hates and despises the man who has flogged him. corporal punishment is revolting, disgusting, and demoralising to the boy; and is degrading to the schoolmaster as a man and as a christian, if schoolmasters must flog, let them flog their own sons. if they must ruin the tempers, the dispositions, and the constitution of boys, they have more right to practise upon their own than on other people's children! oh! that parents would raise--and that without any uncertain sound--their voices against such abominations, and the detestable cane would soon be banished the school-room! "i am confident that no boy," says addison, "who will not be allured by letters without blows, will never be brought to anything with them. a great or good mind must necessarily be the worse for such indignities; and it is a sad change to lose of its virtue for the improvement of its knowledge. no one has gone through what they call a great school, but must have remembered to have seen children of excellent and ingenuous natures (as have afterwards appeared in their manhood). i say, no man has passed through this way of education but must have seen an ingenuous creature expiring with shame, with pale looks, beseeching sorrow, and silent tears, throw up its honest sighs, and kneel on its tender knees to an inexorable blockhead, to be forgiven the false quantity of a word in making a latin verse. the child is punished, and the next day he commits a like crime, and so a third, with the same consequence. i would fain ask any reasonable man whether this lad, in the simplicity of his native innocence, full of shame, and capable of any impression from that grace of soul, was not fitter for any purpose in this life than after that spark of virtue is extinguished in him, though he is able to write twenty verses in an evening?" how often is corporal punishment resorted to at school because the master is in a passion, and he vents his rage upon the poor school-boy's unfortunate back! oh! the mistaken notion that flogging will make a bad-behaved boy a good boy; it has the contrary effect. "'i dunno how 'tis, sir,' said an old farm labourer, in reply to a question from his clergyman respecting the bad behaviour of his children, 'i dunno how 'tis; i beats 'em till they're black and blue, and when they won't kneel down to pray i knocks 'em down, and yet they ain't good.'"--_the birmingham journal._ in an excellent article in _temple bar_(november ) on flogging in the army, the following sensible remarks occur:--"in nearly a quarter of a century's experience with soldiers, the writer has always, and without a single exception, found flogging makes a good man bad, and a bad man worse." with equal truth it may be said that, without a single exception, flogging makes a good boy bad, and a bad boy worse. how many men owe their ferocity to the canings they received when school-boys! the early floggings hardened and soured them, and blunted their sensibility. dr arnold of rugby, one of the best schoolmasters that england ever produced, seldom caned a boy--not more than once or twice during the half year; but when he did cane him, he charged for the use of the cane each time in the bill, in order that the parents might know how many times their son had been punished. at some of our public schools now-a-days, a boy is caned as many times in a morning as the worthy doctor would have caned him during the whole half year; but then, the doctor treated the boys as gentlemen, and trusted much to their honour; but now many schoolmasters trust much to fear, little to honour, and treat them as brute beasts. it might be said that the discipline of a school cannot be maintained unless the boys be frequently caned, that it must be either caning or expulsion. i deny these assertions. dr arnold was able to conduct his school with honour to himself, and with immense benefit to the rising generation, without either frequent canings or expulsions. the humane plan, however, requires at first both trouble and patience; and trouble some schoolmasters do not like, and patience they do not possess; the use of the cane is quick, sharp, decisive, and at the time effective. if caning be ever necessary, which it might occasionally be, for the telling of lies for instance, or for gross immorality, let the head master himself be the only one to perform the operation, but let him not be allowed to delegate it to others. a law ought in all public schools to be in force to that effect. high time that something were done to abate such disgraceful practices. never should a schoolmaster, or any one else, be allowed, _on any pretence whatever_, to strike a boy upon his head. boxing of the ears has sometimes caused laceration of the drum of the ear, and consequent partial deafness for life. boxing of the ears injures the brain, and therefore the intellect. it might be said, that i am travelling out of my province in making remarks on corporal chastisement in schools? but, with deference, i reply that i am strictly in the path of duty. my office is to inform you of everything that is detrimental to your children's health and happiness; and corporal punishment is assuredly most injurious both to their health and happiness. it is the bounden duty of every man, and especially of every medical man, to lift up his voice against the abominable, disgusting, and degrading system of flogging, and to warn parents of the danger and the mischief of sending boys to those schools where flogging is, except in rare and flagrant cases, permitted. . _have you any observations to make on the selection, of a female boarding-school_? home education, where it be practicable, is far preferable to sending a girl to school; as _at_ home, her health, her morals, and her household duties, can be attended to much more effectually than _from_ home. moreover, it is a serious injury to a girl, in more ways than one, to separate her from her own brothers: they very much lose their affection for each other, and mutual companionship (so delightful and beneficial between brothers and sisters) is severed. if home education be not practicable, great care must be taken in making choice of a school. boarding school education requires great reformation. accomplishments, superficial acquirements, and brain-work, are the order of the day; health is very little studied. you ought, in the education of your daughters, to remember that they, in a few years, will be the wives and the mothers of england; and, if they have not health and strength, and a proper knowledge of household duties to sustain their characters, what useless, listless wives and mothers they will make! remember, then, the body, and not the mind, ought, in early life, to be principally cultivated and strengthened, and that the growing brain will not bear, with impunity, much book learning. the brain of a school-girl is frequently injured by getting up voluminous questions by rote, that are not of the slightest use or benefit to her, or to any one else. instead of this ridiculous system, educate a girl to be useful and self-reliant. "from babyhood they are given to understand that helplessness is feminine and beautiful; helpfulness, except in certain received forms of manifestation, unwomanly and ugly. the boys may do a thousand things which are 'not proper for little girls.'"--_a woman's thoughts about women_. from her twelfth to her seventeenth year, is the most important epoch of a girl's existence, as regards her future health, and consequently, in a great measure, her future happiness; and one, in which, more than at any other period of her life, she requires a plentiful supply of fresh air, exercise, recreation, a variety of innocent amusements, and an abundance of good nourishment--more especially of fresh meat; if therefore you have determined on sending your girl to school, you must ascertain that the pupils have as much plain wholesome nourishing food as they can eat, [footnote: if a girl have an _abundance_ of good nourishment, the schoolmistress must, of coarse, be remunerated for the necessary and costly expense; and how can this be done on the paltry sum charged at _cheap_ boarding schools? it is utterly impossible! and what are we to expect from poor and insufficient nourishment to a fast-growing girl, and at the time of life, remember, when she requires an _extra_ quantity of good sustaining, supporting food? a poor girl, from such treatment, becomes either consumptive or broken down in constitution, and from which she never recovers, but drags on a miserable existence.] that the school be situated in a healthy spot, that it be well-drained, that there be a large play-ground attached to it, that the young people are allowed plenty of exercise in the open air--indeed, that at least one-third of the day is spent there in croquet, skipping, archery, battle-dore and shuttlecock, gardening, walking, running, &c. take care that the school-rooms are well-ventilated, that they are not over-crowded, and that the pupils are allowed chairs to sit upon, and not those abominations--forms and stools. if you wish to try the effect of them upon yourselves, sit for a couple of hours without stirring upon a form or upon a stool, and, take my word for it, you will insist that forms and stools be banished for ever from the schoolroom. assure yourself that the pupils are compelled to rise early in the morning, and that they retire early to rest; that each young lady has a separate bed [footnote: a horse-hair mattress should always be preferred to a feather-bed. it is not only better for the health, but it improves the figure] and that many are not allowed to sleep in the same room, and that the apartments are large and well-ventilated. in fine, their health and their morals ought to be preferred far above all their accomplishments. . _they use, in some schools, straight-backed chairs to make a girl sit upright, and to give strength to her back: do you approve of them_? certainly not: the natural and the graceful curve of the back is not the curve of a straight-backed chair. straight-backed chairs are instruments of torture, and are more likely to make a girl crooked than to make her straight. sir astley cooper ridiculed straight-backed chairs, and well he might. it is always well for a mother to try, for some considerable time, such ridiculous inventions upon herself before she experiments upon her unfortunate daughter. the position is most unnatural. i do not approve of a girl lounging and lolling on a sofa; but, if she be tired and wants to rest herself, let her, like any other reasonable being, sit upon a comfortable ordinary chair. if you want her to be straight, let her be made strong; and if she is to be strong, she must use plenty of exercise and exertion, such as drilling, dancing, skipping, archery, croquet, hand-swinging, horse-exercise, swimming, bowls, etc. this is the plan to make her back straight and her muscles strong. why should we bring up a girl differently from a boy? muscular exercises, gymnastic performances, and health-giving exertion, are unladylike, forsooth! household work for girls. . _do you recommend household work as a means of health for my daughter_? decidedly: whatever you do, do not make a fine lady of her, or she will become puny and delicate, listless, and miserable. a girl, let her station be what it might, ought, as soon as she be old enough, to make her own bed. there is no better exercise to expand the figure and to beautify the shape than is bed-making. let her make tidy her own room. let her use her hands and her arms. let her, to a great extent, be self-reliant, and let her wait upon herself. there is nothing vulgar in her being useful. let me ask, of what use are many girls of the present day? they are utterly useless. are they happy? no, for the want of employment, they are miserable--i mean bodily employment, household work. many girls, now-a-days, unfortunately, are made to look upon a pretty face, dress, and accomplishments, as the only things needed! and, when they do become women and wives--if ever they do become women and wives--what miserable lackadaisical wives, and what senseless, useless mothers they will make! choice of profession or trade. . _what profession or trade would you recommend a boy of a delicate or of a consumptive habit to follow_? if a youth be delicate, it is a common practice among parents either to put him to some light in-door trade, or, if they can afford it, to one of the learned professions. such a practice is absurd, and fraught with danger. the close confinement of an in-door trade is highly prejudicial to health. the hard reading requisite to fit a man to fill, for instance, the sacred office, only increases delicacy of constitution. the stooping at a desk, in an attorney's office, is most trying to the chest. the harass, the anxiety, the disturbed nights, the interrupted meals, and the intense study necessary to fit a man for the medical profession, is still more dangerous to health than either law, divinity, or any in-door trade. "sir walter scott says of the country surgeon, that he is worse fed and harder wrought than any one else in the parish, except it be his fiorse."--_brown's horoe subsecivoe._ a modern writer, speaking of the life of a medical man, observes, "there is no career which so rapidly wears away the powers of life, because there is no other which requires a greater activity of mind and body. he has to bear the changes of weather, continued fatigue, irregularity in his meals, and broken rest; to live in the midst of miasma and contagion. if in the country, he has to traverse considerable distances on horseback, exposed to wind and storm; to brave all dangers to go to the relief of suffering humanity. a fearful truth for medical men has been established by the table of mortality of dr. caspar, published in the _british review_. of members of the medical profession, died before their sixty-second year; whilst of persons leading a quiet life--such as agriculturists or theologians--the mortality is only . if we take individuals of each of these classes, theologians, agriculturists, clerks, soldiers, will reach their seventieth year; of professors of the healing art, only will reach that age. they are the sign-posts to health; they can show the road to old age, but rarely tread it themselves." if a boy, therefore, be of a delicate or of a consumptive habit, an out-door calling should be advised, such as that of a farmer, of a tanner, or a land-surveyor; but, if he be of an inferior station of society, the trade of a butcher may be recommended. tanners and butchers are seldom known to die of consumption. i cannot refrain from reprobating the too common practice among parents of bringing up their boys to the professions. the anxieties and the heartaches which they undergo if they do not succeed (and how can many of them succeed when there is such a superabundance of candidates?) materially injure their health. "i very much wonder," says addison, "at the humour of parents, who will not rather choose to place their sons in a way of life where an honest industry cannot but thrive, than in stations where the greatest probity, learning, and good sense, may miscarry. how many men are country curates, that might have made themselves aldermen of london by a right improvement of a smaller sum of money than what is usually laid out upon a learned education? a sober, frugal person, of slender parts and a slow apprehension, might have thrived in trade, though he starves upon physic; as a man would be well enough pleased to buy silks of one whom he could not venture to feel his pulse. vagellius is careful, studious, and obliging, but withal a little thick-skulled; he has not a single client, but might have had abundance of customers. the misfortune is that parents take a liking to a particular profession, and therefore desire their sons may be of it; whereas, in so great an affair of life, they should consider the genius and abilities of their children more than their own inclinations. it is the great advantage of a trading nation, that there are very few in it so dull and heavy who may not be placed in stations of life which may give them an opportunity of making their fortunes. a well-regulated commerce is not, like law, physic, or divinity, to be overstocked with hands; but, on the contrary, flourishes by multitudes, and gives employment to all its professors. fleets of merchantmen are so many squadrons of floating shops, that vend our wares and manufactures in all the markets of the world, and find out chapmen under both the tropics." . _then, do you recommend a delicate youth to be brought up either to a profession or to a trade_? decidedly; there is nothing so injurious for a delicate boy, or for anyone else, as idleness. work, in moderation, enlivens the spirits, braces the nerves, and gives tone to the muscles, and thus strengthens the constitution. of all miserable people, the idle boy, or the idle man, is the most miserable! if you be poor, of course you will bring him up to some calling; but if you be rich, and your boy be delicate (if he be not actually in a consumption), you will, if you are wise, still bring him up to some trade or profession. you will, otherwise, be making a rod for your own as well as for your son's back. oh, what a blessed thing is work! . _have you any remarks to make on the sleep of boys and girls_? sleeping-rooms, are, generally, the smallest in the house, whereas, for health's sake, they ought to be the largest if it be impossible to have a _large_ bedroom, i should advise a parent to have a dozen or twenty holes (each about the size of a florin) bored with a centre-bit in the upper part of the chamber door, and the same number of holes in the lower part of the door, so as constantly to admit a free current of air from the passages. if this cannot readily be done, then let the bedroom door be left ajar all night, a door chain being on the door to prevent intrusion; and, in the summer time, during the night, let the window-sash, to the extent of about two or three inches, be left open. if there be a dressing-room next to the bedroom, it will be well to have the dressing-room window, instead of the bedroom window, open at night. the dressing-room door will regulate the quantity of air to be admitted into the bedroom, opening it either little or much, as the weather might be cold or otherwise. _fresh air during deep is indispensable to health._--if a bedroom be close, the sleep, instead of being calm and refreshing, is broken and disturbed; and the boy, when he awakes in the morning, feels more fatigued than when he retired to rest. if sleep is to be refreshing, the air, then, must be pure, and free from carbonic acid gas, which, is constantly being evolved from the lungs. if sleep is to be health-giving, the lungs ought to have their proper food--oxygen, and not to be cheated by giving them instead a poison--carbonic acid gas. it would be well for each boy to have a separate room to himself, and each girl a separate room to herself. if two boys are obliged, from the smallness of the house, to sleep in one room, and if two girls, from the same cause, are compelled to occupy the same chamber, by all means let each one have a _separate_ bed to himself and to herself, as it is so much more healthy and expedient for both boy and girl to sleep alone. the roof of the bed should be left open--that is to say, the top of the bedstead ought not to be covered with bed furniture, but should be open to the ceiling, in order to encourage a free ventilation of air. a bed-curtain may be allowed on the side of the bed where there are windy currents of air; otherwise bed-curtains and valances ought on no account to be allowed. they prevent a free circulation of the air. a youth should sleep on a horse-hair mattress. such mattresses greatly improve the figure and strengthen the frame. during the day time, provided it does not rain, the windows must be thrown wide open, and, directly after he has risen from bed, the clothes ought to be thrown entirely back, in order that they may become, before the bed be made, well ventilated and purified by the air-- "do yon wish to be healthy?-- then keep the home sweet, as soon as you're up shake each blanket and sheet. leave the beds to get fresh on the close crowded floor let the wind sweep right through-- open window and door the bad air will rush out as the good air comes in, just as goodness is stronger and better than sin. do this, it's soon done, in the fresh morning air, it will lighten your labour and lessen your care you are weary--no wonder, there's weight and there's gloom hanging heavily round in each over full room. be sure all the trouble is profit and gain for there's head ache and heart-ache, and fever and pain hovering round, settling down in the closeness and heat let the wind sweep right through till the air's fresh and sweet, and more cheerful you'll feel through the toil of the day, more refreshed you'll awake when the night's paved away" [footnote: _household verses on health and happiness_ london. jarrold and sons. every mother should read these _verses_.] plants and flowers ought not to be allowed to remain in a chamber at night. experiments have proved that plants and flowers take up, in the day-time, carbonic acid gas (the refuse of respiration), and give off oxygen (a gas so necessary and beneficial to health), but give out, in the night season, a poisonous exhalation. early rising cannot be too strongly insisted upon; nothing is more conducive to health and thus to long life. a youth is frequently allowed to spend the early part of the morning in bed, breathing the impure atmosphere of a bedroom, when he should be up and about, inhaling the balmy and health-giving breezes of the morning:-- "rise with the lark, and with the lark to bed: the breath of night's destructive to the hue of ev'ry flower that blows. go to the field, and ask the humble daisy why it sleeps soon as the sun departs? why close the eyes of blossoms infinite long ere the moon her oriental veil puts off? think why, nor let the sweetest blossom nature boasts be thus exposed to night's unkindly damp. well may it droop, and all its freshness lose, compell'd to taste the rank and pois'nous steam of midnight theatre and morning ball gire to repose the solemn hour she claims; and from the forehead of the morning steal the sweet occasion. oh! there is a charm which morning has, that gives the brow of age, a smack of youth, and makes the lip of youth shed perfume exquisite. expect it not ye who till noon upon a down-bed lie, indulging feverish sleep."--_hurdis_. if early rising be commenced in childhood it becomes a habit, and will then probably be continued through life. a boy ought on no account to be roused from his sleep; but, as soon as he be awake in the morning, he should be encouraged to rise. dozing--that state between sleeping and waking--is injurious; it enervates both body and mind, and is as detrimental to health as dram drinking! but if he rise early he must go to bed betimes; it is a bad practice to keep him up until the family retire to rest. he ought, winter and summer, to seek his pillow by nine o'clock, and should rise as soon as he awake in the morning. let me urge upon a parent the great importance of _not_ allowing the chimney of any bedroom, or of any room in the house, to be stopped, as many are in the habit of doing to prevent, as _they_ call it, a draught, but to prevent, as _i_ should call it, health. . _how many hours of deep ought a boy to have_? this, of course, will depend upon the exercise he takes: but, on an average, he should have every night at least eight hours. it is a mistaken notion that a boy does _better_ with _little_ sleep. infants, children, and youths require more than those who are further advanced in years; hence old people can frequently do with little sleep. this may in a measure be accounted for from the quantity of exercise the young take. another reason may be, the young have neither racking pain, nor hidden sorrow, nor carking care, to keep them awake; while, on the contrary, the old have frequently, the one, the other, or all:-- "care keeps his watch on every old man's eye, and where care lodges, sleep will never lie."--_shakspeare_. on the teeth and the gums. . _what are the beet means of keeping the teeth and the gums in a healthy state_? i would recommend the teeth and the gums to be well brushed with warm salt and water, in the proportion of one large tea-spoonful of, salt to a tumbler of water. i was induced to try the above plan by the recommendation of an american writer--_todd_. the salt and water should be used _every night_. the following is an excellent tooth-powder:-- take of--finely-powder peruvian bark; '' prepared coral; '' prepared chalk; '' myrrh, of each half an ounce '' orris root, a quarter of an ounce: mix them well together in a mortar, and preserve the powder in a wide mouthed stoppered bottle. the teeth ought to be well brushed with the above tooth-powder every morning. if the teeth be much decayed, and if, in consequence, the breath be offensive, two ounces of finely-powdered charcoal well mixed with the above ingredients will be found a valuable addition. some persons clean their teeth every morning with soap; if soap be used it ought to be castile soap; and if the teeth be not white and clean, castile soap is an excellent cleanser of the teeth, and may be used in lieu of the tooth powder as before recommended. there are few persons who brush their teeth properly. i will tell you the right way. first of all procure a tooth brush of the best make, and of rather hard bristles, to enable it to penetrate into all the nooks and corners of the teeth; then, having put a small quantity of warm water into your mouth, letting the principal of it escape into the basin, dip your brush in warm water, and if you are about using castile soap, rub the brush on a cake of the soap, and then well brush your teeth, first upwards and then downwards, then from side to side--from right to left, and from left to right--then the backs of the teeth, then apply the brush to the tops of the crowns of the teeth both of the upper and of the lower jaw,--so that _every_ part of each tooth, including the gums, may in turn be well cleansed and be well brushed. be not afraid of using the brush; a good brushing and dressing will do the teeth and the gums an immensity of good; it will make the breath sweet, and will preserve the teeth sound and good. after using the brush the mouth must, of course, be well rinsed out with warm water. the finest get of teeth i ever saw m my life belonged to a middle-aged gentleman; the teeth had neither spot nor blemish, they were like beautiful pearls. he never had toothache in his life, and did not know what toothache meant! he brushed his teeth, every morning, with soap and water, in the manner i have previously recommended. i can only say to you--go and do likewise! camphor ought never to be used as an ingredient of tooth-powder, it makes the teeth brittle. camphor certainly has the effect of making the teeth, for a time, look very white; but it is an evanescent beauty. tartar is apt to accumulate between and around the teeth; it is better in such a case not to remove it by sealing instruments, but to adopt the plan recommended by dr richardson, namely, to well brush the teeth with pure vinegar and water. prevention of disease, etc . _if a boy or a girl show great precocity of intellect, is any organ likely to become affected_? a greater quantity of arterial blood is sent to the brain of those who are prematurely talented, and hence it becomes more than ordinarily developed. such advantages are not unmixed with danger; this same arterial blood may exite and feed inflammation, and either convulsions, or water on the brain, or insanity, or, at last, idiocy may follow. how proud a mother is in having a precocious child! how little is she aware that precocity is frequently an indication of disease! . _how can danger in such a case be warded off_? it behoves a parent, if her son be precocious, to restrain him--to send him to a quiet country place, free from the excitement of the town; and when he is sent to school, to give directions to the master that he is not on any account to tax his intellect (for a master is apt, if he have a clever boy, to urge him forward); and to keep him from those institutions where a spirit of rivalry is maintained, and where the brain is thus kept in a state of constant excitement. medals and prizes are well enough for those who have moderate abilities, but dangerous, indeed, to those who have brilliant ones. an over-worked precocious brain is apt to cause the death of the owner; and if it does not do so, it in too many instances injures the brain irreparably, and the possessor of such an organ, from being one of the most intellectual of children becomes one of the most commonplace of men. let me urge you, if you have a precocious child, to give, and that before it be too late, the subject in question your best consideration. . _are precocious boys in their general health usually strong or delicate_? delicate: nature seems to have given a delicate body to compensate for the advantages of a talented mind. a precocious youth is predisposed to consumption, more so than to any other disease. the hard study which he frequently undergoes excites the disease into action. it is not desirable, therefore, to have a precocious child. a writer in "eraser's magazine" speaks very much to the purpose when he says, "give us intellectual beef rather than intellectual veal." . _what habit of body is most predisposed to scrofula_? he or she who has a moist, cold, fair, delicate and almost transparent skin, large prominent blue eyes, protuberant forehead, light-brown or auburn hair, rosy cheeks, pouting lips, milk-white teeth, long neck, high shoulders, small, flat, and contracted chest, tumid bowels, large joints, thin limbs, and flabby muscles, is the person, most predisposed to scrofula. the disease is not entirely confined to the above; sometimes she or he who has black hair, dark eyes and complexion, is subject to it, but yet, far less frequently than the former. it is a remarkable fact that the most talented are the most prone to scrofula, and being thus clever their intellects are too often cultivated at the expense of their health. in infancy and childhood, either water on the brain or mesenteric disease; in youth, pulmonary consumption is frequently their doom: they are like shining meteors; their life is short, but brilliant. . _how may scrofula be warded off_? strict attention to the roles of health is the means to prevent scrofula. books, unless as an amusement, ought to be discarded. the patient must almost live in the open air, and his residence should be a healthy country place, where the air is dry and bracing; if it be at a farm-house, in a salubrious neighbourhood, so much the better. in selecting a house for a patient predisposed to scrofula, _good pure water should be an important requisite;_ indeed for every one who values his health. early rising in such a case is most beneficial. wine, spirits, and all fermented liquors ought to be avoided. beef-steaks and mutton-chops in abundance, and plenty of milk and of farinaceous food--such as rice, sago, arrowroot, &c., should be his diet. scrofula, if the above rules be strictly and perseveringly followed, may be warded off; but there must be no half measures, no trying to serve two masters--to cultivate at the same time the health and the intellect. the brain, until the body becomes strong, must _not_ be taxed. "you may prevent scrofula by care, but that some children are originally predisposed to the disease there cannot be the least doubt, and in such cases the education and the habits of youth should be so directed as to ward off a complaint, the effects of which are so frequently fatal."--_sir astley cooper on scrofula_. . _but suppose the disease to be already formed, what must then be done_? the plan recommended above must still be pursued, not by fits and starts, but steadily and continuously, for it is a complaint that requires a vast deal of patience and great perseverance. warm and cold sea-bathing in such a case are generally most beneficial. in a patient with confirmed scrofula it will of course be necessary to consult a skilful and experienced doctor. but do not allow without a second opinion any plan to be adopted that will weaken the system, which is already too much depressed. no, rather build up the body by good nourishing diet (as previously recommended), by cod-liver oil, by a dry bracing atmosphere, such as, either brighton, or ramsgate, or llandudno; or if the lungs be delicate, by a more sheltered coast, such as, either st leonards or torquay. let no active purging, no-mercurials, no violent, desperate remedies be allowed. if the patient cannot be cured _without_ them, i am positive that he will not be cured _with_ them. but do not despair; many scrofulous patients are cured by time and by judicious treatment but if desperate remedies are to be used, the poor patient had better by jar be left to nature: "let me fall now into the hand of the lord; for very great are his mercies; but let me not fall into the hand of man."--_chronicles_. . _have you any remarks to make on a girl stooping_? a girl ought never to be allowed to stoop: stooping spoils the figure, weakens the chest, and interferes with the digestion. if she cannot help stooping, you may depend upon it that she is in bad health, and that a medical man ought to be consulted. as soon as her health is improved the dancing-master should be put in requisition, and calisthenic and gymnastic exercises should be resorted to. horse exercise and swimming in such a case are very beneficial the girl should live well, on good nourishing diet, and not be too closely confined either to the house or to her lessons. she ought during the night to lie on a horsehair mattress, and during the day, for two or three hours, flat on, her back on a reclining board. stooping, if neglected, is very likely to lead to consumption. . _if a boy be round-shouldered and slouching in his gait, what ought to be done_? let him be drilled; there is nothing more likely to benefit him than drilling. you never see a soldier round-shouldered nor slouching in his gait he walks every inch like a man. look at the difference in appearance between a country bumpkin and a soldier! it is the drilling that makes the difference: "oh, for a drill-sergeant to teach them to stand upright, and to turn out their toes, and to get rid of that slouching, hulking gait, which gives such a look of clumsiness and stupidity!" [footnote: a. k, h. b., _fraser's magazine_, october .] . _my daughter has grown out of shape, she has grown on one ride, her spine is not straight, and her ribs bulge out more on the one side than on the other; what is the cause, and can anything be done to remedy the deformity_? the causes of this lateral curvature of the spine, and consequent bulging out of the ribs that you have just now described, arise either from delicacy of constitution, from the want of proper exercise, from too much learning, or from too little play, or from not sufficient or proper nourishment for a rapidly-growing body. i am happy to say that such a case, by judicious treatment, can generally be cured--namely, by gymnastic exercises, such as the hand-swing, the fly-pole, the patent parlour gymnasium, the chest-expander, the skipping rope, the swimming bath; all sorts of out-door games, such as croquet, archery, &c.; by plenty of good nourishment, by making her a child of nature, by letting her almost live in the open air, and by throwing books to the winds. but let me strongly urge you not, unless ordered by an experienced surgeon, to allow any mechanical restraints or appliances to be used. if she be made strong, the muscles themselves will pull both the spine and the ribs into their proper places, more especially if judicious games and exercises (as i have before advised), and other treatment of a strengthening and bracing nature, which a medical man will indicate to you, be enjoined. mechanical appliances will, if not judiciously applied, and in a proper case, waste away the muscles, and will thus increase the mischief; if they cause the ribs to be pushed in in one place, they will bulge them out in another, until, instead of being one, there will be a series of deformities. no, the giving of strength and the judicious exercising of the muscles are, for a lateral curvature of the spine and the consequent bulging out of one side of the ribs, the proper remedies, and, in the majority of cases, are most effectual, and quite sufficient for the purpose. i think it well to strongly impress upon a mother's mind the great importance of early treatment. if the above advice be followed, every curvature in the beginning might be cured. cases of several years' standing might, with judicious treatment, be wonderfully relieved. bear in mind, then, that if the girl is to be made straight, she is first of all to be made strong; the latter, together with the proper exercises of the muscles, will lead to the former; and the _earlier_ a medical man takes it in hand, the more rapid, the more certain, and the more effectual will be the cure. an inveterate, long-continued, and neglected case of curvature of the spine and bulging out of the ribs on one side might require mechanical appliances, but such a case can only be decided on by an experienced surgeon, who ought always, _in the first place_, to be consulted. . _is a slight spitting of blood to be looked upon as a dangerous symptom_? spitting of blood is always to be looked upon with suspicion; even when a youth appears, in other respects, to be in good health, it is frequently the forerunner of consumption. it might be said that, by mentioning the fact, i am unnecessarily alarming a parent, but it would be a false kindness if i did not do so:-- "i most be cruel, only to be kind."--_shakspeare_. let me ask, when is consumption to be cured? is it at the onset, or is it when it is confirmed? if a mother had been more generally aware that spitting of blood was frequently the forerunner of consumption, she would, in the management of her offspring, have taken greater precautions; she would have, made everything give way to the preservation of their health; and, in many instances, she would have been amply repaid by having the lives of her children spared to her. we frequently hear of patients, in _confirmed_ consumption, being sent to mentone, to madeira, and to other foreign parts. can anything be more cruel or absurd? if there be any disease that requires the comforts of home--and truly may an englishman's dwelling be called _home!_--and good nursing more than another, it is consumption. . _what it the death-rate of consumption in england? at what age does consumption most frequently occur? are girls more liable to it than boys? what are the symptoms of this disease_? it is asserted, on good authority, that there always are in england, , cases of consumption, and that the yearly death-rate of this fell disease alone is , ! consumption more frequently shows itself between the ages of fourteen and twenty-one: after then, the liability to the disease gradually diminishes, until, at the age of forty-five, it becomes comparatively rare. boys are more prone to this complaint than girls. some of the most important symptoms of pulmonary consumption are indicated by the stethoscope; but, as i am addressing a mother, it would, of course, be quite out of place to treat of such signs in conversations of this kind. the symptoms it might be well for a parent to recognise, in order that she may seek aid early, i will presently describe. it is perfectly hopeless to expect to cure consumption unless advice be sought at the _onset_, as the only effectual good in this disease is to be done _at first_. it might be well to state that consumption creeps on insidiously. one of the earliest symptoms of this dreadful scourge is a slight, dry, short cough, attended with tickling and irritation at the top of the throat. this cough generally occurs in the morning; but, after some time, comes on at night, and gradually throughout the day and the night. frequently during the early stage of the disease _a slight spitting of blood occurs_. now, this is a most dangerous symptom; indeed, i may go so far as to say that, as a rule, it is almost a sure sign that the patient is in the _first_ stage of a consumption. there is usually hoarseness, not constant, but coming on if the patient be tired, or towards the evening; there is also a sense of lassitude and depression, shortness of breath, a feeling of being quickly wearied--more especially on the slightest exertion. the hair of a consumptive person usually falls off, and what little remains is weak and poor; the joints of the fingers become enlarged, or clubbed as it is sometimes called; the patient loses flesh, and, after some time, night sweats make their appearance: then we may know that hectic fever has commenced. hectic begins with chilliness, which is soon followed by flushings of the face, and by burning heat of the hands and the feet, especially of the palms and the soles. this is soon succeeded by perspirations. the patient has generally, during the day, two decided paroxysms of hectic fever--the one at noon, which lasts above five hours; the other in the evening, which is more severe, and ends in violent perspirations, which perspirations continue the whole night through. he may, during the day, have several attacks of hectic flushes of the face, especially after eating; at one moment he complains of being too hot, and rushes to the cool air; the next moment he is too cold, and almost scorches himself by sitting too near the fire. whenever the circumscribed hectic flush is on the cheek, it looks as though the cheek had been painted with vermilion, then is the time when the palms of the hands are burning hot. crabbe, in the following lines, graphically describes the hectic flush:-- "when his thin cheek assumed a deadly hue, and all the rose to one small spot withdrew: they call'd it hectic; 'twas a fiery flush, more fix'd and deeper than the maiden blush." the expectoration at first is merely mucus, but after a time it assumes a characteristic appearance; it has a roundish, flocculent, woolly form, each portion of phlegm keeping, as it were, distinct; and if the expectoration be stirred in water, it has a milk-like appearance. the patient is commonly harassed by frequent bowel complaints, which rob him of what little strength he has left. the feet and ankles swell. the perspiration, as before remarked, comes on in the evening, continues all night--more especially towards morning, and while the patient is asleep; during the time he is awake, even at night, he seldom sweats much. the thrush generally shows itself towards the close of the disease, attacking the tongue, the tonsils, and the soft palate, and _is a sure harbinger of approaching death_. emaciation rapidly sets in. if we consider the immense engines of destruction at work-viz., the-colliquative (melting) sweats, the violent bowel complaints, the vital parts that are affected, the harassing cough, the profuse expectoration, the hectic fever, the distressing exertion of struggling to breathe--we cannot be surprised that "consumption had hung out her red flag of no surrender," and that death soon closes the scene. in girls, provided they have been previously regular, menstruation gradually declines, and then entirely disappears. . _what are the causes of consumption_? the _predisposing_ causes of consumption are the tuberculous habit of body, hereditary predisposition, narrow or contracted chest, deformed spine, delicacy of constitution, bad and scanty diet, or food containing but little nourishment, impure air, close in-door confinement in schools, in shops, and in factories, ill-ventilated apartments, dissipation, late hours, over-taxing with book-learning the growing brain, thus producing debility, want of proper out-door exercises and amusements, tight lacing; indeed, anything and everything, that either will debilitate the constitution, or will interfere with, or will impede, the proper action of the lungs, will be the predisposing causes of this fearful and lamentable disease. an ill, poor, and insufficient diet is the mother of many diseases, and especially of consumption: "whatsoever was the father of a disease, an ill diet was the mother." the most common _exciting_ causes of consumption are slighted colds, neglected inflammation of the chest, long continuance of influenza, sleeping in damp beds, allowing wet clothes to dry on the body, unhealthy employments--such as needle-grinding, pearl button making etc. . _supposing a youth to have spitting of blood, what precautions would you take to prevent it from ending in consumption_? let his health be the first consideration; throw books to the winds; if he be at school, take him away; if he be in trade, cancel his indentures; if he be in the town, send him to a sheltered healthy spot in the country, or to the south coast; as, for instance, either to st leonards-on-sea, to torquay, or to the isle of wight. i should be particular in his clothing, taking especial care to keep his chest and feet warm. if he did not already wear flannel waistcoats, let it be winter or summer, i should recommend him immediately to do so: if it be winter, i should advise him also to take to _flannel_ drawers. the feet must be carefully attended to; they ought to be kept both warm and dry, the slightest dampness of either shoes or stockings should cause them to be immediately changed. if a boy, he ought to wear double-breasted waistcoats; if a girl, high dresses. the diet must be nutritious and generous; he should be encouraged to eat plentifully of beef and mutton. there is nothing better for breakfast, where it agree, than milk; indeed, it may be frequently made to agree by previously boiling it. good home-brewed ale or sound porter ought, in moderation, to be taken. wine and spirits must on no account be allowed. i caution parents in this particular, as many have an idea that wine, in such cases, is strengthening, and that _rum_ and milk is a good thing either to cure or to prevent a cough! if it be summer, let him be much in the open air, avoiding the evening and the night air. if it be winter, he should, unless the weather be mild for the season, keep within doors. particular attention ought to be paid to the point the wind is in, as he should not be allowed to go out if it is either in the north, in the east, or in the north-east; the latter is more especially dangerous. if it be spring, and the weather be favourable, or summer or autumn, change of air, more especially to the south-coast--to the isle of wight, for instance-- would be desirable; indeed, in a case of spitting of blood, i know of no remedy so likely to ward off that formidable, and, generally, intractable complaint--consumption--as change of air. the beginning of the autumn is, of course, the beat season for visiting the coast. it would be advisable, at the commencement of october, to send him either to italy, to the south of france--to mentone [footnote: see _winter and spring on the shores of the mediterranean_, by j. henry bennet, m.d., london: churchill.]--or to the mild parts of england--more especially either to hastings, or to torquay, or to the isle of wight--to winter. but remember, if he be actually in a _confirmed_ consumption, i would not on any account whatever let him leave his home; as then the comforts of home will far, very far, out-weigh any benefit of change of air. . _suppose a youth to be much predisposed to a sore throat, what precautions ought he to take to ward off future attacks_? he must use every morning thorough ablution of the body, beginning cautiously; that is to say, commencing with the neck one morning, then by degrees, morning after morning, sponging a larger surface, until the whole of the body be sponged. the chill at first must be taken off the water; gradually the temperature ought to be lowered until the water be quite cold, taking care to rub the body thoroughly dry with a coarse towel--a turkish rubber being the best for the purpose. he ought to bathe his throat externally every night and morning with luke-warm salt and water, the temperature of which must be gradually reduced until at length no warm water be added. he should gargle his throat either with barm, vinegar, and sage tea, [footnote: a wine-glassful of barm, a wine-glassful of vinegar, and the remainder sage tea, to make a half-pint bottle of gargle.] or with salt and water--two tea-spoonfuls of table salt dissolved in a tumbler of water. he ought to harden himself by taking plenty of exercise in the open air. he must, as much as possible, avoid either sitting or standing in a draught, if he be in one, he should face it. he ought to keep his feet warm and dry. he should take as little aperient medicine as possible, avoiding especially both calomel and blue pill. as he grows up to manhood he ought to allow his beard to grow, as such would be a natural covering for his throat. i have known great benefit to arise from this simple plan. the fashion is now to wear the beard, not to use the razor at all, and a sensible fashion i consider it to be. the finest respirator in the world is the beard. the beard is not only good for sore throats, but for weak chests. the wearing of the beard is a splendid innovation, it saves no end of trouble, is very beneficial to health, and is a great improvement "to the human face divine." . _have you any remarks to make on the almost universal habit of boys and of very young men smoking_? i am not now called upon to give an opinion of the effects of tobacco smoking on the middle-aged and on the aged. i am addressing a mother as to the desirability of her sons, when boys, being allowed to smoke. i consider tobacco smoking one of the most injurious and deadly habits a boy or young man can indulge in. it contracts the chest and weakens the lungs, thus predisposing to consumption. it impairs the stomach, thus producing indigestion. it debilitates the brain and nervous system, thus inducing epileptic fits and nervous depression. it stunts the growth, and is one cause of the present race of pigmies. it makes the young lazy and disinclined for work. it is one of the greatest curses of the present day. the following cases prove, more than any argument can prove, the dangerous and deplorable effects of a boy smoking. i copy the first case from _public opinion_. "the _france_ mentions the following fact as a proof of the evil consequences of smoking for boys--'a pupil in one of the colleges, only twelve years of age, was some tune since seized with epileptic fits, which became worse and worse in spite of all the remedies employed. at last it was discovered that the lad had been for two years past secretly indulging in the weed. effectual means were adopted to prevent his obtaining tobacco, and he soon recovered.'" the other case occurred about fifteen years ago in my own practice. the patient was a youth of nineteen. he was an inveterate smoker. from being a bright intelligent lad, he was becoming idiotic, and epileptic fits were supervening. i painted to him, in vivid colours, the horrors of his case, and assured him that if he still persisted in his bad practices, he would soon become a drivelling idiot! i at length, after some trouble and contention, prevailed upon him to desist from smoking altogether. he rapidly lost all epileptic symptoms, his face soon resumed its wonted intelligence, and his mind asserted its former power. he remains well to this day, and is now a married man with a family. . _what are the best methods to restrain a violent bleeding from the nose_? do not, unless it be violent, interfere with a bleeding from the nose. a bleeding from the nose is frequently an effort of nature to relieve itself, and therefore, unless it be likely to weaken the patient, ought not to be restrained. if it be necessary to restrain the bleeding, press firmly, for a few minutes, the nose between the finger and the thumb; this alone will often stop the bleeding; if it should not, then try what bathing the nose and the forehead and the nape of the neck with water quite cold from the pump, will do. if that does not succeed, try the old-fashioned remedy of putting a cold large door-key down the back. if these plans fail, try the effects either of powdered alum or of powdered matico, used after the fashion of snuff--a pinch or two either of the one or of the other, or of both, should be sniffed up the bleeding nostril. if these should not answer the purpose, although they almost invariably will, apply a large lump of ice to the nape of the neck, and put a small piece of ice into the patient's mouth for him to suck. if these methods do not succeed, plunge the hand and the fore-arm into cold water, keep them in for a few minutes, then take them out, and either hold, or let be held up, the arms and the hands high above the head: this plan has frequently succeeded when others have failed. let the room he kept cool, throw open the windows, and do not have many in the room to crowd around the patient. doubtless dr richardson's local anaesthetic--the ether spray--playing for a few seconds to a minute _on_ the nose and _up_ the bleeding nostril, would act most beneficially in a severe case of this kind, and would, before resorting to the disagreeable operation of plugging the nose, deserve a trial. i respectfully submit this suggestion to my medical brethren. the ether--rectified ether--used for the spray ought to be perfectly pure, and of the specific gravity of . . if the above treatment does not soon succeed, send for a medical man, as more active means, such as plugging of the nostrils--_which, is not done unless in extreme cases_--might be necessary. but before plugging of the nose is resorted to, it will be well to try the effects of a cold solution of alum:-- take of--powdered alum, one drachm; water, half a pint: to make a lotion. a little of the lotion should be put into the palm of the hand and sniffed up the bleeding nostril; or, if that does not succeed, some of the lotion ought, by means of a syringe, to be syringed up the nose. . _in case of a young lady fainting, what had better be done_? lay her flat upon her back, taking care that the head be as low as, or lower than, the body; throw open the-windows, do not crowd around her, [footnote: shakspeare knew the great importance of not crowding around a patient who has fainted. he says-- "so play the foolish throngs with one that swoons; come all to help him, and so stop the air by which he should revive."] unloosen her dress as quickly as possible; ascertain if she have been guilty of tight-lacing--for fainting is sometimes produced by that reprehensible practice. apply smelling salts to her nostrils; if they be not at hand, burn a piece of rag under her nose; dash cold water upon her face; throw open the window; fan her; and do not, as is generally done, crowd round her, and thus prevent a free circulation of air. as soon as she can swallow, give her either a draught of _cold_ water or a glass of wine, or a tea-spoonful of sal-volatile in a wine-glassful of water. _to prevent fainting for the future._--i would recommend early hours; country air and exercise; the stays, if worn at all, to be worn slack; attention to diet; avoidance of wine, beer, spirits, excitement, and fashionable amusements. sometimes the cause of a young lady fainting, is either a disordered stomach, or a constipated state of the bowels. if the fainting have been caused by _disordered stomach_, it may be necessary to stop the supplies, and give the stomach, for a day or two, but little to do; a fast will frequently prevent the necessity of giving medicine. of course, if the stomach be _much_ disordered, it will be desirable to consult a medical man. if your daughter's fainting have originated from a _costive state of the bowels_ (another frequent cause of fainting), i beg to refer you to a subsequent conversation, in which i will give you a list of remedies for the prevention and the treatment of constipation. a young lady's fainting occasionally arises from debility--from downright weakness of the constitution; then the best remedies will be, change of air to the coast, good nourishing diet, and the following strengthening mixture: take of--tincture of perchloride of iron, two drachms; tincture of calumba, six drachms; distilled water, seven ounces: two table-spoonfuls of this mixture to be taken three times a day. or for a change, the following:-- take of--wine of iron, one ounce and a half distilled water, six ounces and a half to make a mixture. two table spoonfuls to be taken three times a day. iron medicines ought always to be taken _after_ instead of _before_ a meal. the best times of the day for taking either of the above mixtures will be eleven o'clock, four o'clock, and seven o'clock. . _you had a great objection to a mother administering calomel either to an infant or to a child, have you the same objection to a boy or a girl taking it when he or she requires an aperient_? equally as great. it is my firm belief that the frequent use, or rather the abuse, of calomel and of other preparations of mercury, is often a source of liver disease and an exciter of scrofula. it is a medicine of great value in some diseases, when given by a _judicious_ medical man, but, at the same time, it is a drag of great danger when either given indiscriminately, or when too often prescribed. i will grant that in liver diseases it frequently gives temporary relief, but when a patient has once commenced the regular use of it, he cannot do without it, until, at length, the _functional_ ends in _organic_ disease of the liver. the use of calomel predisposes to cold, and thus frequently brings on either inflammation or consumption. family aperient pills ought never to contain, in any form whatever, a particle of mercury. . _will you give me a list of remedies for the prevention and for the cure of constipation_? if you find it necessary to give your son or daughter an aperient, the mildest should be selected, for instance, an agreeable and effectual one, is an electuary composed of the following ingredients-- take of--beat alexandria senna, powdered, one ounce best figs, two ounces, best raisins (stoned), two ounces, all chopped very fine. the size of a nutmeg or two to be eaten, either early in the morning or at bedtime. or, one or two tea-spoonfuls of compound confection. of senna (lenitive electuary) may occasionally, early in the morning, be taken. or, for a change, a tea-spoonful of henry's magnesia, in half a tumblerful of warm water. if this should not be sufficiently active, a tea-spoonful of epsom salts should be given with the magnesia. a seidlitz powder forms another safe and mild aperient, or one or two compound rhubarb pills may be given at bed time. the following prescription for a pill, where an aperient is absolutely necessary, is a mild, gentle, and effective one for the purpose-- take of--extract of socotrine aloes, eight grains, compound extract of colocynth, forty-eight grains, hard soap, twenty four grains, treacle, a sufficient quantity to make twenty four pills. one or two to be taken at bedtime occasionally. but, after all, the best opening medicines are--cold ablutions every morning of the whole body, attention to diet, variety of food, bran-bread, grapes, stewed prunes, french plums, muscatel raisins, figs, fruit both cooked and raw--if it be ripe and sound, oatmeal porridge, lentil powder, in the form of du barry's arabica revalenta, vegetables of all kinds, especially spinach, exercise in the open air, early rising, daily visiting the water-closet at a certain hour--there is nothing keeps the bowels open so regularly and well as establishing the habit of visiting the water-closet at a certain hour every morning, and the other rules of health specified in these conversations. if more attention were paid to these points, poor school boys and school girls would not be compelled to swallow such nauseous and disgusting messes as they usually do to their aversion and injury. should these plans not succeed (although in the majority of cases, with patience and perseverance, they will) i would advise an enema once or twice a week, either simply of warm water, or of one made of gruel, table-salt, and olive-oil, in the proportion of two table-spoonfuls of salt, two of oil, and a pint of warm gruel, which a boy may administer to himself, or a girl to herself, by means of a proper enema apparatus. hydropathy is oftentimes very serviceable in preventing and in curing costiveness; and as it will sometimes prevent the necessity of administering medicine, it is both a boon and a blessing. "hydropathy also supplies us with various remedies for constipation. from the simple glass of cold water, taken early in the morning, to the various douches and sea-baths, a long list of useful appliances might be made out, among which we may mention the 'wet compresses' worn for three hours over the abdomen [bowels], with a gutta percha covering." i have here a word or two to say to a mother who is always physicking her family. it is an unnatural thing to be constantly dosing either a child, or any one else, with medicine. one would suppose that some people were only sent into the world to be physicked! if more care were paid to the rules of health, very little medicine would be required! this is a hold assertion; but i am confident that it is a true one. it is a strange admission for a medical man to make, but, nevertheless, my convictions compel me to avow it. . _what is the reason girls are so subject to costiveness_? the principal reason why girls suffer more from costiveness than boys, is that their habits are more sedentary; as the best opening medicines in the world are an abundance of exercise, of muscular exertion, and of fresh air. unfortunately, poor girls in this enlightened age must be engaged, sitting all the while, several hours every day at fancy work, the piano, and other accomplishments; they, consequently, have little time for exercise of any kind. the bowels, as a matter of course, become constipated; they are, therefore, dosed with pills, with black draughts, with brimstone and treacle--oh! the abomination! --and with medicines of that class, almost _ad infinitum_. what is the consequence? opening medicines, by constant repetition, lose their effects, and, therefore, require to be made stronger and still stronger, until at length, the strongest will scarcely act at all, and the poor unfortunate girl, when she becomes a woman, _if she ever does become one_, is spiritless, heavy, doll, and listless, requiring daily doses of physic, until she almost lives on medicine! all this misery and wretchedness proceed from nature's laws having been set at defiance, from _artificial_ means taking the place of _natural_ ones--from a mother adopting as her rule and guide fashion and folly, rather than reason and common sense. when will a mother awake from her folly and stupidity? this is strong language to address to a lady, but it is not stronger than the subject demands. mothers of england do, let me entreat you, ponder well upon what i have said. do rescue your girls from the bondage of fashion and of folly, which is worse than the bondage of the egyptian task masters, for the israelites did, in making bricks without straw, work m the open air--"so the people were scattered abroad throughout all the land of egypt to gather stubble instead of straw," but your girls, many of them, at least, have no work, either in the house or in the open air--they have no exercise whatever. they are poor, drawling, dawdling, miserable nonentities, with muscles, for the want of proper exercise, like ribands, and with faces, for the lack of fresh air, as white as a sheet of paper. what a host of charming girls are yearly sacrificed at the shrine of fashion and of folly. another, and a frequent cause of costiveness, is the bad habit of disobeying the call of having the bowels opened. the moment there is the slightest inclination to relieve the bowels, _instantly_ it ought to be attended to, or serious results will follow. let me urge a mother to instil into her daughter's mind the importance of this advice. . _young people are subject to pimples on the face, what is the remedy_? these hard red pimples (acne--"the grub pimple") are a common and an obstinate affection of the skin, affecting the forehead, the temples, the nose, the chin, and the cheeks, occasionally attacking the neck, the shoulders, the back, and the chest; and as they more frequently affect the young, from the age of to , and are disfiguring, they cause much annoyance. "these pimples are so well known by most persons as scarcely to need description; they are conical, red, and hard; after a while, they become white, and yellow at the point, then discharge a thick, yellow-coloured matter, mingled with a whitish substance, and become covered by a hard brown scab, and lastly, disappear very slowly, sometimes very imperfectly, and often leaving an ugly scar behind them. to these symptoms are not unfrequently added considerable pain, and always much unsightliness. when these little cones have the black head of a 'grub' at their point, they constitute the variety termed _spotted acne_. these latter often remain stationary for months, without increasing or becoming red; but when they inflame, they are in nowise different in their course from the common kind."--_wilson on healthy skin_. i find, in these cases, great benefit to be derived from bathing the face, night and morning, with strong salt and water--a table-spoonful of table-salt to a tea-cupful of water; by paying attention to the bowels; by living on plain, wholesome, nourishing food; and by taking a great of out-door exercise. sea-bathing, in these cases, is often very beneficial. grubs and worms have a mortal antipathy to salt. . _what is the cause of a gum-boil_? a decayed root of a tooth, which causes inflammation and abscess of the gum, which abscess breaks, and thus becomes a gum-boil. . _what is the treatment of a gum-boil_? foment the outside of the face with a hot camomile and poppy head fomentation, [footnote: four poppy heads and four ounces of camomile blows to be boiled in four pints of water for half an hoar, and then to be strained to make the fomentation.] and apply to the gum-boil, between the cheek and the gum, a small white bread and milk poultice, [footnote: cut a piece of bread, about the size of the little finger-- without breaking it into crumb--pour boiling hot milk upon it, cover it over, and let it stand for five minutes, then apply the soaked bread over the gum-boil, letting it rest between the cheek and the gum.] which renew frequently. as soon as the gum-boil has become quiet, _by all means_ have the affected tooth extracted, or it might cause disease, and consequently serious injury of the jaw; and whenever the patient catches cold there will be a renewal of the inflammation, of the abscess, and of the gum-boil, and, as a matter of course, renewed pain, trouble, and annoyance. moreover, decayed fangs of teeth often cause the breath to be offensive. . _what is the best remedy for a corn_? the best remedy for a _hard corn_ is to remove it. the usual method of cutting, or of paring a corn away, is erroneous. the following is the right way--cut with a _sharp_ pair of pointed scissors around the circumference of the corn. work gradually round and round and towards the centre. when you have for some considerable distance well loosened the edges, you can either with your fingers or with a pair of forceps generally remove the corn bodily, and that without pain and without the loss of any blood: this plan of treating a corn i can recommend to you as being most effectual. if the corn be properly and wholly removed it will leave a small cavity or round hole in the centre, where the blood-vessels and the nerve of the corn--vulgarly called the root--really were, and which, in point of fact, constituted the very existence or the essence of the corn. moreover, if the corn be entirely removed, you will, without giving yourself the slightest pain, be able to squeeze the part affected between your finger and thumb. _hard corns_ on the sole of the foot and on the sides of the foot are best treated by filing--by filing them with a sharp cutting file (flat on one side and convex on the other) neither too coarse nor too fine in the cutting. the corn ought, once every day, to be filed, and should daily be continued until you experience a slight pain, which tells you that the end of the corn is approaching. many cases of _hard corn_ that have resisted every other plan of treatment, have been _entirely_ cured by means of the file. one great advantage of the file is, it cannot possibly do any harm, and may be used by a timid person--by one who would not readily submit to any cutting instrument being applied to the corn. the file, if properly used, is an effectual remedy for a _hard_ corn on the sole of the foot. i myself have seen the value of it in several cases, particularly in one case, that of an old gentleman of ninety five, who had had a corn on the sole of his foot for upwards of half a century, and which had resisted numerous, indeed almost innumerable remedies, at length i recommended the file, and after a few applications entire relief was obtained, and the corn was completely eradicated. the corns between the toes are called _soft corns_. a _soft corn_ is quickly removed by the strong acetic acid--acid. acetic fort--which ought to be applied to the corn every night by means of a camel's hair brush. the toes should be kept asunder for a few minutes, in order that the acid may soak in, then apply between the toes a small piece of cotton wool. galbanum plaster spread either on wash leather, or on what is better, on an old white kid glove, has been, in one of our medical journals, strongly recommended as a corn plaster, it certainly is an admirable one, and when the corn is between the toes is sometimes most comfortable--affording immense relief. corns are like the little worries of life--very teazing and troublesome a good remedy for a corn--which the galbanum plaster undoubtedly is-is therefore worth knowing. _hard corns_, then, on the sole and on the side of the foot are best treated by the file, _hard corns_ on the toes by the scissors, and _soft corns_ between the toes either by the strong acetic acid or by the galbanum plaster. in the generality of cases the plans recommended above, if properly performed, will effect a cure, but if the corn, from pressure or from any other cause, should return, remove it again, and proceed as before directed. if the corn have been caused either by tight or by ill fitting shoes, the only way to prevent a recurrence is, of course, to have the shoes, properly made by a clever shoemaker--by one who thoroughly understands his business, and who will have a pair of lasts made purposely for the feet. [footnote: as long as fashion instead of common sense is followed in the making of both boots and shoes, men and women will, as a matter of course, suffer from corns. it has, often struck me as singular, when all the professions and trades are so overstocked, that there should be, as there is in every large town, such a want of chiropodists (corn-cutters)--of respectable chiropodists--of men who would charge a _fixed_ sum for every visit the patient may make, for instance to every working man a shilling, and to every gentleman half-a-crown or five shillings for _each_ sitting, and not for _each_ corn (which latter system is a most unsatisfactory way of doing business). i am quite sure that of such a plan were adopted, every town of any size in the kingdom would employee regularly one chiropodist at least. however we might dislike some few of the american customs, we may copy them with advantage in this particular--namely, in having a regular staff of chiropodists both in civil and in military life.] the german method of making boots and shoes is a capital one for the prevention of corns, as the boots and shoes are made, scientifically to fit a _real_ and not an _ideal_ foot. one of the best preventatives of as well as of the best remedies for corns, especially of soft corns between the toes, is washing the feet every morning as recommended in a previous conversation, [footnote: youth--ablution, page .] taking especial care to wash with the thumb, and afterwards to wipe with the towel between each toe. . _what are the best remedies to destroy a wart_? pure nitric acid, [footnote: a very small quantity of pure nitric acid--just a drain at the bottom of a stoppered bottle--is all that is needed, and which may be procured of a chemist.] carefully applied to the wart by means of a small stick of cedar wood--a camel's hair pencil-holder--every other day, will soon destroy it. care must be taken that the acid does not touch the healthy skin, or it will act as a caustic to it. the nitric acid should be preserved in a stoppered bottle and must be put out of the reach of children. glacial acetic acid is another excellent destroyer of warts: it should, by means of a camel's hair brush, be applied to each wart, every night just before going to bed. the warts will, after a few applications, completely disappear. . _what is the best remedy for tender feet, for sweaty feet, and for smelling feet_? cold water: bathing the feet in cold water, beginning with tepid water; but gradually from day to day reducing the warm until the water be quite cold. a large nursery-basin one-third full of water, ought to be placed on the floor, and one foot at a time should be put in the water, washing the while with a sponge the foot, and with the thumb between each toe. each foot should remain in the water about half a minute. the feet ought, after each washing, to be well dried, taking care to dry with the towel between each toe. the above process must be repeated at least once every day--every morning, and if the annoyance be great, every night as well. a clean pair of stockings ought in these cases to be put on daily, as perfect cleanliness is absolutely necessary both to afford relief and to effect a cure. if the feet be tender, or if there be either bunions, or corns, the shoes and the boots made according to the german method (which are fashioned according to the actual shape of the foot) should alone be worn. . _what are the causes of so many young ladies of the present day being weak, nervous, and unhappy_? the principal causes are--ignorance of the laws of health, nature's laws being set at nought by fashion and by folly, by want of fresh air and exercise, by want of occupation, and by want of self-reliance. weak, nervous, and unhappy! well they might be! what have they to make them strong and happy? have they work to do to brace the muscles? have they occupation--useful, active occupation--to make them happy? no! they have neither the one nor the other! . what diseases are girls most subject to? the diseases peculiar to girls are--chlorosis--green-sickness--and hysterics. . what are the usual causes of chlorosis? chlorosis is caused by torpor and debility of the whole frame, especially of the womb. it is generally produced by scanty or by improper food, by the want of air and of exercise, and by too close application within doors. here we have the same tale over again--close application within doors, and the want of fresh air and of exercise. when will the eyes of a mother he opened, to this important subject?--the most important that can engage her attention! . what is the usual age for chlorosis to occur and what are the symptoms? chlorosis more frequently attacks girls from fifteen to twenty years of age; although unmarried women, much older, occasionally have it. i say _unmarried_, for, as a rule, it is a complaint of the _single_. the patient, first of all, complains of being languid, tired, and out of spirits; she is fatigued with the slightest exertion; she has usually palpitation of the heart (so as to make her fancy that she has a disease of that organ, which, in all probability, she has not); she has shortness of breath, and a short dry cough; her face is flabby and pale; her complexion gradually assumes a yellowish or greenish hue--hence the name of chlorosis; there is a dark, livid circle around her eyes; her lips lose their colour, and become almost white; her tongue is generally white and pasty, her appetite is bad, and is frequently depraved--the patient often preferring chalk, slate pencil, cinder, and even dirt, to the daintiest food, indigestion frequently attends chlorosis, she has usually pains over the short-ribs, on the _left_ side, she suffers greatly from "wind"--is frequently nearly choken by it, her bowels are generally costive, and the stools are unhealthy, she has pains in her hips, loins, and back, and her feet and ankles are oftentimes swollen. _the menstrual discharge is either suspended or very partially performed_, if the latter, it is usually almost colourless. hysterical fits not unfrequently occur during an attack of chlorosis. . _how may chlorosis be prevented_? if health were more and fashion were less studied, chlorosis would not be such a frequent complaint. this disease generally takes its rise from mismanagement--from nature's laws having been set at defiance. i have heard a silly mother express an opinion that it is not _genteel_ for a girl to eat _heartily!_ such language is perfectly absurd and cruel. how often, too, a weak mother declares that a healthy, blooming girl looks like a milk maid! it would be well if she did! how true and sad it is, that "a pale, delicate face, and clear eyes, indicative of consumption, are the fashionable _desiderata_ at present for complexion."--_dublin university magazine._ a growing girl requires _plenty_ of _good_ nourishment--as much as her appetite demands, and if she have it not, she will become either chlorotic, or consumptive, or delicate. besides, _the greatest beautifier in the world is health_, therefore, by a mother studying the health of her daughter, she will, at the same time, adorn her body with, beauty! i am sorry to say that too many parents think more of the beauty than of the health of their girls. sad and lamentable infatuation! nathaniel hawthorne--a distinguished american--gives a graphic description of a delicate young lady. he says--"she is one of those delicate nervous young creatures not uncommon in new england, and whom i suppose to have become what we find them by the gradually refining away of the physical system among young women. some philosophers choose to glorify this habit of body by terming it spiritual, but in my opinion, it is rather the effect of unwholesome food, bad air, lack of out-door exercise, and neglect of bathing, on the part of these damsels and their female progenitors, all resulting in a kind of hereditary dyspepsia." nathaniel hawthorne was right. such ladies, when he wrote, were not uncommon, but within the last two or three years, to their great credit be it spoken, "a change has come o'er the spirit of their dreams," and they are wonderfully improved in health, for, with all reverence be it spoken, "god helps them who help themselves," and they have helped themselves by attending to the rales of health--"the women of america are growing more and more handsome every year for just this reason. they are growing rounder of chest, fuller of limb, gaining, substance and development in every direction. whatever may be urged to the contrary we believe this to be a demonstrable fact. when the rising generation of american girls once begin to wear thick shoes, to take much exercise in the open air, to skate, to play at croquet, and to affect the saddle, it not only begins to grow more wise but more healthful, and which must follow as the night the day--more beautiful"--_the round table_. if a young girl had plenty-of wholesome meat, varied from day to day, either plain roast or boiled, and neither stewed, nor hashed, nor highly seasoned for the stomach, if she has had an abundance of fresh air for her lungs, if she had plenty of active exercise, such as skipping, dancing, running, riding, swimming, for her muscles, if her clothing were warm and loose, and adapted to the season, if her mind were more occupied with active _useful_ occupation, such as household work, than at present, and if she were kept calm and untroubled from the hurly-burly and excitement of fashionable life--chlorosis would almost be an unknown disease. it is a complaint of rare occurrence with country girls, but of great frequency with fine city ladies. . _what treatment should you advise_? the treatment which would prevent should be adopted when the complaint first makes its appearance. if the above means do not quickly remove it, the mother must then apply to a medical man, and he will give medicines _which will soon have the desired effect_. chlorosis is very amenable to treatment. if the disease be allowed for any length of time to run on, it may produce either organic--incurable--disease of the heart, or consumption or indigestion, or confirmed ill-health. . _at what period of life is a lady most prone in hysterics, and what are the symptoms_? the time of life when hysterics occur is generally from the age of fifteen to fifty. hysterics come on by paroxysms--hence they are called hysterical fits. a patient, just before an attack, is low-spirited; crying without a cause; she is "nervous," as it is called; she has flushings of the face; she is at other times very pale; she has shortness of breath and occasional palpitations of the heart; her appetite is usually bad; she passes quantities of colourless limpid urine, having the appearance of pump water; she is much troubled with flatulence in her bowels, and, in consequence, she feels bloated and uncomfortable. the "wind" at length rises upwards towards the stomach, and still upwards to the throat, giving her the sensation of a ball stopping her breathing, and producing a feeling of suffocation. the sensation of a ball in the throat (_globus hystericus_) is the commencement of the fit. she now becomes _partially_ insensible, although she seldom loses _complete_ consciousness. her face becomes flushed, her nostrils dilated, her head thrown back, and her stomach and bowels enormously distended with "wind." after a short time she throws her arms and her legs about convulsively, she beats her breast, tears her hair and clothes, laughs boisterously and screams violently; at other times she makes a peculiar noise; sometimes she sobs and her face is much distorted. at length she brings up enormous quantities of wind; after a time she bursts into a violent flood of tears, and then gradually comes to herself. as soon as the fit is at an end she generally passes enormous quantities of colourless limpid urine. she might, in a short time, fall into another attack similar to the above. when she comes to herself she feels exhausted and tired, and usually complains of a slight headache, and of great soreness of the body and limbs. she seldom remembers what has occurred during the fit. hysterics are sometimes frightful to witness, but, in themselves, are not at all dangerous. hysterics--an hysterical fit--is sometimes styled hysterical passion. shakspeare, in one of his plays, calls it _hysterica passio_-- "oh how this, mother, swells up toward my heart! _hysterica passio!_" sir walter scott graphically describes an attack--"the hysterical passion that impels tears is a terrible violence--a sort of throttling sensation--then succeeded by a state of dreaming stupidity" . _what are the causes of hysterics_? delicate health, chlorosis, improper and not sufficiently nourishing food, grief, anxiety, excitement of the mind, closely confined rooms, want of exercise, indigestion, flatulence and tight-lacing, are the causes which usually produce hysterics. hysterics are frequently feigned, indeed, oftener than any other complaint, and even a genuine case is usually much aggravated by a patient herself giving way to them. . _what do you recommend an hysterical lady to do_? to improve her health by proper management, to rise early and to take a walk, that she may breathe pure and wholesome air,--indeed, she ought to live nearly half her time in the open air, exercising herself with walking, skipping, etc., to employ her mind with botany, croquet, archery, or with any out-door amusement, to confine herself to plain, wholesome, nourishing food, to avoid tight lacing; to eschew fashionable amusements; and, above all, not to give way to her feelings, but, if she feel an attack approaching, to rouse herself. _if the fit be upon her_, the better plan is, to banish all the _male_ sex from the room, and not even to have many women about her, and for those around to loosen her dress; to lay her in the centre of the room, flat upon the ground, with a pillow under her head, to remove combs and pins and brooches from her person; to dash cold water upon her face; to apply cloths, or a large sponge wetted in cold water, to her head; to throw open the window, and then to leave her to herself; or, at all events, to leave her with only one _female_ friend or attendant. if such be done, she will soon come round; but what is the usual practice? if a girl be in hysterics, the whole house, and perhaps the neighbourhood, is roused; the room is crowded to suffocation; fears are openly expressed by those around that she is in a dangerous state; she hears what they say, and her hysterics are increased ten-fold. . _have you any remarks to make on a patient recovering from a severe illness_? there is something charming and delightful in the feelings of a patient recovering from a severe illness: it is like a new birth: it is almost worth the pain and anguish of having been ill to feel quite well again: everything around and about him wears a charming aspect--a roseate hue: the appetite for food returns with pristine vigour; the viands, be they ever so homely, never tasted before so deliciously sweet; and a draught of water from the spring has the flavour of ambrosial nectar: the convalescent treads the ground as though he were on the ambient air; and the earth to him for a while is paradise: the very act of living is a joy and gladness:-- "see the wretch that long has tost on the thorny bed of pain again repair his vigour lost and walk and run again. the meanest flow'ret of the vale, the amplest note that swells the gale, the common air, the earth, the skies, to him are opening paradise."--_grey_ * * * * * concluding remarks if this book is to be of use to mothers and to the rising generation, as i humbly hope and trust that it has been, and that it will be still more abundantly, it ought not to be listlessly read, merely as a novel or as any other piece of fiction; but it must be thoughtfully and carefully studied, until its contents, in all its bearings, be completely mastered and understood. * * * * * in conclusion: i beg to thank you for the courtesy, confidence, and attention i have received at your hands; and to express a hope that my advice, through god's blessing, may not have been given in vain; but that it may be--one among many--an humble instrument for improving the race of our children--england's priceless treasures! o, that the time may come, and may not be far distant, "that our sons may grow up as the young plants, and that our daughters may be as the polished corners of the temple!" index. ablution of a child of an infant of a youth thorough, of boy and girl accidents of children how to prevent acne, symptoms and treatment of advice to a mother if her infant be poorly to _mr pater familias_ ailments, the distinction between between _serious_ and _slight_ of infants air and exercise for youth the importance of good the necessity of fresh, and changing the airing an infant's clothes alternately to each breast american ladies amusements for a child for a boy for a girl ankles, weak antipathies of a child aperients for a child for an infant for a new-born babe for a youth danger of frequent appeal to mothers appetite, on a child losing his applications, hot apron, washing archery arnold, dr, on corporal punishment arrow-root for an infant artificial food for an infant at breast asses' milk babes should kick on floor babe's clothing babe himself taking exercise babyhood, the language of baby daughter baked crumb of bread for an infant flour for an infant bakers' and home made bread bathing after _full_ meal baths, cold, tepid, and warm warm, as a remedy for flatulence beard, best respirator bed, on placing child in beds, feather purification of bed-rooms, the ventilation of cool large a plan to ventilate bee, the sting of beef, salted or boiled beer, on giving child belladonna, poisoning by belly-band, best kind when to discontinue beverage for a child "black-eye," remedies for bladder and bowels of an infant bleeding from navel, how to restrain of nose blood, spitting of blows and bruises boarding schools for females on cheap (note) boiled bread for infants' food flour for infants' food boils, the treatment of boots and shoes bottles, the best nursing boulogne sore-throat bow-legs bowels, large, of children looseness of protrusion of lower regulation of, by diet boys should be made strong brain, water on the bran to soften water bran poultices breakfast of a child of a youth breast on early putting an infant to breathing exercise brimstone and treacle brown and polson's corn flour bronchitis, the treatment of broth for infants for a new born infant and soup brothers and sisters bruises, remedies for bullying a child burns and scalds butter, wholesome cadbury's cocoa essence calomel, the danger of a mother prescribing the ill effects of camphor makes teeth brittle caning a boy caps, flannel care in preparation of food carpets in nurseries carriage exercise carron oil in burns castor oil to heal the bowels cat, bites and scratches of a "chafings" of infants, the treatment of chairs, straight backed change of air linen in sickness chapped hands, legs, &c lips chest, keeping warm the upper part of the "chicken breasted" and narrow breasted children pox chilblains child should dine with parents "child-crowing" the treatment of a paroxysm of children's hour parties chimneys, on the stopping of chiropodists (_note_) chloralum as a disinfectant chlorosis and green sickness not in rural districts choking, what to be done in a case of _cholera infantum_ cisterns, best kind of clothes, on airing an infant's the ill effects of tight clothing of children of infants during winter of youths coffee as an aperient and tea coin, on the swallowing of a cold bed-room healthy cold, a feverish on child always catching feet, method to warm concluding remarks on infancy conclusion constipation, prevention and cure of consumption attacks the _upper_ part of the lungs the age at which it usually appears causes of death rate importance of early consulting a medical man in spitting of blood in symptoms of consumptive patient, the treatment of a convulsions of children cause insensibility from hooping-cough no pain in cooked fruit for child corns corn plaster, an excellent coroners inquests on infants corporal punishment at schools costiveness of infants, the means to prevent remedies for the reason why so prevalent in weak children cough, the danger of stopping a cow, the importance of having the milk from one pox lymph direct from heifer from healthy child cream and egg, and water for babe crinoline and burning of ladles crib, covering head of croquet for girls crossness in a sick child croup the treatment of cry of infant cure, artificial and natural "curious phenomenon" in scarlet fever cut finger, the application for dancing, and skipping danger of constantly giving physic delicate child, plan to strengthen a dentition lancing of gums second painful diarrhoea of infants treatment of diet of a child who has cut his teeth of children of a dry nursed child of infants on a mother being particular in attending to variety of for child of youth dietary in infants dieting a child dinner for a child youth diphtheria symptoms, causes, and treatment of dirty child diseased nature and strange eruptions diseases of children girls infants obscure the prevention of produced by tight lacing symptoms of _serious_ disinfectants in scarlet fever doctor on early calling in dog the bide of a doleful child don't dowle on _the foot and its covering_ drainage dress, female of a child while asleep of a babe, child, and youth dresses, high for delicate child dressing babe for sleep dribbling bibs drinking fountains dropping child, danger of dry nursed children, the best food for "dusting powder" for infants dysentery, symptoms and treatment of ear, discharges from removal of a pea or bead from ear-ache, treatment of wig in ear early rising education of children infant schools home, the best for girls education, modern for youth eggs for children electuary of figs emetic tarter dangerous for child eneme apparatus (_note_) of warm water engravings in nurseries eruptions about the mouth excorations applications for best remedy for exercise best composing medicine during teething for children in wet weather on violently tossing infants horse and pony an infant himself taking in very cold weather in wet weather for youth eve, substances in faecal matter in pump-water fainting from constipation from debility from disordered stomach falling-off of hair falls on the head farinaceous food give _babes_ wind fash on dangerous effects of strictly attending to the present, of dressing children fashionable _desiderata_ for complexion favouritism feeding bottles infants, proper times for at breast new born babe with gruel feet smelling sweating tender female dress fire, on a child playing with danger of back to in night nursery the manner of extinguishing, if clothes be on guards fire-proof, making dresses flannel cap for babe night-gowns shifts for a delicate child waistcoats to wash child with flatulence, remedies for fleas, to drive away flute, bugle and other wind-instruments fly pole fog, on sending a child out in folly, of giving physic after vaccination food, artificial, during snacking care in preparing infant's for dry-nursed infants for infants who are sucking formula, for milk, water, salt, and sugar friction after ablation frightening a child fruit as an aperient during teething garters impede circulation gently speak to child gin or pepperment in infant's food giving joy to a child glass, a child swallowing broken gluttony glycerine goats' milk _godfrey's cordial_ poisoning by treatment grazed skin green dresses poisonous paper hangings for nurseries peas as a vegetable "gripings" for infants groin rupture "gross superstition," "grub-pimple" gums, the lancing of the gum-bod, cause and treatment gum-sticks, the best gymnasium, value of hair, the best application for falling off making tidy management of half-washed and half starved child hand-swing happiness to a child happy child hard's farinaceous food hardening of children's constitutions of infants hartehorn, on swallowing hats for a child, the best kind hawthorn, nathaniel, on american ladies head, fall upon heat, external application of hectic flush, description of hiccups of infants hints conducive to the well-doing of a child home of childhood--the nursery hooping-cough obstinate treatment of horse exercise for boys or girls and pony exercise hot-water bag or bottle household work for girls hurdle on early rising hydrophobia _hysterica passio_ hysterics ice, on the value of illness, recovery from importance of our subject india-rubber hot-water bottle ingoldsby legend on thumb-sucking infants should be encouraged to use exertion infant schools ipecacuantis wine, preservation of joyful to bed, on sending child ladies "affecting the saddle" laudanum, poisoning by laugh of a child law, physic, and divinity leaden cisterns learning without health leech bites, the way to restrain bleeding from lessons for child lice in head after illness light, best artificial, for nursery the importance of, to health lightly clad child lime in the eye to harden the bones lime-water and milk "looseness of the the bowels" the treatment love of children lucifer-matches the poisonous effects of luncheon for a child lungs, inflammation of precautions to symptoms of treatment of lying lips of a child mad dog, the bite of description of magnesia to cool a child management of child's mother's question massacre of innocents mattresses, horse-hair, best for child may, the month of meals, a child's measles and scarlet fever treatment of meat, daily, on giving raw in long-standing diarrhoea in exhaustive diseases when a child should commence taking meddlesome treatment medical man, a mother's treatment towards medicine, the best way of administering on giving new-born infants on making palatable (_note_) menstruating female during suckling mercury, on the danger of parents giving milk, on the importance of having it from one cow bad, very nasty for babe indispensable in every form or meat, or both a plan to make a child take sugar of, and water the value of, for children unboiled a way to prevent, turning sour -crust mismanaged baby modified small-pox and chicken-pox mother fretting, injurious to infant a foolish of many diseases mother's and cow's milk, on mixing health during suckling influence motions, healthy, of babe mumps naaman, the syrian napkins, when to dispense with nature's physic navel, management of the rupture of sore -string separation of neaves' farinaceous food nervous and unhappy young ladies nettle-rash new-born infants and aperients when feeble night-commode night-terrors nose, removal of foreign substances from bleeding from, means to restrain nurse, on the choice of a a lazy strong and active young, not desirable for the sick nursery-basin of a sick child a child's own domain selection, warming, ventilation, arrangements of on the light of a must be airy observations, further windows to be often opened nursing-bottles, the best opium, a case of poisoning by the danger of administering to infants the treatment of poisoning by over-education over-lying a child pain, convulsions, and death paint-boxes dangerous as toys parental baby-slaughter parritch, the halesome peevishness of a child, the plan to allay perambulators physicking a child, on the frequent pies and puddings pimples on the face, treatment of pin, on a child swallowing pins, in dressing of babe play, a course of education in play-grounds for children and play pleasant words to a child poisoning, accidental by the breath poppy-syrup pork an improper meat for children position of a sleeping child potatoes for children poultice, a white-bread powder, "dusting" _precocity of intellect_ precocious youths, the health of prescriptions for a child princess of wales and her baby (note) professions and trades proper person to wash an infant prunes, the best way of stewing profession or trade, choice of, for delicate youth delicate youth should be brought up to puddings for children pals of child pye chavasse's fresh air treatment of scarlet fever milk food quack medicines quacking an infant quick lime in eye rain water recapitulation of ablution red gum respiration, products of poisonous rest, the best time for a child to retire to re-vaccination, importance of every seven years recommended by jenner revalenta arabica rheumatic fever, flannel vest and drawers ribs, bulging out of rice, prepared as an infant's food rich children _richardson, dr, ether spray_ rickets various degrees of roberton on child-crowing rocking-chairs, and rockers to cradle, rocking infants to sleep rooms ill effects, of dark round shoulders round worm running scall rupture rusks sallowness, cause of in young girls salt water and fresh water should be added to an infants food bag of hot necessary to human life salt-and water ablations for a delicate child for teeth and gums meats for children scalds and burns of mouth scarlatina scarlet-fever and diphtheria the contagion of the danger of giving aperients in the dropsy of fresh air treatment of hybrid management of child after and measles, the importance of distinguishing between the principal danger of purification of house after treatment of utter prostration in schools, female boarding public screaming in sleep scrofula prevention of scurfy head sea-bathing and fresh-water bathing for a young child secrets, talking, before child senna as an aperient shivering fit, importance of attending to a treatment of shoes, _plan to waterproof_ preferable to boots sound and whole and stockings for children and youths the ill effects of tight "shortening" an infant shoulder-blades "growing out" sick child, the nursing of a not to be staffed with food sick-room, management of, sickness of infants singing and reading aloud beneficial to a child single-stick sitting with back to fire sitz-bath for protrusion of bowels skating for boys and girls skin, grazed sleep of children sleep, infant's in middle of day beneficial much, necessary for infants temperature of an infant's bedroom during right time of putting a child to putting infants to of youth -walker sleeping on lap -rooms, importance of well-ventilating sleepless child slippers, the best for sick-room (_note_) small-pox a pest and disgrace modified when in neighborhood, to prevent pitting of smoking, on a boy smothering of infants, the cause socks and stockings for a child soda, ill effects of washing clothes with sounds, joyful soups and broths speak gently to a child spencer, a knitted worsted spines, distorted spine, injury to curvature of twisted spirits, deadly effects of, to the young spitting of blood precautions spurious croup stammering, cause of cure of stays, the ill effects of stillness of sick-room sting of bee or wasp stir-about and milk stockings and shoes stooping in a girl stopping of chimneys stoves in nursery strawberry-tongue stuffing a sick child with food a babe "stuffing of the nose" of infants stunning of a child "stye," treatment of substitute for mother's milk sucking of thumb suckling, the proper times of suet pudding sugar for infants confectionery -of-milk _raw_, as an aperient sun-stroke sunday supper for a child and for a youth surfeit water and saffron tea sweet things and sour digestion sweetmeats and cakes swimming, on boys and girls symptoms of serious diseases tape-worm taste for things refined tea, on giving a child green, the ill effects of teeth, attention to, importance of child should not have meat till he have cut several the diet of a child who has cut all his and gums right way of brushing appearance and number of _first_ set of _second_ set of second crop of teething causing convulsions eruptions from frequent cause of sickness fruitful source of disease purging during restlessness from second symptoms and treatment of painful in town or country temperature and ventilation of a nursery of a warm-bath thread-worm throats, sore, precautions to prevent thrush, cause, symptoms, prevention and cure of thumb best gum-stick tight bands, belts, and hats tight-lacing, the ill effects of times for suckling an infant tobacco-smoking for boys cases illustrating the danger of toe-nails, the right way of cutting, tongue-tied, an infant "tooth-cough," tooth-powder, an excellent top-crust of bread as infant's food tossing an infant tous-les-mois toys, children's painted with arsenic trade or profession for delicate youth, treatment of a delicate child of some urgent serious diseases troubles of child truth, the love of tub, commencement of washing infant in tubbing a child tumbling and rolling of a child vaccination appearance of scab arm after giving medicine after, making babe poorly veal for a child vegetables for a child ventilation, and stopping of chimneys and sleep of a nursery violet-powder walking, on the early, of infants exercise, value in his sleep, a child warm-bathe for children external applications warts washing of boys and girls washing a child an infant a new-born infant's head with brandy washing a nursery floor wasp, the sting of a water, on the importance of good, on the brain closet, on going regularly to, cold and warm for ablution, hard for drinking -fright pure, essential to health to whole of skin weaned child, the diet of a weaning, proper time and manner of weather, on a child almost living in the air in flue on the sending a child out in wet weight of new-born infants (_note_) wet flannel application wet-nurse diet of for feeble babe management of "wetting the bed" during sleep wheezing of a new-born infant white lily leaf for bruises "wind," babe suffering from windows of a nursery wind pipe, foreign substance in wine and youth wine for children and youths winter clothing woolen garments worms quick medicines for the nervous child published by the joint committee of henry frowde, hodder & stoughton warwick square, london, e.c. the nervous child by hector charles cameron m.a., m.d.(cantab.), f.r.c.p.(lond.) physician to guy's hospital and physician in charge of the children's department, guy's hospital "respect the child. be not too much his parent. trespass not on his solitude."--emerson. london henry frowde hodder & stoughton oxford university press warwick square, e.c. _first edition_ _second impression_ printed in great britain by morrison & gibb ltd., edinburgh preface to-day on all sides we hear of the extreme importance of preventive medicine and the great future which lies before us in this aspect of our work. if so, it follows that the study of infancy and childhood must rise into corresponding prominence. more and more a considerable part of the profession must busy itself in nurseries and in schools, seeking to apply there the teachings of psychology, physiology, heredity, and hygiene. to work of this kind, in some of its aspects, this book may serve as an introduction. it deals with the influences which mould the mentality of the child and shape his conduct. extreme susceptibility to these influences is the mark of the nervous child. i have to thank the editors of _the practitioner_ and of _the child_, respectively, for permission to reprint the chapters which deal with "enuresis" and "the nervous child in sickness." to dr. f.h. dodd i should also like to offer thanks for helpful suggestions. h.c.c. _march_ . contents chap. page i. doctors, mothers, and children ii. observations in the nursery iii. want of appetite and indigestion iv. want of sleep v. some other signs of nervousness vi. enuresis vii. toys, books, and amusements viii. nervousness in early infancy ix. management in later childhood x. nervousness in older children xi. nervousness and physique xii. the nervous child in sickness xiii. nervous children and education on sexual matters xiv. the nervous child and school index the nervous child chapter i doctors, mothers, and children there is an old fairy story concerning a pea which a princess once slept upon--a little offending pea, a minute disturbance, a trifling departure from the normal which grew to the proportions of intolerable suffering because of the too sensitive and undisciplined nervous system of her royal highness. the story, i think, does not tell us much else concerning the princess. it does not tell us, for instance, if she was an only child, the sole preoccupation of her parents and nurses, surrounded by the most anxious care, reared with some difficulty because of her extraordinary "delicacy," suffering from a variety of illnesses which somehow always seemed to puzzle the doctors, though some of the symptoms--the vomiting, for example, and the high temperature--were very severe and persistent. nor does it tell us if later in life, but before the suffering from the pea arose, she had been taken to consult two famous doctors, one of whom had removed the vermiform appendix, while the other a little later had performed an operation for "adhesions." at any rate, the story with these later additions, which are at least in keeping with what we know of her history, would serve to indicate the importance which attaches to the early training of childhood. among the children even of the well-to-do often enough the hygiene of the mind is overlooked, and faulty management produces restlessness, instability, and hyper-sensitiveness, which pass insensibly into neuropathy in adult life. to prevent so distressing a result is our aim in the training of children. no doubt the matter concerns in the first place parents and nurses, school masters and mistresses, as well as medical men. yet because of the certainty that physical disturbances of one sort or another will follow upon nervous unrest, it will seldom happen that medical advice will not be sought sooner or later; and if the physician is to intervene with success, he must be prepared with knowledge of many sorts. he must be prepared to make a thorough and complete physical examination, sufficient to exclude the presence of organic disease. if no organic disease is found, he must explore the whole environment of the child, and seek to determine whether the exciting cause is to be found in the reaction of the child to some form of faulty management. for example, a child of two or three years of age may be brought to the doctor with the complaint that defæcation is painful, and that there has existed for some time a most distressing constipation which has resisted a large number of purgatives of increasing strength. whenever the child is placed upon the stool, his crying at once begins, and no attempts to soothe or console him have been successful. it is not sufficient for the doctor in such a case to make an examination which convinces him that there is no fissure at the anus and no fistula or thrombosed pile, and to confine himself to saying that he can find nothing the matter. the crying and refusal to go to stool will continue after the visit as before, and the mother will be apt to conclude that her doctor, though she has the greatest confidence in him for the ailments of grown-up persons, is unskilled in, or at least not interested in, the diseases of little children. if, on the other hand, the doctor pursues his inquiries into the management of the child in the home, and if, for example, he finds that the crying and resistance is not confined to going to stool, but also takes place when the child is put to bed, and very often at meal-times as well, then it will be safe for him to conclude that all the symptoms are due to the same cause--a sort of "negativism" which is apt to appear in all children who are directed and urged too much, and whose parents are not careful to hide from them the anxiety and distress which their conduct occasions. if this diagnosis is made, then a full and clear explanation should be given to the mother, or at any rate to such mothers--and fortunately they are in the majority--who are capable of appreciating the point of psychology involved, and of correcting the management of the child so as to overcome the negativism. to attempt treatment by prescribing drugs, or in any other way than by correcting the faulty management, is to court failure. as charcot has said, in functional disorders it is not so much the prescription which matters as the prescriber. but the task of the doctor is often one of even greater difficulty. often enough there will be a combination of organic disturbance with functional trouble. for example, a girl of eighteen years old suffered from a pain in the left arm which has persisted on and off since the olecranon had been fractured when she was two years of age. she was the youngest of a large family, and had never been separated for a day from the care and apprehensions of her mother. the joint was stiff, and there was considerable deformity. the pain always increased when she was tired or unhappy. again, a girl had some slight cystitis with frequent micturition, and this passed by slow degrees into a purely functional irritability of the bladder, which called for micturition at frequent intervals both by day and night. in such cases treatment must endeavour to control both factors--the local organic disturbance must if possible be removed, and the faults of management corrected. it is a good physician who can appreciate and estimate accurately the temperament of his patient, and the need for this insight is nowhere greater than in dealing with the disorders of childhood. it can be acquired only by long practice and familiarity with children. in the hospital wards we shall learn much that is essential, but we shall not learn this. the child, who is so sensitive to his environment, shows but little that is characteristic when admitted to an institution. only in the nursery can we learn to estimate the influences which proceed from parents and nurses of different characters and temperaments, and the reaction which is produced by them in the child. the body of the child is moulded and shaped by the environment in which it grows. pure air, a rational diet, free movement, give strength and symmetry to every part. faults of hygiene debase the type, although the type is determined by heredity which in the individual is beyond our control. mothers and nurses to-day are well aware of the need for a rational hygiene. mother-craft is studied zealously and with success, and there is no lack of books to give sound guidance and to show the mean between the dangerous extremes of coddling and a too spartan exposure. yet sometimes it has seemed as if some mothers whose care for their children's physical health is most painstaking, who have nothing to learn on the question of diet, of exercise, of fresh air, or of baths, who measure and weigh and record with great minuteness, have had their attention so wholly occupied with the care of the body that they do not appreciate the simultaneous growth of the mind, or inquire after its welfare. yet it is the astounding rapidity with which the mental processes develop that forms the distinguishing characteristic of the infancy of man. were it not for this rapid growth of the cerebral functions, the rearing of children would be a matter almost as simple and uneventful as the rearing of live stock. for most animals faults of environment must be very pronounced to do harm by producing mental unrest and irritability. thus, indeed, some wild animal separated from its fellows and kept in solitary captivity may sicken and waste, though maintained and fed with every care. yet if the whole conditions of life for the animal are not profoundly altered, if the environment is natural or approximately natural, it is as a rule necessary to care only for its physical needs, and we need not fear that the results will be spoiled by the reaction of the mind upon the body. but with the child it is different; airy nurseries, big gardens, visits to the seaside, and every advantage that money can buy cannot achieve success if the child's mind is not at rest, if his sleep is broken, if food is habitually refused or vomited, or if to leave him alone in the nursery for a moment is to evoke a fit of passionate crying. the grown-up person comes eventually to be able to control this tremendous organ, this brain, which is the predominant feature of his race. in the child its functions are always unstable and liable to be upset. evidence of mental unrest or fatigue, which is only rarely met with in grown persons and which then betokens serious disturbance of the mind, is of comparatively common occurrence in little children. habit spasm, bed-wetting, sleep-walking, night terrors, and convulsions are symptoms which are frequent enough in children, and there is no need to be unduly alarmed at their occurrence. in adult age they are found only among persons who must be considered as neuropathic. to make the point clear, i have chosen examples from the graver and more serious symptoms of nervous unrest. but it is equally true that minor symptoms which in adults are universally recognised to be dependent upon cerebral unrest or fatigue are of everyday occurrence in childhood. broken and disturbed sleep, absence of appetite and persistent refusal of food, gastric pain and discomfort after meals, nervous vomiting, morbid flushing and blushing, headache, irritability and excessive emotional display, at whatever age they occur, are indications of a mind that is not at rest. in children, as in adults, they may be prominent although the physical surroundings of the patient may be all that could be desired and all that wealth can procure. it is an everyday experience that business worries and responsibilities in men, domestic anxieties or childlessness in women, have the power to ruin health, even in those who habitually or grossly break none of its laws. the unstable mind of the child is so sensitive that cerebral fatigue and irritability are produced by causes which seem to us extraordinarily trivial. in the little life which the child leads, a life in which the whole seems to us to be comprised in dressing and undressing, washing, walking, eating, sleeping, and playing, it is not easy to detect where the elements of nervous overstrain lie. nor is it as a rule in these things that the mischief is to be found. it is in the personality of mother or nurse, in her conduct to the child, in her actions and words, in the tone of her voice when she addresses him, even in the thoughts which pass through her mind and which show themselves plainly to that marvellously acute intuition of his, which divines what she has not spoken, that we must seek for the disturbing element. the mental environment of the child is created by the mother or the nurse. that is her responsibility and her opportunity. the conduct of the child must be the criterion of her success. if things go wrong, if there is constant crying or ungovernable temper, if sleep and food are persistently refused, or if there is undue timidity and tearfulness, there is danger that seeds may be sown from which nervous disorders will spring in the future. there are many women who, without any deep thought on the matter, have the inborn knack of managing children, who seem to understand them, and have a feeling for them. with them, we say, the children are always good, and they are good because the element of nervous overstrain has not arisen. there are other women, often very fond of children, who are conspicuously lacking in this power. contact with one of these well-meaning persons, even for a few days, will demoralise a whole nursery. tempers grow wild and unruly, sleep disappears, fretfulness and irritability take its place. yet of most mothers it is probably true that they are neither strikingly proficient nor utterly deficient in the power of managing children. if they lack the gift that comes naturally to some women, they learn from experience and grow instinctively to feel when they have made a false step with the child. although by dearly bought experience they learn wisdom in the management of their children, they nevertheless may not study the subject with the same care which they devote to matters of diet and hygiene. it is the mother whose education and understanding best fits her for this task. in this country a separate nursery and a separate nursery life for the children is found in nearly all households among the well-to-do, and the care for the physical needs of the children is largely taken off the mothers' shoulders by nurses and nursemaids. that this arrangement is advantageous on the whole cannot be doubted. in america and on the continent, where the children often mingle all day in the general life of the household, and occupy the ordinary living rooms, experience shows that nerve strain and its attendant evils are more common than with us. nevertheless, the arrangement of a separate nursery has its disadvantages. nurses are sometimes not sufficiently educated to have much appreciation of the mental processes of the child. if the children are restless and nervous they are content to attribute this to naughtiness or to constipation, or to some other physical ailment. their time is usually so fully occupied that they cannot be expected to be very zealous in reading books on the management of children. nevertheless, in practical matters of detail a good nurse will learn rapidly from a mother who has given some attention to the subject, and who is able to give explicit instructions upon definite points. it is right that mothers should appreciate the important part which the environment plays in all the mental processes of children, and in their physical condition as well; that they should understand that good temper and happiness mean a proper environment, and that constant crying and fretfulness, broken sleep, refusal of food, vomiting, undue thinness, and extreme timidity often indicate that something in this direction is at fault. nevertheless, we must be careful not to overstate our case. we must remember how great is the diversity of temperament in children--a diversity which is produced purely by hereditary factors. the task of all mothers is by no means of equal difficulty. there are children in whom quite gross faults in training produce but little permanent damage; there are others of so sensitive a nervous organisation that their environment requires the most delicate adjustment, and when matters have gone wrong, it may be very difficult to restore health of mind and body. when a peculiarly nervous temperament is inherited, wisdom in the management of the child is essential, and may sometimes achieve the happiest results. heredity is so powerful a factor in the development of the nervous organisation of the child that, realising its importance, we should be sparing in our criticism of the results which the mothers who consult us achieve in the training of their children. a sensitive, nervous organisation is often the mark of intellectual possibilities above the average, and the children who are cast outside the ordinary mould, who are the most wayward, the most intractable, who react to trifling faults of management with the most striking symptoms of disturbance, are often those with the greatest potentialities for achievement and for good. it is natural for the mother of placid, contented, and perhaps rather unenterprising children, looking on as a detached outsider, seeing nothing of the teeming activities of the quick, restless little brain, and the persistent, though faulty reasoning--it is natural for her to blame another's work, and to flatter herself that her own routine would have avoided all these troublesome complications. the mother of the nervous child may often rightly take comfort in the thought that her child is worth the extra trouble and the extra care which he demands, because he is sent into the world with mechanism which, just because it is more powerful than the common run, is more difficult to master and takes longer to control and to apply for useful ends. it is through the mother, and by means of her alone, that the doctor can influence the conduct of the child. without her co-operation, or if she fails to appreciate the whole situation, with the best will in the world, we are powerless to help. fortunately with the majority of educated mothers there is no difficulty. their powers of observation in all matters concerning their children are usually very great. it is their interpretation of what they have observed that is often faulty. thus, in the example given above, the mother observes correctly that defæcation is inhibited, and produces crying and resistance. it is her interpretation that the cause is to be found in pain that is at fault. again, a mother may bring her infant for tongue-tie. she has observed correctly that the child is unable to sustain the suction necessary for efficient lactation, and has hit upon this fanciful and traditional explanation. the doctor, who knows that the tongue takes no part in the act of sucking, will probably be able to demonstrate that the failure to suck is due to nasal obstruction, and that the child is forced to let go the nipple because respiration is impeded. the opportunities for close observation of the child which mothers enjoy are so great that we shall not often be justified in disregarding their statements. but if we are able to give the true explanation of the symptoms, it will seldom happen that the mother will fail to be convinced, because the explanation, if true, will fit accurately with all that has been observed. thus the mother of the child in whom defæcation is inhibited by negativism may have made further observations. for example, she may have noted that the so-called constipation causes fretfulness, that it is almost always benefited by a visit to the country or seaside, or that it has become much worse since a new nurse, who is much distressed by it, has taken over the management of the child. to this mother the explanation must be extended to fit these observations, of the accuracy of which there need be no doubt. fretfulness and negativism with all children whose management is at fault come in waves and cycles. the child, naughty and almost unmanageable one week, may behave as a model of propriety the next. the negativism and refusal to go to stool are the outcome of the nervous unrest, not its cause. again, the nervous child, like the adult neuropath, very often improves for the time being with every change of scene and surroundings. it is the _ennui_ and monotony of daily existence, in contact with the same restricted circle, that becomes insupportable and brings into prominence the lack of moral discipline, the fretfulness, and spirit of opposition. lastly, the conduct of the nervous child is determined to a great extent by suggestions derived from the grown-up people around him. refusal of food, refusal of sleep, refusal to go to stool, as we shall see later, only become frequent or habitual when the child's conduct visibly distresses the nurse or mother, and when the child fully appreciates the stir which he is creating. the mother will readily understand that in such a case, where constipation varies in degree according as different persons take charge of the child, the explanation offered is that which alone fits with the observed facts. a full and free discussion between mother and doctor, repeated it may be more than once, may be necessary before the truth is arrived at, and a line of action decided upon. only so can the doctor, remote as he is from the environment of the child, intervene to mould its nature and shape its conduct. if the doctor is to fit himself to give advice of this sort, he must be a close observer of little children. he must not consider it beneath his dignity to study nursery life and nursery ways. there he will find the very beginnings of things, the growing point, as it were, of all neuropathy. a man of fifty, who in many other ways showed evidence of a highly nervous temperament, had especially one well-marked phobia, the fear of falling downstairs. it had never been absent all his life, and he had grown used to making the descent of the stairs clinging firmly to the stair-rail. family tradition assigned this infirmity to a fall downstairs in early childhood. but all children fall downstairs and are none the worse. the persistence of the fear was due, i make no doubt, to the attitude of the parents or nurse, who made much of the accident, impressed the occasion strongly on the child's memory, and surrounded him thereafter with precautions which sapped his confidence and fanned his fears. in what follows we will consider first the subject of nursery management, searching in it for the origin of the common disorders of conduct both of childhood and of later life. i have grouped these nursery observations under the heads of four characteristic features of the child's psychology--his imitativeness, his suggestibility, his love of power, and his acute though limited reasoning faculties. i feel that some such brief examination is necessary if we are to understand correctly the ætiology of some of the most troublesome disorders of childhood, such as enuresis, anorexia, dyspepsia, or constipation, disorders in which the nervous element is perhaps to-day not sufficiently emphasised. finally, we can evolve a kind of nursery psycho-therapeutics--a subject which is not only of fascinating interest in itself, but which repays consideration by the success which it brings to our efforts to cure and control. chapter ii observations in the nursery _(a)_ the imitativeness of the child it is in the second and third years of the child's life that the rapidity of the development of the mental processes is most apparent, and it is with that age that we may begin a closer examination. at first sight it might seem more reasonable to adopt a strictly chronological order, and to start with the infant from the day of his birth. since, however, we can only interpret the mind of the child by our knowledge of our own mental processes, the study of the older child and of the later stages is in reality the simpler task. the younger the infant, the greater the difficulties become, so that our task is not so much to trace the development of a process from simple and early forms to those which are later and more complex, as to follow a track which is comparatively plain in later childhood, but grows faint as the beginnings of life are approached. at the age, then, of two or three the first quality of the child which may arrest our attention is his extreme imitativeness. not that the imitation on his part is in any way conscious; but like a mirror he reflects in every action and in every word all that he sees and hears going on around him. we must recognise that in these early days his words and actions are not an independent growth, with roots in his own consciousness, but are often only the reflection of the words and actions of others. how completely speech is imitative is shown by the readiness with which a child contracts the local accent of his birthplace. the london parents awake with horror to find their baby an indubitable cockney; the speech of the child bred beyond the tweed proclaims him a veritable scot. again, some people are apt to adopt a somewhat peremptory tone in addressing little children. often they do not trouble to give to their voices that polite or deferential inflection which they habitually use when speaking to older people. listen to a party of nurses in the park addressing their charges. as if they knew that their commands have small chance of being obeyed, they shout them with incisive force. "come along at once when i tell you," they say. and the child faithfully reflects it all back, and is heard ordering his little sister about like a drill sergeant, or curtly bidding his grandmother change her seat to suit his pleasure. if we are to have pretty phrases and tones of voice, mothers must see to it that the child habitually hears no other. again, mothers will complain that their child is deaf, or, at any rate, that he has the bad habit of responding to all remarks addressed to him by saying, "what?" or, worse still, "eh?" often enough the reason that he does so is not that the child is deaf, nor that he is particularly slow to understand, but simply that he himself speaks so indistinctly that no matter what he says to the grown-up people around him, they bend over him and themselves utter the objectionable word. we all hate the tell-tale child, and when a boy comes in from his walk and has much to say of the wicked behaviour of his little sister on the afternoon's outing, his mother is apt to see in this a most horrid tendency towards tale-bearing and currying of favour. she does not realise that day by day, when the children have come in from their walk, she has asked nurse in their hearing if they have been good children; and when, as often happens, they have not, the nurse has duly recounted their shortcomings, with the laudable notion of putting them to shame, and of emphasising to them the wickedness of their backsliding--and this son of hers is no hypocrite, but speaks only, as all children speak, in faithful reproduction of all that he hears. those grown-up persons who are in charge of the children must realise that the child's vocabulary is their vocabulary, not his own. it is unfortunate, but i think not unavoidable, that so often almost the earliest words that the infant learns to speak are words of reproof, or chiding, or repression. the baby scolds himself with gusto, uttering reproof in the very tone of his elders: "no, no," "naughty," or "dirty," or "baby shocked." speech, then, is imitative from the first, if we except the early baby sounds with reduplication of consonants to which in course of time definite meaning becomes attached, as "ba-ba," "ma-ma," "na-na," "ta-ta," and so forth. action only becomes imitative at a somewhat later stage. the first purposive movements of the child's limbs are carried out in order to evoke tactile sensations. he delights to stimulate and develop the sense of touch. at first he has no knowledge of distance, and his reach exceeds his grasp. he will strain to touch and hold distant objects. gradually he learns the limitations of space, and will pick up and hold an object in his hand with precision. often he conveys everything to his mouth, not because his teeth are worrying him, or because he is hungry, as we hear sometimes alleged, but because his mouth, lips, and tongue are more sensitive, because more plentifully furnished with the nerves of tactile sensation. by constant practice the sense of touch and the precision of the movement of his hands are slowly developed, and not these alone, for the child in acquiring these powers has developed also the centres in the brain which control the voluntary movements. when the child can walk he continues these grasping and touching exercises in a wider sphere. as the child of fifteen or eighteen months moves about the room, no object within his reach is passed by. he stretches out his hand to touch and seize upon everything, and to experience the joy of imparting motion to it. the impulse to develop tactile sensation and precision in the movements of his hands compels him with irresistible force. it is foolish to attempt to repress it. it is foolish, because it is a necessary phase in his development, and moreover a passing phase. no doubt it is annoying to his elders while it lasts, but the only wise course is to try to thwart as little as we can his legitimate desire to hold and grasp the objects, and even to assist him in every way possible. but the mother must assist him only by allowing free play to his attempts. to hand him the object is to deprive the exercise of most of its value. incidentally she may teach him the virtue of putting things back in their proper places, an accomplishment in which he will soon grow to take a proper pride. if she attempts continually to turn him from his purpose, reproving him and snatching things from him, she prolongs the grasping phase beyond its usual limits. and she does a worse thing at the same time. lest the quicker hands of his nurse should intervene to snatch the prize away before he has grasped it, he too learns to snatch, with a sudden clumsy movement that overturns, or breaks, or spills. if left to himself he will soon acquire the dexterity he desires. he may overturn objects at first, or let them fall, but this he regards as failure, which he soon overcomes. a child of twenty months, whose development in this particular way has not been impeded by unwise repression, will pick out the object on which he has set his heart, play with it, finger it, and replace it, and he will do it deliberately and carefully, with a clear desire to avoid mishap. dr. montessori, who has developed into a system the art of teaching young children to learn precision of movement and to develop the nerve centres which control movement, tells in her book a story which well illustrates this point.[ ] [footnote : _the montessori method_, pp. , .] "the directress of the casa del bambini at milan constructed under one of the windows a long, narrow shelf, upon which she placed the little tables containing the metal geometric forms used in the first lesson in design. but the shelf was too narrow, and it often happened that the children in selecting the pieces which they wished to use would allow one of the little tables to fall to the floor, thus upsetting with great noise all the metal pieces which it held. the directress intended to have the shelf changed, but the carpenter was slow in coming, and while waiting for him she discovered that the children had learned to handle these materials so carefully that in spite of the narrow and sloping shelf, the little tables no longer fell to the ground. the children, by carefully directing their movements, had overcome the defect in this piece of furniture." by slow degrees the child learns to command his movements. if his efforts are aided and not thwarted, before he is two years old he will have become capable of conducting himself correctly, yet with perfect freedom. the worst result of the continual repression which may be constantly practised in the mistaken belief that the grasping phase is a bad habit which persistent opposition will eradicate, is the nervous unrest and irritation which it produces in the child. a passionate fit of crying is too often the result of the thwarting of his nature, and the same process repeated over and over again, day by day, almost hour by hour, is apt to leave its mark in unsatisfied longing, irritability, and unrest. above all, the child requires liberty of action. we have here an admirable example of the effect of environment in developing the child's powers. a caged animal is a creature deprived of the stimulus of environment, and bereft therefore to a great extent of the skill which we call instinct, by which it procures its food, guarantees its safety from attack, constructs its home, cares for its young, and procreates its species. if, metaphorically speaking, we encircle the child with a cage, if we constantly intervene to interpose something between him and the stimulus of his environment, his characteristic powers are kept in abeyance or retarded, just as the marvellous instinct of the wild animals becomes less efficient in captivity. the grasping phase is but a preliminary to more complex activities. just as in schooldays we were taught with much labour to make pot-hooks and hangers efficiently before we were promoted to real attempts at writing, so before the child can really perform tasks with a definite meaning and purpose, he must learn to control the finer movements of his hands. once the grasping phase, the stage of pot-hooks, is successfully past--and the end of the second year in a well-managed child should see its close--the child sets himself with enthusiasm to wider tasks. to him washing and dressing, fetching his shoes and buttoning his gaiters, all the processes of his simple little life, should be matters of the most enthralling interest, in which he is eager to take his part and increasingly capable of doing so. in the montessori system there is provided an elaborate apparatus, the didactic material, designed to cultivate tactile sensation and the perception of sense stimuli. it will generally suffice to advise the mother to make use of the ordinary apparatus of the nursery. the imitativeness of the young child is so great that he will repeat in almost every detail all the actions of his nurse as she carries out the daily routine. at eighteen months of age, when the electric light is turned on in his nursery, the child will at once go to the curtains and make attempts to draw them. at the same age a little girl will weigh her doll in her own weighing-machine, will take every precaution that the nurse takes in her own case, and will even stoop down anxiously to peer at the dial, just as she has seen her mother and nurse do on the weekly weighing night. but at a very early age children appreciate the difference between the real and the make-believe. they desire above all things to do acts of real service. at the age of two a child should know where every article for the nursery table is kept. he will fetch the tablecloth and help to put it in place, spoons and cups and saucers will be carried carefully to the table, and when the meal is over he will want to help to clear it all away. all this is to him a great delight, and the good nurse will encourage it in the children, because she sees that in doing so they gain quickness and dexterity and poise of body. the first purposive movements of the child should be welcomed and encouraged. it is foolish and wrong to repress them, as many nurses do, because the child in his attempts gets in the way, and no doubt for a time delays rather than expedites preparations. the child who is made to sit immobile in his chair while everything is done for him is losing precious hours of learning and of practice. it is useless, and to my mind a little distasteful, to substitute for all this wonderful child activity the artificial symbolism of the kindergarten school in which children are taught to sing songs or go through certain semi-dramatic activities which savour too much of a performance acquired by precise instruction. if such accomplishments are desired, they may be added to, but they must not replace, the more workaday activities of the little child. the child whose impulses towards purposive action are encouraged is generally a happy child, with a mind at rest. when those impulses are restrained, mental unrest and irritability are apt to appear, and toys and picture books and kindergarten games will not be sufficient to restore his natural peace of mind. _(b)_ the suggestibility of the child we may pass from considering the imitativeness of the child to study a second and closely related quality, his suggestibility. his conception of himself as a separate individual, of his ego, only gradually emerges. it is profoundly modified by ideas derived from those around him. because of his lack of acquired experience, there is in the child an extreme sensitiveness to impressions from outside. take, for example, a matter that is sometimes one of great difficulty, the child's likes and dislikes for food. many mothers make complaint that there are innumerable articles of diet which the child will not take: that he will not drink milk, or that he will not eat fat, or meat, or vegetables, or milk puddings. there are people who believe that these peculiarities of taste correspond with idiosyncrasies of digestion, and that children instinctively turn from what would do them harm. i do not believe that there is much truth in this contention. if we watch an infant after weaning, at the time when his diet is gradually being enlarged to include more solid food, with new and varied flavours, we may see his attention arrested by the strange sensations. with solid or crisp food there may be a good deal of hesitation and fumbling before he sets himself to masticate and swallow. with the unaccustomed flavour of gravy or fruit juice there may be seen on his face a look of hesitation or surprise. in the stolid and placid child these manifestations are as a rule but little marked, and pleasurable sensations clearly predominate. with children of more nervous temperament it is clear that sensations of taste are much more acute. even in earliest infancy, children have a way of proclaiming their nervous inheritance by the repugnance which they show to even trifling changes in the taste or composition of their food. we see the same sensitiveness in their behaviour to medicines. the mixture which one child will swallow without resentment, and almost eagerly, provokes every expression of disgust from another, or is even vomited at once. in piloting the child through this phase, during which he starts nervously at all unaccustomed sensations and flavours, the attitude of mother and nurse is of supreme importance. it is unwise to attempt force; it is equally unwise, by excessive coaxing, cajoling, and entreaty, to concentrate the child's attention on the matter. if either is tried every meal is apt to become a signal for struggling and tears. the phase, whether it is short or long continued, must be accepted as in the natural order of things, and patience will see its end. the management of this symptom,--refusal of food and an apparently complete absence of desire for food,--which is almost the commonest neurosis of childhood, will be dealt with later. here it is mentioned because i wish to emphasise that if too much is made of a passing hesitation over any one article of food, if it becomes the belief of the mother or nurse that a strong distaste is present, then if she is not careful her attitude in offering it, because she is apprehensive of refusal, will exert a powerful suggestion on the child's mind. still worse, it may cause words to be used in the child's hearing referring to this peculiarity of his. by frequent repetition it becomes fixed in his mind that this is part of his own individuality. he sees himself--and takes great pleasure in the thought--as a strange child, who by these peculiarities creates considerable interest in the minds of the grown-up people around him. when the suggestion takes root it becomes fixed, and as likely as not it will persist for his lifetime. it may be habitually said of a child that, unlike his brothers and sisters, he will never eat bananas, and thereafter till the day of his death he may feel it almost a physical impossibility to gulp down a morsel of the offending fruit. so, too, there are people who can bolt their food with the best of us, who yet declare themselves incapable of swallowing a pill. another example of the force of suggestion, whether unconscious or openly exercised by speech, is given us in the matter of sleep. among adults the act of going to bed serves as a powerful suggestion to induce sleep. seldom do we seek rest so tired physically that we drop off to sleep from the irresistible force of sheer exhaustion. yet as soon as the healthy man whose mind is at peace, whose nerves are not on edge, finds himself in bed, his eyes close almost with the force of a hypnotic suggestion, and he drops off to sleep. with some of us the suggestion is only powerful in our own bed, that on which it has acted on unnumbered nights. we cannot, as we say, sleep in a strange bed. it is suggestion, not direct will power, that acts. no one can absolutely will himself to sleep. in insomnia it is the attempt to replace the unconscious auto-suggestion by a conscious voluntary effort of will that causes the difficulty. a thousand times in the night we resolve that now we _will_ sleep. if we could but cease to make these fruitless efforts, sleep might come of itself and the suggestion or habit be re-established. in little children the suggestion of sleep, provoked by being placed in bed, sometimes acts very irregularly. often it may succeed for a week or two, and then some untoward happening breaks the habit, and night after night, for a long time, sleep is refused. the wakeful child put to bed, resents the process, and cries and sobs miserably, to the infinite distress of his mother. it then becomes just as likely that the child will connect his bed in his mind, not with rest and sleep, but with sobbing and crying on his part, and mingled entreaties and scoldings from his nurse or mother. an important part in this perversion of the suggestion is played by the attitude of the person who puts the child to bed. often the nurse is uniformly successful, while the mother, who is perhaps more distressed by the sobbing of the child, as consistently fails, because she has been unable to hide her apprehension from him, and has conveyed to his mind a sense of his own power. just in the same way, grown-up people, filled with anxiety because of the helplessness of the young child, unable to divest their minds of the fears of the hundred and one accidents that may befall, or that within their own experience have befallen, a little child at one time or another, unconsciously make unwise suggestions which fill his mind with apprehension and terror. they do not like their children to show fear of animals. nor would they if it were not that their own apprehension that the child may be hurt communicates itself to him. the child is not of himself afraid to fall, it is they who suffer the anxiety and show it by treating the fall as a disaster. the child is not of himself afraid to be left alone in a room. it is they who sap his confidence in himself, because they do not venture to leave him out of their sight, from a nameless dread of what may happen. a little girl cut her finger and ran to her nurse, pleased and interested: "see," she said, seeing it bleed, "fingers all jammy." only when the nurse grasped her with unwise expressions of horror did she break into cries of fear. a town-bred nurse, who is afraid of cows, will make every country walk an ordeal of fear for the children. every mother must be made to realise the ease with which these unconscious suggestions act upon the mind of the little child, and should school herself to be strong to make her child strong, and to see to it that all this suggestive force is utilised for good and not for evil. it is upon this susceptibility to suggestion that a great part of his early education reposes. no one who is incapable of profiting by this natural disposition of the child can be successful in her management of him. turn where you will in his daily life the influence of this force of suggestion is clearly apparent. the child does without questioning that which he is confidently expected to do. thus he will eat what is given him, and sleep soundly when he is put to bed if only the appropriate suggestion and not the contrary is made to him. again we have seen that a perversion of suggestion of this sort is a common source of constipation in early childhood. if the child's attention is directed towards the difficulty, if he is urged or ordered or appealed to to perform his part, if failure is looked upon as a serious misfortune, the bowels may remain obstinately unmoved. in children as in adults a too great concentration of attention inhibits the action of the bowels, and constipation, in many persons, is due to the attempt to substitute will power for the force of habitual suggestion. no matter what other treatment we adopt, the mother must be careful to hide from the child that his failure is distressing to her. a cheerful optimism which teaches him to regard himself as one who is conspicuously regular in his habits, and who has a reputation in this respect to live up to is sure to succeed. to talk before him of his habitual constipation, and to worry over the difficulty, is as surely to fail. in the same way unwise suggestion can interfere with the passing of water at regular and suitable intervals. there are children who constantly desire to pass water on any occasion, which is conspicuously inappropriate, because their attention has been concentrated on the sensations in the bladder. often enough when at great inconvenience opportunity has been found, the desire has passed away, and all the trouble has proved needless. it is not too much to say that every occupation and every action of the day can be made delightful or hateful to the child, according to the suggestion with which it is presented and introduced. dressing and undressing, eating and drinking, bathing, washing, the putting away of toys, even going to bed, can be made matters of enthralling interest or delight, or a subject for tears and opposition, according to the bias which is given to the child's mind by the words, attitude, and actions of nurses and mothers. here we approach very near to the heart of the subject. stripped of all that is not essential we see the problem of the management of children reduced to the interplay between the adult mind and the mind of the receptive suggestible child. that which is thought of and feared for the child, that he rapidly becomes. placid, comfortable people who do not worry about their children find their children sensible and easy to manage. parents who take a pride in the daring and naughty pranks of their children unconsciously convey the suggestion to their minds that such conduct is characteristic of them. nervous and apprehensive parents who are distressed when the child refuses to eat or to sleep, and who worry all day long over possible sources of danger to him, are forced to watch their child acquire a reputation for nervousness, which, as always, is passively accepted and consistently acted up to. differences in type, determined by hereditary factors, no doubt, exist and are often strongly marked. yet it is not untrue to say that variations in children, dependent upon heredity, show chiefly in the relative susceptibility or insusceptibility of the child to the influences of environment and management. it is no easy task to distinguish between the nervous child and the child of the nervous mother, between the child who inherits an unusually sensitive nervous system and the child who is nervous only because he breathes constantly an atmosphere charged with doubt and anxiety. (_c_) the child's love of power let us study briefly a third quality of the child which, for want of a better name, i have called after the ruling passion of mankind, his love of power. perhaps it would be better to call it his love of being in the centre of the picture. it is his constant desire to make his environment revolve around him and to attract all attention to himself. somewhat later in life this desire to attract attention, at all costs, is well seen in the type of girl popularly regarded as hysterical. the impulse is then a morbid and debased impulse; in the child it is natural and, within limits, praiseworthy. a girl of this sort, who feels that she is not likely to attract attention because of any special gifts of beauty or intellect which she may possess, becomes conscious that she can always arouse interest by the severity of her bodily sufferings. the suggestion acts upon her unstable mind, and forthwith she becomes paralysed, or a cripple, or dumb, presenting a mimicry or travesty of some bodily ailment with which she is more or less familiar. "hysterical" girls will even apply caustic to the skin in order to produce some strange eruption which, while it sorely puzzles us doctors, will excite widespread interest and commiseration. now little children will seldom carry their desire to attract attention so far as to work upon the feelings of their parents by simulating disease. they have not the necessary knowledge to play the part, and even if they make the attempt, complaining of this or that symptom which they notice has aroused the interest of their elders, the simulation is not likely to be so successful as to deceive even a superficial observer. but within the limits of their own powers, children are past masters in attracting attention. the little child is unable to take part in any sustained conversation; most of his talking, indeed, is done when he is alone, and is addressed to no one in particular. but he knows well that by a given action he can produce a given reaction in his mother and nurse. a great part of what is said to him--too great a part by far--comes under the category of reproof or repression. he is forbidden to do this or that, coaxed, cajoled, threatened long before he is old enough to understand the meaning of the words spoken, although he knows the tone in which they are uttered and loves to produce it at will. how he enjoys it all! watch him draw near the fire, the one place that is forbidden him. he does not mean to do himself harm. he knows that it is hot and would hurt him, but for the time being he is out of the picture and he is intent on producing the expected response, the reproof tone from his mother which he knows so well. he approaches it warily, often anticipating his mother's part and vigorously scolding himself. he desires nothing more than that his mother should repeat the reproof, forbidding him a dozen times. the mind of all little children tends easily to work in a groove. it delights in repetition and it evoking not the unexpected but the expected. if his sport is stopped by his mother losing patience and removing him bodily from the danger zone, his sense of impotence finds vent in passionate crying. but if his mother takes no notice, the sport soon loses its savour. he is conscious that somehow or other it has fallen flat, and he flits off to other employment. mothers will complain that children seem to take a perverse pleasure in evoking reproof, appeals, entreaties, and exhortations. a small boy of four who had several times repeated the particular sin to which his attention had been directed by the frequency of his mother's warnings and entreaties, finding that on this occasion she had decided to take no notice, approached her with a troubled face: "are you not angry?" he said; "are you not disappointed?" in reality the naughty child is often only the child who has become master of his mother's or his nurse's responses, and can produce at will the effect he desires. the idea that the child possesses a strong will, which can and must be broken by persistent opposition, is based upon this tendency of the child. it is an entire misconception of the situation: strength of will and fixity of purpose are among the last powers which the human mind develops. in little children they are conspicuously absent. what appears to us as a fixed and persistent desire to perform a definite action in spite of all we can say or do, is often no more than the desire to produce the familiar tones of reproof, to traverse again the familiar ground, to attract attention and to find himself again the centre of the picture. if no one pays any attention and no one reproves, he soon gives up the attempt. if too much is made of any one action of the child, a strong impression is made on his mind and he cannot choose but return to it again and again. this little drama of the fireplace may teach us a great deal in the management of children. the wise mother and nurse will find a hundred devices to catch the child's attention and lure him away from the danger zone without the incident making any impression on his mind at all, and will not call attention to it by repeated reproofs or warnings which will certainly lead him straight back to the spot. in matters of greater moment the same impulse to oppose the will of those around him is seen. in considering the point of the child's susceptibility to suggestion, we have mentioned the refusal of sleep and the refusal of food. in both it is possible to detect the influence of this pronounced force of opposition. as the child lies sobbing or screaming in bed, every new approach to him, every fresh attempt at pacification, renews the force of his opposition in a crescendo of sound. but it is in his refusal of food that the child is apt to find his chief opportunity. meal-times degenerate into a struggle. there at least he can show his complete mastery of the situation. no one can swallow his food for him, and he knows it. he can clench his teeth and shake his head and obstinately refuse every morsel offered. he can hold food in his mouth for half an hour at a time and remain deaf to all the appeals of his helpless nurse. if she tries force, he quells the attempt by a storm of crying. if she declines upon entreaty and coaxing, he will not be persuaded. it is the little scene of the fireplace over again. the attempts at force or the attempts at persuasion, by making much of it, have concentrated the attention of the child upon the difficulty, and have taught him his own power to dominate the situation. it is right that parents should realise that the disturbing and irritating element in the child's environment is nearly always provided by the intrusion of the adult mind and its contact with the child's. some supervision and some intrusion, therefore, is of course absolutely necessary, but the best-regulated nursery is that in which it is least evident. something is definitely wrong if a child of two years will not play for half an hour at a time happily and busily in a room by himself. it is an even better test if the child will play amicably by himself with nurse or mother in the room, without the two parties crossing swords on a single occasion, without reproof or repression on the one side or undue attempts to attract attention on the other. if the child is entirely dependent upon the participation of grown-up persons in his pursuits, then not only do those pursuits lose much of their educative force, but they become a positive source of danger because of the constant interplay of personality with personality. the child who, seated on the ground, will play with his toys by himself, rises with a brain that is stimulated but not exhausted. only very rarely do we find that solitary play, or play between children, is too exciting. in older children of very quick intelligence and nervous temperament we occasionally find that the pace which they themselves set is too exciting or exhausting. i recall a little boy of seven, an only child of particularly wise and thoughtful parents, who was brought to me with the complaint that he exhausted himself utterly both in body and mind by the intense nervous energy which he threw into his pursuits. for instance, he had been interested in the maps illustrating the various fronts in the european war, with which the walls of his father's study were hung, and although left entirely by himself he had become intensely excited and exhausted by the eagerness with which he had spent a whole morning, with a wealth of imaginative force, in drawing a map of the garden of his house and converting it into the likeness of a war map, filled with imaginary army corps. such excessive expenditure of nervous force is unusual even in older children, and as in this case is found usually only when there is a pronounced nervous inheritance. in little children in the nursery, solitary play or play between themselves seldom produces nervous exhaustion. it is quite otherwise when the child is dependent to a too great extent upon the participation of adults. it is almost impossible for the mother and nurse not to take the leading part in the exchange of ideas, and no matter what may be their good intentions, the pace set is apt to be too great. environment, without the intrusion of the adult mind, is best able to adjust the necessary stimulus and produce development without exhaustion. play with grown-up persons, the reading aloud of story books, the showing of pictures, and so forth, undoubtedly have their own importance, but they should be confined within strict limits and to a definite hour in the daily routine. there is sometimes too great a tendency for parents to make playthings of their little children. save at stated times, they must curb their desire to join in their games, to gather them in their arms, to hold them on their knee, while they stimulate their minds by a constant succession of new impressions. with an only child, whose existence is the single preoccupation of the nurse and mother, and, often enough, of the father as well, it is difficult to avoid this fault. yet, if wisdom is not learnt, the damage to the child may be distressingly serious. he rapidly grows incapable of supporting life without this excessive stimulation. without the constant society and attention of a grown person, he feels himself lost. he cannot be left alone, and yet cannot enjoy the society he craves. he grows more and more restless, dominating the whole situation more and more, constantly plucking at his nurse's skirts, perversely refusing every new sensation that is offered him to still his restlessness for a moment. the result of all this stimulation is mental irritability and exhaustion, which in turn is often the direct cause of refusal of food, dyspepsia, wakefulness, and excessive crying. the devices by which children will attract to themselves the attention of their elders, and which, if successful, are repeated with an almost insane persistence, take on the most varied forms. sometimes the child persistently makes use of an expression, or asks questions, which produce a pleasant stir of shocked surprise and renewed reproofs and expostulations. one little boy shouted the word "stomachs" with unwearied persistence for many weeks together. a little girl dismayed her parents and continued in spite of all they could do to prevent her to ask every one if they were about to pass water. disorders of conduct of this sort are not really difficult to control. suitable punishment will succeed, provided also that the child is deprived of the sense of satisfaction which he has in the interest which his conduct excites. his behaviour is only of importance because it indicates certain faults in his environment and a certain element of nervous unrest and overstrain. the young child demands from his environment that it should give him two things--security and liberty. he must have security from shocks to his nervous system. it is true that from the greater shocks the children of the well-to-do are as a rule carefully guarded. no one threatens or ill-uses them. they are not terrified by drunken brawls or scenes of passion. they are not made fearful by the superstitions of ignorant people. nevertheless, by the summation of stimuli little emotions constantly repeated can have effects no less grave upon their nervous system. from this constantly acting irritation the child needs security. in the second place, he requires liberty to develop his own initiative, which should be stimulated and sustained and directed. without liberty and without security conduct cannot fail to become abnormal. (_d_) the reasoning power of the child before we proceed to a closer examination of the various symptoms of nervous unrest in detail, we may very briefly consider the scope and power of the child's understanding. as a rule i am sure that it is grossly underestimated. the mental processes of the child are far ahead of his power of speech. the capacity for understanding speech is well advanced, and an appeal to reason is often successful while the child is still powerless to express his own thoughts in words. because he cannot so express himself there is a tendency to underestimate the acuteness of his reasoning, to talk down to him, and to imagine that he can be imposed upon by any fiction which seems likely to suit the purpose of the moment. a child of eighteen months is not too young to be talked to in a quiet, straightforward, sensible way. only if he is treated as a reasonable being can we expect his reasoning faculties to develop. children dislike intensely the unexplained intervention of force. if a pair of scissors, left by an oversight lying about, has been grasped, the first impulse of the mother is to snatch the danger hurriedly from the child's hands, and her action will generally be followed by resistance and a storm of weeping. she will do better to approach him quietly, telling him that scissors hurt babies, and show him where to place them out of harm's way. watch a child at play after his midday meal. he has been out in his perambulator half the morning, and for the other half has been deep in his midday sleep. now that dinner is over he is for a moment master of his time and busily engaged in some pursuit dear to his heart. at two o'clock inexorable routine ordains that he must again be placed in the perambulator and wheeled forth on a fresh expedition. if the nurse does not know her business she will swoop down upon him, place him on her knee, and begin to envelop his struggling little body in his outdoor clothes, scolding his naughtiness as he kicks and screams. if she has a way with children she will open the cupboard door and call on him to help find his gaiters and his shoes because it is time for his walk. in a moment he will leave his toys, forgetting all about them in the joy of this new activity. if the reason for things is explained to children they grow quick to understand quite complicated explanations. a little girl, not yet two, was playing with her noah's ark on the dining-room table with its polished surface. the mother interposed a cloth, explaining that the animals would scratch the table if the cloth were not there. within a few minutes the child twice lifted the cloth, peering under it and saying, "not scratch table." yet how often do we find facetiously-minded persons confound their reasoning and confuse their judgment by foolish speeches and cock-and-bull tales, which, just because of their foolishness, seem to them well adapted to the infant intelligence. an attempt to deceive the child is almost always wrong, and because of our tendency to underestimate the child's intelligence it generally fails. if a little girl has a sore throat, and the doctor comes to see her, she knows quite well that she is the prospective patient. it is useless for the mother to begin proceedings by trying to convince her that this is not so--that mother has a sore throat too. such a plan only arouses apprehension, because the child scents danger in the artifice. closely connected with the reasoning powers of the child is the difficult question of the growth of his appreciation of right and wrong, or, to put it in another way, the growth of obedience or disobedience. sooner or later the child must learn to obey; on that there can be no two opinions. nevertheless, i think there can be no doubt that far more harm is done by an over-emphasis of authority than by its neglect. if the nurse or mother is of strong character, and the authority is exercised persistently and remorselessly, so that the whole life of the child is dominated, much as the recruit's existence in the barrack yard is dominated by the drill sergeant, his independence of nature is crushed. he is certain to become a colourless and uninteresting child; he runs a grave risk of growing sly, broken-spirited, and a currier of favour. if a child is ruthlessly punished for disobedience from his earliest years, there is, it need hardly be said, a grave risk that he will learn to lie to save his skin. i have seen a few such cases of what i may call the remorseless exercise of authority, and the result has not been pleasing. fortunately, perhaps, not many women have the heart to adopt this attitude to the waywardness of little children--a waywardness to which their whole nature compels them by their pressing need to cultivate tactile sensations, to experiment, and to explore. therefore, much more commonly, the authority is exercised intermittently and capriciously, with the result that the child's judgment is clouded and confused. conduct which is received indulgently or even encouraged at one moment is sternly reprimanded at another. every one who has the management of little children must above all see to it, whatever the degree of stringency in discipline which they decide to adopt, that their attitude is always consistent. the less that is forbidden the better, but when the line is drawn it must be adhered to. if once the child learns that the force which restrains him can be made to yield to his own efforts, the future is black indeed. from that day he sets himself to strike down authority with a success which encourages him to further efforts. i have known a child of five years terrorise his mother and get his own way by the threat, "i will go into one of my furies." the difficulty of successfully enforcing authority, and of carrying off the victory if that authority is disputed, should make mothers wary of drawing too tight a rein. the conflict between parent and child must always be distressing and must always be prejudicial to the child, whatever its outcome, whether it brings to him victory or defeat. he learns from it either an undue sense of power or an undue sense of helplessness, and the knowledge of neither is to his benefit. although frequently worsted in the conflict, nurses will often return to the attack again and again and hour after hour, restraining, reproving, forbidding, and even threatening. nor do they see that they are really goading the children into disobedience by their misdirected efforts at enforcing discipline. reproof, like punishment, loses all its effect when it is too often repeated, and the child soon takes it for granted that all he does is wrong, and that grown-up people exist only to thwart his will, to misunderstand, to reprove, or even to punish. in the nursery the word "naughty" is far too frequently heard. it is naughty to do this, it is naughty to do that. there is no gradation in the condemnation, and the child loses all sense of the meaning of the word. he himself proclaims himself naughty almost with satisfaction: his doll is naughty, the dog is naughty, his nurse and mother are naughty, and so forth. in reality the little child is peculiarly sensitive to blame, if he is not reproof-hardened. it is hardly necessary to use words of blame at all. if he is asked kindly and quietly to desist, much as we would address a grown-up person, and does not, he can be made to feel that his conduct is unpopular by keeping aloof from him a little, by disregarding him for the time being, and by indicating to him that he is a troublesome little person with whom we cannot be bothered. any one who has had much to do with children will realise that, if wrongly handled, they are apt to take a positive delight in doing what they conceive to be wrong. there is clearly a delightful element of excitement in the process of being naughty, of daring and of braving the wrath to come, with which they are so familiar and for which they care nothing at all. but the perverseness of which we are now speaking has a different origin. it arises only when children are reproved, appealed to, and expostulated with too often and too constantly. negativism is a symptom which is common enough in certain mental disorders. the unhappy patient always does the opposite of what is desired or expected of him. if he be asked to stand up he will endeavour to remain seated, or if asked to sit he will attempt to rise to his feet. like many other symptoms of nervous disturbance which we shall study later, this negativistic spirit is often displayed to perfection by little children when the environment is at fault and when grown-up people have too freely exercised authority. a mother, anxious to induce her little son to come to the doctor, and knowing well that her call to him to enter the room, as he stands hesitating at the door, will at once determine his retreat to the nursery, has been heard to say, "run away, darling, we don't want _you_ here," with the expected result that the docile child immediately comes forward. to the doctor, that such a device should be practised almost as a matter of course and that its success should be so confidently anticipated, should give food for thought. it may shed light on much that is to follow later in the interview. the question of punishment, like that of reproof, is beset with difficulty. there are fortunately nowadays few educated mothers who are so foolish as to threaten punishment which they obviously do not intend to administer and which the child knows they will not administer. it is clear that punishment must be rare or else the child will grow habituated to it, and with little children we cannot be brutal or push punishment to the point of extreme physical pain. it is more difficult to say, as one is tempted to say, that all punishment is futile and should be discarded. probably mothers are like schoolmasters in that no two schoolmasters and no two mothers obtain their effects in exactly the same way or by precisely the same means. nor do all children accept reproof or submit to punishment in the same way. some make light of it and take a pleasure in defying authority. others are unduly cast down by the slightest adverse criticism. it is generally true that extreme sensitiveness to reproof is a sign of a certain elevation of character. always we must remember that for a mother to inflict punishment, whether by causing physical pain or mental suffering, is to take on her shoulders a certain responsibility. it is a serious matter if she has misapprehended the child's act--if the sin was not really a sin, but only some perverted action, the intention of which was not sinful, but designed for good in the faulty reasoning of the child. a little girl, in bed with a feverish cold, was found shivering, with her night-dress wet and muddy. it was an understanding mother who found that her little brother, having heard somehow that ice was good for fevered heads, had brought in several handfuls of snow from the garden, not of the cleanest, and had offered them to aid his sister's recovery. it need hardly be said that punishment should always be deliberate. the hasty slap is nothing else than the motor discharge provoked by the irritability of the educator, and the child, who is a good observer on such points, discerns the truth and measures the frailty of his judge. the frequent repetition of words of reproof and acts of punishment has a further disadvantage that the older children are quick to practise both upon their younger brothers and sisters. there is something wrong in the nursery where the lives of the little ones are made a burden to them by the constant repression of the older children. but although set and artificial punishments are as a general rule to be used but sparingly, the mother can see to it that the child learns by experience that a foolish or careless act brings its own punishment. if, for example, a child breaks his toy, or destroys its mechanism, she need not be so quick in mending it that he does not learn the obvious lesson. if the baby throws his doll from the perambulator, in sheer joy at the experience of imparting motion to it, she need not prevent him from learning the lesson that this involves also some temporary separation from it. throughout all his life he is to learn that he cannot eat his cake and have it too. the use of rewards is also beset with difficulties. their coming must be unexpected and occasional. they must never degenerate into bribes, to be bargained for upon condition of good behaviour. rewards which take the form of special privileges are best. the æsthetic sense of children develops very early. from the very beginning of the second year they take delight in new clothes, and in personal adornment of all sorts. they show evident pleasure if the nursery acquires a new picture or a new wall-paper. they have pronounced favourites in colours. even tiny children show dislike of dirt and all unpleasant things. personal cleanliness should be clearly desired by all children. a sense of what is pleasant and what is unpleasant should be encouraged. any delay in its appearance is apt to imply a backwardness in development of mind or of body. only children who are tired out by physical illness or by nervous exhaustion will lie without protest in a dirty condition. affection and the attempt to express affection appear clearly marked even in the first year. too much kissing and too much being kissed is apt to spoil the spontaneity of the child's caresses. we must not, however, expect to find any trace in the young child of such a complex quality as unselfishness or self-abnegation. the child's conception of his own self has but just emerged. it is his single impulse to develop his own experience and his own powers, and his attitude for many years is summed up in the phrase: "me do it." we must not expect him to resign his toys to the little visitor, or the little visitor to cease from his efforts to obtain them. in all our dealings with children we must know what we may legitimately expect from them, and judge them by their own standards, not by those of adult life. we cannot expect self-sacrifice in a child, and, after all, when we come to think of it, obedience is but another name for self-sacrifice. if the tiny child could possibly obey all the behests that are heaped upon him in the course of a day by many a nurse and mother, he would truly be living a life of complete self-abnegation. surely it is because the virtue of obedience, the virtue that is proclaimed proverbially the child's own, is so impossible of attainment that it is become the subject of so much emphasis. as madame montessori has put it: "we ask for obedience and the child in turn asks for the moon." only when we have developed the child's reasoning powers, by treating him as a rational being, can we expect him deliberately to defer his wishes to ours, because he has learned that our requests are generally reasonable. chapter iii want of appetite and indigestion the mind of the child is so unstable and yet so highly developed, that symptoms of nervous disturbance are more frequent and of greater intensity than in later life. only rarely and in exceptional cases do certain symptoms, common in childhood, persist into adult life or appear there for the first time, and then usually in persons who, if they are not actually insane, are at least suffering from intense nervous strain. we have already mentioned the symptom of negativism and noted its occasional occurrence as an accompaniment of mental disorder in adult life, and its frequency among children who are irritable or irritated. similarly, we may cite the digestive neuroses of adult life to explain the common refusal of food and the common nervous vomiting of the second year of life. thus, for example, there exists in adult life a disturbance of the nervous system which is called "anorexia nervosa." a boy of nineteen was brought to the out-patient department of guy's hospital suffering from this complaint. he was little more than a skeleton, unable to stand, hardly able to sit, and weighing only four and a half stones. his mother, who came with him, stated that he had always been nervous, and that lately, after receiving a call to join the army as a recruit, his appetite, which had for some time been capricious, had completely disappeared. in spite of coaxing he resolutely refused all food, or took it only in the tiniest morsels, although at the same time it was thought that he sometimes took food "on the sly." a careful examination showed absolutely no sign of bodily disease. he was admitted to a ward for treatment by hypnotic suggestion, but before this could be begun he endeavoured to commit suicide by setting fire to his bed. a girl of twenty-four years of age had become almost equally emaciated. constant vomiting had persisted for many years and had defied many attempts at cure. it had even been proposed to perform the operation of gastro-enterostomy in the belief that some organic disease existed. in suitable surroundings and with the energetic support of a good nurse, who spent much time and care in restoring her balance of mind, the vomiting ceased, and she gained over two stones in weight. work was found for her in some occupation connected with the war, and she left the nursing home to undertake this, bearing with her four pounds which she had abstracted from the purse of another patient. those who have not opportunities of observing how all-powerful is the effect of the mind upon the body, and especially perhaps upon the process of digestion, may find it hard to believe that these distressing symptoms and profound changes in the aspect and nutrition of the patients were due entirely to mental causes and were symptoms in accord with the attempted suicide or the theft of the money. in nervous little children we shall not often find such complex actions as suicide or theft, although they do occur, but combined with other evidence of nervousness we shall meet commonly enough with a persistent setting aside of appetite and refusal of food and with continuous and habitual vomiting, from nervous causes. the experiments of pawlow and others have explained the dependence of digestion upon mental states. they show that even before the food is taken into the mouth, while the meal is still in prospect, there has been instituted a series of changes in the wall of the stomach, which gives rise to the so-called psychic secretion of gastric juice. these changes are preceded by the sensation of appetite, which is evoked not by the presence of food in the stomach--for the food has not yet been swallowed--but by the anticipation of it, by the sight and smell of food, as well as by more complex suggestions, such as the time of day, the habitual hour, the approach of home, and so forth. emotional states of all sorts--grief, anger, anxiety, or excitement--put a stop to the process or interfere with its action, so that the sense of appetite is absent, and the taking of food is apt to be followed by discomfort or pain or vomiting. no doubt good digestion leads to a placid mind, but it is equally true that a placid mind is necessary for good digestion. therefore we civilised people, living lives of mental stress and strain, try to increase the suggestive force of our surroundings and to provoke appetite by all devices calculated to stimulate the æsthetic sense. the dinner hour is fixed at a time when all work and, let us hope, all worry is at an end for the day. the dinner-table is made as pretty as possible, with flowers and sparkling glass. we are wise to dress for dinner, that with our working clothes we may put off our working thoughts. in the treatment of adult dyspepsia we seldom succeed unless we can place the mind at rest. we may advise a visit to the dentist and a set of false teeth, or we may administer a variety of stomach tonics and sedatives, but if the mind remains filled with nameless fears and anxieties we shall not succeed. in adult life the nervous person when subjected to excessive stress and strain is seldom free from dyspeptic symptoms of one sort or another, and what is true of adult life is even more true of childhood, when the emotions are more poignant and less controlled. then tears flow more readily than in later life, and tears are not the only secretions which lie under the influence of strong emotion. emotional states, which would stamp a grown man as a profound neurotic, are almost the rule in infancy and childhood, and may be marked by the same physical disturbances--flushing, sweating, or pallor, by the discharge of internal glandular secretions as well as by inhibition of appetite, by vomiting, gastric discomfort, or diarrhoea. naturally enough, mothers and nurses are wont to demand a concrete cause for the constant crying of a little child, and teething, constipation, the painful passage of water, pain in the head, or colic and indigestion are suggested in turn, and powders, purges, or circumcision demanded. there can be no doubt that nervous unrest is capable of producing prolonged dyspepsia in infancy and childhood--a dyspepsia which, while it obstinately resists all attempts to overcome it by manipulation of the diet, is very readily amenable to treatment directed to quiet the nervous system. where a primary dyspepsia exists for any length of time, the growth and the nutrition of the child is clearly altered for the worse. the character of the stools, their consistency, smell, and colour, is apt to be changed because the bacterial context of the bowel has become abnormal. rickets, mucous disease, lienteric diarrhoea, infantilism, prolapse of the rectum, and infection with thread-worms are common complications. no doubt children with primary dyspepsia are often nervous and restless, and the elements of infection and of neurosis are frequently combined. yet often we meet with cases in which the gastric or intestinal disturbance comes near to being a pure neurosis. the nutrition, then, seldom suffers to any very great extent, or to a degree in any way comparable to that which is characteristic of dyspepsia from other causes. emaciation, wrinkling of the skin, dryness and falling out of the hair, decay of the teeth, are not as a rule part of the picture of nervous dyspepsia. the child may be slim and thin and nervous looking, but as a rule he is active enough, with a good colour and fair muscular tone, so that one has difficulty in believing the mother's statements, which are yet true enough, as to the trouble which is experienced in forcing him to eat, or as to the frequency of vomiting. in early childhood the difficulty of the refusal of food often passes or diminishes when the child learns to feed himself with precision and certainty. to teach him to do so, it is not wise to devote all our attention to making him adept at this particular task. the fault is that the brain centres which control the movements of hands, mouth, and tongue have not been developed, because his activities in all directions have not been encouraged. it is much less trouble for a nurse to feed a little child than to teach him to feed himself, and if he is not given daily opportunities of practice he will certainly not learn this particular action. but the fault as a rule lies deeper. the child who cannot feed himself cannot be taught until fingers and brain have been developed in the thousand activities of his daily routine, by which he acquires general dexterity. a child who is still too young to feed himself is learning the dexterity which is necessary as a preliminary in every action of the day. if he can carry the tablecloth and the cups and saucers to the tea-table, imitating in everything the action of his nurse, it will be strange if he does not also imitate her in the central scene, the actual eating of the food. if, on the other hand, he is waited upon hand and foot, if he is restrained and confined, sitting too much passively, now in his perambulator, now in his high chair, now on his nurse's lap, his imitative faculties and his tactile dexterity alike remain undeveloped. the child who is slow in learning to feed himself shows his backward development in every movement of his body. one may note especially the stiff, "expressionless" hands, indicating a general neuro-muscular defect. i have seen many children of eighteen months or two years of age in whom the movements necessary for efficient mastication and swallowing had failed to develop satisfactorily. in some a pure sucking movement persisted, so that when, for example, a morsel of bread or rusk was put in the child's mouth, it would be held there for many minutes and submitted only to suction with cheeks and tongue. attempts to swallow in such a case are so incoordinate that they give rise frequently to violent fits of choking, which distress the child and produce resistance and struggling, while at the same time they alarm the mother or nurse so much that further attempts to encourage the taking of solid food are hastily and for a long time abandoned. in this helpless condition the other factors which tend to develop what we have called negativism have full play. the want of imitation and the lack of dexterity is not the sole or perhaps the main cause of the child's refusal of food and of the apparent want of appetite, but it is the cause of the failure to learn to feed himself, which places him in a condition which is peculiarly favourable to the operation of other factors. if only we can teach the child to feed himself, the difficulties of the situation become much less formidable. the first of the factors which encourage the persistent refusal of food is the extreme susceptibility of the child to suggestion. a particular article of diet may be refused on one occasion, perhaps in pique, because another more favoured dish was hoped for or expected, or perhaps because the taste is not yet familiar. then if on this occasion a struggle for the mastery is waged, and a painful impression is made on the child's mind connecting this particular dish with struggling and tears, from that day forward the child may persistently refuse it on every occasion it is offered. matters are made worse if the nurse, anticipating refusal, attempts to overcome the resistance by peremptory orders, or by excessive praise extolling the delicious flavour with such fervour that the child's suspicions are at once aroused. previous experience has made him connect these excessive praises with articles which have aroused his distaste. if these fads and fancies on the part of the child are to be avoided, it is essential that we should do nothing to focus his attention on his refusal. it is better that his dinner should be curtailed on one occasion than that taste and appetite should be perverted perhaps for years. every nurse or mother should cultivate an off-hand, detached manner of feeding the child, and should patiently continue to offer the food without uncalled-for comments or exhortations. let her always remember the force of suggestion on the child's mind, and that a confident manner which never questions the child's acceptance will meet with acceptance, while a hesitating address, from fear of the impending refusal, will be apt to meet with refusal. sometimes a still worse fault manifests itself, when nurse and mother speak before the child of the smallness of his appetite, and of his persistent refusal of this or that article of diet. the suggestion then acts still more powerfully on his mind. he is aware that the whole household is distressed by his peculiarity, and he grows to identify it with his own individuality, and to regard himself with some satisfaction as possessing this mark of distinction. if there is any difficulty of this sort it is often directly curative to reverse the suggestion and to speak before him of his improving appetite, and to say that he begins every day to eat better and better, even if to do so we have to break a good rule never to say to the child what is not strictly true. or once or twice we may take his plate away before he has finished, saying positively that he has eaten so much that he must eat no more. if in spite of every care antipathies to certain articles of food appear and persist, we must be content to bide our time. when the child grows of an age to reason, we should seize every opportunity to make him feel that his persistent refusal is a little ridiculous and childish. little by little the seed is sown, and will germinate till one day we shall note with surprise that he has taken of his own accord that which he has neglected for so long and with such obstinacy. but the force which is acting most strongly in producing this refusal of food is the force of which we have spoken in a previous chapter--the force which results in negativism, the force which is in reality the habit of opposition, the love of power, and the desire to attract attention. here again the refusal of food, if due to this cause, is never the sole manifestation of the fault. just as the delay in learning to swallow and to chew properly and to feed himself is part of a general want of dexterity and capacity manifested in all his actions, so it will seldom happen that the child's anxiety to oppose is only seen at meal-times. watch a nervous child in the nursery before the dinner hour. he is cross and restless and inclined to cry. the nurse hands him a doll, and he throws it away saying, "no, no doll." at the same moment he may catch sight of his ball, and it too is violently rejected, "no, no ball." everything in turn is treated in the same way. finally he falls upon his nurse, crying and beating her with his hands, saying, "no, no nurse." if that long-suffering woman at that moment summons him to dinner, it will be strange indeed if his attitude is not "no, no dinner," and "no, no" to every mouthful offered him. how strong this love of opposition may be is illustrated by the case of a little boy who was brought to me for refusal of food. three weeks before, he had been taken in a motor-car to his grandfather's to midday dinner on sunday, when his absolute refusal of food had spoiled the day and had occupied the attention and the efforts of the whole party. doubtless he had enjoyed himself, for three weeks later, when he caught sight of the car which was to bring him to me, and which he had not seen in the interval, he at once said, "not eat my dinner." this child's father told me that the sight or sound of the preparation of a meal was enough to bring on a paroxysm of opposition. now this force of opposition, as we have seen, only develops into a serious difficulty when the child's own will has been opposed too much, when authority has been too freely exercised, and when the child has been urged and entreated and reproved with too great frequency. his opposition grows with all counter-opposition. and he is not really naughty, only irritable and restless from the thwarting of his natural impulses, and unable to express his thoughts and desires. negativism will not often confine itself to meal-times. it will show clearly in all the actions of the child, and to get him to eat well and freely we must so change our management of him that negativism disappears or at least diminishes. there is no other way. no entreaty, no force, no threats of force will ever succeed, but will only make him worse, and, since negativism is due to mental unrest, the struggles and crying will only perpetuate the cause. the one way to banish negativism and overcome the opposition is to cease to oppose, and to practise this aloofness not so much at meal-times, for somehow by patience the child must be got to take his food, but in all our conduct to him. repression and reproof, and thwarting of the child's will, and coaxing and entreaty must cease. there is no fear that we shall thereby make the child unduly disobedient. we have already, in another chapter, decided that negativism is not strength of will on the part of the child which must be broken, but is the result of constant attempts to oppose his nature, and the consequent nervous unrest. if we cease to oppose, the symptoms will tend rapidly to disappear, the child will become busy and contented and happy in his play, and we shall hear no more of his refusal of food. if sometimes it recurs for a week or two, we shall know how to deal with it. in children, as with us, periods of nervous unrest and unhappiness are apt to recur in a sort of cycle. this cyclical character of mental disturbance is often a marked feature. we see it in epilepsy and in what the french have called folie circulaire. we see it in the dipsomaniac, in the intermittency of his craving for drink and of his periodical outbursts, and we see it in ourselves in those periods of depression which recur so often, we know not why. little children too sometimes get out on the wrong side of their beds, and never get right the whole long day. their own experience of the vagaries of mental states should lead mothers to be indulgent to the children in their days of cloud and to be particularly careful not to goad them by well-intentioned efforts into bursts of naughtiness and passion, each one of which tends to perpetuate the condition and increase the nervous unrest. we know how closely dependent is the sensation of appetite upon emotional states, and we must do all in our power--and the task is sometimes one of real difficulty--to keep the child's mind sufficiently at rest to preserve the healthy desire for food unimpaired. if there is no sign of appetite, but every sign of restlessness and irritability, we must seek in the management of the child until we find the fault. if food is taken mechanically and without appetite, if the preliminary changes in the stomach wall which are necessary for adequate digestion do not take place, but are inhibited by the mental unrest, the meal is apt to be followed by gastric pain and discomfort, or, more commonly with children, the stomach may promptly reject its contents. at the worst, nervous vomiting of this sort may follow almost every meal, although, again, it is curious to note how little, comparatively speaking, the nutrition of the child suffers. the vomiting too, as in adults, comes very near being a voluntary act, and mothers and nurses will often remark that they get the impression that it can be controlled at will. if once the diagnosis is made that the want of appetite or the vomiting is of nervous origin, the treatment of the condition is clear. sedative drugs directed towards quieting the nervous excitability may be of service, but tonics, appetisers, laxatives, and drugs with a direct action on the stomach will have but little effect. nor is there as a rule anything to be gained by modifying the diet or by excluding this or that article of food. the frequency of the vomiting is such that it is apt to have brought discredit one after the other upon almost every article of food which the child can take, with the result that many useful and necessary foods have been abandoned for long on the ground that they are the cause of the dyspepsia. a permanent cure will only be effected when the faults of environment have been overcome, when the cause of the nervous unrest has been removed, and when the child's mind is at peace. nervous vomiting of this kind is not difficult to control, if those in charge of the children can be made to understand that the cause lies in the anxiety which they themselves show before the child, increasing his own apprehension or adding to his sense of power or importance. once the child is convinced that his conduct excites no particular interest, the vomiting soon ceases. in more than one instance, vomiting which has persisted for many months has stopped at once after the matter has been fully explained to the parents. in the most inveterate case of this sort which has come under my notice, the child was regularly sick as soon as he caught sight of a white cloth being laid on the table for meals. yet even this child never vomited when he was under the charge of a particular nurse who had to return more than once to the family, and on each occasion was successful in breaking the habit. chapter iv want of sleep so far, almost all that has been written--and there has been a great deal of unavoidable repetition--has been devoted to an attempt to determine the causes which lead the child to refuse food and the methods which we adopt to prevent or overcome the difficulty. other neuroses may be studied in less detail, because they depend for their existence upon the same causes. for example, the habit of refusing sleep, which is as common and almost as distressing as the habit of refusing food, depends both upon a perversion of suggestion and upon the phenomenon that we have called negativism. if struggling and crying has occurred upon a series of nights, the child comes to associate his bed not with sleep but with tears. if a mother values her peace of mind, if she would spare herself the discomfort of hearing her child sob himself nightly into uneasy sleep, she must be wary how this all-important event of going to bed is approached. with a nervous and restless child the preliminaries of preparing for bed must be managed carefully and tactfully. the hour before bedtime is almost universally the most interesting of the whole day for the child. then the baby, with his best frock on, and books and toys, is the centre of interest in the drawing-room, till the clock strikes and the nurse appears at the door. suddenly it is all over, and inexorable routine sends him off to bed. the good nurse will give the child a little time to recover from the shock of her arrival, and will not hurry him. she knows that his little mind is slow to act, and that he must be led gradually to face a new prospect. if she hurries him, catching him up in her arms from the midst of his unfinished pursuits, resistance and tears are almost sure to follow, and the difficult task of the day--the putting to bed--has made the worst possible start. when this has happened on one or two successive evenings, the habit of resistance to going to bed becomes fixed, and, like all bad habits, is difficult to break. a nurse who has a way with children will arouse his interest in a new pursuit, in which he can play the chief part, the putting away of his picture books and toys. if he is too small to carry his own chair or table to its allotted place in the room, at least he can show his learning by pointing out the spot. in the waving of good-byes he is expert and takes a legitimate pride, and upstairs he has learnt that there are new delights. he himself can turn on the taps in the bathroom, and he can set every article in the proper place ready for use. all children love their bath, and if interest and good temper has been so far preserved, without a break, it will be ill-fortune if even the drying process is not carried off without a hitch. afterwards, for a little, nervous babies, whose brains still teem with all the excitements of the day, are best left to sit for a few moments by the nursery fire, while the nurse puts all the garments one by one to bed. each as it goes to rest will be greeted by him with cheerful farewells; and so does the force of suggestion act, till the central figure himself plays his part in the scene, of which he feels himself the controller and director, and climbs to bed. but if there has been a hitch anywhere, if the bugbear of negativism has appeared, if he has been scolded or coaxed or repressed too much and there have been tears and struggles, then going to bed is a poor preparation for instant and quiet sleep. with excitable, highly-strung children, the best laid plans and the most tactful nurse will not always succeed, and to place him in his cot is to provoke a storm of angry refusal and resistance. there are mothers who believe that the best way is then to turn out the light and leave the child to cry himself to sleep. this is a point on which no one can lay down rules which are applicable for all children. it may sometimes succeed, and the child may reason correctly and in the way we wish him to reason, deciding that the game is not worth the candle and so give it up. but with nervous, highly-strung children i doubt if this spartan conduct is commonly successful. often if the attempt is made, the troubled mother, listening to all these heart-breaking sobs, can bear it no longer, and goes back to the side of the cot to soothe and persuade him. then certainly the longer she has restrained her natural inclination, the longer the child has sobbed himself into a pitiful little ball of perspiration and tears, the more difficult will be her task in quieting him, the stronger will be the impression formed on the child's mind, and the greater will be the suggestion which will act under the same circumstances to-morrow. children who fall a prey to this uncontrolled crying, cry on because they cannot stop when they have begun. they do not then cry purposely or with a fixed intention, desiring to attain some object. they cry because their minds are not at rest, but are irritated and overwrought by the happenings of the day. we decided that it was useless to attempt by exhortations at meal-times to induce a nervous child to eat who habitually refuses food, and that we can only cure the condition by eliminating from his daily life the elements of repression and opposition which provoke the counter-opposition. and we must seek the same solution in this other difficulty of the refusal of sleep. it is useless to attempt to treat the symptom of refusal of sleep and to leave the cause of that symptom still constantly in action. if, in spite of our care to avoid unrest and irritation of the child's brain, sleep is refused, as may often happen, it is, as a rule, wise to cut short the crying if we can, before a vicious circle has been formed and the unrest has been intensified by the emotional storm. it is useless with little children to urge them to go to sleep or to coax. it is not usually wise to leave the child for a little and then to return. each time the child is left, each time the mother or nurse returns, the crying bursts forth again with renewed force and vigour. it is at least one good plan with a little child to turn the light out, and, treating the whole incident in the most matter-of-fact way possible, lightly to stroke his head or pat his back rhythmically without speaking. with older children, if the crying is more purposeful and less emotional, the mother may busy herself for a little with some task in the room, ostentatiously neglecting the storm and making no reference to it. if she speaks to the child at all she should do so in a matter-of-fact way, referring lightly to other matters. if only she can convince him that his conduct is a matter of indifference to her, the victory is won. it is because the child knows so well that his mother does care that he so often has the upper hand. it is not difficult to distinguish between a true emotional storm and the tyrannous cry of a wilful child who demands his own way. light and broken sleep is a common accompaniment of a too excitable and overstimulated brain. the placid child, who eats well, plays quietly, and does not cry more than is usual, as a rule sleeps so soundly that no ordinary sounds, such as conversation carried on in quiet tones in his neighbourhood, have the power to waken him. when he wakes, he does so gradually, perhaps yawning and stretching himself. the nervous child may move at the slightest sound, or with a sudden start or cry is wide awake at once. a hard mattress should be chosen without a bolster, and with only a low pillow. flannel pyjamas, which cannot be thrown off in the restless movements of the child, should be worn. the temperature of the room should be cool, and the air from the open window should circulate freely, while draughts may be kept from striking on the child by a screen. all the sensations of the nervous child are abnormally acute. thus, for example, an itching eruption, or tight clothing, will produce an altogether disproportionate reaction, and may result in a frenzy of opposition. especially such a child is sensitive to a stuffy atmosphere or to an excess of bedclothes. cool rooms and warm but light and porous clothing are essential. an electric torch, which can be flashed on the child for an instant, will assist the mother or nurse to make sure that the child has not thrown off all the bedclothing. sometimes want of sleep is accounted for by a real want of physical exercise. town children especially are apt to suffer from their limited opportunities of running freely in the open. it is often considered enough that the child seated in his perambulator should take the air for three or four hours daily, while much of his time indoors as well is devoted to sitting. it is necessary for his proper development that he should have opportunities of daily exercise in the open. if for any reason this is not always practicable, a large room, as free as possible from furniture, should be chosen, with windows thrown wide open, in which the child may romp until he is tired. it is rare for children of two or of three years of age, whose case we are now considering, to be troubled by bad dreams, nightmares, or night-terrors. if these should occur, obstructed breathing due to adenoid vegetations is sometimes at work as a contributory cause. finally, we should always remember that refusal of sleep is, for the most part, caused and kept up by harmful suggestions derived from mother and nurse, who allow the child to perceive their distress and agitation, who speak before the child of his habitual wakefulness, who unwittingly focus his attention on the difficulty. it is cured in the moment that the suggestion in the child's mind is reversed, in the moment when he comes to regard it as characteristic of himself not to make a fuss about going to bed, but to sleep with extraordinary readiness and soundness. let every one join together to produce this effect. let the suggestion act strongly on his mind that all these troubles of sleeplessness are diminishing, that night after night sees an improvement, and soon his reputation as a good sleeper will be established, and, as always with children, it will be rigidly adhered to. in assisting to break the habit of sleeplessness, and in the process of altering the character of the suggestions which act on the child's mind, we can be of the greatest assistance to the mother by prescribing a suitable hypnotic. as to whether it is right in insomnia in childhood to prescribe depressant drugs is a question on which very various opinions are held. that it is wrong and probably ineffective to trust entirely to the drugs is certainly true, but as a temporary measure, to break the faulty suggestion and the bad habit, their use is both legitimate and successful. the dose required in children relatively to the adult is much smaller. in grown people, some specific distress of mind, whether real or imaginary, may suffice to resist very large doses of hypnotic. in children it is rare to find the same resistance, and comparatively small doses have a very constant effect. with deeper and more refreshing sleep, the conduct of the child during the day almost always changes for the better. a sound sleep, for a few nights in succession, will produce apparently quite a remarkable change in the whole disposition of the child. when good temper and interest take the place of fretfulness and restlessness, we may confidently expect that the symptom of sleeplessness will begin to abate. sleeplessness by night and fretfulness by day form a vicious circle, and attempts must be made to break it at all points. chloral occupies the first place as a hypnotic for young children. in combination with bromide its effects are wonderfully constant and certain. two grains of chloral hydrate and two grains of potassium bromide with ten minims of syrup of orange, given just before bedtime, will bring sound sleep to a child of a year old. at three years the dose may be twice as great, and three times at six years. it is seldom that other means are required. aspirin for children seems relatively without effect. for children who are both sleepless and feverish, a grain of dover's powder, and a grain of antipyrin, for each year of the child's age up to three, is very helpful. lastly, if chloral and bromide cannot break the insomnia, and the condition of the child is becoming distressing, we can almost always succeed if we combine the prescription with an ordinary hot pack for twenty minutes. chapter v some other signs of nervousness habit spasm next to refusal of food and refusal of sleep perhaps the most frequent manifestation of nervous unrest is provided by the group of symptoms which we may call, with a certain latitude of expression, habit spasms. by a habit spasm is meant the constant repetition of an action which was originally designed to produce some one definite result, but which has become involuntary, habitual, and separated from its original meaning. the nervous cough forms a good example of a habit spasm. a cough may lose its purpose and persist only as a bad habit, especially in moments of nervousness, as in talking to strangers, in entering a room, or at the moment of saying "how do you do" or "good-bye." twitching the mouth, swallowing, elongating the upper lip, biting the lips, wrinkling the forehead so strongly that the whole scalp may be put into movement, and blepharospasm are all common tricks of little children which may become habitual and uncontrolled. in worse cases there may be constant jerking movements of the head, nodding movements, or even bowing salaam-like movements. in mild cases we may note hardly more than a restless movement of mouth or forehead, or constant plucking or writhing of the fingers whenever the child's attention is aroused, when he is spoken to, or when he himself speaks. in nervous children these movements, which should properly be confined to moments of real emotional stress, become habitual, and are displayed apart from the excitement of particular emotions. whatever their intensity, habitual and involuntary movements of this nature should not be overlooked, and should be regarded as evidence of mental unrest. they do not commonly appear during the first or second years of the child's life. they are more frequent after the age of five, but they may begin to be marked as early as the third year. with refusal of food and refusal of sleep they form the three common neuroses of early childhood. two of the three qualities which we have mentioned as characteristic of the child's mind are concerned in the causation of habit spasm. in the early stages the movement is sometimes due to imitation, but the susceptibility of the child to suggestion plays the chief part in determining its persistence. it is an interesting speculation how far tricks of gesture, attitude, or gait are inherited and how far they are acquired by imitation. a child by some characteristic gesture may strikingly call to mind a parent who died in his infancy. a whole family may show a peculiarity of gait which is at once recognisable. it is told of the son of a famous man, who shared with his father the distinctive family gait, that when a boy his ears were once boxed by an old gentleman who chanced to observe him hurrying to overtake his parent, and who resented what he took to be an act of impertinent caricature. in the reproduction by the child of the habitual actions of his parents, heredity is largely concerned, but imitation too plays its part. in habit spasm the force of imitation is clearly seen. a child who has developed a habit spasm of one sort or another will readily serve as a model to other children. the malady will sometimes spread through a school almost with the force of a contagious disorder. a child affected in this way may prove an unwelcome guest. the little visitor with a trick of contorting his mouth and grimacing is apt to leave his small host an expert in faithfully reproducing the action. a cough that is genuine enough in one member of the family may produce a crop of counterfeits in brothers and sisters. the force of suggestion acting upon the child's mind can clearly be traced. once his attention is focused upon the particular movement by unwise emphasis on the part of the parents, he loses the power to control its occurrence. this trio of common neuroses--refusal of food, refusal of sleep, and habitual involuntary movement--grows only in an atmosphere of unrest and apprehension. parents and nurses anxiously watch their development. they are distressed beyond measure to note their steady growth in spite of every attempt which they make to control or forbid them. and of all this unrest and unhappiness the child is acutely conscious. the whole household may become obsessed with the misfortune which has befallen it, and the mother, losing all sense of proportion, feels that she cannot regain her peace of mind until it has been overcome. the child is in need of mental and moral support from those around him, and all that he finds is an openly expressed apprehension and sense of impotence. even grown-up people, when their nerves are on edge, are apt to be obsessed by uncontrollable impulses or by vague and nameless apprehensions, and surely all have learnt the support they gain from contact and conversation with some one strong and sane, who treats their worries in such a matter-of-fact way that immediately they lose their power and become of no account. the child with habit spasm cannot control these movements. the more he is reproved or entreated, the less able does he find himself to hold them in check. he does not wish them to continue. he has lost control of what he once controlled, and the realisation of this is not pleasant, and may be alarming to him. yet when unconsciously he looks to his mother for support, he finds in her open dismay that which serves only to increase his uneasiness. she must subdue her own feelings and give the child strength. if she treats the whole thing in a matter-of-fact way, as a temporary disturbance which is of no importance in itself, and only has meaning because it implies that the brain has been over-stimulated, she will no longer exercise a prejudicial effect on the child. if the bad habit is taken as a matter of course, if too much is not made of it, if the child is encouraged to think that nobody cares much about it at all, then recovery will soon take place. it goes without saying that habit spasms and tics of all sorts are made worse by excessive emotional display and by nervous fatigue. on the other hand, if the child becomes absorbed in some interesting occupation, the movements will disappear for the time being. air swallowing, thigh rubbing, thumb sucking at a somewhat earlier age than that in which habit spasms become common, and before bed wetting appears as a formidable difficulty, we meet with another group of habitual actions which yet retain their voluntary character. among such habitual actions are thumb sucking, thigh rubbing, and air swallowing. if the child is old enough to express himself on the subject, he will explain that these actions are performed because of the satisfaction derived from them, because it is "comfy" and "nice." even if the child is too small to speak, the expression is that of beatitude and content. these actions are not confined to nervous children, and their occasional practice need not be taken to imply that there is any strong element of nervous overstrain. it is only when the action is repeated with great frequency and persistence, and when signs of irritation ensue if gratification is not obtained, that we are justified in classing it among the symptoms of mental unrest. the second of these actions, thigh rubbing, is found for the most part in little girls, and inasmuch as it consists of a stimulation of the sexual organs sometimes causes much distress to the parents. it is in reality a habit of small importance unless exercised with very great frequency. it is, of course, not associated in the child's mind with any sexual ideas, and is of precisely the same significance as the other two actions of the same class. children who can speak will refer to it openly without any sense of shame. as a rule the action is performed in a half-dream state, that condition between sleeping and waking which is found when the child is lying in the morning in her cot or in her perambulator after the midday nap. the child's attention should not be focused on the symptom. she should lie on a hard mattress, and when she wakes in the morning she should either leave her cot at once or she should be roused into complete wakefulness by encouraging her to play with her toys. little children should be taught to sleep with their hands folded and placed beside the cheek. if the movement occurs on going to sleep, it is best left alone and completely neglected. as a rule each child has his or her own favourite action of this class, and they are seldom combined in the same child. if thigh rubbing is very constant and obstinate and does not yield to the measures suggested, it may even sometimes be a successful manoeuvre to substitute the thumb-sucking habit in the expectation that this less distressing habit may eject the other more objectionable action. as a rule, however, a wise neglect and careful watching during the drowsy condition that follows sleep in a warm bed will succeed in stopping the practice of thigh rubbing before the end of the second or third year. apparatus designed to restrain movement of the child's legs or blistering the opposed surfaces of the thighs are both of no effect. they have indeed the positive disadvantage that they focus the child's attention on the practice. the habit ceases only when the child has forgotten all about it, and these devices serve only to keep it in remembrance. the same may be said of any system of punishments. further, we cannot always have the child under observation, and at some time or other opportunity will be found for gratification. of older children, in whom self-control and a sense of honour can be cultivated, i am not here speaking. air swallowing is less common than thigh rubbing, but belongs to the same group of actions and takes place in the same drowsy condition. the child will rapidly gulp down air which distends the stomach, and is then regurgitated with a loud sound. thumb sucking seldom distresses the mother to the same extent, and the proper attitude of tolerance is adopted towards it. if much is made of it, it is astonishing how persistent the habit may become, surviving all attempts to forbid it, to break it by rewards or punishments, or to render it distasteful by the application of a variety of ill-tasting substances smeared on the offending digit. pica and dirt eating certain other bad habits will become ingrained if attention is called to them, because of that curious spirit of opposition which characterises little children, and because of their susceptibility to suggestion. some children will constantly pluck out hairs and eat them, or will devour particles of fluff drawn from the blankets. others will seize every opportunity to eat unpleasant things, such as earth, sand, mud, or dirt of any sort. all tricks of this sort are best neglected and treated by attracting the child's attention to other things. in adult life they are associated with serious mental disturbance, in early childhood they are of little account, or at most suggest a certain nervousness which may be due to nervous irritation from faults of management which we must strive to correct. constipation as has been already mentioned, much of the common constipation of the nursery is due to neurosis. the excessive concentration of the nurse's thoughts on this daily question communicates itself to the child. the difficulty is emphasised, and an attempt is made to substitute will power for forces of suggestion which are at once inhibited by concentration of the mind upon the process. here also, just as in the refusal of food, a further stage of "negativism," that is, of active resistance with crying and struggling, is reached, so that complaint may be made by the mother that defæcation is painful. the same negativism may be shown in micturition, and mothers will give distressing accounts of the suffering of the child during the passing of water. breath-holding and laryngismus stridulus in some children, in the first two years of life, we find a definite and measurable increase in the irritability and conductivity of the peripheral nerves. the strength of current necessary to produce by direct stimulation of the nerve a minimal twitch of the corresponding muscle may be many times less than the normal. of this heightened irritability of the nervous system, to which the name "spasmophilia" has been given in america and on the continent, the most striking symptom is a liability alike to tetany or carpo-pedal spasm, to generalised convulsions, and to laryngismus stridulus. in addition, in most cases it is generally possible to demonstrate the presence of chvostek's sign and of trousseau's sign. chvostek's sign consists in a visible twitch of the facial musculature, especially of the orbicularis palpebrarum or of the orbicularis oris, in response to a gentle tap administered over the facial nerve in front of the ear. trousseau's sign is the production of tetany by applying firm and prolonged pressure to the brachial nerve in the upper arm. the ætiology of spasmophilia is still a matter for dispute, but the evidence which we possess is in favour of the view that we have here to deal with a disturbance of calcium metabolism. the calcium content both of the blood and of the central nervous system has been shown to be much lowered. it is in keeping with this that clinically we note how frequently spasmophilia and rickets occur in the same child. in some families the condition recurs through many generations. for our present purpose--the examination of some common neuroses of nursery life--it would be out of place to enter into a detailed consideration of this disorder of spasmophilia as a whole. the symptom of laryngismus stridulus--the so-called breath-holding--alone need concern us, and that for a special reason. the spasm of the glottis is produced under the influence of any strong emotion--in anger, for example, or in fear, in excitement or in crying for any reason. to control or prevent it we must direct attention not only to the condition of spasmophilia, but also to the management of the children who are always excitable and emotional. in these children every burst of crying, however produced, whether by a fall, by a fright, by the entrance of a stranger, or by a visit to a doctor, is apt to be ushered in by a long period of apnoea, due to spasm of the glottis and of the diaphragm. the first few expirations are not followed by any inspiration. for several seconds the silence may be complete, while the child steadily becomes more and more cyanosed, or the body may be shaken by incomplete expiratory movements and strangled cries which are suppressed because the chest is already in a position of almost complete expiration. in the worst cases, when the apnoea lasts a very long time, there may be convulsive twitching of the muscles of the face, or the attack may even terminate in general convulsions. very occasionally the spasm is actually fatal. in all fatal cases which have come to my notice the child at the moment of death had been alone in the room. i have met with no fatal case where the baby could be picked up and assisted. as a rule, therefore, the cause and mode of death must be conjectural, but when an infant is found dead in its cot unexpectedly, it would seem likely that it has waked from sleep with a sudden start, become excited, and, about to cry, has been seized by the fatal spasm. in two instances reported to me a cat had been found in the room with the dead child, and it was suggested that the animal had lain upon the child's face. both these children, however, were vigorous and capable of powerful movements of resistance. i think it more likely that the cat may have awakened them in fright, and that the emotional excitement, giving rise to the spasm, was the cause of the suffocation. that the apnoea in these extremely rare instances should end fatally produces a difficult position for the doctor. it need hardly be said that the seizures are alarming to the parents. for the sake of great accuracy in the statement of our prognosis are we to add a hundred times to the mother's alarm by stating the possibility of death? in each case we must use our own judgment. i believe that in a child over a year old the risk is almost negligible. fortunately in all save the rarest possible instances the apnoea yields and a deep inspiratory movement follows. as the air rushes past the glottis, which is still partially closed, a sound recalling the whoop of pertussis is heard. often this recurs throughout all the burst of crying which follows, and each inspiration is accompanied by a shrill stridulous sound. with the re-establishment of respiration the cyanosis rapidly fades, to be succeeded in some cases by pallor and perspiration. it need hardly be said that we should do all in our power to prevent these alarming and distressing attacks. each seizure predisposes to a repetition. in some children we notice that months and even years after an attack of whooping-cough, a slight bronchial catarrh may be sufficient to bring back the characteristic cough. in laryngismus in the same way we may suppose that the reflex path is made easy and the resistance lowered by constant use. fortunately the spasms are not usually difficult to control. calcium bromide, in doses of from two to four grains, according to age, three times daily, is generally successful with or without the addition of chloral hydrate in small doses. at the same time we must endeavour in every way possible to keep the child calm, by paying close attention to nursery management. the child with spasmophilia is as a rule excitable and easily upset, and although calcium bromide is a drug which offers powerful aid it is not able to achieve its effect unless we are able at the same time to guarantee a reasonable immunity from emotional upsets. it is for this reason that i have included some description of laryngismus, although its origin is undoubtedly very different from that of the other disorders of conduct which we have examined. migraine and cyclic vomiting the ætiology of cyclic or periodic vomiting in childhood is not yet completely understood. we do not know how far it is dependent upon disturbance of the liver, and it is still disputed whether the acidosis which accompanies it is the cause or the result of the profuse vomiting. into these difficult questions we need not at the moment enter. it is enough in the present connection to recognise that the great majority of children who suffer from cyclic vomiting are sensitive, excitable, and nervous, and that every one is agreed that the nervous system is intimately concerned in its causation. a close association between cyclic vomiting in children and that form of periodic headache known as migraine has often been observed. it is sometimes found that one or both parents of a child with cyclic vomiting suffer habitually from migraine. in a few instances the one condition has been observed to be gradually replaced by the other, the child with cyclic vomiting becoming in adult life a sufferer from migraine. there is indeed much which is common to the two conditions. the periodic nature of the seizure, often following a time when the general health and vigour appear to have been at their optimum, the extreme prostration, and the comparatively sudden recovery are found in both. in the cyclic vomiting of children, it is true, little complaint is made of headache, the visual aura is absent, and the vomiting is invariably the most prominent symptom. cyclic vomiting seldom occurs before the fourth year. it is characterised by sudden profuse and persistent vomiting and by very great prostration. all food, it may be even water, is promptly rejected. the vomited matter is generally stained with bile; occasionally the violence of the vomiting causes hæmatemesis. in many cases the temperature is raised; sometimes it may be as high as ° f. the duration of an attack varies. in most cases it does not last longer than forty-eight hours. on the other hand, attacks lasting as long as a week are by no means unknown. within a short time of the onset the urine may be found to contain acetone bodies, the breath may smell distinctly of acetone, and the child may become torpid and drowsy or agitated and restless. at times there may be exaggerated and deepened respiratory movements--the so-called air hunger. in many cases, however, otherwise characteristic, these more severe manifestations are absent or but little apparent. recovery is usually rapid and complete. the child asks for food, which is retained. a fatal ending is very rare, though not unknown. the frequency of attacks is very various. sometimes months or even years may elapse between successive seizures; in other cases a fortnightly or monthly rhythm establishes itself. it is clear that both the frequency and the severity of the attacks are much influenced by the general state of the child's health. like migraine, cyclic vomiting appears to be a symptom of nervous exhaustion. it affects, for the most part, children who are intellectually alert, impressionable, and forward for their age, and who, when well, throw themselves into work or play with a great expenditure of nervous energy. often their physical development is unsatisfactory, and we must set ourselves to correct this as the first step in prevention. it is highly important that children suffering in this way should have free opportunities for exercise in the open country, and that all the excretory organs--the skin, kidneys, and bowels--should be acting freely and efficiently. the child should live a life of ordered routine. sleep should be sound and sufficient in amount. the diet must not exceed the strict physiological needs. many of these children appear to have a lowered tolerance for fats of all sorts, and it may be necessary to limit strictly the consumption of milk, cream, butter, and so forth. a daily administration of a small dose of alkali by the mouth is credited with preventing attacks. in the present connection, however, we shall not do wrong to emphasise the part played by the nervous system in the production of the attacks. in all cases of cyclic vomiting it should be our endeavour to recognise and remove the elements in the daily life of the child which are proving too exhausting. unexplained pyrexia in nervous children we sometimes meet with inexplicable rises of temperature. the pyrexia may have the same periodic character as that just noted in cases of cyclic vomiting. at intervals of three, four, or five weeks there may be a rise of temperature to ° f., or even higher, which may last for two or three days before subsiding. in other cases the chart shows a slight persistent rise over many weeks or months. that in nervous children the temperature may be very considerably elevated without our being able to detect much that is amiss does not of course make it any the less necessary to be careful to exclude organic disease. pyelitis, tuberculosis, and latent otitis media occur with nervous children as with others and must not be overlooked. if, however, organic disease can be excluded, and if the pyrexia is the only circumstance which prevents the decision that the child is well and should be treated as well, then the thermometer may be overruled and the pyrexia neglected. chapter vi enuresis i have dealt in previous chapters with certain common disorders of conduct in childhood, which show clearly their origin in the apprehensions of the grown-up people who have charge of the children, and in the unwise suggestions which they convey to them. the same forces are at work in the production of enuresis, or bed wetting, although the matter is here often complicated by the development later on of a sense of shame and unhappiness in the child. there comes a time when the child passionately desires to regain control and is miserable about her failure, until the concentration of her thoughts on the subject becomes a veritable obsession. every night she goes to bed with this only in her mind. every night she falls asleep, miserably aware that she will wake to find the bed wetted. the suggestion impressed in the first place on the mind of the tiny child by injudicious management has become fixed by the growing sense of shame and the complete loss of self-confidence. it is usually taught that a great variety of causes is concerned in producing enuresis. it is said to be due to a partial asphyxia during sleep from adenoid vegetation. it is said to be caused by phimosis, and to be cured by circumcision. it is said that the urine is often too acid and so irritating that the bladder refuses to retain it for the usual length of time. it is said that enuresis may be due to a deficiency of the thyroid secretion, and that it can be cured by thyroid extract. such a number of rival causes may make us hesitate to accept the claims of any one of them. certainly i have not been able to satisfy myself that any one of these conditions exercises any influence at all or is commonly present in cases of enuresis. i think that if we examine a large number of cases of bed wetting in children we can come to no other conclusion than that the cause of the trouble is due to just such a pervasion of suggestion as we have been considering above. there are certain points in the behaviour of a child with enuresis which seem to point to this conclusion. _(a)_ in the first place, the trouble is seldom serious or very well developed in early childhood, and the reason for this, i take it, is that an occasional lapse in a child of perhaps two or three years of age is usually treated lightly and in the proper spirit of tolerance. it is only with children a little older that nurses and parents become distressed and begin unwittingly by urging the child to present the suggestion to her mind, that the bed may or will be wetted. hence the usual history is that control was partially acquired in the second year, but that, instead of later becoming complete, relapses began to be more frequent, and that since that time all that can be done seems only to make matters worse. _(b)_ in the second place, the influence of suggestion is shown by the behaviour of the child when removed to a hospital for observation. it is the invariable experience that the enuresis then promptly stops. in hospital the attitude of those around the child is entirely different. she has the comfortable and consoling feeling that in wetting the bed she is doing exactly what is expected of her. there is even a feeling that otherwise she is showing herself to be something of a fraud, and that she has then been admitted to the hospital on false pretences. hence, perhaps for the first time in many years, the child is free from the obsession, and the bed is not wetted. _(c)_ in the third place, it is easy to recognise in the history of many of the cases, the ill-effects of circumstances which add new force to the fear of failure or shake the confidence in the control which had been regained. thus a boy, an only child, who had suffered from enuresis till his seventh year, had regained complete control till his eleventh year, when he went to school. in his dormitory at school was a boy who had enuresis, and who was being fined and punished by the schoolmaster. the enuresis at once reappeared and continued unchecked so long as he was at school. as might be expected, school life is very inimical to cure, unless the trouble can be kept from the knowledge of the other boys. anything which directly increases the nervousness of the child--an illness, for example, with loss of weight and failure of nutrition, or some mental stress, such as the approach of an examination--is apt to accentuate the enuresis. _(d)_ in the fourth place, the incontinence sometimes spreads to the daytime, and the child is wet both by day and night. further, in bad cases it is not uncommon to find incontinence of fæces making its appearance also. these extensions of the fault only take place when the management continues to be very faulty, when the grown-up people around them are more than usually distressed and pessimistic, and have redoubled their expostulations and appeals. now these peculiarities of enuresis seem to me only explicable if we assume that the want of control is due to auto-suggestion, dependent at the beginning on the unwise attitude adopted towards the fault by the nurses and parents, and later kept up by the sense of shame and the mental distress involved. the forms of treatment which have been recommended from time to time are, as might be expected, very numerous. _(a) operative._--(i) removal of tonsils and adenoids, (ii) circumcision. _(b) manipulative._--(i) injection of saline solution under the skin in the perineal and pubic regions, with object of lowering the excitability of the bladder by counter-irritation. (ii) gradual distension of the bladder by hydrostatic pressure, (iii) tilting the foot of the bed so as to throw the urine to the fundus of the bladder, in order to protect the sensitive trigone from irritation. _(c) educative._--(i) curtailing the fluid drunk. (ii) waking the child at intervals during the night by an alarm clock or otherwise. (iii) rewards and punishments. _(d) medicinal._--(i) belladonna. (ii) thyroid extract. _(e) by suggestion._--(i) by simple suggestion. (ii) by hypnotic suggestion. i do not think that any single one of these various forms of treatment outlined under the first four heads has any effect other than to aid the suggestion of cure which we proffer in adopting it. removal of tonsils and adenoid vegetations might conceivably cure an enuresis which is nocturnal, it cannot account for an incontinence which spreads to the day. we might believe that to distend the bladder by hydrostatic pressure was a cure for incontinence of urine, and that it acted by removing the local cause,--the smallness and contraction of the bladder,--were it not that the loss of control is so apt to spread to the rectum as well. there is no evidence that the urine is peculiarly irritating. indeed, such evidence as we have goes to show that, as in some other neuroses, the urine in enuresis is unduly copious, and of very low specific gravity. incidentally, we have in this polyuria a further argument against the view recently advanced that a small and contracted irritable bladder is the cause of enuresis. we do, of course, meet with cases of irritable bladder often enough, but the complaint is then not of incontinence, but always of the discomfort of having to rise so frequently for micturition. to deprive the child of fluid, to wake her many times at night, to tilt the foot of the bed, are devices which may help in the hands of some one who is confident of his ability to cure the condition and can communicate the confidence to the child. carried out hopelessly and pessimistically by a tired and exasperated mother, they are well calculated to strengthen the hold which the obsession has on the child, so that often we meet with a mother who rightly enough maintains that the more she wakes the child, the oftener the bed is wet, till she wonders where it all comes from. the treatment of enuresis to be successful must be conducted through and by means of the grown-up persons who have the control of the children. to stop the development of enuresis in early infancy we must intervene to prevent the concentration of the child's mind on the difficulty. during the time when control is ordinarily developed, in the second and third year, judicious management of the child is essential. the emphasis should be laid upon successes, not upon failures. for every child his reputation will sway in the balance for a time. he must be helped and encouraged to self-confidence, not rendered diffident or self-conscious. if the case is well established before it comes under our notice, the mother, the nurse, the schoolmaster, or whoever is responsible for the child's management, must understand clearly the nature of the trouble. the suggestion acting on the child's mind must be altered, and self-confidence restored. the child must learn to see that the thing is not so desperately tragic. he should be told that the trouble always gets well, and that it only goes on now because he is worried about it and keeps thinking of it. if the whole environment of the child is bad, so that such a change of suggestion is not possible, and if enuresis is but one of many symptoms of mental or moral instability, it may be necessary to remove the child and place him under the influence of some one else. sometimes the prescription of a rubber urinal, which the child can slip on at night, is directly curative. a public school boy, who was about to be sent away from school for this failing, fortified by the possession of this apparatus, wrote six months later to say that he knew now that it must be all worry that caused the trouble, because with the urinal in position he had not once had the incontinence. in inveterate cases hypnotic suggestion is always, i think, successful. it is obvious, however, that in many cases there are objections to its use. often enuresis is evidence that the child's home environment has been at fault, and that his mental and moral development has been retarded. it is the management which must be modified or the home, if necessary, changed. hypnotic suggestion will make this one symptom disappear promptly enough, but it will rather perpetuate than combat the cause--that undue susceptibility to suggestion, which is characteristic alike of the little child and of many older neuropathic persons. chapter vii toys, books, and amusements any one who has an opportunity of watching little children must have observed that they are happiest and most contented when playing alone. the education of the little child is carried on by means of games and toys. handling the various objects which we give him, imparting movement to them, transferring them from hand to hand and from one situation to another, he learns dexterity and precision of movement, and in the process hand and brain grow in power. when at play, his whole energies should be absorbed to the exclusion of everything else. he will often be oblivious to everything that is going on around him, intent only on the purpose of the moment. in order to permit this fervour of self-education it is necessary that the child should be accustomed to playing alone, and it is well, if only for convenience' sake, that he should be accustomed to playing in a room by himself. something is wrong if the child cannot be left for a few moments without breaking into tears or displaying bad temper. engrossed in his own tasks, he should be content to leave his nurse to move in and out of the room without protest. if this fault has appeared and the child cannot be left alone, our whole educational system is undermined, and play will be profitless and over-exciting, because it demands the constant participation of grown-up people. as a preliminary to all improvement in the management of a nervous child, we must see to it that he becomes accustomed to being alone. we must so arrange his nursery that he can do no damage to himself. scissors and matches must not be left lying about, and a fireguard must be fixed in position so that it cannot be disturbed. then, disregarding his protests, the nurse must leave him to himself, at first only for a moment or two, re-entering the room in a matter-of-fact way without speaking to him, and again leaving it. soon he will learn that a temporary separation does not mean that we have abandoned him for all time. then the period of absence can be gradually lengthened till all difficulty disappears. once his attention is removed from the grown-up people who mean so much to him, his natural impulse to explore and experiment with his playthings will show itself. those toys are best which are neither elaborate nor expensive. for a little child a small box containing a miscellaneous collection of wooden or metal objects, none of them small enough to be in danger of being swallowed, forms the material for which his soul craves. everything else in the room may be out of his reach. a dozen times he will empty the box and then replace each object in turn. he will arrange them in every possible combination, and then sweep the whole away to start afresh. at eighteen months of age observation and imitative capacity will have made more complex pursuits possible. as a rule the objects which are most prized and which have most educative value are those which lend themselves best to the actions with which alone the child is familiar. hence the supreme importance of the doll and the doll's perambulator. the doll will be treated exactly as the child is treated by the nurse. it will be washed, and dressed, and weighed, and put to bed in faithful reproduction of what the child has daily experienced. dusting, and sweeping, and laying the table will be exactly copied. if a child has no opportunity of being familiar with horses, if he has not seen them fed, and watered, and groomed, and harnessed, he may not find any great satisfaction in a toy horse, or pay much attention to it, no matter how costly or realistic it may be. in the third year more precise tasks, such as stringing beads, drawing, and painting, will play their part, while at the same time the increased imaginative powers will give attraction to toy soldiers or a toy tea-service. playing at shop, robbers, and rafts are developments of still later growth. in the child's games we recognise the instinct of imitation--playing with dolls, sweeping and dusting, playing at shop or visitors; the instinct of constructiveness--making mud pies and sand castles, drawing or whittling a stick; and the instinct of experiment--letting objects fall, rattling, hammering, taking to pieces. all this activity must be encouraged, never unduly repressed or destroyed. but whatever form it takes, the bulk of the play must be carried on without the intervention of grown-up persons, or it will lose its educative value and prove too exacting. if grown-up people attempt to take part, the child will lose interest in the play and turn his attention to them. children differ very much in their attitude towards books. one child quite early in the second year will be happy poring over picture books, while another will seldom glance at the contents and finds pleasure only in turning over the pages, opening and shutting them, and carrying them from place to place. such differences are natural enough and foreshadow perhaps the permanent characteristics that divide men and women, and produce in later life men of thought and men of action, women who are marthas and women who are marys. nevertheless, we should bear in mind that there is danger in a training that is too one sided, and that books and toys have both their part to play in developing the powers of the child. all the activities of the child should be used in as varied a way as possible. the eye is but one doorway to knowledge and understanding, the ear is another, the hand a third. from pictures an imaginative child will derive very strong impressions, and mothers should be careful in their choice. it is foolish to confuse the growth of æsthetic perceptions by presenting children with books which depict children as grotesquely ugly beings with goggle eyes and heads like rubber balls. children love animals and endow them with all their own reasoning attributes, and in stories of the home life of rabbits, and bears, and squirrels they take a pure delight. books of the "struwwelpeter" type are less to be recommended. the faults which they are intended to eradicate become peculiarly attractive from much familiarity. a little boy of two and a half who resolutely refused all food for some days was in the end detected to be playing the part of that augustus, once so chubby and fat, who reduced himself to a skeleton, saying, "take the nasty soup away; i don't want any soup to-day." tales of naughty children who meet with a distressing fate may either frighten the child unduly, or else produce in a child of inquiring mind the desire to brave his fate and put the matter to the test. pictures should not be terrifying or horrible. ogres devouring children are out of place as subjects for pictures and may cause night-terrors. children should be taught to be careful of books and toys. the indestructible book, generally falsely so called, is often responsible for the immediate dissolution of all others less protected which come to hand. the sympathy which little children have with the sufferings of all inanimate objects and their habit of endowing them with their own sensations may be made of use in teaching them care and gentleness. they are naturally prone to sympathise with the doll that has been crushed or the book that has been torn. they will learn very easily to be kind to a pet animal and to be solicitous for its feelings, and the lesson so learnt will be applied to inanimate objects as well. there is, however, another side to the question. it is true that if the child is not to be over-stimulated upon the psychical side, we must see to it that his play, for the most part, is not dependent upon the participation of grown-up persons. in practice this excessive stimulation is the common fault with which we meet. there are few children in well-to-do homes, with loving mothers and devoted nurses, who suffer from too little mothering and nursing. too many show signs of too much. to observe the opposite fault we must seek the infants and children who for a long time are inmates of institutions, orphanages, infirmaries, hospitals, and so forth. in such surroundings the mental life of the child may languish. his physical wants are cared for, but there the matter ends. in a rigid routine he is washed and fed, but he may not be talked to or played with or stimulated in any way. his day is spent passively lying in his cot, unnoticed and unnoticing. i have seen a poor child of three years just released from such a life, and after eighteen months returned to his mother, unable to talk and almost unable to walk, crying pitifully at the novelty and strangeness of the noisy life to which he had returned, worried by contact with the other children, and without any desire or power to occupy himself in the home. for an hour in the day mothers may devote themselves wholeheartedly to the children, and if they set them romping till they are tired out, so much the better. in the garden or in an airy room with the windows open, a game with a ball or a toy balloon, or a game of hide-and-seek, will be all to the good, and the children may climb and be rolled over and swung about to their heart's content. with an only child, especially with a child whose home is in town, and whose outings are limited to a sedate airing in the park, such free play is especially necessary. it may help more than anything else to quiet restless minds and tempers that are on edge all day long from excessive repression. on the other hand, those forms of entertainment which are known as "children's parties" are generally fruitful of ill results, at any rate with nervous and highly-strung children. sometimes they entail a postponement of the usual bedtime, and nearly always they involve over-heated and crowded rooms. perverse custom has decreed that these gatherings shall take place most commonly in the winter, when dark and cold add nothing to the pleasure and a great deal to the risk of infection which must always attend the crowding of susceptible children together in a confined space with faulty ventilation. there is clearly on the score of health much less objection to summer garden parties for children, but these for some reason are less the vogue. as a rule parties are not enjoyed by nervous children. there is intense excitement in anticipation, and when at length the moment arrives, there is apt to be disillusion. either the excitement of the child may pass all bounds and end in tears and so-called naughtiness, or the unfamiliar surroundings may leave him distrait with a strange sense of unreality and unhappiness. it is not always fair to blame the want of wisdom in his hostess's choice of eatables, if the excited and overstimulated child fails in the work of digestion and returns to the nursery to suffer the reaction, with pains and much sickness. the same arguments may be urged against taking little children to the theatre. the nerve strain is apt to be out of proportion to the enjoyment gained. if children must go to theatres and parties, the treat should be kept secret from them until the moment of its realisation, in order that the period of mental excitement should be contracted as much as possible, and grown-up people should be advised to treat the whole expedition in a matter-of-fact sort of way that does nothing to add to the excitement or increase the risk of subsequent disillusion. chapter viii nervousness in early infancy we may now pass back to consider the nervous system of the child in infancy. there, too, from the moment of birth there are clearly-marked differences between individuals. the newborn baby has a personality of his own, and mothers will note with astonishment and delight how strongly marked variations in conduct and behaviour may be from the first. one baby is pleased and contented, another is fidgety, restless, and enterprising. at birth the baby wakes from his long sleep to find his environment completely changed. within the uterus he lies in unconsciousness because no ordinary stimulus from the outer world can reach him to exert its effect. he lies immersed in fluid, which, obeying the laws of physics, exercises a pressure which is uniformly distributed over all points of his body. no sound reaches him, and no light. after birth all this is suddenly changed. the sense of new points of pressure breaks in upon his consciousness. cold air strikes upon his skin. loud sounds and bright lights evoke a characteristic response. a placid child who inherits a relatively obtuse nervous organisation will be but little upset by this sudden and radical change in the nature of his environment. his brain is readily but healthily tired by the new sensations which stream in from all sides, and he falls straight away into a sleep from which he rouses himself at intervals only under the impulse of the new sensation of hunger. babies of nervous inheritance, on the other hand, will show clearly by the violence of the response provoked that their nervous system is easily stimulated and exhausted. they will wriggle and squirm for hours together, emitting the same constant reflex cry. the whole body will start convulsively at a sudden touch or a loud sound which would evoke no response from a more stolid infant. the sleeplessness and crying exhaust the baby, rendering the nervous system more and more irritable, while the sensation of hunger which is delayed in other children by twelve hours or more of deep sleep appears early and is of extreme intensity. we must see to it that sense stimuli are reduced to the lowest possible level. true, we cannot again restore the child to a bath of warm fluid, of the same temperature as his body, where he can be free from irksome pressure and from all sensations of sound and light, but we can so arrange matters that he is not disturbed by loud sounds and bright lights, and that he is not moved more than is necessary. sudden unexpected movements are especially harmful. jogging him up and down, patting him on the back, expostulation, and entreaties are all out of place and do all the harm in the world. the first bath should be as expeditious as possible, and above all the baby must not be chilled by tedious exposure. cold irritates his nervous system more than anything else, unless it be excessive warmth. in preserving the proper temperature so that we do not render the child restless by excess of heat or by excess of cold, we too-civilised people have made our own difficulties. we have exaggerated the completeness of the sudden separation of mother and child which nature decrees. it is the function of all mother animals to approximate the unstable temperature of the newly born to their own by the close contact of their bodies, which provide just the proper heat. labour is nowadays so complicated and exhausting a process for mothers that, all things considered, we are wise in completing the separation of mother and child and in removing the baby to his own cot. but the difficulty remains, and we must arrange that any artificial heating needed is constant and of proper degree. if the baby is very restless and irritable, too wide awake and too conscious of his surroundings, the all-important task of getting him to the breast and getting him to draw the milk into the breast is apt to be difficult. his sucking is a purely reflex and involuntary act. it can be produced by anything which gently presses down the tongue, and a finger placed in the proper position will provoke the movement without the child's consciousness being aroused. the placid child whose mind is at rest will suck well and strongly. if, on the other hand, the brain is too much stimulated and the child is restless and irritable, the reflex act of suction is inhibited, and it is a difficult matter to get the child to the breast. he is too eager, mouthing, and gulping, and spluttering. or sometimes his mental sufferings seem too much for his appetite, and though wide awake and crying loudly, he refuses to grasp the nipple, turning his head away and wriggling blindly hither and thither. this effect of mental unrest on the newborn infant is often disastrous, because it is one of the common causes of the failure of women to nurse their children. this is not the place to sketch in detail a scheme for the proper technique of breast nursing, a matter which is much misunderstood at the present day. it will be enough shortly to say that an efficient supply of milk depends upon the complete and regular emptying of the breast. the breasts of all mothers will secrete milk if strong and vigorous suction is applied to the nipple by the child. if anything interferes with suction, the milk does not appear or, if it has appeared, it rapidly declines in amount. the mother's part is to a great extent a passive one, provided that she can supply one essential--a nipple that is large enough for the child to grasp properly. within wide limits what the mother eats or drinks, whether she be robust or whether she has always been something of an invalid, matters not at all. a frail woman may naturally not be able to stand the strain of nursing for many months, but that is not here the point in question. we are dealing only with the establishment of lactation and with the milk supply of the early days and weeks which is of such vital importance for the child. if the mother is ill, if, for example, she has consumption, we may separate her from the child in the interests of both; but if this is not done, she will continue to secrete milk for a time as readily as if she were in perfect health, and the breasts of many a dying woman are to be seen full of milk. mothers are too apt to attribute the disappointment of a complete failure to nurse to some weakness or want of robustness in their own health. this is never the reason of the failure, and the fault, if the mother has a well-formed nipple, is generally to be found in some disturbance in the child. prematurity, with extreme somnolence, breathlessness from respiratory disease, nasal catarrh, which hinders breathing through the nose, infections of all sorts, are common causes of this failure to suck effectively. but perhaps the most common cause of all is the inhibition from nervous unrest of that reflex act of sucking which works so well in the placid and quiet child. it is a point to which too little attention is paid, and mothers and the books which mothers read commonly neglect the nervous system of the child and devote themselves to such considerations as the relative merits of two-hourly and four-hourly feedings--important points in their way, but less important than this. the matter is complicated in two other ways. in the first place, the nervous baby, just because he is so active and wakeful and restless, is apt rapidly to lose weight and to have an increased need for food. the restlessness is generally attributed to hunger, and this is true, because hunger is soon added to the other sensations from which he suffers, and like them is unduly acute. it is difficult not to give way and to provide artificial food from the bottle. yet if we do so we must face the fact that these restless little mortals are quicker to form habits than most, and once they have tasted a bottle that flows easily without hard suction, they will often obstinately refuse the ungrateful task of sucking at a breast which has not yet begun to secrete readily. the suction that is devoted to the bottle is removed from the breast, and the natural delay in the coming in of the milk is increased indefinitely. at the worst, the supply of milk fails almost at its first appearance. we must devote our attention to quieting the nervous unrest by removing all unnecessary sensory stimulation from the baby. he must be in a warm cot, in a warm, well-aired, darkened, and silent room, and the necessary handling must be reduced to a minimum. sometimes sound sleep will come for the first time if he is placed gently in his mother's bed, close to her warm body. if he is apt to bungle at the breast from eagerness and restlessness, it is not wise always to choose the moment when he has roused himself into a passion of crying to attempt the difficult task. so far as is possible he should be carried to the breast when he is drowsy and sleepy, not when he is crying furiously, and then the reflex sucking act may proceed undisturbed. in the second place, we must guard against the ill effect which the ceaseless crying of these nervous babies has upon the mother. she may be so exhausted by the labour that her nerves are all on edge, and she grows apprehensive and frightened over all manner of little things. the tired mother is apt to fear that she will have no milk, and her agitation grows with each failure on the part of the child. now the first secretion of milk is very closely dependent upon the nervous system of the mother. we have said that within wide limits her physical condition is of less importance, but her peace of mind is essential. and so it is wise for some part of the day to keep the nervous baby out of hearing of the mother, and so far as possible to choose moments when the child is quiet to put him to the breast. a nurse with a confident, hopeful manner will effect most; a fussy, over-anxious, or despondent attitude will do untold harm. we shall sometimes fail if the nervous unrest is very obstinate either in mother or in child, but we shall fail less often if we diagnose the cause correctly in the cases we are considering. lastly, it is possible to control the condition in both mother and child by the careful use of bromide or chloral. it is not, of course, suggested that these drugs should be given freely or as a routine to every hungry baby wailing for the breast, or that we can hope to combat or ward off an inherited neuropathy by a few doses of a sedative. there are, however, not a few babies in whom there develops soon after birth a sort of vicious circle. they can suck efficiently and digest without pain only when they sleep soundly. if they are put to the breast after much crying and restlessness, each meal is followed by flatulence, colic, and renewed crying. the only effective treatment is to secure sleep and to carry a slumbering or drowsy infant to the breast. then the sucking reflex comes to its own again, the breast is drained steadily and well, and digestion proceeds thereafter without disturbance and during a further spell of sleep. two or three times in the day we may be forced, as meal-time approaches, to cut short the restlessness of the child by giving a teaspoonful of the following mixture: pot. brom., grs. ii. [ grains] chloral hydrate, gr. i. [ grain] syrup, m x. [ minims] aq. menth. pip., ad i. [ dram] after this has been taken the child should be laid down for a quarter of an hour until soundly asleep. then very gently he can be carried to his mother and the nipple inserted. if in this way a few days of sound sleep and less disturbed digestion can be secured, the difficulty will in most cases permanently be overcome. the steadier suction and more efficient emptying of the breast will promote a freer flow of milk, and the deeper and more prolonged sleep will lower greatly the needs of the child for food. most of the babies who show this fault are thin, meagre, and fidgety, and with some increase of muscular tone. the head is held up well, the limbs are stiff, the hands clenched, the abdomen retracted, with the outline of the recti muscles unusually prominent. if we can relax this exaggerated state of nervous tension, if we can help them to become fatter and to put on weight, the dyspepsia will disappear with the other symptoms. it is a question still to be answered whether the rare conditions of pyloric spasm and pyloric hypertrophic stenosis are not further developments of the same disturbance. certainly these grave complications appear most commonly in infants with a pronounced nervous inheritance, and, as might be expected, they are more commonly found in private practice than among the hospital classes. in passing, we may note that there are babies who exhibit the opposite fault, and in whom the contrary regimen must be instituted. premature children, children born in a very poor state of nutrition, and children born with great difficulty, so that they are exhausted by the violence of their passage into the world, are apt to show the opposite fault of extreme somnolence. they are so little stimulated by their surroundings, and they sleep so profoundly, that the sucking reflex is not aroused. put to the breast they continue to slumber, or after a few half-hearted sucking movements relapse into sleep. we must rouse such children by moving them about and stirring them to wakefulness before we put them to the breast. once the child has been got to the breast, once the milk has become firmly established, we have overcome the first great difficulty which besets us in the management of nervous little babies, but it is by no means the last. restlessness and continual crying must be combated or digestion suffers, and may show itself in a peculiar form of explosive vomiting, which betokens the reflex excitability and unrest of the stomach. the sense of taste is as acute as all other sensations. if the child is bottle-fed, the slightest change in diet is resented because of the unfamiliar taste, and the whole may promptly be rejected. the tendency to dyspeptic symptoms is apt to lead to much unwise changing of the diet, and everything tried falls in turn into disrepute, until perhaps all rational diets are abandoned, and some mixture of very faulty construction, because of its temporary or accidental success, becomes permanently adopted--a mixture perhaps so deficient in some necessary constituent that, if it is persisted with, permanent damage to the growth of the child results. we must pay less attention to changes of diet and explore our management of the child to try and find how we can make his environment more restful. it is wise to accustom a nervous child from a very early age to take a little water or fruit juice from a spoon every day. otherwise when breast-feeding or bottle-feeding is abandoned one may meet with the most formidable resistance. infants of a few months can be easily taught; the resistance of a child of nine months or a year may be difficult to overcome. the difficulty of weaning from the breast recurs with great constancy in nervous children. by this time the influence of environment has become clearly apparent. the child is often enough already master of the situation, and is conscious of his power. such children will sometimes prefer to starve for days together, obstinately opposing all attempts to get them to drink from a spoon, a cup, or even a bottle. when this happens, sometimes the only effective way is to change the environment and to send the baby to a grandmother or an aunt, where in new surroundings and with new attendants the resistance which was so strong at home may completely disappear. when weaning is resented, and difficulties of this sort arise, it is clear that the mother, whose breast is close at hand, is at a great disadvantage in combating the child's opposition. for nervous infants, alas! broken sleep is the rule. what, then, is to be done? it is astonishing to me that any one who has studied the behaviour of only a few of these nervous and restless infants should uphold the teaching that the crying of the young infant is a bad habit, and that the mother who is truly wise must neglect the cry and leave him to learn the uselessness of his appeals. it is true that the youngest child readily contracts habits good or bad. either he will learn the habit of sleep or the habit of crying. mercifully the inclination of the majority is towards sleep. but to encourage habits of restlessness and crying there is no surer way than to follow this bad advice and to permit the child to cry till he is utterly exhausted in body and in mind. it is unwise _always_ to rock a baby to sleep; it is also unwise to allow him to scream himself into a state of hysteria. a quiet, darkened room, the steady pressure of the mother's hand in some rhythmical movement, will often quiet an incipient storm. the longer he cries, the more trouble it is to soothe him. sleep provokes sleep, so that often we find restlessness and sound sleep alternating in a sort of cycle, a good week perhaps following a bad one. the nurse who is quick to cut short a storm of crying and to soothe the child again to sleep is helping him to form habits of sleep. the nurse who leaves him to cry, believing that in time he will of his own accord recognise the futility of his behaviour, is making him form habits of crying. a rigid routine in sleep is a good thing, but the routine belongs to the baby, not to the nurse. the child must be educated to sleep, not taught to cry. a baby has but little power of altering his position when it becomes strained or uncomfortable. he cannot turn over and nestle down into a new posture. if we watch him wake, the first stirring may be very gradual, and in a moment he may fall again to sleep. a few minutes later he stirs again more strongly, and is wider awake and for longer. it may only be after a third waking, by a summation of stimuli, that he is finally roused and breaks into loud crying. the nurse who is on the watch, who, sleeping beside him, wakes at the slightest sound and is quick to turn him over and settle him into a new position of rest, will probably report in the morning that the baby has had a good night. the nurse who lets the child grow wide awake and start crying loudly, will spend perhaps many hours before quiet is again restored. of the voluntary, purposive crying of infants a little older i am not here speaking. infants in the second six months are quite capable of establishing a "tyranny of tears" and feeling their power. fortunately it requires no great experience to distinguish one from the other, and to adopt for each the appropriate treatment. again, in elementary teaching upon the management of infants stress is laid, rightly enough, upon the importance of regularity in the times of feeding, and on the observance in this respect also of a very strict routine. but in the case of the very nervous infant a certain latitude should be allowed to an experienced nurse or mother. we may wreck everything by a blind adhesion to a too rigid scheme, which may demand that we leave the child to scream for an hour before his meal, or that, when at length he has fallen into a sound sleep after hours of wakefulness, we should proceed to wake him. symptoms of dyspepsia which are due to continued nervous excitement demand treatment which is very different from that which would be appropriate to dyspepsia which is due to other causes, such as overfeeding or unsuitable feeding. the temporary restriction of food, which is commonly ordered in dyspepsia from these causes, is very badly supported by the nervous infant. hunger invariably increases the unrest, and the unrest increases the dyspepsia. the difficulties of managing a nervous infant are very real, and call for the most exemplary patience on the part of the mother and the clearest insight into the nature of the disturbance. chapter ix management in later childhood in the early days in the nursery the actions of the infant, for the most part, follow passively the traction exercised by nurses and mothers, sometimes consciously, but more often unconsciously. we have now to consider a period when the child becomes possessed of a driving force of his own, and moves in this direction or that of his own volition. in this new intellectual movement through life he will not avoid tumbles. he will feel the restraints of his environment pressing upon him on all sides, and he will often come violently in contact with rigid rules and conventions to which he must learn to yield. from time to time we read in the papers of some terrible accident in a picture-palace, or in a theatre. although there has been no fire, there has been a cry of fire, and in the panic which ensues lives are lost from the crowding and crushing. yet all the time the doors have stood wide open, and through them an orderly exit might have been conducted had reason not given place to unreason. it is the task of those responsible for the children's education to guide them without wild struggling along the paths of well-regulated conduct towards the desired goal, influenced not by the emotions of the moment, but only by reason and a sense of right; not ignorant of the difficulties to be met, but practised and equipped to overcome them. it is easy thus to state in general terms the objects of education, and the need for discipline. to apply these principles to the individual is a task, the immeasurable difficulty of which we are only beginning to appreciate with the failure of thirty years of compulsory education before us. a recent writer[ ] gives it as his opinion that the aim of education is to equip a child with ideals, and that this task should not be difficult, because the lower savages successfully subject all the members of their tribe to the most ruthless discipline. their lives, he says, "are lived in fear, in restraint, in submission, in suffering, subject to galling, unreasoning, unnecessary, arbitrary prohibitions and taboos, and to customary duties equally galling, unreasoning, unnecessary, and arbitrary. they endure painful mutilations, they submit to painful sacrifices.... how are these wild, unstable, wayward, impulsive, passionate natures brought to submit to such a rigorous and cruel discipline? by education; by the inculcation from infancy of these ideals. in these ideals they have been brought up, and to them they cling with the utmost tenacity." one might as well contend that it was easy to teach all men to live the self-denying life of earnest christians because some savage tribe was successful in maintaining among its members a universal and orthodox worship of idols. the ideals set before the child are too high and too complex to be inculcated by physical force, or even by force of public opinion. a rigid discipline, with many stripes and with terrible threats of a still worse punishment in the world to come, was the almost invariable lot of children until the last century was well advanced. yet has this drastic treatment of young children fulfilled its purpose? were the men of fifty years ago better conducted and more controlled than the men of to-day? in any one family did a greater proportion turn out well? is it not true that at least among the educated classes the relaxation of nursery and schoolroom discipline which the last fifty years has seen has been justified by its results? is it not true that the childhood of our grandmothers was often lived "in fear, in restraint, in submission, in suffering subject to galling, unreasoning, unnecessary, arbitrary prohibitions and taboos, and to customary duties equally galling, unreasoning, unnecessary, and arbitrary." and though perhaps the grandmothers of most of us may not have been much the worse for all this discipline, is it not true that of the little brothers who shared the nursery with them a surprising number broke straightway into dissipation when the parental restraints were removed? if we are to teach a child to be gentle to the weak it is not wise to beat him. the qualities which we wish him to possess are not more subtle than the means by which we must aid him to their possession. [footnote : _the principles of rational education_, by dr. c.a. mercier.] education comprises physical, mental, and moral training. in earlier times physical strength and the power to fight well, alone were prized and were the chief objects to be gained in the education of youth. later, under the stress of intellectual competition for success in life, mental acquirements have come to occupy the first place. we are only now learning to lay emphasis upon the supreme need for moral training. not that it is possible to separate the sum of education into its constituent parts, and to regard each as distinct from the others. that many men of great intellectual activity, and many men pre-eminent for their moral qualities have harboured a great brain or a noble character in a weakly or deformed body, forms no argument to disprove the general rule that a healthy, vigorous physique is the only sure foundation upon which to build a highly developed intellect and a stable temperament. in childhood the intimate connection between vigour of mind and vigour of body is almost always clearly shown. a child with rickets, unable to exercise his body in free play, as a rule shows a flabbiness of mind in keeping with his useless muscles and yielding bones. such children talk late, are infantile in their habits and ways of thought, and are more emotional and unstable than healthy children of the same age. the connection between bodily ailments and instability of nervous control is even more clearly seen in the frequent combination of rheumatism and chorea. a very high proportion of older children suffering from the graver neuroses, such as chorea, syncopal attacks, phobias, tics, and so forth, show defective physical development. scoliosis, lordosis, knock-knee, flat foot, pigeon chest, albuminuria, cold and cyanosed extremities, are the rule rather than the exception. if the body of the child is developed to the greatest perfection of which it is capable we shall not often find a too sensitive nervous system. the boy of fine physique may have many faults. he may be bad-tempered or untruthful or selfish, but such faults as he has are as a rule more primitive in type, more readily traced to their causes, and more easy to eradicate than the faults which spring from that timidity, instability, and moral flabbiness which has so often developed in the lax delicate child reared softly in mind and body. physical training children thrive best in the healthy open-air life of the country, and if there is any tendency to nervous disturbances the need for this becomes insistent. physical training, further, includes the manual education of the child. the system of child-training advocated by dr. montessori is based upon the cultivation of tactile sensations and the development of manual dexterity. exercises such as she has devised have an immediate effect in calming the nervous system and in changing the restless or irritable child into a self-restrained and eager worker. lord macaulay, whose phenomenal memory as a child has become proverbial, was so extraordinarily unhandy that throughout life he had considerable difficulty in putting on his gloves, while he had such trouble with shaving that on his return from india there were found in his luggage some fifty razors, none of which retained any edge, and nearly as many strops which had been cut to pieces in his irritated and ineffectual efforts. if we teach a child manual dexterity it is an advantage to him, because manual dexterity is seldom associated with restlessness and irritability of mind. to excel in some handicraft not only bespeaks the possession of self-control, it helps directly to cultivate it. the teaching of froebel and montessori holds good after nursery days are over. mental training mental training enables the child to retain facts in his memory, to obtain information from as many sources as possible, to understand and piece them together, and finally to reach fresh conclusions from previously acquired data. so far as is possible the teacher must satisfy the natural desire to know the reason of things. it must be his endeavour to prevent the child from accepting any argument which he has not fully understood, and which, as a result, he is able not to reconstruct but only to repeat. mental work which is slovenly and perfunctory is as harmful to the child's education as mechanical work which is bungled and ineffective. taking advantage of his natural aptitudes, his interest should be developed and extended in every way possible. tasks which are accomplished without enthusiasm are labour expended in vain, because the knowledge so acquired is not assimilated and adds nothing to the child's mental growth. there should be no sharp differentiation between work and play. moral training moral training depends upon the force of example rather than of precept. parents must be scrupulously just and truthful to the child, for his quick perception will detect the slightest deceit, and the evil impression made on his mind may be lasting. they must confidently expect conduct from him of a high moral standard, and be careful at this early age to avoid the common fault of giving a dog a bad name. if it is said on all sides that a child has an uncontrollable temper, is an inveterate grumbler, is lacking in all power of concentration, or has a tendency to deceit, it is likely that the child will act up to his reputation. he comes in time to regard this failing of his as part of himself just as much as is the colour of his hair or the length of his legs. it may be said of a schoolboy that he shows no aptitude for his work. term by term the same report is brought home from school, and each serves only to confirm the boy in his belief that this failing is part of his nature, and that no effort of his own can correct it. if one subject only has escaped the condemnation of his master, then it may be to that study alone that he returns with zest and enjoyment. spendthrift sons are manufactured by those fathers who many times a day proclaim that the boy has no notion of the value of money. and so with children! parents must take it for granted that they will display all the virtues they desire in them. they must trust to their honour always to speak the truth, and always to do their best in work or play whether they are with them or not. again and again the children will fail and their patience will be tried to the utmost. they must explain how serious is the fault, and for the time being their trust may have to be removed; but with the promise of amendment it must again be fully restored and the lapse completely forgotten. if the child feels he is not trusted he ceases to make any effort, and lapse will succeed lapse with increasing frequency. in efforts at moral training there is often too great an emphasis laid upon negative virtues. it is wrong to do this: to do that is forbidden. children cannot progress by merely avoiding faults any more than a man may claim to be an agreeable companion at table because he does not eat peas with a knife or drink with his mouth full. there must be a constant effort to achieve some positive good, to acquire knowledge, to do service, to take thought for others, to discipline self, and the parent will get the best result who is comparatively blind to failure but quick to encourage effort and to appreciate success. when the child knows well that he is doing wrong, exhortation and expostulation are usually of little avail if repeated too often, and serious talks should only take place at long intervals. we know how effective the so-called "therapeutic conversation" may be in helping some overwrought and nervously exhausted man or woman to regain peace of mind and self-control. after an intimate conversation with a medical man who knows how to draw from the patient a free expression of the doubts, anxieties, and fears which are obsessing him, many a patient feels as though he had awakened in that instant from a nightmare, and passes from the consulting-room to find his troubles become of little account. not a few patients return to be reassured once more, and derive new strength on each occasion. yet visits such as these must be infrequent or they will lose their power. now, just as the physician is well aware that his intervention if too frequently repeated will lose its effect, so the parent must be chary of too frequent an appeal to the moral sense of the child. at long intervals opportunity may be taken with all seriousness to set before the child ideals of conduct, to-speak to him of the meaning of character and of self-discipline, and of the standards by which we judge a man or woman to be weak and despicable, or strong and to be admired. the effect of such an intimate conversation, never repeated, may persist throughout life. constantly reiterated appeals, on the other hand, do more harm than good. to tell a child daily that he is "breaking mother's heart," or that he is "disappointing his father," is to debase the moral appeal and deprive it of its strength. for everyday use it is best to cultivate a manner which can indicate to the child that he is for the moment unpopular, but which at the same time denies to the small sinner the interest of attempting his own defence. on the other hand, should the child be reasonably in doubt as to the nature of his offence we must spare no trouble in explaining it to him. punishment will be most effective when the child is convinced that he is rightly convicted. if it is to act as a real deterrent, he must agree to be punished--a frame of mind which, if it can be produced, may be welcomed as a sure sign that training is proceeding along the right lines. by physical training, mental training, and moral training the child's character is formed and self-discipline is developed. with the child of neuropathic disposition and inheritance matters may not proceed so smoothly. reasoning and conduct may be alike faulty, and the nervous disturbances may even cause detriment to the physical health. not that the nervous child requires an environment different from that of the normal child. the difficulties which the parents will encounter and the problems which must be solved differ not in kind but in degree. an error of environment which is without effect in the normal child may be sufficient to produce disastrous results in the neuropathic. it must be granted that there are some unfortunate children in whom the moral sense remains absent and cannot be developed--children who steal and lie, who seem destitute of natural affection, or who appear to delight in acts of cruelty. these moral degenerates need not be considered here. serious errors of conduct, however, in children who are not degenerate or imbecile, frequently arise directly from faults of management and can be controlled by correcting these faults. suppose, for example, that a child is found to have taken money not his own. the action of the parents faced with this difficulty and disappointment will determine to a great extent whether the incident is productive of permanent damage to the child's character. the peculiar circumstances of each case must be considered. for example, the parent must bear in mind the relation in which children stand to all property. the child possesses nothing of his own; everything belongs in reality to his father and mother, but of all things necessary for him he has the free and unquestioned use. unless his attention has been specially directed to the conception of ownership and the nature of theft, he may not have reasoned very closely on the matter at all. very probably he knows that it is wrong to take what is not given him, but he does not regard helping himself to some dainty from a cupboard as more than an act of disobedience to authority. he may have imbibed no ideas which place the abstraction of money from a purse belonging to his parents on a different plane, and which have taught him to regard such an action as especially dishonourable and criminal. finally, a child who, undetected, has more than once taken money belonging to his father and mother, may pass without much thought to steal from a visitor or a servant. to deal with such a case effectively, to ensure that it shall never happen again, requires much insight. if the father, shocked beyond measure to find his son an incipient criminal, differing in his guilt in no way from boys who are sent to reformatories as bad characters, convinces the child that although he did not realise it, he has shown himself unworthy of any further trust, untold harm will be done. almost certainly the child will act in the future according to the suggestions which are thus implanted in his mind. if the household eyes him askance as a thief, if confidence is withdrawn from him, he sees himself as others see him and will react to the suggestions by repeating the offence. the seriousness of what he has done should be explained to him, and after due punishment he must be restored completely and ostentatiously to absolute trust. only by showing confidence in him can we hope to do away with the dangers of the whole incident. to inculcate good habits and encourage good behaviour we must let the child build up his own reputation for these virtues. it need not make him priggish or self-satisfied if parents let him understand that they take pride in seeing him practise and develop the virtue they aim at. for example, it is desired above all that he should always speak the truth. then they must ostentatiously attach to him the reputation of truthfulness and show their pride in his possessing it. if he falls from grace they must remember that he is still a child, and that if that reputation is lightly taken from him and he is accused of a permanent tendency towards untruthfulness, he is left hopeless and resigned to evil. let any mother make the experiment of presenting to her child in this way a reputation for some particular virtue. for example, if an older child shows too great a tendency to tease and interfere with the younger children, let the mother seize the first opportunity which presents itself to applaud some action in which he has shown consideration for the others. let her comment more than once in the next few days on how careful and gentle the older child is becoming in his behaviour to the little ones, and in a little the suggestion will begin to act until the transformation is complete. if, on the other hand, the mother adopts the opposite course and rebukes the child for habitual unkindness, she will be apt to find unkindness persisted in. the criminal records of the nation show too often the truth of the saying that "once a thief always a thief." deprived of his good repute, man loses his chief protection against evil and his incentive to good. the inability of a child--and especially of a nervous and sensitive child--to form conceptions of his own individuality except from ideas derived from the suggestions of others, gives us the key to our management of him and to our control of his conduct. he has, as a rule, a marvellously quick perception of our own estimate of him, and unconsciously is influenced by it in his conception of his own personality, and in all his actions. parents must believe in his inherent virtue in spite of all lapses. if they despair it cannot be hid from the child. he knows it intuitively and despairs also. it is then that they call him incorrigible. if it happens that one parent becomes estranged from the child, despairs of all improvement, and sees in all his conduct the natural result of an inborn disposition to evil, while the other parent holds to the opinion that the child's nature is good, and to the belief that all will come right, then often enough the child's conduct shows the effect of these opposite influences. in contact with the first he steadily deteriorates, affording proof after proof that judgment against him has been rightly pronounced. in contact with the other, though his character and conduct are bound to suffer from such an unhappy experience, he yet shows the best side of his nature and keeps alive the conviction that he is not all bad. the force of suggestion is still powerful to control conduct and determine character in later childhood. the impetus given by the parents in this way is only gradually replaced by the driving power of his own self-respect--a self-respect based upon self-analysis in the light of the greater experience he has acquired. chapter x nervousness in older children in older children the line which separates naughtiness, fractiousness, and restlessness from definite neuropathy begins to be more marked. the nature of the young child, taking its colour from its surroundings, is sensitive, mobile, and inconstant. with every year that passes, the normal child loses something of this impressionable and fluid quality. with increasing experience and with a growing power to argue from ascertained facts, character becomes formed, and if tempered by discipline will come to present a more and more unyielding surface to environment, until finally it becomes set into the stability of adult age. we may perhaps, with some approach to truth, look upon the adult neurotic as one whose character retains something of the impressionable quality of childhood throughout life, so that, to the last, environment influences conduct more than is natural. all the emotions of neurotic persons are exaggerated. disappointments over trifles cause serious upsets; grief becomes overmastering. violent and perhaps ill-conceived affection for individuals is apt to be followed by bitter dislike and angry quarrelling. on the physical side, sense perception is abnormally acute, and many sensations which do not usually rise up into consciousness at all become a source of almost intolerable suffering. to these most unhappy people summer is too hot and winter too cold; fresh air is an uncomfortable draught, while too close an atmosphere produces symptoms of impending suffocation. in some neurotics there is an excessive interest in all the processes of the life of the body, and when attention is once attracted to that which usually proceeds unconsciously, symptoms of discomfort are apt to arise. thus so simple an act as swallowing may become difficult, or for the time being impossible. to breathe properly and without a sense of suffocation may seem to require the sustained attention of the patient; or again, the voice may be suddenly lost. more commonly, perhaps, neuropathy exhibits itself in an undue tendency to show signs of fatigue upon exertion of any sort, mental or physical. sustained interest in any pursuit or task becomes impossible. nameless fears and unaccountable sensations of dread establish themselves suddenly and without warning, and may be accompanied on the physical side by palpitation, flushing, headache, or acute digestive disturbances. all these manifestations are best controlled by selecting a suitable environment, and as a rule the character of the environment is determined by the temperament and disposition of those who live in close contact with the patient. like the tiny children with whom we have dealt so far, the behaviour of neuropathic persons is subject wholly to the direction of stronger and more dominant natures. with faulty management at the hands of those around them, no matter how loving and patient these may be, the conduct of the neurotic tends to become abnormal. in children beyond earliest infancy we recognise a gradual approach to the conditions of adult life. fractiousness and naughtiness, ungovernable fits of temper, inconsolable weeping and inexplicable fears should disappear with early childhood even if management has not been perfect. if they persist to older childhood we shall find in an increasing percentage of cases evidence of definite neuropathic tendencies which urgently call for investigation and for a precise appreciation of the nature of the abnormality. it may be that the only effective treatment is that which we recognise as essential in the grosser mental disturbances--removal from the surroundings in which the abnormal conduct has had free play, and separation from the relatives whose anxiety and alarm cannot be hidden. in young nervous children fear is the most prominent psychical symptom. the children are afraid of everything strange with which they come in contact. they are afraid of animals, of a strange face, or an unfamiliar room. older children usually manage to control themselves, suppress their tears, and prevent themselves from crying out, but it is nevertheless easy to detect the struggle. often we find those distressing attacks to which the name "night-terrors" has been given. the child wakes with a cry,--usually soon after he has gone to sleep,--sits up in bed and shows signs of extreme terror, gazing at some object of his dreams with wide-open startled eyes, begging his nurse or mother to keep off the black dog, or the man, or whatever the vision may be. even after the light is turned up and the child has been comforted, the terror continues, and half an hour may elapse before he becomes quiet and can be persuaded to go back to bed. in the morning as a rule he remembers nothing at all. phobias of all sorts are common in nervous children, and result from a morbid exaggeration of the instinct for self-preservation. some cannot bear to look from a height, others grow confused and frightened in a crowd; dread of travelling, of being in an enclosed space such as a church or a schoolroom, or of handling sharp objects may develop into a constant obsession. i have known a little girl who was seized with violent fear whenever her father or mother was absent from the house, and she would stand for hours at the window in an agony of terror lest some harm should have befallen them. as if with some strange notion of propitiating the powers of darkness these children will often constantly perform some action and will refuse to be happy until they have done so. the same little girl who suffered such torments of anxiety in her parents' absence would always refuse to go to bed unless she had stood in turn on all the doormats on the staircase of her home. other children feel themselves forced to utter certain words or to go through certain rhythmical movements. they fully understand that the fear in their mind is irrational and devoid of foundation, but they are unable to expel it. often it is hugged as a jealous secret, so that the childish suffering is only revealed to others years afterwards, when adult age has brought freedom from it. we will do well to try by skilful questioning to gain an insight into the mental processes of a child when we find him showing an uncontrollable desire to touch lamp-posts or to stand in certain positions; or when he develops an excessive fear of getting dirty, or is constantly washing his hands to purify them from some fancied contamination. the treatment of all these symptoms calls for much insight. the child's confidence must be completely secured, and he must be encouraged to tell of all his sensations and of the reasons which prompt his actions. the nervous child has a horror of appearing unlike other children, and will suffer in silence. if his troubles are brought into the light of day with kindness and sympathy they will melt before his eyes. even night-terrors are, as a rule, determined by the suppressed fears of his waking hours. if they are provoked by his experiences at school, by the fear of punishment or by dismay at a task that has proved beyond his powers, he should be taken away from school for the time being. night-terrors are said to be aggravated by nasal obstruction due to adenoid vegetations. clothing at night should be light and porous, and particular attention should be paid to the need for free ventilation. we have spoken in an earlier chapter of the trouble sometimes experienced in inducing a nervous child to go to sleep. in older children insomnia is common enough. even when sleep comes it may be light and broken, as though the child slept just below the surface of consciousness and did not descend into the depths of sound and tranquil slumber. we have often noticed how different is the estimate of the patient from that of the nurse as to the number of hours of sleep during the night. the sick man maintains that he has hardly slept at all, whilst the nurse, drawing us aside, whispers in our ear that he has slept most of the night. in estimating sleep we have to consider not only its duration, but also its depth, and the patient who denies that he has slept at all has lain perhaps half the night with an active restless brain betwixt sleep and wakefulness. often enough when he comes to consider in the morning the problems that vexed his soul at midnight, he is quite unable to recall their nature, and recognises them as the airy stuff that dreams are made of. although in a sense asleep he may have retained a half-consciousness of his surroundings and a sense of despair at the continued absence of a sounder sleep. with nervous children we are apt to find sleep which is of little depth and which constantly shows evidence of a too-active brain. the body is tossed to and fro, words are muttered, and the respiration is hurried and with a change in rhythm, because there is no depth of anæsthesia. the body still responds to the impulses of the too-active brain. from the nature of his dream--as shown by chance words overheard--we may sometimes gather hints to help us to find where the elements of unrest in his daily life lie. sleep-walking is only a further stage in this same disorder of sleep, in which the dream has become so vivid that it is translated into motor action. if a child begins to suffer from active sleeplessness we must not make the mistake of urging him to sleep. he is no more capable than we are ourselves of achieving sleep by an effort of will power. to urge him to sleep is likely to cause him to keep awake because we direct his attention to the difficulty and make him fear that sleep will not come. if he understands that all that he needs is rest, he will probably fall asleep without further trouble. day-dreams also may become abnormal, and tell of an unduly nervous temperament. any one who watches a little child at play will realise the strength of his power of imagination. the story of red riding hood told by the nursery fire excites in the mind of the child an unquestioning belief which is never granted in later life to the most elaborate efforts of the theatre. all this imaginative force is natural for the child. it becomes abnormal only when things seen and acts performed in imagination are so vivid as to produce the impression of actual occurrences, and when the child is so under the sway of his day-dreams that he fails to realise the difference between pretence and reality. imagination which keeps in touch with reality by means of books and dolls and toys is natural enough. not so imagination which leads to communion with unseen familiars or to acts of violence due to the organisation of "conspiracies" or "robber bands" amongst schoolboys. if evidence of abnormal imagination appears, the child must be kept in close touch with reality. we must give him interesting and rational occupation, such as drawing, painting, the making of collections of all sorts, gardening, manual work, and so forth. in older children we must especially supervise the reading. in many nervous children we find a faulty contact with environment, so that instead of becoming interested in the thousand-and-one happenings of everyday life and experiences, they become introspective and self-conscious. as a result, sensations of all sorts, which are commonly insufficient to arouse the conscious mind, attract attention and, rising into consciousness, occupy the interest to the exclusion of everything else. the conscious mind is not capable of being occupied by more than one thing at a time. if attention is concentrated upon external matters, bodily sensations, even extreme pain, may pass altogether unnoticed. the mohawk, lord macaulay tells us, hardly feels the scalping-knife as he shouts his death song. the soldier in the excitement of battle is often bereft of all sense of pain. on the other hand, the patient who is morbidly self-conscious becomes oblivious of his surroundings while he suffers intensely from sensations which are usually not appreciated at all. self-conscious children will complain much of breathlessness and a sense of suffocation, of headache, of palpitation, of intolerable itching, of the pressure of clothing, or of flushing and a sense of heat. excessive introspection influences their conduct in many ways. at children's parties, for example, they will be found wandering about unhappy, dazed and unable to feel the reality of the surroundings which afford such joy to the others; or they may be anxious to join in play, but finding themselves called upon to take their turn are apt to stand helplessly inactive, or to burst into tears. at school, though they may be really quick to learn, they will often be found oblivious of all that has gone on around them, not from stupidity, but from inability to dissociate their thoughts from themselves and to concentrate attention upon the matter in hand. in such a case we must aim at developing the child's interest to the exclusion of this morbid introspection. taking advantage of his individual aptitude, we must strengthen his hold upon externals in every way possible, and we must explain to him the nature of his failing and teach him that his salvation lies in cultivating his capacity for paying attention to things around him and developing an interest in suitable occupations. fainting fits are not uncommon amongst nervous children from about the sixth year onwards, and are apt to give rise to an unwarranted suspicion of epilepsy. in other cases fears have been aroused that the heart may be diseased. in children who faint habitually the nervous control of the circulation is deficient. we notice that when they are tired by play, or when they are suffering from the reaction that follows excitement of any sort, the face is apt to become pale, and dark lines may appear under the eyes. yet there may be no true anæmia present: it is only that the skin is poorly supplied with blood for the moment. after a little rest in bed, or under the influence of a new excitement, the colour returns, and the tired look vanishes. if children of this type are made to stand motionless for any length of time, and if at the same time there is nothing to attract their interest or attention--a combination of circumstances which unhappily is sometimes to be found during early morning prayers at school--the want of tone in the blood vessels may leave the brain so anaemic that fainting follows. the first fainting attack is a considerable misfortune, because the fear of a recurrence is a potent cause of a repetition. standing upright with the body at rest and the mind vacant, the circulation stagnates, the boy's mind is attracted by the suggestion, he fears that he will faint as he has done before, and he faints. schoolmasters are well aware that if one or two boys faint in chapel and are carried out, the trouble may grow to the proportion of a veritable epidemic. it is important that this habit of fainting should be combated not only by general means to improve the tone of the body and circulation, but also by taking care that the child understands the nature of the fainting fit, and the part which association of ideas plays in producing it. disease of the heart seldom gives rise to fainting. the same vasomotor instability which shows itself in the tendency to syncopal attacks is apparent in many other ways. sudden sensations of heat and of flushing, equally sudden attacks of pallor, coldness of the extremities, abundant perspiration,--raising in the mind of the anxious mother the fear of consumption,--and excessive diuresis are common accompaniments. a further group of symptoms is provided by the extreme sensibility of the digestive apparatus. dyspepsia, hyperaesthesia of the intestinal tract, viscero-motor atonies and spasms, and anomalies of the secretions, whether specific like that of the gastric juice or indifferent like that of the nasal, pharyngeal, gastric, and intestinal mucus, are all of common occurrence. whenever the nervous child is subjected to any exhausting experience, any excitement, pleasurable or the reverse, or any undue exertion, whether mental or physical, one may note the subsequent gastro-intestinal derangement, including even a coating of the tongue. the slightest deviation from the usual diet, the most trivial fatigue, a chill of the body, even a change in the temperature of the food may set loose the most extreme reactions in the gastro-intestinal tract--motor, sensory, or secretory. it is not an accident that so often the mucous diarrhoea, which may have afflicted an excitable child in london for many months, and which a visit to the seaside, with all its healthy activities, may seem to have completely cured, relapses within a day or two of the return to the restricted environment and uninteresting routine of life in london. the child who was happy and busy and at peace with himself, at play in the open air, resents the sudden cessation of all this, and the nervous unrest returns. to attempt treatment by dietetic restrictions alone is to deal only with a symptom. the gastro-intestinal reactions are so violent that the parents are generally voluble on the subject of the many foods which cannot be taken and the few which are not suspect. to prescribe rigid tables of diet is to add to the alarm of the mother, and to sustain her in the belief that the child is in daily danger of being poisoned by a variety of common articles of diet. only by lowering the excitability of the nervous system, by occupying the mind and giving strength to the child's powers of control can we effectively combat the hyperaesthesia. if necessary the personnel of the management of the child will have to be altered. there may be no other way to achieve certain and rapid improvement in a condition which is causing grave danger to the child and very genuine distress and suffering to the parents. a violent reaction to intoxications of all sorts is a further stigma of nervous instability. sudden and even inexplicable rises of temperature are frequent complaints, and the constitutional effects of even trivial local infections are apt to be disproportionately great. fatigue is easily induced and is exhibited in all varieties of activity--mental, physical, or visceral. mental work may produce fatigue with extreme readiness even although the quality of the work may remain of a high standard. to darwin and to zola work for more than three hours daily was an impossibility, and yet their work done under these restrictions excites all men's admiration. the palpitation and breathlessness which follows upon trivial exertion, such as climbing a flight of stairs, is a good example of visceral fatigue. among adult neuropaths we recognise the harm which may be done by unwise speeches on the part of relatives, or still more on the part of doctors. a chance word from a doctor or nurse off their guard for the moment will implant in the minds of many such a person the unyielding conviction that he or she is suffering from some gastric complaint, from some cardiac affection, or from some constriction of the bowel. it may take the united force of many doctors to uproot this pathological doubt which was implanted so easily and so carelessly. the medical student is notoriously prone to recognise in himself the symptoms of ailments which he hears discussed. little children, too, are apt to suffer in the same way. how much illness could be avoided if mothers would cease to erect some single manifestation of insufficient nervous control into a local disorder which becomes an object of anxiety to the child and to the whole household. undue liability to fatigue, irritability, instability, lack of control over the emotions, extreme suggestibility, prompt and exaggerated reactions to toxins of all sorts, excessive vasomotor reactions and anomalies of secretion, weakness of the gastro-intestinal apparatus--these, and many other symptoms, are of everyday occurrence in the nervous child. to discuss them more fully would be to pass too far from our nursery studies into a consideration of psychological medicine. chapter xi nervousness and physique it has already been said that symptoms of nervousness are often accompanied by faults in the physical development of the child. the defects may assume so many forms as to make any attempt at description very difficult. nevertheless, certain types of physical defect present themselves with sufficient frequency, in combination with neurosis, to merit a detailed description. for example, we recognise a type of nervous child which is marked by a persistence into later childhood of certain infantile characteristics of the build and shape of body. further, we meet with a group characterised by a special want of tone in the skeletal muscles, by lordosis, by postural albuminuria, and by abdominal and intestinal disturbances of various sorts. we recognise also the rheumatic type of child with a tendency to chorea, and in contrast to this a type with listlessness, immobility, and katatonia. lastly, in a few children, in boys as well as in girls, we may meet with cases of hysteria.[ ] [footnote : if we accept as hysterical all symptoms which are produced by suggestion and which can be removed by suggestion, we may correctly speak of a physiological hysteria of childhood, which includes a very large number of the symptoms discussed. the term is used here in its older more limited sense.] ( ) a group with persistence of certain infantile characteristics during the first year or eighteen months of life, the rounded infantile shape of body persists. the limbs are short and thick, the cheeks full and rounded, the thorax and pelvis are small, the abdomen relatively large and full. the great adipose deposit in the subcutaneous tissue serves as a depôt in which water is stored in large amounts. in the healthy child of normal development by the end of the second year a great change has taken place. the shape of the body has become more like that of an adult in miniature. the limbs have grown longer and slimmer. the thorax and pelvis have developed so as to produce relatively a diminution in the size of the abdomen. the body fat is still considerable, but no longer completely obliterates the bony prominences of the skeleton. delay in this change, in this putting aside of the infantile habit of body, is commonly associated with a corresponding backwardness in the mental development. such children walk late, talk late, learn late to feed themselves, to bite, and to chew effectively. watery and fat, they carry with them into later childhood the infantile susceptibility to catarrhal infections of the lung, bowel, skin, etc., and they are apt to suffer, in consequence, from a succession of pyrexial attacks. nasal catarrh, bronchitis, otitis media, enteritis, eczema, urticaria papulata, are apt to follow each other in turn, giving rise in many cases to a persistent enlargement of the corresponding lymphatic glands. the effect upon the different tissues of the body of these repeated infections is very various. we are probably not wrong in attributing the failure to develop and the persistently infantile appearance to a prejudicial effect upon the various ductless glands in the body. the condition is associated with an excessive retention of fluid in the body, secondary in all probability to alterations in the concentration and distribution of the saline constituents of the body. a rapid excretion of salts may be followed by a correspondingly speedy dehydration of the body, a retention of salts by a sudden increase of weight. the parathyroid glands are probably closely concerned in regulating the retention and excretion of salts, and especially of calcium, a circumstance which becomes of significance when we remember how frequently rickety changes, tetany, and other convulsive seizures form part of the clinical picture which we are now considering. while it is difficult to determine the effect of repeated infections upon the functions of the endocrine glands, we have clear evidence of the deleterious influence upon almost all the tissues of the body, the functioning of which it is more easy to estimate. for example, the cells of the skin and of the mucous membranes which happen to be visible to the eye show clear evidence of diminished vitality and increased vulnerability. physiological stimuli, incapable of producing any visible reaction in healthy children, habitually determine widely spread and persistent inflammatory reactions. for example, the licking movements of the tongue at the corners of the mouth produce the little unhealthy fissures which the french call _perlèche_. the physiological stimulus of the erupting tooth is capable of causing a painful irritation of the gum, so that the child is said to suffer from teething, accompanied, it may be, and the association is significant, by "teething convulsions." the irritation of the urine produces rawness and excoriation of the skin of the prepuce, contact with intestinal contents not in themselves very abnormal, an intractable dermatitis of the buttocks or a persistent diarrhoea and enteral catarrh. improvement in the general health, the result of the cessation for the time being of the recurrent infections, perhaps consequent upon improved hygienic conditions, always determines the rapid disappearance of all these accompaniments of the general diminution of tissue vitality. the muscular system and the bones are commonly also involved, so that rickety changes are often found in these infantile and watery children. in early childhood the processes of calcification and decalcification proceed side by side and with great rapidity, and in health there is always a balance on the side of the constructive process. in the children whom we are now considering, saturated as they are, from time to time, with the toxins resulting from repeated infection, ossification may be so interfered with as to cause softening and bending, with the evolution of a state of rickets. between bone and muscle, too, we find a close relationship. we do not find powerful muscles with softened bone, nor flabby muscle with rigid and well-formed bone. in the nervous system, the conditions are somewhat different. in skin, in bone, and in muscle new cell elements are constantly being formed, and the life of the individual cell is relatively short. in the nervous system, on the other hand, the individual cells are long lived. their life-history may even be coterminous with that of the individual, and if destroyed they are not replaced. nevertheless, they do not escape undamaged in the general disturbance. in a deprivation of calcium we have, in all probability, the explanation of the increased irritability of peripheral nerves and of the tendency to convulsive seizures of all sorts which is a common accompaniment of the condition. convulsions, laryngismus stridulus, tetany, or carpopedal spasm are all frequently met with. in crying, the children hold their breath to the point of producing extreme cyanosis, ending, as the spasm relaxes, with a crowing inspiration, which resembles and yet differs in tone from both the whoop of whooping-cough and the crowing inspiration of croup. apart, however, from this tendency to convulsive seizures the nervous system of these children is abnormal. as a rule they are excitable, and develop late the power to control their emotions. lagging behind in physical development and in the capacity to interest themselves in the pursuits of normal children, their emotional state remains that of a much younger child. in the infant classes at schools they are recognised as dullards, learning slowly, speaking badly, and lacking co-ordination in all muscular movements. the clinical picture so depicted is encountered with extreme frequency among the children of the poor in our large cities. to find a name for the condition is no easy matter. to call it "rickets" is to place an undue emphasis upon the bony changes which, though common, are by no means invariable. elsewhere i have suggested the name status catarrhalis, on an analogy with the name status lymphaticus, which in the post-mortem room is used to describe the secondary overgrowth of lymphatic tissue which is found in these catarrhal children. in the present connection it is of interest to us to note how commonly the nervous system is involved in the general picture and the frequency both of convulsive disorders and of neuropathy. the nervous symptoms of both sorts are to be allayed only by improving the general hygiene of the child and raising its resistance against infection. a sufficiency of fresh air and of sunlight, and a management which encourages independence of action in the child, are both necessary. the diet is of the first importance. it should be sufficient, and no more than sufficient, to cover the physiological needs of the child for food. the majority of these children have enormous appetites, and excess of food, and especially of carbohydrate food, plays some part in the production of the disturbance. we must guard against overfeeding, against want of air and want of exercise, and against those errors of management described in previous chapters, which produce the maximum of disturbance in this type of child. ( ) a group with muscular atrophy, lordosis, and postural albuminuria at an older age, in children from the fifth year onwards, a second type of physical defect associated with pronounced nervous disturbance presents itself with some frequency. the body is thin and badly nourished, and the muscular system especially poorly developed and very lax in tone. the most striking feature is the extreme lordosis, accompanied usually by a secondary and compensatory curve in the cervico-dorsal region, so that the shoulders are rounded, with the head poked forward. viewed from in front the abdomen is seen to be prominent, overhanging the symphysis pubis, while the shoulders have receded far backwards. the scapulæ have been dragged apart, as though by the weight of the dependent arms, with eversion of their vertebral borders and lowering of the points of the shoulders. the position which they adopt is that into which the body falls when it ceases to be braced by strong muscular support. the muscular system is here so weakly developed and so toneless that the posture is determined by the bony structure and its ligamentous attachments. the lordosis resembles the similar deformity which develops in cases of primary myopathy, when the spinal muscles have undergone complete atrophy. as in myopathy the movements are very uncertain. the children are apt to fall heavily when the centre of gravity is suddenly displaced, because their upright posture is maintained by balancing the trunk upon the support of the pelvis. the frequency and severity of the falls which these children suffer is a common complaint of the mother. the faulty posture is often associated with slight albuminuria. its appearance is very capricious, but it is dependent to a great extent upon the assumption of the erect posture. there has been much discussion as to its explanation. it has been argued that the lordosis itself produces the albuminuria by mechanical compression of the renal vein, and it is said that albuminuria can be produced, even in the prone position, by placing the child in a plaster jacket applied so as to maintain the position of lordosis. other observers, however, have not obtained this result. it seems most likely that the albuminuria is due to defective tone in the vasomotor musculature, comparable in every way to the defective tone in the muscles of the skeleton. we have often further evidence of vasomotor weakness. fainting attacks are so common as to be the rule rather than the exception. again, mothers are likely to complain of the child's pallor and of dark lines under the eyes, especially after exertion or in the reaction which follows excitement of any sort. as a rule a blood count will not show any very striking evidence of true anæmia. the pallor is of vasomotor origin, determined by faults in the distribution of the blood from vasomotor weakness and not by deficient blood formation. circulatory and vasomotor disturbance probably also accounts for the dyspeptic pains and vomiting which commonly accompany any emotional excitement, or follow any unusual exertion or fatiguing experience. constipation is a common, and mucous diarrhoea an occasional, symptom. the abdomen is often pigmented. the hands and feet are usually cold and cyanosed. the extreme nervousness of the children is the point upon which most stress may be laid in the present connection. the association of albuminuria with neurosis in childhood has been noticed by many observers. the gastric and intestinal symptoms are especially characteristic. if the condition of the children is not materially improved, and if the symptoms, both of the physical defect and of the nervous disturbance, are not cut short, we may predict that in adult age their lives will be made miserable by a variety of abdominal symptoms dependent both on the vasomotor disturbance and upon the accompanying neurosis. now that surgery forms so large a part of our therapeutic proceedings, they may not reach middle life without being submitted to one or more surgical operations. with good management both on the physical side and on the moral or psychological side they can be made into strong and useful members of society. the treatment of these cases may be summed up as follows: _(a)_ we must search for any source of infection, a source which is often to be found in the condition of the tonsils. enucleation may then be indicated as the first step in treatment. _(b)_ massage and gymnastic exercises calculated to improve the muscular tone, while every effort is made to secure for the child as perfect hygiene in the environment as possible. _(c)_ the stimulating effect of cold douches is often very evident in improving the vasomotor tone. these children, however, will not stand well the abstraction of heat from their thin and chilly little bodies, so that it is a good plan before the colder douche to immerse the child in a hot bath and to return again to the bath momentarily afterwards. with these precautions children will often enjoy a cold spray, the temperature of which may be constantly lowered as they become used to it. prolonged hot bathing has a correspondingly prejudicial effect. _(d)_ we must be on the watch to prevent the development of further postural deformities, such as scoliosis. if a child of strong muscular tone and good physique habitually adopts some posture, curled up, it may be, in some favourite easy-chair, there is little likelihood that its constant assumption will produce deformity. when the muscular system is lax and weak, on the other hand, deformity such as scoliosis is very readily caused. it is important, for example, to see that the child does not habitually incline to one side in reading or writing. when there is little energy for free and energetic play the children are apt to become great bookworms. if there is shortsightedness, the dangers are correspondingly increased. a special chair may be made with a well-fitting back and the seat a little tilted upwards so as to throw the child's trunk on to the support of the back. lastly, a desk, the height of which can be regulated at will, can be swung into the proper position. the child, sitting straight and square, with the weight supported by the foot-rest and back as well as by the seat of the chair, should be taught to write with an upright hand, avoiding the slope which leads to sitting sideways with the left shoulder lowered. (e) malt extract, cod liver oil, parrish's food, and other tonics may be of undoubted service. ( ) rheumatism and chorea it is certain that there is a close association between rheumatism in childhood and the common nervous affection known as chorea. we are still ignorant of the precise nature of the infection which we know as rheumatism. there is much to suggest that in rheumatism we have to deal only with a further stage in those catarrhal infections to which so much infantile ill-health is to be attributed, and that endocarditis and arthritis, when they arise, signalise the entry of these catarrhal, non-pyogenic organisms into the blood stream, overcoming at last the barrier of lymphoid tissue which has hypertrophied to oppose their passage. certainly the connection of rheumatism with catarrhal infections of the mucous membranes and adenoid enlargements of all sorts is a close one. whatever its nature, the rheumatic infection in childhood is more lasting and chronic than in adult life. rheumatism in childhood is not manifested by acute and short-lived attacks of great severity so much as by a long-continued succession of symptoms of a subacute nature, a transient arthritis, perhaps, succeeding an attack of sore throat with torticollis, to be followed by carditis, to be followed again by another attack of tonsillitis. and so the cycle of symptoms revolves. in most cases the child grows thin and weak; in most cases he becomes restless, irritable, and unhappy; often there is definite chorea. of this cerebral irritability chorea is the expression. in adults, chorea is perhaps more obviously associated with mental stress of all sorts and with states of excitement and agitation. in the case of little children it is often only the mother who really appreciates how radical an alteration the child's whole nature has undergone, and how great the element of nervous overstrain has been before the chorea has appeared. of the treatment of chorea there is no need to speak. it is purely symptomatic. isolation, best perhaps away from home, as might be expected, gives the best results. if there are pronounced rheumatic symptoms, the salicylates will be needed; if there is anæmia, arsenic and iron; if there is sleeplessness and great restlessness, bromides or chloral. hypnotism is often almost instantly successful, but, apart from hypnosis, curative suggestions proceeding from the attendants form the principal means at our disposal. ( ) exhaustion and katatonia a large number of children, in convalescence from infective disorders, when the nutrition of the body has fallen to a low ebb, show as evidence of cerebral exhaustion a group of symptoms which in a sense are the reverse of those which characterise cerebral irritation and chorea. the healthy child is a creature of free movement. the children we are now considering will sit for a long time motionless. the expression of their faces is fixed, immobile, and melancholy. if the arm or leg is raised it will be held thus outstretched without any attempt to restore it to a more natural position of rest for minutes at a time. the posture and expression remind us at once of the katatonia which is symptomatic of dementia præcox and other stuporose and melancholiac conditions in adult life. symptoms of this sort are especially common in children with intestinal and alimentary disturbances of great chronicity. the symptom is so frequently met with that it is strange that it should have attracted so little attention as compared with the contrasting condition of chorea. and yet it is of more serious significance, more difficult to overcome, and with a greater danger that permanent symptoms of neurasthenia will result. in early childhood a careful dietetic régime, suitable hygienic surroundings, and a stimulating psychical atmosphere will often effect great improvement. as in chorea, however, relapses are frequent, and there are cases which for some unexplained reason are peculiarly resistant to all remedial influences. ( ) hysteria in hysteria, in contrast to the types previously described, the infective element may be completely absent. except in some special features of minor importance the symptoms of hysteria do not differ from those of adults, and, as in adult age, the condition of hysteria may be present although the physical development may be perfect. we cannot here speak of any physical characteristics which are associated with the nervous symptoms. the third or fourth year represents the age limit, below which hysterical symptoms do not appear. thereafter they may be occasionally met with, with increasing frequency. at first, in the earlier years of childhood, there is no preponderance in the female sex. as puberty approaches, girls suffer more than boys. it may be said to be characteristic of hysteria in childhood that its symptoms are less complex and varied than in adult life. the naive imagination of the child is content with some single symptom, and is less apt to meet the physician half-way when he looks for the so-called stigmata. similarly mono-symptomatic hysteria is characteristic of oases occurring in the uneducated or peasant class. in children, hysterical pain, hysterical contractures or palsies, mutism, and aphonia are the most usual symptoms. hysterical deafness, blindness, and dysphagia are manifestations of great rarity in childhood. chapter xii the nervous child in sickness in time of sickness the management of the nervous child becomes very difficult. restlessness and opposition may reach such a pitch that it may be almost impossible to confine the patient to bed or to carry out the simplest treatment. sometimes days may elapse before the sick-nurse who is installed to take the place of the child's usual attendant is able to approach the cot or do any service to the child without provoking a paroxysm of screaming. in such a case any systematic examination is often out of the question, with the result that the diagnosis may be delayed or rendered impossible. there is only one reassuring feature of a situation, which arises only in nurseries in which the management of the children is at fault; the doctor has learned from experience that this pronounced opposition of the child to himself, to the nurse, and even to the mother, is of itself a reassuring sign, indicating, as a rule, that the condition is not one of grave danger or extreme severity. when the child is more seriously ill, opposition almost always disappears, and the child lies before us limp and passive. only with approaching recovery or convalescence does his spirit return and renewed opposition show itself. extreme nervousness in childhood carries with it a certain liability towards what is known as "delicacy of constitution." the sensitiveness of the children is so great that they react with striking symptoms to disturbances so trivial that they would hardly incommode the child of more stable nervous constitution. for example, a simple cold in the head, or a sore throat, may cause a convulsion or a condition of nervous irritability which may even arouse the suspicion that meningitis is present. or, again, a little pharyngeal irritation which would ordinarily be incapable of disturbing sleep may be sufficient to keep the child wide awake all night with persistent and violent coughing. the little irritating papules of nettlerash from which many children suffer are commonly disregarded by busy, happy children during the day, and even at night hardly suffice to cause disturbance. the nervous child, on the other hand, will scratch them again and again till they bleed, tearing at them with his nails, and making deep and painful sores. the temperature is commonly unstable and readily elevated. moreover, feverishness from whatever cause is often accompanied by an active delirium, which is apt to occasion unnecessary alarm. this symptom of delirium is always a manifestation of an excitable temperament. i remember being called to see a young woman who was thought to be suffering from acute mania. examination showed that she was suffering from pneumonia in the early stages. it was only later that we discovered that she had always been of an unstable nervous temperament, and had been in an asylum some years before. those of us who are fortunate in possessing a placid temperament and have developed a high degree of self-control are not likely to show delirium as a prominent symptom should we fall ill with fever; just as we should not struggle and scream too violently when we "come round" from having gas at the dentist's. looked at from this point of view, it is natural for all children to become delirious readily, and this tendency is peculiarly marked in those who are unduly nervous. as a consequence of this extreme sensitiveness, the nervous child is likely to suffer more than others from a succession of comparatively trifling ailments and disturbances. the delicacy of the child has, in this sense, a real existence, and is not confined to the imagination of over-anxious and apprehensive parents. no doubt the nervous mother of an only child does worry unnecessarily, and is far too prone to feed her fears by the daily use of the thermometer or the weighing-machine; but her friends who are happy in the possession of numerous and placid children are not justified in laying the whole blame upon her too great solicitude. children who are members of large families, whose nervous systems have been strengthened by contact with their brothers and sisters, are not habitually upset by trifles, and suffer even serious illnesses with symptoms of less severity. nervous children, and only children, on the other hand, show the opposite extreme. nevertheless, the mother of a nervous and delicate child--a child, that is to say, who, even if he is not permanently an invalid, nevertheless never seems quite well and lacks the robustness of other children--should realise clearly how much of this sensitiveness is due to the atmosphere of unrest and too great solicitude which surrounds him. it is a matter of universal experience that excess of care for only children has a depressing influence which affects their character, their physical constitution, and their entire vitality. at all costs we must hide our own anxieties from the child, and we must treat his illnesses in as matter-of-fact a way as possible. when illness comes, his daily routine should be interrupted as little as possible. in dealing with nervous children, it is often better to lay aside treatment altogether rather than to carry out a variety of therapeutic procedures which have the effect of concentrating the child's mind upon his symptoms. when we grown-up people are sick, we often find a great deal of comfort in submitting ourselves to some form of treatment. we have great faith, we say, in this remedy or in that. it is _our_ remedy, a _nostrum_. the physician knows well that the opportunities which are presented to him of intervening effectually to cut short the processes of disease by the use of specific cures are not very numerous, and that often enough the justification for his prescription is the soothing effect which it may exercise upon the mind of the patient, who, believing either in the physician or in his remedy, finds confidence and patience till recovery ensues. as a rule this form of consolation is denied to little children. they have no belief in the efficacy of the remedies which are applied with such vigour and persistence. indeed, it is not the child, but his anxious mother, who finds comfort in the thought that everything possible has been done. therefore, a prescription must be written and changed almost daily, the child's chest must be anointed with oil, and the air of the sick-room made heavy with some aromatic substance for inhalation, and all this when the disturbance is of itself unimportant, and owes its severity only to the undue sensitiveness of the child's nervous system. the very name of illness should be banished from such nurseries. everything should be done to reassure the child and to make light of his symptoms, and we can keep the most scrupulous watch over his health without allowing him to perceive at all that our eye is on him. with older children the evil results of suggestions, unconsciously conveyed to them by the apprehension of their parents, become very obvious. the visit of the doctor, to whom in the child's hearing all the symptoms are related, is often followed by an aggravation which is apt to be attributed to his well-meant prescription. the harm done by examinations, which are specially calculated to appeal to the child's imagination, as, for instance, an x-ray examination, is often clearly apparent. i remember a schoolboy of thirteen who was sent to me because he had constantly complained of severe abdominal pain. he was a nervous child with a habit spasm, the son of a highly neurotic father and an overanxious mother. an x-ray examination was made, but showed nothing amiss. the child's interest and preoccupation in the examination was painfully obvious. that night his restraint broke down altogether, and he screamed with pain, declaring that it had become insupportable. younger children, less imaginative but equally perverse, noticing how anxiously their mothers view their symptoms, will often make complaint merely to attract attention and to excite expressions of pity or condolence. sometimes they will enforce their will by an appeal to their symptoms. i have had a little patient of no more than thirteen months of age who suffered severely and for a long time from eczema, and who in this way used his affliction to ensure that he got his own way. if he was not given what he wanted immediately he would fall to scratching, with an expression upon his face which could not be mistaken. to him, poor child, the grown-up people around seemed possessed of but one desire--to stop his scratching; and he had learnt that if he showed himself determined to scratch they would give way on every other point. the ill-effects of departing too readily from ordinary nursery routine on account of a little illness, and of adopting straightway a variety of measures of treatment, is well shown in cases of asthma in children. the asthmatic child is almost always of a highly nervous temperament, and often passionate and ungovernable. often the most effective treatment of an attack, which usually comes on some hours after going to bed, is to make little of it, to talk naturally and calmly to the child, to turn on the light, and to allow him, if he will, to busy himself with toys or books. to be seized with panic, to send post-haste for the doctor, to carry the patient to the open window, to burn strong-smelling vapours, and so forth, not only is apt to prolong the nervous spasm on this occasion, but makes it likely that a strong impression will be left in his mind which by auto-suggestion will provoke another attack shortly. with nervous children a seeming neglect is the best treatment of all trivial disorders. meanwhile we can redouble our efforts to remedy defects in management, and to obtain an environment which will gradually lower the heightened nervous irritability. when the illness is of a more serious nature, as has been said, the restlessness as a rule promptly disappears. in each case it must be decided whether it is best for the child to be nursed by his mother and his own nurse, or by a sick-nurse. in the latter event the ordinary nurse and the mother should absent themselves from the sick-room as much as possible. often the firm routine of the hospital nurse is all that is wanted to obtain rest. less often, the child will be quiet with his own nurse, and quite unmanageable with a stranger. there is, however, another side to the question. the relation of neurosis in childhood to infection of the body is complex. i have said that with the nervous child a trivial infection may produce symptoms disproportionately severe. persistent and serious infection, however, is capable of producing nervous symptoms even in children who were not before nervous, and we must recognise that prolonged infection makes a favourable soil for neuroses of all sorts. the frequency with which st. vitus's dance accompanies rheumatism in childhood forms a good example of this tendency. the child who, from time to time, complains of the transient joint pains which are called "growing pains," and who is found by the doctor to be suffering from subacute rheumatism, is commonly restless, fretful, and nervous. appetite, memory, and the power of sustained attention become impaired. often there is excessive emotional display, with, perhaps, unexplained bursts of weeping. the child is readily frightened, and when sooner or later the restless, jerky movements of st. vitus's dance appear, the usual explanation is that some shock has been experienced, that the child has seen a street accident, has been alarmed by a big dog jumping on her, or by a man who followed her--shocks which would have been incapable of causing disturbance, and which would have passed almost unappreciated had not the soil been prepared by the persistent rheumatic infection. the management of the nervous child whose physical health remains comparatively good is difficult enough, but these difficulties are increased many times when the physical health seriously fails. to steer a steady course which shall avoid neglecting what is dangerous if neglected, and overemphasising what is dangerous if over-emphasised, calls for a great deal of wisdom on the part both of the mother and her doctor. chapter xiii nervous children and education on sexual matters in this chapter i approach with diffidence a subject which is rightly enough occupying a great deal of attention at the present time: the instruction of our children in the nature, meaning, and purpose of sexual processes. it is a subject filled with difficulties. every parent would wish to avoid offending the sense of modesty which is the possession of every well-trained child, and finds it difficult to escape the feeling that discussion on such matters may do more harm than good. there is certainly some risk at the present time that, putting reticence on one side, we may be carried too far in the opposite direction. the evils which result from keeping children in ignorance are well appreciated. we have yet to determine the effect upon them of the very frank and free exposure of the subject which is recommended by many modern writers. nevertheless, it must be granted that it is not right to allow the boy or girl to approach adolescence without some knowledge of sex and the processes of reproduction. if nothing is said on such subjects, which in the nature of things are bound to excite a lively interest and curiosity in the minds of older children, evil results are apt to follow. because parents have never mentioned these subjects to their child, they must not conclude that he is ignorant of all knowledge concerning them. it is not unlikely that the question has often occupied his thoughts, and that his speculations have led him to conclusions which are, on the whole, true, although perhaps incorrect in matters of detail. most children, unable to ask their mother or father direct questions upon matters which they feel instinctively are taboo, have pieced together, from their reading and observation, a faulty theory of sexual life. the pursuit of such knowledge, in secret, is not a healthy occupation for the child. his parents' silence has given him the feeling that the unexplored land is forbidden ground. in satisfying his curiosity he is most certainly fulfilling an uncontrollable impulse, but he has been forced to be secretive, and to look upon the information he has acquired as a guilty secret. so far even the best of children will go upon, the dangerous path. if training has been good, and if the child has responded well to it, he will go no further. though he can hardly be expected to refrain from constructing theories and from testing them in the light of any chance information which may come his way, he will instinctively feel that the subject is one best left alone. he will not talk of it with other boys--not even with those who are older than himself and whose superior knowledge in all other matters he is accustomed to respect. we need not be surprised, however, that the majority of children do not attain to this high standard of conduct, and that the interest and excitement of exploring the unknown and the forbidden proves too great. children will consult with each other about such matters, and knowledge of evil may spread rapidly from the older to the younger. in some schools, as is well known, there may grow up with deplorable facility an unhealthy interest in sexual matters. on the surface of school life all may seem fair enough, but beneath, hidden from all recognised authority, lies much that is unspeakable. if the boy has not been taught to have clean thoughts upon matters which are essentially clean, if he has not learned to know evil that he may avoid it, he may not escape great harm. the fault in us which kept him in ignorance will recoil upon our own heads. he will maintain the barrier which was erected in the first place by our own unhappy reticence, and we may find it a hard task to penetrate behind it and prevent his constant return to secret thoughts and imaginings or secret habits and practices. certain physiological processes come to have for him an unclean flavour which is yet perniciously attractive. he knows little of the real meaning of sexual processes or of the great purpose for which they are designed. it is only that an unhealthy interest becomes attached to all subjects which are scrupulously avoided in general conversation. in secret he develops a wrong attitude to all these matters. oliver wendell holmes[ ] tells us that in religion certain words and ideas become "polarised," that is to say, charged with forces of powerful suggestion, and must be "depolarised." [footnote : _the professor at the breakfast table_, oliver wendell holmes.] * * * * * "i don't know what you mean by 'depolarising' an idea, said the divinity-student. "i will tell you, i said. when a given symbol which represents a thought has lain for a certain length of time in the mind, it undergoes a change like that which rest in a certain position gives to iron. it becomes magnetic in its relations--it is traversed by strange forces which did not belong to it. the word, and consequently the idea it represents, is polarised. "the religious currency of mankind, in thought, in speech, and in print, consists entirely of polarised words. borrow one of these from another language and religion, and you will find it leaves all its magnetism behind it. take that famous word, o'm, of the hindoo mythology. even a priest cannot pronounce it without sin; and a holy pundit would shut his ears and run away from you in horror, if you should say it aloud. what do you care for o'm? if you wanted to get the pundit to look at his religion fairly, you must first depolarise this and all similar words for him. the argument for and against new translations of the bible really turns on this. scepticism is afraid to trust its truths in depolarised words, and so cries out against a new translation. i think, myself, if every idea our book contains could be shelled out of its old symbol and put into a new, clean, unmagnetic word, we should have some chance of reading it as philosophers, or wisdom-lovers, ought to read it--which we do not and cannot now, any more than a hindoo can read the 'gayatri' as a fair man and lover of truth should do." * * * * * now in the minds of many boys and some girls certain words and ideas connected with certain physiological processes become polarised. it is the parents' duty to depolarise them. it is a task which cannot well be deputed to others; nor can much help be derived from books, though many have been written with the object of initiating children into the mysteries of sex. no one but a parent is likely to be on sufficiently intimate terms with the child to enable the subject to be approached without restraint or awkwardness, and no book can adapt itself to the varying needs of individual children. an exposition in cold print, or a single formal lecture on the subject, is apt to do more harm than good. i have seen instructions to parents to deliver themselves of set speeches, examples of which are given, which seem to me well calculated to repel and frighten the nervous child. still more dangerous is the advice to make sexual hygiene a subject for class study. the task requires that parents should be upon very intimate terms with their children, and on suitable occasions, when this feeling of intimacy is strong, children should be encouraged to speak freely and to ask for explanations. by a judicious use of such opportunities piece by piece the whole may be unfolded. in order that the child may approach the subject in the proper spirit we may stimulate interest by a few lessons in natural history. a child of eight or ten years of age is not too young to learn a little of the outlines of anatomy and physiology. if he is told a few bald facts about the skeleton, about the circulation and the processes of digestion such as any parent can teach at the cost of a few hours' study of a handbook, this will lead naturally enough, in later lessons, to a similar talk upon the excretory organs, reproduction, and the anatomy and processes of sex, suitable to the individual. to achieve "depolarisation," there is nothing more efficacious than the frankness and explicitness of scientific statement, however elementary. later a little knowledge of botany and zoology will enable a parent to sketch briefly the outlines of fertilisation and reproduction. the child may grasp the conception that the life of all individual plants and animals is directed towards the single aim of continuing the species. he can be told how the bee carries the male pollen to the female flower, how all living things habitually conjugate, the lowest in the scale of development as well as the highest, and how the fertilised egg becomes the embryo which is hatched by the mother or born of her. as the child grows older and understands more and more of these natural processes an opportunity can be used to make the presentation of the subject more personal. he can be told that during childhood his own sexual processes have been undeveloped, but that as he grows older they will awake. that with their awakening in adolescence new temptations to self-indulgence in thought or action may assail him, but that these temptations are delayed by the wisdom of nature until his understanding has grown and his man's strength of character has developed. a high ideal of purity should be set before boy and girl alike, and the conception of sex from the beginning should be associated in their minds with the high purpose to which some day it may be put. before the boy goes to a boarding-school he should have imbibed from his father the desire for moral cleanliness, the knowledge of good and of evil, and a cordial dislike for everything that is sensual, self-indulgent, or nasty. talks on such subjects should be very infrequent, but i believe that, if "depolarisation" is to be achieved, they must be repeated every now and then during later childhood and in adolescence. to attempt to impart all this interesting information in a single constrained and awkward interview is to court failure, or at least to run the risk that the explanation is not fully understood, so that the child is mystified, or even offended in his sense of propriety. i have dwelt at some length upon this question of sex education, because it is one of especial difficulty when we have to deal with a child of nervous inheritance, or with a child in whom symptoms of neurosis have developed in a faulty home environment. misconduct in sexual matters is a sign of deficient nervous and moral control, and when the conduct in other respects is ill-regulated, the development of sexual processes must be watched with some anxiety. there are those who see a still more intimate relationship between errors of conduct or symptoms of neurosis in childhood and the sexual instincts. it is perhaps necessary here briefly to refer to the teaching of sigmund freud of vienna, because his views have attracted a great deal of attention in this country and have become familiar to a great part of the reading public. freud believes that the origin of many abnormal mental states and of the disturbances of conduct which are dependent upon them is to be traced back to forgotten experiences, the recollection of which has faded from the conscious mind, but which are still capable of exerting an indirect influence. he regards the process of forgetting, not as merely a passive fading of mental impressions, but as an active process of repression, by which the experience, and especially the unpleasant experience, is thrust and kept out of consciousness. there thus arises a mental conflict between the forces of repression and the forces which tend to obtrude the recollection into consciousness, and at times the energy engendered in this conflict escapes from the censorship of the repressing forces and finds vent in the production of abnormal mental states or disorders of conduct. thus to take a simple example, a business man who has had a trying day at the office, on returning home in the evening may succeed in thrusting out of his consciousness the thought of his disappointments and worries, yet the disturbance in his mind may show itself in quarrels with his wife or complaints of the quality of the cooking at dinner. freud has called attention to the part which the suppressed and long-forgotten experiences of early childhood play in the production of neuroses of all sorts at a later date, and he has laid especial emphasis on sexual experiences as peculiarly fruitful causes of such disturbances. those who have embraced freud's teaching have gone even farther than he in this direction, and by psycho-analysis--that is to say, by attempting in intimate conversation to arouse the dormant memory and lay bare the buried complex, the suppression of which has produced the conflict in the mind of the sufferer--will seldom fail to discover the influence of sexual forces and sexual attractions which, while capable of causing disorders of mind and of conduct, show themselves only obscurely and indirectly, as, for example, in dreams or in symbolic form. so far as the nervous disorders of children are concerned, much that is written to-day upon the influence of repressed sexual experiences may be dismissed as grotesque and untrue. the conclusions to which the psycho-analyst is habitually led, and which he puts forward with such confidence, can be convincing only to those who have replaced the study of childhood by the study of the writings of freud and his school. thus it is common enough to find a mother complaining that her child of two or three years of age is bitterly jealous of the new baby who has come to share with him his mother's love and attention. according to the views of freud, we are to recognise in this jealousy an exhibition of the sexual instincts of the older child, who scents a possible rival for the affections of his mother. even if we give to the term sexual the widest possible meaning, it is difficult for a close observer of children to detect any truth in this conclusion. the behaviour of the older child to the newly born will be determined mainly by the attitude adopted by the grown-up persons around him and by the unconscious suggestions which his impressionable mind receives from them. if the mother is fearful of what may happen, and refuses to leave the children alone, she will find it hard to hide from the older child her conviction that danger is to be apprehended from him. if this suggestion acts upon his mind, and if the reputation that he is jealous of the new baby becomes attached to him, he will assuredly not fail to act up to it, and her daily conduct will appear to prove the justness of his mother's apprehension. fortunately, mothers are commonly able to divest themselves of such fears as these. the older child is brought freely to the baby to admire him, to bestow caresses on him, and to speak to him in the very tones of his elders. in a few days his reputation is established, that he is "so fond of the baby," and to this reputation too he faithfully conforms. we have seen in an earlier chapter that constantly and ostentatiously to oppose a child's will is to produce a counter-opposition which because of its persistence and vigour appears to have behind it the strongest possible concentration of mind and power of will. yet if we cease to oppose, the counter-opposition which appeared so formidable at once dissolves, and the difficulty is at an end. we took as an example the child's apparent determination to approach as near as possible to the fire, the one place in the room which our fear of accident forbids him. the difficulty with the new baby is but another example of the same tendency. if he does not know that the ground is forbidden, if we do not concentrate his attention on the prohibition, he will show no particular desire to approach it. his apparent jealousy of his little brother is the result not of the rivalry of sex, but of bad management. again, it is occasionally a subject of complaint that children will apparently dislike their father, that they will shrink from him or burst into tears whenever he approaches them. there is no need to see in this the child's jealousy of the father as a rival in the affections of his mother, which is the explanation proffered by the school of freud. every action and every occupation of the child during the whole day can be made a pleasure or a pain to him, according to the attitude of his nurse and mother towards it. eating and drinking should be pleasant and are normally pleasant. the same forces which are sufficient to make every meal-time a signal for struggling and tears, are sufficient to produce this dislike, apparently so invincible, to the father of his being. although the nervous troubles of infancy are not commonly due, as freud and his numerous followers would have us believe, to suppressed sexual desires or experiences, it is clear that in the sensitive mind of the child the reception of a severe shock may have effects long after the memory of it has disappeared from consciousness. in a medical journal there was recently recounted the case of an officer of the r.a.m.c. who all his life had suffered from claustrophobia--the fear of being shut up in a closed space. by skilful questioning, the remembrance of a terrifying incident in his childhood was regained. as a child of five he had been shut in a passage in a strange house by the accidental banging to of a door, unable to escape from the attentions of a growling dog. a complete cure was said to follow upon the discovery that in this incident lay the origin of the phobia. nevertheless, observation would lead me to lay the greater stress not upon any one particular shocking or terrifying experience, but upon the attitude of parents and nurses in focusing the child's attention upon the danger, and in sapping his confidence by showing their own apprehensions and communicating them to him. as a method of treatment for neuroses of childhood, psycho-analysis is not only unsuccessful, it has dangers and produces ill effects which far outweigh any advantage which may be gained from it. there can be no doubt that freud has exaggerated the part which sexual impulses play in causing neurosis. it will be sufficient for us to recognise that for the nervous child the sexual life has especial dangers, and we should redouble our efforts to prevent his ideas on the subject becoming "polarised." for the child whose environment has been well regulated and who has developed strength of character, self-control, and self-respect, there need be no fear. chapter xiv the nervous child and school at the onset of puberty childhood comes to an end, and the period of adolescence begins. into these further stages of development it is not proposed to enter, but it may be well to consider a question which is apt to present itself for answer at this period: "should the boy, or girl, of nervous temperament, or whose development up to this point has been accompanied by symptoms of nervous disorder, be sent to a boarding-school?" so long as the child remains at home the home environment is the force which alone is concerned in moulding his character. we have seen how plastic the young child is, how imitative, how suggestible, how prone to form habits good or bad. the diversity of type shown by the homes is reflected in the diversity of character and conduct exhibited by the children. the home is the culture medium, and in no two homes is its composition the same. for each child home influence remains to a great extent unchanged, and in great part unchangeable. its action upon the child is constant and long sustained. hence, it is not surprising that the growth of his character and powers is commonly unequal. at one point we may find a good crop of virtues, at another a barren tract; and the home influences which have ripened the one and blighted the other are calculated by the lapse of time to increase the contrast rather than to diminish it. i suppose it is for this reason that the custom of sending children to boarding-schools has so firm a hold among us. the boarding-school forms an environment selected to correct the inequalities which result from the special action upon the child of individual homes. the life of a boy in one of our large public schools is well calculated to act as a corrective in this way not only by reason of its ordered routine and discipline, but still more because it is affected, perhaps for the first time, by the strong force of public opinion. it is the strength of this public opinion which gives to our public schools their peculiar character and produces their peculiar effects. that which the schoolboy most despises is what he calls "bad form," and he bows down and worships an idol he himself has set up, the name of which is "good form." public opinion forms the code of morals observed in the school. the standard set is commonly not so high as to be very difficult of attainment. it demands many good qualities. to lie, to sneak, to tell tales, to bully, to "put on side," are bad form. in some respects the definition of what is virtuous may be a little hazy. thus it may be wrong to cheat to gain a prize, but to copy from one's neighbour only so much as will enable one to pass muster and escape condemnation is no great sin. in short, good form demands that a boy should have all the social virtues: that he should be a good fellow, easy to live with, and possessed of a high sense of public spirit--good qualities certainly, though perhaps not those which help to make the reformers or martyrs of this world. the school life is the life of the herd, and to be successful in it the boy must mingle with the herd, not break from it or shun it. good form--if we came to analyse the conception that underlies it--consists only in a close approximation to the standard pattern; bad form, in any deviation from it. it is this similarity of type and community of ideals which makes it so easy for most public-school boys to get on well with one another. when in after life they are thrown among a set of men who know nothing of their conception of good form, and whose training has been on completely different lines, there may be a corresponding difficulty. now what is true of public-school life is of course also true of the larger life after schooldays are over for which all education is a preparation. these qualities of sociability and good sportsmanship will stand a man in good stead throughout life. even the most ardent and active spirit will benefit by being subjected for some years to this steady pressure of public opinion. the most part will learn from it good sense, consideration for others, and self-control. as they pass from the lower forms to the higher in the school they will learn too to support authority without doing injustice, and to bring the weight of public opinion to bear upon others. and to all this training many a man owes his happiness in after life--a happiness which he could not have secured if his character had been moulded only by the environment of his home, or by the home in combination with the less-powerful corrective of a day school. for the nervous child the passage from home to school life may involve considerable mental strain. he may be morbidly self-conscious and timid, or, unknown to himself--because he has as yet no power of self-analysis and has no opportunities of comparing himself with others--he may have developed certain eccentricities. in most cases the plunge into school life will be taken well enough; in a few the little vessel will not right itself, and proves permanently unseaworthy. no doubt as a rule a private school will have preceded the public school, and this gradation should make the entrance to the public school a lesser ordeal. but it often happens that it is just in the case of the nervous child that this intermediate stage has been omitted, and that his thirteenth birthday finds him still in the home circle. if the boy's father has first-hand knowledge of life in the lower forms of public schools, his experience may enable him to form some estimate of the effect of school life upon the nervous system of his son. it is when parents or guardians have no such experience of their own to guide them that mistakes are most liable to be made. i can myself remember the unhappy state of some solitary and eccentric schoolfellows of mine who aroused the resentment of "the herd" by their behaviour or opinions. if it is clear that the boy has a peculiar temperament and is likely to suffer in this way, some _via media_ must be found. the home has failed so that he must leave home and come under the influence of some one who understands the nature of the difficulty and can adapt the boy to school life. a change of environment of this sort as a preliminary to the public school is often all that is needed. if his age permits, every effort should be made in this way to obtain for the nervous child who has developed peculiarities or faults the benefits of a public-school education. some types of nervous children will show immediate improvement when they go to school. the boy who is passionate and disobedient, and whose parents cannot control him, is best at school. boys who, from being much with grown-up people, have become too precocious and have acquired the habits and tastes of their elders, will dislike school at first, but it will do them good. their fault shows that they are quick to learn and sensitive to the influences of others, and they will soon adapt themselves to their new surroundings. boys who are dreamy and imaginative, who early adopt a "specialist" attitude towards life, who, however ignorant they may be of everything else, cultivate a reputation for omniscience in some particular subject, such as egyptology, astronomy, or the construction of battleships, are usually nervous boys whose symptoms will disappear at school. where undue timidity, phobia, or habit spasm is present, the question is more difficult to decide. every individual case must be studied as a whole, and our object should be not unnecessarily to deprive the boy of the wholesome training of public-school life. there are parents who from sheer ignorance add to the difficulties which the boy encounters in going to school. failure to appreciate very small points may cause unnecessary suffering. to be the only boy in the school to wear combinations is not a distinction that any new boy craves, however strong his nerves may be. a friend of mine still relates with feeling how, twenty years ago, he arrived at school with shirts which _buttoned_ at the neck! at night when every one else in the dormitory was asleep he sat for hours on his bed, miserable beyond words, removing the buttons and doing his best in the dark to bore buttonholes which would admit what every other boy in the school had--a collar stud. with girls perhaps this question of fitness for school life does not arise in so urgent a way. girls are usually older when they go to school, and girls' schools are perhaps less terrifying and more like home. there is, however, one important point which should be borne in mind. the date of the onset of puberty varies much in both sexes. if the boy grows to a great hulking fellow at fourteen, and even displays a desire secretly to borrow his father's razor, he is at no particular disadvantage as compared with his fellows. he is so much bigger and stronger than the others that he may thereby early enjoy the distinction of playing at "big side," or of getting a place in the school eleven. he is probably much envied by those of the same age who, with the aid of their youthful aspect, can still occasionally extract compensation by inducing the railway company to let them travel to school at half fare. but with girls it is different. many at fourteen or fifteen are children still; some are grown up, with the tastes, feelings, and attraction of maturity. those who have developed fastest are often, for that very reason, kept backward in school learning. often they are nervously the least stable. now that large schools for girls on the model of our public schools are become the fashion, such precociously developed and nervously unstable girls are apt to find themselves in the very uncongenial society of little girls of twelve or thirteen. the elder girls commonly hold aloof, while mistresses are apt to view this precocious development with disapproval, and to attempt to retard what cannot be retarded by insisting that the young woman has remained a child. i remember being called in consultation by a surgeon who had been asked to operate for appendicitis upon a girl of fourteen. i found a tall, well-grown girl, with an appearance and manner that made her look four years older. i could find no signs of appendicitis, but i learned from her that she had been for three months at a large girls' school, and that in a few days' time her second term was due to begin. as we became friends, she agreed that her appendicitis and her resolve not to return to school, where she was unhappy, were but different ways of saying the same thing. she was an only child who had travelled a great deal with her parents, had found her interests in their pursuits, and had grown backward in school work. the little girls with whom she was expected to associate seemed to her mere children. the elder girls did not want her friendship, and snubbed her. i prescribed a change to a small boarding-school with only a few girls, where age differences would not matter so much, and where she could make friends with girls older than herself, though not more mature. into their school life we need not follow the children. happily the time is past when schoolmasters and schoolmistresses were incapable of understanding their charges, and confounded nervous exhaustion with stupidity or timidity with incapacity. and so we come back to the point from which we started: the nervous infant, restless, wriggling, and constantly crying! the nervous child, unstable, suggestible, passionate, and full of nameless fears! the nervous schoolboy or schoolgirl prone to self-analysis, subject-conscious, and easily exhausted! and how many and how various are the manifestations of this temperament! refusal of food, refusal of sleep, negativism, irritability, and violent fits of temper, vomiting, diarrhoea, morbid flushing and blushing, habit spasms, phobias--all controlled not by reproof or by medicine, but by good management and a clear understanding of their nature. the hygiene of the child's mind is as important as the hygiene of his body, and both are studies proper for the doctor. neuropathy and an unsound, nervous organisation are often enough legacies from the nervous disorders of childhood. index abdomen, prominent abdominal symptoms of neurosis accent, local, facility with which acquired acetone, in breath and urine during cyclic vomiting acidosis, accompanying cyclic vomiting action, imitativeness of liberty of, in early childhood activities in the nursery not to be restrained without intervention of grown-up people wonderful nature of adenoid vegetations, night-terrors aggravated by removal of, in treatment of enuresis adolescence, and education on sexual matters adults, child in relation to the society of Æsthetic sense, in early childhood affection, in the child air hunger, in cyclic vomiting air swallowing, habitual action of albuminuria, associated with faulty posture cause of, in neuropaths allimentary disturbances, symptom of alkali, in treatment of cyclic vomiting anæmia, of neuropaths anorexia nervosa a case illustrating apnoea, fatal cases of following burst of crying twitching of facial muscles in appetite, emotional states affecting loss of, case illustrating causes and characteristics treatment means of stimulating nature of the sensation of apprehension, causes of growth of neuroses in atmosphere of artificial feeding aspirin asthma, treatment of attention, child's love of attracting examples of authority, delight in defying over-exercise of, by parents, results of babies. _see_ newborn baby backward development signs of "bad form" bad habits bath, baby's first experience of bed, dislike of how overcome efforts to resist preparation for bedroom, airing and temperature of bedtime management at bed wetting. _see_ enuresis behaviour. _see_ conduct bladder, hydrostatic distension of, for enuresis boarding-schools, object of bodily ailments, and instability of nervous control, connection between _see also_ disorders body, and mind, development of development of environment influencing effect of mind on gradual alterations in the shape of infantile characteristics in later childhood bone, and muscle, changes in, in infantile children books, child's attitude towards educative value of kinds most suitable brachial nerve, pressure causing tetany breast-feeding, best time for causes of failure in observations on _see also_ lactation breath-holding action during fatal cases of phenomena of bromides, administration of to newborn baby cajoling, futility of calcium bromide, in treatment of spasms calcium metabolism, disturbance of care, ill effects of excess of carpo-pedal spasm catarrhal infections connection of rheumatism with, cerebral anæmia cerebral circulation, stagnation of cerebral exhaustion. _see_ mental exhaustion cerebral functions, rapid growth of unstable in the child _see also_ mental character, formation of during school life home influence in the development of ideals of, how inculcated children's parties, disadvantages of chloral, administration of to newborn baby in treatment of spasms chorea, and rheumatism, association between symptom of cerebral irritability treatment of chvostek's sign, characteristics and nature of circulation, cerebral, stagnation of nervous control of claustrophobia clothing, kind suitable new, child's delight in coaxing, futility of cold douches, improving vasomotor tone coldness of extremities conduct, control of, factors in errors of, and sexual instincts control of correction of due to faults of management in neuropathic children excessive introspection influencing ideals of, how inculcated influence of environment on influenced by suggestion mother's influence on of neuropaths perverse suggestion in the control of constipation, mental causes of negativism in perversion of suggestion a common cause of suggestion in relation to constitution, delicacy of convulsions, fatal cases of generalised convulsive disorders cough, nervous counter-opposition, child's opposition growing with crying, constant formation of habit of in emotional and excitable children management of mechanism of phenomena of purposeful cyclic or periodic vomiting. _see_ vomiting day-dreams, indicating nervous temperament deceit defæcation, inhibition of painful delicacy of constitution delirium, tendency to depolarisation of ideas depression, recurrence of periods of dexterity, lack of manual, advantages of toys developing diaphragm, spasm of diarrhoea, mucous diet, likes and dislikes for articles of opposition to of newborn child, changes in _see also_ food digestion, emotional states affecting digestive disorders, mental causes of digestive neuroses digestive system, symptoms of extreme sensibility of dirt eating discipline in later childhood in the school misdirected efforts at enforcing severe, effects of dishonesty disobedience, growth of habit of personality and perverse attitude of reproof and coaxing causing disorders, ætiology of associated with neurosis common environment as cause and cure of of neuropaths treatment of trifling diuresis, excessive doll, child's care of, an example of imitativeness educative value of douches, cold, improving vasomotor tone dover's powder dreams, nature of, indicating nature of mental unrest drugs, in sleeplessness ductless glands, in relation to infantile characteristics dullards dyspepsia, complications of course and effects of mental aspects of nervous symptoms of symptoms in newborn infant treatment early childhood, care during impulse of opposition in love of power in early childhood, nervousness in reasoning power in three common neuroses of toys, books, and amusements in _see also_ newborn baby education, aim of by games and toys on sexual matters educative value, of books, games, and toys emotional states, appetite affected by causing spasm management of of neurotics, exaggeration of physical disturbances due to producing laryngismus stridulus emotional storms endocrine glands enuresis, causal factors in characteristics and peculiarities of condition of urine during mental aspects of mistakes in treatment of perversion of suggestion as cause of removal of tonsils in treatment, essentials in hypnotic suggestion in methods of environment, body moulded and shaped by change of, beneficial effects of effect in developing child's powers effect on common disorders errors of, and neuropathic children essentials of faulty contact with, in neuropathic children for neuropaths influence on conduct in later childhood influence on mental processes influence on personality irritating nature of the adult mind in of the home, reflected in the child of school life stimulus of susceptibility to influences of epilepsy, cyclical character of evil, inborn disposition to excitable children, management of exercise, sleep in relation to exhaustion. _see_ mental exhaustion expostulation, frequent, bad effects of _see also_ reproof expressions, to attract attention facial muscles, twitching of associated with apnoea fæces, incontinence of fainting fits, cause and characteristics control of of neuropaths fatigue, mental, physical, and visceral fats, lowered tolerance to faults, correction of not corrected by too frequent reproof fear, causes of phenomena of prominent psychical symptom of neuropathic children treatment of feeding, artificial factors in of newborn infant, regularity in fertilisation, method of imparting knowledge of food, force of suggestion in relation to healthy desire for likes and dislikes for how overcome phenomena of the desire of refusal of nervous causes of persistent, factors encouraging suggestion in relation to treatment of force and cajoling, futility of freud, teaching of functional disturbances, in combination with organic disease gait, peculiarity of games, educative value of gastric disturbances gastric juice, psychic secretion of gastric symptoms, of neurosis gastro-intestinal derangement, causes of environment as cause and cure of gentleness, inculcation of girls' schools glottis, spasm of, strong emotion causing "good form" grasping habit, reproof in relation to growing pains habit spasms, age of appearance of cause of definition of examples of spread of suggestion in relation to treatment of habits, regulation of suggestion in relation to habitual actions, infant's pleasure in mental unrest in relation to of the parent, reproduction in the child varieties and characteristics habitual wakefulness hands, control of movement of expressionless happiness and contentment, of child when playing alone headache, periodic. _see_ migraine heat and cold, newborn baby in relation to heat and flushing, sudden sensations of heredity, and temperament and type of child nervous disorders in relation to home influence, in development of character reflected in the child hunger, of the newborn baby hypnotic suggestion, in treatment of enuresis hypnotics hysteria, age of appearance of suggestion in relation to symptoms of hysterical girls, characteristics of ideals, inculcation of ideas, polarisation and depolarisation of illness. _see_ sickness imagination, abnormal, correction of child's stories and tales in relation to developed by toys imitativeness, age at which apparent extent of illustration of lack of of action of speech tell-tale child an illustration of incontinence of urine incorrigible children infantile characteristics, ductless glands in relation to nervous system in relation to infective disorders, convalescence from producing nervous symptoms relation of neurosis to inflammatory reactions insomnia. _see_ sleeplessness intellect, compared with physique intelligence, in early childhood intestinal disturbance of neurosis symptom of intoxications, violent reaction to introspection, and neuropathic children excessive, evidences of influencing conduct irritation, child to be free from joint pains kindergarten school, artificial symbolism of kindness, inculcation of lactation, care of child during care of mother during causes of failure in establishment of tongue-tie in relation to laryngismus stridulus. _see_ breath-holding later childhood, infantile characteristics in management in mental backwardness in likes and dislikes lordosis and neurosis producing albuminuria manual dexterity, advantages of massage, improving tone of muscles medicines, sensitiveness to melancholy children mental aspects, of digestive disorders of enuresis of management in early childhood mental backwardness, and infantile characteristics in later childhood mental disturbances, cyclical character of indicating neuropathic tendencies irregularities of sleep due to psycho-analysis of mental exhaustion, during convalescence from infective disorders easily produced in nervous children mental irritability, chorea a symptom of mental life of the child mental power, active before beginning of speech in early childhood mental processes, development of age at which most apparent in later childhood effect of unconscious suggestions on heredity in relation to influence of environment on mental training compared with physical training objects and advantages of mental unrest, avoidance of crying in relation to digestive disturbances due to growth of neuroses in atmosphere of habitual actions in relation to in the adult in the child negativism due to of newborn infant, effects of _see also_ nervous unrest micturition, functional disorder of negativism in regulation of _see also_ enuresis migraine, periodic vomiting associated with symptom of nervous exhaustion mind, and body, development of effect on the body vigour of, in relation to that of body money, theft of montessori system of training moral degeneracy moral standard of school life moral training importance and effects of negative virtues and objects and advantages of parents' responsibilities in morals, public opinion forming code of morbid introspection mothers, ability and inability to manage children attitude in regard to temperament of child care of, during lactation conduct of child influenced by inability to understand nature of child's disorders influence of, on tone and manner of speech mental environment of child created by personality of relation to the child motionless children mouth, habit of conveying everything to, cause of movements, precision of purposive, development of self-command of muscular atrophy, and neurosis muscular system, changes in infantile children weak development of muscular tone, how improved myopathy, primary nasal obstruction and failure of lactation night-terrors aggravated by natural history, sexual matters taught by naughtiness, child's delight in naughty, use of the term negative virtues, and moral training negativism, cause of characteristics factors developing in constipation in micturition spirit of treatment of want of sleep depending on nerve centres, controlling movement, development of nervous control, instability of, connection between bodily ailments and nervous cough nervous disorders, and psycho-analysis common, causes, characteristics, and treatment frequency of nervous exhaustion, cyclic vomiting and migraine symptoms of nervous instability, stigma of nervous system, abnormal in children in relation to cyclic vomiting increased irritability of infantile characteristics of nervous unrest, environment in relation to factors increasing manifestations of recurrence of periods of symptoms of _see also_ mental unrest nervous vomiting. _see_ vomiting nervousness, and digestive disorders and neuropathy in early infancy in older children parents' attitude causing nettlerash neurasthenia neuropathic children, common symptoms of conduct of faulty contact with environment in fear the prominent symptom of introspection and self-consciousness of management of training of neuropathic tendencies, evidence of, in older children neuropaths, adult faulty management in child life leading to phenomena of phobias of selection of suitable environment for symptoms of neuroses, and psycho-analysis association of albuminuria with constipation frequently due to examination of growth in atmosphere of unrest and apprehension relation of, to infection of the body treatment of neurotics, and physique characteristics exaggeration of emotions of newborn baby, administration of sedatives to artificial feeding of breast feeding of case of effect of mental unrest on first impressions of formation of habits of sleep and crying in heat and cold in relation to hunger of induction of the sucking movements of of nervous inheritance personality of prevention of restlessness and crying reduction of sense stimuli in reflex action of sucking in sense of taste of symptoms of dyspepsia in times of feeding weaning of night-terrors, aggravation of, causes of of neuropathic children nursery, activities in, child's interest in importance of child's being alone in observations in nursery life, advantages of nursery psycho-therapeutics nurses, ability and inability to manage children influence of, on tone and manner of speech mental environment of child created by personality of nursing, during sickness of the newborn infant obedience and perverse pleasure growth of obsession of bed wetting opposition and counter-opposition during sickness force of, factors influencing development habit of impulse of love of, in early childhood to food organic disturbance, in combination with functional trouble pain, frequent loss of sense of, in neuropaths pallor sudden attacks of palpitation, example of visceral fatigue parathyroid glands, function of parents, and children, conflict between and silence on sexual matters habitual actions of, reproduced in the child mental attitude of, in relation to conduct over-exercise of authority by, results of responsibilities in moral training of child suggestions unconsciously conveyed by, evil results of parties, disadvantages of patient, temperament of, physician in relation to pelvis, development of peripheral nerves, increase in irritability and conductivity of personal adornment, delight in personality, and disobedience child's own conception of environment influencing in early childhood of newborn baby perspiration, abundant, sudden attacks of, phobias, characteristics and varieties frequency of treatment of physical defects, accompanying neurosis physical disturbances, due to emotion physical exercise, lack of, causing want of sleep physical fatigue, easily produced in nervous children physical phenomena of neuropaths physical training, objects and advantages of physician, and the temperament of his patient examination by diagnosis by difficulties of physique, intellect compared with pica and dirt eating picture books, educative value of kinds most suitable play, happiness of child during in the nursery with grown-up persons pleasure, sense of, in early childhood polarisation of ideas postural albuminuria posture, faulty prevention of power, child's love of precision of movement, development of psycho-analysis, dangers of observations on public schools, character and effects of punishment, deserved and undeserved frequent, disadvantages of observations on purity, inculcation of high ideals of, purposive movements, earliest, cause of encouragement of pyloric spasm pyrexia, organic disease in relation to rational hygiene reasoning power, active before advent of speech factors influencing development of regulation of habits repression, by older children of younger reproduction, method of imparting knowledge of reproof, cases in which useless causing disobedience effects of extreme sensitiveness to perverse pleasure of too frequent repetition of, futility of restlessness, during sickness rewards, use and dangers of rheumatism, and chorea, association between characteristics in childhood subacute treatment of rickets, mental and intellectual condition in in infantile children occurrence with spasmophilia right and wrong, appreciation of, in early childhood round shoulders st. vitus's dance salts, excretion of school life, and sexual matters moral standard of moral training and moulding of character during of boys of girls schools, public, character and effects of scoliosis, prevention of secretions, anomalies of self, child's conception of self-conscious children, complaints of self-consciousness, of neuropathic children self-discipline, development of self-education, in the nursery self-feeding self-preservation, morbid instinct of self-sacrifice, not to be expected in early childhood sensations, acuteness of bodily, of neuropaths sense perception, of neuropaths sense stimuli, cultivation of perception of in newborn babies sexual matters, education on method of errors of conduct and parents' silence in regard to psycho-analysis in relation to school life in relation to sickness evil effects of suggestions unconsciously conveyed by parents during management during nurse and mother during opposition during temperature during therapeutic measures in therapeutic procedures concentrating child's mind on his symptoms sleep, estimation of the amount of force of suggestion in relation to formation of habit of light and broken, cause of of newborn infant sound, beneficial effects of sleeping attire sleeplessness, breaking of the habit of causes and characteristics drugs in in older children lack of physical exercise causing suggestion in relation to treatment of sleep-walking snatching, habit of spasmophilia ætiology of drugs in treatment of occurrence of rickets with spasms, control of fatal speech, beginnings of facility with which local accent is acquired imitativeness of infant's reasoning power present before advent of influence of nurses and mothers on tone and manner of spinal deformity, prevention of spinal muscles, atrophy of spoon feeding status catarrhalis status lymphaticus story-telling sucking movements, of newborn child, induction of _see also_ lactation suggestion, and habit spasms appetite in relation to bed wetting in relation to bodily habits in relation to characteristics conduct influenced by constipation in relation to effect on mental processes food in relation to force of, on child's mind hysteria in relation to perverse influence of bad habits due to causing constipation want of sleep depending upon refusal of food in relation to sleep in relation to susceptibility to unconsciously conveyed by parents, evil results of suicide suspicions, aroused in the child syncopal attacks, causes and characteristics tactile sensation. _see_ touch taste, perversion of sensations of how controlled sense of, in newborn infant teething convulsions tell-tale child, characteristics temperament, diversity of heredity and mother's attitude in relation to of the patient, physician in relation to temperature, during sickness inexplicable rises in terror, causes, of tetany, liability to, in increased irritability of nervous system pressure to brachial nerve causing theatres, disadvantages of theft therapeutic conversation thigh rubbing, avoidance of characteristics habitual action of thorax, development of thumb sucking persistence of the habit tongue-tie, in relation to lactation tonics tonsils, removal of, in treatment of enuresis touch, sense of, cultivation of early development of organs with greatest development of toys, child's interest in educative value of kind most suitable training, early, importance and object of trousseau's sign, nature and production of truthfulness inculcation of twitching of facial muscles tyranny of tears unkindness, habitual, of children to others untruthfulness over-exercise of authority encouraging urine, condition in enuresis incontinence of, methods of treatment _see also_ enuresis increased secretion of irritation of vasomotor instability conditions indicating in neuropaths vasomotor tone, how improved virtuous, definition of the term visceral fatigue, easily produced in nervous children vocabulary voice, tone of voluntary movements, development of cerebral centres controlling vomiting, cyclic ætiology of age at which it occurs case illustrating causes and characteristics class of child affected by condition of the child during frequency of attacks migraine in association with nervous system in relation to treatment of waking states weaning, difficulty in will, strength of, absence in childhood work and play, differentiation between writing, correct posture during transcriber's notes the following typographical errors were corrected: page : 'sensisive' changed to 'sensitive'. page : 'self-abnegnatio'n changed to 'self-abnegation'. page : fixed 'and and'. page : 'acount' changed to 'account'. first page of index ( ): 'ullimentary' changed to 'allimentary'; also 'ilstrating' channged to 'illustrating'. transcriber's note: do not attempt these formulas. candy medication by bernard fantus, m. d. professor of pharmacology and therapeutics, college of medicine, university of illinois, chicago. [illustration] st. louis c. v. mosby company copyright , by c. v. mosby company _press of c. v. mosby company st. louis_ preface. candy medication has given such delightful results in practice among children that the author believes it should be more widely known and used. a formulary to serve as the common meeting ground for the prescribing physician and the dispensing pharmacist seems absolutely necessary to make this form of medication more generally available; and it is mainly to supply this formulary that this little book has been published. researches conducted by the author in the pharmacologic laboratory of the university of illinois during the past five years, as well as the experience gained by the use of this form of medication in private practice, form the basis of this publication. to give the best results, the sweet tablets described in this formulary should be freshly prepared on physician's order; thereby securing efficiency and palatability to the highest degree, and enabling the physician to prescribe the dose and combination needed for the particular case in hand. to bring these tablets into the category of extemporaneous preparations, the author has elaborated the process of "fat covering" which makes the preparation of these tablets no more difficult than the making of pills or of suppositories. in the pages that precede the formulary, an attempt has been made to present the principles that have been used in the elaboration of the formulae, so that formulae for other medicaments suitable to this form of administration may be developed. concise directions on the care and use of the tablet machine have been included, to enable any pharmacist equipped with an inexpensive tablet machine to prepare these tablets without difficulty. the author is keenly aware of the fact that there are probably still some imperfections in the formulae given herein; though he has spared neither time nor labor in making them as perfect as possible. therefore, comments and criticisms, as well as suggestions, are most welcome, and will receive careful consideration. it is the author's hope that this booklet may be instrumental in robbing childhood of one of its terrors, namely, nasty medicine; that it may lessen the difficulties experienced by nurse and mother in giving medicament to the sick child; and help to make the doctor more popular with the little ones. bernard fantus, m.d. _chicago, march, ._ contents. chapter page i. historical introduction ii. tabellae dulces iii. the uses of sweet tablets iv. the making of sweet tablets v. the tablet machine vi. the construction of formulae for sweet tablets choice of flavor subduing of tastes choice of color vii. formulae for the preparation of sweet tablets viii. formulae for stock preparations references index candy medication chapter i. historical introduction. the idea of presenting medicine in candy form is really very old. the term confection, which originally meant a medicinal compound being derived from the latin word "_conficere_," to put together, has been applied since the days of classical antiquity to mixtures of medicinal substances with saccharine matter. the only official relics of this once very extensive class of preparations are the confection of rose and the confection of senna; both of which, however, are also practically obsolete. the reason for this is not difficult to find. neither of them come up to our modern ideas of a confection. we may officially call them a confection, but a youngster would be disrespectful enough to disagree with the pharmacopoeia. more closely akin to candy are lozenges, and yet they are not real candy. the only one among them that is pleasant is the santonin lozenge; and it is the only one that is popular. an especially good imitation of candy form are the deservedly popular so-called german worm lozenges. it was acquaintance with these that led the writer to seek for other real candy medicaments. he could find only two such upon the market: viz., calomel tablets under the name of "aromatic calomel," and phenolphthalein tablets under various fanciful trade-names, such as "purgen," "phenolax," etc., unless "candy cathartic cascarets," and the french candy laxative known as "tamar indien" were also to be included. * * * * * convinced that administration in candy form would be ideal for children, the author took a number of years ago a course of instruction with a candy-maker, in the hope of finding in the confectioner's art some new form of pleasant administration for medicine. he made sulphur taffy and cod-liver oil chocolate creams;[ ] but these and a large number of other attempts were unsuccessful. it may be of interest, in this connection, to note that, in , sir james sawyer[ ] published in "the lancet" a process for the production of what he calls "cremulae" or medicated chocolate creams. they were prepared by evaporating a mixture of sugar and of milk to the consistency of paste, in which various medicaments might be incorporated, and which is then covered with chocolate, as in the popular chocolate drop. this is, as will be seen, a troublesome process. the author's studies in the candy shop seemed to point to "fondant" as the most suitable candy form for purposes of medication. "fondant", however, has the disadvantage of becoming hard with age. free from this objection and closely similar to the "fondant" is a rather lightly compressed tablet made of finely powdered cane sugar. and so finally the tablet form was chosen as the best and most convenient for candy medication--a form which was already in successful use, as has been stated, for the administration of calomel and of phenolphthalein. for such tablets the term _tabellae dulces_,[ ] or sweet tablets, might be proposed. chapter ii. tabellae dulces. to be successful, sweet tablets must meet the following requirements: . they must be perfectly delicious sweets, attractive in form, color, and odor; and free from the slightest suspicion of disagreeable or medicinal taste. . they must disintegrate rapidly in the mouth; for a sick child will usually not suck candy as a healthy youngster would. . to constitute a real advance in therapeutics, it must be possible for the average pharmacist to prepare them extemporaneously, so that the physician may be able to fit the medicament to suit the case, and that the pharmacist may not be forced to carry in stock a large assortment of these more or less perishable goods. in view of these exacting requirements, it may seem remarkable that over fifty different medicaments are at present available for administration in the form of sweet tablets. this has been accomplished by taking advantage of the fact that some medicines are practically tasteless; that modern synthetic chemistry has enriched our resources in this direction by the production of a large number of tasteless, or almost tasteless, and yet active substances; and that many of the isolated active principles of drugs are easily disguised. in some cases a chemical trick is successful, e. g., using a little alkali or a little acid to render the substance less soluble in the mouth. some of the bitterest alkaloids, e.g., strychnine, have been rendered available for candy medication by the use of finely powdered fuller's earth, or of lloyd's reagent, to be described later. quite a number of almost insoluble substances of slight but lingering taste can be made perfectly pleasant by saccharinization. chapter iii. the uses of sweet tablets. it may seem strange that modern pharmacy which boasts of so many elegant and palatable preparations suitable for adults, has thus far done so little to render medicine more acceptable to children; and yet attractiveness and palatability are even more important for the little ones than for the grown-ups. syrups have hitherto been our chief aids in making medicines more pleasant for children. unfortunately, however, many a child has had its palate offended by liquid medicines to such a degree that it abhors spoon-medicine of any kind, and will struggle even against the most palatable. when one witnesses the struggling of the average child against the average medicine, one cannot but wonder whether at times the struggle does not do more harm than the medicine can do good, and wish that we had other means of administering medicines to the little ones. as all children love candy, this would seem the form most desirable for them. for one who has not used candy medication there is a revelation in store in the positive enjoyment and eagerness with which children take these sweet tablets. and many a petted child that has grown up into a sensitive woman, who believes she cannot swallow a pill, also cannot and will not take medicine. it so happens that just these are often excessively fond of candy and will take candy medicine. another use for candy medication is in the treatment of the insane, who frequently will not take medicine, but may take it in candy form. it may be of interest to see how many indications may be met, confining oneself entirely to the list of candy medicaments: . for effect upon the alimentary tract: _absorbent:_ charcoal. _antacid:_ chalk. magnesia. sodium bicarbonate. _emetics:_ apomorphine. tartar emetic. emetine. _antiemetics:_ cocaine. anaesthesine. morphine. bismuth subnitrate or subcarbonate. chalk. cerium oxalate. _antidiarrheal:_ bismuth subnitrate or subcarbonate. tannalbin. morphine. chalk. _cathartics:_ calomel. mercury with chalk. phenolphthalein. elaterin. resin of podophyllum. resin of jalap. senna. sulphur. _antispasmodic:_ atropine. _intestinal antiseptic:_ magnesium salicylate. mercurials. lactic acid ferment. _anthelmintic:_ santonin. . for effect upon the respiratory system: _expectorants:_ apomorphine. emetine. terpin hydrate. sajodin. _antitussic:_ heroine. morphine. sabromin. _antispasmodic:_ atropine. . for effect upon the circulatory system: _circulatory stimulants:_ digitalis. strophanthin. atropine. strychnine. caffeine. _circulatory depressant:_ aconitine. _vaso-dilator:_ nitroglycerin. . for effect upon genito-urinary system: _diuretic:_ diuretin. caffeine. _urinary antiseptic:_ hexamethylenamine. . for effect upon skin: _diaphoretic:_ pilocarpine. dover's powder. _anhydrotic:_ atropine. . for effect upon nervous system: _depressants:_ morphine. hyoscine. sabromin. sulphonmethane. adalin. _stimulants:_ atropine. cocaine. strychnine. caffeine. . antipyretics: acetphenetidin. antipyrin. acetylamidosalol (salophen). aconitine. aristochin. . hematinics: iron, reduced iron, iron carbonate, saccharated. arsenic. . tonics: iron, quinine, strychnine. . specifics: _in malaria:_ aristochin. saloquinine. arsenic. _in syphilis:_ mercurials. sajodin. _in rheumatic fever:_ acetylsalicylic acid (aspirin). acetylamidosalol (salophen). magnesium salicylate. _in myxedema:_ thyroid. of course, a large variety of combinations of these could be elaborated. it, therefore, seems established that we have, in candy medication, a method of fairly extensive applicability; an almost complete therapeutic armamentarium of the greatest possible value in the treatment of children. for the tiny infant this method is, of course, unsuitable as well as unnecessary. as soon, however, as the youngster commences to know what candy is, it is ready for candy medication. it is particularly during the ages of from three to ten that this form of administration is indicated. several objections have been raised against this method. perhaps the most serious one lies in the danger of poisoning, from the fact that children enjoy these tablets so much that they are likely to eat a large number of them at one time, should the mother be careless enough to leave them within reach. the only way to prevent such an occurrence is not to prescribe more tablets than would constitute a safe dose should all of them be taken at one time. it is better to have the patient get a new supply daily than to have a single case of death or serious disturbance occur from this source. another objection that has been raised is that the dose of some of the medicines is very small. in the case of such remedies as sulphur and chalk the author admits that the dose is perhaps too small to be of practical importance. in the case of most other medicaments, however, the smallness of dose is of advantage rather than of disadvantage, in that it necessitates administration at short intervals. if the administration of small doses frequently repeated until the desired effect is obtained is a good principle in practice, it is particularly so in pediatrics. for are not all the vital processes of the child much more rapid than those of the adult; are not its bowel movements, its urinations more frequent, does it not need nourishment more often? then why not medicine? chapter iv. the making of sweet tablets. it is generally supposed that tablet making is an art, requiring special expertness and expensive machinery. now while both of these ideas are correct when the preparation of a large variety of tablets and of large quantities is contemplated, they are erroneous in regard to the making of prescription quantities of these sweet tablets, which present a comparatively simple and relatively uniform problem in tablet making. though the process of making moulded tablets was introduced by dr. robert m. fuller of new york before the academy of medicine on february , , in a paper entitled: "dose-dispensing simplified,"[ ] the simplification was evidently not such that druggists could notice it; for moulded tablets have not become popular among them, perhaps mainly because they require drying. likewise are compressed tablets, which were introduced even earlier by professor brockeden of england in , considered unsuitable for extemporaneous preparation, as granulation of the powder by moistening is believed to be necessary; and this, of course, also requires drying. a step in the direction of rendering tablet making available for extemporaneous preparation was made in by a. schleimer[ ] by advocating the use of cacao butter in lieu of granulation of the powder and subsequent drying. this brings tablets into the category of extemporaneous preparations. all that is necessary is to add three percent of cacao butter to the powder, and it is ready for immediate compression in a tablet machine. having found that cacao butter is liable to become rancid on keeping of some tablets made with it, the author experimented to find a substitute devoid of this tendency, and found it in paraffin of low melting point.[ ] for tablets that are not to be kept for any length of time, cacao butter is preferable, as it melts readily and is digestible. the amount of paraffin, however, that enters into the composition of each tablet is so small that in spite of its indigestibility, it seems that it could not meet with any but theoretic objection. either of these materials, in form of fine shavings, is added to the extent of three to five per cent. with just sufficient trituration to distribute fairly well. excessive trituration lessens the efficiency of the lubricating agent. if the tablet has a tendency to stick to the punches, the material can be worked better if a little talcum, say three per cent. is added to the powder by stirring it in with a spatula rather than by trituration. this process renders tablet making no more difficult or time-consuming than the making of pills or capsules. * * * * * the author has succeeded in still further simplifying the process by the preparation of what he would propose to call "fat sugar." having noticed that the addition of, say, per cent. of powdered cacao to sugar forms an almost ideal powder for immediate compression in the tablet machine, the idea occurred to him to reproduce, as nearly as possible, the physical condition of cacao by covering each particle of powdered starch with a thin layer of fat, which can readily be done by triturating starch with liquid petrolatum. while other fat, such as cacao butter, "crisco" or paraffin, might be used for this purpose, by dissolving the fat in ether and thus distributing it over the starch, permitting the ether subsequently to evaporate, the author has found that liquid petrolatum, part, distributed over parts of starch forms a powder which added to sugar in proportion of about twenty per cent. renders it admirably suitable for compression in a tablet machine. the starch might be sweetened by previously triturating it with an alcoholic solution of saccharin and permitting the alcohol to evaporate; though this sweetening is not essential. for starch, thus prepared, the author proposes the name "fat starch", the formula for which will be found in chapter viii. sugars containing twenty per cent. of "fat starch", are ready for immediate compression in the tablet machine; and admit of admixture of a moderate amount of medicament without losing this quality. if a large amount of medicament is to be incorporated, then an additional amount of "fat starch" should be allowed. sugars containing "fat starch" the author has called "fat sugars" for want of a better name. he is aware of the fact that petrolatum is not a fat in the true sense of the word. nevertheless it is, no doubt, its "fatty" nature that does the work; other fatty substances, such as cacao butter or "crisco", producing the same result as far as rendering the powder suitable for compression in the tablet machine is concerned. liquid petrolatum has the advantage over these of being devoid of tendency to rancidity. excessive trituration interferes with the efficiency of the fat starch, evidently by distributing the fat all over the powder, rendering it homogeneous, which is inimical to tablet making. therefore in case of the red fat sugar which is used as a vehicle for poisonous medicaments that require very thorough trituration, it is recommended that the fat starch be added after the trituration. the author would suggest that the pharmacist prepare the various fat sugars described in chapter viii and that he keep them on hand, in a cool and _dark_ place, adding the medicament as prescribed by the physician, making use of chapter vii for guidance in the elaboration of individual formulae. chapter v. the tablet machine. the groundlessness of the second objection to tablet making by retail druggists, namely, the necessity of possessing expensive machinery, can perhaps best be shown by the illustrations here given. the simplest and yet practical form of tablet machine known to the author is the "no. " machine of whitall-tatum company of philadelphia (fig. ). the price of this machine is about ten dollars. its chief disadvantage is that it works rather slowly, as the powder must be put into the die by hand with a small tool furnished with the machine. an automatically feeding machine of reasonable price is the "eureka" hand tablet machine, furnished by the f. j. stokes co., of philadelphia (fig. ). this machine may also be obtained for motor power. detailed directions for the putting up and the use of these machines seem unnecessary here as they accompany the machine when sent out by the manufacturer. a few points on the care of the tablet machine may, however, be brought out in order to save the novice trouble and mishaps. all compressing machines for tablet making consist essentially of a die and two punches, an upper and a lower. it is important that these be kept scrupulously clean and free from rust, nicks and scratches; for unless these parts be perfectly smooth it is impossible to get them to work properly. when not in use, they should be kept completely covered with vaselin or else immersed in liquid petrolatum, in order to protect them against rust. when required for use, the grease is removed from them as completely as possible by means of a soft cloth. [illustration: fig. a simple yet practical form of tablet machine.] in putting the die and punches into the machine, it is best to put in the lower punch first, making sure that it has been pushed completely down into its socket. then put in the die, so that the top of the die be exactly flush all around with the table of the machine. see to it that the face of the lower punch be exactly flush with the top of the die when the punch is at its highest point. then insert the upper punch in its socket; and let it enter the die before locking it in place, so as to insure perfect alignment. [illustration: fig. . the eureka hand tablet machine. an automatically feeding machine of reasonable price.] when die and punches are to be removed, take out the upper punch first, then the lower punch and die, which may come out suddenly and be injured by knocking against the upper punch if the latter be still in place. when particles of the powder stick to the die or punches, they should not be scraped off with a hard instrument, as this is liable to scratch, but should be wiped off with a soft, slightly moistened cloth. to prevent sticking, a little talcum may be used, sprinkled over the powder and lightly mixed by stirring with a spatula. when the upper face of the tablet splits off, we speak of "capping." to overcome this, ten per cent. of fat starch may be added to the powder. should "capping" still occur, the amount of fat starch might be increased. "capping" may also be due to the use of excessive pressure. it may furthermore be due to die or punches being worn or damaged. when this has occurred, the best thing to do is to get a new set of punches, or to have the damaged one refinished by an expert mechanic, preferably the makers of the tablet machine. it would lead us beyond the scope of this work to give detailed directions for making tablets of all kinds. a pharmacist who has equipped himself with a tablet machine and has developed the ambition to make a general line of tablets[ ] may be referred to mr. joseph r. wood's book[ ] on this subject. chapter vi. the construction of formulae for sweet tablets. choice of flavor. there are quite a number of medicines sufficiently free from taste and odor to be made perfectly pleasant by the mere admixture of sugar and of flavoring. these can, of course, be prepared with any flavor desired. in the formulary, rose has been chosen as the flavor under these circumstances, but any other flavor may be used instead. substances that have a slightly acrid taste are generally best disguised by peppermint. for sour taste, lemon is best. wintergreen was chosen as the flavor for salicylates. substances that have a slightly bitter taste are best disguised by "vanilla cacao sugar." for drugs that, in addition to a slightly bitter taste, have an odor that needs disguising, "cinnamon cacao sugar" is to be preferred. the subduing of tastes. there are quite a number of drugs that have a tendency to leave a rather persistent disagreeable after-taste, drugs of slight solubility, particles of which remain on the tongue longer than the sugar does, so that their taste lingers after the taste of the sugar has disappeared. for such drugs saccharinization solves the problem of candy medication. the saccharin will be most efficient, as the author has shown by repeated experiments, if it is directly incorporated with the drug in solution rather than in dry form. saccharinization is, therefore, carried out in the formulary by triturating the drug with a saturated ( per cent.) alcoholic solution of saccharin, and permitting the alcohol to evaporate subsequently. the drying may be expedited by using a hot mortar. when alcohol is not permissible, as in the case of "alcresta" preparations (see below), dry saccharinization must be used instead, that is, triturating the drug with saccharin, preferably a to trituration. likewise when time does not permit moist saccharinization, triturating the substance with a somewhat larger amount of saccharin will answer the purpose. a second expedient for the subduing of taste is fat covering, which consists of triturating the drug with liquid petrolatum or other fat, e. g., crisco in ether, and permitting the ether to evaporate. the thin film of fat left on the drug delays its solution to a slight degree, yet sufficiently to reduce the taste, so that certain drugs--such as aspirin, digitalis, diuretin--can be administered in the form of sweet tablets in useful dose. in these cases, saccharinization and fat covering combined give the best results. * * * * * most of the alkaloids can be administered in candy form by saccharinization with or without additional fat covering, and, in the case of some, the addition of sodium bicarbonate is still further useful in lessening the solubility, thereby subduing the taste. only in the case of the bitterest alkaloids such as strychnine and of alkaloids that have to be given in large doses such as quinine are different expedients necessary. for quinine, aristochin or saloquinine solve the problem. for strychnine, lloyd's "alcresta" strychnine gives good results. in , john uri lloyd[ ] of cincinnati discovered that the addition of fuller's earth to alkaloids almost completely abolished their bitter taste. he found on further research that this activity resided in the finest particles, especially those of colloidal dimensions, which could be separated from the coarser portion of fuller's earth by elutriation. by means of this powder, now known as lloyd's reagent, it is possible to obtain the bitterest alkaloids, even strychnine, in almost tasteless form. that this strychnine combination is still active, can be proved by the fact that it will kill a dog almost as readily as the uncombined strychnine. lloyd has coined the name "alcresta" for these alkaloidal combinations; they are marketed by ely lilly and company. the combination of the strychnine with fuller's earth is destroyed by alkali and by alcohol. hence alcohol must not be added to the powder after the alcresta combination has been incorporated. the addition of a little acid lessens the bitterness of the combination by lessening solubility in the mouth. the addition of acid is also of advantage to lessen the solubility in the saliva, and with it the taste, of such resinous bodies as the resin of podophyllum. choice of color. to indicate tablets containing poisonous substances, a dark red color is chosen, unless cacao disguises the taste better. it would be advisable not to prescribe more than a small number of such tablets to be dispensed at one time, so as to prevent the possibility of poisoning. the choice of the other colors has been more or less without special principle underlying it, yellow having been chosen for lemon, and green for wintergreen, leaving pink for rose and white for peppermint. the relation of color to flavor can, of course, be varied. chapter vii. formulae for the preparation of sweet tablets the subjoined formulae are published to serve for guidance in the preparation of sweet tablets and as a basis for further study and improvement. the doses given are children's doses, none of them exceeding a dose safe for a child three years of age. most of the tablets carry as large a dose as can well be given in this way; which in some cases, though not in many, is not sufficient for a three-year-old child. where a larger dose can easily be disguised in the same manner, this fact is noted in connection with the formulae. a warning may not be amiss, in this connection, not to put up in this form anything that does not result in a faultlessly pleasant, actually delicious candy. for confidence once lost is not easily restored. formulae for the preparation of the stock sugars referred to in this formulary will be found in chapter viii. they can all be prepared extemporaneously. the drying necessary after the addition of coloring may be expedited by the use of a warm mortar. nevertheless, alternate formulae have been inserted in most instances to facilitate rapid extemporaneous compounding, in case the stock sugar be not at hand. while most of these tablets keep well, a few deteriorate. in any case, the freshly prepared tablet will be found more pleasant than one that has become stale by being kept in stock. should difficulty be experienced in the compression of some of these tablets, the addition of a little shaved paraffin by gentle trituration in a mortar; or the stirring in of a little talcum powder with a spatula; or both measures combined will probably overcome the trouble. some powders work best with light pressure; others require rather heavy pressure. . tabellae acetphenetidini dulces. sweet tablets of acetphenetidin. . gm. (gr. ). _caution:_--only a moderate number should be ordered at one time. acetphenetidin . gm. alcoholic solution of saccharin, % . cc. vanilla cacao sugar . gm. mix the acetphenetidin with the alcoholic solution of saccharin (in a hot mortar if in a hurry) and permit the alcohol to evaporate; then mix with the vanilla cacao sugar by thorough trituration in a mortar; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. acetphenetidin . gm. saccharin . gm. tincture of vanilla . cc. cacao powder . gm. sugar, powdered . gm. mix the saccharin with the tincture of vanilla, then add the acetphenetidin and permit the alcohol to evaporate. finally add the other ingredients, triturating until they are thoroughly mixed. compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae acetylamidosaloli dulces. sweet tablets of acetylamidosalol (salophen). . gm. (gr. ). acetylamidosalol . gm. green fat sugar . gm. mix by thorough trituration in a mortar, and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. acetylamidosalol . gm. spirit of gaultheria . cc. malachite green solution, : . cc. fat starch . gm. sugar, powdered . gm. mix the acetylamidosalol and the sugar with the coloring and the flavor by thorough trituration; add the fat starch by gentle trituration; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae acidi acetylsalicylici dulces. sweet tablets of acetylsalicylic acid (aspirin). . gm. (gr. / .) acetylsalicylic acid . gm. alcoholic solution of saccharin, % . cc. liquid petrolatum . cc. yellow fat sugar . gm. mix the acetylsalicylic acid with the alcoholic solution of saccharin (in a hot mortar if in a hurry), and permit the alcohol to evaporate. add the liquid petrolatum and triturate. finally mix with the yellow fat sugar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae aconitini dulces. sweet tablets of aconitine. . gm. (gr. / ). _caution:_--order only a small number at one time. aconitine, crystallized . gm. red fat sugar . gm. mix the aconitine with the red fat sugar by very thorough trituration in a mortar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. aconitine, crystallized . gm. carmine . gm. spirit of cinnamon, % . cc. fat starch . gm. sugar, powdered . gm. triturate the aconitine with the sugar, added in portions, until well mixed. add the spirit of cinnamon and the carmine and triturate again until the red color is perfectly uniform. then add the fat starch, triturating gently and for a short time only. compress in tablet machine, using / -inch die and punches, and make one hundred . gm. tablets. . tabellae adalini dulces. sweet tablets of adalin. . gm. (gr. / ). _caution:_--only a moderate number should be ordered at one time. adalin . gm. alcoholic solution of saccharin, % . gm. white sugar fat . gm. mix the alcoholic solution of saccharin with the adalin (in a hot mortar if in a hurry), and permit the alcohol to evaporate. then mix thoroughly with the white fat sugar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. adalin . gm. saccharin . gm. spirit of peppermint . cc. fat starch . gm. sugar, powder . gm. mix the saccharin with the spirit of peppermint, then add the adalin, and triturate. then incorporate the sugar by thorough trituration. finally add the fat starch and triturate gently. compress in tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae anaesthesini dulces. sweet tablets of anaesthesine. . gm. (gr. / ). not more than a small number of these tablets should be ordered at one time. anaesthesine . gm. pink fat sugar . gm. mix the anaesthesine with the pink fat sugar and compress in tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. anaesthesine . gm. spirit of rose, % . cc. carmine . gm. fat starch . gm. sugar, powdered . gm. triturate the anaesthesine with the sugar and the spirit of rose, add the carmine, and triturate until thoroughly mixed. finally, add the fat starch with gentle trituration and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae antimonii et potassii tartratis dulces. sweet tablets of antimony and potassium tartrate (tartar emetic). . gm. (gr. / ). _caution:_--only a moderate number of these tablets should be ordered at one time, . gm. having produced death in children. it would take fifty of these tablets, however, to yield such dose. larger dose might be administered in this form. antimony and potassium tartrate . gm. red fat sugar . gm. mix by thorough trituration in a mortar and compress in tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. antimony and potassium tartrate . gm. carmine . gm. spirit of cinnamon, % . cc. fat starch . gm. sugar, powdered . gm. having thoroughly triturated the antimony and potassium tartrate with the sugar, add the coloring and the flavoring; and triturate again until the color is perfectly uniform. then add the fat starch, triturating gently and for a short time only. compress in a tablet machine using / -inch die and punches, to make one hundred . gm. tablets. . tabellae antipyrinae dulces. sweet tablets of antipyrine. . gm. (gr. / ). _caution:_--only a moderate number should be ordered at one time. antipyrine . gm. alcoholic solution of saccharin, % . cc. liquid petrolatum . cc. vanilla cacao sugar . gm. mix the antipyrine with the alcoholic solution of saccharin (in a hot mortar if in a hurry) and permit the alcohol to evaporate. add the liquid petrolatum and triturate. then incorporate the vanilla cacao sugar; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. antipyrine . gm. saccharin . gm. tincture of vanilla . cc. liquid petrolatum . cc. cacao powder . gm. sugar, powdered . gm. mix the tincture of vanilla with the saccharin, add the antipyrine and permit the alcohol to evaporate. add the liquid petrolatum and triturate. then incorporate the cacao powder and the sugar by thorough trituration; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae apomorphinae dulces. sweet tablets of apomorphine. . gm. (gr. / ). _caution:_--only a small number should be ordered at one time; two milligrams of apomorphine having produced alarming collapse in a child. apomorphine hydrochloride . gm. vanilla cacao sugar . gm. mix the ingredients by thorough trituration in a mortar; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. apomorphine hydrochloride . gm. tincture of vanilla . cc. cacao powder . gm. sugar, powdered . gm. directions, same as above. . tabellae aristochinae dulces. sweet tablets of aristochin. . gm. (gr. ). aristochin . gm. alcoholic solution of saccharin, % . cc. sodium bicarbonate . gm. vanilla cacao sugar . gm. mix the aristochin with the alcoholic solution of saccharin (in a hot mortar if in a hurry) and permit the alcohol to evaporate. then add the vanilla cacao sugar, and finally the sodium bicarbonate by thorough trituration in a mortar. compress in a tablet machine, using / -inch die and punches to make one hundred . gm. tablets. _note:_--if any difficulty be experienced in compressing this powder into tablets, the addition of a little shaved paraffin will probably overcome the trouble. alternate formula. aristochin . gm. saccharin . gm. sodium bicarbonate . gm. tincture of vanilla . cc. cacao powder . gm. sugar, powdered . gm. mix the saccharin with the tincture of vanilla, add the aristochin and mix by trituration. incorporate the cacao powder, the sugar, and finally the sodium bicarbonate. mix by thorough trituration in a mortar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. _note:_--see above note. . tabellae arseni trioxidi dulces. sweet tablets of arsenic trioxide. . gm. (gr. / ). _caution:_--owing to the toxicity of arsenic trioxide not more than a small number should be ordered at one time. larger doses could be administered in this form. arsenic trioxide . gm. red fat sugar . gm. mix the arsenic trioxide with the red fat sugar by thorough trituration in a mortar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. arsenic trioxide . gm. carmine . gm. spirit of cinnamon, % . cc. fat starch . gm. sugar, powdered . gm. having triturated the arsenic trioxide with the sugar, add the carmine and the spirit of cinnamon, and triturate again until the color is perfectly uniform. then add the fat starch, triturating gently and for a short time only. compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae atropinae dulces. sweet tablets of atropine. . gm. (gr. / ). _caution:_--only a small number should be ordered at one time. atropine sulphate . gm. vanilla cacao sugar . gm. mix the atropine sulphate with the vanilla cacao sugar by thorough trituration in a mortar; then compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. atropine sulphate . gm. tincture of vanilla . cc. cacao powder . gm. sugar, powdered . gm. triturate the atropine sulphate with the sugar until thoroughly mixed; then add the cacao powder and the tincture of vanilla, and triturate again until the color is perfectly uniform. compress in tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae bismuthi subcarbonatis dulces. sweet tablets of bismuth subcarbonate. . gm. (gr. ). bismuth subcarbonate . gm. fat starch . gm. pink fat sugar . gm. mix by thorough trituration in a mortar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. bismuth subcarbonate . gm. carmine . gm. spirit of rose, % . cc. fat starch . gm. sugar, powdered . gm. thoroughly mix the bismuth subcarbonate with the sugar, the carmine, and the spirit of rose by trituration in a mortar; add the fat starch by gentle trituration; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae bismuthi subnitratis dulces. sweet tablets of bismuth subnitrate. . gm. (gr. ). bismuth subnitrate . gm. fat starch . gm. pink fat sugar . gm. mix by thorough trituration in a mortar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. bismuth subnitrate . gm. carmine . gm. spirit of rose, % . cc. fat starch . gm. sugar, powdered . gm. thoroughly mix the bismuth subnitrate with the sugar, the carmine, and the spirit of rose by trituration in a mortar; add the fat starch by gentle trituration; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae caffeinae dulces. sweet tablets of caffeine. . gm. (gr. / ). caffeine (alkaloid) . gm. alcoholic solution of saccharin, % . cc. vanilla cacao sugar . gm. mix the alcoholic solution of saccharin with the caffeine (in a hot mortar if in a hurry) and permit the alcohol to evaporate. then mix with the vanilla cacao sugar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. caffeine (alkaloid) . gm. saccharin . gm. tincture of vanilla . cc. cacao powder . gm. sugar, powdered . gm. mix the saccharin with the tincture of vanilla, then add the caffeine and finally the other ingredients, and triturate until they are thoroughly mixed. compress in tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae carbonis ligni dulces. sweet tablets of charcoal. . gm. (gr. ). charcoal, finely powdered . gm. alcoholic solution of saccharin, % . cc. alcohol . cc. extract of glycyrrhiza, powdered . gm. spirit of anise, % . cc. spirit of coriander, % . cc. cacao butter, in thin shavings . gm. sugar, powdered . gm. mix all the ingredients except the cacao butter by thorough trituration (in a warm mortar if in a hurry), permit the alcohol to evaporate _completely_; then incorporate the cacao butter by gentle trituration for a short time only. compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae cerii oxalatis dulces. sweet tablets of cerium oxalate. . gm. (gr. ). cerium oxalate . gm. fat starch . gm. white fat sugar . gm. mix by thorough trituration in a mortar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. cerium oxalate . gm. spirit of peppermint . cc. fat starch . gm. sugar, powdered . gm. mix the cerium oxalate, the powdered sugar, and the spirit of peppermint by thorough trituration in a mortar; add the fat starch by gentle trituration for a short time only; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae cocainae dulces. sweet tablets of cocaine. . gm. (gr. / ). _caution:_--only a small number of these tablets should be ordered at one time, as centigram doses have produced lethal results in children. cocaine hydrochloride . gm. vanilla cacao sugar . gm. mix by thorough trituration in a mortar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. cocaine hydrochloride . gm. tincture of vanilla . cc. cacao powder . gm. sugar, powdered . gm. mix the cocaine hydrochloride and sugar by trituration in a mortar; then add the cacao and the tincture of vanilla, and triturate again until the color is perfectly uniform; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae cretae dulces. sweet tablets of chalk. . gm. (gr. ). each tablet represents approximately one half teaspoonful of the official chalk mixture. prepared chalk . gm. fat starch . gm. red fat sugar . gm. mix by thorough trituration in mortar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. prepared chalk . gm. carmine . gm. spirit of cinnamon, % . cc. fat starch . gm. sugar, powdered . gm. mix the chalk, the flavoring, and the coloring with the sugar by thorough trituration in a mortar, until the pink color is perfectly uniform; then add the fat starch by gentle trituration for a short time only; and compress in a tablet machine, using a / -inch die and punches, to make one hundred . gm. tablets. . tabellae digitalis dulces. sweet tablets of digitalis. . gm. (gr. / ). _caution:_--owing to the toxicity of the digitalis, it is best not to order more than a limited number of these tablets at one time. digitalis powder . gm. alcoholic solution of saccharin, % . cc. liquid petrolatum . cc. cinnamon cacao sugar . gm. mix the powdered digitalis with the alcoholic solution of saccharin (in a warm mortar if in a hurry) and permit the alcohol to evaporate. then add the liquid petrolatum and triturate. finally incorporate the cacao sugar by thorough trituration in a mortar. compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. digitalis powder . gm. alcoholic solution of saccharin . cc. liquid petrolatum . cc. spirit of cinnamon, % . cc. cacao powder . gm. sugar, powdered . gm. prepare the digitalis, as above described. mix it with the cacao, the sugar, and the spirit of cinnamon by thorough trituration in a mortar; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae elaterini dulces. sweet tablets of elaterin. . gm. (gr. / ). _caution:_--only a small number of these tablets should be ordered at one time. elaterin trituration, % . gm. red fat sugar . gm. thoroughly triturate the elaterin with the red fat sugar, added in portions, and make one hundred . gm. tablets by compressing in a tablet machine, using / -inch die and punches. alternate formula. elaterin trituration, % . gm. carmine . gm. spirit of cinnamon, % . cc. fat starch . gm. sugar, powdered . gm. having thoroughly mixed the elaterin trituration with sugar, add the carmine and the spirit of cinnamon, and triturate again until the color is uniform. then add the fat starch by gentle trituration; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae emetinae dulces. sweet tablets of emetine. . gm. (gr. / ). _caution:_--only a moderate number should be ordered at one time. emetine . gm. sodium bicarbonate . gm. vanilla cacao sugar . gm. mix the ingredients by thorough trituration in a mortar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. _note:_--if the powder does not work well in the machine, a little shaved paraffin added by gentle trituration will overcome the trouble. alternate formula. emetine . gm. sodium bicarbonate . gm. tincture of vanilla . cc. cacao powder . gm. sugar, powdered . gm. thoroughly triturate the emetine with the sugar and sodium bicarbonate; then add the cacao powder and the tincture of vanilla, and triturate again until the color is perfectly uniform; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. _note:_--see note under above formula. . tabellae fermenti acidi lactici dulces. sweet tablets of lactic acid ferment. . gm. (gr. ). lactic acid ferment . gm. yellow fat sugar . gm. triturate gently in a mortar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. lactic acid ferment . gm. spirit of lemon, % . cc. tincture of curcuma . cc. fat starch . gm. sugar, powdered . gm. mix the sugar with the tincture of curcuma and the spirit of lemon and permit the alcohol to evaporate. then thoroughly incorporate the lactic acid ferment by gentle trituration in a mortar. finally add the fat starch by gentle trituration for a short time only; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae ferri carbonatis dulces. sweet tablets of ferrous carbonate. . gm. (gr. / ). saccharated ferrous carbonate . gm. cinnamon cacao sugar . gm. mix by thorough trituration in a mortar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. saccharated ferrous carbonate . gm. spirit of cinnamon, % . cc. cacao powder . gm. sugar, powdered . gm. mix by thorough trituration; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae ferri et arseni dulces. sweet tablets of iron ( . gm.), and arsenic ( . gm.). _caution:_--only a moderate number of these tablets should be ordered at one time. arsenic trioxide . gm. saccharated ferrous carbonate . gm. cinnamon cacao sugar . gm. mix by thorough trituration in a mortar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. arsenic trioxide . gm. saccharated ferrous carbonate . gm. spirit of cinnamon, % . cc. cacao powder . gm. sugar, powdered . gm. triturate the arsenic trioxide with the sugar, added in portions, until thoroughly mixed. then add the other ingredients; triturate again until the color is perfectly uniform; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae ferri reducti dulces. sweet tablets of reduced iron. . gm. (gr. ). reduced iron . gm. vanilla cacao sugar . gm. mix by thorough trituration in a mortar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. reduced iron . gm. tincture of vanilla . cc. cacao powder . gm. sugar, powdered . gm. directions same as above. . tabellae ferri, quininae et strychninae dulces. sweet tablets of iron, quinine and strychnine. equivalent to about cc. of elixir of iron, quinine and strychnine. _caution:_--only a moderate number of these tablets should be ordered at one time. alcresta strychnine, % . gm. lloyd's reagent . gm. aristochin . gm. saccharated ferrous carbonate . gm. saccharin . gm. cinnamon cacao sugar . gm. mix the ingredients by thorough trituration in a mortar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. alcresta strychnine, % . gm. lloyd's reagent . gm. aristochin . gm. saccharated ferrous carbonate . gm. saccharin . gm. spirit of cinnamon, % . cc. cacao powder . gm. sugar, powdered . gm. mix the spirit of cinnamon with the sugar, and set aside. mix the other ingredients by thorough trituration in a mortar; and finally incorporate the flavored sugar. compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae glycerylis nitratis dulces. sweet tablets of nitroglycerin. . gm. (gr. / ). _caution:_--only a small number of these tablets should be ordered at one time. these tablets do not keep well, hence should be freshly prepared when wanted. larger doses might be administered in this form. spirit of nitroglycerin, % . cc. red fat sugar . gm. triturate the spirit of nitroglycerin with the red fat sugar and permit the alcohol to evaporate. when thoroughly dry, compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. spirit of nitroglycerin, % . cc. spirit of cinnamon, % . cc. carmine . gm. fat starch . gm. sugar, powdered . gm. triturate the carmine with the spirit of cinnamon and the sugar, until the color is perfectly uniform. then add the spirit of nitroglycerin, and triturate again thoroughly but gently. finally incorporate the fat starch by gentle trituration for a short time only; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae heroinae dulces. sweet tablets of heroine. . gm. (gr. / ). _caution:_--owing to the toxicity of heroine only a small number of these tablets should be ordered at one time. heroine hydrochloride . gm. alcoholic solution of saccharin, % . cc. sodium bicarbonate . gm. vanilla cacao sugar . gm. mix the heroine hydrochloride with the alcoholic solution of saccharin (in a hot mortar if in a hurry) and permit the alcohol to evaporate; then add the vanilla cacao sugar. triturate thoroughly; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. _note:_--if any difficulty is found in the compressing of these tablets, the addition of a small amount of shaved paraffin will overcome it. alternate formula. heroine hydrochloride . gm. saccharin . gm. sodium bicarbonate . gm. tincture of vanilla . cc. cacao powder . gm. sugar, powdered . gm. mix the saccharin with the tincture of vanilla; then add the heroine hydrochloride. permit the alcohol to evaporate. thoroughly triturate with the sugar, added in portions. finally add the sodium bicarbonate and the cacao powder; and triturate again until the color is uniform. compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. _note:_--see note under above formula. . tabellae hexamethylenaminae dulces sweet tablets of hexamethylenamine (urotropin). . gm. (gr. / ). as much as . gm. (gr. ) may be given in this form. hexamethylenamine . gm. vanilla cacao sugar . gm. mix by thorough trituration in a mortar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. hexamethylenamine . gm. tincture of vanilla . cc. cacao powder . gm. sugar, powdered . gm. directions, same as above. . tabellae hydrargyri chloridi mitis dulces. sweet tablets of mild mercurous chloride (calomel). . gm. (gr. / ). much larger dose could be administered in this form. mild mercurous chloride . gm. pink fat sugar . gm. mix by thorough trituration in a mortar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. mild mercurous chloride . gm. carmine . gm. spirit of rose, % . cc. fat starch . gm. sugar, powdered . gm. having thoroughly triturated the mild mercurous chloride with the sugar, add the carmine and the spirit of rose; and triturate again until the pink color is perfectly uniform. then add the fat starch by triturating gently and for a short time only. compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae hydrargyri cum creta dulces. sweet tablets of mercury with chalk. . gm. (gr. / .). larger dose could be administered in this form. mercury with chalk . gm. white fat sugar . gm. mix by thorough trituration in a mortar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. mercury with chalk . gm. spirit of peppermint . cc. fat starch . gm. sugar, powdered . gm. mix the ingredients, with the exception of the fat starch, by thorough trituration in a mortar; add the latter by gentle trituration for a short time only; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae hydrargyri iodidi flavi dulces. sweet tablets of yellow mercurous iodide. . gm. (gr. / ). larger dose could be administered in this form. these tablets must be well protected against light or they will rapidly become dark; when thus protected, they keep fairly well. yellow mercurous iodide . gm. white fat sugar . gm. mix by thorough trituration in a mortar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. yellow mercurous iodide . gm. spirit of peppermint . cc. fat starch . gm. sugar, powdered . gm. having thoroughly triturated the yellow mercurous iodide with the sugar, add the spirit of peppermint and triturate again. then add the fat starch, triturating gently and for a short time only. compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae hydrargyri iodidi rubri dulces. sweet tablets of red mercuric iodide. . gm. (gr. / ). _caution:_--only a moderate number of these tablets should be ordered at one time. larger dose of red mercuric iodide could be administered in this form. red mercuric iodide . gm. red fat sugar . gm. thoroughly mix the red mercuric iodide with the red fat sugar by trituration in a mortar; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. red mercuric iodide . gm. spirit of cinnamon, % . cc. carmine . gm. fat starch . gm. sugar, powdered . gm. having thoroughly triturated the red mercuric iodide with the sugar, add the carmine and the spirit of cinnamon and triturate again. then add the fat starch, triturating gently and for a short time only. compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae hyoscinae dulces. sweet tablets of hyoscine. . gm. (gr. / ). much larger dose could be administered in this form, _e. g._, . gm. (gr. / ) per tablet. _caution:_--only a small number of these tablets should be ordered at one time. hyoscine hydrobromide . gr. red fat sugar . gm. triturate the hyoscine hydrobromide with red fat sugar, added in portions, and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. hyoscine hydrobromide . gm. carmine . gm. spirit of cinnamon, % . cc. fat starch . gm. sugar, powdered . gm. having thoroughly triturated the hyoscine hydrobromide with the sugar, add spirit of cinnamon and the carmine, and triturate again until the color is perfectly uniform. then add the fat starch, triturating gently and for a short time only. compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae ipecacuanhae et opii dulces. sweet tablets of ipecac and opium (dover's powder). . gm. (gr. / ). _caution:_--owing to the toxicity of opium, only a small number should be ordered at one time. powdered ipecac . gm. deodorized opium . gm. alcoholic solution of saccharin, % . cc. sodium bicarbonate . gm. cinnamon cacao sugar . gm. mix the ipecac with the opium and the alcoholic solution of saccharin (in a warm mortar if in a hurry) and permit the alcohol to evaporate; then add the other ingredients, triturate thoroughly; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. _note:_--if any difficulty is experienced in the compression of these tablets, the addition of a little shaved paraffin will probably remedy it. alternate formula. powdered ipecac . gm. deodorized opium . gm. alcoholic solution of saccharin, % . cc. spirit of cinnamon . cc. sodium bicarbonate . gm. cacao powder . gm. sugar, powdered . gm. directions, same as above. . tabellae magnesii oxidi dulces. sweet tablets of magnesia. . gm. (gr. ). the dose may seem small; it represents, however, / teaspoonful of magnesia magma (milk of magnesia) n. f. heavy magnesium oxide . gm. saccharin . gm. spirit of peppermint . cc. fat starch . gm. sugar, powdered . gm. mix the saccharin with the spirit of peppermint, add the magnesia, and mix by thorough trituration in a mortar. then incorporate the sugar by thorough trituration, and fat starch by gentle trituration for a short time only. compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae magnesii salicylatis dulces. sweet tablets of magnesium salicylate. . gm. (gr. / ). magnesium salicylate . gm. green fat sugar . gm. mix by thorough trituration in a mortar, and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. magnesium salicylate . gm. spirit of gaultheria, % . cc. solution of malachite green, : . cc. fat starch . gm. sugar, powdered . gm. mix the ingredients, excepting the fat starch, by thorough trituration in a mortar; incorporate the fat starch by gentle trituration for a short time only; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae morphinae dulces. sweet tablets of morphine. . gm. (gr. / ). _caution:_--owing to the toxicity of morphine only a few of these tablets should be ordered at one time, perhaps not more than three, as a few milligrams are liable to constitute a lethal dose. morphine (alkaloid) . gm. alcoholic solution of saccharin, % . cc. sodium bicarbonate . gm. vanilla cacao sugar . gm. mix the morphine with the alcoholic solution of saccharin (in a hot mortar if in a hurry), and permit the alcohol to evaporate; then add the sodium bicarbonate and the vanilla cacao sugar, triturating thoroughly; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. _note:_--if any difficulty is experienced in the compression of these tablets, the addition of a little shaved paraffin will probably remedy it. alternate formula. morphine (alkaloid) . gm. saccharin . gm. tincture of vanilla . cc. sodium bicarbonate . gm. cacao powder . gm. sugar, powdered . gm. mix the saccharin with the tincture of vanilla, add the morphine, and allow the alcohol to evaporate. then incorporate the other ingredients by thorough trituration in a mortar; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. _note:_--see note under above formula. . tabellae phenolphthaleini dulces. sweet tablets of phenolphthalein. . gm. (gr. ). phenolphthalein . gm. alcoholic solution of saccharin, % . cc. vanilla cacao sugar . gm. mix the phenolphthalein with the alcoholic solution of saccharin (in a hot mortar if in a hurry), and permit the alcohol to evaporate. then add the vanilla cacao sugar. mix thoroughly and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. phenolphthalein . gm. saccharin . gm. tincture of vanilla . cc. cacao powder . gm. sugar, powdered . gm. mix the saccharin with the tincture of vanilla, and incorporate the phenolphthalein. finally add the sugar and the cacao by thorough trituration in a mortar. compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae pilocarpinae dulces. sweet tablets of pilocarpine. . gm. (gr. / ). _caution:_--only a moderate number of these tablets should be ordered at one time. pilocarpine hydrochloride . gm. vanilla cacao sugar . gm. mix by thorough trituration in a mortar; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. pilocarpine hydrochloride . gm. tincture of vanilla . cc. cacao powder . gm. sugar, powdered . gm. mix the pilocarpine hydrochloride with the sugar by thorough trituration in a mortar, add the cacao powder and triturate again until the color is perfectly uniform. finally incorporate the tincture of vanilla and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae resinae jalapae dulces. sweet tablets of resin of jalap. . gm. (gr. / ). _caution:_--only a small number of these tablets should be ordered at one time. resin of jalap . gm. cinnamon cacao sugar . gm. mix by thorough trituration in a mortar; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. resin of jalap . gm. spirit of cinnamon, % . cc. cacao powder . gm. sugar, powdered . gm. mix the resin of jalap, the cacao, and the sugar by thorough trituration in a mortar; finally incorporate the spirit of cinnamon; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae resinae podophylli dulces sweet tablets of resin of podophyllum. . gm. (gr. / ). _caution:_--only a small number of these tablets should be ordered at one time. citric acid . gm. resin of podophyllum . gm. alcoholic solution of saccharin, % . cc. cinnamon cacao sugar . gm. mix the resin of podophyllum and the citric acid with the alcoholic solution of saccharin and permit the alcohol to evaporate. add the cinnamon cacao sugar; triturate thoroughly; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. citric acid . gm. resin of podophyllum . gm. alcoholic solution of saccharin, % . cc. spirit of cinnamon, % . cc. cacao powder . gm. sugar, powdered . gm. directions, same as above. . tabellae sabromini dulces. sweet tablets of sabromin. . gm. (gr. ). sabromin . gm. pink fat sugar . gm. mix the sabromin with the pink fat sugar by thorough trituration in a mortar. compress in a tablet machine, with rather heavy pressure, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. sabromin . gm. spirit of rose, % . cc. carmine . gm. fat starch . gm. sugar, powdered . gm. mix the sabromin with the carmine and the sugar, add the spirit of rose, and triturate until thoroughly mixed. finally incorporate the fat starch; and compress in tablet machine, with rather heavy pressure, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae sajodini dulces. sweet tablets of sajodin. . gm. (gr. ). sajodin . gm. pink fat sugar . gm. mix the sajodin with the pink fat sugar by thorough trituration in a mortar. compress in a tablet machine, with rather heavy pressure, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. sajodin . gm. spirit of rose, % . cc. carmine . gm. fat starch . gm. sugar, powdered . gm. mix the sajodin with the carmine and the sugar, add the spirit of rose, and triturate until thoroughly mixed. finally incorporate the fat starch; and compress in tablet machine, with rather heavy pressure, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae saloquininae dulces. sweet tablets of saloquinine. . gm. (gr. ). saloquinine . gm. green fat sugar . gm. mix the saloquinine with the green fat sugar by thorough trituration in a mortar; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. saloquinine . gm. spirit of gaultheria, % . cc. solution of malachite green, : . cc. fat starch . gm. sugar, powdered . gm. mix the saloquinine and the sugar, the coloring and the flavoring by thorough trituration in a mortar; incorporate the fat starch by gentle trituration; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae santonini dulces sweet tablets of santonin. . gm. (gr. / ). _caution:_--only a small number of these tablets should be ordered at one time, perhaps not more than three, as . gm. has caused the death of a child. santonin . gm. alcoholic solution of saccharin, % . cc. vanilla cacao sugar . gm. mix the alcoholic solution of saccharin with the santonin (in a hot mortar if in a hurry) and permit the alcohol to evaporate. then mix thoroughly with the vanilla cacao sugar; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. santonin . gm. saccharin . gm. tincture of vanilla . cc. cacao powder . gm. sugar, powdered . gm. mix the saccharin with the tincture of vanilla, add the santonin, and permit the alcohol to evaporate. then mix with the sugar and the cacao by thorough trituration in a mortar. compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae sennae dulces. sweet tablets of senna. . gm. (gr. ). senna, powdered . gm. alcoholic solution of saccharin, % . cc. paraffin, in thin shavings . gm. yellow fat sugar . gm. pour the alcoholic solution of saccharin over the senna and permit the alcohol to evaporate completely. (dry saccharinization, using . gm. of saccharin, is slightly less efficient; but may be used for extemporaneous preparations.) incorporate the yellow fat sugar by thorough trituration in a mortar; and finally the paraffin by gentle trituration for a short time only. compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. senna, powdered . gm. saccharin . gm. spirit of lemon, % . cc. tincture of curcuma . cc. fat starch . gm. sugar, powdered . gm. mix the saccharin with the senna, add the sugar and triturate thoroughly until well mixed. then add the spirit of lemon and the tincture of curcuma, and permit the alcohol to evaporate and the powder to dry completely. finally incorporate the fat starch by gentle trituration for a short time only. compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae sodii bicarbonatis dulces. sweet tablets of sodium bicarbonate. . gm. (gr. ). sodium bicarbonate . gm. spirit of peppermint . cc. fat starch . gm. sugar, powdered . gm. mix the sodium bicarbonate with the sugar and the spirit of peppermint by thorough trituration in a mortar. then incorporate fat starch by gentle trituration for a short time only; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae strophanthini dulces. sweet tablets of strophanthin. . gm. (gr. / ). _caution:_--only a small number of these tablets should be ordered at one time. strophanthin trituration, % . gm. alcoholic solution of saccharin, % . cc. vanilla cacao sugar . gm. mix the strophanthin trituration with alcoholic solution of saccharin (in a hot mortar if in a hurry); and permit the alcohol to evaporate. add the vanilla cacao sugar and triturate thoroughly. compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. strophanthin trituration, % . gm. saccharin . gm. tincture of vanilla . cc. cacao powder . gm. sugar, powdered . gm. mix the saccharin with the tincture of vanilla, add the strophanthin, and permit the alcohol to evaporate. mix with the sugar by thorough trituration in a mortar; and incorporate the cacao powder, triturating until thoroughly mixed and the color is uniform. compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae alcresta strychninae dulces. sweet tablets of alcresta strychnine. . gm. (gr. / ). _caution:_--only a small number of these tablets should be ordered at one time, probably not more than ten, as four milligrams have been lethal to a child. citric acid . gm. alcresta strychnine, % . gm. saccharin . gm. cinnamon cacao sugar . gm. mix the citric acid, alcresta strychnine and saccharin by thorough trituration in a mortar. add the cinnamon cacao sugar in portions and triturate thoroughly. compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. citric acid . gm. alcresta strychnine, % . gm. saccharin . gm. spirit of cinnamon, % . cc. cacao powder . gm. sugar, powdered . gm. mix the spirit of cinnamon with the sugar; permit the alcohol to evaporate. in another mortar mix the citric acid, the alcresta strychnine, and the saccharin; add the flavored sugar in portions, and triturate until thoroughly mixed; finally add the cacao powder, and triturate again until the color is uniform. compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae sulphonmethani dulces. sweet tablets of sulphonmethane. . gm. (gr. / ). _caution:_--only a moderate number of these tablets should be ordered at one time. sulphonmethane . gm. alcoholic solution of saccharin, % . cc. liquid petrolatum . cc. white fat sugar . gm. mix the sulphonmethane with the alcoholic solution of saccharin (in a hot mortar if in a hurry) and permit the alcohol to evaporate. add the liquid petrolatum and triturate again. finally add the white fat sugar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. sulphonmethane . gm. saccharin . gm. liquid petrolatum . cc. spirit of peppermint . cc. fat starch . gm. sugar, powdered . gm. mix the saccharin with the spirit of peppermint and the sulphonmethane. allow the alcohol to evaporate. add the liquid petrolatum and triturate again. incorporate the sugar by thorough trituration in a mortar; add the fat starch, triturating gently and for a short time only. compress in a tablet machine, using / -inch die and punches to make one hundred . gm. tablets. . tabellae sulphuris dulces. sweet tablets of sulphur. . gm. (gr. ). precipitated sulphur . gm. cinnamon cacao sugar . gm. mix by thorough trituration in a mortar; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. precipitated sulphur . gm. spirit of cinnamon, % . cc. cacao powder . gm. sugar, powdered . gm. directions, same as above. . tabellae tannalbini dulces. sweet tablets of tannalbin. . gm. (gr. ). tannalbin . gm. vanilla cacao sugar . gm. mix by thorough trituration in a mortar, and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. tannalbin . gm. tincture of vanilla . cc. cacao powder . gm. sugar, powdered . gm. directions, same as above. . tabellae terpini hydratis dulces. sweet tablets of terpin hydrate. . gm. (gr. / ). represents half-teaspoonful of the elixir of terpin hydrate, n. f., in a much more pleasant form. terpin hydrate . gm. vanilla cacao sugar . gm. mix by thorough trituration in a mortar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. terpin hydrate . gm. tincture of vanilla . cc. cacao powder . gm. sugar, powdered . gm. mix the cacao, the sugar, and the tincture of vanilla, and allow the alcohol to evaporate. add the terpin hydrate; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae terpini hydratis cum heroina dulces. sweet tablets of terpin hydrate ( . gm.) with heroine. . gm. (gr. / ). represents a half-teaspoonful of the n. f. elixir with but half the amount of heroine in a much more pleasant form. _caution:_--only a small number of these tablets should be ordered at one time. heroine hydrochloride . gm. alcoholic solution of saccharin, % . cc. terpin hydrate . gm. vanilla cacao sugar . gm. mix the heroine hydrochloride with the alcoholic solution of saccharin (in a hot mortar if in a hurry), and permit the alcohol to evaporate. add the terpin hydrate and the vanilla cacao sugar; triturate thoroughly; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. heroine hydrochloride . gm. saccharin . gm. tincture of vanilla . cc. terpin hydrate . gm. cacao powder . gm. sugar, powdered . gm. mix the heroine hydrochloride with the saccharin and the tincture of vanilla, and allow alcohol to evaporate. mix with the sugar, added in portions. finally incorporate the terpin hydrate and the cacao powder by thorough trituration; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae theobrominae sodio-salicylatis dulces. sweet tablets of theobromine sodio-salicylate (diuretin). . gm. (gr. / ). theobromine sodio-salicylate . gm. alcoholic solution of saccharin, % . cc. liquid petrolatum . cc. white fat sugar . gm. mix the diuretin with the alcoholic solution of saccharin (in a hot mortar if in a hurry), and permit the alcohol to evaporate. add the liquid petrolatum and triturate. finally incorporate the white fat sugar, and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. theobromine sodio-salicylate . gm. saccharin . gm. liquid petrolatum . cc. spirit of peppermint . cc. fat starch . gm. sugar, powdered . gm. mix the theobromine sodio-salicylate and the saccharin with the spirit of peppermint and permit the alcohol to evaporate. add the liquid petrolatum and triturate. finally incorporate the sugar by thorough trituration and the fat starch by gentle trituration; and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. . tabellae thyroideae dulces. sweet tablets of thyroid. . gm. (gr. ). desiccated thyroid gland . gm. cinnamon cacao sugar . gm. mix by thorough trituration in a mortar and compress in a tablet machine, using / -inch die and punches, to make one hundred . gm. tablets. alternate formula. desiccated thyroid gland . gm. spirit of cinnamon . cc. cacao powder . gm. sugar, powdered . gm. directions, same as above. chapter viii. formulae for stock preparations. (referred to in chapter vii.) . fat starch. alcoholic solution of saccharin, %,[a] . cc. liquid petrolatum . cc. starch . gm. mix the starch with the solution of saccharin, and permit the alcohol to evaporate completely. then incorporate the liquid petrolatum. . cinnamon cacao sugar. spirit of cinnamon, % . cc. cacao powder . gm. dextrose[b] . gm. sugar, powdered . gm. mix thoroughly by trituration in a mortar; and preserve in a well-stoppered bottle. . green fat sugar. spirit of gaultheria, % . cc. solution of malachite green, : . cc. fat starch . gm. sugar, powdered . gm. mix the powdered sugar with the solution of malachite green; permit to dry. add the fat starch and the spirit of gaultheria, and preserve in a well-stoppered bottle. keep in a dark place. . pink fat sugar. solution of carmine, n. f. . cc. spirit of rose, % . cc. fat starch . gm. sugar, powdered . gm. add the solution of carmine to the sugar and triturate until thoroughly mixed. then add the fat starch and the spirit of rose, and preserve in a well-stoppered bottle in a dark place. . red fat sugar. solution of carmine, n. f. . cc. spirit of cinnamon, % . cc. fat starch . gm. sugar, powdered . gm. mix the carmine solution with the sugar and permit the powder to dry. then add the spirit of cinnamon. owing to the fact that the red fat sugar is used with poisonous substances requiring very thorough trituration which is liable to lessen the efficiency of the fat starch, it is well to add the latter _after_ the medicament has been incorporated with the red cinnamon sugar. preserve in a well-stoppered bottle in a dark place. . vanilla cacao sugar. tincture of vanilla . cc. cacao powder . gm. dextrose[c] . gm. sugar, powdered . gm. mix thoroughly by trituration in a mortar, and preserve in a well-stoppered bottle. . white fat sugar. spirit of peppermint . cc. fat starch . gm. sugar, powdered . gm. to the powdered sugar add the fat starch and the spirit of peppermint. mix and preserve in a well-stoppered bottle in a dark place. . yellow fat sugar. spirit of lemon, % . cc. tincture of curcuma . cc. fat starch . gm. sugar, powdered . gm. mix the powdered sugar with the tincture of curcuma and permit the alcohol to evaporate; then add the spirit of lemon and the fat starch. mix well and preserve in a well-stoppered bottle in a dark place. footnotes: [a] not absolutely necessary. [b] equivalent amount of sugar might be used though powder may not work quite as well in machine. [c] equivalent amount of sugar might be used, though powder may not work as well in machine. references. end notes: [ ] _fantus, b._--candy medication, journal of the american medical association, september , , vol. lix, p. . [ ] _sawyer, sir james_--the lancet, august , , p. . [ ] _fantus, b._--tabellae dulces, journal of the american pharmaceutical association, may, , vol. iii. [ ] _fuller, robert m._--dose dispensing simplified, new remedies, march, , p. . [ ] _schleimer, a._--the national druggist, february, , p. . [ ] _fantus, b._--candy medication formulary, journal of the national association of retail druggists, may and , and june and , , vol. xvi, pp. , , , . [ ] _fantus, b._--the making of tablets by the retail druggist, journal of the american pharmaceutical association, january, , vol. iii, no. , p. . [ ] _wood, joseph r._--tablet manufacture, j. b. lippincott co., philadelphia, pa. [ ] _lloyd, john uri_--lloyd's reagent, preliminary announcement, journal of the american pharmaceutical association, may, , vol. iii, no. , p. . index a absorbents, alcresta strychnine, anhydrotic, antacids, anthelmintic, antidiarrheals, antiemetics, antipyretics, antiseptic, urinary, antiseptics, intestinal, antispasmodics, antitussic, aromatic calomel, c cacao butter process, "capping", cathartics, chocolate creams, medicated, choice of color, choice of flavor, cinnamon cacao sugar, circulatory depressant, circulatory stimulants, color, choice of, confection, construction of formulae, cough remedies, cremulae, d depressants, depressant, circulatory, diaphoretics, difficulties in tablet making, , diuretics, e emetics, eureka tablet machine, expectorants, f fat covering, , fat starch, fat sugars, , fat sugar process, flavor, choice of, fondant, formulae, construction of, formulae for stock preparations, formulae for sweet tablets, formulary, - fuller's earth, g green fat sugar, h hematinics, historical introduction, i indications for sweet tablets, intestinal antiseptics, l lloyd's reagent, lozenges, m machine, tablet, making of sweet tablets, malaria, specifics in, myxedema, specific in, o objections to sweet tablets, p paraffin process, phenolax, pink fat sugar, purgen, r references, red fat sugar, rheumatic fever, specifics in, s saccharinization, specifics, "sticking," stimulants, stimulants, circulatory, stock preparations, subduing of tastes, sweet tablets: acetphenetidin, acetylamidosalol, acetylsalicylic acid, aconitine, adalin, alcresta strychnine, anaesthesine, antimony and potassium tartrate, antipyrine, apomorphine, aristochin, arsenic trioxide, aspirin, atropine, bismuth subcarbonate, bismuth subnitrate, caffeine, calomel, cerium oxalate, chalk, charcoal, cocaine, digitalis, diuretin, dover's powder, elaterin, emetine, ferrous carbonate, heroine, hexamethylenamine, hyoscine, ipecac and opium, iron and arsenic, iron, quinine and strychnine, jalap, lactic acid ferment, magnesia, magnesium salicylate, mercuric iodide, red, mercurous chloride, mild, mercurous iodide, yellow, mercury with chalk, morphine, nitroglycerin, phenacetine, phenolphthalein, pilocarpine, podophyllum, reduced iron, resin jalap, resin podophyllum, sabromin, sajodin, salophen, saloquinine, santonin, senna, sodium bicarbonate, strophanthin, strychnine, sulphonal, sulphonmethane, sulphur, tannalbin, tartar emetic, terpin hydrate, terpin hydrate with heroine, theobromine sodio-salicylate, thyroid, urotropin, syphilis, specifics in, t tabellae dulces, acetphenetidini, acetylamidosaloli, acidi acetylsalicylici, aconitini, adalini, anaesthesini, antimonii et potassii tartratis, antipyrinae, apomorphinae, aristochinae, arseni trioxidi, atropinae, bismuthi subcarbonatis, bismuthi subnitratis, caffeinae, carbonis ligni, cerii oxalatis, cocainae, cretae, digitalis, elaterini, emetinae, fermenti acidi lactici, ferri carbonatis, ferri et arseni, ferri reducti, ferri, quininae et strychninae, glycerylis nitratis, heroinae, hexamethylenaminae, hydrargyri chloridis mitis, hydrargyri cum creta, hydrargyri iodidi flavi, hydrargyri iodidi rubri, hyoscinae, ipecacuanhae et opii, magnesii oxidi, magnesii salicylatis, morphinae, phenolphthaleini, pilocarpinae, resinae jalapae, resinae podophylli, sabromini, sajodini, saloquininae, santonini, sennae, sodii, bicarbonatis, strophanthini, strychninae, sulphonmethani, sulphuris, tannalbini, terpini hydratis, terpini hydratis cum heroina, theobrominae sodio-salicylatis, thyroideae, tablet machine, tablet machine, f. t. stokes co., tablet machine, whitall-tatum co., tamar indien, tastes, subduing of, tonics, u urinary antiseptics, uses of sweet tablets, v vanilla cacao sugar, vaso-dilator, w white fat sugar, y yellow fat sugar, * * * * * transcriber's notes: the index contains many entries that are not used in the actual text although related forms of the words may exist, for example the entry on "phenacetine" is not actually in the text but the page referenced has "acetphenetidin." instead of trying to sort out what the author or editor meant, these entries are retained as printed. page , opening quote added ("phenolax," etc.) page , repeated word "the" removed from text. original read (from the the latin word) page , " , " changed to " . " ( . gm. (gr. / )) page , " " changed to " / " ( / -inch die) page , period added at end of paragraph (results in children.) page , "so" changed to "to" (punches, to make one) page , "gm:" changed to "gm." twice in table terpin hydrate . gm. vanilla cacao sugar . gm. page , removed extraneous comma in second line of "fat starch" table after "liquid petrolatum". page , added closing period to end of endnote . (august , , p. .) page , "antipyrene" changed to "antipyrine" (antipyrine, ) page , "nitroglycerine" changed to "nitroglycerin" (nitroglycerin, ) page , reference "t" added to index.