UC-NRLF 
 
OF THE 
 
 UNIVERSITY 
 
 OF 
 
 BIOLOGY 
 LIBRARY 
 

 
WHAT You OUGHT To KNOW 
 ABOUT YOUR BABY 
 
 By LEONARD KEENE HIRSHBERG, B.A., M.D. 
 
 A Text Book for Mothers 
 on the Care and Feeding 
 of Babies, with Questions 
 and Answers Especially 
 Prepared by the Editor 
 
 PUBLISHED BY 
 
 THE BUTTERICK PUBLISHING COMPANY 
 HJTTERICK BUILDING 1910 NEW YORK 
 
%IOLOGY 
 LIBRARY 
 
 COPYRIGHT, 1910, BY 
 THE BUTTERICK PUBLISHING COMPANY 
 
 NEW YORK 
 
*> I 
 
 BIOLOGY 
 LIBRARY 
 
 TABLE OF CONTENTS 
 
 PAGE 
 
 I. THE SLAUGHTER OF THE INNOCENTS 1 
 
 II. THE NEW-BORN BABY 13 
 
 in. THE BABY'S FIRST FEW MONTHS 17 
 
 IV. THE NURSING BABY 21 
 
 V. MOTHER AND BABY 26 
 
 VI. THE BOTTLE-FED BABY 30 
 
 VII. A CHAPTER ON MILK 36 
 
 VIII. THE FOOD FOR GROWING CHILDREN 42 
 
 IX. WHAT YOU OUGHT TO KNOW ABOUT YOUR SCHOOL . 51 
 
 X. NEED EVERY CHILD HAVE CATCHING DISEASES? . . 59 
 
 XI. IF YOUR BABY HAD DIPHTHERIA 61 
 
 XII. IF YOUR BABY HAD SCARLET FEVER . . . .71 
 
 XIII. WHOOPING COUGH. IT KILLS MORE THAN DIPHTHERIA AND 
 
 SCARLET FEVER TOGETHER 79 
 
 XIV. IF YOUR BABY HAD PNEUMONIA 85 
 
 XV. NEED EVERY CHILD HAVE MEASLES? . . 91 
 
 M8152Q2 
 
Appreciatively dedicated to Mr. 
 George W. Wilder, whose earnest 
 efforts for the child's broader 
 welfare prompted this book. 
 
A WORD TO MOTHERS 
 
 This is a book that THE DELINEATOR sends to mothers because 
 we believe that the American woman needs a knowledge of child 
 hygiene. The census statistics show that one in every six of the 
 children born in the United States does not live to be one year of 
 age. A great many of those who survive grow up to a life of suffer- 
 ing and incapacity, handicapped in the struggle of existence, for 
 from 70 to 90 per cent, of American school-children have one or 
 more physical defects. The conservation of humanity, the per- 
 fection of the race, is the watchword of to-day. More and more the 
 doctor is interpreting it as his mission to teach people how to keep 
 well. And the place to begin is with the babies. Mother instinct 
 has done much through the ages. But mother training equipped 
 with all the knowledge that science can give, may do much 
 more. For the new motherhood that shall know how, this book is 
 published. 
 
CHAPTER I. THE SLAUGHTER OF THE INNOCENTS 
 
 WOMAN enters a car with a baby in her arms. 
 An old gentleman rises and gives her a seat 
 beside another woman. The baby begins to 
 cry. The mother bounces him up and down. 
 
 "I suppose the poor little dear is teething," 
 ventures the stranger affably. 
 
 "Yes," replies the mother. "He cut two 
 last week and now he's on his third. It's put 
 him all out of sorts. Last night he had a croupy attack, and if 
 I hadn't given him a dose of ipecac at once we might have had 
 to send for the doctor." 
 
 The mother takes a milk bottle from her satchel, carefully wipes 
 the nipple with a rag, and gives it to her offspring. A gurgle 
 and he is still. The women talk on. The child empties the bottle 
 and begins to fret again. The mother produces a rubber "paci- 
 fier" from her capacious hand-bag, and he begins to gnaw it. 
 "Is he a good child?" asks the stranger. 
 
 "A real angel," replies the mother proudly. "He never wakes 
 more than twice a night, and then a half-bottle of milk quickly 
 quiets him. My mother has taken complete charge of him. She 
 has raised eight children and knows more than the doctor. She 
 won't let me give him anything but boiled milk." 
 
 A common enough conversation, certainly. You have heard 
 it yourself a dozen times, in trolley car and train. It seems utterly 
 harmless and yet there is in it evidence enough to convict the 
 mother of no less than seven separate and distinct crimes of 
 omission, commission, ignorance, indulgence and superstition 
 against her innocent youngster, and, indirectly, against posterity, 
 her country and long-suffering humanity. 
 
 Let us go back and listen again. The woman enters the car. 
 The baby begins to cry. She bounces it up and down. Crime 
 number one! Babies should not be bounced up and down. It 
 nauseates them; it strains them; it makes them unhappy. 
 
 1 
 
The baby is teething. "It's put him out of sorts." Crime 
 number two! this time one of superstition. Teething does not 
 put a healthy baby "out of sorts." If the little fellow is a normal 
 child his teeth come through the gums without pain. If he cries 
 at the time, the chances are that it is because maternal ignorance 
 has given him bad habits. If that is not true, he is sick, and the 
 chances are that the sickness has its seat, not in his gums, but in 
 his stomach. 
 
 "Last night he had a croupy attack, and if I hadn't given him 
 ipecac." Crime number three! For true croup, ipecac is no 
 remedy. For a slight cough and most mothers group all dry 
 coughs under the generic name of "croup" no medicine is needed. 
 The ipecac makes the little dear vomit; he becomes exhausted and 
 falls into a heavy sleep. Nature cures his cough. 
 
 The mother takes a bottle from her hand-bag., wipes the nipple 
 and gives it to her offspring. A gurgle and he is still. Crime 
 number four! The hand-bag is full of germs, the nipple is full of 
 germs, the rag used to wipe it is full of germs and the bottle is full 
 of germs. Yet the baby lives! And why? Because the human 
 body is so tough that nine times out of ten, in a battle with germs, 
 it wins. But the tenth time it loses. 
 
 The child empties the bottle and begins to fret. The mother 
 produces a "pacifier." Crime number five! The "pacifier" is 
 ev^;i dirtier than the milk bottle. Germs thrive upon it like bar- 
 nacles upon a floating log. If the baby is in luck they are the 
 comparatively mild and puny germs, that cause blisters in the 
 mouth, sore gums, stomach-ache, diarrhea and rashes. If fortune 
 frowns upon him, they are the virulent and deadly germs of cholera 
 infantimi. 
 
 The baby is an angel. "He seldom wakes more than twice a 
 night." Crime number six! this time one of maternal fondness. 
 A healthy baby should sleep from dusk to dawn without waking. 
 If he doesn't, it is because his mother has permitted him to acquire 
 bad habits. 
 
 "My mother has taken charge of him." Crime number seven! 
 True enough, the dear old lady has raised eight of her own. But 
 the acts of her daughter prove that she still clings to a whole con- 
 fession of ancient delusions. She believes, for instance, that normal 
 teething should torture babies and make them cry. She believes 
 that babies should be nauseated with ipecac whenever they happen 
 
 2 
 
to cough. She believes that wiping a rubber nipple with a rag 
 makes it clean. She believes that babies should be bounced up 
 and down, and that, when they cry, they should be given "paci- 
 fiers" to gnaw. She believes, in a word, in medical fallacies that 
 were venerable in the days of Hippocrates. And yet she "knows 
 more than the doctor!" 
 
 Is the picture overdrawn? Is it a farce? Not at all. Look 
 at it squarely and you will see that it is tragedy tragedy of the 
 gloomy, every-day sort we have learned to watch unheeding. A 
 hundred thousand American babies die every year. Fully half of 
 these deaths are the sad result, I believe, of unwise feeding, 
 of stupid dosing, of precedent, habit, custom and superstition. 
 
 On the face of it, of course, it seems reasonable to maintain that 
 a woman who has brought up eight children of her own, and watched 
 by the bedsides of perhaps a dozen others, should know something 
 about the art. But this conclusion is based upon faulty logic. 
 
 The fact that grandma's eight children lived shows only that they 
 were sturdy and lucky that their natural recuperative powers 
 enabled them to survive her blunders or they that were rescued by 
 some hard-working family doctor. The knowledge that she ac- 
 quired in raising them consists, in good part, of things that are 
 obviously untrue. Because she once, or twice, or eight times 
 observed that a certain procedure seemed to be followed by a cer- 
 tain result, she maintains, to-day, as an uncontrovertible propo- 
 sition, that that same procedure will be followed by that same result 
 inevitably and always. 
 
 The doctor is a mere man, and it may be he has no babies of 
 his own, but his knowledge of babies, even accepting the grand- 
 mother's test, is infinitely greater than her own. He has walked 
 the hospitals for five years and he has seen and studied, not eight 
 babies, but eight hundred or a thousand. He has read the books; 
 he has listened to the great physicians. He has given his days and 
 nights to the investigation of human maladies their cause and 
 their cure. 
 
 And so, is it not reasonable, when he says that contaminated 
 cow's milk is not good for babies, and that "pacifiers" are likely 
 to inoculate them with the germs of cholera infantum is it not 
 reasonable to set up his authority against that of the grandmother 
 whose eight babies were lucky and so faced these perils unslain, 
 if not unscathed? 
 
 3 
 
Two considerations must be kept ever in mind in discussing the 
 care of infants. One is the fact that silly superstitions, far from 
 being confined to the slum mothers who give their babies beer and 
 dress them in wadded flannels, are rampant to an astonishing 
 degree among women otherwise intelligent and presumably sane. 
 The other is the fact that the ignorance of the mother, even when 
 the baby passes childhood in apparent health and safety, often paves 
 the way for suffering later on. 
 
 The tendency to blame all sorts of things upon intestinal para- 
 sites affords a double illustration. A baby, let us say, is restless 
 and fretful. Its body twitches and it moves about in its sleep. 
 
 It awakes suddenly and with a frightened cry. By day it 
 squirms in its high chair, picks at its nose and scratches the back 
 of its neck. Its mother is alarmed, and so its grandmother, two 
 aunts and four neighbors are called in consultation. The grand- 
 mother has raised eight children; the aunts, between them, have 
 raised nine; and the neighbors point proudly to twenty. Here 
 we have a gigantic conglomeration of expert aid. Thirty-seven 
 human beings are monuments to the science of seven mothers. 
 
 "The poor dear has worms," says the grandmother. 
 
 "Give him some quassia, " says one of the aunts. 
 
 "Why not try turpentine?" says the other. 
 
 "Or cucumber seeds," suggests one of the neighbors. "Wnen 
 my little Johnnie 
 
 So the corner druggist makes a sale of shop-worn goods, the child 
 swallows a staggering dose and during the ensuing forty-eight 
 hours it spends most of its time in a stupor that seems like sleep. 
 Isn't this a proof that it has been cured by the quassia, the tur- 
 pentine or whatever other specific the seminary of experts agreed 
 upon? Of course it is! 
 
 But all the same a rash intruder might make the observation 
 that babies are not designed by nature for the ingestion of drugs, that 
 a comparatively small dose shocks and exhausts them, and 
 that this exhaustion is often mistaken for healthy and refreshing 
 slumber. And this same observer, sometime later on, might point 
 out that the baby is again wakeful and restless that it again 
 squirms in its bed and chair and again cries in the night. 
 
 In the end, perhaps, it ceases its troubling, and the "cure" is 
 ascribed to the repeated doses that have been forced down its throat. 
 But, on the other hand, there is a chance that it will show no im- 
 
 4 
 
provement, and that its father, with courage born of alarm, will 
 at last invade the prerogatives of the feminine side of the house 
 and call in a physician. The physician, if all of his honesty has not 
 oozed out of him, will make a thorough examination, and the 
 probability is that he will find the baby to be suffering from adenoids 
 or, perhaps, St. Vitus's dance. 
 
 Adenoids are curious little cauliflower-like growths which ap- 
 pear at the juncture of the nasal cavity and the pharynx. They 
 are often observed at birth, but they seldom cause discomfort until 
 some months later. Then they interfere with respiration and cause 
 the baby to be restless. It tosses in its sleep and wakens suddenly, 
 crying out as if in distress. 
 
 If adenoids are permitted to remain they deform the mouth, 
 teeth, throat, chest and face. At their worst they produce pop- 
 eyes and what is called a frog-face. They cause mouth-breathing, 
 with all its attendant evils. They open the way for a hundred and 
 one ills, from rupture of the ear-drum, running from the ears, 
 coughs and tonsilitis, to pulmonary tuberculosis. 
 
 A slight operation suffices to remove them. The baby suffers 
 little pain and loses little blood. Out they come and with them 
 the overgrown tonsils that commonly accompany them. If they 
 are suffered to remain, they may never be discovered. But it is 
 certain that in one way or another, they will cause damage. 
 
 The mother of eight may say that she never heard of adenoids. 
 But despite her reluctance to include them in her lexicon, they 
 actually do exist. One child in every three has them. In low- 
 lying sea-coast towns they may be found in two children in every 
 three. A generation ago they were unobserved, and it is only for 
 a decade or so that their great importance has been fully realized. 
 And so it is no wonder, perhaps, that the average grandmother 
 is unaware of them. But the poor baby! It pays for her igno- 
 rance in pain, wakeful nights and misery, now and hereafter! 
 
 Given a child born at full term and of healthy parents, and it 
 is safe to say that half of its infantile ills are due to the ignorance 
 of its mother. She loves it, and so, when it sets up a cry, she nurses 
 it and it becomes an ill-mannered little glutton, with a penchant 
 for colic. She loves it, and so she feeds it too often and too much 
 and it becomes ripe for cholera infantum. She loves it, and so, 
 after it has had its fill, she coddles it, bounces it and plays with 
 it and it vomits. 
 
 5 
 
Despite the general idea that some babies are foreordained to 
 suffer from colic and that nothing can save them, it is nearly al- 
 ways preventable. Its appearance indicates that the little sufferer 
 is getting food of a sort his stomach can't digest, and missing food 
 of the sort he needs. It means that his mother, if he is at the 
 breast, is in no condition properly to feed him. It means that the 
 infant food he is taking, if he is upon the bottle, is poisoning him. 
 The remedy in each case is a consultation with a competent phy- 
 sician. This man, though not a mother himself, will determine 
 exactly what the baby needs, and he will write a prescription that 
 will insure the baby's getting it. 
 
 The word "prescription" may suggest the idea of drugs of 
 paregoric, ipecac, spirits of nitre and all the other ancient contents 
 of the infantile medicine-chest but in this case the prescription 
 will be, not for drugs, but for milk. What the baby needs is pure, 
 nourishing food, and, failing a good maternal supply, the best food 
 he can possibly get is cow's milk cow's so modified that it contains 
 the exact amount of proteids, of sugar and of fats that he needs. 
 
 In all large cities there are now laboratories, in charge of skilled 
 men, which make a business of supplying cow's milk that has been 
 modified according to physicians' prescriptions. Plain cow's 
 milk is bad for babies, even after it has been boiled, because it 
 lacks certain constituents that they need, and contains others 
 that they should not be called upon to digest. The work of modi- 
 fying it is done scientifically and cleanly, and the result is the nearest 
 approach to a perfect food that science has yet evolved. 
 
 The laboratory man will compound this, and the result will 
 be a bottle of milk of milk that seems to the feminine expert to 
 be quite like ordinary milk. But when the sick baby has taken 
 it at the hours and intervals laid down by the physician he will 
 have colic no longer, and in the process he will have acquired good 
 habits. 
 
 The notion that constant nocturnal bawling is a diversion 
 necessary to the baby's well-being is a fallacy as old as the super- 
 stition that sulfur and molasses are good for the blood. If an in- 
 fant wakes and cries at night it is an evidence of one of two things 
 either it is ill or it has been permitted to acquire bad habits. If 
 it is ill, the best thing to do is to send for a doctor. 
 
 If, after a thorough examination, he decides that it is in good 
 health, the fault lies with its mother. She fed it whenever it 
 
 6 
 
cried; she made it associate the act of crying with the production 
 of a meal ; she fastened upon it the habit of feeding when it should 
 be asleep. 
 
 A healthy infant, properly trained, should go to sleep every 
 night at seven o'clock and sleep soundly until daylight. It should 
 be fed when it awakes in the morning, and it should be fed again 
 at regular intervals throughout the day every two hours when 
 it is very young, and every three or four hours as it grows older. 
 Its last meal should come just before it is tucked into its crib. And 
 if it cries for food after that, it should be permitted to cry until 
 the habit is broken. 
 
 The only things that should ever touch an infant's lips, during 
 its first year, are boiled water and milk mother's milk, or cow's 
 milk properly modified. If it is born strong and sound and is 
 properly fed it will need no medicines. And all other things 
 mush, soup, porridge, fruits, pretzels, alcohol, vegetables, meats, 
 "pacifiers," rubber rings, orris-root, sugar, rattles and its nurse's 
 fingers are abominations in its mouth. They spell indigestion 
 in a dozen forms, not to speak of colic, fevers, wakefulness, faulty 
 growth and cholera infantum. 
 
 Next to unwise feeding, as a source of infantile ills, comes over- 
 coddling. Kissing the baby after it has been fed, for instance, 
 is very likely to cause it to vomit, and vomiting is even more ex- 
 hausting to a child than to an adult. The desire of all aunts, 
 cousins, sisters, grandmothers, neighbors, parlor maids, cooks, 
 seamstresses and other members of the affectionate sex to "hold 
 the baby" and kiss it, and of all uncles, grandfathers and bachelor 
 friends of its father to hoist it to the ceiling, should be rigorously 
 denied. Such delightful domestic pastimes do the baby no good, 
 and very often hurt it. At best it becomes peevish. At worst 
 it shows signs of hysteria. Children should play when they are 
 old enough to play with children. 
 
 And let there be an end to home doctoring! Most intelligent 
 mothers have learned to be wary of soothing-sirups, but the great 
 majority still put a good deal of faith in paregoric. It is a favorite 
 for diarrhea, stomach-ache and a host of other ills. Often, perhaps, 
 it gives what seems to be relief, since opium, its main constitu- 
 ent, is the greatest of the gifts of the gods. But is it safe for 
 mothers to give their children opium? 
 
 In most other home remedies there is less positive danger, but 
 
 7 
 
all of them do harm in at least two ways: they postpone the be- 
 ginning of proper treatment, and they subject the poor baby to 
 excessive and harmful medicating. 
 
 Deliberate neglect of her baby is a felony seldom proved against 
 an American mother or against any mother, for that matter. 
 Yet I sometimes feel that neglect, in the long run, would often do 
 less damage than too much loving. The classical "villainess" 
 of American romance and folklore, who wastes her time in social 
 gaiety and hands over her offspring to professional nurses, seems 
 like some revolting and inhuman monster, and perhaps she is. 
 But did it ever occur to you, oh, indignant critic, that the children 
 of such callous mothers, though they may lack a proper reverence 
 for the canon law and the ordinances against motor speeding, 
 are nevertheless uncommonly healthy animals? The fashionable 
 young woman appears in the divorce courts a bit too often, but she 
 seldom lands in a hospital. She is vigorous and strong. She has 
 a sound digestion. She swings her golf club with muscular arms. 
 And her brother is tough literally as well as figuratively. He 
 has no morals, but he has a good wind and strong legs. 
 
 The cause of all this, I fancy, lies in the fact that these young 
 persons were never coddled. Professional nurses fed them, with 
 inhuman disregard for their yells, upon proper food at proper 
 intervals. An early realization of the futility of bawling led them 
 into regular habits. They swallowed no soothing-sirups; they 
 took no camomile; they knew not the flaxseed poultice nor the 
 home-made liniment. No one rocked them to sleep ; no one tickled 
 them ; no one bounced them up and down. They were kissed only 
 upon state occasions and then in a gingerly, aseptic way, 
 upon the forehead or the cheek. 
 
 Consider now the baby of the great middle class the baby en- 
 throned upon a mountain of pillows, the baby whose mother trem- 
 bles when he cries and worries for days about the mole on his neck 
 and wears herself out slaving for him. How zealously she guards 
 him against drafts! He is clothed in warm flannels; his cradle 
 he should really sleep in a comfortable crib is dragged far from 
 the window ; he is buried in bedclothes, and he is kept indoors on 
 windy days. The mother's intentions are good, beyond a doubt, 
 but her prophylaxis is hopelessly fatuous. The baby needs air 
 beyond all things. He should spend as much as possible of his 
 first year in the open. He should be taken out in his go-cart 
 
 8 
 
upon every fair day, and kept out in all the intervals between 
 meals. He should sleep in a room with open windows, Winter 
 and Summer. 
 
 Babies should be put into short clothes at their birth if they 
 come into the world in warm weather, and at two months if they 
 first see the earth in a mantle of snow, and thereafter they should 
 be clad very sparingly. 
 
 An infant's skin is so tender that perspiration quickly causes 
 it to chafe. To guard against this the baby should be kept cool 
 and bathed often. And after it has been bathed it should be laid 
 on a clean sheet and not first frescoed with powder and then swathed 
 in habiliments fit only for a mummy. 
 
 In Winter the fact that the weather is cold should not condemn 
 the child to hot rooms and bad air. It is easy enough to dress it 
 warmly without burying it in clothes, and if it is warmly dressed 
 the cold will not hurt it. Let it not be understood that I am ar- 
 guing that infants are fit to face blizzards. But in most parts 
 of the United States blizzards are rare, and the majority of Winter 
 days, though cold, perhaps, are fine. On such days the baby 
 should spend hour after hour outdoors. Awake or dozing, it should 
 be wheeled up and down in the pale sunshine. 
 
 The popular notion that all babies are predestined to suffer at- 
 tacks of a long string of infantile ills, from chicken-pox to diphtheria 
 is utter foolishness. There is no reason, whatever, why a child 
 should take any of these diseases. A baby that has grown ac- 
 customed to sunlight and the open that sleeps soundly, digests 
 normally and has lost, seemingly, all capacity for taking cold is 
 little likely to fall a victim to the common infections. Its veins 
 are full of good, red blood, and this blood is prepared, at all times, 
 to wage a terrific war upon germs. And even in case the germs 
 prevail, and the baby grows ill, its chance of having but a mild 
 attack and of recovering quickly and without distressing and linger- 
 ing complications is infinitely greater than that of the vulnerable, 
 ailing, coddled child. The evil effects of coddling do not appear 
 at once. If they did, there would be no coddling. But they ap- 
 pear certainly, none the less, and too often they make the difference 
 between a mild case of scarlet fever and a very bad one, with 
 Bright 's disease following after. 
 
 The baby that is fed every time it cries, whose stomach is over- 
 loaded day and night with improper food, is the baby that falls 
 
 9 
 
before the germs of cholera infantum. This is less often a malady 
 of filth in the popular conception of the word than a disease bred 
 of faulty nutrition, overbundling and grandmotherly therapeutics. 
 A flaxseed poultice may lay the foundation for pneumonia. A 
 drop of paregoric may kill. A mistaken diagnosis of "worms" 
 may mean St. Vitus's dance, or adenoids and long years of suffering. 
 A flannel garment may pave the way for measles or diphtheria. 
 A home-brewed tea may delay the physician until it is too 
 late. A kiss may spell tuberculosis. 
 
 Home dosing and coddling herein we have the foot-notes that 
 explain the tables of infant mortality. Throw away your pare- 
 goric, your ipecac, and your camomile! These things are abom- 
 inations as bad as your patent soothing-sirups and sarsaparillas. 
 Your baby doesn't need drugs, but pure food and fresh air. If 
 he seems ill, let your doctor prescribe for him. Nine times out of 
 ten he will order milk rather than purges. Open the windows and 
 let in the air! Throw away your stock of chest-protectors, belly- 
 bands and padded woolens! Let the baby kick! Let him breathe! 
 Let him be bare! 
 
 QUESTIONS FOR THE MOTHER ABOUT CHAPTER I 
 
 Is there anything you would not do to save your baby? 
 
 No. 
 
 Is anything too good for your baby? 
 
 No. 
 
 Do you want the best advice in bringing up your baby? 
 
 Yes. 
 
 Is grandma's advice or your neighbor's advice the best? 
 
 No. 
 
 To whom can you safely trust your baby? 
 
 To the doctor. 
 
 Should a mother wait till her baby is sick before taking it to the 
 doctor? 
 
 No. The doctor can tell a mother many things about the care 
 of her baby that will keep it from getting sick. 
 
 How often should your doctor see your baby, whether it is well or 
 sick? 
 
 At least once in two weeks until two years old. 
 
 10 
 
Is this not an unnecessary extravagance? 
 
 No. The cost of a ten minute examination of the baby by the 
 doctor once in two weeks will, in the long run, be very much less 
 than the cost of the doctor's visits and the bills for medicines if 
 the baby has a severe illness. 
 
 How many babies die under one year of age in the United States 
 to-day? 
 
 One out of every six babies born dies before it reaches one year 
 of age. One out of every four babies born dies before it reaches 
 five years of age. 
 
 Shall your baby be the sixth one? 
 
 No. 
 
 How can you save it? 
 
 By striving to learn the best methods known by experts on feed- 
 ing, clothing and caring for the baby. 
 
 What are some of the superstitions and customs of mothers that 
 make babies sick? 
 
 Soothing sirups; pacifiers; feeding the baby whenever it cries; 
 patent medicines; patent baby foods; family remedies; the idea 
 that babies are doomed to be sick when their teeth come ; that the 
 baby must be constantly played with or kept in constant motion; 
 the idea that because so many babies die to-day they must always 
 die. 
 
 What are the diseases of which babies die? 
 
 Diarrhea; pneumonia; whooping cough; tuberculosis; menin- 
 gitis and a few of contagious diseases such as diphtheria; measles 
 and scarlet fever. 
 
 How many of these diseases are preventable? 
 
 All of them. 
 
 How many of them are due to ignorance on the part of the mothers? 
 
 All of them. 
 
 How many of them are germ diseases? 
 
 All of them. 
 
 How do germs get into the babies' system? 
 
 Through impure milk; through sucking a dirty pacifier or rag; 
 through drinking water that has not been boiled ; through nursing 
 bottles and nipples that have not been sterilized. 
 
 What is the best way to make a baby able to resist germs? 
 
 By keeping it out in the air all the time, and by being sure that 
 it is well nourished. 
 
 11 
 
Why is the pacifier habit or the habit of sucking the thumb especially 
 bad? 
 
 Because it forms the habit of breathing through the mouth. 
 This encourages the growth of adenoids. Because the tissues 
 of the throat become infected with germs taken in this way. 
 
 What are adenoids? 
 
 Adenoids are small spongy lumps that grow back of the nose 
 and partly close the nostrils. 
 
 Why should adenoids be removed? 
 
 Because if permitted to remain in the growing child, the mouth, 
 teeth, face and chest become deformed; because they are the 
 direct cause of deafness, constant colds and throat trouble, and 
 often lead to pulmonary tuberculosis. 
 
 How can adenoids be removed? 
 
 By a slight surgical operation which can be performed in less 
 than a minute and which causes very little pain, and but slight 
 loss of blood. 
 
 Why are mothers glad when they have not delayed in having adenoids 
 removed? 
 
 Because the change in the health and happiness of the child 
 is so immediate and so marked. 
 
 What is the young mother's gospel? 
 
 Clean air, clean milk, clean baby. 
 
 12 
 
CHAPTER II. THE NEW-BORN BABY 
 
 UST as every man is firmly convinced that he is 
 perfectly competent to drive a nail, run a 
 newspaper or direct the destinies of the nation, 
 so every woman believes that she knows how 
 to care for a baby. The only difference is that 
 the man looks upon his fitness as the result 
 of profound study and a high order of intellect, 
 while the woman, more modest, gives the 
 credit to instinct. Both are wrong. 
 
 Instinct and mother love, it is plain, will restrain even the most 
 ignorant young mother from feeding her baby upon cucumbers, 
 but in other ways, unless she is well instructed, she is apt to 
 make mistakes, and these mistakes may be costly. If the instruc- 
 tion she receives comes from one of those well-meaning old women 
 who radiate maternal lore so copiously in all communities, her 
 blunders are certain to be numerous and bad. But if she is 
 sensible, and seeks advice from a physician or a graduate nurse, 
 she will learn a great deal, and the things that she learns will 
 have the merit of being true. With a good groundwork thus 
 laid, she will approach unaccustomed problems and emergencies 
 in an intelligent, efficient fashion. 
 
 In choosing the physician who is to assist in bringing her first 
 child into the world, it is well for the young mother to be extremely 
 critical. Unluckily enough, all holders of the doctor's degree are 
 not of the first rank, and very often the man with the most impres- 
 sive beard and of the most heartening geniality is the least competent. 
 The best thing to do is to select a practitioner who has been 
 trained in a college of the best sort and who, whether young or old 
 has standing in his profession. If he is of such admitted compe- 
 tence that his fellow physicians are known to seek and respect his 
 advice, so much the better. 
 
 Most towns will have a doctor of hospital experience and skill 
 in conducting infant cases. His fees may seem large, but he 
 
 13 
 
well earns them, for his presence is an assurance against many 
 very distressing accidents. The majority of the dangers attending 
 childbirth, indeed, disappear with scientific care. This is especially 
 true of the complications due to infections childbed fever and 
 blood-poisoning in the mother, and that appalling eye inflam- 
 mation which leads to blindness in the child. It has been esti- 
 mated that nearly half of the blindness in the United States to- 
 day had its origin in infections at birth. A scientific physician 
 knows how to prevent such accidents with almost absolute 
 certainty, but the ordinary neighborhood midwife does not. 
 
 The average weight of a white American baby, at birth, is seven 
 and one quarter pounds, but a child may weigh little more than 
 six pounds and still be perfectly healthy. The twelve-pound 
 baby of popular tradition is very rare in fact, and his celebrity 
 is largely due to inaccurate scales and heavy clothes. A child 
 of abnormal size is not to be envied, since he is usually no stronger 
 than a smaller one, and his entry) into the world is attended by 
 far greater hazards and difficulties. 
 
 A new-born baby appears such a tiny and distorted caricature 
 of a human being that it is often difficult to convince the alarmed 
 mother that nothing is wrong with it. In color it is a fiery red, 
 and in expression it is utterly vacuous. Its head is large and ob- 
 long, and there are spaces between the soft bones of its skull through 
 which the movements of its brain may be observed. The oblong 
 shape of the head soon gives way to rotundity, and the process re- 
 quires no artificial aid. The notion that the contour of the skull 
 may be modified by the manner in which the child is laid upon its 
 bed has little basis in fact. So long as it is comfortable and has a 
 soft pillow under it, it is safe. 
 
 An infant's abdomen appears enormous, just as its chest appears 
 small. This is because at birth, the development of its digestive 
 apparatus has proceeded much further than that of its respiratory 
 organs. For a week or so its breathing may be quick and irregu- 
 lar. Sometimes it will miss a breath, and then again it may 
 breathe so fast that it seems to be suffocating. Do not worry. 
 It is merely a way that new-born babies have. 
 
 During its first week the child is apt to lose its red color and be- 
 come yellowish. Many midwives note this as a dangerous sign, 
 and proceed at once to dose the little one with honey, sulfur and 
 various teas. As a matter of fact, the yellow color is nothing more 
 
 14 
 
than the symptom of a passing jaundice which disappears in short 
 order and is by no means alarming. All babies do not have it, but 
 those that do, suffer no damage. 
 
 About the same time the child's skin begins to break up into 
 fine scales and come off, and its hair the fine down on its body 
 and the longer hair which may have covered its head at birth 
 begins to fall out. 
 
 All of this shedding is quite normal, and is a mere preliminary 
 to the appearance of the true, soft, satiny baby skin. With the 
 beautiful texture of the latter every woman is familiar. It is 
 nearly white on the body and limbs, but becomes a deep rose-pink 
 on the palms and soles. 
 
 A healthy baby usually celebrates its advent into this wicked 
 world by setting up a shrill cry. When this primal utterance 
 is not heard, the doctor often provokes it by manipulating the new- 
 comer's arms and legs, or even by treating it to a gentle spanking. 
 This cry is a good sign, for it proves that the baby has sturdy lungs 
 and that it has promptly discovered their use. But the absence 
 or postponement of a wail need arouse no fears, for plenty of 
 healthy babies greet the world with dignified silence. It is the 
 firm belief of nearly all midwives that a child which cries feebly 
 or not at all during its first few minutes of life is doomed to ill- 
 ness and early death. This belief is an heirloom from the age 
 of portents and premonitions. 
 
 In this connection it may be of interest to note that a new-born 
 baby, no matter how lustily it may signify its discontent, never 
 sheds tears. This is because its lachrymal glands, like many of 
 its lesser organs, have not yet found their function. Neither does 
 it slobber, as babies of larger growth are apt to do, for its salivary 
 glands are still inert, and its tongue, in consequence, is white and dry. 
 
 Loving mothers and imaginative aunts are wont to discover 
 evidences of perception and intelligence during the first week, 
 but as a matter of fact, a human infant, until it is fully a month 
 old, is alive, and that is all. Its eyes may see, but its brain 
 cannot understand, and all of its acts are automatic reflexes. 
 Crying constitutes the primitive language whereby it makes 
 known its few wants. It cries when it is hungry and when it is 
 uncomfortable. The young mother will quickly grow familiar 
 with its normal voice and so learn to detect variations. 
 
 A healthy baby cries about two hours a day for no other reason 
 
 15 
 
than that it needs exercise. This crying is not continuous, but 
 is distributed over the twenty-four hours in short spells. 
 
 QUESTIONS FOR THE MOTHER ABOUT CHAPTER II 
 
 Should not the bringing up of a child strong in body and character 
 require as systematic, careful and scientific study as any profession? 
 
 Yes. Enlightened mother-love learns the most advanced methods 
 of caring for children. 
 
 How can the average mother get this knowledge? 
 
 In some large cities and small towns there are classes for young 
 mothers with doctors held in the public schools or in the mothers' 
 clubs. Many health departments send doctors or educational 
 nurses to teach mothers in their homes the care of babies. 
 
 What should a mother do to belong to such a class? 
 
 She should ask her health commissioner or school superintendent 
 whether he can direct her to such a class or send a teacher to her. 
 
 When should a mother put herself in the care of a doctor? 
 
 As soon as she knows a baby is coming to her. She should have 
 a thorough physical examination and should consult her doc- 
 tor frequently to prevent the dangers that often attend childbirth. 
 
 Should a mother go to a hospital for her confinement? 
 
 If the care of her home and children is heavy, she should do 
 so. The rest and care of the hospital, as well as the education it 
 will give her, is invaluable to her and to her baby. 
 
 What are the tests she should use in selecting her physician? 
 
 The best recommendation for a physician is that he is sought by 
 his fellow physicians for advice. 
 
 What should she do if she is in doubt? 
 
 She should go to her health department and ask for advice in 
 selecting the doctor to care for her and her baby. 
 
 Why should a mother never employ a midwife when she can go to a 
 doctor? 
 
 Because many more babies who are brought into the world by 
 midwives die than babies who are brought into the world by phy- 
 sicians. Because a midwife's education falls far below that of 
 a physician. A woman should sacrifice her own prejudice, and 
 always employ a physician. The best is not too good for her baby. 
 
 16 
 
CHAPTER III. BABY'S FIRST FEW MONTHS 
 
 HE young child has almost no 'power of reason, 
 but, like a little animal, it soon learns to make 
 a sort of unconscious correlation between 
 cause and effect. That is to say, it learns that 
 certain acts lead to certain results. If its 
 nurse or mother stills it once or twice by tak- 
 ing it in her arms, it will cry thereafter when- 
 ft ever it wants to be taken up. In the same way 
 it will learn, in an incredibly short time, how to bring some one 
 to its cradle-side to rock it. These cries of habit should be 
 promptly suppressed, for, in the first place, it is not good for a 
 child to be handled or rocked; and in the second place, com- 
 pliance will quickly give it perverse and disagreeable habits. Let 
 it cry for three nights in succession and it will hold its peace 
 thereafter. The ancient fear that a baby which is permitted to 
 yell away, without effort to soothe it and still it, will rupture itself, 
 is groundless. A baby lying upon a soft pillow cannot possibly 
 rupture itself, no matter how violently it cries or how vigorously it 
 tosses about. 
 
 The cry of habit iis much like the normal cry of every baby. 
 The wails are long drawn out and have a sort of rising and falling 
 cadence. They are still at once if the baby gets what it wants. If 
 it does not, they gradually grow less loud and so cease. 
 
 The cry of pain, on the contrary, is a short, quick, gasping cry. 
 The baby commonly draws up its legs and gives other evidences of 
 serious disturbance. Mild colic, which is not dangerous, often pro- 
 duces this cry. Unless it is prolonged there is no need to be alarmed. 
 The prudent nurse, however, will make a diligent search for 
 tight napkins and loose pins. 
 
 The cry of hunger is a quick, sharp, staccato cry, with high, 
 shrill notes, but less vigorous than the cry of pain. It should cease 
 at once on feeding. 
 
 The cry of temper and temper is exhibited by very young chil- 
 
 17 
 
ctren is long, sharp, and high-pitched. It indicates that the 
 youngster is enraged that it wants more light in the room, that its 
 bed is uncomfortable, that it wants some one to change its posi- 
 tion, or that it does not want the food forced upon it. Some children 
 have such violent tempers that they throw back their heads and grow 
 blue in the face and seem to cease breathing. The mother often 
 fancies that they are in convulsions and sends for the doctor post- 
 haste. The best way to deal with such recalcitrant little folks is to 
 lay them in bed and let them cry. They will quickly observe the 
 futility of their efforts and so cease. 
 
 When children grow older they acquire what might be called the 
 "insulted " cry. A child of six months is sensitive to sharp words 
 and gives voice to the humiliation they produce. This cry consists 
 of a short sob, followed by a longer one, and slowly rising in volume, 
 though not in pitch. Indeed, it is not unlike the cry of a woman. 
 
 The cries of pain, hunger and temper are accompanied by a 
 drawing up of the legs. In the other cries the child's limbs have 
 no part. 
 
 Babies change so much during their first few weeks that their 
 appearance at birth gives no hint as to their future complexion, form 
 or stature. One may come into the world with its mother's blue 
 eyes and small nose, and attain its majority, twenty-one years later 
 with the darker orbs and more formidable nose of its father. 
 This is because nearly all babies have eyes of an indefinite, bluish 
 color, and noses of no particular shape at all. The color of their 
 hair, if they have any, is also misleading, for, as a general thing, it 
 is considerably lighter than it will be in after years. 
 
 During its first month a baby has almost no control over its 
 muscles. If you lay it down, it remains just where you put it and 
 cannot change its position. If you hold it up, its head rolls about. 
 In nursing, its movements are entirely automatic and unconscious 
 as much so, indeed, as those of the minute organisms which bridge 
 the border-line between plants and animals. There is good reason 
 to doubt, indeed, that it is conscious of pain. Its cry appears as a 
 mere reflex and without the interposition of cognition or effort. 
 
 But this stage does not last long, for a baby grows with remarkable 
 rapidity. The rate at which it lives is well demonstrated by ob- 
 serving the functioning of its organs. Its heart beats at a rate that 
 would be fatal to an adult, and, as we have seen, it breathes very 
 fast. At birth, for example, its pulse is often one hundred and for- 
 
 18 
 
ty-five a minute, which is just twice the normal rate in a grown man 
 or woman. Its respiration is similarly hurried, being forty-five 
 or more a minute for the first few weeks, as against sixteen to eight- 
 een in the adult. The bowels of a new-born baby are usually 
 very active, but the bladder may not function until after its first 
 day. 
 
 By the time it is four months old the child weighs almost twice 
 as much as it did at birth and is plainly making rapid progress. It 
 can now hold up its head 'without support, and it has developed a 
 habit of grasping any small objects which touch its hands. Be- 
 fore it is a month old it may smile, but it is not until some 
 time later that its smile seems to be associated with any definite 
 idea. But by the time it enters upon its fourth month its intel- 
 ligence is fully dawning. It learns to recognize its mother, and 
 ceases to cry when she takes it in her arms. Its eyes follow lights 
 and moving objects and its ears detect noises. 
 
 Soon afterwards it begins to distinguish between its mother and 
 other persons and to become fully conscious of the world about it. 
 
 A baby begins to utter sounds other than those of crying when 
 very young, and before it is six months old it often acquires a vo- 
 cabulary of three or four vowels. The first that it masters is 
 commonly the broad "a," and this diligently repeated, as "ah- 
 ah-ah-ah, " convinces its mother that it has learned to say "mama." 
 But, as a matter of fact, the youngster is merely voicing, with the 
 one elementary sound at its command, its general feeling of comfort. 
 This "ah-ah, " indeed, is a brother to the purr of the house-cat upon 
 the hearth-rug, and is similarly devoid of any underlying con- 
 cept. 
 
 Soon, however, a multitude of crude but vastly interesting ideas 
 throng the infantile brain, and the baby tries to talk. Some babies 
 make such efforts as early as the ninth month, but others are much 
 slower. The fact that a child is backward in talking is no sign of 
 defective intelligence, nor does it prove that it will be a slow pupil 
 later on. Some of the greatest men of genius the world has known 
 were unable to form intelligible words until the age of two years. 
 
 In the matter of walking and teething there is the same unac- 
 countable variation. Some babies are able to sit up at the age 
 of six months and begin to make efforts to crawl at the same time. 
 Held upright on its feet, a youngster of such precocity will try 
 to stand erect, and will crow with delight if it succeeds. There 
 
 19 
 
are babies, equally intelligent and healthy, which seem to be hope- 
 lessly clumsy and are utterly unable to make the crudest approach 
 to locomotion. As a general thing, a baby which begins to walk 
 at sixteen months is doing well enough. Plenty of children try 
 in vain until after they are two years old. If the baby's legs are 
 strong and it is in good health there is no reason why backwardness 
 in this respect should cause alarm. The various mechanical con- 
 trivances for teaching children to walk rolling chairs, frames, etc. 
 are of questionable utility and may produce dangerous strains 
 upon the weak bones and muscles. 
 
 QUESTIONS FOR THE MOTHER ABOUT CHAPTER III 
 
 What are some of the habits a young baby should be taught to form? 
 
 It should be nursed at regular intervals. 
 
 It should be fed, bathed, dressed and put to bed at the same 
 hours each day. 
 
 It should be allowed to sleep most of the day and night except 
 when it is time to be fed or to be bathed. 
 
 Is should be taught to eliminate its food at regular hours. There 
 is no need for the disagreeable and unhealthy custom of soiled 
 diapers. If you hold the child on its little "chair" once an hour, 
 you will help it form clean habits that will prevent constipation, 
 
 Need a baby always wear flannel next the skin? 
 
 A baby should be dressed according to the weather. It should 
 never be allowed to get chilled. It should never be allowed to 
 get into a perspiration, for its body is apt to become chilled. A 
 baby's little body will become chilled or heated quicker than an 
 adult's. Keep its hands and feet warm in winter and dress it very 
 lightly in summer. 
 
 Should a baby wear long clothes? 
 
 If it is born in the cold weather, it may wear long clothes for the 
 first few months, but they must not be long enough to be heavy 
 and drag on the child's shoulders. If it is born in the warm 
 weather, it should wear dresses not below its feet. 
 
 What should a mother remember about her baby's clothes? 
 
 She should put herself in the baby's place. She should remem- 
 ber that its skin is very tender and that buttons, pins, wrinkles 
 hurt it, make it restless, uncomfortable and fretful. 
 
 20 
 
CHAPTER IV. THE NURSING BABY 
 
 HUMAN infant, during the first few months 
 of its life, is an extremely delicate organism, 
 and so it should be handled with care, which 
 means that it should be handled as seldom as 
 possible. The young mother who, in the excess 
 of her pride and love, cuddles her baby to her 
 breast and showers kisses upon it by the half- 
 hour makes a pretty picture, it must be 
 admitted, but it cannot be maintained that the little one is 
 benefited by her caresses. Quite to the contrary, her every kiss 
 helps to make it nervous and irritable and prepares the way for 
 the seeds of disease. A baby that is fondled too much is a baby 
 that cries too much, and is ill too much. 
 
 Despite the evidences of intelligence apparent to loving eyes 
 after the first week, an infant's mind is a happy blank, and it gets 
 no joy out of the affections. To it, its mother appears merely as 
 a source of food, and later on, when its brain begins to function, 
 this primitive association of a craving and the means of satisfaction 
 is probably the first definite idea that formulates in its mind. When 
 it is hungry, it wants its mother to feed it, and before long, in- 
 stead of merely crying for food, it cries for her. 
 
 When it is not hungry, its chief need and desire is for sleep. A 
 healthy baby, during its first month, should sleep at least eighteen 
 hours a day. And this sleeping should be done, not in a rocking, 
 nerve-racking cradle, but in a solid, comfortable crib. The cradle 
 belongs to the age of spinning-wheels and flails, of soothing syrups 
 and necromancy. 
 
 It is not until the fourth day after the baby's birth that its mother's 
 milk is truly nourishing, but such as it is, it exactly meets the needs 
 of the child. It is, in fact, a sort of laxative serum, which stimu- 
 lates the entire digestive tract and prepares the stomach for the 
 reception of food. On the first day the baby should be nursed only 
 once, but it should be given a drink of boiled water every three 
 
hours or so. On the second day it should be nursed three times 
 morning, afternoon and night with the same allowance of water. 
 On the third day the routine of the second day should be repeated. 
 At the end of the third day it will be found that the child has lost 
 a quarter or half a pound. This need cause no alarm, for it is per- 
 fectly natural, and a steady gain will immediately begin. 
 
 On the fourth day both baby and mother are ready for regular 
 feedings at shorter intervals. From this time onward, until to- 
 ward the end of its second month, the child should be nursed every 
 two hours, with a slightly longer wait after its daily bath, and an 
 interval of seven hours in the night. In all, it should have about 
 nine feedings during the twenty-four hours, as follows: 6, 8 and 
 10 A. M. and 1, 3, 5, 7, 9 and 11 P. M. Between eleven o'clock in 
 the evening and six in the morning it should not be fed at all. 
 The fact that most babies demand food during this time merely 
 shows that most babies have bad habits. Let the child cry in vain 
 for three nights running and it will never cry again. But during 
 the day, even if it happens to be sound asleep, it is well to waken it 
 in order to keep to this schedule faithfully. 
 
 The bath should be given just before the ten o'clock feeding in the 
 morning. The water should be at the temperature of the body 
 about 99 degrees and soap should be used very sparingly. After 
 the child has been gently washed, sponge it with a soft cloth dipped 
 in cold water and give it a brief rub-down with alcohol. This will 
 bring the blood to the surface, stimulate the circulation and pre- 
 vent colds. It is well to let the baby sleep three or four hours after 
 its bath. Then, if it has not already awakened and demanded 
 food, it should be aroused and the regular schedule of feeding re- 
 sumed. 
 
 The length of time that the child should be kept at the breast at 
 each feeding depends so much upon the volume of the milk and its 
 own idiosyncrasies that it is impossible to lay down an invariable 
 rule. The mother should be guided by the fact that a newly-born 
 infant's stomach has a capacity of but one ounce, or eight teaspoon- 
 fuls. Some babies are able to ingest this amount of milk in a few 
 minutes, while others require much longer. But it is rarely safe to 
 keep a child at the breast for more than from ten to fifteen minutes. 
 
 An infant's stomach is not a fully developed organ, and, as every 
 one knows, it can digest only milk, or something closely approxi- 
 mating milk in composition. As a matter of fact, it probably plays 
 
 22 
 
but a minor role even in the digestion of milk, for it stands almost 
 perpendicular and is really little more than an extension of the bow- 
 els. The food which enters it passes into the bowels very quickly, 
 and there the more important part of the process of digestion takes 
 place. But, all the same, a baby should be given no more food 
 than its stomach can hold. 
 
 A baby, like an adult, needs water as regularly as it needs food. 
 The milk that it gets, though a liquid, does not satisfy its thirst. 
 It should be given water at least three times a day, and this water 
 should be nearly, if not quite, free of organisms. The water that 
 comes from the average city main or country spring is alive with 
 microscopic plants and animals, even when it seems clear and 
 sparkling. These minute organisms, as a rule, are harmless to 
 adults, but in the delicate stomach of the baby they are apt to 
 cause disturbances, and so they must be eliminated. The best 
 way to get rid of them is to allow the water to boil twenty minutes. 
 After that, let it cool and store it in clean, well-corked bottles which 
 have been previously immersed in boiling water for five minutes. 
 Glass stoppers are better than corks. 
 
 Boiled water is tasteless and insipid because of the absence of 
 air-bubbles, but the baby seldom notices it. It is best drunk out of a 
 thoroughly clean nursing-bottle. Offer water to the infant every 
 four hours, and let it drink as much as it wants. The supply for 
 each day should be boiled in the morning. Under no circum- 
 stances should water be kept more than a day. 
 
 QUESTIONS FOR THE MOTHER ABOUT CHAPTER IV 
 
 Who should kiss your baby? 
 
 Nobody should kiss it on the mouth, not even you. You should 
 instruct every one who is likely to come in contact with it to kiss 
 it on its cheek or forehead. Instruct your nurse not to let strangers 
 kiss the baby. A consumptive's kiss might give it tuberculosis. 
 
 How much should your baby sleep? 
 
 A heal thy infant should sleep most of the time except feeding time. 
 
 Should any attempt be made to develop a young baby's mind? 
 
 No. A baby should not even be played with, or in any way 
 excited. This makes it nervous and gives it indigestion. Remem- 
 ber, much joy as your baby gives you, it should never be made 
 
 23 
 
to give you, your family, or friends, entertainment at the sacri- 
 fice of its own health and regular habits. 
 
 How should a baby be put to bed in the day time? 
 
 A baby should always sleep alone. It must have a little bed of 
 its own. Not a cradle, but a crib with a flat mattress and a low 
 pillow or no pillow. The baby should be put to sleep on a shaded 
 piazza, or yard, or in a room with the windows open. Its covers 
 should be suited to the temperature of the day. It should never 
 be allowed to become chilled or to perspire. In cold weather the 
 sun should shine on its bed but never in the child's eyes. 
 
 What is meant by being ''regular" with the baby? 
 
 That it should be fed at the same hours every day bathed at 
 the same hour every day put to sleep at the same hour and taken 
 up at the same hour. That its bowels should move at the same 
 hours that it should not be fed whenever it cries not to be taken 
 up to entertain visitors that it should be expected to sleep all 
 night without feeding or petting. 
 
 How often should the baby be bathed? 
 
 The baby should be bathed every day before the ten o'clock feed- 
 ing. Everything necessary to the bath should be in readiness before 
 the baby is undressed. Hang up a list of the necessary articles in 
 the bathroom and consult it every day. The baby may get chilled 
 while you are hunting up something you have forgotten. 
 
 LIST 
 
 Tub warm water bath-room thermometer soap gauze 
 cotton wads in covered glass powder vaseline flannel apron 
 towel gauze towels clean clothes and diaper alcohol. So- 
 lution of boracic acid in covered glass. 
 
 How should the bath 63 given? 
 
 Let the room be thoroughly warm before you undress the baby. 
 Be sure there is no cold air on its little body. 
 
 Wash the baby's eyes and mouth with a swab of aseptic cot- 
 ton dipped in a weak solution of boracic acid. Wind up a little 
 wad of cotton and clean its ears. Dip a wad of cotton in vaseline 
 to cleanse its nose. Never stick anything hard into a child's ears 
 or nose, and be careful not to leave any cotton in the ears or nose. 
 A baby's membranes are very easily injured. 
 
 Then put the child into a tub of warm water and wash it all over 
 with a mild soap. Teach the baby to enjoy the bath. Let it splash 
 
 24 
 
about and have fun. It will save you much trouble. Never pro- 
 long the bath to please the baby or to entertain friends. Do not 
 let people go in and out of the room while the baby is undressed. 
 Use for a wash rag a piece of aseptic gauze, or bleached cheese 
 cloth, boiled. A sponge catches and develops germs. It is un- 
 clean as it cannot be boiled without ruining it. Complete the bath 
 with all dispatch. Wrap the baby in a woolen blanket to absorb 
 the moisture quickly. Powder it with soft powder, dress it and feed 
 it and put it at once to sleep in the air. 
 
CHAPTER V. MOTHER AND BABY 
 
 HE nursing-bottle and nipple, whether used for 
 water or for artificial food, should be immersed 
 in boiling water for at least five minutes every 
 day, and when they are not in use they 
 should be kept in a covered glass filled with a 
 weak solution of boracic acid. Such a so- 
 lution is of constant usefulness in the nursery, 
 and it is well to prepare it in bulk. A cupful 
 of boracic acid, to be had at any drug store, will suffice for 
 two gallons of water. Keep it well covered and it will last for 
 a long while. Use it to wash all dishes, cups, bottles, spoons and 
 other utensils that play a part in the baby's commissariat. 
 
 The best possible food for a baby is mother's milk, and this is 
 what it should get whenever possible. The mother who permits 
 social " duties, ' ' laziness or any other such excuse or motive to in- 
 terfere with her highest of privileges is a woman unfit to bring human 
 beings into the world. The best of all infant foods, like the best of 
 all varieties of modified cow's milk, is but a sorry substitute for 
 mother's milk. Nothing devised by the ingenuity of physicians and 
 chemists can so perfectly combine the offices of food, drink and 
 medicine as does this natural food. 
 
 When I say medicine, I speak literally, for mother's milk gives 
 to the baby some measure of her own acquired power of resistance 
 to disease. There is, indeed, good ground for the old saying that, 
 so long as a child is at the breast, the blood of its mother continues 
 to flow through its veins. Recent investigation in susceptibility 
 and immunity have shown that this is true, at least in effect, for 
 the breast-fed child shows a distinctly greater capacity for re- 
 sisting the organisms of all the principal infectious diseases than 
 the child fed upon artificial food. To put it simply, the baby nursed 
 by its mother is far less likely to take measles, scarlet fever or 
 chicken-pox, and far more likely to recover quickly and completely 
 if it does, than the baby nourished by cow's milk and cereals. 
 
 26 
 
Unfortunately, contingencies sometimes arise which make it 
 unwise or impossible for the mother to nurse her child. It may 
 happen, for instance, that the former is suffering from some in- 
 fectious disease, such as tuberculosis. Under such circumstances, 
 nursing is out of the question, for, besides its dangerous effect upon 
 the health of the mother, it is also apt to bring disaster to the baby. 
 
 The child of a consumptive mother should be taken from her at 
 once and brought up away from her. She has a battle for life ahead 
 of her which will consume all of her available energies, and the 
 child, too, has a serious but not hopeless battle against inherited 
 predisposition. An infant is ill-fitted to breathe the air of a con- 
 sumptive's sick-room, and an impulsive kiss may doom it to long 
 suffering with "spine disease," for example, a frequent form of 
 tuberculosis in children and an early death. 
 
 Any other sort of serious illness is sufficient ground for weaning 
 the child at once. There are also other conditions which make it 
 impossible, however good her intentions, for a mother to nurse 
 her child. 
 
 Even while she is nursing her child, some physical or mental 
 disturbance may interfere, temporarily, with a mother's supply of 
 milk. Household cares are often responsible for these difficulties, 
 which show themselves in a scanty supply or in illness in the child. 
 The mother who has half a dozen other children to care for and a 
 house to look after is not capable of providing her baby with the 
 nourishment it needs. During the nursing period she should be 
 relieved as much as possible of domestic cares. Needless to say, 
 she should avoid all excitement of whatever sort. Giving a dinner- 
 party is almost as costly to her strength as a fit of passion or a severe 
 fright, and either may cause the supply of milk to cease or render 
 it unfit for the baby's stomach. Severe intestinal disturbances 
 in nursing children are often caused by maternal imprudences. 
 
 The nursing mother should eat plenty of simple^ nourishing 
 food, and avoid all stimulants. Alcohol, in particular, is to be 
 held in abomination. She should eat meat sparingly, and should 
 make eggs and vegetables her chief articles, of diet. Let her drink 
 milk freely, and avoid coffee and tea. Of raw fruit she had better 
 be wary, but plenty of cooked fruit will help to keep her well. 
 Needless to say, she must pay quick heed to all minor illnesses, 
 particularly disturbances in the digestive tract. 
 
 Young mothers are prone to take an unsafe pride in getting 
 
 27 
 
about as soon as possible after their babies are born. This ambition, 
 it is plain, deserves no encouragement. The average American 
 woman, especially in the large cities, is far from perfect phys- 
 ically, and so it is well for her to be extremely prudent. But at the 
 end of three weeks it is usually safe for her to take a short drive 
 or shorter walk. As her strength grows she should begin regular 
 daily exercise, preferably walking. Let her keep the windows of 
 her room open, and remain in the open air as much as possible. 
 She needs eight hours of sleep in the twenty-four, at the very least. 
 
 When it becomes impossible for a mother to nurse her child, 
 two courses are open: either the baby may be handed over to a 
 wet-nurse, or some effort may be made to nourish it with arti- 
 ficial foods or modified cow's milk. 
 
 Wet-nurses, at their best, are unsatisfactory, and at their worst 
 they are exceedingly dangerous. One of them may submit her- 
 self to the scrutiny of careful physicians and pass them as perfectly 
 sound, and yet be suffering, all the while, from a communicable 
 malady. Taken as a class, they are ignorant, careless and unclean. 
 Setting aside the cocasional gem among them, they seldom pro- 
 vide their charges with nourishment as wholesome as that to be 
 had from the milk laboratorv. 
 
 QUESTIONS FOR THE MOTHER ABOUT CHAPTER V 
 
 What should a baby be fed? 
 
 For the first few months, its mother's milk is the only food that 
 should be given to the baby. 
 
 The baby should have water three times a day, every four hours, 
 between feedings. It should be boiled and cooled and given in a 
 nursing bottle that has been boiled, or with a spoon. 
 
 How can a mother keep her milk in good condition so that it will 
 nourish the baby? 
 
 She should eat three plain well-cooked meals a day at regular 
 hours. She should drink water between meals. Keep her bowels 
 regular constipation in a nursing mother often causes colic in 
 her baby. The baby's health is dependent upon the mother's 
 health. Often when it seems as if the baby must be put on art- 
 ificial food, by building up the mother's health her milk is improved 
 and the baby thrives on it. 
 
 28 
 
What may make a mother's milk poor? 
 
 Lack of rest and nervousness. Not enough nourishing food. 
 Constipation. 
 
 What is the mistake most mothers of young babies make? 
 
 They try to do too much. They should stay in bed at least three 
 weeks after the birth of a baby, and should cultivate the habit of 
 resting as much as possible before the birth and during the nursing 
 period.- It should be a happy, restful time when sleep, food and 
 exercise are abundant. To make it so is the duty of a mother. 
 It is far more important for the future of her family than are the 
 many things she wears out her strength doing. 
 
 Why is nursing so essential to a baby's future health? 
 
 Because mother's milk is the natural food. It gives the child 
 the immunity of its parent. It aids the mother by reflexly 
 strengthening her internal organs. A child will grow and thrive 
 on cow's milk, but it has twice as many chances to reach 
 maturity when breast-fed. 
 
CHAPTER VI. THE BOTTLE-FED BABY 
 
 EXT to mother's milk, the best of all available 
 foods for human infants is cow's milk. I 
 say "best," but in this connection the word is 
 almost meaningless, for the difference between 
 mother's milk and cow's milk is great. The 
 first is at once a perfect food and an efficient 
 medicine, while the second is a very unsatis- 
 factory food and no medicine at all. That is 
 why a child fed at the breast, all other things being equal, has 
 just about twice as many chances of growing up healthy and 
 sturdy as a child fed from a bottle. Bottle food, no matter how 
 carefully it may be prepared, is a mere substitute and, like all 
 substitutes, it is likely to be dangerous. 
 
 The chief superiority of mother's milk lies in the fact that it 
 contains all of the nutritive elements needed by the baby, in pre- 
 cisely the right proportions and nothing else. It is easy enough 
 to prepare an artificial food that contains one or more of these 
 elements, but no man has yet invented one that contains all of 
 them. Again, it is impossible to rid artificial foods of certain 
 things whose presence in the infantile digestive tract causes trouble. 
 Some of these things are merely superfluous, but others are often 
 indistinguishable from poisons. 
 
 Saving only the milk sugars and the water, not one of the im- 
 portant constituents of mother's milk is exactly duplicated in cow's 
 milk. Consider, for instance, the difference between the caseins 
 of the two. To understand it, one must remember that a casein is 
 made up of proteids and that proteids constitute the most im- 
 portant of all elements of human nourishment. The albumen 
 found in the white of an egg is a proteid, and the lean part of meat 
 is heavy with proteids. 
 
 Well, all proteids, when they reach the stomach, begin to clot, 
 just as the albumen in an egg coagulates when the egg is heated. 
 The proteids in mother's milk and in cow's milk clot in just this 
 
 30 
 
way, but what a difference in the manner of their clotting! Those 
 of mother's milk clot into fine flakes, which remain separate and 
 are easily attacked by the secretions of the baby's stomach, and 
 so start at once upon their metamorphosis into blood. But those 
 of cow's milk clot into large, tough lumps, with which the baby's 
 stomach struggles in vain. 
 
 The result is that mother's milk is digested easily and rapidly, 
 while cow's milk is digested only with difficulty, and sometimes not 
 at all. This fact explains the frequent colics, vomiting, diarrhea 
 and other forms of indigestion. 
 
 Again, cow's milk contains nearly three times as much casein, 
 proportionately, as mother's milk, and in consequence the child 
 who ingests it undiluted is overfed. This helps to burden the har- 
 assed stomach and makes the disorder more violent and more 
 frequent. 
 
 There are similar differences between all the other constituents 
 of mother's milk and cow's milk, particularly the acids, but they are 
 understandable only to physicians and chemists. More apparent 
 and more important is the fact that cow's milk, as it is received from 
 the dairyman, is alive with a multitude of germs that are never 
 found in mother's milk. There is no doubt that, if the latter were 
 stored in vessels and transported long distances before being fed 
 to babies, it would be just as bad, but every one knows that it is 
 never so stored and transported. It reaches the baby's stomach 
 warm and fresh and without exposure to the air, and so it is always 
 clean and pure. 
 
 When a cow is milked the milk takes up floating germs from the 
 air through which it passes in its descent to the can, just as the 
 rain-drops of a Summer shower take up "the gay motes that dance 
 along a sunbeam." These germs, finding the milk a fertile soil, 
 begin to multiply at once and with enormous rapidity. According 
 to some observers, the process begins within thirty seconds. If 
 the can is unclean, or has been washed with contaminated water, 
 if the milkman has dirty hands, or if the cow itself is infected with 
 tuberculosis or any other infectious disease, other and more viru- 
 lent germs reenforce those of the air, and before long the innocent- 
 appearing can of fresh milk is swarming with organisms. 
 
 It is impossible to stamp out these germs entirely, but proper 
 handling of the milk greatly reduces their number. This proper 
 handling looks to two things a constant low temperature, and 
 
 31 
 
absolute cleanliness. The milk must be cooled, and it must be 
 kept cool until it is used. Again, it must be transported, not in 
 open cans, but in air-tight bottles. In practically every American 
 city milk is sold in just such bottles. 
 
 Once free of germs, or reasonably so, cow's milk is still unfit to 
 be fed to the baby, for its proteids, sugar, fats and acids are yet 
 present in improper proportions. It has, for instance, certain 
 strange acids, and these must be neutralized. 
 
 I desire to impress upon all mothers, the desirability of seeking 
 advice from a good physician whenever it becomes necessary to 
 take the baby from the breast. Only a doctor can accurately de- 
 termine the needs of a given child. 
 
 In most cities there are milk laboratories which make a business 
 of modifying cow's milk upon prescription. The physician, know- 
 ing the child's peculiar requirements, decides just how much casein, 
 sugar and fats should enter into each quart of milk that it in- 
 gests, and the laboratory prepares a milk containing these things 
 in exactly the right proportions. Such milk may be prepared at 
 home by the mother under a physician's direction. 
 
 Until it is six months old the bottle-fed baby should take nothing 
 but modified milk and boiled water into its stomach. It should be fed 
 according to the schedule I have laid down for breast-fed children, 
 and should get just as much water. The strength of the modified 
 milk should be increased from month to month. During the first 
 few weeks it may be advisable to use four, five or even six parts of 
 water to one of milk, but after the first month the proportion of 
 milk may be increased in amount quite rapidly. By the end of 
 the second month, if the baby seems to be thriving, it may take 
 equal parts of milk and water, and later on the milk rnay exceed 
 the water until, toward the end of the first year, the child may take 
 almost pure milk. But this should be managed with caution, and at 
 the first sign of digestive disturbance there should be a wise retreat. 
 
 When the first teeth appear it is time to add something more 
 substantial to the diet. Many physicians condemn baby foods 
 without reservation, but in this I cannot concur. Wisely employed, 
 they are often of great value, but it is not wise to use them unless 
 absolutely necessary, and then only in selected instances. I often, 
 but not always, add them cautiously to the milk, beginning with 
 very little milk, then, if all goes well, gradually increase the pro- 
 portion. Such foods should not be used save in such conjunc- 
 
 32 
 
tion with milk. In selecting a food it is well to remember that 
 the advice of your doctor is far more valuable than that of your 
 neighbor, for babies differ. 
 
 By the time the baby is a year old its diet should begin to include 
 fruit juices and the whites of eggs. Begin with a wine-glass of 
 chicken broth or bouillon, fed from a spoon, and as these things 
 are increased, gradually decrease the amount of bottle food. Soon 
 after it turns its first year the child should learn to drink from a 
 small cup. After that its meals may be reduced to five a day, 
 with an occasional drink of orange juice and plenty of water. 
 
 The first meal should have modified milk as its chief con- 
 stituent, with half as much infant food or strained oatmeal added. 
 The second meal, in the middle of the morning, may be a repeti- 
 tion of the first. Early in the afternoon a gill of chicken broth, 
 or half as much beef juice, may be given, and this may be varied 
 every few days, with the white of an egg boiled, say, for a minute. 
 The two remaining meals should have milk as their mainstay. 
 After a month or so of such diet, if the baby is in good health, its 
 mid-morning meal may begin to include dry toast, zwieback, thin 
 oatmeal and other cereals, and its afternoon dinner may include 
 a whole egg, soft-boiled or poached. Fruits should be given freely, 
 but it is always best to have them well cooked. 
 
 I need scarcely refer again to the need for keeping all bottles, 
 nipples, glasses and spoons absolutely clean. They should be 
 scalded after each meal, and should be kept, between meals, in a 
 vessel filled with a dilute solution of boracic acid. Just before using 
 they should be washed thoroughly in very hot water. Particular 
 attention must be paid to the rubber nipples. They are veritable 
 havens for wandering germs. 
 
 QUESTIONS FOR THE MOTHER ABOUT CHAPTER VI 
 
 Why is it that so many more bottle-fed babies get sick and die than 
 breast-fed babies? 
 
 Babies often have diarrhea and vomit because the milk is not 
 clean has not been kept cold has been kept too long is not 
 properly prepared or the nursing bottles and nipples are dirty. 
 
 How can a mother avoid the danger that comes to babies through 
 cow's milk? 
 
 33 
 
She should consult a doctor that knows about babies, and find 
 out if she can not nurse the child. If not, she should get from her 
 doctor a prescription for preparing the milk to suit her baby's 
 stomach. She should weigh her baby on the same scales once a 
 week, and if she finds the child losing weight or not gaining for 
 several weeks, she should consult her doctor again and ask that the 
 formula be changed. 
 
 What is the best and easiest way to prepare the milk? 
 
 The milk should be prepared every morning for the day's supply. 
 It should be put into the feeding bottles and corked with aseptic 
 cotton and put on the ice. Each bottle should be warmed by put- 
 ting the bottle in hot water just before giving it to the baby. 
 
 The bottles should be boiled just before filling with the day's milk. 
 
 Throw away what the baby leaves. Never give the left over 
 milk to it for another feeding. 
 
 As soon as the bottle used by the baby is empty, it should be 
 thoroughly washed with cold water then cleansed with borax and 
 hot water (one teaspoonful of borax to a pint of water). The nipple 
 should be thoroughly washed after each nursing with hot water 
 and when not in use should soak in boric water in a covered glass. 
 The nipple must be rinsed in boiling water just before the baby 
 uses it. Bottles and nipples should be boiled once a day. 
 
 Why need such extreme care be taken to sterilize bottles and nip- 
 ples before giving them to the baby? 
 
 Because milk is one of the best "culture" mediums. Germs de- 
 velop in milk with incredible rapidity. Therefore you may often 
 be giving poison to your baby when you think you are giving it 
 clean, nourishing milk. 
 
 What should a mother do if her baby has diarrhea? 
 
 She should stop all food at once give cool boiled water, no 
 medicine. Take the baby to a doctor at once. It is dangerous 
 to wait, especially in summer. 
 
 What causes diarrhea? 
 
 Diarrhea comes from too much food too frequent feeding 
 too little water too little sleep too much handling too little 
 air, and from milk that is dirty or has not been kept on ice. 
 
 Why does a child vomit and have diarrhea? 
 
 Because some food that it cannot digest, some sour or dirty milk 
 has been taken into its stomach, and it vomits and has diarrhea 
 because it is trying to get rid of the food that is making it sick. 
 
 34 
 
Why does diarrhea come to babies in summer? 
 
 Because in summer milk gets warm, and germs and poisons mul- 
 tiply. 
 
 Why do more bottle-fed than breast-fed babies have diarrhea? 
 
 Because cow's milk is less likely to be pure and suited to the baby's 
 stomach than mother's milk. 
 
 How can a mother prevent diarrhea? 
 
 By taking a baby to her doctor to be sure its food is right before 
 hot weather sets in by keeping it out in the fresh air, bathing it 
 daily and sponging it with cool water on hot days by keeping 
 it quiet and letting it have plenty of sleep. Thus its body will be 
 able to resist disease. 
 
 35 
 
CHAPTER VII. A CHAPTER ON MILK 
 
 FTER all, those socialists who insist that the 
 bread-and-butter problem is the one all-in- 
 clusive human problem are not very far from 
 right. A man's mental, moral and physical 
 make-up depends, to a degree incredible to 
 the casual observer, upon the food he eats, 
 and, to a degree still more incredible, upon 
 the food he ate when he was a baby. Save 
 only the air he breathes, nothing more potently determines the 
 sort of man he is to be not even his nationality or his faith. 
 
 Of course, it is impossible to find out, with any approach to ex- 
 actness, the eventual effect of a given food-stuff, but every one is 
 well aware of the peculiar emotional consequences which arise out 
 of certain general conditions of diet. The starving man has no 
 conscience, and the dyspeptic has no soul. At the other pole 
 stands the well-fed man of sound stomach. He is as happy after 
 dinner as any human being can ever hope to be. 
 
 Between these two extremes one may find a thousand other 
 proofs, physical, and psychical, of the effect of food upon the human 
 animal. It is, indeed, fast becoming a favorite theory among bi- 
 ologists that many of those changes which cause the evolution of 
 species are due to changes in nutrition; and there is even some 
 ground for believing that man's enormous superiority over all other 
 beings to-day is due in part to the fact that his remote ancestors, 
 one lucky day, discovered the art of cookery. 
 
 Nature provides the best of all possible foods for babies in moth- 
 er's milk, but accidents often make this unavailable, and so it 
 becomes necessary to seek a substitute. This substitute has almost 
 invariably been the milk of the cow, the goat, the reindeer, the 
 horse or the camel. Until recently it was generally believed that 
 the substitute was as good as the thing it supplanted. But one day 
 there appeared a man named Louis Pasteur, who showed the world 
 that cow's milk, to name but one of these substitutes, was always 
 
 36 
 
a dangerous food, and that, in a great many cases, it was a violent 
 and fatal poison. 
 
 Pasteur proved this by his discovery that cow's milk, by the time 
 it reaches the nursery, always contains microscopic forms of life. 
 Some of these minute organisms, perhaps, are harmless enough, 
 but others are the very reverse. So noxious are they, in fact, 
 that it is fair to blame them for a large proportion of the maladies 
 of childhood, and, in addition, for not a few of those defects of 
 bodily function which, while not at once fatal, pave the way for 
 illness and death later on perhaps as late as middle life. . 
 
 The layman may here want to know why it is that cow's milk, 
 if it is so badly contaminated, does not poison the calves for whom 
 nature intended it; and why, again, if cow's milk is so dangerous, 
 mother's milk is not just as bad. The answer lies in the fact that, 
 when any milk is fed to the offspring of its mother in the way nature 
 intended it to be fed, it does not come in contact with dirt. 
 
 A bacteriologist named Soxhlet, in 1882, finding that a certain 
 degree of heat would kill germs proposed a simple method of heating 
 milk, and it was believed for a time that the problem was solved. 
 During the next twenty years, however, with sterilization widely 
 practised, the death-rate among infants declined very little. 
 
 Then it was discovered that heating the milk, while it killed the 
 germs, caused changes in the proteids, salts, fats and other con- 
 stituents, and that the products of such changes were often danger- 
 ous. It was also found that the constituents of cow's milk differ 
 vastly from those of mother's milk, and that some of them in their 
 natural state are poisonous to human infants. The result was an 
 effort to change these constituents in such a way that they would 
 more closely resemble the corresponding constituents of mother's 
 milk. This effort is still in progress, and its visible fruit is the large 
 number of "modified" milks now offered. Some of these are ex- 
 cellent, and, if properly administered, almost all of them do more 
 good than harm, but we are still far from a modified cow's milk which 
 exactly duplicates mother's milk. This is proved by the fact that, 
 despite the progress made, the death-rate among bottle-fed babies 
 exceeds by far that among babies fed at the breast. Both have 
 declined enormously in the past twenty years, but that decline is 
 due, not so much to improvements in food as to improvements in 
 the prevention and treatment of contaminated milk and the dis- 
 eases it produces. 
 
 37 
 
A gigantic hoard of ancient fallacies and superstitions clusters 
 about the nursing mother. There are a thousand signs, and por- 
 tents which command immediate weaning, and I suspect that, 
 in the case of many of them, the wish is father to the too-ready 
 belief. All sorts of slight indispositions are seized upon as excuses 
 for condemning the baby to the bottle a trifling cold, a tempo- 
 rary reduction in the quantity of milk, a day or two of poor appetite, 
 a headache, even a toothache. "That tired feeling," accompanied 
 by irregularities in the milk-supply, is often the effect of a 
 night at the theatre, a game of bridge or an attempt at heavy 
 housework. The nursing mother must take good care of herself, 
 she must keep early hours, get plenty of sleep and food, and avoid 
 all emotional excitement, but she is by no means an invalid, and 
 those slight aches and illnesses which afflict all of us incessantly 
 do not afford her a sound reason for neglecting her sacred obli- 
 gation to her child and to the human race. I have succeeded in 
 bringing milk back into women's breasts who had not nursed the 
 child for three months. 
 
 It is commonly believed that if the nursing mother, for some 
 minor indisposition, takes a drug of any sort, it will appear in the 
 milk and injure the child. In the main, this is not true. Very 
 few drugs do this, and it is easy for the mother to avoid those. 
 Among them are codein, salicylic acid and mercury. The last is 
 not frequently prescribed, but the first is contained in many pa- 
 tent "headache cures," and the second is often used to preserve 
 canned foods. It is easy enough to avoid "headache powders" 
 and it is easy, too, to avoid canned foods. Even in case the latter 
 are eaten, it is possible to avoid those which contain salicylic acid, 
 for the presence of this drug, thanks to the new pure food law, 
 must now be announced upon the label. 
 
 The nursing mother would better eschew all stimulants, but if she 
 has been in the habit of drinking, say, a glass of beer a day, there 
 is no reason why she should stop it during the nursing period. I 
 am no apologist for alcohol, but it is an undoubted fact that those 
 who are habituated to it, in small quantities, suffer discomfort on 
 abandoning its use, and this discomfort may imperil the milk-supply 
 far more than the alcohol itself. 
 
 The old notion that a bottle of beer, ale or porter a day benefits 
 mother and child by " strengthening " the former and increasing the 
 supply of milk is an utterly nonsensical superstition. Far from be- 
 
 38 
 
ing strengthening, beer is the very reverse, and ale and porter, 
 having more alcohol in them, are even worse. Therefore, it is dan- 
 gerous for any woman to begin their use during the nursing period, 
 but, all the same, it is inadvisable for a woman who has grown ac- 
 customed to them to abandon them suddenly. 
 
 The same thing may be said of tea and coffee. The woman who 
 has looked forward daily to her afternoon cup of tea can not for- 
 swear it without discomfort, and this emotional storm may easily 
 interfere with the milk-supply. Such a woman needs her cup of 
 tea as much as a smoker needs his after-dinner cigar. As every 
 one knows, the smoker who tries to stop smoking suddenly often 
 suffers agonies which bring him to the verge of an actual nervous 
 breakdown. 
 
 But in all such matters it is wise to exercise great moderation. 
 Beer, tea and coffee must ever be regarded not as necessary foods, 
 but as necessary evils. The woman who employs stimulants to 
 enable her to perform the double task of nursing a baby and doing 
 heavy housework, is very short-sighted, to say the least. Within 
 a short time the penalty will have to be paid and the poor baby, 
 unluckily, will have to pay most of it. 
 
 Best of all stimulants and auxiliaries for nursing mothers is clean, 
 fresh cow's milk. An adult woman, in most cases, is able to di- 
 gest it without discomfort. Its nourishing constituents will give 
 her healthy blood and general well-being, and these boons she will 
 pass on to her child. This is the best of all methods of modifying 
 cow's milk for infant consumption, and the wizards of the laboratory 
 will never produce anything to equal it. 
 
 QUESTIONS FOR THE MOTHER ABOUT CHAPTER VII 
 
 Why is mother's milk better for young babies than cow's milk? 
 
 Nature has put ah 1 the elements necessary to nourish and develop 
 the baby in the milk of a healthy mother. 
 
 Why must cow's milk be modified for babies? 
 
 It must be made as nearly as possible like mother's milk. 
 
 Why will not the same formula do for all babies? 
 
 Each mother's milk is different, suited to the particular needs 
 of her baby. No two babies' stomachs are exactly alike. There- 
 fore, the doctor makes an analysis of a mother's milk to find out 
 
 39 
 
just how to prepare the artificial food for her baby. Often when 
 he finds out what is lacking in the mother's milk, he can, by special 
 diet in the matter, rectify her rnilk or supplement the absent in- 
 gredients by giving the baby one bottle-feeding a day. 
 
 Why must the baby's formula be frequently changed? 
 
 Because the baby's stomach develops and requires different in- 
 gredients to continue the development. Nature varies mother's 
 milk to suit the baby's developing stomach. 
 
 Why is pasteurized milk often recommended for babies? 
 
 Because many bacteriologists believe that pasteurization kills 
 the germs in milk that make babies sick. 
 
 What is pasteurization? 
 
 It is raising milk to a temperature of from 140 to 167 degrees 
 Fahrenheit and keeping it at that temperature for from 20 to 30 
 minutes. 
 
 How is it that pasteurization does not kill the germs in milk that 
 nourish the "favorable" germs? 
 
 There is no reason to believe that it does not. Does this not 
 work an injury to the baby? Many physicians believe that it 
 does. Many also believe that this is a lesser evil than impure 
 milk. 
 
 Is there no way of procuring raw milk, that is safe? 
 
 Yes, milk that is carefully and intelligently produced is safe for 
 the baby to take raw if properly modified. 
 How may a mother know if raw milk is safe? 
 
 She may have her board of health make frequent bacteriologi- 
 cal tests of the milk coming from the dairy. She may visit the farm 
 and inspect the methods of producing milk. 
 
 What are some of the things up-to-date dairymen do to protect milk? 
 
 They keep the cows in a well-aired, clean smelling cow-barn. 
 They feed cows clean, good food. They have their men wear clean 
 white milking suits. They have the cows' bellies and udders washed 
 in disinfectant and the men wash their hands in disinfectant before 
 milking. They have all bottles thoroughly sterilized. They 
 have milk immediately cooled and kept at 50 degrees Fahrenheit 
 until it reaches the consumer. 
 
 Does not this increase the cost of producing milk? 
 
 Yes, every mother should be willing to pay extra to have the best 
 milk. Milk that is fit for babies cannot be produced under 8 cents 
 a quart. Beware of 5 cent milk. Beware of " loose" milk. 
 
 40 
 
7s not 10 or 15 cents a quart far milk for your baby cheaper than 
 letting it get sick and perhaps die? 
 
 Yes, you pay it not only for your baby but for all babies. Every 
 time a mother buys cheap milk she makes it harder for dairymen 
 to produce, good, clean milk. The realization of this fact by moth- 
 ers will do more than any other thing to secure a universally 
 safe milk supply. 
 
 Must milk be always kept at 50 degrees Fahrenheit? 
 
 Yes. It is better to get a small supply twice a day if you have 
 no ice. A small piece of ice in water will keep milk bottles cold all 
 day and sometimes longer. If you cannot get ice wrap a cloth 
 wrung out in cold water around the milk bottle. Always keep 
 milk covered. If you know that the milk has been warmer than 
 50 F. for long, then boil it before using it. 
 
 41 
 
CHAPTER VIII THE FOOD FOR GROWING CHILDREN 
 
 OWARD the end of the first year a human in- 
 fant begins to be the most interesting thing 
 in the world. Heretofore it has lived a life 
 of colorless, unconscious, vegetative growth; 
 and though its mother, perhaps, has discerned 
 a meaning and a portent in its every sign, its 
 actions, in sober truth, have been chiefly re- 
 actions, and, as such, have sadly lacked motive 
 and coherence. But now its intelligence is dawning and the mys- 
 terious something that we call personality is unfolding. It begins 
 to differ from other babies of its age in a thousand surprising and 
 delightful ways; it acquires habits, appetites, little vanities, likes 
 and dislikes, and what may be called a customary attitude of mind. 
 And these things appear, one after the other, with truly dazzling 
 rapidity. Every week sees noticeable progress. Every day has 
 its perceptible change. 
 
 Mind and body join in the metamorphosis. Muscular and or- 
 ganic activity increases, and a multitude of ideas nebulous, maybe, 
 but still vastly engaging begin to throng the child's brain. It 
 begins to take note of the world about it; to recognize differences; 
 to observe cause and effect; to put fact and fact together. And 
 with all this awakening from within there comes a need of changes 
 without. 
 
 As every woman knows, the time for weaning commonly brings 
 perils for the infant. That this is the rule is shown by the fact that 
 popular lore has given it the dignity of an immutable law of nature. 
 As a matter of fact, there is no reason whatever why weaning should 
 bring serious consequences to either mother or child, for it is as 
 thoroughly normal an incident of life as birth or teething. In 
 practically all cases the disasters of this period are due to an in- 
 accurate reading of the baby's needs. 
 
 Many mothers believe that a prolongation of nursing is beneficial 
 to the child, but this is not true. The baby fed upon milk exclu- 
 sively beyond the normal time is usually a weak and anemic child, 
 
 42 
 
whose external appearance gives evidence of the retarded develop- 
 ment of its organs of assimilation. 
 
 Until it is well on toward its second birthday, the principal food 
 of every child should be milk, but this milk needs reenf or cement. 
 Let one meal be of modified cow's milk alone, and the next of milk 
 and toast, with milk next and then a bit of mashed potato, and so on. 
 
 In this connection, and before proceeding to a consideration of 
 the diet later on, it may be well to point out that the dietary needs 
 of every child are determined more by its weight than by its age. 
 An average baby, weighing about eight pounds at birth, should 
 weigh about seventeen pounds at the age of nine months, when it 
 is ready to be weaned. If it weighs less than this, it is well to seek 
 medical advice before making changes in its food. 
 
 The same factor determines the amount of food required by the 
 child each day. A normal baby of twelve months, weighing twenty- 
 one pounds, will need five feedings of modified cow's milk, of eight 
 ounces each and at intervals of four hours, in addition to the alter- 
 nate meals of toast, rice, and so on. But if the child weighs but 
 sixteen or seventeen pounds, six or seven ounces of milk will be 
 sufficient. By the same token, if it weighs more than twenty-one 
 pounds, it may well take a bit more than eight ounces. 
 
 Once the milk of early infancy has been reenf orced by the starchy 
 foods, and the child has passed the Rubicon in safety, it is in order 
 to reduce the former, by slow stages, to second place. As soon as 
 possible teach the child to drink from a cup and give it its daily 
 milk in that way. Reduce its allowance of milk to four eight- 
 ounce rations a day, and at the same time add a meal of beef-juice 
 or mutton-broth with a soft-boiled or poached egg. By the time 
 the child is a year and a half old, broiled and scraped steak may be 
 substituted for the broths. 
 
 To prepare this sear a round steak, on the outside only, over a 
 brisk fire and scrape it into a fine pulp with a knife. Take about 
 two tablespoonfuls of this and mix it thoroughly with an equal 
 amount of stale bread-crumbs. Then let the baby eat it with a 
 spoon. 
 
 Toward the end of the second year it is time to abandon the 
 schedule of meals I have given in a previous chapter, and to progress, 
 by degrees, toward three a day. Begin by omitting the meal of 
 milk taken just before bedtime and gradually increase the im- 
 portance of the midday dinner. By this time the baby will begin 
 
 43 
 
to show dietetic likes and dislikes, and, within reason, these should 
 be taken into consideration, for a child, like a grown person, thrives 
 much better upon dishes it relishes. 
 
 Let breakfast consist of a cereal with plenty of milk but little su- 
 gar, and a single egg, either soft-boiled or poached. As every one 
 knows, the American market affords an infinite array of palatable 
 cereals, and the great majority of them, luckily enough, are ex- 
 cellent and harmless. But it must be remembered that, with a few 
 exceptions, all of these so-called breakfast-foods, whatever the labels 
 may say to the contrary, are utterly unfit for children's food unless 
 they are thoroughly cooked. It is best, indeed, to boil them for 
 several hours, and this, of course, may be done most conveniently 
 the day before. In the morning all that is necessary is to warm 
 them over and add hot milk. A child two and a half or three 
 years old should be given a single cupful. 
 
 It is essential that the eggs given to small children be of undoubted 
 freshness, for those of the cold-storage variety, besides being un- 
 palatable, are not easily digested. One minute's boiling is all 
 they need. Hard-boiled eggs, as the post-Easter epidemics of 
 stomach-aches prove, are not suitable food for children. Neither 
 is it safe to give a child fried eggs or omelets, since in both of these 
 agreeable dishes the albumen of the egg is converted into a greasy, 
 leathery and indigestible fabric. 
 
 Milk should be the drink at breakfast for all children until their 
 tenth year. They should never drink coffee or tea under any cir- 
 cumstances, nor at any hour of the day, and even cocoa is an ill 
 substitute for milk. A single cupful, warmed, is sufficient at 
 breakfast, since it is taken, not to relieve thirst, but as a food. Every 
 child (and every adult, too, for that matter) should take a drink 
 of water upon arising. Breakfast may be begun within twenty 
 minutes thereafter without harm. 
 
 Until it is three years old, the child's midday meal should consist 
 chiefly of meat-broths, chopped or scraped meat and potatoes 
 (boiled or baked). Beginning with very small portions, green 
 vegetables, such as spinach, beans, celery, young lettuce well cooked 
 and mashed, may be added, and as a dessert at the end there 
 may be part of a baked apple or pear (the skin and seeds removed), 
 or a few stewed prunes, seeded. Water, but no milk, should be 
 given with this meal. 
 
 After its third birthday the child may safely enlarge its animal 
 
 44 
 
diet by the addition of roasts and chops, poultry and fish, but it is 
 well to serve all of these things finely chopped until the fifth or 
 sixth year, since all children, even when their teeth are equal to 
 the task of masticating meats, are likely to bolt them without prop- 
 er chewing. The daily allowance should be not more than a few 
 ounces, and it should be reduced on the first indication of digestive 
 disturbance. 
 
 Needless to say, all forms of pork are dangerous, and no child 
 should taste the flesh of the swine until its eighth or ninth year, at 
 least. In particular, such things as bacon, ham, shoulder and 
 sausage should be avoided, and the same may be said of all parts 
 of beef, mutton and poultry, save the finest cuts. A child's stomach 
 is ill fitted for the digestion of giblet-stew, liver and bacon, sour 
 beef, calves-head, bologna sausage, pigs' feet and other such deli- 
 catessen. Similarly, it can ill cope with fried chops or fried 
 fish. The best meats for it are beef and mutton, boiled, broiled 
 or roasted, and the best fish are the larger ones, which may be 
 boiled or baked. Under poultry I include chicken (broiled or baked, 
 but never fried), roast turkey and roast barn-yard duck. 
 
 Many mothers are under the impression that all vegetables, 
 without exception, have excellent dietetic and medicinal virtues, 
 but this is not true, even in the case of adults. With children it 
 is well to avoid all save those which may be boiled for several hours, 
 and to make a further extension of the ban to cabbage sprouts 
 and corn. The vegetables which enter into a meat stew, such as 
 potatoes, carrots, turnips and onions, all well boiled, are nourish- 
 ing and harmless, and the same is true of spinach. But it must 
 be remembered here that "well boiled" should be taken literally. 
 It is not sufficient to boil carrots until they are tender. Instead, 
 they must be cooked to pieces. 
 
 Of all the fruits which may enter into the midday dinner the 
 apple, peeled, baked and seeded, is by far the best. After it come 
 its near relatives, the pear and peach. It is well to bake or stew 
 all three before giving them to children, at least until the age of 
 six or seven years, but the juice of the peach, without the pulp, is 
 harmless. In the same way, the juices of tamarinds, grapefruit 
 and pineapples may be fed to children, even as early as the third 
 year, with safety and benefit, whereas all of these fruits, eaten in 
 the ordinary way, are exceedingly dangerous. It is true enough 
 that many children eat them, but it is also true enough that many 
 
 45 
 
children die of cholera infantum and diarrhea. They harbor germs, 
 their woody pulp is indigestible, and some have numerous seeds. 
 Cherries and the smaller berries are undesirable also, and bananas, 
 while seedless and germless, overburden the stomach. 
 
 The third meal of a child's day, taken in early evening, should 
 be much like its breakfast, save in the absence of the morning 
 egg. Milk and toast or milk and a cereal should constitute its 
 mainstay, with a cupful of milk added. At these two milk-meals 
 no meat, vegetable or fruit should be served. Until its eighth or 
 ninth year a child should never eat meat more than once a day, 
 and no fruits should be served when milk is on the table. 
 
 As soon as the three-meal-a-day schedule has been established 
 the child should be refused all solid food between meals, but it is 
 a good custom throughout childhood and necessary until the 
 seventh year to give a generous cupful of milk in the middle of 
 the morning and another in the middle of the afternoon. If the 
 child is hungry, let it drink two cupfuls, and, on the other hand, 
 do not press it to drink if it is not so disposed, as the appetites of 
 children vary as much as those of adults. 
 
 In conclusion, remember this: that until it is fourteen a child 
 is not capable of dealing with the miscellaneous mass which makes 
 up the civilized bill of fare. If it must eat at the family table, 
 see that its share of the dishes is rigorously limited. Discourage 
 the use of coffee, chocolate and tea, and give it little, if any, pork 
 in any form. Hot rolls, waffles, pancakes and other things of that 
 sort, are always dangerous. 
 
 In the matter of candies and other sweets exercise a stern cen- 
 sorship. If it were possible, it would be well for the children of 
 the land to grow up in ignorance of these delights. Nevertheless, 
 every mother may do much to discourage the ancient custom of 
 making candy a reward for diligence and good order. A child how- 
 ever needs some sugar and should have a little on its food. 
 
 QUESTIONS FOR THE MOTHER ABOUT CHAPTER VIII 
 
 Why has a child's diet more to do with its future welfare than any 
 other thing? 
 
 The correct diet of a baby and child is responsible for the bone, 
 
 46 
 
teeth, muscle, physical reserve, mental capacity that is needed by 
 a successful adult. 
 
 The following bills of fare for young children were prepared by 
 Dr. Charles V. Chapin, Commissioner of Health, Providence, R. I., 
 May, 1909. 
 
 FROM 12 TO 15 MONTHS 
 
 Accustom the child to drink from cup and take food from a 
 spoon. Five meals should be given in 24 hours. 
 
 BREAKFAST 
 
 Cup of cow's milk, a saucer of oat meal or barley flour jelly, with 
 milk, or cream of wheat with milk. The oatmeal jelly is made by 
 putting 4 tablespoons of coarse oatmeal into a pint of cold water, 
 let it stand 24 hours and then boil it down to ^ a pint and strain 
 through a coarse cloth. What goes through is oatmeal jelly, and 
 may be kept in a cool place. Make a fresh supply every day. 
 Milk may be warmed to suit taste ; it should not be iced. 
 
 LUNCH 
 Cup of cow's milk. 
 
 DINNER 
 Broth or beef juice, bread a day old crumbed in milk. 
 
 SUPPER 
 Bread crumbed in milk. 
 
 If possible, give two to four tablespoons of orange juice, or other 
 fruit juice in season before morning lunch. Be sure the fruit is 
 sound and ripe. Do not give fruit juice at same time as milk. 
 
 Water may be given as desired, but sparingly at meals. 
 
 FROM 15 TO 18 MONTHS 
 
 BREAKFAST 
 
 Cup of cow's milk, saucer of oatmeal jelly, with milk or flour 
 or Indian meal gruel, with milk, small piece of bread a day old 
 with butter. 
 
 47 
 
LUNCH 
 
 Cup of milk, small piece of bread and butter. 
 
 DINNER 
 
 Broth or beef juice with boiled rice or barley, and a small piece 
 of bread and butter. 
 
 AFTERNOON LUNCH 
 Cup of milk. 
 
 SUPPER 
 
 Cup of milk, bread a day old and butter, a little apple sauce or 
 pulp of stewed prunes or baked apples with skin and seeds removed. 
 
 Water may be given as desired, but sparingly at meals. 
 
 FROM 18 MONTHS TO 2 YEARS 
 
 BREAKFAST 
 Cereal and milk. Cup of milk. Bread a day old and butter. 
 
 LUNCH 
 
 Cup of milk with bread and butter, or simple crackers, or Indian 
 meal Johnny cakes and milk. 
 
 DINNER 
 
 Broth with boiled rice or barley, or eggs, soft boiled or poached, 
 baked or mashed potatoes with butter and salt, bread and butter. 
 
 AFTERNOON LUNCH 
 Piece of bread and butter. 
 
 SUPPER 
 
 Milk, bread and butter, or milk toast, pulp of baked apple, apple 
 sauce, stewed prunes or ripe fruit according to season. 
 
 Water may be given as desired, but sparingly at meals. 
 
 FROM 2 TO 3 YEARS 
 
 Additions to the diet must be gradually made by selecting ar- 
 ticles from the list below, always giving small portions at first, and 
 
never trying two new articles at one meal. All food must be finely 
 cut or mashed, and well chewed. 
 
 Select from the following articles : milk, eggs, soft-boiled, poached 
 or scrambled, baked or mashed potatoes, young peas or beans, 
 scraped beef, white meat of chicken, boiled fish, oatmeal, hominy, 
 wheat-germ, cream of wheat (all these cereals being thoroughly 
 cooked) ; broths and soups ; white and graham bread a day old, 
 toast, zweiback, plain crackers, milk toast, junket, plain custard, 
 corn starch pudding, bread pudding, blanc mange, ice cream, rice 
 pudding; oranges, baked apples, apple sauce, stewed prunes and 
 pulp of peaches and pears if ripe and sound. 
 
 FROM 3 TO 6 YEARS 
 
 From 3 to 6 years select in addition from the following articles : 
 beefsteak, roast lamb, stew of mutton or beef, hash of mutton, 
 beef or fish; mutton or lamb chop, corned beef, baked beans, 
 string beans, spinach, asparagus, summer or winter squash, beets, 
 carrots, turnips, tapioca pudding, molasses gingerbread, sugar or 
 molasses cookies, grapes (with seeds and skin removed), bananas 
 (if ripe), melons. 
 
 During the 3 to 6 years four meals should be given at regular 
 intervals, as, 7 A. M., 10 A. M., 1.30 P. M. and 5 P. M. 
 
 The following is suitable for a child of four years : 
 BREAKFAST 
 
 Juice of half an orange, two tablespoonfuls of cereal with milk 
 and sugar or salt, glass of milk, bread and butter. 
 
 LUNCH 
 Glass of milk or cup of broth, bread and butter or crackers. 
 
 DINNER 
 
 Two tablespoonfuls of stewed meat finely cut, tablespoonful of 
 baked potato with butter and salt, a tablespoonful of green peas 
 well mashed, bread and butter, a cup custard. 
 
 SUPPER 
 
 Milk, bread and butter, a tablespoonful of stewed prunes. 
 
 49 
 
t)o not give articles on the following list till the child is four years 
 old, many of them not until seven years old. 
 
 Fried meats and vegetables, cabbage, raw or fried onions, raw 
 celery, cucumbers, tomatoes, lettuce, radishes, egg plant or green 
 corn, hot bread or hot rolls, buckwheat or other griddle cakes, 
 fruit cakes, pies, tarts, doughnuts, candy, nuts, tea, coffee; never 
 give children wine, beer or cider. 
 
 When children are constipated, do not dose them with medicines 
 but consult a physician. If children over two years of age are con- 
 stipated give them more vegetables, ripe fruit, stewed prunes, oat- 
 meal, molasses gingerbread, rye mush and molasses, rye bread and 
 Graham bread. Avoid wheat bread and crackers. 
 
 50 
 
CHAPTER IX. WHAT YOU OUGHT TO KNOW ABOUT 
 YOUR SCHOOL 
 
 HE German doctors have invented the term 
 "school sickness" to describe a malady which 
 is even more wide-spread, I fear, in the New 
 World, than in Germany. It is the direct 
 product of the ancient pedagogical doctrine, 
 that the more a child is forced to study, the 
 more it will learn. A healthy youngster, 
 fi ^SS^fg?" f, exposed for a few years to the operations of 
 this doctrine, is converted into a weak, sickly and inefficient being, 
 with ragged nerves and a bad stomach. Its mind, perhaps, has 
 acquired a mastery of the scale of G minor and of many irregular 
 verbs, but its blood has forgotten how to grapple with germs. 
 
 The schoolmarm, like the loving mother, is too assiduous in her 
 attentions. The mother, coddling her child, measurably increases 
 its chances of death (as I have shown in past chapters) ; and the 
 teacher, seeking to lead it too precipitately into the Elysian fields 
 of knowledge, sadly over-burdens its brain and its eyes, its lungs 
 and its muscles, its back and its nerves. The result of this class- 
 room forcing is entirely and inevitably pernicious. No good can 
 possibly come of it. 
 
 The teacher, I suppose, is really not to blame, after all, for if 
 the mother were not behind her egging her on to her sinister task, 
 she would probably let indolence serve the benevolent purpose 
 of mercy. As it is, she is expected to convert the baby of four or 
 five years into a virtuoso with an extensive repertoire of kin- 
 dergarten arias ; and by the time the poor child is seven, she must 
 have instilled into it a comprehensive grasp of spelling, arithmetic, 
 reading, writing, Mexican bead-work and plain sewing. The mother 
 of such a prodigy is proud of its attainments, and feels a glow when 
 bored friends hypocritically marvel. Later on she will wonder why 
 her child has watery eyes, constant colds or round shoulders. 
 As a matter of fact, it seems to me to be very unwise to send a 
 
 51 
 
boy or girl to school until the age of eight, at least. In America, 
 six is the common age for beginning with the three R's, and four 
 and a half the age for kindergarten mummery, but it is entirely 
 improbable that] this early start is an advantage, even if the 
 mere accumulation of knowledge be accepted as the sole aim of 
 education. It is beginning to be recognized more that the child 
 which begins school at eight is far more capable of learning 
 quickly than the child which begins at six; and at ten the 
 former is almost certain to know as much as the latter, despite 
 the fact that one has had four years of schooling, while the other 
 has had but half as much. And after that, there will begin to 
 appear a noticeable difference between the two. The one will 
 bear some permanent mark of its too-early bending over desk and 
 slate; the other will be a healthy animal. 
 
 The healthy boy of six displays little or no inclination to dally 
 with books. His thirst for knowledge is satisfied by the accu- 
 mulation of a vast store of baseball lore, with many intricate 
 subtleties of rule, precedent and decision; and his natural yearn- 
 ing to be up and doing finds its proper outlet in purely physical 
 activity. He eats plain, wholesome food, and he spends at least 
 ten hours of the twenty-four in sleep. Between meals he is 
 in the open air, galloping, marauding and fighting his fellows. 
 He is a savage, true enough but that touch of savagery will be 
 worth more to him than Greek in the years to come, when he is 
 a grown man doing the hard work of the world, and needs an 
 abounding reserve of brute vigor to draw upon. 
 
 Against this tough and uncultivated boy place the typical young 
 pundit of his years. This last is a master, not only of the spell- 
 ing-book, but also of the works of Oliver Optic. He is studious and 
 his parents are proud of him. Instead of chasing three-baggers 
 in the outfield, he traces the course of the river Amazon. He 
 is quiet, reserved, polite, obedient and has a touch of mild 
 vanity. He has no liking for the barbarous sports of other boys. 
 He excels at none of their games. At a baseball match he is con- 
 tent to keep score. 
 
 Such a boy I believe, is as abnormal as" a boy with an obvious 
 physical deformity. Instead of being encouraged in his unhealthy 
 studiousness, as is commonly the case, he should be taken from 
 school and, to borrow a lowly term, "turned out to grass." That 
 is to say, he should be led, willy-nilly, into the savage mode of 
 
 52 
 
life of the normal boy, in the hope that it will awaken in him some 
 spark of the savage. His dislike for games is really nothing but 
 a feeling of physical incapacity. He realizes that he is not as 
 strong and tough as other boys, and so he shrinks from competing 
 with them. Let him put his books aside for a while let him 
 straighten up his bent back, breathe pure air, get wet by the rain, 
 and make acquaintance with splinters, bruises and sunburn and his 
 shrinking will begin to disappear. Some day, let us hope, he will 
 have progressed so far that he will return home with a black eye, 
 acquired honorably in open and valiant combat. When that 
 day arrives, it will be time to send him back to school. 
 
 Three hours a day is enough study for any child during its first 
 year or two in school, and this period should be broken by a recess 
 of at least half an hour. In many large American cities the day's 
 session is divided into two parts one of two and a half or three 
 hours and the other of two hours or less, with an intermission of an 
 hour or an hour and a half. This is rather too much for the child 
 of seven or eight, especially since home study is commonly added, 
 but there is one saving grace to the scheme, and that lies in the long 
 midday recess. 
 
 It is very important that the meal eaten during this recess be 
 a warm one, and whenever possible it should be prepared and eaten 
 at home. Until a child is ten or twelve years old it must have its 
 dinner, or principal meal of the day, at noon. The rest of the 
 household may dine in the evening, but for the youngster so 
 heavy a repast near bedtime is certain to be deleterious. A bundle 
 of cold sandwiches will not serve as a substitute for the midday 
 dinnner, for the child needs not only the warm, home-cooked food, 
 but also the walk home, the change of scene, the bit of play on the 
 way, and the hour's forgetfulness of lessons. 
 
 Sitting still for two or three hours is an exhausting and pain- 
 ful proceeding to a child of seven or eight. It is as painful, almost, 
 as it would be for a grown man to stand immovable for the same 
 length of time. The child, unable to bear the strain, is apt to 
 lounge in some unhealthful manner. Out of this lounging this 
 resting upon the desk come round shoulders. And out of round 
 shoulders come a host of ills. 
 
 The strain upon the back, in school, is equaled by the tax 
 upon the eyes. If blackboards were really black, they might just- 
 ify their existence, but in practise they are usually a dirty gray, 
 
 53 
 
which reflects the light in blinding flashes and subjects the eyes to 
 harassing duty. From them the child turns to its book and there 
 it encounters more assaults upon its vision. The fruits of this 
 eye-strain are so many that it would be impossible to catalogue 
 them. They range from irritability and headache to serious de- 
 rangements of the digestion. 
 
 How many mothers who read this have ever entered the school- 
 rooms in which their children spend from four to six hours a day? 
 It is not common, I believe, for such visits of inspection to be 
 made, and in many places they are no doubt discouraged by the ped- 
 agogic authorities, but they are plainly a part of every mother's 
 duty. You may find that your child is forced to sit all day beside 
 a draf ty window or near a heater ; that it is so far from the black- 
 board that it can scarcely see ; that it occupies a desk too large or 
 too small for it; or that its schoolroom is a dark, evil-smelling, 
 ill- ventilated place. 
 
 Suppose one or another of these conditions is found? What 
 can you do to remedy it? Well, you can protest, certainly, and if 
 your single protest does no good you can get other mothers to 
 protest with you. If the school is a private one, and you are pay- 
 ing tuition, your objections will be heard politely enough; and even 
 if it is a public school, and the principal is entrenched behind the 
 patronage of the ward boss, you will not find him so independent 
 as you may think. The disgusting condition of the public schools 
 in many American cities is due almost entirely to the lethargy of 
 parents. Whenever and wherever there has been intelligent and 
 active criticism of school methods and housing, substantial re- 
 forms have followed. Even a ward boss has a healthy respect 
 for the collective indignation of a party of mothers. 
 
 If, after exerting your best efforts to work improvements, you 
 find that alarming conditions still exist, take your child away from 
 school, by all means especially if it is still under nine years old. 
 It is during the first few years that the greatest damage is done, 
 and the least advantage gained by risking it. I am firmly con- 
 vinced, indeed, that the average school does more harm than good 
 to all children under nine. Too many are herded into one class, 
 and too little attention is paid to individual idiosyncrasies. The 
 theory is that all children of an age are alike a theory comparable, 
 for soundness, to the political doctrine that all men are equally 
 capable of voting intelligently. The bright child is retarded by 
 
 54 
 
the stupid ones, and the healthy child is contaminated by the un- 
 healthy child. The level that is thus attained is a very low 
 level, indeed. 
 
 No doubt there has occurred to many readers a practical objection 
 to one part of my argument. It is this: that if a child be kept 
 from school until it is eight years old it will go through its whole 
 period of schooling two years behind the child which began at six. 
 The children in a school are not taught individually, but in classes, 
 and after it is once entered in a class, a child's rate of progress is 
 the class rate of progress. 
 
 In answer to this, let me suggest that the child be kept from 
 school, not only until it is eight, but until it is ten. Let it spend 
 its whole time at play until it is eight, and then let it begin to 
 study at home, either under its mother's supervision or in care 
 of some competent teacher. If it begins with two hours a day, 
 and proceeds to three and finally four, it will be fully as far 
 advanced, after two years, as the child which has spent four 
 years picking up a haphazard knowledge of the rudiments in the 
 average schoolroom. It will then be possible to enter, not in 
 the first class, but in the fifth, and it will go through the succeeding 
 classes with children of its age. 
 
 The labor of teaching a child the things taught in the first few 
 grades of a primary school is not nearly so forbidding as you may 
 imagine. In the classroom the individual child gets no more than 
 a few minutes of the teacher's undivided attention a day, and yet 
 it makes progress. If you fancy that it derives much benefit from 
 the instruction given to the other children, you have but to visit 
 a classroom to be undeceived. On the contrary, most of its time, 
 when it is not actually performing its own day's task, is spent in 
 necessary, if unlawful, efforts to relieve the intolerable tedium of 
 its imprisonment. 
 
 I am convinced, indeed, that an ordinarily intelligent child, 
 with an hour's individual instruction a day, five days a week, can 
 make far greater progress than the average child in the average 
 classroom. And just consider what it gains! Instead of being 
 shut up for hours in a noisy room, it has one hour of work and 
 all the rest of its time for play for fresh-air and healthful mus- 
 cular activity. If it arises moody or dull, its hour of study may 
 be removed from morning to afternoon, or divided into two half 
 hours. It may devote the whole of the rare, bright days of Win- 
 
 55 
 
ter to play, and make up for its lost time on stormy days. It 
 will have a clean, airy room for study, with no distractions; warm 
 meals ; and no home-study tasks for the evenings. 
 
 Later on, of course, the school will begin to reckon if only for 
 the salutary effect that its rough democracy and emulation have 
 upon character. But for the very young child the classroom holds 
 out few advantages. It is the easiest way, perhaps, but it is always 
 the way of headache, anemia, lassitude, nervousness, hysteria 
 and broken health. 
 
 QUESTIONS FOR THE MOTHER ABOUT CHAPTER IX 
 
 Why do you send your child to school? 
 
 To fit him for life to make him a self-supporting, self-respect- 
 ing, happy citizen. What is the first essential to this good health 
 with it nine-tenths of the battle of life are won. 
 
 What are the years when health is established? 
 
 From birth to 16 years of age. 
 
 How many of these years are spent in school? 
 
 Ten or eleven. 
 
 Could an unhealthful school environment unfit a child for life? 
 
 Yes, it often does. 
 
 How? 
 
 Bad air breeds contagion. Bad air and contagious diseases 
 undermine a child's vitality poor light, dirty windows, shiny 
 blackboards, fine print, glossy paper, too much close-range work 
 strain a child's eyes. Eye-strain causes indigestion, nervousness, 
 injured eyesight. Ill-adjusted desks cause round shoulders, curved 
 spines, restlessness. Too little recess, relaxation from application 
 to lessons overstrains the child's nerves and disgusts him with 
 school work or any work. 
 
 Dust, dry-sweeping, unclean rooms spread tuberculosis sun, 
 fresh air, soap and disinfectant kill tuberculosis germs. 
 
 Cold lunch eaten at school gives a child indigestion malnutrition. 
 Every child should have a hot, hearty, nourishing dinner, at noon, 
 at home if possible. 
 
 Should not the place where your child spends the greater part of 
 his days for at least 9 months in the year, receive every mother's in- 
 dividual attention? 
 
 56 
 
By all means. Neglect of the school environment might mean 
 life-long failure to the child and disappointment to the mother 
 and father. 
 
 What should a mother look for in her child's school? 
 
 Open windows, a schoolroom thermometer, adjustable desks 
 adjusted, clean floors scrubbed not dry swept, good light for 
 every child in the room recess out-of-doors individual drinking 
 cups, individual towels. 
 
 Cleanly dressed children. 
 
 A medical inspector to examine the children for contagious dis- 
 eases such as consumption, measles, scarlet fever, pneumonia, 
 diphtheria, mumps, colds, sore throats, tonsilitis, scabies, pediculo- 
 sis. A physician to examine children for physical defects such as 
 bad teeth, adenoids, enlarged tonsils, defects of hearing and sight, 
 tuberculosis. 
 
 Are these things absolutely essential to the good health of school 
 children? 
 
 Yes. 
 
 What should a mother do if she finds these essentials lacking? 
 
 She should go to the principal of the school and ask to have de- 
 fects of school equipment rectified. If the principal cannot do 
 this she should go to the school board and make complaint. If 
 the school board will or can do nothing, she should put the matter 
 before the citizens of her town, either through the local paper, 
 Mothers' Club or Citizens' Union. No government can long resist 
 the demands of a number of parents for the welfare of their children. 
 
 What should a mother do if the school doctor finds physical defects 
 in her child? 
 
 She should at once send the child to a physician, dentist, or 
 surgeon and have the defect rectified. If taken in time the child 
 can usually be made normal. If neglected its health will be un- 
 dermined. 
 
 Should children with tuberculosis be allowed to be in school with 
 other children? 
 
 Never. 
 
 In some cities there are special schools for tuberculous children. 
 It is not safe to risk infection of well children. It is very unfair 
 to the tuberculous child. It needs fresh air all the time, very little 
 mental effort, plenty of rest and sleep, large quantities of milk 
 and eggs and the constant attention of a physician. 
 
 57 
 
How can the tuberculous children be weeded out? 
 
 Every child should be examined for tuberculosis before entering 
 school each fall. Children with tuberculous parents should have 
 special tests. Their sputum should be examined bacteriologically 
 and a tuberculin skin test made. Children who have not tuber- 
 culosis, but have tuberculous parents, or are especially weak, 
 should be in school but part of the day; the rest of the day 
 they should be out-of-doors or resting. They should have a 
 feeding of milk and eggs between meals, morning and afternoon. 
 
 58 
 
CHAPTER X. NEED EVERY CHILD HAVE "CATCHING 
 DISEASES?" 
 
 HE notion that every child is doomed to suffer 
 from catching diseases at some time during 
 its first ten years, is a dangerous and stupid 
 error. There is no more reason why a child 
 need have diphtheria, scarlet fever, measles, 
 or whooping cough than why it need have 
 smallpox, lockjaw or hydrophobia if proper 
 preventive methods be used. All these in- 
 fections are preventable. 
 
 What is the best method far the prevention of contagious diseases? 
 Thorough physical examination of the child at frequent inter- 
 vals; a healthy condition of mouth and teeth; removal of enlarged 
 tonsils or adenoid growths; care and isolation of a child with a 
 cold or sore throat ; living and sleeping in the fresh air. 
 
 Why do bad teeth, failure to brush teeth daily, neglected tonsils and 
 adenoids favor contagious diseases? 
 
 Because germs lodge in decayed teeth and in the unhealthy tissue 
 of tonsils and adenoids. 
 
 Why does neglect of colds increase contagious diseases? 
 Because a cold is often the first sign of such diseases as whoop- 
 ing cough, measles, scarlet fever, etc., at the time when these dis- 
 eases are most infectious. Because a neglected cold may often 
 result in pneumonia or tuberculosis. 
 
 What are the first steps to take when a child conies down with a con- 
 tagious disease? 
 
 Send for a doctor. Put the child to bed in a well-aired, sunny 
 room. Keep it away from other members of the family. Keep 
 persons who have been exposed to the disease away from other 
 people or school. Report the disease to the board of Health ; put a 
 notice on the door stating that the disease is present in the house. 
 What is the invariable treatment for contagious diseases? 
 1. Fresh air. 
 
 59 
 
2. Complete quarantine. 
 
 3. Disinfection of all sheets, dishes, clothing used for the patient. 
 
 4. Fumigation of the room. 
 
 5. Thorough examination of the child by a physician on recovery 
 to prevent further complications. 
 
 6. Nourishing food, such as fresh eggs and milk, outdoor life 
 and rest. 
 
 What should your medicine chest contain? 
 
 Absorbent cotton, aseptic gauze, carbolic vaseline, castor oil, 
 hot water bag, and NO PATENT MEDICINES. 
 
 60 
 
CHAPTER XL IF YOUR BABY HAD DIPHTHERIA 
 
 F all the maladies that afflict small children none 
 causes more terror to the agonized mother 
 than diphtheria. It has an air of mystery and 
 awfulness. It seems, almost, to presage cer- 
 tain death. The doctor's reluctant verdict 
 his brief, but positive orders regarding isolation 
 and nursing the mention of antitoxin, of 
 antiseptics, of subcutaneous injections the post- 
 ing of the warning sign upon the door all of these things bring 
 the mother of the little patient to a pitiable state of alarm. 
 
 And yet, for all its indubitable dangers, diphtheria is one of the 
 diseases that modern medicine may fairly claim to have conquered. 
 Its cause is known and its course is known. It may be prevented, 
 and in the great majority of cases it may be cured. When the 
 doctor pronounces its dread name, there is no reason whatever 
 why one should give thought to grievous possibilities, because 
 these possibilities, fortunately for the human race, are now hap- 
 pily remote. Ten years ago more than half of the babies who took 
 diphtheria died from it. To-day the deathrate is less than one- 
 tenth, and, under conditions easily attainable, than less one- 
 twentieth. 
 
 The credit for this belongs absolutely to the men who devised 
 and perfected diphtheria antitoxin. No other single medical dis- 
 covery of recent years has better proved its value to the human 
 race, or better justified the bold experimentation the ruthless 
 slaughter of rabbits and guinea pigs the patient toil with culture 
 tube and microscope of medical science. 
 
 No doubt you have heard assertive persons say that antitoxin is 
 a snare, and that it kills more babies than it cures, and perhaps 
 this sort of criticism has made some impression upon you. If it 
 has, be warned in time. Your own child may take diphtheria to- 
 morrow. If it does, antitoxin is the only thing under the sun that 
 will aid it. When your doctor tells you so, show your faith in him 
 
by letting him go ahead with his work of inoculation. Half an 
 hour's delay means regret poignant and everlasting. 
 
 To understand the nature of diphtheria antitoxin it is necessary 
 first of all, to know something about diphtheria. In the view of 
 the layman it appears as an extraordinarily violent species of sore 
 throat, with an unaccountable tendency to infect others and to 
 end in death. In the view of the pathologist it is an acute infectious 
 disease of the first class, caused by a definite organism called the 
 bacillus diphtheria, which secretes a powerful soluble toxin, or 
 poison; which, in turn, produces death by inhibiting the proper 
 action of the heart. 
 
 The bacillus diphtheria, despite the popular notion of bacilli, 
 is not an animal, but a plant. Unlike the varieties of vegetation 
 that are most familiar to us, it does not need an immovable soil 
 for its roots, but floats about and grows luxuriantly in the human 
 blood, or in any other suitable liquid. It is so small that a mi- 
 croscope magnifying one thousand times barely reveals it. In 
 shape it resembles a minute rod, rather thick in section, and with 
 one end swelling out a bit. It tends to grow in curious little clus- 
 ters which much resemble the five outstretched fingers of a human 
 hand. 
 
 The bacillus diphtheria is very tenacious of life, and even when 
 dried and seemingly withered, it is capable of remaining alive for 
 months. This explains the fact that it is very difficult to stamp 
 out an epidemic of diphtheria. Once the bacilli gain a foothold 
 in a house, a school or a neighborhood, they are very apt to infect 
 child after child. They float about in the air; they appear, in 
 countless millions, in the mouths of children who are ill with the 
 disease ; and they appear, too, though in less number, in the mouths 
 of those who may be perfectly well. Only the most skilful use of 
 antiseptics, by some one with sound scientific knowledge, is of any 
 value in the effort to stamp them out. 
 
 When a swarm of these bacilli take lodgment in a child's throat 
 or tonsils, they begin at once to increase and multiply. Within 
 a few hours they are present by the billion. Each individual throws 
 off a minute stream of poison, and these streams, commingling, 
 attack the throat tissue. They kill the mucous membrane, and 
 the little blood-vessels below it rush scar-forming materials to the 
 scene to repair the damage. At the same time the white blood 
 corpuscles in the blood vessels engage the bacilli in combat 
 
 62 
 
attacking them and trying to swallow them. Before long the scene 
 of the battle is littered with all sorts of de*bris dead membrane, 
 dead bacilli, dead corpuscles, and bits of scar tissue. This debris, 
 in the end, forms quite a large mass, and becomes, in fact, the 
 familiar diphtheria throat membrane. 
 
 The membrane obstructs the windpipe of the sufferer, and unless 
 something is done to break it strangulation is apt to follow. Some- 
 times it is necessary to cut into the neck of the patient below the 
 place of obstruction and insert a silver tube, to give the lungs air. 
 More often, it is possible to force a tube down the throat, in 
 front of the membrane. This operation requires great skill, and 
 should be entrusted only to some expert who has done it often 
 before. 
 
 Despite the size and toughness of the membrane, however, 
 strangulation is seldom the cause of death in diphtheria. Much 
 more often, the patient dies of heart failure, produced by the 
 activity of the poisons secreted by the bacilli. These poisons are 
 frightfully virulent, and being soluble they are carried to all parts 
 of the body in the blood stream. It is evident, therefore, that if 
 they can be attacked and destroyed in the blood their power of 
 doing damage may be broken. This office of attacking and des- 
 troying them is the function of diphtheria antitoxin. 
 
 The manufacture of the antitoxin is based upon the fact that 
 healthy blood, whenever germ poisons appear in it, begins auto- 
 matically and at once to make antidotes for them. Inject a few 
 drops of diphtheria poison into the veins of a healthy, full-grown 
 man, and his blood will at once neutralize it, and as a result he will 
 show no bad effects whatever. If the amount injected be very 
 small, his blood, indeed, will manufacture a great deal more anti- 
 dote than is necessary to neutralize it, and will keep on making 
 antidote for some time after all of the poison present has been 
 rendered harmless. 
 
 But if a large quantity of poison be injected, or if active bacilli 
 in large numbers are lodged somewhere in the body, and are hard 
 at work sending forth more poison, the blood will soon give up the 
 hopeless struggle. It will fight valiantly as long as possible, and in 
 the course of the battle it will neutralize a vast quantity of poison, 
 but in the end the enemy will be too strong for it, and it will sur- 
 render. This is what happens when a child is infected with diph- 
 theria and a colony of bacilli lodge in its throat. For a while its 
 
 63 
 
blood fights on, but in the end it is overcome, and the poison begins 
 to course, without obstruction, through its veins. 
 
 Fortunately, it is possible to lend the body aid by reinforcing 
 it. And how? Simply by injecting into the patient's veins blood 
 from some animal which is capable of making a better fight against 
 diphtheria than a human being. In practise the animal selected 
 is always the horse. It is a hardy, cleanly and healthy beast; 
 it is capable of losing a great deal of blood without damage; and 
 its blood has a peculiar capacity for opposing and neutralizing the 
 poisons of the diphtheria bacillus. 
 
 A fine, strong horse is selected, and the manufacture of antitoxin 
 is begun by injecting into one of its veins a small amount of diph- 
 theria poison. The amount is so small that the blood of the horse 
 neutralizes it at once, and the animal suffers no ill effects at all. 
 Four days later twice as much poison is injected. This, too, is 
 neutralized by the horse's blood, and in addition, the blood, stim- 
 ulated to activity, manufactures a large extra portion of antidote. 
 Four days later a still larger dose of poison is administered, and 
 thereafter for six months the process is kept up. The horse's 
 blood, in the long battle, always manages to keep a bit ahead of 
 the poison. At the end of the six months, it is so heavy with an- 
 tidote that it is capable of neutralizing any conceivable amount 
 of poison. The horse, in fact, is utterly diphtheria-proof. One 
 might inject into its veins enough diphtheria poison to kill an 
 army, and it would go unscathed. 
 
 All that remains is to draw off some of this immunized blood 
 and get it into the veins of the human patient. The process, it 
 is obvious, is a very simple one. One of the veins of the animal is 
 opened, a quantity of its blood is collected, and a portion of this 
 blood (after it has settled and has been strained) is injected into 
 the human patient. The strained blood is a sticky, yellowish liquid. 
 It is what the doctors and druggists call diphtheria antitoxin. 
 
 This antitoxin, then, is nothing more than horse blood which 
 has acquired an extraordinary capacity for combating diphtheria 
 poisons. When it enters the blood-vessels of the patient it begins 
 at once to seek out the diphtheria poisons and destroy them. It 
 does its work almost instantaneously, and if enough is used, the 
 result is certain. All of the diphtheria poisons are neutralized 
 and the patient begins to grow better. 
 
 But it is plain that the antitoxin must be used quickly and in 
 
 64 
 
sufficient quantity if this desirable end is to be achieved. So long 
 as the patient's blood fights on unaided, the amount of poisons 
 present in it will go on increasing. By and by these poisons may 
 be present in such great quantity that they will begin to impede 
 the action of the heart. When that stage is reached the patient is 
 dying, and it is too late to battle with the disease. 
 
 Therefore, it is important that the diphtheria antitoxin be used 
 just as soon as there is good ground for believing that diphtheria 
 is present. If it is used on the first day of the disease, the latest 
 statistics show that it will save the lives of ninety-eight patients 
 out of one hundred. If its use is put off until the second day, it 
 will save only ninety-six. If it is used after the fourth day, it will 
 not save more than eighty out of a hundred. 
 
 And it must be used in sufficient quantity. If one injection does 
 not bring relief, let there be another, and then another, and yet 
 another. The antitoxin can do no harm. In cases on record, 
 wherein its use has long been delayed, almost incredible quantities 
 have been injected. The scientific physician has a safe rule. He 
 knows that there is hope so long as life lasts; and so he proceeds 
 with the treatment until the danger line is passed and the patient 
 shows signs of it. 
 
 You mothers learn a great deal about the care of children, but 
 in the presence of a disease as dangerous as diphtheria you must 
 yield up the custody of your child to the doctor and the nurse. 
 Your family doctor must be a man in whom you have implicit 
 confidence. Select him with the utmost care, and do it, by pref- 
 erence, at some time when there is no sickness in the household. 
 Then, after you have chosen him and sickness comes, give him the 
 faith and support that his learning and experience deserve. His 
 whole life is devoted to the cure of human ills, and your common 
 sense will teach you that, if he is an intelligent man, this devotion 
 must profit him in wide knowledge. 
 
 Do not oppose him or hamper him in the sick-room . He knows 
 what is best for the patient. If he proposes to use antitoxin, let 
 him do so at once. The persons who go about denouncing such 
 invaluable gifts to the human race are the heirs of those ancient 
 wiseacres who laughed at Sir William Harvey when he said that 
 the blood flowed through the veins, and hooted at Jenner when he 
 proposed to vaccinate all England, and called Klemke a lunatic 
 when he maintained that tuberculosis was infectious. 
 
 65 
 
That antitoxin, employed in time, will cure diphtheria is a fact 
 as easily demonstrable as the fact that the sun rises every 
 morning. And the fact that nothing else in the world no medicine, 
 throat mopping or surgical operation will cure it, is demon- 
 strable, too. Medicines and moppings have their usefulness as 
 aids, but it is the antitoxin or, when the antitoxin is not used, 
 long-suffering nature that wins the battle. 
 
 It is evident, however, that the antitoxin, while it neutralizes 
 the poisons secreted by the bacilli, does not directly kill the bacilli 
 themselves. The business of getting rid of them falls upon the 
 white blood corpuscles, and the great majority of them are soon 
 gobbled up, but not a few remain. These, unless something is 
 done to kill them, are apt to infect other persons. Active germs 
 have been found in the throats of recovered diphtheria patients 
 three months after the disease itself apparently disappeared, 
 and there is one remarkable case on record, where they remained 
 alive for twenty-two months. They also live in the air, in water, 
 and elsewhere. 
 
 In consequence, it is highly important that children who are 
 convalescent be kept away from other children. They should be 
 isolated for at least a month, and it is unwise to send them to school 
 for several weeks longer. The business of stamping out the stray 
 bacilli which may happen to infect the sick-room should be en- 
 trusted to some one who knows how to do it. The common device 
 of hanging up cloths saturated with carbolic acid is utterly useless. 
 In many cities the municipal health department takes charge of 
 all disinfections. 
 
 When this is the case, it is very unwise for mothers to offer 
 opposition. The health department experts know what they are 
 about, and their work may very easily prevent other cases in 
 the same house or epidemics in the neighborhood. One little life 
 saved is worth all the bother and disorder that these men, with 
 their enmity to wall-papers, cause in a household. 
 
 During the progress of a case of diphtheria, the rooms occupied 
 by the patient and it is best to have two bedrooms, that there 
 may be frequent changes should be isolated absolutely from the 
 rest of the house, and it is advisable, whenever possible, to send 
 all the other children of the house away and withdraw them from 
 school until all possibility that they, too, are infected has been 
 eliminated. 
 
 66 
 
It is best, whenever possible, to call in a graduate nurse, but too 
 often the fear-stricken mother must herself assume the office of 
 bedside attendant. To those confronted by this difficult duty, I 
 would suggest the importance of submitting to a preventive in- 
 jection of antitoxin. Small doses for this purpose are especially 
 prepared by the various manufacturers. The inoculation causes 
 little discomfort and no illness, but it is a certain preventive. 
 Most adults are immune to diphtheria, but the importance of keep- 
 ing the nurse in good health throughout the period of nursing is 
 obvious, and so it is well to take no chances. 
 
 You should have the doctor give you a prescription for a mouth 
 gargle and use it every hour. In addition you should wash your 
 hands at frequent intervals with antiseptic soap. All spoons 
 glasses and other vessels should be cleansed with a three per cent, 
 solution of carbolic acid. Toys, cushions, carpets, pictures and 
 furniture in fact, everything movable should be taken from the 
 sick-room. Its furnishings should be limited entirely to the bed, 
 a table and a chair for the nurse. The floor and walls should be 
 sponged once a day with a one-tenth of one per cent, solution of 
 bichloride of mercury. The bedclothes and garments of both 
 patient and nurse should be boiled, and all sick-room de"bris should 
 be burned. The eyes, nose and mouth of the patient should be 
 frequently swabbed with moist absorbent cotton, and the cotton 
 should then be burned. 
 
 Not a solitary person besides the nurse and the doctor should 
 be permitted to enter the sick-room under any circumstances. 
 As I have said, most adults are immune to diphtheria, but it is 
 perfectly possible for them to carry away the germs and infect 
 children. I recently encountered in my own practice the case of 
 a drawing teacher who infected at least a score of children without 
 being ill herself. The germs of the disease were in her throat. 
 
 The nursing of a case of diphtheria requires eternal watchful- 
 ness and care. Even when the disease is making favorable pro- 
 gress, there is danger of sudden heart failure and collapse, and the 
 management of such emergencies is beyond the skill of the mother. 
 If your little patient seems to be fainting, and the pulse grows 
 weak, send for the nearest doctor at once. In any case the con- 
 valescent is always very much exhausted, and should be kept in 
 bed a good while. The diet should be rigidly prescribed by the 
 physician. It is exceedingly dangerous to add a coveted dish to 
 
 67 
 
it no matter how harmless that dish may seem without his 
 express permission. 
 
 Methods of preventing diphtheria will present themselves to 
 the intelligent mother. The notion that every child is doomed to 
 suffer from the disease at some time during its first decade (and 
 to suffer attacks of a long string of other infantile epidemics, like- 
 wise) is a dangerous and stupid error. There is no reason whatever 
 why any child need have diphtheria, scarlet fever or measles, just 
 as there is no reason why it need have smallpox, lockjaw or hy- 
 drophobia. All of these infections are preventable. 
 
 In a great many cases kissing spreads diphtheria particu- 
 larly from adults, in whose mouths the germs may be impotent, 
 to children. Therefore, the custom of permitting small children 
 to be fondled and kissed by every sentimental woman relative and 
 visitor, should be under the ban. Again, it is well to break children 
 of the habit of putting things into their mouths. It is easy to do 
 this, and the precaution may save lives. Rubber pacifiers, the toys 
 used to divert children in photograph galleries, and other things 
 of that sort frequently swarm with the bacilli. 
 
 As I have tried to show, success in battling with diphtheria de- 
 pends almost entirely upon promptness. A delay in sending for 
 the doctor is often fatal. Whenever a child's throat is sore, and a 
 membrane obstructs the air passages, it is safe to conclude that 
 there is some diphtheretic infection. Even a mild redness, without 
 membrane, or pain, may indicate the presence of the disease. Such 
 a mild case may pursue an uneventful and unalarming course 
 and then suddenly ead in heart failure. It is best, at all times, 
 to put no trust in home remedies for the treatment of sore throats. 
 Only a physician is capable of differentiating between diphtheria 
 and less dangerous infections. 
 
 The so-called "pseudo-diphtheria" of the old-school family 
 doctors is not diphtheria at all, but a milder tonsil infection due to 
 the presence of organisms called the streptococcus and staphylo- 
 coccus. But the existence of such an infection shows that the little 
 patient's throat membranes afford good soil for germs, and so it 
 should be guarded against diphtheria with unusual vigilance. 
 Bad teeth, mouth sores, enlarged tonsils, catarrhal inflammations 
 and other abnormalities in the respiratory tract also predispose 
 to the disease. Susceptibility is increased, again, by measles and 
 scarlet fever. In the majority of cases, the germs first find a lodg- 
 
 68 
 
ment in the tonsils. Therefore, it is a wise precaution to have 
 enlarged and sensitive tonsils removed in early infancy. 
 
 When a child has been exposed to infection, and the fact is known, 
 an immunizing injection of antitoxin should be made at once. 
 If this is done in time, the disease is effectually headed off. As 
 I have said, the antitoxin is harmless, and cannot possibly injure 
 a healthy child. The prejudice against it (and traces of this 
 prejudice are to be encountered among ignorant, old-fashioned 
 doctors as well as among silly mothers) is doubtless due to the fact 
 that it has been in use but a short while. Not until 1894 was its 
 value demonstrated, and only since 1895 has it been in general 
 use. In these few years, I should say, it has saved the lives of at 
 least three hundred thousand children. 
 
 QUESTIONS FOR THE MOTHER ABOUT CHAPTER XI 
 
 What is the one thing that has reduced the death-rate from diph- 
 theria so marvelously in the last ten years? 
 
 Diphtheria antitoxin. 
 
 How soon should the antitoxin be administered? 
 
 As soon as diphtheria is suspected to be present. 
 
 How can this be proved? 
 
 A "culture" should be taken of the patient's throat. 
 
 How is this culture taken ? 
 
 The doctor scrapes the patient's throat and has the mucous 
 examined at once by a bacteriologist to see if the diphtheria germ 
 is present. 
 
 How can a mother protect the family from taking diphtheria from 
 the patient before she is sure it is diphtheria? 
 
 She should call a doctor for tonsilitis or a bad sore throat and 
 should isolate a child suffering from a cold or sore throat. 
 
 How can she prevent the disease from attacking those who have been 
 exposed to itf 
 
 She should at once notify the Board of Health. Either a 
 Board of Health doctor or her private physician will make a mild 
 injection of antitoxin for each person exposed. If the mother 
 takes care of the child she should have such an injection also, 
 as her health is all-important at this crisis. 
 
 What can we do to prevent diphtheria? 
 
 69 
 
Brush the teeth thoroughly after each meal; use a mouth wash; 
 have adenoid growths or enlarged tonsils removed; take care not 
 to infect other people if we have a cold or sore throat. Take care 
 not to let other people infect us if they have a cold or sore throat. 
 Never kiss one another on the mouth. 
 How can we prevent diphtheria epidemics at schoolf 
 Diphtheria germs are present in the mouths of many healthy 
 persons. These persons are called "germ carriers." A "culture" 
 should be taken of every child's throat before it enters school in 
 the fall. In this way the "germ carriers" can be weeded out. 
 
 70 
 
CHAPTER XII. IF YOUR BABY HAD SCARLET FEVER 
 
 OW that smallpox, thanks to compulsory vac- 
 cination, has become a rarity in civilized 
 communities, scarlet fever steps forward as 
 the worst of the eruptive diseases of childhood. 
 It is a malady of enormous antiquity. Thu- 
 cydides, writing nearly five hundred years 
 before the beginning of our era, called it a 
 heritage from the remote past. It has scourged 
 the white races in all ages and all countries, and the physicians 
 of all schools have leveled their heaviest artillery upon it. Yet it 
 remains a puzzle unsolved and an enemy unconquered even to-day. 
 We are in doubt as to its cause, and there is as yet no drug or anti- 
 toxin that will cure it. 
 
 But despite all this, the death-rate from scarlet fever is steadily 
 declining, and we may expect it to decline more and more as the 
 years go by. The reason for this, I take it, lies in the fact that the 
 modern doctor is a great deal more sparing with pills and powders 
 than his predecessor, and a great deal more lavish with water, 
 air and antiseptics. In the old days it was customary to dose 
 scarlet fever patients with all sorts of violent remedies, in staggering 
 quantities, and, as a result, many of them died. To-day medi- 
 cines are but minor auxiliaries in the sick-room, and both doctor 
 and nurse devote their main energies to preventing a spread of 
 the infection. 
 
 Though the exact cause of scarlet fever is still far from certain, 
 there is no doubt whatever that it will be determined with absolute 
 accuracy within a few years. A large number of competent ob- 
 servers, in truth, have already come to the conclusion that the 
 causative agent must be a minute parasite closely related to that 
 which produces malaria. The organisms of diphtheria, tuber- 
 culosis and most other common maladies belong to the vegetable 
 kingdom, like the germs of the yeast, but this so-called scarlet fever 
 organism is a true animal. It is at the very bottom of the scale 
 
 71 
 
of brute creation, and is almost as far below the caterpillar as the 
 latter is below the highest grade of man-like ape. 
 
 An attack of scarlet fever may begin a day or so after the patient 
 has been exposed to contagion, and then again there may be an 
 incubation period of a week or even more. Several years ago, 
 in the course of my practice, I one day visited a family in which 
 there were four bad cases. Next day I left the city and remained 
 away for a full week. On the day of my return I fell ill with the 
 disease, and a very severe attack was immediately in progress. In 
 this case the incubation period seems to have been no less than 
 eight days. 
 
 Scarlet fever usually begins with chills, rising fever, headache, 
 loss of appetite and pains in the limbs, and sometimes, particularly 
 in very young children, with convulsions. A sore throat and 
 painful tonsils next afflict the patient, and at the end of a day or 
 so the characteristic red rash appears. This commonly begins 
 around ':he neck and over the chest, and at the start consists 
 of tiny scarlet blotches the size of pinheads. The blotches soon 
 run together and the whole surface of the body becomes a brilliant 
 red. The membranes of the mouth are affected in much the same 
 way, and the tongue becomes swollen and takes on the so-called 
 " raspberry ' ' appearance. 
 
 Despite the almost universal notion, there is no crisis in scarlet 
 fever. A crisis, in medicine, means a sudden change in or termi- 
 nation of symptoms. In scarlet fever the fever does not cease 
 suddenly, but slowly. This is called a termination by lysis, which 
 is the very reverse of crisis. When the fever goes down usually 
 about the fifth day the scarlet rash begins to disappear and the 
 skin of the patient begins to peel off. Sometimes it comes off in 
 large patches, and the skin of nearly a whole hand may separate 
 in a single piece. 
 
 When this peeling has fairly begun, the malady itself may be 
 said to have practically run its course, but there yet remains 
 a grave danger from serious complications. The worst of these 
 are Bright 's disease, several varieties of heart disease and inflam- 
 mation of the inner ear. Bright 's disease, as every one knows, 
 may readily lead to long invalidism and death, and inflammation 
 of the inner ear only too often produces meningitis, abscesses on 
 the brain, or permanent deafness. The belief that scarlet fever 
 tends to leave some nasty souvenir of its visit is far from a mere 
 
 72 
 
superstition. It has an unpleasant habit, too, of paving the way 
 for other acute diseases, such as pneumonia, bronchitis and even 
 diphtheria. 
 
 All this makes it apparent that a case of scarlet fever needs very 
 careful nursing. Whenever it is possible a trained nurse should be 
 engaged, and in any event the doctor's orders should be obeyed 
 with scrupulous exactness. Nothing could be more foolish than the 
 common custom of seeking advice in such emergencies from grand- 
 mothers, neighbors who have " pulled their own children through" 
 and other well-meaning, but blundering "experts" of that species. 
 Good nursing means not only intelligent care of the patient, and 
 a capacity for quickly and accurately recognizing threatening 
 complications, but also intelligent efforts to prevent a spread of 
 the infection. Scarlet fever is one of the most contagious of known 
 maladies, and in achieving an effective quarantine of his patient 
 the cautious physician often takes measures which, to the layman, 
 may seem almost ridiculously elaborate. 
 
 When one of your children develops the disease, put it to bed in 
 a large and airy room, preferably on the top floor of the house, and 
 prepare another room nearby, into which the child may be taken 
 when the sick-room proper is being aired and cleaned. Take all 
 unnecessary furnishings out of both rooms. Under this heading 
 come carpets, rugs, pictures, draperies and ornaments. In the 
 sick-room a bed for the patient and a chair and table for the nurse 
 are about all that may be called needful. A plain clothes-rack will 
 suffice for holding the necessary changes of bed-clothes. 
 
 If it is at all possible, send the other children of the household 
 to some relative's home and keep them away from school for a 
 week. If they are apparently well at the end of that time, it will 
 be safe to let them go back to school. If sending them away is 
 out of the question and they must remain in the house, keep them 
 away from all other children until the patient up-stairs is well. 
 They may take the disease at any time, even in the face of careful 
 precautions, and you certainly would be greatly grieved to see 
 them carry it to their fellow-pupils and playmates. 
 
 If you are able to engage a trained nurse or, better still, two of 
 them the problem of nursing is much simplified, for the nurses 
 will carry out the doctor's orders intelligently and faithfully, and 
 in their comings and goings they will see to it that they do not carry 
 the infection. Your own visits to the sick-room should be as far 
 
 73 
 
apart as your anxiety will permit you to make them, you should 
 stay but a short while, and avoid handling the patient. Before 
 you enter the room put on a long duster or rain coat that com- 
 pletely covers your ordinary clothes. Place a close-fitting hood, 
 such as housemaids wear when dusting, over your hair. These 
 garments should be kept at the sick-room door. When you leave, 
 wash your hands thoroughly, putting a few drops of carbolic acid 
 into the water. After that, spend half an hour in the open air 
 and sunlight. 
 
 If you decide to nurse your child yourself, you must resign your- 
 self to an entire separation from the other children in the house for 
 a period of at least six weeks. Your bedroom should be next 
 to or very near that of the patient, of course, but I cannot advise 
 your sleeping in the sick-chamber itself. Besides increasing the 
 chances of infection, this practice results in unduly vitiating the air 
 of the room. The oxygen that you consume is needed by the 
 child, for in a sick-room the supply of oxygen is never too ample. 
 
 With proper treatment, the patient should be quiet enough to 
 give you a reasonable amount of rest, but you must school your- 
 self to awaken easily in order that you may look after its noc- 
 turnal wants. It is highly important that you go out every day 
 for an hour or so for fresh air and exercise, and during this time 
 some one else must be on guard. This assistant nurse, during her 
 stay in the sick-room, should wear the long coat and the dust-cap 
 I have already described. You, yourself, on leaving the sick- 
 room, should make a complete change of clothes, and wash your 
 face and hands thoroughly. The clothes you wear outside should 
 be kept in an ante-room. 
 
 These precautions may seem unduly elaborate, but in view of 
 the extraordinary infectiousness of scarlet fever, they are not. 
 In my own practice I wear a skull-cap and long rain coat whenever 
 I enter the room of a patient ill with the disease. In addition, 
 I cover my mustache and beard with strips of sterile cotton, and 
 see to the surgical cleanliness of my hands and this is far greater 
 than ordinary soap-and-water cleanliness when I depart. 
 
 In the sick-room, for general antiseptic purposes, you should 
 keep a wooden (not a metal) bucket filled with a one-tenth per 
 cent, solution of corrosive sublimate. The drug stores sell this 
 powerful germicide in convenient tablet form. Use one tablet 
 for every pint of water. All towels, sheets and other cloths used 
 
 74 
 
in the sick-room should be soaked in this solution for an hour be- 
 fore they are placed in the family laundry basket. It should be 
 used, too, instead of plain water, for moistening all cloths employed 
 in wiping the floor and furniture. 
 
 You know, of course, that corrosive sublimate is a most violent 
 poison, but this fact need not worry you, for a weak solution, such 
 as I have recommended, can do little damage. After it wets your 
 hands, wash them with soap and water. It may make the skin 
 a bit dark and rough, but this will wear off very quickly. In mop- 
 ping the floor, see that the cloth is moist, and not soaking wet. 
 The sick-room must never be dusty (this bans all sweeping), but 
 neither should it be steamy and damp. 
 
 The doctor will give you detailed instructions as to the care of 
 the patient. The little sufferer will probably be greatly annoyed 
 by the discharges from its nose, throat and ears, and these must 
 constantly be looked to. Instead of a handkerchief or napkin for 
 keeping it clean, use small bits of the absorbent cotton sold by every 
 druggist. This cotton is cheap, it has been sterilized, and its 
 application is not irritating. Every piece should be burned im- 
 mediately after it has been used. 
 
 It will be a great aid to the doctor if you can give him an accurate 
 report upon the varying temperature of the patient. To the lay- 
 man, taking a temperature may appear difficult, but it is really 
 a very simple matter. A clinical thermometer costs less than a 
 dollar, and the doctor will show you how to read it. If the patient 
 is afraid to hold it under the tongue, place it in the rectum. The 
 normal temperature of a human being is 98.6 degrees Fahrenheit. 
 In scarlet fever it may rise to 103 or even 105 degrees. Whenever 
 it begins to grow high, the doctor should be informed at once. 
 
 After the fever goes down and the child's skin begins to shed, 
 it will suffer greatly from itching. This can be relieved by rubbing 
 the body very gently with carbolated vaseline. During this stage 
 the child should be bathed often in cold lime-water or in water 
 which contains a small amount of ordinary baking-soda. Hot 
 baths are to be avoided, but the water may be warmed enough, 
 as the phrase goes, "to take the chill off. " Do not attempt to help 
 nature by pulling off the pieces of loose skin. They will drop off 
 themselves just as soon as the new skin beneath them is hard 
 enough to be exposed. 
 
 The ancient belief that a sick-room may be disinfected by hanging 
 
 75 
 
up cloths saturated with weak carbolic acid or some other anti- 
 septic is without a basis in fact. An antiseptic, to kill a germ,must 
 be brought into actual contact with it. 
 
 That is why all towels and sheets must be not merely dampened 
 by, but actually soaked in, the corrosive sublimate. If you man- 
 aged to get enough carbolic acid into the air to kill the germs, 
 you would kill the human occupants, too. 
 
 Scarlet fever is most contagious from the third to the seventh 
 day, but its contagiousness does not disappear entirely for a long 
 while after that. Until the shedding of the skin and the discharge 
 from the ears have quite ceased, no person save the doctor and the 
 nurses should be permitted to approach the patient, and in any case 
 the period of quarantine should be at least six weeks. 
 
 If you have had scarlet fever in childhood you need not fear for 
 your own health, but, even if you haven't, your chances of taking 
 it are small. It is, in fact, rare among adults, but all the same it 
 is well to adopt precautions. 
 
 After the patient has recovered, the sick-room should be thor- 
 oughly cleansed; and this means cleansed in the surgical, and not 
 in the common, sense. In large cities the work is best entrusted 
 to the health department. When such experts are not available, 
 the floor, walls and ceilings should be mopped again and again 
 with the corrosive sublimate solution, and the windows should 
 be thrown wide open. It is always best to have the wall-paper 
 scraped off. 
 
 There is no reason to fear the worst when the doctor's verdict 
 is scarlet fever. In all maladies, you should remember that the 
 death-rate is kept up by the enormous number of deaths among 
 the children of the very poor. 
 
 QUESTIONS FOR THE MOTHER ABOUT CHAPTER XII 
 
 What is the one thought you should have in your mind where there 
 is scarlet fever? 
 
 The danger of one case of scarlet fever in a town to the rest of 
 the community. 
 
 Why? 
 
 Because scarlet fever is one of the most contagious of diseases. 
 
 Because it is very dangerous and leads to other serious diseases. 
 
 76 
 
What is necessary to protect a community against scarlet fever? 
 
 That every case, as soon as it is discovered, should be reported 
 to the health department. 
 
 What will the health department do? 
 
 It will send a doctor to examine the child. It will give the 
 mother information about preventing the spread of the disease to 
 the other children in her family or in the town. It will place a 
 sign "scarlet fever" on the door to warn people. It will fumigate 
 the home. 
 
 What should a mother do if the health department does not take 
 such care of a scarlet fever case? 
 
 She should send at once for her doctor and ask him how to care 
 for the child and how to disinfect. She should place a large red 
 letter sign SCARLET FEVER on her door to protect her neighbors. 
 She should keep all the persons who have been exposed to scarlet 
 fever away from other persons, and the children away from school 
 or play on the street until the time in which they might come down 
 with the disease is passed. 
 
 What are the precautions to be taken to prevent infection from 
 scarlet fever? 
 
 All sheets, nightgowns, towels, etc., used by the patient and the 
 nurse should be soaked twenty-four hours in a solution of carbolic 
 acid before taken from the sick-room, then thoroughly boiled. 
 
 Every dish used in the sick-room should be washed in carbolic 
 acid solution before taken from the room. 
 
 Every book, toy or article that cannot be boiled should be burned. 
 A child has caught scarlet fever from a book that had been in the 
 room when her brother had scarlet fever two years before. 
 
 No letter written by the patient should be permitted to leave the 
 room. Allowing an infected letter to go through the mails, carry- 
 ing a child with a contagious disease through the street car or 
 trains is a crime to one's fellowmen that should be punishable by 
 law. If it is necessary to take a child in a hack to the hospital or 
 home, the hack should be fumigated and disinfected before being 
 entered by another person. 
 
 How long is there danger of infection from a scarlet fever case? 
 
 Until every bit of the old skin skin that peels off comes off 
 the body naturally. 
 
 What should be done when the patient recovers? 
 
 It should be bathed and its hair washed in disinfectant before 
 
 77 
 
leaving the room. Place a clean wrapper at the door and have 
 clean clothes for it in another room where it may get dressed. 
 Then burn a formaldehyde candle in the room, wash the floors and 
 the woodwork and the walls with a solution of corrosive sublimate. 
 Then the wall paper should be torn off the wall and the room should 
 be repapered. 
 
 How much cheaper is this than another case of scarlet fever, 
 perhaps resulting in death. 
 
 78 
 
CHAPTER XIII. WHOOPING COUGH: IT KILLS 
 
 MORE CHILDREN THAN SCARLET FEVER 
 
 AND DIPHTHERIA TOGETHER 
 
 HOOPING cough is one of the most contagious 
 of all maladies of childhood, and, in very 
 young children, one of the most dangerous. 
 Personal contact is not necessary in order to 
 transfer the infection from one child to an- 
 other. Children may take it by merely enter- 
 ing a house in which there is a patient, and 
 * some observers assert that it may even be 
 transmitted from child to child on the street. After the third 
 year it is not often fatal, but among very small children it 
 plays havoc. During the whole of the first year indeed, it 
 shows a death rate of at least 25 per cent. This proves how 
 important it is to guard babies against contagion. The notion 
 that whooping cough is a mild disease, which every child would 
 better acquire early, for its subsequent good, is a costly fallacy. 
 We are yet somewhat in the dark as to the cause of whooping 
 cough, but there is very good reason to hold that it is produced 
 by a small organism allied to the germs of the other infectious 
 diseases. This organism, it is possible, enters through the mouth 
 or nose and takes up its home in the larynx, where it at once pro- 
 ceeds to irritate and destroy the mucous membrane, and to send 
 forth poisons into all parts of the body. The first result is an 
 accumulation of cellular debris and mucous in the larynx, and the 
 second is a serious interference with the normal working of 
 the bodily machinery, particularly that part of it which makes up 
 the nervous system. 
 
 The accumulation in the larynx, it seems likely, is the direct 
 cause of the suffocating cough, though certain observers believe 
 that the principal seat of trouble is elsewhere. Whatever the 
 precise mechanism, it is plain that the effort in the cough is directed 
 toward ridding the larynx of its obstruction, and that the ex- 
 
 79 
 
pulsion of this obstruction, which comes up in the form of a sticky 
 mass, is followed by a cessation of the paroxysm. 
 
 Whooping cough starts like a common cold, and sometimes 
 it runs so mild a course that it is scarcely recognizable. But 
 ordinarily, its peculiar characteristics begin to appear after a few 
 days. One of these is the tendency of the cough to grow worse 
 at night, and another is its tendency to become convulsive and 
 racking. The child gasps for breath after each attack and 
 seems to be much exhausted. 
 
 In a week or ten days the familiar whoop sets all doubts at rest. 
 Anyone who has ever heard this whoop will never forget it. It is 
 caused by the labored in-breathing of air through the narrowed 
 glottis, and well exhibits the distress of the patient. The cough 
 itself is violent in the extreme. The child, as if suffocating, grasps 
 at nearby objects, its face grows red, the veins of its neck swell, 
 the tongue protrudes and the muscles of the whole upper part of 
 the body are strained. After each effort to clear the air passages 
 there comes the whoop. Finally, there is a spasm of extra violence, 
 the mass of mucous is expelled, and the child sinks back ex- 
 hausted. 
 
 It is common for vomiting to follow, and in some cases this 
 vomiting is so severe that it becomes one of the most distressing 
 symptoms. At times, indeed, the patient seems unable to retain 
 any food in the stomach. In such cases, of course, the exhaustion 
 becomes progressively more severe, and the physician finds the 
 nutrition of the patient a serious problem. 
 
 The number of coughing spells in the twenty-four hours varies 
 greatly, and is modified somewhat by the care exercised in nursing. 
 A sudden draught will often bring on a severe paroxysm, as will 
 a drink of cold water. Children are also apt to start coughing on 
 hearing some one else cough, and any other noise or shock may 
 have the same effect. The paroxysms are always more frequent 
 at night, and between the severe ones there may be a large num- 
 ber of lesser ones. 
 
 Very little can be done to shorten or mitigate the paroxysm, 
 once it starts. If the child is old enough to stand alone, it is best, 
 perhaps, not to touch it. If it is in arms, it should be held gently, 
 but firmly. Inhalations are often of value, but they can be used to 
 better advantage between the paroxysms rather than during their 
 progress. Often the mucous coughed up is bloody, and there may 
 
 80 
 
be bleeding from the nose or throat. Unless this is very profuse 
 it need cause no alarm. 
 
 The whooping stage continues for from three weeks to two months, 
 after which the cough grows milder, the vomiting ceases and the 
 child begins to regain strength. Even when there are no complica- 
 tions, whooping cough is a very exhausting malady, and so it is 
 necessary to observe the child closely during convalesence. It 
 should get plenty of fresh air, but it must be guarded against cold, 
 for an ordinary cold, at this stage, may quickly lead to pneumonia. 
 A visit to the seashore, if it does not involve a long journey, and 
 the weather is fine, is an excellent means of hastening convalesence. 
 
 In the absence of a definite cure for the disease, the treatment 
 of whooping cough is a battle with symptoms and complications, 
 and these are so numerous and so various in their manifestations 
 that it is impossible to give general advice. A severe case taxes 
 the ingenuity and experience of a specialist, and so it is apparent 
 that the home treatment, so often depended upon, is highly danger- 
 ous. As soon as your child develops a bad cough, send for a phy- 
 sician; and do not grow impatient if he fails to make an immediate 
 diagnosis and give the patient instant relief. As I have said, it is 
 often difficult to detect whooping cough during the first week. It 
 is possible, indeed, for a child to have the disease and yet never 
 whoop, and it is possible, again, for a child to whoop, and yet not 
 have whooping cough. A child who has once had the malady is 
 very apt to whoop for years afterward, whenever it takes cold. 
 
 Cleanliness and fresh air are just as important in the treatment 
 of whooping cough as they are in measles or pneumonia. Let 
 the room in which the patient is confined be cheerful and sunny, 
 and whenever possible give it two rooms, so that one may be cleaned 
 and disinfected while the other is in use. If the weather is fine 
 and it is strong enough, it should be taken out for an airing every 
 day. But if the air is damp, or there is a wind, it would best be 
 kept indoors. 
 
 The complication most to be feared, during the winter months, 
 is pneumonia. During the summer, particularly if the patient is 
 very young, there is almost equal danger from diarrhea. In order 
 to ward off the latter it is necessary to exercise great care in the 
 diet. The patient's meals should have diluted milk and egg-albumen 
 for their mainstays, and there should be no feeding of raw fruits 
 or red meats, save with the consent of the physician. Among 
 
 81 
 
infants convulsions are not infrequent, and often they cause death. 
 Despite the appalling fight for breath during the paroxysms of 
 coughing, it is seldom that a patient dies by actual suffocation. 
 
 Whooping cough is such a contagious malady, and runs such a 
 long course that it is never safe to keep other children under the 
 same roof with a patient. As soon as the disease is detected, let 
 the other children be sent away at once to some house in which 
 they will be the only youngsters, and keep them away from school 
 for sixteen days. If, at the end of that time, they appear to be in 
 good health, they may be sent back to school. 
 
 All of these precautions are necessary because there is good 
 reason to believe that whooping cough is contagious, not only during 
 the whooping stage, but also in the very earliest stage. Thus a 
 child who seems at the moment to have nothing worse than a 
 mild cold may yet spread whooping cough from end to end of a 
 large school. Where a hundred children are exposed to the in- 
 fection, it is not uncommon for 90 to develop the disease. It is, 
 indeed, one of the most virulent of childhood's plagues, and as I 
 have shown, one of the most dangerous. In the United States 
 to-day, it kills more children each year than scarlet fever. 
 
 The room in which a patient sleeps should be disinfected every 
 ten days. In order that this may be done, of course, the patient 
 must be moved to another room. As soon as aH is in readiness 
 swab the furniture with a weak solution of bichloride of mercury 
 or carbolic acid. Then close the room tightly and burn a for- 
 maldehyde candle. After an hour or so, throw open the windows, 
 and let the fumes of the formaldehyde escape. If this is done early 
 in the morning, it is usually possible for a child to sleep in the room 
 that night. 
 
 The virtue of this disinfection lies in the fact that a child recover- 
 ing from whooping cough sometimes seems to become reinfected, 
 probably from the bed-clothes or other furnishings. In other 
 words, the patient apparently acquires the disease all over again, 
 when on the road to recovery. Disinfection minimizes this danger, 
 and in addition it disposes of all the stray germs that may have 
 wandered in and so reduces the danger of pneumonia and other com- 
 plications. 
 
 It is not wise to let the patient come into contact with other 
 children until at least a month after the whooping has ceased. 
 Even then, it is best that it sleep alone for another month. Before 
 
 82 
 
the rooms in which it has been housed while ill are used by other 
 children they must be disinfected in a thorough manner. This 
 may be done with the antiseptic solutions and the formaldehyde, 
 using both more freely than in the periodic disinfections, but it is 
 advisable, whenever possible, to have the work done by experts. 
 In all large cities the health department will send men to do it, 
 sometimes for a small fee and sometimes without charge. 
 
 There are dozens of patented remedies for whooping cough and 
 all of them now bear the misleading notice "Guaranteed under the 
 Pure Food and Drug Act." The layman fancies that this notice 
 signifies, in some mysterious manner, that the national government 
 endorses the extravagant claims of the makers. As a matter of 
 fact, it does nothing of the sort. All it proves is that the nostrum 
 contains no more of certain specified poisons than is indicated on 
 the label. Innumerable drugs which, under the law, need not be 
 specified on the label, are extremely dangerous. 
 
 It may be stated with all due fairness to the patent medicine 
 men, that not one of their cough syrups and elixirs is of value in 
 whooping cough. True enough, some of them may contain drugs 
 which, in the hands of a competent physician, may be of appreciable 
 service, but all of these do far more harm than good if the dosage 
 is not adapted to the peculiar needs of the individual patient, and 
 all of them are very apt to upset the stomach. Vomiting and 
 diarrhea are common enough in whooping cough as it is. Drugs 
 in the stomach are always foes of an uneventful recovery, and the 
 physician, when he gives them at all, does so with great care and 
 great reluctance. 
 
 The common home remedies are even worse than the drug- 
 store messes. Those ghastly infusions of camomile and other 
 herbs, so often prescribed by wise old grandmothers to provoke 
 perspiration, and so "sweat out the fever," are the advance agents 
 of pneumonia. So are all the ancient plasters and poultices of 
 the family medicine chest. Let them be anathema! 
 
 I sometimes think, indeed, that the degree of civilization of a 
 community may be judged by the contents of its average family 
 medicine chest. In the old days this chest bulged with herbs, 
 barks, roots, soothing syrups, headache powders, lint, salves and 
 ointments. Paregoric was in the place of honor, and behind it 
 stood carboys of arnica and sweet spirits of nitre. 
 
 In the future, I fancy, the medicine chest will be smaller and 
 
 83 
 
less horrifying. It will contain a box of aseptic cotton, a bottle 
 of carbolic vaseline, a bottle of castor oil, a hot water bag and very 
 little else. 
 
 QUESTIONS FOR THE MOTHER ABOUT CHAPTER XIII 
 
 Why should whooping cough be especially avoided? 
 
 Because the mortality is very high, especially among very young 
 children. Babies who have whooping cough are more likely to 
 develop pneumonia in the winter time and diarrhea in the summer 
 time. Tuberculosis often results from the physical debility caused 
 by whooping cough. 
 
 Should a child with whooping cough be isolated? 
 
 Yes. Whooping cough is so exceedingly contagious that it is 
 not safe to have other children in the same house with a whooping 
 cough patient. 
 
 Should a child with whooping cough be allowed to go to school? 
 
 No. One case of whooping cough can infect a school from end 
 to end. Though children with whooping cough are able to run 
 about, they should be kept away from all other children. 
 
 What is the best way to get rid of whooping cough? 
 
 The room in which the child sleeps should be disinfected every 
 ten days. Whooping cough is so exceedingly infectious that the 
 child can reinfect itself, thus prolonging the disease. Sheets, 
 bedding and clothes should be soaked in carbolic acid solution; 
 woodwork and floors and walls should be washed down with this 
 solution, and a formaldehyde candle burned every ten days. 
 
 Is it necessary to have a doctor for whooping cough? 
 
 By all means. It is not safe to use any home remedies or patent 
 medicines. Let the doctor watch the little patient very closely. 
 A child with whooping cough should be warmly clothed, but should 
 have plenty of fresh air. 
 
 84 
 
CHAPTER XIV. IF YOUR BABY HAD PNEUMONIA 
 
 HE sinister distinction of holding first place 
 upon the American table of mortality belongs 
 to pneumonia, a disease of the lungs. It 
 causes more than one-tenth of all the deaths 
 that occur in the United States each year. 
 It slays the babe of a few months and the 
 grandfather of fourscore years. It lays low 
 the rich and the poor, the sturdy and the weak, 
 the overfed and the starving. And it is one of the few diseases 
 that the modern physician can do little to combat. When the 
 patient gets well, it is nearly always nature that works the cure 
 nature and, be it added, good nursing. 
 
 In view of this fact it is plain that every American mother should 
 endeavor to learn something about the malady, for it is upon her, 
 when the patient is a child, that the burden of nursing commonly 
 falls. 
 
 Reduced to its elementals, pneumonia is nothing more than a 
 clogging up of the lungs, due to the presence and activity of count- 
 less hordes of some breed or other of virulent germ. 
 
 As every one knows, oxygen enters the body through the nostrils 
 and the windpipe, as a result of the act of breathing. At its lower 
 end the windpipe divides into two branches the bronchial tubes 
 one of which makes off to the right and the other to the left. 
 At the end of each bronchial tube there is a further division, and 
 at the end of each division another one, and so on. The incoming 
 oxygen, proceeding down these constantly dividing passages, 
 comes at last to the ultimate lung-cells. 
 
 Now, when virulent germs invade the lungs, the blood and tissues 
 make an effort to paralyze and kill them, and the result of the 
 battle is a mass of debris dead germs, broken-off lung cells, mucous, 
 dead blood-cells and other things. This debris fills many of the 
 lung-cells and puts thousands of them out of commission. In 
 consequence the blood gets less oxygen than it should get, and the 
 
 85 
 
heart tries to make up for the deficiency by pumping blood into the 
 remaining clear cells a good deal faster than usual, and by making 
 the lungs breathe faster. This plan works very well for a while, 
 and if the blood makes good progress in killing the invading germs 
 and the debris is quickly absorbed or coughed up, the difficulty 
 will be tided over and the lungs will soon be working normally 
 again. But sometimes so many cells are clogged up that the blood 
 can not get enough oxygen, no matter how hard the heart works, 
 and then there is great danger of collapse and death. Again, the 
 germs may send out poisons which paralyze the heart, and then 
 there is great danger, too. All this proves, you will observe, that 
 pneumonia, though a lung disease, makes its final onslaught upon 
 the heart. 
 
 The foremost pathologists in the world have been trying for many 
 years to discover some specific for pneumonia, but so far their 
 efforts have been in vain. That is to say, there is nothing under 
 the sun that will directly kill the germs or directly aid the blood 
 in its war upon them. It is possible, of course, to assist nature by 
 combating the fever which appears with the disease. What the 
 patient most needs is a clean bed and plenty of air. Given these 
 things and a good constitution, the blood will fight the germs, 
 rout them, kill them and get rid of them. The chances are always 
 in favor of recovery. 
 
 An attack of pneumonia begins in a manner which suggests a 
 very bad cold. The patient has a chill and a fever and suffers 
 from pains in the side. A cough soon appears and the breath 
 becomes short and quick. The valiant battle of the overworked 
 heart is indicated by a quick pulse and flushed cheeks. Soon there 
 are signs of great exhaustion, with headache, sleeplessness and 
 (sometimes) delirium. 
 
 During all of this period the blood is waging a tremendous war 
 upon the invading germs. If it is destined to lose, the exhaustion 
 will grow more and more marked and the patient will die. But 
 if it is destined to win there will come a time it will be between 
 the fifth and the tenth day when the patient will suddenly seem 
 brighter. The temperature will fall, the breathing will be more 
 regular, and the violent jumping of the pulse will cease. When 
 this happens it is a sign that the battle is won. 
 
 But though the germs have been conquered, it is just at this 
 stage that careful nursing is most needed. The lungs are full of 
 
 86 
 
purulent wreckage, and the business of getting rid of this is difficult. 
 The attack itself has greatly exhausted the patient, and his strength 
 is next to nothing. Good nursing must recruit it for him nursing 
 which takes the form of plenty of fresh air and a supply of easily 
 assimilated food. 
 
 The fact that pneumonia might be called simply a shutting-off 
 of oxygen shows how important it is to give the patient plenty of 
 air. In several large New York hospitals, indeed, sufferers from the 
 disease are carried to the roof, and kept there day and night. 
 When your child grows ill, move it to the largest and sunniest room 
 in the house, and open the windows. If it is too cold for that, 
 have another room near by, into which the patient may be moved 
 at least three times a day, to permit a thorough ventilation of the 
 sick-room. All unnecessary furniture and all pictures, hangings 
 and other impedimenta should be taken out of both rooms. 
 
 It is dangerous to permit pneumonia patients to remain too long 
 in one position. They should be moved about often, and should 
 be frequently propped up with pillows. The notion that the child 
 must be buried in blankets to protect it from "catching cold" is 
 little more than a mere superstition. The child already has the 
 worst of all conceivable colds, and what it needs, beyond every- 
 thing else, is air and freedom of movement. 
 
 When the little patient's temperature ranges alarmingly high, 
 some means should be employed to bring this temperature down, 
 but this means should never take the form of drugs. The use of 
 such things as phenacetine, antipyrin, acetanilid and their combina- 
 tions is exceedingly hazardous, on account of their interference with 
 the proper working of the heart. Quinine is almost as bad. The 
 best thing to do is to sponge the baby with alcohol or cold water. 
 Next after that comes the use of ice-bags and compresses. 
 
 During the bath it is a good plan to rub the child's skin all over 
 of course, very gently. This has a good effect upon the circulation, 
 and tends to prevent delirium and restlessness. In addition, there 
 is probably some more subtle psychic effect. Every one knows 
 how pleasant it is to be gently massaged how it drives away pain, 
 calms the nerves and produces a feeling of healthfulness and well- 
 being. Sleep and comparative comfort usually follow the bath 
 and rubbing down. Upon the reappearance of any nervous 
 symptoms, repeat the bath. 
 
 As I have said, it is impossible to aid the body directly in its 
 
 87 
 
struggle with the pneumonia organisms, but there are countless 
 ways of giving it indirect assistance. When a cough is severe, for 
 example, a good effect is often produced by the inhalation of the 
 vapors of creosote, carbolic acid or menthol. Again, alcohol 
 and other stimulants are often capable of lending the heart a hand 
 at a critical moment. But it is not well for the mother to employ 
 such things on her own responsibility. Have the doctor give you 
 full instructions, and then carry them out faithfully. 
 
 There are so many varieties of pneumonia that it would be im- 
 possible to specify all of them. What is known as broncho-pneu- 
 monia is the most common form among small children. Six times 
 out of ten it appears as a sequel to whooping cough or some other 
 infantile ailment, and is then usually traceable to faulty nursing. 
 It represents, indeed, nothing more than a transfer of the germ 
 of some disease to the lungs. 
 
 True lobar pneumonia usually comes on suddenly, like a bolt 
 from the blue, and not as a sequel of some other malady. It is 
 most common between. the ages of three and eight and usually 
 attacks children who have seemed to be perfectly healthy. It 
 always follows the course I have described, whereas bronchial 
 pneumonia may drag on for weeks, and in some cases may become 
 genuinely chronic. The immediate death-rate in lobar pneumonia 
 is higher than in the bronchial variety, but, in the long run, it is 
 less to be dreaded, for it is seldom marked by relapses, and re- 
 covery, when it occurs, is always complete. 
 
 After a child has had pneumonia, no matter what form of the 
 malady, and convalescence has begun, it is best to take it to the 
 country. The disease leaves the body enormously thirsty for 
 fresh air; and fresh air, in a large city, is almost a curiosity. Be- 
 sides that, a change of scene is always of great benefit during re- 
 covery. Unluckily, pneumonia confers no durable immunity. 
 As a matter of fact, the recovered patient is more liable to the 
 disease than it was before the attack. In addition, its weakened 
 lungs afford unusually good soil for the germs of other maladies, 
 too, and one of these is tuberculosis. Fresh air is the only thing 
 that can reduce this liability. 
 
 At times, pneumonia sweeps through an entire household, and 
 in all cases it is well to isolate the patient, particularly when there 
 are other children in the house. Your own child may be protected 
 against pneumonia by very simple precautions. See that it gets 
 
 88 
 
wholesome, easily digested food and that it has plenty of air, day 
 and night. Too much coddling is the principal cause of childish 
 ailments. 
 
 You may think that fresh air causes colds, but as a matter of 
 fact the very reverse is true. The child that is always taking cold 
 is the child who has been coddled and whose mode of life ill adapts 
 it to meeting the vicissitudes of existence here on earth. It is 
 part of life for all of us, now and then, to stand in drafts and to 
 get our feet wet. No matter how much we try to avoid it, we must 
 do so at frequent intervals. Therefore, the thing to do with a 
 child is, not to make a vain attempt to protect it against acci- 
 dental and inevitable exposure, but so to rear it that it will be 
 able to face such exposure without damage. A cold is always 
 a sign of a low power of resistance. The entirely healthy human 
 being never takes cold. 
 
 Therefore, when your baby begins to cough and snuffle, send 
 for your doctor and have him examine it. The very fact that it 
 is coughing is proof that it needs attention. The doctor's visit, 
 if it is made in time, may head off an attack of pneumonia. Most 
 mothers regard a cold as a trivial and harmless thing, but, as I 
 have shown, it is not. The difference between a cold and pneu- 
 monia is one of degree only, and not one of kind. Both are definite 
 infections, and both prove, with equal force, that the little pa- 
 tient is not as well fitted as he should be to survive in the struggle 
 for existence. 
 
 In conclusion, let me warn all mothers who read this chapter to 
 remember that there is no reason for flying into a panic when the 
 doctor's verdict is " pneumonia. " Given good and faithful nursing 
 and obedience to the doctor's orders, there is no reason why your 
 child should not get well. In all cases, no matter how serious, the 
 chances are in favor of recovery. 
 
 QUESTIONS FOR THE MOTHER ABOUT CHAPTER XIV 
 
 What is the one preventive as well as cure for pneumonia? 
 Fresh air. 
 
 How will fresh air cure pneumonia? 
 
 Pneumonia is a disease that shuts off oxygen from the lungs. 
 Therefore the patient needs to get as much fresh air as possible. 
 
 89 
 
 
 
Its bed should be put on the piazza or roof or under a large 
 window. 
 
 How will fresh air prevent pneumonia? 
 
 It builds up the body, makes a child hardy, and its blood able 
 to resist cold and pneumonia germs. Keep the children out of 
 doors all day. Let them sleep in the open air at night and do not 
 worry about pneumonia. 
 
 Why should a cold be treated as if it were the most serious of diseases? 
 
 Because it is a sign that the child is run down; that its body is 
 in a condition to be attacked by other germs. Because a cold 
 neglected may lead to pneumonia or even tuberculosis. Because 
 a cold is often a symptom of a contagious disease. If the child is 
 not isolated, the family or school may be exposed to contagion. 
 
 Why should a child with a cold have a thorough physical examina- 
 tion by a doctor ? 
 
 Not only that he may prevent the cold from developing into 
 something more serious, but because it is a sign that the child needs 
 a change of air, of food or habits. It is often a sign that the child 
 has adenoids, and adenoids may open the way for pneumonia or 
 tuberculosis. 
 
 Why should a pneumonia patient have the constant care of a physi- 
 cian and a graduate nurse? 
 
 Because the death rate from pneumonia is very great and is 
 constantly increasing ; because the disease is so severe and short. 
 Three, two or even one day may decide whether an attack of 
 pneumonia means life or death. 
 
 What care should a convalescent have? 
 
 He should have his lungs thoroughly examined, have a " culture" 
 taken to be sure he has not tuberculosis. He should take pains 
 to avoid fatigue, over-heated rooms; should make a point of eating 
 plenty of nourishing food, and of keeping out in the fresh air. 
 
 90 
 
CHAPTER XV. NEED EVERY CHILD HAVE MEASLES? 
 
 EXT to the common cold, measles is probably 
 the most wide-spread of all infectious diseases, 
 at least in civilized countries. Almost every- 
 one gets over it, many do not. This has 
 led to the popular idea that measles is some- 
 thing to be regarded lightly, and that it is 
 best, all things considered, for a child to take 
 it and have it over. Nothing could be further 
 In itself, perhaps measles is seldom a direct 
 cause of death, but too often it leaves the body in a very 
 debilitated state, and other, and worse, maladies come in its train. 
 Thus, like influenza, it is chiefly to be feared, not on its own 
 account, but on account of the things that follow it. 
 
 No one has yet succeeded in tracking down, with certainty, the 
 germ that causes measles. We know that the cause is a germ, be- 
 cause its effects and mode of multiplication are exactly those of other 
 germs, but beside the fact that it is an animal parasite we know 
 very little else about it. Until we learn more, it will be impossible 
 to make a direct war upon it. Even now, of course, we can take 
 measures to prevent its spread from one person to another, and 
 after it has begun its work we can deal with symptoms and com- 
 plications it produces, but we know of no way to kill it, once it 
 has invaded the body, and we know of no way to limit or modify 
 its activity there. 
 
 Fortunately for us, nature knows more than we do. As soon 
 as the measles germ enters the body, nature begins to battle with it, 
 and in the vast majority of cases she succeeds in stamping it out. 
 This battle is begun automatically, and unless death intervenes 
 it always proceed s in a more or less regular manner. In consequence 
 we say that measles is a self-limiting disease, which means that it 
 runs a clearly-marked course, beginning with the first appearance 
 of the germs in the body and ending with their complete destruction 
 and expulsion. 
 
 91 
 
The more obvious signs of measles the fever, the lassitude, 
 the sore eyes, running nose, and sore throat, and beyond all, the 
 red rash are familiar to every one. There are, in addition, 
 several signs which give earlier warning, but which are seldom 
 perceptible, save to the physician. One of them is Koplik's sign, so 
 called after the New York pathologist who first noticed it. It con- 
 sists in the appearance of small blue-white specks on the mucous 
 membrane lining the inside of the cheeks. These specks usually 
 appear two or three days before the rash and so they give the physi- 
 cian a chance to be forewarned and forearmed. They explain why it 
 is that when a child complains of feeling ill and shows a rising 
 fever, the doctor usually makes a thorough examination of its 
 mouth. 
 
 After a child has been exposed to measles, it takes from eleven 
 to fourteen days for the disease to develop. The first symptom 
 is a general feeling of illness and uneasiness, with the signs, perhaps, 
 of a bad cold in the head. Then the eyes begin to water, the tem- 
 perature rises, the throat becomes sore, there is a cough, and on 
 the third or fourth day the characteristic eruption appears. As a 
 rule, it is first seen along the edge of the hair on the forehead or 
 neck, or behind the ears. It is made up of small, dark-red spots, 
 often some distance apart and flat with the skin. These spots 
 soon begin to swell and multiply, and in a short while the whole 
 face is covered with them and they begin to appear on the neck 
 and chest, and so on down to the feet. By the time they reach the 
 feet, they are commonly beginning to dry up upon the face. Usual- 
 ly they are in groups, with areas of clear skin between, but some- 
 times they cover the face so thickly that scarcely a speck of clear 
 skin is to be seen. At such times, the whole face is swelled and 
 the eyes are almost closed. 
 
 There are three or four days of this, and then the little pustules 
 begin to grow pale and dry. This is the period of desquamation, 
 or shedding. The dead skin breaks off into small scales, much 
 resembling bran, and the new skin begins to appear underneath. 
 In scarlet fever the skin comes off in large patches, but in measles 
 the scales are small. Often, indeed, they are so small that they 
 are scarcely noticed. 
 
 This shedding continues, as a rule, from five to ten days, though 
 occasionally it may be prolonged to two weeks. It is accompanied 
 by annoying itching, and there is commonly some cough too, and 
 
 92 
 
a lingering weakness in the eyes, but otherwise the patient begins 
 to feel perfectly well again. The appetite returns, the fever has 
 abated, and, if all has gone well, there is nothing amiss in throat 
 or lungs. 
 
 Sometimes the rash in measles is so severe that the small blood 
 vessels in the skin are broken down, and the blood in them comes 
 out. The blood collects under the surface of the skin in small 
 dark patches, much as in a bruise or black eye. This condition 
 was described by the older doctors as "black measles," and it was 
 believed that death almost invariably followed. But, as a matter 
 of fact, the appearance of these dark spots need not cause a panic. 
 As a rule, true enough, they indicate a case worse than the average, 
 but they have been noted, also, in comparatively mild cases, and 
 in themselves they do no harm. It often happens that a few 
 such haemorrhagic eruptions appear in the course of an ordinary 
 case. 
 
 As I have said, nothing can be done to cure measles, as we can 
 cure malaria, diphtheria or a broken arm. The disease must run 
 its course, and we can never even tell how long that course is going 
 to be, save very roughly. But it is perfectly possible to guard 
 the little patient against the disastrous complications which lurk 
 along the trail of the measles germ, and it is possible, too, to re- 
 lieve much of the patient's suffering. In accomplishing this, 
 the nurse plays a part more important perhaps than that of the 
 doctor. 
 
 As soon as a child grows ill and feverish, and begins to complain 
 of discomfort in the eyes and nasal passages, it should be put to 
 bed in a well- ventilated, darkened room, and the physician should 
 be summoned. So many infantile maladies begin in the same 
 way that it is often impossible, at this stage, to say whether the 
 little patient is developing measles, scarlet fever, influenza, or 
 merely a cold, but it is always best, whenever it shows a fever, 
 however slight, to put it to bed. In a day or two, more certain 
 diagnosis will follow the first doubt. 
 
 Let me say here with all possible emphasis, that putting a child 
 to bed does not mean burying it beneath a matterhorn of woolen 
 blankets. There is a popular notion, that, in all maladies accom- 
 panied by fever, a vigorous and constant perspiration is beneficial 
 and necessary, but this is scarcely true. Sweating will not modify 
 the course of meaeles, and neither will bad air, except in an un- 
 
 93 
 
favorable way. See that the patient is well protected from all 
 draughts, but let the blankets be light enough for comfort, and 
 make sure that there is constant ingress of fresh air into the room. 
 
 As a help toward that sweating which woolen blankets, how- 
 ever thick, only partly achieve, it is customary, among amateur 
 nurses, to employ vast doses of various hot teas. All such dis- 
 gusting messes should be thrown to the dogs. Camomile, sassafras 
 or what-not they do a lot of harm and no good at all. It is 
 difficult to make the average grandmother believe that camomile 
 is a fraud, and so, when she recommends it and you refuse to 
 administer it, she will go away offended, but it is far better to 
 offend her than to injure your child. All the little patient needs, 
 in the way of drink, is plenty of cooled water not ice water, 
 but water of the ordinary hydrant temperature. Do not keep 
 a pitcher full in the sick-room, but draw a fresh glass of a pure or 
 boiled water that has been cooled whenever it is wanted. Day 
 or night, never deny the child a drink. 
 
 Regarding the food to be given to the patient, it is best to consult 
 the attending physician in the particular instance. In an ordinary 
 case of measles, the child will be satisfied with milk, soft-boiled 
 eggs and meat broths during its few days of severe illness, and 
 may approach its usual diet soon thereafter, but in case there are 
 complications, particularly in the digestive tract, great care in 
 feeding must be exercised. Have the doctor draw up a bill of 
 fare and fix the meal times, and then stick to the schedule religious- 
 ly. A feverish child requires very little food and it is best never 
 to try to force it to eat. 
 
 The patient's eyes will probably be inflamed and painful. Keep 
 them clean by swabbing them every few hours with a little mop 
 of sterilized cotton that has been dipped into a solution of boracic 
 acid. The cotton comes in boxes to be had for ten cents or a 
 quarter at any drug store. Never use ordinary raw cotton, for no 
 matter how clean it may seem, it is always full of irritating particles 
 and the germs of various diseases. The boracic acid is a near 
 relative to borax and may be had at the drug-store. Put a table- 
 spoonful into a tumbler of water and use the clear solution. 
 
 If there is so much discharge from the eyes that the lids stick 
 together, dip a piece of the sterilized cotton into vaseline and gently 
 smear the edges of the lids. Sometimes the eyes^are so painful 
 and so much inflamed that it is necessary to apply ice-packs to 
 
 94 
 
them. When this is necessary, the doctor will show you how to 
 do it. 
 
 There is a great deal of itching in measles, particularly after 
 the dead skin begins to shed. To relieve it, apply a thin film of 
 vaseline either the plain or the carbolated. Besides reducing the 
 itching, this will loosen the scales and so help the process of des- 
 quamation. But never rub the skin! The friction of the wash- 
 rag or cotton and the clothing is all that nature needs. 
 
 During the few days of fever, of course, the child need be bathed 
 only at the doctor's orders. As soon as the shedding begins it 
 should have a daily warm bath. This should be given with the 
 room warm and all the windows closed, and it should not be pro- 
 longed. Use a very soft wash-cloth or absorbent cotton and little, 
 if any, soap ; and after drying, anoint all those parts of the body 
 upon which the rash has appeared with vaseline. The physician 
 may prescribe some other ointment, but if he does not it is best to 
 use only vaseline. The common drug-store salves and ointments 
 may do a great deal of harm. 
 
 The child's cough, headache, sore throat and other discomforts 
 must be combatted, not by the nurse, but by the physician. Aside 
 from its simple food and its plentiful supply of cooled water, it 
 should take nothing into its stomach that has not been prescribed 
 by its medical attendant. There are dozens of grandmothers' 
 elixirs for the various symptoms of measles, and all of them are 
 abominations. From boneset tea to sweet spirits of nitre they 
 are dangerous frauds, one and all. 
 
 Measles is an exceedingly contagious disease, but its virulence, 
 unlike that of scarlet fever, does not last very long. As soon 
 as a case appears in a household, all of the other children should 
 be kept from school, but it is unnecessary to send them out of the 
 house. The room in which the patient is being nursed should be 
 isolated from the rest of the house, with as rigid a quarantine 
 as if the contagion was always fatal. If the mother is the nurse, 
 she should keep away from the other children until at least two 
 weeks after the patient has recovered. It is possible for a child to 
 take measles by merely passing the open door of a room in which 
 a patient is confined. 
 
 If, as often happens, there are two patients at the same time, 
 it is best, whenever possible, to put them into separate rooms. 
 This is because the more dangerous maladies which sometimes 
 
 95 
 
follow or complicate measles, such as pneumonia, are apt to be 
 communicated from one patient to another. Herein, no doubt, 
 we find an explanation of the fact that epidemics of measles are 
 always more severe in boarding-schools and orphan-asylums than 
 among children at home. One patient, developing pneumonia 
 or diphtheria, communicates it to many others. 
 
 Inasmuch as measles is already contagious before its outward 
 signs appear that is, during the period of incubation, or breeding 
 it is exceedingly difficult to protect a child against it, particularly 
 if the child goes to school or to Sunday School, or otherwise as- 
 sociates with its fellows. But in the case of weakly children, it 
 is well to make extraordinary efforts to secure this protection, 
 for measles, in such children, very frequently leads to pneumonia, 
 chronic bronchitis, and even tuberculosis. If, after an attack, the 
 patient continues to cough and to remain weak, it should be sent 
 into the country; preferably, to the mountains. The seeds 
 of life-long illness and early death are sowed by apparently mild 
 attacks of measles. 
 
 A week after the last signs of shedding have disappeared it is 
 safe to permit the patient to mingle again with other children. 
 But before the room in which it has been confined is used as a 
 sleeping apartment, it should be thoroughly disinfected. The 
 measles germs do not cling to life very vigorously, and outside of 
 the human body they soon die, but it is well to take no chances. 
 
 QUESTIONS FOR THE MOTHER ABOUT CHAPTER XV 
 
 Why should every precaution be taken to protect a child from measlesf 
 
 Because though it is not often fatal, it weakens the child so that 
 it readily takes other diseases. 
 
 What are the first signs of measles? 
 
 A cold, fever, sore throat and weariness ; later a red rash and 
 blue-white spots inside the cheeks. 
 
 Why should a child with measles be quarantined? 
 
 Because measles is contagious and it is not fair to other children 
 to give them a disease that may lower their vitality and pave the 
 way for other diseases. 
 
 How long should a child that has been exposed to measles be kept 
 away from other children? 
 
 96 
 
It takes from eleven to fourteen days for the disease to develop. 
 
 What precautions should be taken to prevent the spread of measles? 
 
 Measles should be reported to the Board of Health; a sign 
 MEASLES should be put on the door. No one but the nurse 
 should be allowed to go into the child's room or to pass the door 
 when it is open. The room should be thoroughly fumigated before 
 it is used again. 
 
 What are the special precautions to prevent bad after-effects from 
 measles? 
 
 The room should be kept dark, and the child should not be al- 
 lowed to read, write or sew or to use its eyes at any close-range 
 work. Great care should be taken that the child does not catch 
 cold. This does not mean that all the windows should be kept 
 closed. Fresh air in a sick-room is the best preventive of colds. 
 The lungs and throat of a child should be thoroughly examined 
 after measles, and it should have rest, nourishing food and out- 
 door life until its health is thoroughly restored. 
 
 97 
 
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