LIBRARY OF CONGRESS. 
 
 Chap........ Copyright No... 
 
 UNITED STATES OF AMERICA. 
 
6H) 
 
THE CARE OF THE CHILD 
 IN HEALTH 
 
■?&#*&■ 
 
THE CARE OF THE CHILD 
 IN HEALTH 
 
 BY 
 
 NATHAN OPPENHEIM 
 
 A.B. (Habv.), M.D. (Coll. P. & S., N.Y.) 
 
 ATTENDING PHYSICIAN TO THE CHILDREN'S DEPARTMENT 
 
 OF MT. SINAI HOSPITAL DISPENSARY 
 
 AUTHOR OF "THE DEVELOPMENT OF THE CHILD " 
 
 AND "THE MEDICAL DISEASES OF CHILDHOOD" 
 
 THE MACMILLAN COMPANY 
 
 LONDON: MACMILLAN & CO., Ltd. 
 1900 
 
 All right* reserved 
 
TWO COPihi. .Jt-OEIVED, 
 
 library uf C»ngr Q t% 
 Office of the 
 
 MAY ] 2 1900 
 
 Ulster of Copyrltfiit^ 
 
 SECOND COPY, x 
 
 o 
 
 59105 
 
 Copyright, 1900, 
 By THE MACMILLAN COMPANY. 
 
 KToriwooti $regg 
 
 J. S. Cushing & Co. — Berwick & Smith 
 Norwood Mass. U.S.A. 
 
^ 
 
 
 Co mg lister 
 
 C. L. G. 
 
CONTENTS 
 
 CHAPTER PAGE 
 
 I. Introductory ....... 1 
 
 II. The Pregnant Woman ..... 23 
 
 III. The B art's Outfit and Nursery . . 47 
 
 IV. Feeding 70 
 
 V. Bathing Ill 
 
 VI. Sleep , . .128 
 
 VII. Exercise 146 
 
 VIII. Clothing from the Time of Infancy . . 163 
 
 IX. Habits 180 
 
 X. Relation of Parents to Children , . 204 
 
 XL Education , 225 
 
 XII. Defective Children ..... 251 
 
 XIII. Common Diseases 270 
 
THE CARE OF THE CHILD 
 IN HEALTH 
 
 CHAPTER I 
 
 INTRODUCTORY 
 
 It is not hard to imagine the glow of enthu- 
 siasm with which a young man begins his 
 college life, enters a profession, or starts a 
 business. All the traditions of his vocation, 
 all the prospects of success, and the expecta- 
 tions of a useful development of his faculties 
 combine to make a state of mind that becomes 
 capable of surmounting obstacles, providing a 
 rational outlet for natural energy, of giving a 
 guiding point by which his various impulses 
 are directed. His intellectual status and the 
 usefulness of his future work may be measured 
 not so much by their separate effects and acts 
 as by the informing spirit which controls them. 
 Such things have an inevitable sequence of 
 action, on account of which the superior man, 
 
 B 1 
 
2 THE CARE OF THE CHILD IN HEALTH 
 
 the person of high mind and character, selects 
 an admirable field of work, or such a field as 
 is susceptible of being dignified by the exercise 
 of thorough work and preparation, of thought- 
 ful attention to details, of a large grasp of the 
 inherent potentialities of the vocation, which 
 marks it off from the sordid and petty affairs 
 of ordinary, petty life. Great results are not 
 obtained by a preternatural flash of wondrous 
 inspiration. On the contrary, they rest upon 
 unremitting toil, upon tireless industry, upon 
 an endless struggle with adverse conditions, 
 the conquering of which means a great step 
 toward the final evolution of civilization. 
 
 This is the basis of genius, and a careful 
 examination of the works of any great man will 
 show how scrupulously he has met the demands 
 of the situation. Leonardo da Vinci was will- 
 ing to grind his own colors, and make his own 
 paints in order to obtain the desired effects ; 
 and in the wide range of activities in which 
 he was proficient there was no detail too small 
 or too burdensome to be carefully mastered. 
 William Morris, who was great in both poetry 
 and art, in order to produce works of beauty 
 became a printer, a dyer, a weaver. There was 
 no labor too commonplace, no outlay of time 
 
INTRODUCTORY 3 
 
 too great, no course of study and investigation 
 too exhaustive, for his industry. Such men 
 have achieved the great things of the world, 
 and no one who is unwilling to recognize the 
 truth of their methods is able to lead a really 
 profitable life. Such a life cannot be passed 
 in an atmosphere of carelessness, of disregard 
 of duty, of a perpetual avoidance of burdens. 
 Whatever truth there is in this view has a 
 universal, not a particular, application; and 
 men in every walk of life must recognize it in 
 their work, or lacking this recognition must 
 fail. Every citizen of the world has his share 
 of work to do and problems to solve ; and the 
 true judge of whether the doing and the solv- 
 ing are successful is not entirely the opinion of 
 existing authority, but rather the ideal, based 
 upon the most objective conception of the 
 worker's intention, as well as his performance. 
 A vigorous sense of responsibility is, after all 
 has been said, at the root of a really profitable 
 career. Expediency must have no part in it, 
 and makeshift devices must necessarily end in 
 some form of worthlessness. The inner spirit 
 of a piece of work is as worthy of scrupulous 
 attention as the outer form. The one stands 
 for everlasting principle, while the other repre- 
 
4 THE CARE OF THE CHILD IN HEALTH 
 
 sents the adaptation of that principle to the 
 exigencies of practical circumstances. And the 
 perfect blending of these two factors rounds 
 out a life-work as well as a character. It 
 must be said that an appreciation of this truth 
 is oftener found among men than among women. 
 Such a statement is hard to make; it really 
 hurts in the saying, especially if one has a 
 normal respect for the many excellences of the 
 womanly character. But an impartial observa- 
 tion of life necessarily leads one to this conclu- 
 sion; and what one sees must be said. 
 
 There could not be a better demonstration of 
 the unprejudiced truth of this idea than may 
 be had from recognizing the methods which 
 women employ in caring for their children. 
 Such methods constitute a fair standard of com- 
 parison because they are the principal occupa- 
 tion of a majority of the really useful women in 
 the world. Those women who are regarded as 
 fortunate have as their vocation and life-work 
 the bearing and the rearing of offspring. They 
 grow up from girlhood with the hope and the 
 belief that such work will be their future call- 
 ing. Every other employment is frankly re- 
 garded as subsidiary, as a temporary means of 
 gain or occupation, which is to be gladly and 
 
INTRODUCTORY 5 
 
 unhesitatingly relinquished when the great 
 opportunity presents itself. This great oppor- 
 tunity usually seems so natural and inevitable 
 that its demands are supposed to work them- 
 selves out in quite an irresponsible fashion, 
 fully as irresponsible as the choice of a spouse 
 commonly is. On the other hand, the necessi- 
 ties of competition demand a certain amount 
 of preparation for obtaining even a low grade 
 of commercial work, and, for a similar reason, 
 a fair amount of effort is demanded to hold the 
 position. Naturally enough, women recognize 
 this fact, even if they have not thought about the 
 matter very much ; but they go no farther than 
 the barest demands of competition, because they 
 recognize, and the world at large recognizes, 
 that the ordinary commercial employments are 
 for them scarcely more than a temporary means 
 of gain or occupation. At the same time, the 
 corollary of the proposition is that household 
 and maternal duties are their permanent work, 
 for which they are peculiarly designed and 
 adapted, and in which they are expected, in the 
 scheme of nature, to find their greatest gratifi- 
 cation as well as usefulness. 
 
 A recent writer in a popular American maga- 
 zine, in expressing the discontent of the women 
 
b THE CARE OF THE CHILD IN HEALTH 
 
 of to-day, cries out: "Give us labor! For 
 countless ages, for thouands, millions it may 
 be, we have labored. When man first wan- 
 dered, the naked, newly erected savage, and 
 hunted and fought, we wandered with him; 
 each step of his was ours. Within our bodies 
 we bore the race, on our shoulders we carried 
 it; we sought the roots and the plants for its 
 food; and when man's barbed arrow or hook 
 brought the game, our hands dressed it. Side 
 by side, the savage man and the savage woman, 
 we wandered free together and labored free 
 together. And we were contented." She then 
 goes on to explain that as uncivilized conditions 
 changed to civilized, the woman had less and 
 less work to do, until to-day the race is in 
 danger of degeneracy on account of her weak- 
 ness, her lack of occupation, her unsatisfied con- 
 dition of mind, and her increasing parasitism. 
 
 This cry for work is, in a certain way, aston- 
 ishing, for the common belief has been that one 
 of the main tendencies of the modern woman 
 was away from the field of hard, manual labor, 
 away from the personal performance of house- 
 hold duties which naturally constitute the 
 quoted writer's "work." And this belief is 
 very commonly held among various classes in 
 
INTRODUCTORY 7 
 
 society at large. It is often stated to be at the 
 root of the increasing difficulty in supporting a 
 household. At all events, we see that mar- 
 riages are being contracted at a later age than 
 formerly and with more difficulty ; that house- 
 holds are conducted on a more extravagant plan 
 than was ever customary ; that less work is done 
 by mistresses, and that the spread of luxury is 
 ever increasing. It is claimed that children are 
 no longer willing, in planning the externals of 
 their prospective careers, to begin where their 
 parents began, and to go through the same 
 laborious course of financial evolution. On 
 the contrary, they want to begin where their 
 parents left off, evidently believing that a 
 change in external circumstances and the de- 
 tails of social environment in the direction of 
 simplicity was not to be endured, and meant 
 a fall in public estimation. 
 
 An additional fact of interest is the change 
 that has gradually been taking place in com- 
 mercial life. There is a growing competition, 
 there is an increasing development of business 
 methods which requires more energy, more 
 capital, more industry for the successful prose- 
 cution of a business enterprise than ever before. 
 The successful business is falling more and 
 
8 THE CARE OF THE CHILD IN HEALTH 
 
 more into the hands of groups of wealthy capi- 
 talists, or into those of one unusually active 
 man who often represents a group or syndicate. 
 As a result, many persons who formerly con- 
 ducted individual enterprises must now be con- 
 tent to accept salaried positions whose pay is 
 not great, either actually or prospectively. The 
 most characteristic thing which one can say is 
 that the plan of specialization is extending into 
 every business and into the individual depart- 
 ments thereof; and that while there are a few 
 places which are highly remunerative, the gen- 
 eral salary does not tend to increase, the indi- 
 vidual wage cannot be expected to grow larger. 
 Thus, as the result of the centralization of re- 
 sponsibility as well as capital, a larger and larger 
 proportion of the possible situations are subor- 
 dinate. Such positions must from their nature 
 require less of the qualities of the proprietor 
 and more of the qualities of the employee. They 
 must be administered by persons who have com- 
 paratively little personal connection with the 
 intimate policy and welfare of the enterprise, 
 who may be as useful to one firm as another, and 
 who are ready to change from one to another 
 according to the demands of a passing necessity 
 or the whims of personal preference. 
 
INTRODUCTORY 9 
 
 This has made the opportunity for thousands 
 of women to participate in business life. They 
 feel the constant impulse to increasing luxury, 
 their needs are not so easily satisfied as formerly 
 by the wage-earning head of the family, and 
 during the interregnum between the period of 
 their entire dependence and the equally distinct 
 period when by marriage they believe that entire 
 independence must come, they endeavor to 
 piece out their possibilities of enjoying life, of 
 gratifying their desire for petty luxury, and, 
 possibly, for the present large necessities of life, 
 by obtaining subordinate positions. They are 
 able to accept less pay than the wage-earning 
 head of the family, because their needs are less. 
 And at the same time, on account of the divi- 
 sions and subdivisions of specialized business, 
 they are able to do the work almost as well, or 
 fully as well as he does. Many of these posi- 
 tions — being subordinate, having comparatively 
 little responsibilitjr, being merely functional — 
 demand no more than a special, narrow prepara- 
 tion, for which the ordinary woman, whose 
 needs are immediate and whose prospects are 
 liable at any time to undergo a radical change, 
 is almost as well fitted as her brother. He, on 
 the other hand, knows that he must continue 
 
10 THE CARE OF THE CHILD IN HEALTH 
 
 for the rest of his life to be a wage-earner; and 
 his prospects, in all likelihood, will never 
 change unless he, by his own power and re- 
 sourcefulness, is able to bring the change about. 
 When the woman comes to marry, as she 
 naturally and inevitably hopes to do, she finds 
 that her husband's income does not permit the 
 same indulgences to which she has become 
 accustomed. They are certainly not possible 
 without the exercise of rigid economy, personal 
 willingness to do many pieces of work in the 
 household, intimate knowledge of all the de- 
 tails of household management, and a full 
 experience of all the homely details that make 
 for the family's prosperity or lack of prosperity. 
 It is really rare that the woman tries in a sys- 
 tematic way to familiarize herself with and to 
 perfect herself in all these details. Her cook- 
 ing is done as it was learned, by haphazard, by 
 rule of thumb, by the patchwork knowledge 
 which comes from indiscriminate attempts and 
 unregulated experience. She has no acquaint- 
 ance with the physiology of nutrition, and is 
 utterly unable to regulate her meals so that the 
 maximum of strength is distributed at a mini- 
 mum cost. She knows very little about fabrics, 
 about dressmaking ; but she needs costly clothes 
 
INTRODUCTORY 11 
 
 or imitations of such clothes. She knows noth- 
 ing about the care of her children, about the 
 rules which will increase their measure of 
 health, strength, and useful training; but she 
 feels the necessity and the fitness of handing 
 the care of these children over to nurses and 
 teachers. She has, in short, lost the sympathy 
 for a plain, modest, hard-working, homely life, 
 without at the same time being capable of pro- 
 viding a more efficient plan of work than her 
 grandmothers possessed. 
 
 In the wealthier classes the situation is as 
 bad, or possibly worse. Girls are willing to 
 contract marriage without much thought of their 
 probable responsibilities, and wish even less 
 preparation and training for their certain duties. 
 I believe that there is no exaggeration in the 
 statements about their wishing to begin their 
 active life in circumstances which are equiva- 
 lent to those obtained by their parents after a 
 long period of effort. Of course there are 
 exceptions, as there always are to any broad 
 generalization. But the statement, as a rule, 
 holds good. Manners of living are undoubtedly 
 more extravagant than ever before, fashions of 
 dress are more extravagant than ever before, 
 the amount of personal work which is supposed 
 
12 THE CARE OF THE CHILD IN HEALTH 
 
 to be done by the wife and mother is smaller 
 than ever before. These customs are to be 
 commonly found among the women of the more 
 fortunately situated classes, and they necessitate 
 larger numbers of servants, lessened attention 
 on the part of the mistress, greater expense and 
 wastefulness in the management of the house. 
 And as the natural energy of these women must 
 find some outlet, it shows itself in distortions 
 from its normal manifestations, which have been 
 called all manner of hard names by one part of 
 the community and all manner of fine names by 
 another. These fads do not call for great praise 
 or great blame, any more than neurasthenia or 
 indigestion should be praised or blamed. They 
 should be regarded as the natural expressions of 
 certain conditions of life ; and if these manifes- 
 tations are unsatisfactory and burdensome, relief 
 may be obtained by changing the conditions 
 which produced them. 
 
 The inevitable result of these tendencies is a 
 progressive increase in the burdens of the whole 
 household. Difficulties are piled upon the 
 man, and dissatisfaction becomes the lot of 
 the woman. He suffers from care, worry, and 
 the lack of opportunity to cultivate the finer 
 and gentler parts of his nature. She becomes 
 
INTRODUCTORY 13 
 
 more artificial, more worldly, more self-seeking 
 than she formerly was or than she ought to be. 
 Each comes to have a separate world, which 
 has few points of contact with that of the other. 
 Concord gives way to discord, intimate affection 
 to indifference; and, finally, the end of the 
 matter is strife or unhappiness. Under such 
 circumstances it is easy to understand the recent 
 cry that marriage is a failure ; for nothing but 
 failure can attend any enterprise which is not 
 founded upon mutual understanding, common 
 effort, and a common purpose. It makes very 
 little difference whether the enterprise is in the 
 way of commercial management or domestic 
 management; the salient rules that govern the 
 one may with equal justice be applied to the 
 other. In both there is the strongest need to 
 recognize fundamental requirements, to prepare 
 for the efficient administration of them, and to 
 undertake the working out of such requirements 
 to their logical results which an elevated ideal 
 demands. 
 
 The problem which the present time has to 
 solve is the adaptation of its domestic conditions 
 to the changed circumstances of commercial life. 
 We must revert to the state where the women 
 of a household had as active a share in its for- 
 
14 THE CARE OF THE CHILD IN HEALTH 
 
 tunes as men, where the women's responsible 
 positions and occupations were as sharply de- 
 fined as men's, where natural energy had as 
 wholesome a method of expression in one as in 
 the other. The woman of to-day is a more 
 intelligent creature than her predecessor and 
 ancestress of the eighteenth or seventeenth cen- 
 tury. She has larger needs, a larger range of 
 potentialities, and an enlarged outlook. These 
 opportunities are fine things in their way, but 
 they bear with them their commensurate share 
 of responsibility. The woman of to-day has 
 greater privileges than ever before; but also 
 she must know that her duties should likewise 
 be interpreted in a more developed and more 
 strenuous manner. Instead of giving less of 
 herself to her duties, she ought to give more ; 
 she ought to bring to her work an increased 
 zest, a more logical method, a greater efficiency 
 than was formerly expected. There must be a 
 distinct correspondence between what she ex- 
 pects to give and what she expects to get. The 
 demands of the past, instead of being lessened, 
 ought in all likelihood to be increased, for in 
 no other way can the progress of the world be 
 furthered. The spirit of the present time de- 
 mands thoroughness of preparation, intensity, 
 
INTRODUCTORY 15 
 
 and devotion to principle in a greater degree 
 than at any other period. And women must 
 participate in this movement to as great an 
 extent as men. The well-meant efforts of many 
 women to increase the family's income, and to 
 obtain an outlet for their own activity by plung- 
 ing into business enterprises cannot go to much 
 further lengths without evil consequences. 
 For the stability of the home and domestic in- 
 stitutions will inevitably be adversely affected. 
 Women must, in the final analysis, be the ones 
 who set the standard of the home ; and the ideals 
 and practices which they represent are the pat- 
 terns by which the household will be guided. 
 The further inquiry about what means may 
 be employed to remove the disabilities and the 
 hardships of women in particular and families 
 in general will be best answered by considering 
 certain fundamental facts, and holding to cer- 
 tain elementary truths; and when these facts 
 and truths have been ascertained, the next step 
 consists in adapting the current conditions of 
 life to them. We must recognize that domestic 
 careers exist, and have their value in the scheme 
 of existence, just as surely as commercial or 
 professional careers. They are not the simple 
 pursuits that the general public so commonly 
 
16 THE CAKE OF THE CHILD IN HEALTH 
 
 takes them to be, but, on the contrary, demand 
 as thorough preparation and as intelligent study 
 as any other work. The objects which they are 
 intended to serve are among the worthiest and 
 the most vital which can occupy human atten- 
 tion, for they include not only the comfort and 
 the social progress of the family, but its very 
 existence as well. In former times, when the 
 opportunities which women possessed of going 
 out into the world and mingling in its struggle, 
 its successes, and failures, were very limited or 
 did not exist, there was no choice for them but 
 to stop at home and devote themselves to the 
 occupations which the home provided. In those 
 times they wove the cloth which clothed the 
 family; they made the candles that illuminated 
 the house; they preserved the fruits and the 
 meats that were to last over the hard season of 
 winter. The man had one work in the outer 
 world, the woman had another in the inner. 
 
 As customs changed, as labor-saving inven- 
 tions grew in number and complexity, the bal- 
 ance became disturbed, the unprotected position 
 of men forced them to observe the changes and 
 keep in consonance with them. The compara- 
 tively protected and isolated position of women 
 allowed them to go on in much the same chan- 
 
INTRODUCTORY 17 
 
 nels as before, and did not necessitate as prompt 
 and entire a conformity to the new methods. 
 As the result of inventions and new methods, 
 wealth increased; but the demands of business 
 and professional life became greater, and the 
 standards set for success became higher. Men 
 acquiesced with comparative readiness in the 
 new demands and the new standards, and thus 
 the business part of the world has gone on with 
 no more than temporary disturbances and inter- 
 ruptions. There are many persons now living 
 who well remember the hardships and indus- 
 trial disorders that arose from the extensions of 
 railroads into territory where the carrying trade 
 had previously been done by sail-power, horse- 
 power, or man-power. And the consequent 
 changes occasioned local hardships, local up- 
 heavals, local dissatisfaction. But these were 
 no more than temporary phases which in the 
 course of a few years passed away, and were 
 replaced by other and superior industrial con- 
 ditions. The hardships gave way to ease, the 
 upheavals to quiet, the dissatisfaction to con- 
 tent. The business life of these localities 
 increased and flourished, for the business men 
 saw the futility of stupid resistance, they 
 recognized the demand for newer plans of work, 
 
18 THE CARE OF THE CHILD IN HEALTH 
 
 they welcomed the prospect of greater outlays 
 of specialized skill. 
 
 Let us ask in all fairness whether similar 
 changes, and free acquiescence in their neces- 
 sity, have come about in household manage- 
 ment. And in making the inquiry I am not 
 impelled by any manner of sex-feeling or 
 sex-jealousy. For I recognize to the full the 
 valuable parts of women's character, their pos- 
 sibilities of self-sacrifice, their generous will- 
 ingness to respond to worthy appeals, and their 
 fund of devotion to a worthy cause. At the 
 same time, it is quite clear that they have not 
 participated fully enough in the spirit of the 
 age which calls for a clear-sighted view of the 
 exigencies of everyday life. They, as well as 
 men, know that a woman's work has always 
 been and must always be connected with the 
 home. The best exponents of the sex have 
 never attempted to deny this, and at most have 
 justified the taking up of business careers and 
 the desertion of home life on the plea of para- 
 mount necessity. The whole excuse is that the 
 man is not able to accomplish enough alone, is 
 not able to make enough money to support the 
 family on the scale that has become common ; 
 and that therefore the girls and the women must 
 
INTRODUCTORY 19 
 
 leave their homes to help them. In the mean- 
 while much of the necessary work is done by 
 various servants, who, in turn, want to help 
 their families. 
 
 Another and more logical solution of the diffi- 
 culty is possible. The woman must recognize 
 and conform to the greater demands for special- 
 ized work. Since being a wife and mother is 
 her best and natural profession, she must fit 
 herself for its duties ; and she must clearly have 
 in mind the greater needs and the more compli- 
 cated duties which the present time demands. 
 She need not weave cloth for clothes, she need 
 not dip candles, she need not collect potash and 
 fat for soap-making. But she has other work 
 that requires a greater degree of study and 
 preparation for its learning. She must know 
 that these times require a keener intellect and 
 a greater energy than any former period in the 
 world's history, and she must fit herself to 
 develop such qualities in her husband and chil- 
 dren. These things cannot be learned after she 
 has become a wife, for then, and before then, 
 they must have been in active working. Long 
 before she assumes these tremendously important 
 duties, she ought to know how the greatest 
 amount of nutrition is to be obtained from the 
 
20 THE CAKE OF THE CHILD m HEALTH 
 
 smallest expenditure of time and money, what 
 nutrition means, and how it may be obtained 
 and conserved. She must know what work is 
 to be done in a household, how and when it is to 
 be done, as well as every advanced method by 
 which one may augment the health, comfort, 
 and pleasure of the family. She ought to know 
 what health is and what sickness is, how one 
 leads into the other, and the wonderful changes 
 that can be accomplished with a knowledge of 
 hygiene, and sanitation, and elementary biol- 
 ogy. She must have information of her pro- 
 spective duties as a mother, so that the birth 
 of a child may be an occasion for rejoicing 
 rather than a harbinger of extravagant outlay, 
 largely increased household expenses, and 
 domestic disorder. She must know what the 
 child's growth entails, what demands will be 
 made upon her store of information and inge- 
 nuity. She must, most of all, be prepared to 
 take entire charge of her offspring, recognizing 
 that this is the proper and natural outlet for her 
 self-sacrifice, her willingness to respond to 
 ideals, and her devotion to worthy causes. 
 Moreover, she must constantly have the convic- 
 tion that she is morally responsible for all these 
 facts and conditions; that the burden of duty 
 
INTRODUCTORY 21 
 
 weighs upon her just as heavily as if she were 
 working under a written contract. Indeed, she 
 ought to feel the responsibility even more keenly 
 than any form of mercantile agreement could 
 make her realize. As matters now stand, the 
 woman, as soon as she marries, is apt to feel that 
 she is answerable to no one, and that there is 
 no standard for her work except the one which 
 she chooses to elect. But as surely as such a 
 plan would work disaster in business affairs, 
 just so certainly must it produce domestic 
 irregularity, disorder, and failure. 
 
 The proper sphere for women is not to fight 
 in the outer world for a miserable wage in 
 dollars. Her potentialities are too fine for that, 
 and in submitting herself to the consequent 
 competition she is losing too much. She is 
 much more able to save at home, to prevent 
 countless occasions of waste, to raise the 
 standard of healthfulness, of self-reliance, and 
 usefulness in her husband and children, so that 
 the burden of support is not too heavy for a man 
 to bear. If she accomplish that, if she can ac- 
 quire a good enough sense of proportion so that 
 the foolish tendencies to artificial extrava- 
 gances of methods and household manners are 
 kept within bearable limits, she will do a great 
 
22 THE CARE OF THE CHILD IN HEALTH 
 
 deal to end the competition between the sexes. 
 Such competition is unnatural, unprofitable, not 
 susceptible of a desirable outcome. The cry, 
 "Give us labor! " is right; for no one can live 
 without work, and enough work. But let us be- 
 ware lest we look far off for this opportunity to 
 expend our energies and develop our characters, 
 while we are unmindful of the opportunities 
 which lie immediately before us, so close, in 
 fact, that we stumble over and tread upon them. 
 The change must come, not from without the 
 household, but from within it; not by the 
 woman's entering into competition with her 
 father, husband, and brother in sorts of work 
 where she must necessarily occupy an unde- 
 sirable position, but by increasing her value at 
 home, by diminishing the amount of needless 
 waste — in a word, by fitting herself for her 
 vocation as carefully as she would if she wished 
 to employ her male relatives in a commercial 
 labor of value and responsibility. As much as 
 home-content is better than home-discontent, as 
 much as peace is better than discord, as much 
 as real prosperity is better than artificial show, 
 so much is the true training of women better 
 than what is so commonly given. "Give us 
 labor! " is a good enough cry; but "Let us do 
 the labor that is within our hands ! " is a better. 
 
CHAPTER II 
 
 THE PREGNANT WOMAN 
 
 The pregnant woman is the centre of the 
 world's progress; she must regard herself as 
 endowed with a great responsibility, whose 
 pleasures are as sweet, and whose possibilities 
 for good are as vast as those of any position in 
 life. She should look upon herself not only as 
 the giver of a living pledge to her husband, 
 but also as the transmitter of humanity itself, 
 of all its endeavors, hopes, and aspirations. 
 Her function, while on the one hand private 
 and domestic, is on the other a matter of world- 
 note, of the upbuilding of the race and the 
 working out of every right-minded dream of 
 the poet and philosopher. She must realize that 
 in this matter, as in every other in human 
 affairs, there is a necessity for exact prepara- 
 tion, for the discernment of elements of strength 
 and weakness, and for the recognition of the 
 methods which will increase the advantages and 
 decrease the disadvantages of the situation. 
 
 23 
 
24 THE CARE OF THE CHILD IN HEALTH 
 
 The pregnant woman should recognize that 
 one of the best preparations for the efficient 
 future of her child is the efficient present care of 
 herself. In this condition the welfare of both 
 is so closely interwoven that a point of separa- 
 tion between them cannot reasonably be made. 
 During this preparatory period the child is 
 growing and developing, is laying the founda- 
 tion for the future blossoming of mind and 
 body, just as surely as in the later times when 
 he requires meat and drink, shoes and caps, 
 gowns and books. From the very moment of 
 conception he begins to be a human being with 
 definite needs; and carelessness of his welfare 
 during his prenatal existence is fully as inex- 
 cusable as ignorant and stupid ordering of his 
 affairs after birth. His various physical re- 
 quirements and functions have as distinct an 
 existence at one time as at the other. Instead 
 of breathing through his lungs, he breathes 
 through the maternal placenta ; instead of ab- 
 sorbing food from his stomach and intestines 
 into his blood, he is nourished directly by the 
 blood of his mother. If her blood is poorly 
 oxygenated and nourished he feels the effect 
 immediately and intimately. And in propor- 
 tion to his extreme feebleness and immaturity 
 
THE PREGNANT WOMAN 25 
 
 he must necessarily be well or ill influenced. 
 But the main fact that physiological activity 
 exists is as true of one time as the other. 
 Nothing can possibly be more important, from 
 the standpoint of the collective welfare as 
 well as that of the individual, than a dis- 
 criminating knowledge of the relations of 
 parent and child; in other words, of heredity. 
 The general belief that descent acts in some 
 blind and unchangeable manner is not only 
 wrong, but also infinitely mischievous. While 
 the oft-quoted aphorism that a child's training 
 should begin two hundred years before his birth 
 may be true enough, nevertheless a highly 
 important fact which calls for an equal amount 
 of consideration is that the immediate progeni- 
 tors have a great part in the matter of a child's 
 health and strength ; and that, most of all, the 
 nourishment which the mother can and does 
 give before his birth will have much to say in 
 deciding what manner of person he may grow 
 to be. And when one speaks of health and 
 strength, the terms have so wide an application 
 that they include the vitality of bone, muscle, 
 and nerve tissue, of body and mind. 
 
 Thus the prospect of the child's birth must 
 be a matter of constant thought and preparation, 
 
26 THE CAKE OF THE CHILD IN HEALTH 
 
 not only in the way of providing for his physi- 
 cal requirements, but also in so disposing of 
 the mother's forces and energies that she will 
 undergo the minimum of wear and tear while 
 obtaining the maximum of normal activity. 
 She must maintain a calm and placid mind, 
 should try to develop a cheerful manner of 
 looking at the world, must endeavor to see the 
 beauty of life and all its relations. In olden 
 times the Greeks decorated the rooms of preg- 
 nant women with beautiful statues, that the 
 mind, dwelling on the images of strength and 
 loveliness, might obtain a more favorable im- 
 pression than it formerly had, and thus would 
 hand on to the new-born child a heritage of a 
 like nature. While the physiological ideas 
 involved in this custom may have been misty, 
 nevertheless, there was a large element of prac- 
 tical truth in it; for the woman who realizes 
 that she can to a notable extent, by controlling 
 and regulating her physical and mental condi- 
 tion, mould the body and mind of her unborn 
 child, has progressed to an appreciable extent 
 in the direction of being an ideal mother. Such 
 a woman will keep a strict account of her 
 thoughts and emotions, will try to encourage 
 beautiful and worthy ideas and ideals, will 
 
THE PEEGNANT WOMAN 27 
 
 endeavor to make her everyday life square with 
 these theoretical conceptions, and similarly 
 will eliminate unfavorable acts and their con- 
 sequences. Nothing that in any way affects 
 her will be considered as trivial, for every fact, 
 whether it is great or small, has its commensu- 
 rate influence. Similarly, no burden of pains- 
 taking will be too great for her strength; for 
 she is the beginning of generations that may 
 change the face of the world. The stimulant 
 for good of such a course is not to be overesti- 
 mated; it will serve as a pillar of cloud by day 
 and a pillar of fire by night to guide and re- 
 strain; it will keep alive the sense of respon- 
 sibility and promote the conviction that the 
 pregnant woman is one of the real makers of 
 the world and its destinies. Viewed in this 
 light, the condition represents a great oppor- 
 tunity whose importance, as far as the welfare 
 of the community is concerned, is not exceeded 
 by that of any profession or vocation in the 
 world. 
 
 It is noteworthy that a belief in prenatal 
 effects upon the child has from times imme- 
 morial been more or less prevalent, although as 
 commonly interpreted it has no foundation in 
 fact. The so-called maternal impressions are 
 
28 THE CARE OF THE CHILD IN HEALTH 
 
 no more than fortuitous thoughts and accidents 
 which are supposed to leave their impress in 
 some indelible manner upon the child. Thus, 
 as an example, a woman may be frightened by 
 the sight of an ugly or deformed person, by an 
 accident, by some chance blow, fall, or misstep ; 
 in other cases she may have had bad dreams 
 whose grotesqueness haunts her even during 
 the waking hours ; in yet others, she may have 
 heard some shocking news, or may even be 
 afflicted by an equally disturbing train of 
 thoughts which fascinate her by their persis- 
 tence and ugliness. In almost all cases the 
 apprehensions are ill founded and should re- 
 ceive no attention. It is a noteworthy fact that 
 the most fanciful and easily alarmed women 
 encounter the greatest number of alarming 
 sights and accidents, and are afflicted with the 
 most stubborn obsessions. Nevertheless, these 
 very women in the greatest number of cases 
 bear children who show no marks of injuries ; 
 and where such abnormalities appear, their oc- 
 currence can usually be explained on other and 
 more reasonable grounds. If one wishes to 
 state the matter in the form of a general rule, 
 one should say that the growth of a child before 
 birth is as regular and as fully subject to physio- 
 
THE PREGNANT WOMAN 29 
 
 logical laws as after birth, and that on account 
 of the protecting circumstances of the foetus, 
 ordinarily trivial accidents rarely produce im- 
 portant results; moreover, the main factor in 
 the infant's development is the normal nutri- 
 tion of the mother, her healthful activity, and 
 the wise regulation of her daily life. 
 
 Thus a woman in the course of a visit or an 
 afternoon walk may see a cripple or an invalid, 
 or may be startled by some animal; in other 
 cases she may inflict some slight injury upon 
 herself, or may encounter another person who 
 has undergone an accident. In such cases it is 
 no uncommon experience for her to begin a 
 course of worry, of self-tormentings, of belief 
 in the possibility that her child may bear in his 
 body or mind the likeness of these events. As 
 a matter of plain fact she is doing more harm by 
 the worry than the thing which she fears can 
 ever accomplish. For if such a transitory con- 
 cept could have any power, then similarly every 
 act and experience of her daily life would be 
 faithfully portrayed in her offspring. Such a 
 connection would result in a child that was a 
 veritable patchwork, a freak, or a monstrosity. 
 It is absolutely opposed to every rational inter- 
 pretation of ordinary children as we see them 
 
30 THE CARE OF THE CHILD IIST HEALTH 
 
 from day to day. If a defect does finally 
 appear, its origin assuredly has a more logical 
 basis than such fleeting cloud-shadows. There 
 must rather be some more organic defect present 
 in the child's nourishment, which is translated 
 into a local or general manifestation, according 
 to the various circumstances of the case. This 
 is normally regulated by the mother's general 
 condition rather than fortuitous impressions 
 which come from without. 
 
 There is an additional and noteworthy 
 thought which if fairly considered ought to 
 clear up one's ideas about maternal impres- 
 sions. If a passing emotion or impulse of an 
 unfavorable nature can injure the unborn child, 
 why should not every happy emotion or impulse 
 benefit him ? If the sight of a cripple can blast 
 his growth, why should not the sight of a finely 
 formed person benefit him ? If the hearing of 
 bad news can depress the future gayety of his 
 mind, why should not the reception of good 
 news equally elevate it ? Practically always 
 one hears of injurious maternal impressions, 
 never of helpful; and. this irrational lack of 
 consistency merits some common-sense think- 
 ing. One can always offset the bad impres- 
 sions by possible good ones, so that the result 
 
THE PKEGNANT WOMAN 31 
 
 of the comparison is equality. This is really 
 the normal view to take; and it has the further 
 advantage of imparting a healthy control of 
 mind and body. 
 
 Such control involves an intelligent oversight 
 of all the ordinary faculties and functions. 
 The pregnant woman ought to have a diet 
 which, although liberal, excludes articles of food 
 that are hard to digest or have small nutritive 
 properties. Thus, all fried foods, "made" 
 dishes and salads, greasy and fatty preparations, 
 and pastries should be avoided; coffee and tea 
 may be taken in moderate quantities, and light 
 and effervescent whines may similarly be advised. 
 The ordinary meats, fish, fresh vegetables, and 
 fruits must constitute the meals rather than 
 dainties, relishes, and the usual articles that a 
 fickle, capricious, and sometimes morbid appe- 
 tite may seek. In fact, this element of nor- 
 mality should be the keynote of her daily 
 routine. Instead of searching for, recognizing, 
 and exaggerating abnormal factors, she should 
 in every possible manner repress them. Her 
 condition is not an unnatural one ; on the con- 
 trary it is one that is physiologically charac- 
 teristic of her whole being. This view will 
 tend to dispel many of the perplexing doubts 
 
32 THE CARE OF THE CHILD IN HEALTH 
 
 concerning the arrangement of her time. The 
 day may well be begun by a pleasantly cool 
 shower- or plunge-bath on arising. This bath, 
 since it lasts for a very few minutes, and since 
 it should be followed by a brisk rubbing of the 
 body, is not too severe for even a delicate or 
 nervous person. Then there will be a greater 
 zest to the appetite, and the light breakfast of 
 fruit, cereal, eggs, and chops will be more 
 eagerly welcomed than otherwise. After 
 breakfast, and as soon as household duties per- 
 mit, she may take a walk, the length and ra- 
 pidity of which are proportioned to her energy 
 and vigor. The remainder of the morning may 
 be devoted to her ordinary domestic work. 
 After lunch she should take a nap for about an 
 hour, which may be followed by another walk, 
 drive, or visiting. In the evening the ordinary 
 domestic recreations may pass the time, and 
 occasionally she may see a play at the theatre 
 or hear a concert. Especially on such occasion 
 she must resist the temptation to remain up 
 late, for sufficient sleep is one of the main fac- 
 tors in a healthful life, most of all for a woman 
 who has to supply nerve energy not only for 
 herself, but for her unborn child as well. The 
 proverb " qui dort dine " applies to such a person 
 
THE PREGNANT WOMAN 33 
 
 with more force than in all likelihood to any- 
 other; and its good effects will be seen in les- 
 sened emotional disturbances, fewer nervous 
 manifestations, and rarer complaints of inordi- 
 nate fatigue. 
 
 Such a general scheme as the above may 
 seem difficult of accomplishment to some women 
 who believe that the demands of their house- 
 hold and growing family take up all their avail- 
 able time. While in some cases reasons of 
 domestic economy prevent as much liberty as 
 one might desire, nevertheless, in most homes 
 — even those that are supported on moderate 
 incomes — the wife's time and energies are often 
 unnecessarily frittered away in a poorly arranged 
 plan of work and superintendence. Indeed, 
 one of the greatest needs in the ordinary house- 
 hold is a carefully arranged system by which 
 each certain piece of work is made to begin and 
 end at its fixed time, where there is the ex- 
 change of duties between different members of 
 the family or between different servants, where 
 every routine need is provided for in a schedule 
 that should be as direct and businesslike as 
 the working of a successful factory or mercan- 
 tile establishment. If this is done, and I know 
 by experience that it is not impossible or un- 
 
34 THE CARE OF THE CHILD IK HEALTH 
 
 reasonably difficult, the increased opportunities 
 for exercise, recreation, and care of self which 
 the ordinary wife and mother may find at her 
 command will be sufficient and gratifying. 
 Wherever there is an accumulation of duties 
 and work, or the presence of several persons 
 with their various needs and desires, there must 
 be a controlling discipline, which will regulate 
 conflicting interests, prevent loss of time, and 
 promote good feeling and ease of temper. 
 Doubtless there is no place where wise manage- 
 ment can be better demonstrated than in the 
 ordinary household. 
 
 Of all the subjects of preparation which the 
 pregnant woman must consider, none is more 
 susceptible of intelligent management than her 
 method of dressing. If this matter is poorly 
 arranged she will experience discomfort, un- 
 dergo unnecessary expense; she may suffer in 
 health and surely will present an ungraceful, 
 uncouth, and, possibly, immodest appearance. 
 But such undesirable conditions need not ex- 
 ist, and, indeed, may with the help of proper 
 costumes be replaced by those that are con- 
 venient, healthful, and seemly. Clothing 
 may, unfortunately, cover one's nakedness, and 
 yet suggest too much of the form ; it may pro- 
 
THE PREGNANT WOMAN 35 
 
 tect the body from heat and cold, and yet the 
 protection may be partial or unevenly distrib- 
 uted; it may decorate, and yet not beautify. 
 Knowing these things we must try to select and 
 make the clothing of the pregnant woman with 
 a view to providing a sufficient lightness, 
 warmth, freedom of movement, and a due 
 regard for appearances. While in ordinary cir- 
 cumstances it is not desirable either to follow 
 the changing modes too slavishly or to neglect 
 them so completely as to make the impression 
 of eccentricity, in the special period of preg- 
 nane}' a woman should subordinate the usual 
 obedience to the current styles to the reasonable 
 demands of health and convenience of herself 
 and her child. 
 
 The underwear should be of wool, the thick- 
 ness of which must be suited to the season ; for 
 this reason she should have three different 
 weights : the lightest for summer, the medium 
 for spring and autumn, the heaviest for winter. 
 Some people prefer for underwear the so-called 
 natural wool, others choose a mixture of three- 
 quarters wool and one-quarter silk or cotton; 
 of late a tendency to choose a linen mesh has be- 
 gun to make itself felt, and also some "reform- 
 ers "have been endeavoring to discredit the use 
 
36 THE CARE OF THE CHILD IN HEALTH 
 
 of wool and substitute cotton in its place. 
 After the whole matter has been thoroughly dis- 
 cussed, and there is no necessity for repeating 
 all the lengthy details here, a white or gray 
 wool, with or without a partial admixture of silk 
 or cotton, will be found to give the greatest 
 amount of satisfaction. The form of the gar- 
 ments should be what is now popularly called 
 "union," that is, the shirt and drawers should 
 be woven together into one piece. When new 
 suits of this pattern cannot be readily obtained, 
 the separate garments may be fitted and sewed 
 together so that a fair substitute results. In 
 this way one can lessen the amount of weight 
 that otherwise would hang on the hips and, at 
 the same time, slightly decrease the unsightly 
 and unnecessarily thick layers of clothing which 
 accentuate the outlines of the protuberant abdo- 
 men. 
 
 In the matter of underskirts, a rational mod- 
 eration must control one's choice. Especially 
 must their number be not too great. In ordi- 
 nary cases they need at most be no more than 
 two, a fairly short flannel and a mediumly long 
 muslin one. They must be sufficiently full, 
 and, instead of being closed by means of but- 
 tons, may be fitted to the changing form by a 
 
THE PREGNANT WOMAN 37 
 
 broad band to which a draw-string is attached. 
 This draw-string should be in two parts, one to 
 control the back and the other the front. Both 
 should issue from their pockets at the side, 
 where they may be tied without making a 
 noticeable lump. In place of drawing them 
 very tightly and thereby holding them fast, 
 the band of the skirt may be supported from 
 the waist or corset cover or by straps which 
 hang from the shoulders. If additional warmth 
 for the lower extremities is desired, it may be 
 obtained by equestrian tights made of a knitted 
 fabric, which, while being very comfortable, 
 are not bulky. The stockings should be suf- 
 ficiently warm and must be held up by side 
 supporters, and not by garters, which are se- 
 cured to the waist instead of by the common 
 device of an abdominal band. The corset waist 
 is one of the most important garments, and de- 
 serves the most careful thought and attention. 
 It must be strong, light, pliable; if the seams 
 are somewhat heavier than the rest of the gar- 
 ment, it will, in spite of the drag of the skirts 
 and stocking supporters, keep its shape. Its 
 shoulder pieces will hang the weight from the 
 shoulders, where it will be least felt. In place 
 of this corset waist some women prefer an 
 
38 THE CAHE OF THE CHILD IN HEALTH 
 
 empire corset, which is so narrow that it makes 
 no pressure on the abdomen, but supports the 
 breasts sufficiently well. If such a corset is 
 worn, the waist may be somewhat lighter than 
 the usual corset waist and somewhat heavier 
 than the ordinary corset cover; for one must 
 remember that the empire corset is not designed 
 to support either skirts or stockings, which, 
 therefore, must be fastened to the waist. The 
 ordinary corset should, without the slightest 
 hesitation, be laid aside for the period of preg- 
 nancy and lactation. I do not care to begin a 
 discussion of corsets for ordinary occasions, for 
 most women under such circumstances will per- 
 sist in using them without regard for their 
 unhygienic influences. Although no competent 
 observer doubts that they may and do bring 
 about harmful results, nevertheless, as long as 
 they help to improve appearances and make 
 dresses set better, they will in all likelihood 
 continue to be worn. But when a woman is 
 pregnant, a further and vastly weightier factor 
 comes into the equation — the future welfare of 
 her child. The question ceases to be a merely 
 academic one of hygiene or aesthetics, but comes 
 to represent a modified degree of physical and 
 mental development ; or, stated differently, the 
 
THE PKEGNANT WOMAN 39 
 
 moral, intellectual, and material efficiency in 
 the child's various future spheres of activity. 
 It is the same idea that applies to all the details 
 of preparation for his birth, and the effort to 
 free him from as many disabilities as possible. 
 The only difference is one of degree ; no matter 
 what may be the divergence of opinion about 
 other details, everybody who is familiar with 
 the subject believes that at this time the ordi- 
 nary corset should be laid aside, for the inter- 
 visceral pressure and the restricted opportunities 
 for free movement are facts of radical impor- 
 tance. The usual excuse that the woman's back 
 needs the support of a corset, is not sufficient; 
 for a strong waist or the comparatively harm- 
 less empire corset will give enough support. 
 At the same time, a much better plan would be 
 to exercise the weakened muscles of the back, 
 and thus increase their strength to such a point 
 that artificial support is not needed. 
 
 The outer dress and the methods of designing 
 it so that it will best conceal the necessary 
 deformities are commonly matters of supreme 
 importance to the usual woman, and rightly so. 
 For at this period of her married life there are 
 many occasions when the ordinary peace and 
 quiet of the household are disturbed, and human 
 
40 THE CARE OF THE CHILD IN HEALTH 
 
 nature is often so frail that it will willingly 
 suffer inconveniences from a graceful, well- 
 gowned w^oman that it would tolerate grudg- 
 ingly from one who was dowdy, awkward, or 
 unpleasing. At the same time, the necessity 
 of frequently altering the size of the skirts or 
 of obtaining new ones is apt to make the attempt 
 to look as well as possible a somewhat costly 
 one. For this reason, if for no other, it is 
 advisable to prepare for this period as efficiently 
 as possible. The main requirements are to get 
 rid of the belt or any horizontal lines about the 
 body and to emphasize the vertical lines in the 
 costume. For this reason a street dress may be 
 made in the empire style, if one desires to have 
 separate waist and skirt. The waist should 
 be made with a loose, falling front like the 
 "fedora" or "matinee" waist. The skirt 
 should be cut with all its breadths of equal 
 length, and should be full enough to allow of 
 being let out as far as may be required. The 
 extra length in the front, as well as the back, 
 may be hidden in tucks or folds, and as occasion 
 demands may be let out. This garment should 
 not be closed in the back with buttons or hooks, 
 but preferably may be shirred to fit the form by 
 two draw-strings, one for the front and the 
 
THE PREGNANT WOMAN 41 
 
 other for the back, which issue and are fastened 
 at the sides. Another good plan is to make 
 two side openings to the skirt instead of one 
 behind. These plackets should be from twenty 
 to twenty-four inches in length. The waist- 
 band is to be broad and elastic and msij be in 
 separate pieces for the front and back, having 
 long ends for tying. When the wearer dons 
 the skirt, she ties the long ends of the rear 
 waistband in front, and then fastens those of 
 the front waistband in the rear. Naturally the 
 garment must be made full enough to conform 
 to the increasing size. And if it is heavy, it 
 may, when so desired, be supported by straps to 
 the waist or from the shoulders. A still further 
 plan, which I have found to give satisfactory 
 results, is to make the skirt full at the waist, 
 closing it in the usual manner behind. Over 
 the placket a broad single or double box-pleat 
 is laid, which must be tacked to the waistband 
 above and to the skirt below the placket. As 
 the abdomen increases in size, this box-pleat 
 may be shifted more and more from its original 
 position, so that it fills up the empty space 
 between the two sides of the opening. For 
 house wear, wrappers which are loose in front 
 should be worn ; the back may be given a fair 
 
42 THE CARE OF THE CHILD IN HEALTH 
 
 degree of grace by means of a watteau fold or 
 pleat. 
 
 For walking purposes a sufficiently long cape 
 or cloak should always be used, to the rigid 
 exclusion of the tight jacket or coat. Not only 
 will the general appearance be improved, but 
 also an added degree of comfort will be ob- 
 tained. Finally, the costume majr be com- 
 pleted by the addition of heavj', fairty broad 
 shoes that permit of planting the foot comfort- 
 ably and strongly upon the ground. The usual 
 belief that a light, thin shoe is easier to walk in 
 is an undoubted fallacy. Especially is this 
 true when the shoe is made on an artificially 
 shaped last, with the plain purpose in view of 
 making a certain dainty appearance rather than 
 giving the protection that wind, weather, and 
 the hard condition of the pavements demand. 
 A small vamp, a narrow toe, a thin sole, and a 
 high heel that is placed too far forward are all 
 conditions that make for disability in walking. 
 On account of them the foot cannot be planted 
 full upon the ground, the muscles of the legs 
 and back cannot relax and contract in a normal 
 manner, and the weight of the body is not 
 properly distributed. As a result the woman 
 complains of pains in the back and thighs. She 
 
THE PREGNANT WOMAN 43 
 
 takes insufficient exercise, and tissue-change 
 as well as nutrition is defective. These dis- 
 abilities can be removed by wearing a shoe 
 that is long and broad enough, that has a 
 strong, heavy sole, large enough vamp, and a 
 low heel that is placed sufficiently far back to 
 distribute the body weight where it can be best 
 borne. 
 
 There is one detail of dressing connected 
 with walking in bad weather which I consider 
 of no little importance. It concerns the use of 
 waterproof leggings that must come to or 
 above the knee. The exposure and discomfort 
 that come with wet skirts are usually sufficient 
 to keep indoors a woman who otherwise would 
 gladly take her regular exercise in spite of rain, 
 snow, or hail. Therefore, in bad or threaten- 
 ing weather I always advise my patients to wear 
 such leggings, for I know that a prolific source 
 of catching cold is thus removed, and that they 
 can with impunity face a storm which otherwise 
 would be prohibitory. There is nothing essen- 
 tially injurious in walking in rain or snow, 
 provided that one is properly clothed. On 
 the contrary, the brisk glow that follows the 
 struggle with the weather is commonly exhil- 
 arating. With sufficient protection, with the 
 
44 THE CARE OF THE CHILD IK HEALTH 
 
 prospect of wet skirts flapping about chilled 
 and wet lower limbs removed, the majority of 
 women, who otherwise would be mewed up in- 
 doors to their undoubted detriment, will gladly 
 take their daily walk. 
 
 Another bar to comfort and the taking of exer- 
 cise, which is fortunately not very common, is 
 a very large, prominent, or pendulous abdomen. 
 It will be sufficient to suggest the use of an ab- 
 dominal band which goes under and supports 
 the abdomen, and closes in the small of the 
 back ; it may be supported and held in place by 
 straps across the shoulders. Its ends may be 
 fairly narrow, but its middle portion must be 
 broad and of a hollow shape, which will adjust 
 itself accurately to the outline of the body. 
 If this device is properly adjusted the wearer 
 will obtain enough relief to change a painful 
 and laming pregnancy to a comparatively com- 
 fortable one. It is by such small details that 
 many disadvantages are overcome ; and, in gen- 
 eral, one may say that life as a whole is no 
 more than a massing of such details, each of 
 which is worthy of conscientious attention. In 
 the preparation for a child's birth there is a 
 paramount opportunity to exhibit fidelity to an 
 ideal, thoroughness of preparation, wise fore- 
 
THE PREGNANT WOMAN 45 
 
 thought, and a broad comprehension of ultimate 
 possibilities. 
 
 While the pregnant woman is arranging all 
 these details, it will be wise for her to prepare 
 for the lying-in. The things which she needs, 
 while not numerous or expensive, are too im- 
 portant to be neglected. She should have at 
 least two or even three agate or china-ware 
 basins, and one or two large pitchers or ewers 
 for the use of the physician. Also there should 
 be a pound carton of absorbent cotton and some 
 clean gauze or cheese-cloth with which the nurse 
 may make napkins or pads for the mother. The 
 cheese-cloth should be washed, dried, and cut 
 into pieces about eighteen inches in length by 
 twelve inches in breadth. The cotton may be 
 cut into pieces about nine inches long, six 
 inches wide, and one inch thick. When the 
 cheese-cloth is folded about the cotton, one has 
 an ideal napkin that is convenient, comfortable, 
 and cheap. To insure surgical cleanliness, 
 these napkins, as soon as they are made, should 
 be packed in a strong piece of muslin or a 
 towel, which is then to be securely pinned up, 
 placed in an oven, and baked for about twenty 
 or thirty minutes. The package should not be 
 opened until after the child is born. 
 
46 THE CARE OF THE CHILD IN HEALTH 
 
 The abdominal binder may be made from one 
 or two thicknesses of unbleached muslin; it 
 should be large enough to span and overlap 
 the woman's girth, while in breadth it should 
 extend from a short distance below the breasts 
 down to and even below the hips. To secure it 
 in place one should have a few large safety-pins. 
 
 The careful woman, in order to protect the 
 mattress, will obtain two pieces of rubber 
 sheeting, one of which is large enough to cover 
 the whole mattress, while the other is no more 
 than half as big. The first is to be securely 
 fastened all about the edges, but the second is 
 to be used loose. Immediately after the child 
 has been born, the smaller may be removed, 
 while the other prevents any overflow or drip- 
 ping of fluid from soiling the mattress. In the 
 course of a day, or when the physician thinks it 
 safe, the second may likewise be discarded. 
 
 In addition there should be a plentiful supply 
 of towels, a baby's bath-tub, which the physician 
 may need in resuscitating a partially asphyxi- 
 ated child, a piece of narrow, strong tape (which 
 is to be sterilized by boiling) for tying the cord, 
 a bottle of carbolic acid or tablets of bichloride 
 of mercury for making solutions, and a bottle of 
 boracic acid solution for washing the baby's eyes. 
 
CHAPTER III 
 
 THE BABY'S OUTFIT AND NURSERY 
 
 Long before the baby is born, his outfit should 
 have been obtained in its entirety. If one waits 
 until the pregnancy is about to end, there will 
 usually be so much of a hurry in procuring the 
 various articles, in struggling with transient 
 attacks of indisposition, and making the various 
 preparations for the mother's needs, that some 
 things may be forgotten or neglected, or in the 
 hurry a compromise be made and inferior or less 
 convenient garments and utensils be accepted 
 than otherwise. One should go about prepar- 
 ing the layette as a matter of love and not 
 merely of duty or necessity. Into every little 
 skirt or band some affection, some wholesome 
 aspiration should be put; under such auspices 
 care and work lose their tediousness, and every 
 hour of labor becomes sanctified as a partial 
 preparation for the doing of useful deeds and 
 the thinking of wholesome thoughts. 
 
 There are a few general rules which should 
 47 
 
48 THE CAKE OF THE CHILD IN HEALTH 
 
 control the making and the choice of clothing. 
 The garments must be warm, light, and entirely 
 without harshness. Infants need more warmth 
 than adults, and a lack of it depresses their 
 physical condition more than one would usually 
 suppose. And not only must there be sufficient 
 warmth, but, also, it must be evenly distributed. 
 A baby whose chest is overloaded and whose 
 legs are bare cannot be expected to keep up a 
 nicely balanced thermal equilibrium, but, on 
 the other hand, is apt to fall into congestive 
 disturbances. The fabric of which the gar- 
 ments is made must be as soft and bland as 
 possible, for the delicacy of a young baby's skin 
 is not to be estimated by our mature standards. 
 Its delicacy seems at times almost pathological, 
 and only by forethought and scrupulous care are 
 skin disorders, with their resulting acute suffer- 
 ing, avoided. In addition to these fundamental 
 requirements, one should remember that a child 
 in arms depends for a large part of his exercise 
 upon the freedom to move arms and legs at will ; 
 therefore his clothes must be free enough to 
 avoid constriction and all manner of rigorous 
 binding. There must be as few pins used as 
 possible, and even the number of buttons and 
 buttonholes must be kept down to the minimum 
 
THE BABY'S OUTFIT AND NURSERY 49 
 
 in order to allow the girth of the garments to 
 be adapted to the requirements of growth. 
 Their place is well filled by tapes and draw- 
 strings, which plainly have many advantages 
 and few objectionable features. Lastly, there 
 must be a sufficient number and variety of 
 garments to allow as frequent changes as the 
 requirements of health and convenience de- 
 mand. 
 
 A proper outfit for a well-cared-for child 
 should contain at the least the following 
 articles : — 
 
 1 hamper or bassinet or 2 wrappers, 
 basket. 3 coats. 
 
 2 pieces of diapering. 1 shawl. 
 
 3 flannel bands. 2 caps. 
 
 4 shirts. 1 pair of knit tights. 
 6 pairs of stockings. 4 bibs. 
 
 2 pairs of "booties." Safety-pins, large and 
 
 4 barrow coats or pin- small, in sufficient 
 
 ning blankets. number. And, lastly, 
 
 4 nightgowns. a box of fine talcum 
 
 4 slips. dusting powder. 
 
 Although this list should not be abbreviated, 
 it may be indefinitely enlarged. Not only are 
 there many variations in quality, but the num- 
 
50 THE CARE OF THE CHILD IN HEALTH 
 
 ber of pieces may be increased according to the 
 fancy and means of the parents. The main 
 advantage of an increased quantity, outside of 
 reasons of luxury, is the smaller number of 
 washings through which each piece must go, 
 and the consequently lessened amount of 
 shrinkage and injury that necessarily follows. 
 I have made no attempt to mention all the dif- 
 ferent varieties of garments because such detail 
 is unnecessary and would, in addition, create 
 the impression that many more articles are 
 required than are really essential. Moderation 
 in providing the layette is by all means desir- 
 able, since it may have much to do with fixing 
 the standard according to which the dressing of 
 the child will be gauged for years to come. 
 The mother should keep before her eyes the fact 
 that the child, much sooner than she is apt to 
 fancy, absorbs ideas of station and scale of liv- 
 ing, and that the habit of luxury is more easily 
 formed than discarded. She must recognize 
 frankly and definitely her present and probable 
 future economical scope, and as a matter of 
 convenience keep well within reasonable limits. 
 For such reasons, as well as the equally im- 
 portant one of good taste, she should try to 
 make the layette reasonably inexpensive, good 
 
THE BABY'S OUTFIT AND NUBSERY 51 
 
 in qualitj', not overburdened with ornamenta- 
 tion, and frankly serviceable. 
 
 One of the first articles which may be obtained 
 is a hamper or bassinet. One of liberal size is 
 to be recommended, and preferably should have 
 one or more portable trays ; if it rests upon cas- 
 tors it can be so easily moved about that its use- 
 fulness is materially enhanced. Such a hamper 
 has many advantages over the ordinary dressing 
 basket, since it can contain the whole outfit, 
 and thus saves much time that would be wasted 
 in going to and fro in search of the various gar- 
 ments, while simultaneously it promotes habits 
 of neatness and order. In the hamper each sort 
 of clothes should be placed in a certain position 
 which, when once found to be practical, must 
 be always maintained. It is an excellent plan 
 to have the hamper divided horizontally by a 
 tray, which not only may separate different 
 sorts of articles but also may be of considerable 
 use in carrying garments from one place to 
 another. 
 
 The material for diapers may be cotton or 
 linen, and should be bought by the piece. 
 Although the linen is somewhat more expen- 
 sive than the cotton, nevertheless it remains so 
 much softer and shrinks so much less that its 
 
52 THE CARE OF THE CHILD IN HEALTH 
 
 advantages overweigh the added cost. The 
 diapers may be cut in three sizes, and one 
 should progress from the small to the larger as 
 the child grows. Convenient sizes are squares 
 of sixteen inches, eighteen inches, and twenty- 
 four inches. A sufficient quantity of these 
 should be provided, because every diaper should 
 be thoroughly washed and aired after being used, 
 even if it has been no more than dampened ; and 
 since it is often possible that the washing can- 
 not be promptly done, there must be enough 
 clothes to serve for at least two or two and a 
 half days. It is wise to provide a covered pail 
 to contain the soiled diapers until they can be 
 washed, for they should not be thrown with the 
 other clothes of the baby or of the rest of the 
 family. 
 
 For the first three or four months the child 
 should wear an abdominal band, w T hich after 
 that time may, unless there are special indi- 
 cations for continuing its use, be discarded. 
 Three are usually sufficient — one for the 
 night, one for the day, and the remaining one 
 for change. They are often made of plain 
 flannel, but a better and preferable quality is 
 made of soft knitted wool, of cashmere, or of 
 a mixture of wool and silk. It is rarely neces- 
 
THE BABY'S OUTFIT AND NURSERY 53 
 
 sary to make them more than six inches wide, 
 and one should not commit the mistake of buy- 
 ing some of those recently devised which extend 
 to the armpits, thus tending to restrict the easy 
 play of the chest walls and the contained 
 organs. The main reason for putting a band 
 on an infant is not entirely for warmth, as is so 
 commonly believed, but rather to prevent a 
 hernia, or rupture of the navel. The custom of 
 using these bands for the whole of the baby's 
 first year is to a certain extent a superfluity; 
 the main purpose will have been attained at the 
 end of two or three months, for after that period 
 there is not much danger of an umbilical hernia. 
 The little shirts that go next to the skin 
 should be supplied in two weights, if the mother 
 wishes to get no more than is absolutely neces- 
 sarjr, but in three if her means permit a some- 
 what greater expenditure. These garments are 
 commonly of too small a size, and are not cut 
 with the view of their inevitable shrinkage and 
 the child's natural growth. They should have 
 long sleeves, and instead of being fastened by 
 buttons may advantageously be closed with 
 tapes. In most cases the buttons are so small 
 that after a little use the holes become unduly 
 large, and, consequently, the garment is open 
 
54 THE CARE OF THE CHILD IIST HEALTH 
 
 quite as often as closed. These shirts may be 
 made of wool, of a mixture of wool and silk, or 
 of cashmere, all of which may be bought in 
 various thicknesses from a fairly heavy material 
 to the thinnest gauze. They must extend from 
 the neck to below the buttocks, so that there is 
 no likelihood of their shrinking to or beyond 
 the edge of the diaper. It is scarcely necessary 
 to say that those used during the day must be 
 changed for others at night. The first, after 
 being thoroughly aired, may be used on the 
 following day. 
 
 In regard to the stockings there are two main 
 observations that require attention : they must 
 be of the proper weight, and by all means 
 should be sufficiently long. The first require- 
 ment is easily satisfied, for every well-stocked 
 shop has a large enough assortment to allow a 
 selection for the different seasons. The ques- 
 tion of length is not so easily settled, because 
 almost all the stockings that one finds for sale 
 are decidedly short. There is no doubt that 
 they should extend sufficiently high upon the 
 leg to allow of being pinned to the diaper. On 
 most children, as usually dressed, they fall 
 down about the ankles soon after being drawn 
 on, and thereby leave a part of the leg quite 
 
THE BABY'S OUTFIT AND NURSERY 55 
 
 bare. The natural results of exposure and an 
 unequal distribution of heat are not only hard 
 to avoid, but also the habit is commonly apt to 
 promote congestive disturbances. In addition 
 to the stockings, the child, as soon as there is a 
 chill in the air, should wear little knitted shoes, 
 usually called "booties." These, also, may be 
 of two weights and should be changed suffi- 
 ciently often to keep them sweet and wholesome. 
 To complete the list of underclothes we need 
 four or more barrow coats, popularly called 
 pinning blankets. In former times these con- 
 sisted of a band of variable width joined to a 
 long skirt of flannel. It has always been and 
 must always be one of the principal garments, 
 since it covers most of the body; and, if prop- 
 erly made, it gives warmth, does not hinder the 
 child's movements, and is easily manipulated. 
 To make it a perfect garment its upper portion 
 should be changed and lengthened, and its skirt 
 shortened. Instead of a band, the form should 
 be that of a sleeveless coat, and the skirt should 
 extend no lower than a few inches below the 
 baby's feet. The habit of clothing an infant 
 in very long dresses is a thoroughly unneces- 
 sary one ; there is no excuse for it, but, on the 
 contrary, there are distinct reasons against it. 
 
56 THE CARE OF THE CHILD IN HEALTH 
 
 Such skirts are expensive, clumsy, and hard to 
 manipulate. They add materially to the 
 amount of the weekly wash, and, by their 
 weight, especially if heavily embroidered, re- 
 strict the child's movements and help to make 
 an unnecessary burden for the nurse or mother. 
 My objections to them were crystallized about 
 six years ago, when I saw a somewhat weak 
 infant, of about five months of age, whose leg 
 had been broken by the twisting of a weighty, 
 heavily worked, and unusually long skirt. 
 This accident, to be sure, is a very rare one ; 
 but the fact remains that, although rare, it is 
 nevertheless possible. The only thing that 
 one can urge in justification of long skirts is 
 their supposedly decorative effect; but the 
 value of even this is very doubtful, and at best 
 should not be regarded as important. The 
 barrow coat, then, in its abbreviated form and 
 fastened in front with tapes instead of buttons, 
 makes an easily adjusted, comfortable, and 
 well-nigh indispensable garment, which con- 
 tributes much to maintaining an even degree 
 of heat. In extremely cold weather a modified 
 coat containing sleeves may be used. 
 
 Outside of the barrow coat comes the white 
 dress, or slip, made of cambric or nainsook. 
 
THE BABY'S OUTFIT AND NURSERY 57 
 
 No especial directions concerning its form 
 need mention, excepting the emphatic sugges- 
 tion that it must not be unreasonably long; in 
 fact, it should be only long enough to cover the 
 barrow coat. The various slips may be made of 
 different qualities of material and ornamented 
 with the various decorations with which every 
 woman is familiar. It is not out of place to 
 advise simplicity rather than lavishness in this 
 matter; for the baby may look sweet and dainty 
 without being made to imitate an overdressed 
 lay figure or a gaudy fashion-plate. 
 
 A very useful garment is a warm wrapper, 
 made of cashmere, flannel, or any plain material 
 which may be tufted. It is designed to wear 
 at night, early in the morning, after the bath, 
 or whenever the child needs a warm, comfort- 
 able dress that may be put on and off with the 
 least delay. It must be long enough to cover 
 the feet comfortably, large and long in the 
 sleeves, and sufficiently snug in the neck to 
 prevent gaping. It may be closed at the neck 
 and on the chest by ribbons or cords, and about 
 the waist may have a heavier cord which will 
 keep the free edges from falling apart. Such 
 a wrapper may at an emergency be used as an 
 auxiliary nightgown, although the ordinary 
 
58 THE CARE OF THE CHILD IN HEALTH 
 
 night-dresses should be made in different 
 weights to suit the seasons. Thus, they may- 
 range from cambric and nainsook to flannel and 
 knitted goods. They should be large and 
 roomy, long enough to keep the feet thoroughly 
 warm, and closed with tape or ribbons instead 
 of pins or buttons. 
 
 Very little more need be said about the 
 layette, excepting a few minor suggestions. 
 Thus, one often sees an external diaper made 
 of stockinet or other rubber material. The use 
 of such an article is to be condemned on the 
 ground that it sets a premium on laziness and 
 lack of attention, that it is provocative of irri- 
 tations and disorders of the skin, and that its 
 logical effect resembles closely that of a poul- 
 tice. This is easy to understand when one 
 considers that a poultice is designed to main- 
 tain artificial heat and moisture on a selected 
 part of the body, which is exactly what the 
 impervious diaper-cover is bound in some de- 
 gree to do. There are rare occasions, such as 
 when the child appears in a public place, on 
 which a contrivance like this may be used for 
 an hour or two. But these occasions ought to 
 be very rare, and even then with sufficient care 
 the child can be kept in an unobjectionable 
 
THE BABY'S OUTFIT AND NURSERY 59 
 
 condition with no more than his usual clothing. 
 Another suggestion may be made concerning 
 bibs. The use of these articles is to save the 
 front of the slips from being soiled with food 
 and saliva. They should, therefore, be made 
 of a closely woven material which does not 
 readily absorb and hold moisture. A sodden 
 bib may possibly be the means of dampening 
 and chilling the chest, and thus give rise to a 
 bronchitis or other related disorders. A useful 
 bib for hand-fed babies may be made by folding 
 up its lower margin to form a wide pocket into 
 which drippings of food may run and be held. 
 Such a bib must naturally be made of an imper- 
 vious material, and should be removed shortly 
 after feeding has been completed. 
 
 Now that the baby's outfit is completed, one 
 should consider the problem of selecting a room 
 for the nursery and furnishing it in a comfort- 
 able, hygienic, and attractive manner. The 
 sunniest room in the house ought to be chosen, 
 for babies like flowers need plenty of sunshine 
 and air. A southern exposure is to be pre- 
 ferred to any other, for under such conditions 
 the requirements are most apt to be met. The 
 best facilities for ventilation are essential, and, 
 at the same time, are not hard to provide. 
 
60 THE CARE OF THE CHILD IX HEALTH 
 
 Every day the windows must be left open for a 
 sufficient time, both in winter and summer, to 
 insure the thorough airing of the room. And 
 while they are closed the entrance of fresh air 
 may be insured by one or more of several 
 methods of ventilation. The heating of the 
 room should be so devised as to contribute some 
 assistance to this end. The method which 
 gives the best results is that of a grate fire, 
 properly guarded by high, strong fenders. A 
 good stove that is heavy enough to prevent 
 overturning, especially if it is surrounded by a 
 wire guard, is also a very useful means ; at the 
 same time it does away with the large amount 
 of dust and dirt that a grate fire is bound to 
 cause. A Franklin burner also has many 
 advantages, especially as it is very clean. The 
 most objectionable method is the ordinary steam 
 heat, which clearly ought not to be allowed in 
 any well-appointed nursery. In the other 
 methods the rarefaction of the air caused by 
 the heat and the draught of the chimney bring 
 a corresponding amount of fresh air into the 
 room through the crevices and joints of the 
 windows and doors, and thus serves our pur- 
 pose more actively than one would suppose. 
 A more direct way of ventilation is through 
 
THE BABY'S OUTFIT AND NTTRSEEY 61 
 
 some device connected with the window. One 
 of the simplest and best of these consists of 
 lowering the upper sash about six inches and 
 filling the open space with a plain piece of 
 board. The window is then closed at top and 
 bottom, but open in the middle. The cold air 
 is directed, by the situation of the opening, to 
 the upper part of the room, whence, on account 
 of its weight, it gently descends and produces 
 no draught. Another way is that of the old- 
 time ring ventilator, which is set in a pane of 
 glass in any of the windows. This gives the 
 minimum of trouble, but it is not so easily con- 
 trolled as the first device. There are yet other 
 methods, such as the box ventilator, which is 
 attached to a permanent opening at the top or 
 bottom of the window, and is opened or closed 
 by a sliding panel or similar device. By such 
 means it is always possible to have pure, fresh 
 air in the room; and one must see to it, as a 
 prime necessity, that there should never be a 
 stuffy, close, or unpleasant atmosphere in this 
 most important part of the house. While we 
 are working on the windows we may order the 
 iron gratings for the lower half, which are de- 
 signed to prevent the child from leaning too far 
 out or falling to the ground. This prevention 
 
62 THE CARE OF THE CHILD IIsT HEALTH 
 
 is, naturally, superfluous in the first year of 
 life ; but it is well, so long as one is fitting up 
 a nursery, to make it complete and thus save 
 the trouble of making additions later on. A 
 further detail is the supplying of two sets of 
 roller shades or blinds for the windows, one of 
 a light color and the other of a dark blue or 
 dark green holland. The latter is to be used 
 in darkening the room at whatever time of day 
 the bahy may be sleeping. As will be seen 
 later on, this is a matter of some importance. 
 
 The floor may be made of hard wood and cov- 
 ered with skin rugs, or of the ordinary soft pine 
 painted and similarly covered. The rugs are 
 designed to give warmth even more than for 
 their decorative effect. Their greater cleanli- 
 ness is the reason for preferring them over car- 
 pets, and, therefore, they must not be so large 
 as to render an easy and frequent removal into 
 the air difficult. Fur rugs make a desirable 
 covering for parts of the floor, especially as they 
 serve, when the child is old enough to like 
 stories, as a basis for all sorts of tales concern- 
 ing animals, strange lands, and adventures. 
 Some able mothers prefer a covering of fine 
 Japanese matting in place of the polished or 
 painted floor, on the ground of its greater 
 
THE BABY'S OUTFIT AND NURSERY 63 
 
 warmth, greater sureness for the foot, and 
 almost equal ease in being kept clean. If a 
 few mats or rugs are strewn here and there, its 
 attractiveness is considerably increased. The 
 covering of the side walls and ceiling deserve 
 the expenditure of thought and taste, for they 
 have much to do with deciding the character of 
 the room and the first formative impression upon 
 the child's eyes. Some good, attractive, ele- 
 mental color should be selected as the main 
 note in the decoration and should be logically 
 and tastefully carried out in the wall, ceiling, 
 and even the furniture. 
 
 But before the decorations are begun one 
 should rehearse clearly what sanitary demands 
 must be answered in this part of the room. 
 These are scrupulous cleanliness, lack of incli- 
 nation to acquire disease germs as well as dirt, 
 and ease in renovation. Obviously, the best 
 surface for such purposes is a smooth, hard, 
 and waterproof one. Therefore, the walls and 
 ceiling should be covered with an oil color, 
 with or without a coat of varnish, or with a 
 paper which may be varnished. For this pur- 
 pose one can now buy some very desirable 
 papers with an attractive pattern showing chil- 
 dren at play, animals sporting and at rest, or 
 
64 THE CARE OF THE CHILD IN HEALTH 
 
 pretty sketches of landscape. Some are even 
 made with a hard, glossy finish which permits 
 washing. This is one of the essential features 
 of every nook and cranny of a well-appointed 
 nursery, for by this means we are able to dimin- 
 ish or prevent the likelihood of various sick- 
 nesses. When the wall-paper is of a decorative, 
 thickly covered pattern, little or no additional 
 ornamentation is needed from pictures ; but if 
 pictures are hung up, they must likewise be of 
 such a nature that they may with impunity be 
 washed, or of so little value that on proper pro- 
 vocation they may be destroyed. These articles 
 are of secondary importance, and with a suf- 
 ficiently decorative paper need be supplied in 
 small quantities or not at all. The main ob- 
 jection to them lies in the possibility which 
 they furnish of collecting dust and harboring 
 germs of disease and fermentation. A similar 
 objection may be made against curtains and 
 portidres, the use of which has the additional 
 objection of increasing the danger of fire. But 
 if they are a part of the furnishing, they must 
 not be placed in close proximity to a gas-jet, a 
 stove, or an open fire of any sort. 
 
 The furniture must follow the same rule of 
 sanitary impeccability. Every piece of it, 
 
THE BABY'S OUTFIT AND NURSERY 65 
 
 besides being light and strong, must offer little 
 opposition to being scrubbed or cleansed. For 
 this purpose the use of enamel paints in any 
 desired colors is highly to be recommended. 
 Thus the chairs should be of wood or wicker, 
 painted white or any other light color ; and if 
 upholstery is desired it may be supplied in the 
 form of cushions, which are to be kept in place 
 by ribbons or tapes. If a sofa or lounge is to 
 have a place in the room, it should be of simi- 
 lar material and similarly covered. The cush- 
 ions should be covered with a waterproof fabric, 
 with or without an additional slip cover of 
 chintz, cretonne, denim, or similar wash goods. 
 In this way one can insure the maximum of 
 comfort, convenience, and cleanliness with the 
 minimum of expense, unnecessary work, and 
 danger of harboring infection. This general 
 plan need not be confined to the pieces here 
 mentioned, but to every article that is sus- 
 ceptible of such treatment. 
 
 The other essentials are a bath-tub, a wash- 
 basin, a toilet chair, a screen, and an ice-box. 
 The bath-tub must be small enough to be moved 
 about with ease, as well as to occupy no ex- 
 travagant amount of space when not in use. 
 One of the best models is made of a large pouch 
 
66 THE CARE OF THE CHILD IN HEALTH 
 
 of rubber cloth suspended from a rectangular 
 wooden frame, which is supported upon col- 
 lapsible legs. This tub is inexpensive, easily 
 handled, and sufficiently high to enable the 
 mother, while sitting comfortably on a chair, 
 to give the bath quickly and thoroughly. In 
 this respect it has a decided advantage over the 
 ordinary type of metal tub, which is so low that 
 it makes the bathing of the child a matter of 
 considerable discomfort for the mother or nurse. 
 Of course, it can be raised by means of a chair 
 or a bench ; but such a device is really a clumsy 
 one. In those favored houses where there is a 
 well-heated bath-room attached to the nursery, 
 the large bath-tub may be covered in part by a 
 temporary wooden grating upon which the 
 baby's tub may rest. This prevents the dis- 
 comfort of the low position, it does away with 
 the danger of splashing the floor, rugs, and 
 furniture with water, and, if the small tub is 
 filled by means of rubber pipes attached to the 
 faucets, requires the least trouble in prepara- 
 tion. But as in most cases the bath-room is 
 not connected with the nursery and, in addi- 
 tion, is almost always colder in winter than the 
 other rooms in the house, it generally cannot be 
 used for this purpose. 
 
THE BABY'S OUTFIT AND NURSERY 67 
 
 The wash-basin is used for all washings other 
 than full baths ; it may be in the form of the 
 ordinary basin, but a better type is where it is 
 divided by a partition which makes two com- 
 partments, one for hot and the other for cold 
 water. The partition should have a handle 
 attached to its upper margin by which the basin 
 may be carried with ease. The toilet chair 
 should be made of painted wood or wicker, so 
 that it cannot be injured by frequent and 
 thorough scrubbings. It should form a part of 
 the first outfit, for its use, as will be later on 
 shown, need not be deferred as long as the 
 present custom demands. The screen should 
 be a serviceable article, not designed for dec- 
 oration alone, and will be found very useful in 
 shielding the child while he is asleep, being 
 bathed, or being dressed. It also should be 
 made of waterproof material which permits of 
 as frequent washing as scrupulous cleanliness 
 demands ; it must be strong, light, and not too 
 large to render its constant handling in any 
 way burdensome. The rule must be made and 
 steadfastly enforced against using the screen, 
 or, in fact, any other piece of furniture in the 
 nursery, for the drying of soiled or damp diapers 
 and other garments. Such a habit is to be 
 
68 THE CARE OF THE CHILD IN HEALTH 
 
 heartily discouraged, for it tends to permit or 
 sanction laziness and lack of cleanliness, which 
 are often followed by skin diseases or other 
 troubles of the child's buttocks and body in 
 general. Whenever any of the garments has 
 been in any way soiled, no matter how slight 
 the soiling may be, it should be thoroughly 
 washed and rinsed in the kitchen or laundry, 
 dried, aired, and ironed before being used. It 
 is so easy to disregard this rule, the tempta- 
 tions — especially to a careless nurse — are so 
 common, and the consequences may be so much 
 out of proportion to the seemingly trivial nature 
 of the offence, that no exceptions should be 
 allowed. 
 
 The ice-box is meant to hold the unused food 
 of a hand-fed infant, or that of a somewhat older 
 child who is yet too young to be fed on the 
 varied diet that comes with later years. It may 
 be made of tin or zinc, and must be so light 
 that its weight offers no objection to frequent 
 washings and airings. Its partitions must be 
 removable, for at least once a week they should 
 be taken out, and the whole structure thoroughly 
 scrubbed and allowed to dry in the sunshine. 
 An ice-box that is not surgically clean is a 
 fruitful source of the "spoiling" or fermenta- 
 
THE BABY'S OUTFIT AND NURSERY 69 
 
 tion of food; and if such fermentation did not 
 exist, a large proportion of the diseases of in- 
 fancy would be unknown. The conscientious 
 observance of these details, and others like 
 them, is the very basis of an uneventful and 
 successful conduct of the infant's career. The 
 importance of the matter may be estimated 
 from the fact that the child during this period 
 is going through one of the crises of his life, 
 that the formative character of the first months 
 has much to say about what he is later on 
 going to be, and that efficient administration 
 of all the minutiae of babyhood should — in 
 order to form a correct conception of their 
 value — be translated into forms of the thoughts 
 and deeds, the physical and mental state, of the 
 future man and woman, as well as those who are 
 dependent upon them. The man who said that 
 he would rather write the songs of a people than 
 make their laws, had enough imagination to see 
 beyond the border-line of facts; but his pro- 
 jected empire would have been vastly increased 
 if he could have made a choice of the customs 
 and habits of young children. 
 
CHAPTER IV 
 
 FEEDING 
 
 The problem of feeding a child is not a par- 
 ticularly difficult one if the mother understands 
 clearly what the baby needs and how to make 
 the various changes and modifications that a 
 normal development necessarily entails. Most 
 of all it is important to grasp a few fundamental 
 principles which are at the basis of nutrition. 
 This question of nutrition is one of the main 
 subjects of thought and effort that an intelligent 
 mother has to reckon with; it constantly re- 
 appears in one form or another, touching upon 
 and involving one interest after the other. In 
 the last analysis it stands for most of what we 
 want a child to be — the personification of vigor 
 and strength of body united with vigor and 
 strength of mind. There is little doubt that 
 mental action is closely bound up with physical 
 competency, in the same way that we know 
 quite positively that disturbed action of the body 
 is usually, if not always, associated with dis- 
 
 70 
 
FEEDING 71 
 
 torted function of the mind. These two factors 
 stand to each other in the relation of comple- 
 mentary parts of an intricate machine and their 
 interdependence is as inevitable as it is inti- 
 mate. Thus the fact of feeding a child comes 
 to have a higher significance than merely satis- 
 fying his hunger; we may go even farther, and 
 say that the feeding of a child means much more 
 than the feeding of an adult. For in the latter 
 the desired object is merely to maintain the set- 
 tled equilibrium of the matured organism, to 
 continue a settled condition. In the former. 
 however, it has the additional burden of sup- 
 plying new elements of growth in order to 
 change an unstable to a stable equilibrium, of 
 making something exist where formerlv it did 
 not exist, of changing tissue to so great a de- 
 gree as to be equivalent to a difference in kind. 
 The feeding of an infant should be restricted 
 to the mother's milk. If this natural food is 
 sufficient in quantity and quality it forms the 
 ideal nourishment. All the needs of the or- 
 ganism are fulfilled, at very little danger of the 
 food's possessing an improper composition or 
 being contaminated with germ life or impurities. 
 Xaturally this is a matter of paramount impor- 
 tance and demonstrates how perfectly nature 
 
72 THE CARE OF THE CHILD IN HEALTH 
 
 adapts means to ends. In addition, however, 
 there is another factor of salient importance 
 which makes the nursing of the child by the 
 mother a matter of the greatest value; for the 
 exceedingly intimate relations tend to promote 
 the bond between parent and child, the mother 
 with every nursing period recognizes that the 
 little one is a very part of herself, and that a 
 very part of herself is contributing to make and 
 maintain his life. The resulting sympathy is 
 and must be exquisitely intimate and gives the 
 possibility of insight into the child's physical 
 and mental being which otherwise cannot be 
 obtained. As far as the baby is concerned, who 
 shall say that he is not mightily influenced by 
 the fluid which means life to him, by the won- 
 derfully close relations with the one who nurses 
 him, by the unconscious absorption of char- 
 acteristics which make up the family person- 
 ality! Such influences are at the bottom of 
 the belief that blood is thicker than water and 
 to their cohesive force the tremendous power 
 of child- and parent-relationship is due. The 
 woman who suckles her baby enjoys a great 
 opportunity, for which she ought to be deeply 
 grateful, to assist in moulding him into the form 
 that he ultimately will assume; and nothing but 
 
FEEDING 73 
 
 absolute necessity should induce her to throw 
 away this great privilege. 
 
 In some cases, however, on account of physi- 
 cal incompetency or sickness, she is compelled 
 to forego her privilege and duty. When this 
 necessity has been demonstrated as a fact, she 
 should promptly acquiesce in it, as she should in 
 any other misfortune. Once that the milk has 
 been shown to be too deficient for its purpose, 
 the child should be weaned and a substitute food 
 be given in its place. There should be no hesi- 
 tation or compromise in this, nor should the baby 
 be fed in part on an artificial food and in part 
 on the breast. For if the mother's milk is 
 markedly imperfect, it continues so to be, 
 whether an artificial food is or is not added; and 
 the result is apt to be a continued state of 
 imperfect nutrition. This is apt to be the case 
 where the mother is of an overnervous, hys- 
 terical disposition, if she is markedly unhappy, if 
 she is thoroughly exhausted, or if she regulates 
 the factors of rest, diet, exercise, and relaxation 
 so poorly that a normal secretion of milk is out 
 of the question. Here the quality of the milk 
 may be so bad or it may vary so widely from 
 day to day that a gradual but real starvation 
 must necessarily be present. 
 
74 THE CARE OF THE CHILD IN HEALTH 
 
 An exception should be made of those cases, 
 which are to be distinguished by the physician, 
 where the error in the constitution of the milk 
 is merely temporary, or due to some passing 
 condition in the mother. Thus the total quan- 
 tity may be too small, although the quality is 
 good; in this case an increase in the amount of 
 liquids in her diet will often remedy the fault. 
 In other cases the quantity may be too great, 
 but it can be reduced by the opposite means of 
 reducing the amount of fluids consumed. If 
 the milk is too watery, its relative amount of 
 solids may be increased by taking less exercise, 
 decreasing the quantity of fluids consumed and 
 shortening the intervals between the feedings. 
 If the milk is not watery enough, a desirable 
 effect may be produced by reversing these sug- 
 gestions. The amount of cream or fat in it may 
 be increased by adding more meat to the diet, 
 and lessened by eating less meat. The proteids 
 are increased by a more sedentary life, and 
 decreased by adding largely to the amount of 
 exercise. These rules are naturally meant to 
 apply to cases of minor disturbances, and, if 
 they are carried out with the aid of a competent 
 physician, will undoubtedly be of considerable 
 use. In general, however, the wisest course for 
 
FEEDING 75 
 
 a nursing mother to pursue is to eat regularly 
 and liberally of a sensible diet that includes 
 soups, meats, fresh vegetables, eggs, and meats; 
 she should avoid pastries, hot breads, con- 
 diments, and articles that her ordinary expe- 
 rience and knowledge have demonstrated to be 
 indigestible. Milk especially should have an 
 important place in the daily dietary, and in ad- 
 dition may be the basis of a light meal that 
 should be taken before retiring for the night. 
 In many ways it is superior to the ordinary 
 alcoholic drinks, whose value as milk producers 
 is apt to be overestimated. 
 
 When, in spite of well-directed efforts to 
 conform to a normal and rational plan of diet, 
 exercise, and self-control, the supply of milk is 
 unsatisfactory, a choice must be made between 
 hand-feeding and a wet-nurse. Theoretically 
 the latter has much to recommend her, but prac- 
 tically her selection has many weighty objec- 
 tions. In most cases she is the victim of 
 unhappiness, ill-treatment, or viciousness ; very 
 often she comes from a decidedly unfavorable 
 class of society; her habits — either secret or 
 avowed — are commonly bad, and the change 
 from comparative poverty to the luxury that is 
 lavished on her for the sake of her foster-child 
 
76 THE CARE OF THE CHILD IN HEALTH 
 
 is apt to be demoralizing. Too commonly one 
 sees such a woman — ignorant, lazy, and wrong- 
 headed — elevate herself into the position of a 
 petty tyrant, who domineers over the whole 
 household by means of her influence with the 
 child, and the common fear of interfering with 
 his food supply. The position naturally lends 
 itself to the possibility of abuses, and the 
 temptation for an undisciplined woman to take 
 advantage of it is certainly strong. Besides 
 all this, the psychical effects of the intimate 
 relation are of undoubted, even if indefinite, 
 importance, and offer a constant menace to the 
 mother's peace of mind. Of course, if an 
 unobjectionable person could be obtained, one 
 who was between twenty and thirty years of 
 age, who was quite healthy, with an entirely 
 good milk supply, whose habits were unim- 
 peachable, who had had a previous child, 
 whose temper was even and well controlled, 
 whose disposition was peaceful and affection- 
 ate, and whose outside connections were not 
 embarrassing, the problem of substitute feeding 
 would offer less difficulty than is usually 
 encountered. 
 
 Practically, the only other method that re- 
 mains, if we discard the wet-nurse, is the use of 
 
FEEDING 77 
 
 ordinary cow's milk which has been sufficiently 
 modified to make it approximate as closely as 
 possible to mother's milk. Occasionally an 
 attempt is made to use goat's milk or ass's milk; 
 but the difficulty in obtaining it is so great, the 
 supply is necessarily so limited (one ass giv- 
 ing no more than one-half pint to one pint per 
 day), and the composition would nevertheless 
 so clearly need modification, that we can, as a 
 rule, get more satisfactory results from good, 
 pure, cow's milk. Having decided that this is 
 to be the basis of the food, one is then con- 
 fronted by the vexing question of boiling it or 
 leaving it raw, of sterilizing, pasteurizing, or 
 peptonizing it. The original objection to raw 
 milk was not at all a chemical, but merely a 
 hygienic one. Physicians came to know that 
 it often served as the carrier of disease germs. 
 Thus, tuberculosis, typhoid fever, diphtheria, 
 and other sicknesses have spread, so that almost 
 all the disorders that afflict cows, the farm- 
 hands, and the milk handlers have been, at one 
 time or another, attributed to the use of the 
 unboiled fluid. Moreover, if the cans and pails 
 are not kept scrupulously clean, various degrees 
 of fermentation occur that give rise to diarrhceal 
 troubles and low forms of poisoning. In order 
 
78 THE CARE OF THE CHILD IN HEALTH 
 
 to avoid such contingencies, the practice of 
 boiling the milk in order to kill the germs came 
 into use. Before a long time passed, physicians 
 began to notice that while the amount of germ 
 disease decreased, the number of cases of mal- 
 nutrition decidedly increased; and, promptly 
 enough, the cause was traced to the alteration 
 in the character of the milk produced by the 
 boiling. This alteration consisted of coagula- 
 tion and increased difficulty in digesting the 
 albumin, changes in the milk-sugar, and 
 changed relations of the emulsion in which the 
 fats were suspended. The result was, that 
 children were taking a food that was materially 
 different from what it originally was supposed 
 to be, and on account of which they ceased to 
 thrive. 
 
 In order to do away with these evil effects, 
 but at the same time to kill the germs, the 
 process of sterilization was devised. This con- 
 sists of subjecting the milk to a temperature of 
 212 ° F. for a comparatively long time. Most 
 germs were thus destroyed, while it was hoped 
 that the milk would nevertheless be good. 
 Extended experience showed that a sterile milk 
 could disappoint our expectations of its nour- 
 ishing powers, and that many children who had 
 
FEEDING 79 
 
 been carefully fed in this way became afflicted 
 with scurvy as well as less pronounced forms of 
 malnutrition. Then a further change was made 
 by reducing the amount of heat to 167° F. and 
 cutting down the length of exposure to it ; this 
 process, called pasteurization, was intended to 
 undo the evils of sterilization, as sterilization 
 was intended to reform those of boiling. Unfor- 
 tunately there are observers who find bad results 
 from the use of pasteurized milk, and who are 
 therefore forced to go back to sterilization, or to 
 strike at the root of the whole trouble by insist- 
 ing upon an uncontaminated milk, which they 
 refuse to alter by heat. There is no doubt that 
 such milk has marked advantages over all 
 others, but until of late it could not be had. 
 In recent times, however, state inspection of 
 cattle has done much to clear tuberculosis from 
 the herds, and there are a number of dairy-farms 
 where the animals, their stalls, the utensils, the 
 clothes and the hands of the milkers and milk 
 handlers are kept so clean that the danger 
 of infection is reduced to a minimum. In 
 addition, also, to such care in collecting and 
 handling it, the milk should before it leaves 
 the farm be poured into bottles, which then are 
 to be packed in ice or in refrigerated compart- 
 
80 THE CARE OF THE CHILD IN HEALTH 
 
 ments, and thus kept at a low temperature until 
 it is delivered to the consumer. The essence 
 of the precautions is to have milk from a 
 healthy, well-fed cow or herd of cows, w T hich 
 has not been allowed to be contaminated by im- 
 pure contact or air. 
 
 But even if the milk is quite pure, it is not, 
 on account of its chemical composition, ready 
 for use. Both cow's milk and human milk 
 contain the same elements, but not in the same 
 relative proportions. These elements we know 
 as proteids, or albuminous matter, fats (com- 
 monly called cream), sugar, mineral salts, and 
 water. An analysis of them shows their relation 
 clearly : — 
 
 Human milk. Cow's milk. 
 
 Fat 3.50% 3.50% 
 
 Milk-sugar 6.50 4.30 
 
 Proteids 1.50 4.00 
 
 Mineral salts 0.15 0.70 
 
 Water 88.35 87.00 
 
 The main difference, as we can easily see, lies 
 in the proportion of proteids ; the smaller varia- 
 tions in the sugar and salts are of no great 
 importance. And not only is the percentage of 
 proteids greater in cow's milk, but also the 
 character of the material is different. Before it 
 can be digested, it becomes coagulated by the 
 
 
FEEDING 81 
 
 acid and the gastric juice into a comparatively- 
 hard mass; in human milk, however, it is 
 changed into fine, soft flakes, which, on account 
 of their form, offer a larger surface to the digest- 
 ing agents, and thus are easily and quickly 
 changed into the ultimate condition in which 
 such material is absorbed into the circulation. 
 The main problem, then, has always been to 
 modify the milk in such a way that the proteids 
 would be reduced by one-half or more, while the 
 other constituents remained practically the 
 same. It was for this purpose that "milk 
 laboratories " have been established in some of 
 the large Eastern cities, whose business it is to 
 prepare milk for infants according to the formula 
 which the physician submits to them. While 
 this is the easiest way to obtain a properly 
 modified milk, it is, unfortunately, out of the 
 reach of most families for the two good reasons 
 of locality and expense. The great need is 
 to spread the knowledge of how to modify the 
 milk at home without too much trouble and 
 expense. 
 
 Although it is not feasible to give all the 
 directions necessary for modifying milk to suit 
 the various needs of children whose digestive 
 systems are in an abnormal condition, it is dis- 
 
82 THE CARE OF THE CHILD IN HEALTH 
 
 tinctly desirable to describe an easy method of 
 preparing a suitable milk for a healthy child. 
 To do this, one needs nothing more than the 
 cream of good milk and a definite solution of 
 milk-sugar. If a bottle of milk be placed on 
 the ice for five hours, the cream will rise in such 
 an amount as to constitute 8% of the whole; if 
 it is allowed to stand six hours, it will consti- 
 tute 12%. The cream, after having been 
 allowed to rise, should be decanted off into a 
 clean bottle, and used according to the follow- 
 ing directions. The milk-sugar may be made 
 in a solution with boiled or distilled water by 
 any druggist or at home. In the following 
 mixtures a 7% sugar solution and a 10% sugar 
 solution are employed. For a child of two 
 months or less, we may prepare a mixture con- 
 taining the small proteid percentage which his 
 age calls for in the following proportion : — 
 
 Fat 3% 
 
 Sugar 6 
 
 Proteids 1 
 
 To make such a mixture one should use one 
 part of the 12% cream and three parts of a 7% 
 sugar solution. Mix well. 
 
 For a child from three months to one year of 
 
FEEDING 83 
 
 age, one may increase the amount of proteids, 
 as in this formula : — 
 
 Fat 3.5% 
 
 Sugar 6.0 
 
 Proteids 1.2 
 
 In making this mixture, one should take one 
 part of the 12% cream and two and one-half 
 parts of a 7% sugar solution. This, likewise, 
 must be well mixed. 
 
 For the two months succeeding the first year, 
 the proteids may be yet further increased, as : — 
 
 Fat 4% 
 
 Sugar 7 
 
 Proteids . . 2 
 
 This is made by mixing equal parts of the 
 8% cream and a 10% sugar solution. 
 
 A sufficient quantity of the desired mixture 
 may be made to serve for twenty-four hours. 
 It should immediately be poured into as many 
 bottles as there are feedings, each bottle should 
 be corked with a plug of aseptic absorbent cot- 
 ton, and all should then be put on ice. Each 
 one before being used should be warmed by being 
 immersed in hot water, the cotton plug removed, 
 the nipple should then be adjusted, and the 
 preparations are thus completed. If any milk 
 remains in a bottle, it must under no circum- 
 
84 THE CAKE OF THE CHILD IN HEALTH 
 
 stances be used again, but should immediately 
 be thrown away. As one can easily see, it is 
 not hard to know exactly how much to prepare ; 
 therefore there could then be no waste, and the 
 work will be done at one time and quickly. 
 All this is easily determined by making out a 
 plan of the number of feedings per day, the 
 time of each, the quantity of each, and the total 
 quantity, as follows : — 
 
 Scheme for feeding an Infant, with Intervals and 
 Quantities 
 
 
 INTERVALS 
 BETWEEN 
 FEEDINGS 
 
 AMOUNT IN 
 EACH BOTTLE 
 
 NUMBER OF 
 FEEDINGS 
 PER DAY 
 
 TOTAL 
 AMOUNT 
 
 1 week 
 
 2 hours 
 
 1 ounce 
 
 10 
 
 10 ounces 
 
 2 weeks 
 
 2 " 
 
 lh ounces 
 
 10 
 
 15 " 
 
 3 " 
 
 2 " 
 
 2 " 
 
 10 
 
 20 " 
 
 2 months 
 
 2 " 
 
 21 " 
 
 10 
 
 25 " 
 
 2| " 
 
 2\ " 
 
 3 " 
 
 9 
 
 27 " 
 
 3 " 
 
 2| " 
 
 Sh " 
 
 8 
 
 28 " 
 
 4 " 
 
 3 M 
 
 4J " 
 
 7 
 
 29 " 
 
 5 " 
 
 3 " 
 
 41 " 
 
 7 
 
 31* " 
 
 6 " 
 
 3 " 
 
 51 " 
 
 6 
 
 33 " 
 
 7 " 
 
 3 " 
 
 6| " 
 
 6 
 
 39 " 
 
 8 " 
 
 3| " 
 
 7 
 
 6 
 
 42 " 
 
 9 " 
 
 Sh " 
 
 7 
 
 6 
 
 42 w 
 
 10 " 
 
 31 " 
 
 81 " 
 
 5 
 
 42| " 
 
 11 " 
 
 3i " 
 
 81 " 
 
 5 
 
 44 <{ 
 
 12 " 
 
 3i « 
 
 9 
 
 5 
 
 45 " 
 
 13 and 14 mo. 
 
 4 " 
 
 10 
 
 5 
 
 50 " 
 
 
 
FEEDING 85 
 
 Let us take a few examples and see how easily 
 the work is done. Suppose we wish to prepare 
 the food for a baby six days old. We need 
 ten ounces of milk, which is made up of 
 
 one part of 12% cream, or , 2J oz. 
 
 and three parts of 7% sugar solution, or .... 7 J oz. 
 
 Total, 10 oz. 
 
 As for this time of life there should be ten 
 feedings per day, the mother had best have the 
 ten bottles ready when the mixture is made; 
 they may all be filled at one time, stoppered, 
 and put on the ice until needed. 
 
 Again, suppose the child is six months of age. 
 For this period there should be thirty-three 
 ounces of food, which would be composed of 
 
 one part of 12% cream, or 9J oz. 
 
 and two and one-half parts of 7% sugar solution, 
 
 or 23f oz. 
 
 Total (approximate), 33 cz. 
 
 Since there are to be six feedings, six bottles 
 must be prepared, each containing five and 
 one-half ounces. 
 
 Again, suppose we want to prepare the milk 
 for a baby of twelve months. The quantity 
 is to be forty-five ounces. We then need 
 
86 THE CARE OF THE CHILD IN HEALTH 
 
 one part of the 8% cream, or 22J oz. 
 
 add one part of a 10% sugar solution, or . . . 22J oz. 
 
 Total, 45 oz. 
 
 This quantity is to be divided into five 
 bottles, each of which contains nine ounces. 
 As in the other cases, all the bottles are to be 
 stoppered with aseptic cotton, and placed upon 
 ice until used. 
 
 One more detail may be required in some 
 cases: the normal reaction of human milk is 
 slightly alkaline. Since cow's milk is fre- 
 quently neutral or slightly acid, we may add a 
 small quantity of lime-water to make the desired 
 change. The necessity of the change is ascer- 
 tained by dipping a small piece of red litmus 
 paper, which any druggist or chemist will 
 supply, in the cow's milk and finding that it 
 is turned somewhat blue. A neutral reaction 
 gives no change at all, while an alkaline milk 
 will change blue litmus paper red. If the milk 
 on several testings has shown itself acid or 
 neutral, the lime-water may regularly be added 
 in the proportion of from 3% to 5% to the water 
 in which the milk-sugar is to be dissolved. 
 
 A most important detail of hand feeding is 
 the care of the bottles and nipples. If they are 
 not scrupulously clean, particles of milk adhere 
 
FEEDING 87 
 
 to them, decompose, and give rise to a large 
 number of gastric and intestinal diseases, such 
 as vomiting, diarrhoeas, and summer complaint. 
 In most cases such disorders ought not to exist, 
 and the child who suffers frequently from them 
 has a just cause of complaint against the mother. 
 Such cleanliness is insured by scrubbing, boil- 
 ing, and rinsing the bottles, nipples, and all the 
 utensils which are used in the daily preparation 
 of the milk. Each bottle as soon as it is used 
 should be thoroughly washed with soap and 
 water and a bottle cleaner ; it ought then to be 
 boiled for from twenty to thirty minutes, and, 
 finally, put in a solution of borax until it is 
 wanted the next morning. Before being used, 
 it should be thoroughly rinsed with hot water. 
 The nipples, as soon as a feeding has ended, 
 should be drawn on to a finger, scrubbed with 
 a brush, soap, and water; they may then be 
 turned inside out, replaced on the finger, and 
 again scrubbed. They may, as the next step, be 
 thoroughly washed in hot water, and, finally, be 
 thrown in the borax solution until used again, 
 when they must be well rinsed. These nipples, 
 in order to be easily manipulated, should have a 
 plain, conical shape, somewhat like a dunce's 
 cap, and should be made of plain black rubber, 
 
88 THE CARE OF THE CHILD IN HEALTH 
 
 with an aperture that is not too large. The 
 bottle should preferably be tubular in form, 
 with gradations which mark the ounces and 
 half ounces blown into the side. All attempts 
 at decreasing the labor involved in feeding the 
 child, by air vents in the nipple, rubber tubes 
 connecting the nipple and bottle, and variation 
 in the shape of the bottle on account of which it 
 need not be held, are bad, and ought to be dis- 
 couraged. Such devices make surgical cleanli- 
 ness impossible, they promote laziness, diminish 
 the rightful attention which the child deserves 
 and demands, and serve as prolific sources of 
 serious sickness. The feeding of a child is 
 important enough to call for the nurse's undi- 
 vided attention, and anything which interferes 
 with this duty must sooner or later have vi- 
 cious results. During the process the child 
 should be held in the arms, and the bottle 
 must be so inclined that the nipple is almost 
 full; in this manner the flow of milk can easily 
 be regulated to suit the baby's capacity to 
 drink, while at the same time the possibility 
 of sucking on an empty nipple is obviated. 
 The habit of permitting a child to take a frac- 
 tion of his food, to sleep or play or become 
 irritated by a bad position, and then to begin 
 
FEEDING 89 
 
 nursing again after the milk has become more 
 or less chilled and stale, must not be tolerated. 
 
 Yet another method of feeding is that which 
 does away entirely with bottles and nipples, 
 and substitutes in their place a cup and tea- 
 spoon. This change has much to recommend 
 it, for it does away with the labor of keeping 
 the bottles and nipples clean, and simultan- 
 eously diminishes the danger of infection of 
 the gastro-intestinal track. Likewise it pre- 
 vents too rapid nursing, as well as "wind 
 sucking"; the feeding is completed at one 
 sitting, and the child's habits in general are 
 better kept under control. One of its main 
 advantages is the ease with which it allows 
 weaning to be accomplished. In this period of 
 the child's life the main difficulty lies in replac- 
 ing the bottle with a spoon, and everybody 
 knows the disturbances which are apt to result. 
 Under the circumstances suggested above, these 
 disturbances would not exist, and the baby 
 would go from one stage of his youthful career 
 to the succeeding with almost no evidences of 
 struggle. 
 
 Something ought to be said concerning the 
 use of the proprietary foods which are so exten- 
 sively advertised and widely employed in all 
 
90 THE CARE OF THE CHILD IN HEALTH 
 
 classes of society. If one wishes to make a 
 general statement, one is quite safe in con- 
 demning them all along the line. They really 
 have no good reason for existence — outside of 
 the purely commercial one which gives profit- 
 able employment to their manufacturers. The 
 artificial food has never been made which can 
 adequately take the place of pure, fresh milk, 
 properly modified. The fact that hundreds of 
 children have grown and thrived upon them has 
 little to do with the question ; for many children 
 are so vigorous that they will thrive upon all 
 manner of food-stuffs which we know are meant 
 for older stomachs. As I heard a bright woman 
 once remark, " There are some babies that you 
 can't kill." In regard to such children the 
 question is not how well the little ones develop 
 on this or that food, but rather, how much 
 better they would have developed on a properly 
 modified milk. To such origins we can trace a 
 large proportion of all cases of rickets, infantile 
 scurvy, and a seemingly endless series of obsti- 
 nate cases of malnutrition and malassimilation. 
 The various foods may be divided into certain 
 classes, whose methods of manufacture are not 
 radically dissimilar. Thus, the Liebig foods, 
 such as Horlick's Food, Mellin's Food, Malted 
 
FEEDING 91 
 
 Milk, and Hawley's Food, represent a combina- 
 tion of flours which have been treated with 
 diastase until the starch is changed into forms 
 of sugar, called maltose and dextrine. The 
 milk foods, such as Nestle 's, the various Swiss 
 foods, and Gerber's Food, represent condensed 
 milk which has been sweetened and supple- 
 mented with dextrinized flour. The farinaceous 
 foods, such as Ridge's Food, Imperial Granum, 
 Robinson's Patent Barley, and Hubbell's Pre- 
 pared Wheat, usually consist of a combination 
 of flours, the starch of which has been partly 
 converted into sugar. Carnrick's Soluble Food 
 consists for the most part of sugar and starches ; 
 Lactopreparata has about the same composition, 
 but in it milk-sugar replaces a part of the starch. 
 Lactated Food is composed mostly of sugars and 
 starches. The Peptogenic Milk Powder of 
 Fairchild consists of pancreatin, lactose, and 
 alkaline milk salts. The condensed milks 
 represent ordinary cow's milk which has been 
 evaporated in a vacuum, sterilized, and sweet- 
 ened with cane sugar. The unsweetened 
 variety can also be obtained. 
 
 The main fact to be kept in mind is that, 
 whether such foods approximate more or less 
 closely to natural milk, they must and do 
 
92 THE CARE OF THE CHILD IN HEALTH 
 
 necessarily lose something of their vitality, of 
 their nutritive value, in going through the 
 process of handling and manufacture. Not 
 counting the fact that they are commonly over- 
 rich in proteids, and that they vary in the per- 
 centage of fat, they are not as wholesome, not 
 as invigorating as fresh milk. There are secrets 
 in the products of cell activity which we have 
 never been able to discover, and among them is 
 that profound problem of trying to imitate this 
 result of nature's work which is so familiar to 
 us, and at the same time so inscrutable in the 
 mystery of its making. This is at the basis of 
 all our failures at making an artificial food; 
 and until the problem is solved Ave should use 
 the artificial foods, such as are commonly sold, 
 only as a last resort. 
 
 Closely connected with this matter is the 
 subject of weaning. The change from the 
 breast to the bottle is commonly synonymous 
 with domestic disturbances, with unquiet 
 nights and days. In many, if not in most 
 cases, the natural difficulties of the situation 
 are emphasized and exaggerated by a lack of 
 conviction and a want of firmness in the par- 
 ents. This vacillation is an unfortunate char- 
 acteristic of many mothers, and has a strong 
 
FEEDING 93 
 
 tendency to diminish authority; at the same 
 time it has the equally important — some people 
 think more important — effect of lessening the 
 functional activity of the stomach. 
 
 As was shown on page 82 the feeding should 
 take place at regular intervals, and nothing 
 should be allowed to interfere with this regu- 
 larity; even if the child is asleep, he may with 
 profit be wakened when the proper time for 
 nursing comes. If this course is pursued he 
 will not only contract habits of regularity but 
 also will sleep more quietly in the intervals 
 and at night. A little firmness of intention 
 may be demanded of the mother to inaugurate 
 and carry out such a plan, but the reward in the 
 way of increased rest and comfort for both 
 mother and child will amply repay the effort. 
 It will be noticed that the amount of time 
 laid out by the schedule for each day does 
 not cover four-and-twenty hours; in the re- 
 mainder the child is not supposed to receive 
 any food at all, on the double principle of 
 giving the child's stomach an opportunity to 
 rest and at the same time developing a habit 
 which permits both mother and child to sleep. 
 The period of rest should be confined to the 
 middle of the night, and will usually be man- 
 
94 THE CARE OF THE CHILD IN HEALTH 
 
 aged with ease if the schedule during the day- 
 is carefully maintained. When weaning is 
 called for, the strict habit thus developed will 
 be found to be of marked value. Under ordi- 
 nary, normal circumstances the transition 
 should take place when the child is one year 
 old, and in most cases the process ought to 
 be gradual rather than abrupt. One of the 
 breast feedings may be replaced by a hand 
 feeding ; then, one or two days later, two hand 
 feedings may be substituted, and thus one may 
 continue until the breast is left untouched. 
 During all this time, the integrity of the night 
 must be kept untouched. The mother should 
 be steadied by the conviction that one ill-timed 
 yielding is apt to break up the habit of weeks, 
 and that while thereby gaining a few minutes 
 of peace she loses many hours of rest. 
 
 Under some circumstances, such as preg- 
 nancy, wearing out of the milk supply, or 
 acute sickness of the mother, the change may 
 have to be made before the beginning of the 
 second year. In the last-mentioned contin- 
 gency, where the necessity for artificial feed- 
 ing is no more than temporary, the milk may 
 be prevented from drying up by the consistent 
 use of the breast-pump. In the other events 
 
FEEDING 95 
 
 the best course of action is to recognize the 
 necessity of the case, and to make the change 
 without too prolonged waiting. On the other 
 hand, when the normal nursing period closes in 
 the latter half of the summer, the child may be 
 kept at the breast, so long as the quality and 
 quantity of the milk are sufficient, for a short 
 additional period, in order to reduce the possible 
 dangers of gastric infection that are greatest 
 during the hot weather. This prolongation of 
 breast feeding must be made with the full 
 knowledge that the quality of the milk is apt 
 suddenly to deteriorate, as well as the fact that 
 in the beginning of the second year the diet 
 normally calls for a food-composition and food- 
 bulk which human milk cannot supply. Finally, 
 when the child has definitely been taken from 
 the breast, the flow of milk may be checked by 
 tightly bandaging the breasts, or wearing a 
 strong, sleeveless waist which has been snugly 
 fitted to the form, and may be tightly pinned. 
 
 During the second year the foundation of the 
 food must be good, wholesome, cow's milk. 
 After the fourteenth month of age, most healthy 
 children are able to digest it in its plain, 
 unmodified form; but if any difficulty remains, 
 it is almost always on account of the large 
 
96 THE CARE OF THE CHILD IN HEALTH 
 
 quantity of proteids. In such a case the use of 
 the last modification, given on page 81, is to 
 be continued. An additional element may now 
 be supplied in the way of the various cereals ; 
 these are to be made into a thin gruel or jelly, 
 strained, and mixed with milk. When the 
 little one has demonstrated his ability to digest 
 these articles, clear soups, from which the fat 
 has been removed, may now and then form a 
 part of the diet; next a well-baked apple, stewed 
 prunes, and orange juice may by degrees be 
 allowed. As the middle of the year approaches, 
 he may eat a piece of zwieback, well-toasted, 
 stale wheat bread, or toasted biscuit which has 
 been dipped in milk. The next step takes him 
 to where he may have a poached or soft-boiled 
 egg^ scraped rare beef, and stale bread. Natur- 
 ally, all these things are not to be given at one 
 meal. At this time it is unnecessary to strain 
 the cereals as thoroughly as in the earlier 
 months. 
 
 As a summary, one may lay out such a menu 
 for a healthy child of fifteen months : — 
 
 6.30 a.m., cup of milk with toast or zwieback. 
 
 10.00 A.M., strained oatmeal with milk; 
 toasted or crisp biscuit; orange juice; stewed 
 or baked apple. 
 
 ; 
 
FEEDING 97 
 
 1.30 p.m., clear soup, chicken, beef, or 
 mutton broth; piece of stale or toasted bread. 
 
 5.00 p.m., cup of milk; crisp soda biscuit or 
 zwieback. 
 
 7.00 p.m. (just before going to sleep), cup of 
 milk. 
 
 The question of feeding this growing child is 
 now becoming a very active one. The mother 
 must keep to the golden mean between too strict 
 and too liberal a diet, for the one is about as 
 bad as the other. She must know that there are 
 definite needs to be subserved which must be 
 closely understood. Good intentions alone are 
 not sufficient, nor is the mere fact of a bounti- 
 ful supply of food the only thing to be desired. 
 She must know that the uses of food are vari- 
 ous: to make new tissue, to repair waste of 
 tissue, to act as fuel, to supply a reserve force 
 for future emergencies, and to act as a guard 
 against the exhaustion of tissue or the stored-up 
 supplies of other food derivatives. In order to 
 do this, certain elements of food must be present 
 in sufficient amount, and must be thoroughly 
 digested. The great difficulty in infantile life 
 lies in the way of this sufficient assimilation. 
 Thus the diet should be made up of fats, pro- 
 teids, sugars and starches, mineral salts, and 
 
98 THE CARE OF THE CHILD IN HEALTH 
 
 water. The fats go to make up fatty tissue, 
 and at the same time serve as fuel ; the proteids, 
 also called nitrogenous foods, are used to make 
 muscular and tendinous tissue, and likewise to 
 give heat; the sugars and starches go to make 
 fatty tissue and to give heat. The mineral 
 salts have various chemical uses that require no 
 special mention. In infancy, the carbohydrates 
 and fats hold a very important place, since they 
 serve to develop bodily heat and to produce 
 fat. As the child increases in age, the proteids 
 must occupy a more important position, since 
 they are the basis of muscular growth which 
 progressively becomes more necessary. As 
 examples of these various kinds we may select 
 as representing the proteids, eggs, meats, milk, 
 fish, gluten of wheat. As examples of fats we 
 may mention butter, fat of meat, sweet oil, 
 olive oil, the oils in some cereals. Among the 
 carbohydrates are sugars and starches as they 
 occur alone and in combination, as, for instance, 
 in such vegetables as potatoes, and in cereals. 
 
 These various foods, while different in com- 
 position and process of assimilation, have the 
 same general function of supplying energy in 
 the form of muscular power and heat; and 
 although the amount of potential energy con- 
 
FEEDING 99 
 
 tained in the fats is equal to the combined 
 amounts in the proteids and carbohydrates, 
 nevertheless the needs of the youthful body and 
 its faculty of absorption render the change from 
 the small proteid percentage of infancy to the 
 larger one of later childhood necessarily slow. 
 For in the earlier period the predominant need 
 of the organism lies in the combination of heat 
 and protection rather than the various forms of 
 more active energy; and as the child increases 
 in development, the augmented action of body 
 and mind calls for additional fuel that is 
 designed to subserve these functions. As the 
 need for so-called concentrated foods increases, 
 the added means for helping in digesting them, 
 such as the cutting and grinding action of the 
 teeth and the additional caustic nature of the 
 gastric secretion, simultaneously come into 
 existence. The gastric juice of infancy has 
 little corrosive action; it is not capable of dis- 
 solving cell envelopes, and its development 
 into its later form is very gradual. Morever, 
 when that later and more potent form is reached, 
 every effort must be made to keep the food as 
 pure and as normal as possible. Thus there is 
 no need for the pungent and aromatic spices, 
 since these things are used as whips to drive a 
 
 U of Q t 
 
100 THE CARE OF THE CHILD IN HEALTH 
 
 jaded appetite and digestion; there are strong 
 objections against preserved, pickled, smoked, 
 and dessicated articles, for they have been 
 changed from their normal condition on account 
 of economical reasons or because the adult 
 palate longs for a greater variety than more 
 nutritious food gives; likewise, cakes, pies, 
 and fresh breads are undesirable, not on account 
 of their chemical constitution, but because their 
 physical condition permits of the formation in 
 the stomach of a large, soggy mass, the exterior 
 of which only is affected by the gastric secre- 
 tions, while the interior remains unchanged; 
 bran bread may often be profitably substituted 
 for wheat bread, but the first as well as the second 
 should not be used until it is stale ; coffee and 
 tea are also to be forbidden, since they contain 
 almost no nourishment, but, on the other hand, 
 have alkaloids whose action on the nervous sys- 
 tem is unnecessary and undesirable for children. 
 Again, fried foods of all sorts must not be 
 allowed, outside of any consideration of what 
 they contain, on the ground that the rapid 
 cooking, the high degree of heat used, and the 
 tough coating of deteriorated fat produce an 
 envelope which is hard to digest, while the 
 inner portion is usually affected in unequal 
 
FEEDING 101 
 
 degrees in its various planes. The object in 
 cooking food is to produce chemical changes 
 which promote ease of digestion, greater poten- 
 tial solubility and assimilation, the develop- 
 ment of extractives and aromatic substances in 
 the food, and the stopping of fermentative 
 action and bacterial life. These results are 
 best obtained by boiling, baking, roasting, 
 and broiling; and, as a rule, they must be 
 thoroughly enough conducted to have the 
 resulting changes take place through the 
 whole substance of the food. 
 
 In making out the plan for the feeding after 
 fifteen months, we may reduce the number of 
 meals to four, and at the same time increase 
 the number of articles, as in the following : — 
 
 Breakfast, 7 A.M. Cup of hot milk; stale 
 bread or toast with butter; well-cooked oatmeal 
 with cream or milk, but no sugar. 
 
 Lunch, 11 a.m. Cup of hot milk with bread 
 or toast and butter; in place of the bread or 
 toast one may give zwieback or crisp biscuit. 
 
 Dinner, 2.30 p.m. Cup of clear meat soup or 
 broth from which the fat has been skimmed. A 
 very small portion of scraped beef or beefsteak, 
 or the bone of a lamb chop on which the child 
 may bite and suck. He may have a piece of 
 
102 THE CARE OF THE CHILD IN HEALTH 
 
 bread, or baked or mashed potatoes and meat 
 juice. For a sweet he may eat a small bit of 
 curds and whey, custard, junket, rice pudding, 
 or bread pudding. Of course all these dishes 
 are not supposed to be given at one meal; the 
 mother is supposed to make an intelligent choice, 
 and vary the menu from time to time. 
 
 Supper, 6.30 p.m. Cup of hot milk with 
 bread and butter. 
 
 From the age of one and one-half to three 
 years the bill of fare may read as follows : — 
 
 Breakfast, 7 a.m. Clear juice of an orange, 
 or the pulp of a baked apple, or apple sauce, or 
 stewed prunes; hot milk; well-cooked oatmeal 
 or cracked wheat or rice ; stale bread or toast 
 with butter. When the child is two years old 
 he may have the half of a soft-boiled or poached 
 egg; at two and one-half years of age he may 
 get a whole egg. 
 
 Lunch, 11 a.m. Hot milk; stale bread and 
 butter, or zwieback, or crisp biscuit. 
 
 Dinner, 2 p.m. Plate of clear meat soup or 
 broth from which the fat has been skimmed. A 
 small piece of roast beef, broiled steak, or lamb 
 chop, breast of chicken, or bone of chicken or 
 lamb chop. Whatever meat he receives must 
 be scraped or cut into very small pieces. 
 
FEEDING 103 
 
 Bread and butter; baked, mashed potatoes with 
 meat juice; boiled rice with cream, rice pud- 
 ding, bread pudding, curds and whey, junket, 
 custard, stewed prunes with or without rice. 
 
 Supper, 6.30 p.m. Hot milk with bread and 
 butter; milk toast. 
 
 After the child is over three years old his diet 
 may be gradually enlarged. The meals should 
 be reduced to three ; but it will often be neces- 
 sary to give a hungry youngster a glass of milk 
 at half after ten in the morning, and possibly 
 again at three in the afternoon. All foods 
 must be plain, without other seasoning than 
 salt; there should be no fried foods, "made" 
 salads, no pickles or other relishes, no cakes, 
 pies, coffee, tea, beer, or wines. The breakfast 
 may be about half after seven o'clock, and 
 should consist of fruit (orange, baked banana, 
 baked apple, or stewed prunes), well-cooked 
 oatmeal, cracked wheat, hominy, rice, or farina ; 
 boiled, poached, or scrambled eggs; hot milk; 
 stale bread or toast with butter. Now and then 
 the eggs may be replaced by a piece of broiled 
 fish, which is not very fat, or a chop. Robust 
 children often appreciate and thrive on corn 
 meal, but their delicate brothers and sisters 
 sometimes have trouble in digesting it. 
 
104 THE CARE OF THE CHILD IN HEALTH 
 
 The dinner should be at midday, and should 
 always begin with a dish of clear soup, without 
 fat, or a meat broth. There may then be some 
 sort of broiled, roasted, or baked fish; or the 
 soup may be followed by roast beef, chopped 
 beef which has been broiled, broiled beefsteak, 
 broiled lamb chops, roast lamb, boiled mutton, 
 chicken, turkey, or squabs. One or two vege- 
 tables, such as baked or mashed potatoes, well- 
 boiled spinach, puree of peas, young cauliflower, 
 young beans, young carrots, stewed celery, or 
 boiled rice, may be allowed with the meat. A 
 glass of milk should always accompany the 
 meal, which may end with rice pudding, rice 
 and stewed prunes, or apple sauce, bread pud- 
 ding, farina pudding, sago pudding, junket, 
 curds and whey, custard, or one of the fruits 
 mentioned in the menu for breakfast When 
 the little one comes to be four or five years of 
 age he may receive a portion of clear jelly, 
 gelatine, preserved pears, peaches, apricots, or 
 strawberries. And I have found that a bit of 
 good cream cheese with a crisp soda biscuit is 
 well liked and well digested by growing chil- 
 dren ; incidentally I may say that the nutritive 
 value of this cheese is high. 
 
 The supper may be taken at six o'clock, and 
 
FEEDING 105 
 
 should always be very light and simple. It 
 may be made up of milk with bread and butter 
 or soda biscuits, milk toast, a dish of rice, 
 farina, or hominy with milk, or any of the vari- 
 ous milk soups. Baked or stewed apples or 
 apple sauce, if they have not formed part of the 
 other meals, are very good to end the supper. 
 
 The matter of diet has at times an important 
 influence not only upon the child's general 
 health but also upon certain physical and men- 
 tal functions. In this connection one can men- 
 tion no more weighty factor than the condition 
 which is commonly called habitual constipation. 
 Children are often troubled by it, and as a curi- 
 ous fact the disorder seems sometimes to run in 
 families. On the other hand, the habits of 
 various members of one family may not at all 
 resemble each other; and also the condition of 
 an individual child may vary from one time to 
 another. The whole problem rests upon sev- 
 eral possible causal factors; and while diet is 
 an important one of them, nevertheless the 
 others should have some mention in order to 
 give a comprehensive view of their respective 
 values. 
 
 The very fact of childhood bears with it a 
 certain tendency to constipation. For in the 
 
106 THE CARE OF THE CHILD IN HEALTH 
 
 early months of life the undeveloped pelvis has 
 not room enough for the many coils of intestines 
 which therefore are confined to the abdominal 
 cavity. Here the yielding walls give no proper 
 point of resistance, and therefore the muscular 
 fibres are unable to exert themselves to advan- 
 tage. An additional hindrance is the mainte- 
 nance of any position during defecation other 
 than a crouching one. A third reason is the 
 congenital or acquired weakness of the intes- 
 tinal muscular fibres which naturally are unable 
 to do their requisite amount of work. 
 
 Such conditions can be and often are exagger- 
 ated by poorly devised meals, irregular times of 
 eating, and a too rapid and insufficient chewing 
 of the food. The choice of food is always im- 
 portant, even in infancy. "If an artificial 
 food is the diet, it must be made to simulate in 
 its physical and chemical composition mother's 
 milk. If breast milk is the food, and if on 
 analysis it proves to be deficient in fat, then 
 the requisite amount of cream may be given 
 after each feeding. If the milk be too rich in 
 proteids, the daily life, diet, and exercise of 
 the mother or nurse must be so regulated 
 that the excretion becomes normal. If the 
 milk for any reason remains abnormal, it is 
 
FEEDING 107 
 
 much better in the long run to wean the child 
 without delay." 1 
 
 Older children should have such foods as are 
 not too fine. Bread which is made from the 
 whole wheat, graham bread, corn bread, and 
 rye bread are better than that made from the 
 thoroughly bolted wheat flour. Any fresh ten- 
 der meat among those mentioned earlier in this 
 chapter as desirable may be allowed. The 
 desserts should usually be made of fresh or 
 stewed fruits. The milk which the child 
 drinks should be unboiled, and must contain a 
 large percentage of cream. Both cream and 
 butter are of considerable use in such a diet. 
 Children over four years may have moderate 
 amounts of good cream cheese. The diet 
 should not include dried or canned foods, but 
 in their place fresh foods must be used. In 
 addition to such a plan, the child may be encour- 
 aged to drink liberal quantities of water. These 
 measures reinforced by exercise, massage, pos- 
 tural treatment, and occasional medical over- 
 sight are capable of correcting almost any case 
 of habitual constipation. 
 
 When a child is directed to drink liberal 
 
 1 Oppenheim : "Medical Diseases of Childhood,' ' The 
 Maemillan Company. 
 
108 THE CARE OF THE CHILD IN HEALTH 
 
 amounts of water, the reservation must be kept 
 in mind that the water should be pure. Under 
 ordinary circumstances, especially in large 
 cities, this quality is not easily obtained. It 
 is really rare to find a water supply that can 
 unreservedly be praised, and too often it ought 
 to be condemned. As a result of this state of 
 affairs, parents should see to it that the water 
 which their little ones drink has been made 
 acceptable and harmless. They can insure 
 both palatability and safety by a proper method 
 of filtration, which is not very hard to obtain. 
 The filter must be attached to the supply pipe 
 of the house, and not to a faucet. It must be 
 so devised that no pressure is exerted by the 
 common water supply upon the filtering medium, 
 for the process must be one of slow percolation. 
 Moreover, the apparatus must be of such a kind 
 that the filtering membrane can easily be re- 
 moved, cleansed, or renewed. 
 
 There is no doubt that by such a device a 
 certain amount of the acute specific fevers as 
 well as a respectable proportion of diarrhoeal 
 troubles may be avoided or diminished. Its use 
 is the logical extension of our ideas of asepsis 
 and the application of them to important 
 although ordinary facts of life. But such facts 
 
FEEDING 109 
 
 are the very ones that ought to receive our most 
 careful attention, for they serve as the founda- 
 tion of the more attractive features of our 
 careers. 
 
 From the earliest possible time the habit of 
 eating slowly and chewing the food very 
 thoroughly must be insisted upon. If this is 
 begun at an early enough age, it is easily 
 learned and will prove to be a valuable acqui- 
 sition for later years. If the child eats with 
 an attendant or with the rest of the family, he 
 should be allowed to talk to a reasonable 
 extent; speech should be regulated, not for- 
 bidden. For with children, as well as adults, 
 the act of speaking causes useful breaks in the 
 steady course of masticating and swallowing 
 food; it allows the gastric contents to be well 
 mixed with the secretions of the stomach, and 
 at the same time it provides an atmosphere of 
 reasonable enjoyment that a child may claim 
 as well as his elders. The rule that children 
 should be seen and not heard is capable of too 
 strict an interpretation that lends itself very 
 readily to petty domestic tyranny. So long as 
 there is a reasonable and healthy discipline in 
 the household, every child should be allowed to 
 talk, to take part in the family life, to feel 
 
110 THE CARE OF THE CHILD IN HEALTH 
 
 that he is an integral part of the home circle, 
 and to realize that his words — even if they be 
 not heavy with wisdom — will receive the con- 
 sideration and attention which abiding love 
 and a mild tolerance dictate. The ordinary 
 child, whose environment provides suitable 
 examples of self-restraint and good manners, 
 learns in a surprisingly short time how to con- 
 trol himself within sufficient bounds to be 
 reckoned as a human being, and not as a more 
 or less untamed animal. 
 
CHAPTER V 
 
 BATHING 
 
 The necessity of cleanliness is not the only 
 reason for systematic bathing ; and although 
 cleanliness is a sufficient reason, it is comforting 
 to know that at the same time and by the same 
 means a beneficial effect may in other respects be 
 exerted upon the body. This fact holds good for 
 persons of all ages; and in some ways the young 
 child will receive a greater aid from the wise 
 use of water than his parents. In him the 
 process of tissue-change is especially active, 
 secretion and excretion are naturally brisk, and 
 the skin, which has an important part to play 
 in all people, is in him particularly important. 
 One must keep in mind certain plain facts about 
 the skin, for it is more than a mere exterior 
 finish to the body. In addition it is a most 
 valuable organ of sensation, upon whose exact 
 working much of our general physical safety 
 depends, while at the same time it serves as the 
 active agent of some of our most massive and 
 
 ill 
 
112 THE CARE OF THE CHILD IN HEALTH 
 
 satisfactory pleasures. Besides this, it is an in- 
 dispensable excretory organ, without which the 
 life of the body could not be continued. By 
 this means the organism relieves itself of a large 
 amount of water, of carbonic acid, of urea, and 
 doubtless of other matters; it seems quite certain 
 that even bacteria may be thus excreted. In 
 the process of draining off waste products, the 
 skin bears a close relation to the kidneys : there 
 is a marked similarity between the chemical 
 composition of the sweat and the urine, while 
 more than a few observers have noticed the 
 resemblance between the anatomical structure 
 of the skin and one of the essential portions 
 (the glomerulus) of the kidney. Yet another 
 function is that of a heat regulator, by which 
 heat is freely radiated when the temperature is 
 high, and kept within the body when the tem- 
 perature is low. For this reason burns cover- 
 ing three-fourths of the surface are fatal; and 
 physicians are thoroughly familiar with the 
 seemingly strange fact that extensive burns so 
 interfere with the distribution of heat that 
 serious congestions of the internal organs occur, 
 and may be followed by the formation of ulcers. 
 These facts are in themselves sufficient to 
 show the necessity of keeping the skin active 
 
BATHING 113 
 
 and clear ; but they are not all that ought to be 
 mentioned. If it is true that the outer surface 
 of the body acts as a sense organ, as an excre- 
 tory organ and as a heat regulator, it is equally 
 true that it exerts a considerable effect upon the 
 circulation of the blood and is therefore a sort 
 of " skin-heart." It is a noteworthy fact that 
 almost a third of the blood is contained in the 
 superficial vessels, and this large amount of 
 fluid is directly influenced by the dilatations 
 and contractions of the capillaries. The arte- 
 ries are by no means mere passive conducting 
 tubes; on the contrary they have a keenly sen- 
 sitive nerve supply which causes them to con- 
 tract when only a little blood should be in them, 
 and again to expand when they ought to hold 
 much blood. By the activity of the layers of 
 muscle fibres they can and do help to propel the 
 blood through the capillary vessels, for the large 
 amount of fluid at so great a distance from the 
 central pumping station which we call the heart 
 might otherwise be moved Avith difficulty. It 
 is not an exaggeration of the facts in the case 
 to say that the functional value of these vessels 
 is fully as great as that of the vessels of the 
 lungs, or the stomach, or the kidneys. Each 
 set has its work to do, and the efficiency of the 
 
114 THE CARE OF THE CHILD IN HEALTH 
 
 body as a whole depends on the satisfactory 
 manner in which each discharges its duties. 
 
 The simplest and most natural means to in- 
 sure the health and activity of the skin is by the 
 common-sense use of pure soap and water accord- 
 ing to certain well-known rules. No help is 
 needed from the many powders, creams, oils, and 
 lotions which are sold in such great quantities. 
 In most cases one does not know the composition 
 of these articles. They may contain inert or 
 harmful ingredients, while they frequently 
 enough serve to clog up the skin, and in a va- 
 riable degree diminish its efficiency. For very 
 young babies a simple dusting powder may be 
 used in the folds produced by the large amount 
 of fat, since by this means the inevitable friction 
 and the resulting local irritation are obviated or 
 diminished. But even in this case, the mother 
 should clearly understand that the powder has 
 no reason for existence excepting to prevent 
 local chafing; it is not meant to "strengthen 
 the skin," to absorb urine, or to exert any in- 
 fluence upon the general condition of the child. 
 If irritation of the skin occurs, especially about 
 the buttocks, the cause usually lies in some in- 
 ternal disorder and cannot be cured by a powder. 
 
 All children should be bathed daily, and the 
 
BATHING 115 
 
 habit of bathing that is usually begun almost 
 directly after birth should be continued through 
 the whole of the little one's life. For the first 
 six months the temperature of the water may 
 be about 100° F. The bath may be given about 
 nine or half after nine o'clock in the morning, 
 and should come immediately before rather than 
 immediately after a nursing. The general 
 statement holds good that the longer the inter- 
 val between a bath and the preceding meal, the 
 smaller is the possibility of unfavorably influ- 
 encing the digestion of food; for it is well 
 known that the stomach when it receives food 
 draws a large quantity of blood from the surface 
 into its vessels, and the bath, by dilating these 
 superficial arterioles, defeats the very condition 
 upon which the integrity of digestion depends. 
 Therefore, in infancy the bath may be given an 
 hour and a half after the nursing, and in later 
 life about two hours and a half after the last 
 meal. Before the baby is put into the water 
 one must be sure that there are no draughts in 
 the room, that the windows are carefully closed, 
 unless the weather is very warm, and for added 
 safety that the screen protects the locality of 
 the bath-tub from the direction of any possible 
 exposure. In cool or cold weather the tub 
 
116 THE CAKE OE THE CHILD IN HEALTH 
 
 should be placed in front of the fire, so that the 
 wet skin may receive as little chilling as pos- 
 sible. The person who bathes the child should 
 wear a large apron, made preferably of some 
 soft, thick material, one of the best of which is 
 Turkish toweling. This should not interfere 
 with the use of a large Turkish towel with 
 which to dry the baby; this towel must be 
 thoroughly clean and warm before being used, 
 and should not be employed for more than two 
 successive days without being washed. There 
 should be enough water in the tub to cover 
 the baby's chest, and as the little one reclines 
 in the tub the attendant's left hand should sup- 
 port his back, her forearm should hold up his 
 head, while her right hand does the washing. 
 As soon as the child is immersed, his head may 
 be dampened with water that is slightly cooler 
 than the water which surrounds his body. A 
 pure, unscented white soap should be used 
 rather than the expensive fancy toilet soaps, 
 which are in many ways undesirable. The 
 washing may be done with the bare hand or 
 with a fine sponge, and should start at the face 
 and proceed to the feet. The eyelids should 
 be carefully cleansed and all secretions removed 
 from the corners and the eyelashes ; the ears may 
 
BATHING 117 
 
 be thoroughly washed, but without sticking any- 
 pointed object into their canal; the mouth may 
 be washed with a fine piece of linen and a solu- 
 tion of boric acid; especial attention must be 
 given to all folds, creases, the buttocks, and 
 wherever two skin surfaces touch each other. 
 In little girls the two outer lips of the vulva 
 should be separated and cleansed, and in little 
 boys the foreskin of the penis should be drawn 
 back twice or thrice in a week, and the parts 
 thoroughly cleansed of any trace of urine or 
 smegma. As soon as the washing is completed, 
 the child should be rinsed off with fresh water 
 that is slightly cooler than that of the bath. 
 He may then be rolled up in the towel and 
 rubbed with the hand. As soon as he is well 
 dried, he is to be stripped once more and 
 thoroughly rubbed with the bare hand; if 
 there is any necessity for using alcohol in 
 these frictions, the family physician will give 
 the order. The buttocks and opposing surfaces 
 may then be powdered, the clothing adjusted 
 as quickly as is convenient, and the child 
 snugly placed in his crib. He is now ready 
 for his meal, after which, if he is in good 
 health, he will sleep so sweetly, look so dainty 
 and rosy, and awake so refreshed, that the 
 
118 THE CARE OF THE CHILD IN HEALTH 
 
 operation of bathing must necessarily be re- 
 garded as a joy. 
 
 During the rest of the day, some additional, 
 but partial, washings are needed. After each 
 feeding the mouth may be lightly cleansed with 
 a fine cloth and a solution of boric acid or borax ; 
 and with the removal of each diaper the but- 
 tocks should be carefully washed, rinsed, dried, 
 and powdered. Again at evening, before the 
 child is put to sleep for the night the face, 
 buttocks, and creases of the body may be lightly 
 sponged and thoroughly dried. These are the 
 general rules that govern an infant's care for 
 the greater part of the first year; but in sum- 
 mer a little more attention is needed. Nothing 
 afflicts and depresses a baby more surely than 
 intense heat and humidity, in some cases to 
 such an extent as to be a clearly understood 
 cause of weakness, loss of strength and appe- 
 tite, and even of active disease. To guard 
 against these contingencies we may use two, 
 three, or even four sponge baths in the course 
 of a hot day; and in a close and heavy night, 
 when even strong adults are unable to sleep, 
 we can soothe and put the tormented baby into 
 a quiet slumber by a liberal use of lukewarm 
 water. The common fear that more than one 
 
BATHING 119 
 
 bath per day is weakening should be regarded 
 as idle and superstitious; in most cases where 
 an error is made it is more apt to be on the side 
 of too little rather than too much washing. 
 
 From the second year the temperature of the 
 daily bath may be somewhat reduced ; the child 
 will then be able to enjoy water of 85° or 80° F. 
 instead of 100° or 95°. The bath must con- 
 tinue to be given in the morning, but instead 
 of waiting until half after nine o'clock it may, 
 if the mother wishes, be given on arising. The 
 main difference is one of heat, for if the weather 
 is at all cool most houses are too chilly to bathe 
 an infant early in the morning When the bath 
 is completed, the child's skin maybe rubbed more 
 vigorously than one may do with the younger 
 infants. For this purpose the mother may use 
 the bare hand or a Turkish towel that is not too 
 harsh. The friction should be long enough and 
 brisk enough to cause the skin to react in a 
 thorough manner; the surface should be in a 
 fine blush, should feel warm and full of life, 
 and the little one ought to be lively and happy. 
 Since at this time of life the bladder and rec- 
 tum should be under fairly good if not perfect 
 control, there will be less necessity for repeated 
 washings during the day. In the evening, 
 
120 THE CARE OF THE CHILD IN HEALTH 
 
 however, before the baby is put to bed, he should 
 receive the light sponge bath in order that all 
 the creases and folds of the skin may be 
 thoroughly sweet and clean. Likewise, at this 
 stage of development, when in most cases the 
 teeth are steadily making their appearance, the 
 mother should begin the use of the tooth-brush. 
 This brush must, of course, be very soft, and 
 in using it one must have a light touch; and 
 so long as these requirements are observed 
 there is a full justification for thus cleansing 
 the teeth. In most cases the tooth-brush is 
 not used until a considerably later period. But 
 this is not necessary or rational; a single tooth 
 has the same right to the benefit of cleanliness 
 that ten have, and the same arguments are 
 applicable to the one as to the many. The 
 mother must, however, remember that the 
 mucous membrane of the gums is exceedingly 
 delicate, and cannot well endure violent rub- 
 bing. A bland powder, such as precipitated 
 chalk, may be used, and may be applied morning 
 and night. 
 
 At three and a half years of age the tempera- 
 ture of the bath may be reduced to 70° F., and 
 then by easy stages to 65° or 60°. The fric- 
 tion following it should continue to be satis- 
 
BATHING 121 
 
 factory in both duration and force, although the 
 length of time spent in the water need not be 
 at all long. In fact, as soon as we begin to 
 make the water cool, the duration of exposure 
 should be correspondingly short. There may, 
 therefore, be a need of one or two hot baths per 
 week, which are most conveniently given in the 
 evening. It is undesirable to give them after 
 the evening meal, because the child would 
 have to remain awake too late in order to allow 
 a sufficient interval to elapse between the meal 
 and the bath. The best plan is to bathe him 
 directly before supper, then to put him to bed, 
 where he may be fed with safety and comfort. 
 He will immediately fall into the deep and 
 unruffled sleep of childhood, which will be 
 made all the sweeter on account of his clear and 
 active skin and his satisfied appetite. 
 
 It is a good plan to begin with children of 
 about four or four and a half years of age the 
 practice of cool effusions or douche baths. The 
 beginning should always be made in the late 
 spring or early summer, when the warm air 
 makes the impact of the water both bearable 
 and welcome ; but when once begun it should 
 be continued through the whole year, being 
 intermitted only in the event of sickness. To 
 
122 THE CARE OF THE CHILD IN HEALTH 
 
 prepare this bath one should begin by allowing 
 about ten inches of warm water to run into the 
 tub, the object of which is to keep the child's 
 feet thoroughly warm. Then water directly 
 from the faucet may rapidly be thrown over 
 him. This may be done in two or three differ- 
 ent ways. The water may be allowed to run 
 over him from an overhead douche, it may be 
 thrown over him from two or three full pitchers, 
 or it may be sprinkled through a rubber tube, to 
 the end of which a douche nozzle is attached. 
 A good variation of the last method consists in 
 using a large sprinkling-pot. The use of the 
 pitchers has much to recommend it: the tem- 
 perature of the water is easily regulated, the 
 force of the impact is likewise controlled, and 
 the time consumed by it is exceedingly small. 
 The douching need consume no more than a 
 minute or two, but the final friction may cover 
 from five to ten minutes. If, after being 
 dressed, the child is warm, rosy, and comfort- 
 able, the bath is doing good; if he looks blue, 
 cold, depressed, and is shivering, he is not being 
 helped, but rather is suffering from too long an 
 exposure or too low a degree of temperature. 
 It is often surprising to see how quickly a 
 child of no more than six years will become 
 
BATHING 123 
 
 used to this treatment, and how readily he 
 will welcome the use of cold water even when 
 the weather is cold. 
 
 Yet another method that has given satisfac- 
 tion to many mothers is the familiar tub-bath, 
 which is commonly used in England. The 
 water is drawn into the tub at least two hours 
 or even in the evening before it is to be used. 
 During this period it assumes the temperature 
 of the room, and therefore gives very little 
 shock at all, excepting in a very cold room. 
 Under the latter circumstances the duration of 
 the bath is momentary, and immediate and brisk 
 friction is needed to insure a good reaction. If 
 this tubbing is selected to be the daily habit, 
 there will be a necessity for one or two hot 
 baths per week at evening to insure the thorough 
 cleanliness of the skin. Into either the hot or 
 the cold bath one may dissolve sea salt, accord- 
 ing to one's fancy or belief in its virtues. This 
 belief is widespread, and is held by many physi- 
 cians as well as laymen. Its physiological basis 
 is not easy to recognize, since it certainly does 
 not inhere in any absorption of the salt through 
 the skin. Such absorption is exceedingly 
 difficult and can be accomplished only under 
 exceptionally favorable circumstances. If this 
 
124 THE CARE OF THE CHILD IN HEALTH 
 
 were not true, we should receive the character- 
 istic effects of all the various substances, both 
 harmful and harmless, by which we are con- 
 stantly surrounded. The cook, in the course 
 of preparing a single dinner, comes into contact 
 with various articles which, if thej were directly 
 absorbed through the skin, would have a marked 
 effect upon her physical condition. Thus, she 
 majr handle acetic acid in vinegar and hydro- 
 chloric or sulphuric acid in cleaning fluids; 
 the alkaline salts of soda or the neutral common 
 table salt; bland and soothing starches or sharp 
 and irritating condiments and spices; clean, 
 sterile water, and bacteria-laden fruits, meats, 
 and cheese. Nevertheless, as every one knows, 
 she is not at all influenced, simply because of 
 the impermeable barrier of her skin, that valu- 
 able excretory, but not assimilative organ. In 
 the same way the painter, the dyer, the chem- 
 ist, and a host of other workers who are bound 
 to come in contact with drugs and chemicals, 
 are efficiently protected. 
 
 Thus, one can easily see, without going into 
 the technicalities of physiology, how the bene- 
 ficial effect of artificial salt baths is not founded 
 upon a question of absorption. Most of all it 
 is rational to suppose that if such absorption is 
 
BATHING 125 
 
 necessary, it would be an easy matter to admin- 
 ister these salts internally. Some observers 
 have thought that the salty solution, although 
 not absorbed, acted as a local stimulant and 
 caused the skin to act more briskly than it 
 otherwise would. This theory is at best of 
 doubtful value. In all likelihood the chief 
 value of the procedure lies in the greater care, 
 thoroughness, and regularity of the bath and all 
 its accessories which the directions of the family 
 physician or the special condition of the child 
 necessitate. Doubtless, if the same care were ex- 
 ercised, even without the addition of salt to the 
 water, equally good results could be obtained. 
 
 This question is quite different from that of 
 bathing in the salt water of the ocean ; here the 
 exercise in the open air, the inevitable struggle 
 with the moving water, the playing in the sand, ' 
 the sense of freedom, the exhilaration, and the 
 buoyancy of mind as well as body that sea bath- 
 ing gives, have the possibility of benefiting the 
 child in quite a different way from what the 
 ordinary bath at home can do. The difference 
 is analogous to that between exercising with 
 chest weights at home or playing a game of 
 base-ball or foot-ball in a field ; the first may give 
 strength of muscle, and thus lead to greater 
 
126 THE CARE OF THE CHILD IN HEALTH 
 
 functional activity of the whole body ; but the 
 second gives both health and strength in a more 
 direct and inevitable manner. Bathing at home 
 is not only desirable, but also necessary; bath- 
 ing in the sea is, in addition, a tonic for mind 
 and body. There is no reason why a child 
 should not partake of its benefits in the same 
 way that an adult does. The one precaution 
 which the mother should observe is the possi- 
 bility of a rapid chilling and a consequent gen- 
 eral depression. A child of five years of age 
 may safely be taken into the water, but as soon 
 as his lips and finger-tips begin to turn blue 
 and his teeth begin to chatter, he must be 
 removed, rubbed briskly, and well dried and 
 warmed. Besides the mere act of bathing he 
 should be allowed to play about in the sand, 
 before he takes his dip, as long as he wishes. 
 Let him dig, build houses, make mud pies, and 
 get himself as dirty as his heart desires; let 
 him have unrestrained liberty, encourage him 
 to use whatever investigating and constructive 
 ability he may possess in the mobile medium of 
 the sand; let him be warmed in spirit as well 
 as in body, and he will find a different sort of 
 health and strength from what he obtains at 
 home, and at the same time will lay up 
 
BATHING 127 
 
 memories of enjoyment. A child from his 
 earliest age should be made familiar with 
 water, should be taught to regard the bath as 
 a treat and a pleasure, should be accustomed to 
 resort to it just as readily when exhausted as 
 when dirty. Doubtless, it would not be far 
 from the rigid truth to say that the civili- 
 zation of a people is measured by the amount 
 of water which they use for their personal 
 needs. And it is comforting to know that one 
 can scarcety use too much water. This rule 
 should be impressed upon every youthful mind 
 until its workings may become manifest in the 
 unconscious impulses that go to make what we 
 call second nature. 
 
CHAPTER VI 
 
 SLEEP 
 
 The main business of a young child, outside 
 of eating, is sleeping; one might state the 
 matter somewhat differently and say that the 
 principal necessities of a child are absorbing 
 nourishment and obtaining rest. In health the 
 faculty of the latter is, to a certain extent, self- 
 regulating: a normal child may easily overeat; 
 he practically never oversleeps. Of the two 
 functions in question, the second is sometimes 
 regarded as the more important; for he can go 
 without food for a longer time and with less 
 exhaustion than he can spare sleep. And 
 reasoning in this wa}^, if one wishes to compare 
 the respective values of eating and sleeping, 
 one would have to decide that sleeping is the 
 more vital. This principle of sleep, or rest, 
 may be found in the normal action of every 
 part of the body. Thus, for example, the heart, 
 which seems to be working ceaselessly, has a 
 well-known period of rest, amounting to about 
 
 128 
 
SLEEP 129 
 
 one-half second between each relaxation and 
 contraction of its muscular tissue. One would 
 be quite exact in saying that during this period 
 the heart sleeps. The muscles of breathing have 
 a similar period of rest, that amounts to about 
 two seconds, during which they also may rightly 
 be said to sleep. If one cares to push one's 
 observations yet further, one will clearly recog- 
 nize that the same rule may be noticed in 
 regard to all muscular action, and, indeed, all 
 the various functions of the body. There must 
 be a definite period of rest for each part of the 
 organism, which will be all the more profitable 
 if the laws concerning it are clearly understood 
 and logically carried out. 
 
 One of the first things to understand is that 
 any part of the body at rest demands less stimu- 
 lation and a smaller blood supply than when it 
 is working. As an example, we all know that 
 if we exercise an arm in an active way, it imme- 
 diately feels wider awake than it did before, it 
 obtains a sensation of warmth, it is even some- 
 what larger in circumference than it otherwise 
 would be. The reasons for these changes are 
 the active wear and tear, the rapid tissue- 
 change, and the increased amount of blood in 
 the part; and when the period of exercise has 
 
130 THE CARE OF THE CHILD IN HEALTH 
 
 passed and the member is at rest, fatigue takes 
 the place of activity, the added warmth and 
 increased size fade away as the amount of blood 
 is gradually equalized throughout the body. A 
 similar set of facts is true for the stomach; 
 when it obtains food, the pale hue of its mucous 
 membrane becomes both deeper and brighter, 
 the tissue may be seen to be heavier and more 
 turgid than it formerly was, and a keen activity 
 takes the place of somnolence. But as soon as 
 the work is done, the conditions of activity have 
 no longer any reason for existence and the organ 
 reverts to a state of sleep. The brain has a 
 strictly analogous group of circumstances : dur- 
 ing the waking hours, and sometimes when 
 sleep is imperfect, it is working with more or 
 less industry, it draws to itself a large amount 
 of blood to carry on its functions, it actually 
 increases in size, and assumes a brighter hue 
 than it had during rest. This continues until 
 fatigue sets in, or until the person falls asleep. 
 Then a temporary anaemia results, the color of 
 the brain becomes lighter, its increase in size 
 passes away, and its chemical changes fall to 
 the minimum. 
 
 These facts give us a clear idea of the con- 
 ditions which we should provide for the sleep- 
 
SLEEP 131 
 
 ing child: there should have been a reasonable 
 amount of active exercise, sufficient to fatigue, 
 but not exhaust him; during the period 
 immediately before retiring he should have 
 undergone no great excitement, for unusual 
 commotion would naturally tend to produce 
 cerebral congestion rather than ansemia; his 
 sleeping room should be dark and comfortably 
 cool, since such an environment leads to mental 
 calm and opposes active disturbance; the air 
 should be clean and pure, in order to allow a 
 satisfactory oxygenation of the blood; the body 
 and clothes must be fresh and clean, for these 
 factors help the processes of excretion, and, 
 negatively, are fully as important as proper 
 breathing ; the sleeping time should come within 
 a reasonably short period after the last meal, 
 for where the stomach contains and is actively 
 digesting food it draws into its blood-vessels a 
 comparatively large amount of blood, thus creat- 
 ing some degree of anemia of the brain. The 
 time-honored aphorism which advises exercise 
 after a meal has less truth than is commonly 
 supposed; on the contrary, the best thing that 
 one can do is to rest. And the heavier the 
 meal, the greater is the necessity for resting. 
 Even if one knew nothing about the physiology 
 
132 THE CARE OF THE CHILD IN HEALTH 
 
 of the question, one's experience in feeling 
 drowsy after having eaten well, and the com- 
 mon knowledge that animals regularly wish to 
 sleep after eating any substantial amount, would 
 inevitably direct one's thoughts in the right 
 direction. The same course of reasoning that 
 forbids bathing directly after eating counsels 
 sleeping after eating. 
 
 The younger the child, the more easily does 
 his brain become fatigued, and the greater is 
 his need for rest. This fact every one knows 
 from practical experience ; and thus we know, 
 both theoretically and practically, that during 
 the first three months of life he should spend 
 nine-tenths of the whole day in sleep; from 
 three to six months he will be awake for six or 
 seven hours ; in the next quarter year he will 
 usually sleep about one hour less, and when he 
 is in the second year, twelve hours at night and 
 about two hours in the day will satisfy his 
 needs. The practice of taking a nap after the 
 noon hour is a thoroughly good one, and should 
 be continued as long as the child's activities 
 and duties permit. This will generally be not 
 longer than his seventh year, although this age 
 creates no natural limit to the practice. On 
 the contrary, the unceasing activity of early 
 
SLEEP 133 
 
 childhood makes some such rest highly desir- 
 able, and the result will necessarily be a 
 stronger body, a better disposition, and firmer 
 nerves than otherwise. The fact of taking this 
 nap should not in any way interfere with the 
 rule of early retiring : children of one and a half 
 or two years should regularly go to bed at half 
 after six, or, at the latest, at seven o'clock; 
 those of three, four, and five years may remain 
 up an additional half-hour. Thereafter the 
 increase over this time must be made very 
 slowly, so that at thirteen or fourteen years of 
 age the hour of retiring is no later than half 
 after eight o'clock. There is absolutely no 
 justification for the long hours which growing 
 children are so commonly allowed to have, 
 most of all in large cities. Such children are 
 very apt to show some manifestation of pre- 
 cocity which is commonly destined to assume 
 a vicious or, at best, an unfortunate aspect. 
 
 In regard to the sleeping garments, the same 
 general rules which were suggested in describ- 
 ing an infant's outfit hold good. In summer 
 they may be made of muslin, cambric, and nain- 
 sook; in winter such material may be replaced 
 by some of the various forms of pure wool, of 
 mixtures of wool and silk, or of a fine brand of 
 
134 THE CARE OF THE CHILD IN HEALTH 
 
 Canton flannel. They must be large enough to 
 do away with constricting effects, they are pre- 
 ferably closed with tapes, and should never be 
 fastened with pins. The skirts may extend to 
 the feet, or one or two inches below them; but 
 the use of the really long skirts is to be depre- 
 cated. If the child is weak or has so poor a 
 circulation that his feet are often cold, one can 
 contribute to his comfort and well-being by 
 putting a hot water-bottle at the soles of his 
 feet. Such children are the ones that cause 
 concern on account of their liability to throw 
 off the covers and thus expose themselves. 
 This can easily be prevented by sewing tapes to 
 the corners of the blankets, which are thus to 
 be fastened to the posts or the railings of the 
 bed. For children of two and a half years or 
 more the nightgown may give way to the union 
 suit, the legs of which are lengthened into the 
 form of stockings. These suits may be made 
 of wool or Canton flannel, and there should be 
 a large enough supply to render unnecessary 
 too frequent washings. These older children, 
 as their younger brothers, may have the lightest 
 fabrics for their summer garments. A child 
 thus clothed, lying on a hair mattress, very 
 lightly covered with a sheet in hot weather, 
 
SLEEP 135 
 
 and with woollen blankets in the winter, in a 
 cool, dark, quiet, and well-ventilated room, 
 should sleep a sweet and refreshing sleep. 
 
 There are certain objectionable practices in 
 common use that are important enough to merit 
 a special mention. One of these is the habit 
 of rocking and singing a child to sleep. This 
 form of infantile tyranny is quite without 
 reason, it destroys domestic discipline, makes 
 the infant captious and exacting, and is undoubt- 
 edly burdensome to the mother. A healthy 
 baby of good habits will go to sleep if he is 
 merely placed in his crib at the proper time and 
 with the proper environment. If he does not 
 fall asleep readily, the cause lies either in bad 
 training or in bad health. The first is to be 
 remedied by the mother, and should be as cer- 
 tainly done as she would live up to any other 
 important principle of conduct; the second, if 
 it certainly exists, should be adequately treated 
 by a competent medical man. At all events, 
 the child, the mother, and the household at 
 large must understand the circumstances of the 
 case and the necessity of self-restraint and firm- 
 ness. Especially must the mother be on her 
 guard against this abuse after an acute sick- 
 ness, for then the ordinary rules of feeding may 
 
136 THE CARE OF THE CHILD IIST HEALTH 
 
 have necessarily been put aside, the child may 
 be irritable and tormented by the so-called 
 " false hunger " of invalids, and within a short 
 time the bad habit is formed. But as soon as 
 convalescence sets in, the child ought to be 
 subjected once more to his salutary discipline, 
 to which he will submit if he sees sufficient firm- 
 ness of purpose in his parents and attendants. 
 
 Another related abuse is the employment of 
 an empty rubber nipple or a "sugar teat" to 
 keep the baby quiet by allowing him to suck on 
 it; some women go so far as to allow sucking 
 on one of their fingers, on a coin which is held 
 by a string, or a piece of ivory, or any other 
 convenient material. Thus to take advantage 
 of the infant's sucking reflex is not nearly so 
 clever as it may appear at first glance. In all 
 but the very youngest it produces an excessive 
 quantity of saliva; it is a common cause of 
 mucous erosions; it causes the bad habit of 
 depending upon continuous sucking for putting 
 the child asleep, or amusing him, or even for 
 keeping him quiet. One of its worst faults is 
 the fact that its lack of surgical cleanliness 
 must and often does result in sickness, for by 
 this means various forms of germ-life are put 
 into the baby's mouth. The " comforter " may 
 
SLEEP 137 
 
 have dropped in the bed, on a chair, or on the 
 floor, and as soon as the child cries it is imme- 
 diately put back in his mouth without even the 
 preliminary of washing. Finally, it leads to 
 the habit of thumb sucking and the attendant 
 evils. 
 
 Some families, especially those whose first 
 habits of housekeeping have been acquired in 
 Europe, use feather-beds as the main covering 
 for their children in the winter nights. It is 
 unnecessary to mention more than the uneven 
 distribution of the feathers, and therefore of the 
 heat, and the impossibility of thoroughly airing 
 the feathers to show how unadvisable this cus- 
 tom is. Better protection can more easily be 
 obtained by light but comfortable blankets, the 
 warmth of which is spread evenly over the 
 whole bed; such covering can easily be increased 
 or decreased, it is easily manipulated, and easily 
 kept clean. A further objection should be made 
 to the habit of sleeping in one position during 
 the whole night; from the first day of life the 
 child should be placed on the side, and from 
 time to time should be changed from one side 
 to the other. It is unnecessary and undesirable 
 to produce a one-sided pressure upon the head, 
 most of all in infancy, when the bones are so 
 
138 THE CARE OF THE CHILD IN HEALTH 
 
 soft as to be moulded by a continued pressure 
 upon one spot. Likewise, the custom of main- 
 taining a light in the bedroom during the whole 
 night should be abolished ; for it tends to make 
 sleep less sound, and develops a fear of darkness. 
 Of the two, the second danger is to be the more 
 avoided, since by such factors the whole char- 
 acter may be injuriously affected. Finally, the 
 mother should so arrange the blankets that the 
 child's hands are always outside of them; if 
 this custom is cultivated in early childhood, it 
 may in later years save the child from falling 
 into certain bad habits, which will be men- 
 tioned in a later chapter. 
 
 If these suggestions are carried out, the 
 children who do not rest quietly will be few. 
 Nevertheless, there will always be some com- 
 plaints on this score, so that it is desirable to 
 say a few words concerning it. In young 
 children the causes which lead to insomnia are 
 sickness and pain, over-excitement and nervous- 
 ness, and, finally, bad feeding. The factors of 
 sickness and pain should be so easily recognized 
 and understood that no mention need be made 
 of them. Great excitement and nervousness 
 are legitimate causes which, although common 
 enough, have no good reason for existence ; for 
 
SLEEP 139 
 
 the life of a baby should be as monotonous as 
 possible, it should be protected from all com- 
 motion, and should in all ways be well shielded 
 from surprises. Such a child ought to have no 
 part in domestic celebrations, rejoicings, or occa- 
 sions of emotional disturbance. Since he is too 
 young to know the import of events, he need 
 not participate in them. A disregard for these 
 suggestions can easily bring about so perturbed 
 a state of mind and body that the necessary 
 conditions of sleep are not easily obtained. But 
 the most common cause of disturbed sleep is 
 some form of gastric or intestinal derangement 
 which, in the majority of cases, follows improper 
 feeding. The manner of occurrence is simple 
 enough for any one to understand : certain arti- 
 cles of food are taken into the stomach, but, on 
 account of their indigestibility, or weakness 
 and fatigue of the stomach, they are not fully 
 changed nor properly prepared for absorption. 
 As the result, products of partial digestion are 
 formed, the gastric contents decompose and 
 give rise to gases and matters of fermentation 
 and putrefaction. These are absorbed in vari- 
 ous degrees, and act as the means of a low form 
 of poisoning. At the same time, the working 
 of the body is sufficiently impeded to prevent 
 
140 THE CARE OF THE CHILD IN HEALTH 
 
 the draining off of the waste matter. The situa- 
 tion, finally, amounts to a lack of nourishment 
 even if the food be plentiful, combined with 
 the formation and retention in the system of 
 toxic agents. Some of the symptoms of this 
 condition are greater or less pain, a deficient or 
 capricious appetite, restlessness and nervous 
 irritability, congestion of one or more parts, 
 mental depression and uneasiness. In conse- 
 quence of these abnormalities, the child is 
 plainly unable to be quiet or to sleep; every 
 member of his body may be tingling with its 
 nervous tension, his mind instead of being calm 
 and peaceful is harried by frightful images, 
 unnatural and grotesque impressions, and a 
 lowering of its ordinary tone, which in an 
 adult would be translated as black despair. 
 He, of course, is unable to sleep; or, if he 
 should happen to doze, his sleep is no more 
 than a fitful, unrefreshing, unsatisfactory lack 
 of consciousness from which he is apt suddenly 
 to start in terror. 
 
 Such a condition is one of the commonest 
 causes of nightmare. The pitiable spectacle of 
 a child's awaking from a seemingly sound sleep 
 with cries of abject fear is enough to touch a 
 callous heart. There is no doubt that the little 
 
SLEEP 141 
 
 one suffers as acutely as if the fancied horrors 
 were real; and that in itself would be enough 
 to call for a wise regulation of his body and 
 mind, which would have the end in view of 
 obliterating his suffering. But as a matter of 
 fact, very much more than suffering is thus 
 entailed. These pathological effects produce 
 decidedly harmful impressions on his mind, 
 they rob him of his mental freedom and bravery, 
 they may render him self-conscious, effeminate, 
 deceitful, and, possibly, degenerate. If he 
 suffers from night-terrors of a different origin, 
 such as central nervous disturbances, or eye- 
 strain, the results may be similar in kind, 
 although frequently less in degree. But under 
 all circumstances and whatever their origin may 
 be, they should never be lightly passed over. 
 They are worthy of the most serious attention. 
 But even if markedly pathological effects are 
 not manifested, there may be many conditions 
 where sleep is not perfect or where all of the 
 brain is not at rest. The ordinary phenomenon 
 of falling asleep means no more than that the 
 major part of the brain is at rest. One or more 
 areas may be more or less awake, and partially 
 prepared to show their characteristic activity. 
 The various functions of the body are controlled 
 
142 THE CAKE OF THE CHILD IK HEALTH 
 
 by definite centres in the nervous system of 
 brain and spinal cord, in the same way that the 
 various mental concepts have their respective 
 localities in the brain. Any one of these dif- 
 ferent areas, or a group of them, may be partly 
 awake, may become stimulated even though the 
 child is asleep. The result of such activity 
 expresses itself in what we call dreams. And 
 in so far as the areas in question are fully awake 
 and stimulated, just so far is the consequent 
 dream vivid. And the wandering, discon- 
 nected, and irrational character of dreams is 
 due to the fact that the will and the reason are, 
 under such conditions, in less than their usual 
 state of control — the state that is known by the 
 name of consciousness. And since the mental 
 processes of young children are under less logi- 
 cal restraint than those of adults, the dreams of 
 children seem less unreal, partake more of the 
 nature of actuality than those of mature per- 
 sons do. Thus, one can easily understand that 
 dreams have a real significance, that they mean 
 imperfect sleep, and that if the physician could 
 have a sufficiently profound knowledge of local- 
 ization of cerebral action, he would be able on 
 hearing the recital of the dream to describe the 
 part of the brain which was involved, and even 
 
SLEEP 143 
 
 the extent of its distribution. Perfect sleep is 
 dreamless, unruffled, sweetly restful ; and if a 
 child does not sleep in this manner, he has a 
 right to demand — or, stated differently, the 
 responsibility of the parents should stimulate 
 them to seek — a searching inquiry into the 
 facts of the case and an attempt to right what- 
 ever abnormal conditions may be found. 
 
 A sharply differentiated form of this partial 
 awakening is familiar to everybody under the 
 name of somnambulism. Here the brain is able 
 to stimulate such a train of reflex action in the 
 nervous system as is essential for progression, 
 and at the same time the sense of muscular exer- 
 tion, which is doubtless situated in the cere- 
 bellum, is doubtless awake. Simultaneously 
 that part of the brain whose function is to 
 recognize impressions is not sufficiently awake 
 to collate and know what is taking place. 
 There is plainly a wide gap between the physi- 
 cal experience of walking through rooms, down 
 stairways, and out into the street, on the one 
 hand, and, on the other, the orderly placing of 
 memories, ideas, and conscious reasoning con- 
 nected with them that characterizes such actions 
 in times of lucid wakefulness. And when once 
 the philosophy of these phenomena is clearly 
 
144 THE CARE OF THE CHILD IN HEALTH 
 
 understood, there is always the possibility of 
 sufficiently perfecting the ordinary action of the 
 body so that it may work clearly, uninter- 
 ruptedly, and peacefully. Dreams and som- 
 nambulism are not the wild and wayward fancies 
 that they are so commonly supposed to be ; on 
 the contrary, they are as rigid and inevitable 
 as any other manifestation of natural forces. 
 
 The lesson of the whole matter is that one 
 should not be satisfied with a child's sleep 
 unless it is quiet, serene, and refreshing. Any 
 interruption which occurs regularly or fre- 
 quently should be investigated until the cause 
 has been found; and then one should not be 
 satisfied until the abnormal condition has been 
 removed. For example, a child may snore, or 
 sleep with an open mouth, or pick the nose, or 
 talk incoherently, or throw himself about, or be 
 tormented by depressing dreams, or awake with 
 a feeling of exhaustion. Such things are com- 
 mon, and always have an unfavorable signifi- 
 cance. The cause may be adenoid vegetations, 
 or an abnormal and devious nasal septum, or 
 marked nervous irritability, or disordered di- 
 gestion. But no matter what it is, it should 
 be patiently sought for and finally corrected. 
 Until that has been done, the little one cannot 
 
SLEEP 145 
 
 obtain the rest and recuperation which he 
 needs and must have. And negligence in this 
 respect is more than mere carelessness ; for it 
 means a deprivation of normal nutrition that 
 may cause a life-long want of energy or 
 strength. 
 
CHAPTER VII 
 
 EXERCISE 
 
 The subject of exercise, especially for chil- 
 dren, is one that everybody believes in, but few 
 follow out in a systematic fashion. Everybody 
 knows that it is not only advisable, but neces- 
 sary; and when it is neglected, the cause is in 
 part carelessness and in part a halting appre- 
 ciation of how widespread its influences are. 
 Usually parents believe that exercise is a good 
 enough thing, but that there is no special need 
 for directing it, and that, in addition, children 
 will regulate the matter for themselves. Besides 
 all this, they commonly believe that the best 
 way to dispose of a child's time is to fill the day 
 as full as possible with the various duties which 
 will adequately claim his attention and " keep 
 him quiet," and trust to his ingenuity and 
 natural lawlessness to assert the normal activity 
 between times which all young animals inevita- 
 bly possess. This statement may seem somewhat 
 
 146 
 
EXERCISE 147 
 
 crude and harsh : but if parents will look at the 
 matter frankly, they will recognize that it states 
 the matter with a reasonable amount of truth. 
 In most households there is little or no intelli- 
 gent attention paid to this subject, and in some 
 the whole subject is consciously put aside 
 because it seems too closely connected with 
 what is coarse, gross, or violent. As a matter 
 of fact, such a judgment is very far from the 
 truth; it reverses the true relations of facts, 
 and tends to dwarf one of the best aids which 
 we possess for the development of a nicely bal- 
 anced mental as well as physical equilibrium. 
 
 We must clearly understand that every part 
 of the body is susceptible of steadily improving 
 activity. This is usually well understood in 
 regard to the muscles ; but it is equally appli- 
 cable to the bones, the nerves, and the special 
 organs. One is very apt to think of the bony 
 skeleton as being the foundation and permanent 
 framework of the softer tissues ; but in reality 
 the contrary is the fact. For by the strain and 
 pull of the growing muscles the bones are pulled 
 in one way and another according to the line of 
 maximum force. During the early years, and 
 until they have become consolidated by advanc- 
 ing development, they are susceptible of an in- 
 
148 THE CARE OF THE CHILD IN HEALTH 
 
 definite amount of change. The effect upon the 
 nerves is equally great ; indeed, this influence 
 cannot easily be overestimated. In many chil- 
 dren these structures are exceedingly unstable, 
 are subject to many variations in the way of over- 
 excitement and a one-sided irritability. These 
 effects may be evident at any age : the babe in the 
 cradle may show them by restlessness, nervously 
 disturbed sleep, nervously capricious appetite, 
 and a deficient repose of disposition which can- 
 not be attributed to a discernible organic 
 disorder of the body. In older children the 
 condition may show itself by bad temper, a poor 
 adaptability to normal rules of conduct and 
 self-restraint, and the development of abnormal 
 characteristics. In some cases this may take 
 the form of viciousness, in others, that of an 
 uneven precocity or backwardness. While it 
 is true that such conditions exist at times con- 
 genitally, and are thus very hard to remove, it 
 is likewise true that they may follow a con- 
 gested, an impoverished, or an irritated state of 
 the nervous system. 
 
 Such a tendency is easily created by the 
 necessities and the inevitable conditions of 
 civilized life, especially in large cities. It is 
 not hard to understand why this should be so, 
 
EXERCISE 149 
 
 if we take into account the noise, the hurry, the 
 forced restraint of school and drawing-room, 
 the imperfect methods of ventilation and heat- 
 ing, and the premature experiences that so fre- 
 quently are the rule rather than the exception 
 among a large proportion of growing children. 
 When, in addition to these factors, the child's 
 exercise is limited or badly arranged, the neces- 
 sary metabolism or tissue-change must be cur- 
 tailed or deflected from its rightful course, and 
 the consequent development must as surely be 
 more or less unnatural. The same train of 
 reasoning is as applicable to the special senses 
 as to the nerves and the muscular tissues. The 
 sight, taste, hearing, touch, and smell are all 
 capable of a gradual, healthy, and profitable 
 unfolding; or they may become distorted, 
 blunted, overexcited, or abnormal. And in 
 order to help along the favorable and discourage 
 the unfavorable course, a wise regulation of the 
 daily exercise is of great help. Viewed in this 
 way, exercise is more than a means to increase 
 strength; it should rather be regarded as a 
 necessity for the growth of normal activity. 
 
 In infancy the sorts of possible exercises are 
 limited, but, nevertheless, are adequate. The 
 muscles and nerves are so weak and the control 
 
150 THE CARE OF THE CHILD IN HEALTH 
 
 by means of the will is so rudimentary that 
 more than this limited amount could not be 
 endured. Nature has evidently taken this fact 
 into account when she provided for the constant 
 activity of a healthy baby, which takes the form 
 of seemingly purposeless and random move- 
 ments of hands and arms and body. Physiolo- 
 gists translate this by saying that the centres 
 of inhibition, which restrain and control mus- 
 cular movements, are, in young babies, poorly 
 developed or undeveloped; moreover, this 
 development comes somewhat slowly and only 
 in proportion to the growth of the whole body 
 and its functions. 1 The inevitable result is 
 that whenever the little one is awake he is 
 unconsciously tossing his arms and kicking his 
 legs about in order to strengthen their budding 
 power. This shows a reason why his clothes 
 should not be too long, heavy, and binding, 
 why he should not be pinned and swathed up 
 like a mummy. The little limbs must have 
 every opportunity of unrestrained freedom for 
 preparation against the time when he is able to 
 put them to well-directed use. This exercise 
 is increased by the unavoidable motion involved 
 
 1 See "The Development of the Child," by Nathan 
 Oppenheim. The Macmillan Company, 1898. 
 
EXERCISE 151 
 
 in wheeling him in his carriage and carrying him 
 about in one's arms. While such motion may- 
 be gentle, it is, nevertheless, important, and 
 compares closely to that which an invalid obtains 
 when he is taken out driving or in a roller 
 chair. The additional fact that this exercise is 
 taken in the open air increases its value very 
 much. Finally, the rubbing which he receives 
 after his bath is of no inconsiderable impor- 
 tance, and fills out the sum of his exercise. 
 While these things are of salient importance 
 for him, one should guard against exaggerations 
 of them. As an instance, the habit of tossing 
 a baby into the air, or throwing him violently 
 about for the purpose of amusing him, is a case 
 in point. The resulting disturbance may at 
 any time be harmful, causing vomiting, 
 diarrhoea, and lack of nervous equilibrium. 
 
 As soon as the child passes the age of infancy, 
 his exercise gradually becomes more varied and 
 prolonged. While he is less than three years 
 of age, it naturally consists of no more than 
 being taken to walk, or being wheeled in his 
 go-cart. And these should be done as much as 
 possible in the air. In fact, the more of his 
 time he spends in the air, the greater will be 
 the likelihood of ultimate robustness. Out- 
 
152 THE CARE OF THE CHILD IN HEALTH 
 
 side of the time devoted to the necessary factors 
 of care, such as bathing, eating, dressing, and 
 sleeping, the whole day should be spent out of 
 doors. Thoroughly bad weather will naturally 
 create an exception to this rule, although cold 
 or cloudy days are too easily interpreted as being 
 stay-at-home times. Heavy rains, winds, and 
 snow-storms, or intense heat are the only reason 
 for shutting children within four walls. And 
 with increasing age the amount of time spent 
 at home becomes progressively smaller. The 
 three-years-old child may dig in the sand or 
 the dirt, may make little caves and nests and 
 the well-beloved mud pies. The mother should 
 have no fear of dirt; she may allow him so to 
 cover himself from head to feet, if he will. 
 As long as he is properly dressed in stout, 
 coarse slips, or even overalls, he is easily and 
 rapidly cleaned when meal-time comes. 
 
 At the age of five years the permissible range 
 becomes much wider. If he is forced to stop 
 indoors, light calisthenics and dumb-bell exer- 
 cises may wisely be begun. If these are con- 
 ducted with the accompaniment of a story, 
 simple music, or concerted action, they become 
 amusing as well as beneficial. Only the sim- 
 plest motions should be employed. They must 
 
EXERCISE 153 
 
 not be continued for too long a time, and under 
 no circumstances ought they be allowed to in- 
 volve strain. At this period the child may 
 take longer walks in the open, and his carriage 
 and manner of walking should, if necessary, be 
 corrected. The habit of standing erect, walking 
 with the toes turned out, and allowing the hands 
 to hang easily, is formed more easily at this age 
 than later on. The locality of the walks should, 
 whenever possible, be selected in or toward the 
 country or a park; and an earnest attempt 
 should be made to familiarize the child with 
 facts of nature. It is fully as easy to acquaint 
 him with these facts as with those of the streets. 
 Within a very short time this growing child 
 may be taught to swim. In most cases a boy or 
 girl of six years will learn the art more easily 
 and quickly than those of fifteen; the younger 
 child, if he has the advantage of example, is 
 often more confident and more trustful than the 
 older, and at the same time he is young enough 
 to have retained some of the imitative faculty 
 of the youthful animal. Swimming, if kept 
 within reasonable bounds, is one of the best 
 exercises that a child can have. It need not 
 involve over-exertion, it brings all the muscles 
 of the body into play, and the fatigue which it 
 
154 THE CARE OF THE CHILD IN HEALTH 
 
 brings on may immediately be counteracted at 
 any time by floating. While the child is in the 
 process of learning, he should be taught to dive, 
 to swim on his back, to swim when partly and 
 wholly clothed, and to help a drowning person. 
 At the same time he may be instructed how to 
 support himself if he is seized with a cramp; 
 but he must always be warned against remain- 
 ing a long time in the water, for this is one of 
 the commonest causes of such an accident. In 
 most cases fifteen minutes are as long as he 
 need remain in the water, while in the begin- 
 ning of the season a shorter time is advisable. 
 The common use of the bicycle has made this 
 form of exercise familiar to young boys and 
 girls. Children of six, seven, and eight years 
 now freely indulge in it, and usually with 
 benefit. There are a few suggestions in regard 
 to its employment that may profitably be kept 
 in mind. In the first place, a bicycle ride 
 should not be too long in extent nor too rapid 
 in rate. I have often enough seen compara- 
 tively young children ride ten, fifteen, or more 
 miles at a stretch at the rate of ten or more 
 miles an hour; and in a number of cases I have 
 treated them for abnormal conditions which 
 thereby resulted. Bicycling, when thus carried 
 
EXERCISE 155 
 
 to excess, should be regarded as violent exer- 
 tion, and must not be participated in by any 
 persons except those who are fitted, by strength 
 and training, to withstand the strain. Rapid 
 riding is apt to produce a tired condition of the 
 heart muscle, with the attendant weakening of 
 the circulation and liability to respiratory dis- 
 orders. Another item is the height of the 
 saddle and the plane of elevation in which it 
 rests. When the child sits in the saddle with 
 his legs extended, the lower pedal should touch 
 the sole of the corresponding foot; and the pedal 
 should support the ball rather than the instep 
 of the foot. Very often one may have consid- 
 erable trouble in adjusting the saddle, and the 
 trouble comes, for the most part, from the irri- 
 tation which the peak, or pommel, causes. This 
 part, on account of the pressure which it exerts 
 on the perineum, is the main objection to the 
 ordinary commercial article, and should be abol- 
 ished. If it is tipped up — a favorite position 
 for many children — the weight of the body 
 rests upon the perineum, and may injure some 
 of the near-by delicate structures. If it is 
 tipped down, the child slides forward, and must 
 use part of his strength in supporting instead of 
 propelling himself. The best position, there- 
 
156 THE CARE OF THE CHILD IN HEALTH 
 
 fore, is when the saddle is quite level, and not 
 too far back. If the saddle is thus arranged, 
 if the bicycle is not too heavy, and if the handle- 
 bar is high enough to make the child sit up 
 fairly straight, the exercise obtained by this 
 means will almost always be beneficial to a 
 healthy boy or girl. 
 
 An exercise that is usually recommended for 
 its social and aesthetic, rather than health- 
 giving reasons, is dancing. Nevertheless, if 
 moderately practised, it may benefit the body 
 in a variety of ways. Although the lower part 
 of the body is the one most employed, never- 
 theless the whole organism is, to some extent, 
 brought into play; the finer movements and 
 those used in maintaining an exact balance are 
 especially brought out, so that while the circu- 
 lation is being stimulated, and a healthy glow 
 is made to pervade the body, the child's grace- 
 fulness and lightness of movement are being 
 developed. The fact that this exercise is gen- 
 erally conducted under circumstances of fes- 
 tivity and sociability gives the added advantage 
 of keen enjoyment to it, and thus materially 
 promotes its value. Besides all this, it maybe 
 enjoyed by both boys and girls, and therefore is 
 especially to be commended. There can be no 
 
EXERCISE 157 
 
 greater mistake than the belief that dancing is 
 a mere accomplishment whose purpose is no 
 more than decorative. It is all this, but much 
 more besides. Gentle exercise has its uses as 
 well as that which is violent ; and especially for 
 those children who are endowed with a large 
 amount of animal spirits it may be exceedingly 
 valuable. The necessary formality and court- 
 esy which boys are forced by this exercise to 
 show to their sisters and girl friends has an 
 influence that is all for good. 
 
 This fact brings to mind the limitations 
 under which girls usually are placed in the 
 attempt to gain a sufficient degree of strength 
 and grace. At the same time, their need of 
 vigorous exercise is fully as great as that of 
 their brothers. The fashion of weak and help- 
 less women has passed away, and we shall be 
 fortunate if it never returns. A girl deserves 
 as serious a preparation for future work and 
 life as a boy ; and the fact that her work and life 
 are to be different from his has no bearing upon 
 the necessity for development. She can be fully 
 as maidenly, sympathetic, and useful with a 
 strong body as with a weak one; and in the 
 favorable instead of the unfavorable condition 
 she certainly will gain in health and strength, 
 
158 THE CARE OF THE CHILD IN HEALTH 
 
 self-confidence, and ability to discharge her 
 future duties as wife and mother. When she 
 takes her exercise she must be properly and fitly 
 dressed. Her skirts should not be too many, 
 too heavy, nor too tight. Her shoes should be 
 large, strong, and heavy enough to give an 
 efficient support to the feet and ankle ; and the 
 evil day when she is forced to wear corsets must 
 be put off as long as possible. This article of 
 dress is absolutely unnecessary for young girls 
 whose physical development is such as to render 
 constriction of the waist and support of the 
 breasts superfluous. The evils that it may and 
 very often does create are undoubted, and 
 ought to be sufficient to impress a reasonable 
 mind with their sufficiency. With abdominal 
 and back muscles weakened, with abdominal 
 and pelvic viscera squeezed and pushed out of 
 place, a girl must inevitably be balked in her 
 normal evolution and the attainment of her 
 rightful growth. When the corset is replaced 
 by a strong waist, without bones or stays, she 
 is prepared to participate in many sports and 
 exercises that are, for the most part, handed 
 over to her brothers. 
 
 In selecting exercises for children of ten or 
 more years, those should be preferred that 
 
EXERCISE 159 
 
 actively employ the mind as well as the body. 
 For this reason fencing is highly desirable. It 
 gives abundant movement, may be made as 
 gentle or as violent as the capabilities of the 
 person permit, and simultaneously develops 
 the finer as well as the heavier movements, exer- 
 cises the eye as well as the arm, and brings in 
 the element of emulation. For somewhat simi- 
 lar reasons tennis is a fine game, although it 
 must be plaj^ed much more vigorously if the 
 child aims to excel in it. Basket-ball is also a 
 good game, and involves the very desirable 
 factor of concerted action. This is a most use- 
 ful element, for it develops a wholesome disci- 
 pline, a salutary subordination to authority, a 
 constant watchfulness to take advantage of 
 opportunities. The so-called "team-play" of 
 base-ball and foot-ball gives an undoubted value 
 to those who play the game skilfully; and it is 
 unfortunate that girls have not more amuse- 
 ments which tend to further such qualities. 
 The two games mentioned are thoroughly com- 
 mendable for boys who have the requisite 
 strength and activity ; but the spirit of strenu- 
 ous striving must be brought out, and each 
 player must be drilled to use determination and 
 spirit, to work at every point in the game, to 
 
160 THE CARE OF THE CHILD IN HEALTH 
 
 struggle and fight against defeat. Such 
 reasons of personal influence make the train- 
 ing that comes from sparring and wrestling an 
 influence of much good. This influence stands 
 for physical bravery, endurance, fearlessness, 
 the careful estimating of an opponent's ability, 
 as well as an increase of the body's strength 
 and quickness. Such things are a real gain 
 over the benefits which one derives from riding, 
 driving, or even golf; although these sports 
 have their value for the small number in the 
 community whose wealth makes the item of 
 cost unimportant. 
 
 But whatever games are played must be par- 
 taken of with the double object of the pleasure 
 which they are able to give and the training of 
 mind and body which they as surely provide. 
 The parents should make the selection of these 
 games and sports a matter of careful attention, 
 they should participate in them (and thus 
 obtain, in most cases, valuable training for 
 themselves), and supervise them as carefully 
 as they would select clothes to wear and books 
 to read. When children of any age take their 
 exercise, they should be properly dressed in 
 strong, plain garments which they need not fear 
 to soil or tear. Their sense of physical free- 
 
EXERCISE 161 
 
 dom must be unrestrained, and they should be 
 encouraged to let loose all the physical energy 
 that characterizes the young animal. When 
 their time of exercise is over, they should bathe, 
 change their clothes, and adopt the more con- 
 trolled manner of their ordinary hours. A 
 rapid sponge or shower bath, followed by a 
 brisk rub for a few minutes will bring out the 
 appearance and feeling of bounding health and 
 content, the enjoyment of a vigorous appetite, 
 and the repose of a sweet sleep. 
 
 In every home where children are there 
 should be some substitute for a gymnasium; 
 and whenever they are forced to stop indoors 
 they should be encouraged to use whatever 
 devices are at hand. Any room, whether it is 
 an attic or bed room, nursery or play room, will 
 serve our purpose. The only stationary fixture 
 which we need is a pair of flying rings. If in 
 addition there is a horizontal bar, a striking 
 bag, or a set of parallel bars, or all of them, the 
 opportunities for diversified exercises are much 
 increased. Swinging clubs and dumb-bells are 
 always easily obtained, and the use of them 
 should be encouraged. All of these things are 
 as valuable for girls as for boys, and both of 
 them can profitably employ them at times when 
 
162 THE CARE OF THE CHILD IN HEALTH 
 
 they may not row, skate, or disport themselves 
 in other ways in the open. By all means every 
 child must be made to feel that his body is as 
 worthy of attention as his mind, and that the 
 pleasures which may thereby be attained are 
 both laudable and dignified. 
 
CHAPTER VIII 
 
 CLOTHING FKOM THE TIME OF INFANCY 
 
 There is a fairly well-fixed rule which con- 
 trols the materials and the fashion of an infant's 
 clothes; tradition and experience have settled 
 what this may be, and the variations from it are, 
 as a rule, small and unintentional. But as the 
 child grows older and stronger, mothers feel 
 that they have a wider range of choice, and a 
 smaller need to adhere to a fixed standard. 
 Moreover, the differences between the rich and 
 the poor are then more plainly evident than in 
 the younger children, not only on account of the 
 rapidity with which clothes are outgrown, but 
 also because there are so many fabrics on the 
 market from which clothes are made. The 
 belief has grown that the most expensive gar- 
 ments are necessarily the most serviceable, the 
 healthiest, and the best. Thus, indecision 
 follows lack of information, and a certain 
 amount of inconvenience, or even hardship, 
 may be undertaken for the sake of a supposed 
 
 163 
 
164 THE CARE OF THE CHILD IN HEALTH 
 
 necessity to give a child certain costly kinds of 
 garments. 
 
 For such reasons it may be advantageous to 
 consider what the various fabrics are and what 
 work they are meant to do. Their main func- 
 tion, outside of providing a decent covering for 
 the body and furnishing decorative effects, is to 
 afford protection against cold and heat ; and the 
 main part of the problem consists in regulating 
 the amount of heat which is given off from the 
 body in cold weather. The importance of this 
 question may be estimated from the fact that 
 more than 80% of the heat which is generated 
 in the body is given off from the skin ; and 
 if additional inroads are made by badly selected 
 clothing, the effects upon the health and vitality 
 must necessarily be great. This dissipation of 
 heat takes place through the well-known pro- 
 cesses of radiation, conduction, and evaporation 
 of moisture. Radiation acts mainly when the 
 body comes in contact with cold objects, such 
 as cold clothing, bedding, or furniture. Con- 
 duction is most active when the surrounding 
 air, whether it is hot or cold, is in brisk motion. 
 Both conduction and radiation accomplish their 
 purpose most thoroughly when the wind is cold, 
 harsh, and strong. Evaporation stands for the 
 
CLOTHING FROM THE TIME OF INFANCY 165 
 
 volatilizing of the moisture that is given off on 
 the body surface ; in winter it amounts to very 
 little, but in summer it may be considerable. 
 The object sought for in wearing winter cloth- 
 ing is so to regulate the factors of radiation and 
 conduction that the body maintains its normal 
 and comfortable amount of heat; and of these 
 two factors conduction is the really important 
 one. 
 
 Common experience has demonstrated that 
 wool is the best protection against cold, but the 
 reason why it is efficient is not so well under- 
 stood. There is much loose talk commonly 
 heard about good conductors and poor con- 
 ductors, that one fabric is "heating" and 
 another "chilling." As a matter of plain fact 
 there is very little difference between the 
 organic constitution of the various fabrics as 
 far as their power of conduction is concerned. 
 Also, it is practically a matter of indifference 
 whether the material is of animal origin, like 
 wool or silk, or of vegetable origin, like cotton 
 and linen. And whether the wool is one of the 
 so-called "natural" or copyrighted articles, or 
 the muslin is more or less finely bleached, is, 
 for the most part a matter of indifference. The 
 commonly heard argument that the " natural " 
 
166 THE CARE OF THE CHILD IN HEALTH 
 
 wools are necessarily better than other brands 
 because they tend to copy the state of nature 
 involves striking fallacies; in the first place, 
 we do not in our ordinary matters of life seek 
 to imitate the ways of nature: we want our 
 food cooked, not raw, as animals take it; we 
 want to sleep in comfortable houses, not in the 
 open ; we seek to be guided by reason, and not 
 by instinct. Because wool comes from the 
 sheep's back is no reason why it necessarily 
 excels other fabrics as a means of protection. 
 In fact, where the whole pelt is used, as in fur 
 coats, much more warmth than is usual may be 
 obtained by wearing the wool toward the body 
 and the skin toward the weather. 
 
 The real difference between the various fabrics 
 consists in the way they are woven. If the 
 material in question is so made that it con- 
 tains a fairly large amount of air between its 
 fibres, it keeps out cold better than if it were 
 tight and smooth; for still air is an excellent 
 non-conductor, and under such circumstances 
 it serves a useful and active purpose. Here is 
 where the true advantage of wool may be seen : 
 for it is so made that its fibres are loosely com- 
 bined, the rough ends protrude more or less, 
 and touch the skin in a multitude of fine points. 
 
CLOTHING FROM THE TIME OF INFANCY 167 
 
 As a result, there are strata of still air between 
 the body and the cold. For similar reasons it 
 is wise to have successive layers of thin cloth- 
 ing rather than one very thick garment, even 
 although the latter is equal in weight to or 
 exceeds the weight of the combined suits. The 
 method of dressing used by the Chinese is in 
 this way highly to be commended, for they use 
 the same kinds of garments in all seasons, but 
 vary the number of them to suit the needs of 
 the weather. If cotton, flax, and silk could be 
 so woven as to present the same physical con- 
 ditions as wool, they would also partake of simi- 
 lar excellences ; if instead of being very smooth 
 and tightly woven, they were rougher, looser, 
 and possessed of more irregularities, their use- 
 fulness as clothing would be equally great. 
 Indeed, imitations of wool, which attempt to 
 give the physical peculiarities of their proto- 
 types, have been, and are, giving much satis- 
 faction. And people with sensitive and irritable 
 skins derive both comfort and benefit from fab- 
 rics which are made wholly of cotton or of wool 
 mixed with cotton or silk. 
 
 In addition to this advantage of physical con- 
 formation, wool has the fine characteristic of 
 being able to absorb more moisture than cotton, 
 
168 THE CARE OF THE CHILD IN HEALTH 
 
 silk, or linen. It is capable of taking up more 
 than its own weight of water without immedi- 
 ately losing its elasticity. Evaporation does 
 not take place so readily from it as from the 
 other fabrics mentioned, and, consequently, it is 
 less liable when it is wet to chill the skin. On 
 the other hand, woollen fabrics have a decided 
 disadvantage in the way they react to washing 
 and ironing. The action of washing and rub- 
 bing causes the long, curty fibres to break, 
 become hard and rough, so that the whole gar- 
 ment is finally harsh, feltlike, and shrunken. 
 While this can be in part avoided by care in 
 washing, by the use of lukewarm or cool water 
 in place of hot, and by waving the garment in 
 the water instead of rubbing it, nevertheless, 
 it is always more refractory in its conduct than 
 cotton goods. The latter, on account of their 
 lightness, their ease of manipulation, their 
 smoothness, and the fact of conducting heat 
 well, are the proper materials for summer 
 garments. In the list of available fabrics for 
 clothing, rubber cloth, oil cloths, oil silks, and 
 mackintosh cloth should have no place. They 
 prevent all beneficial movement of air, render 
 evaporation impossible and create a chilled, 
 clammy layer of moisture next to the body that 
 
CLOTHING FROM THE TIME OF INFANCY 169 
 
 makes the probability of taking cold imminent. 
 Finally, the comfort of the clothing can be 
 modified to an appreciable extent by means of 
 their color: for we know experimentally that 
 certain colors take up more heat than others, 
 and that this characteristic makes itself plainly 
 felt in garments of different hues. Thus we know 
 with certainty that black holds more than twice 
 as much warmth as white, and that the interme- 
 diate points are held by yellow, green, red, and 
 blue. The exact order would read as follows : — 
 White Bright red 
 
 Light yellow Dark green 
 
 Dark yellow Pale blue 
 
 Pale green Black 
 
 If we wish to summarize all these facts, we 
 may say that winter clothing should be made of 
 wool, or of mixtures of wool and cotton, or wool 
 and silk that imitate the physical form of wool- 
 len fabrics ; that they should be soft and downy 
 rather than hard or feltlike; that they should 
 be in thin, light layers rather than in one thick, 
 heavy material; that they should not be too 
 loose; and that their color should be red, dark 
 green, blue, or black. In summer they should 
 be made of cotton, muslin, or silk, should be in 
 as few layers as possible, should be very loose, 
 
170 THE CARE OF THE CHILD IN HEALTH 
 
 and that their color should be white, yellow, 
 or pale green. Rubber material should never 
 be used for clothing, nor should that fabric 
 known as stockinet find a place in a child's 
 underclothes, or mackintosh in his overcoats. 
 " Waterproofed " woollen goods have less objec- 
 tions to their use, for they admit of a moderate 
 passage of air. In the future they will doubt- 
 less be used much more than they have been in 
 the past. 
 
 The form of the clothing should be as simple, 
 as light, and loose as a sensible regard for 
 appearances permits. The general plan may 
 with slight modifications be used for all ages up 
 to the time of puberty. Thus, as soon as the 
 child is old enough to have acquired habits of 
 cleanliness, he may wear the so-called union 
 underclothes; these as was stated in a previous 
 chapter, consist of shirt and drawers united in 
 one garment. For the autumn and spring a 
 medium weight should be used, and for winter 
 one may select either a heavy weight, or two 
 lighter garments may be worn at one time. 
 For summer the woollen wear may well be dis- 
 carded for muslin or cambric; but in this event 
 sufficient changes must be made to prevent the 
 wearing of sodden clothes. The stockings in 
 
CLOTHING FROM THE TIME OF INFANCY 171 
 
 winter should be woollen, long enough to reach 
 well above the knee, and should have a fast 
 black dye. In summer they may be of cotton, 
 silk, or cotton mixture, and should be white or 
 one of the light colors. The practice of having 
 short socks on young children, which is unfor- 
 tunately continued by some mothers into cool 
 weather, should not be countenanced. The legs 
 have the same reason for being covered as any 
 other portion of the body, and may likewise be 
 injuriously affected by inequalities of temper- 
 ature, draughts, and other congestive influences. 
 The same reasons forbid the exposure of a child's 
 chest; and even in very warm weather it is 
 advisable to have the whole body covered. 
 There is no doubt that young children may 
 suffer acutely from the heat, and every rational 
 effort must be made to keep them as comfortable 
 as possible. But this can be done by lessening 
 the number, weight, and tightness of the gar- 
 ments, instead of cutting out parts which right- 
 fully should remain. 
 
 Over the undershirt comes a waist to which 
 the shirts and stocking-supporters may be at- 
 tached. This waist is often corded for the sake 
 of giving it a fairly permanent shape, and 
 should be made of the various fabrics that be- 
 
172 THE CARE OF THE CHILD IN HEALTH 
 
 long to different seasons. Thus, in summer it 
 may be muslin, but it must be thin enough for 
 comfort; in spring and autumn it may be made 
 of coutil, and in winter two layers of light 
 coutil or a sufficient thickness of flannel are 
 desirable. This garment should be high in 
 the neck and long in the sleeves, and may be 
 fastened with good-sized buttons. In the lower 
 band there should be a series of worked slits 
 which resemble a buttonhole; and through 
 them a strong and broad tape may be drawn, to 
 which buttons are to be sewed. These buttons 
 are meant to support the two little skirts, one 
 of which should be of flannel, and the other of 
 muslin, cambric, or nainsook. The weight of 
 the flannel skirt must naturally be regulated by 
 the season, and in very hot weather it may be 
 laid aside. For ordinary children in good health, 
 no abdominal band is at all necessary, and the 
 use of it in summer may give an irritating feel- 
 ing of heat and discomfort. Under the usual 
 circumstances there is no more reason for wear- 
 ing a knitted band on the abdomen than one 
 over the lungs or about the throat. 
 
 The outer garments come next in order, and 
 require no special mention; for from what has 
 been said the mother can easily deduce what 
 
CLOTHING FROM THE TIME OF INFANCY 173 
 
 their requirements are. It is hardly necessary 
 to say that young boys' knickerbockers should 
 be buttoned on to the waist in place of the 
 two skirts which girls wear. Boys usually 
 wear a loose waist, or a sailor waist which has 
 a deep enough fall over and below the waist 
 line to hide all traces of band or buttons. All 
 the changes which fashion and individual taste 
 may suggest are usually harmless in their 
 effects so long as they are not allowed to in- 
 terfere with the characteristic necessities of 
 proper material, ease, and looseness of cut, 
 suspension of all weight from the shoulders, and 
 absence of binding or constricting garments 
 or appurtenances, as, for instance, in the way 
 of garters. The round garter should never be 
 worn, for its evil effects are peculiar to itself, 
 while its advantages are better obtained by the 
 suspension elastics which are fastened from the 
 side of the waist. The clothing must be suited 
 not only to the season, but also to the uses 
 which it may be called upon to serve. Thus, 
 in times of play, the child should wear such gar- 
 ments as will not in any way interfere with his 
 entire liberty of both mind and body. If he is 
 daintily and expensively dressed, he will nat- 
 urally be restrained in his running, jumping, 
 
174 THE CARE OF THE CHILD IN HEALTH 
 
 falling, digging, delving, building, and number- 
 less other exercises which are his by right and 
 choice. Therefore his play-suit must be easily 
 washable, strong, and with a fairly smooth sur- 
 face. A good quality of denim answers the 
 purpose excellently; and if it is made in the 
 form of overalls, it will give much satisfaction to 
 both parents and children. Little girls as well 
 as boys may wear them, and the only change 
 from the usual form that need be made is a 
 widening about the waist and buttocks, so that 
 the skirts may be tucked in and be well pro- 
 tected. A child thus clothed has an exhil- 
 arating sense of freedom; he does not fear to 
 express all unrestrained effervescence that is 
 characteristic of his age, and his possibilities of 
 enjoyment are proportionately enlarged. In 
 general terms, one may say that it is a good 
 plan to use old clothes, as long as they last, for 
 nursery use, for use in country and park. In 
 cities, when children are allowed to go to a 
 park, they are commonly overdressed or over- 
 decorated; they may look more genteel or more 
 prosperous, but they do not have as good a time 
 nor do they derive as much benefit from their 
 exercise as if they were plainly or even some- 
 what roughly clothed. 
 
CLOTHING FROM THE TIME OF INFANCY 175 
 
 A noteworthy part of the costume is the shoe ; 
 for on the choice of it depends much of the 
 child's activity, freedom of movement, and 
 grace of carriage. It is a really remarkable 
 fact that in this detail of clothing, which can so 
 easily be properly planned and executed, there 
 should be so many poorly designed articles. 
 Nothing can be easier than to observe carefully 
 the formation of the foot, to obtain its natural 
 outline, and then to adapt the shoe to these 
 elemental requirements. Nevertheless, a cor- 
 rectly made shoe is not easy to find, and manu- 
 facturers continue to make the same faulty styles 
 that were in use many years ago. Even in a 
 baby's shoe these misconceptions may be seen ; 
 and whatever attempts at reform have been made 
 are, in most cases, makeshifts. If one will 
 blacken the sole of the baby's foot, and then 
 take its imprint on white paper, one will readily 
 see that it forms the approximate outlines of a 
 triangle, the apex of which is at the heel ; more- 
 over, when the foot is placed upon the ground, 
 it has a tendency to spread out somewhat in the 
 fashion of a duck's foot. From the toes and 
 the fore part of the foot the fine motions of 
 balancing are accomplished, and the carriage 
 and walk are controlled. This part, therefore, 
 
176 THE CAKE OF THE CHILD IN HEALTH 
 
 should have the maximum of freedom, if the 
 function of the member is to be fully developed. 
 In addition, until the muscles have obtained a 
 useful measure of strength there should be as 
 little restraint put upon them as possible. 
 During the weeks and months while the child 
 is learning to walk he needs all the aids that 
 he can naturally obtain to help him in balanc- 
 ing; and, therefore, a broad, flexible fore part 
 of the foot is much more useful than a narrow, 
 rigidly held one can ever be. Thus, one can 
 easily recognize the need, during infancy, of a 
 soft, soleless shoe, or "bootie," and during the 
 period when the child is learning to walk, of a 
 soft, loose shoe that is narrow at the heel and 
 very broad at the toes — in short, one that is 
 made and shaped like a moccasin. 
 
 As the child grows older and his muscles 
 grow stronger, he will, if he is in health, begin 
 to walk of his own accord. And in almost 
 all cases he needs no artificial helps or aids. If 
 certain muscles, or groups of muscles, are unde- 
 veloped or lacking in native strength, it is not 
 wise immediately to use supports. The defec- 
 tive muscles should be made strong by properly 
 selected exercise rather than weakened by props, 
 which take away the work that they ought to 
 
CLOTHING FROM THE TIME OF INFANCY 177 
 
 do. There is no doubt at all that weakened 
 functional activity can be strengthened by 
 properly directed attention, and such is the 
 proper method to be adopted. If the mother is 
 not able to do this by passive motion, massage, 
 and simple exercises, she should obtain the 
 requisite information from an expert. For this 
 reason it is unwise to use the so-called ankle- 
 shoes, which have the paralyzing effect of a 
 corset. They stifle the free play of the muscu- 
 lar structures; and if the part eventually 
 becomes strong, it is not on account of, but in 
 spite of the artificial support. Naturally, this 
 decision applies to cases of mere muscular weak- 
 ness, and not to those of pathological deformity. 
 With ankle-shoes and braces put out of the way, 
 the shoe must be adapted to the form of the foot 
 instead of the foot being adapted to the shoe. 
 The sole should never be too thin, the front of 
 the shoe must be very broad, the heel and 
 counter should be reasonably small; the high- 
 est part of the arch of the instep should be 
 toward the inside of the foot, from which to 
 the outer edge there is a moderately sharp 
 incline. Such a shoe may not look decorative 
 to eyes that are accustomed to sharp toes and 
 broad heels ; but it has the greater advantage of 
 
178 THE CARE OF THE CHILD IN HEALTH 
 
 being useful and comfortable, of giving a firm 
 foundation for the sole, while it provides 
 sufficient protection to the whole foot. 
 
 The leather which is used in the making of 
 the shoe should be kid, calf, or similar skin 
 that is thoroughly porous. Patent leather, en- 
 amelled leather, and other waterproof material 
 should never be used. They make the skin 
 wet and cold, tender and irritable; and their 
 only extenuation is their decorative effect. 
 High overshoes or rubber boots have a certain 
 amount of justification because they are worn 
 for no more than short and separated intervals, 
 for during those times they adequately protect 
 the feet from cold and moisture. But as soon as 
 the child enters the house, they should be 
 removed and the feet should be thoroughly 
 dried. Before putting on rubber boots the feet 
 should be covered with felt slippers. 
 
 While a child's clothing should be comfort- 
 able, becoming, and of a good quality, it ought 
 never be too pretentious in style nor lavish 
 in its decorations. A child should give the 
 impression of unspoiled simplicity, should stand 
 for a developing personality that is innocent 
 and pure enough to be untouched by the garish 
 vanity and class distinctions of the older world. 
 
CLOTHING FROM THE TIME OF INFANCY 179 
 
 Not only do his clothes influence the estimation 
 which other people form of him, but even more, 
 they affect the opinion in which he is apt to 
 hold himself. One of the best ways to make 
 him vain, conceited, and petty is to overdress 
 him, to fasten his attention on his external 
 decorations. In this way such details come to 
 take the place of an important ideal, and simul- 
 taneously to exclude, in a proportionate degree, 
 the growth of ideals of real value. A reason- 
 able pride in decent and dignified dress is a 
 good thing; the abuse of such pride is a very 
 bad thing. The potentialities of a child are so 
 great that interference with their best fruition 
 should be undertaken with fear and trembling. 
 A child is apt to seem pretty and doll-like, in 
 all likelihood he is pleasing to the casual eye, 
 when he is decked out in gewgaws until he 
 resembles a lay figure ; but such characteristics 
 fade away into woful triviality when one con- 
 siders that in the bespangled breast may beat a 
 heart of future greatness, and under the berib- 
 boned cap may lie a brain that will give out 
 large thoughts. If dress is the index of the 
 man, it certainly has some influence in describ- 
 ing the formative surroundings of the child. 
 
CHAPTER IX 
 
 HABITS 
 
 Matthew Arnold used to say that conduct 
 was three-fourths of life. But he might have 
 gone farther and said that all of conduct was 
 contained in habit; indeed, he would have been 
 strictly within reasonable bounds if he had 
 claimed that habit constituted nine-tenths of 
 life. It is the factor that controls both thought 
 and deeds ; it takes the place that instinct holds 
 in animals, and with every increase in the com- 
 plexity of life it augments its power. We usu- 
 ally think of it as the controlling force in a few 
 of the Avell-settled customs of daily routine; 
 but, as a matter of fact, its range of influence is 
 infinitely wider. The manner of dressing, of 
 washing, of eating, of walking ; the posture and 
 carriage of the body, the peculiar character of 
 physical expression; tricks of speech, the point 
 of view that designates how conduct is directed, 
 the decision which governs most questions of 
 ethics, morals, and religion, all these and more 
 
 180 
 
HABITS 181 
 
 fall within the legitimate confines of that great 
 force which we call habit. Many of the traits 
 which commonly come under the heading of 
 heredity and, practically, all of the effects of 
 environment are really matters of habit. And 
 it is often difficult to say whether any existing 
 characteristics, outside of the organic conforma- 
 tion, has not originated in the ceaseless repeti- 
 tion of acts and thoughts that gradually and 
 unconsciously changes impressions upon plastic 
 infancy and childhood into the fixed and 
 characteristic habits of maturity. 
 
 The question of plasticity is an important 
 one, and the younger the child the more impor- 
 tant is the place it holds. For in such persons 
 nothing is fixed, everything is potential. The 
 brain is not in its mature form, it has not acted 
 as the pathway of numberless nerve-currents, 
 each one of which comes from one definite place 
 and goes to another. According to the forces 
 which may be brought to bear upon it, these 
 nerve-currents may be sent in one direction or 
 another, they may form various intersections, 
 and they may assume various degrees of inten- 
 sity and emphasis. Brain tissue follows the 
 rule of all physical substances in being suscep- 
 tible to certain impressions which, when indefi- 
 
182 THE CARE OF THE CHILD IN HEALTH 
 
 nitely repeated, predispose the constituent 
 particles of such substances to react in a definite 
 and inevitable manner. Thus, a piece of paper 
 that is once folded has ever afterward a tendency 
 to fall into the same crease; and the sureness 
 with which it falls into that crease is measured 
 by the number of times the process is repeated. 
 A piece of wood that is once polished is more 
 and more easily made smooth and shiny — it 
 has acquired the habit of being polished. A 
 road that has been ridged by a heavy wagon- 
 wheel has acquired the habit of containing ruts, 
 and every similar impulse tends to make the 
 ruts deeper and the habit more pronounced. 
 
 In animals similar processes exist, but in 
 greater complexity. Leaving out of account 
 for the moment the factors of obvious training, 
 we know that the whole organism may and does 
 take on certain phases that, by reiteration, 
 become permanent. A dog may become so 
 accustomed to a certain sort of food that he 
 will really faint from hunger, or even starve, 
 rather than eat a different sort. A horse may, 
 as a matter of routine handling, have been 
 spoken to and soothed by the driver's voice and 
 vocal expression, and if this method of control 
 is suddenly altered, he may become uninanage- 
 
HABITS 183 
 
 able and temporarily worthless. And in pro- 
 portion to the place in organic development 
 which an animal or person occupies, his organ- 
 ization is plastic. Human beings, as a whole, 
 have this plasticity in a marked degree, and 
 most of all in their earlier months and years. 
 Thus, an infant may be regarded as no more 
 than a bundle of potentialities, which is another 
 way of saying that his final, crystallized form 
 represents a bundle of more or less firmly set 
 habits. This crystallizing process begins at no 
 exactly definite time. It certainly is in action 
 directly after the child's birth, and may, in 
 addition, begin before birth in the various 
 degrees of the child's nutrition, which predis- 
 pose him to receiving and interpreting certain 
 nervous impulses. A baby may, on account of 
 under- or over-nutrition obtain a corresponding 
 ability to react to certain impressions, and this, 
 in turn, may have an important share in the 
 responsibility of building up his future life. 
 Therefore, an attempt to shape the child's habits 
 ought to begin with a wise and sufficient atten- 
 tion to the mother during her pregnancy, or 
 even before. 
 
 At all events, after the little one has come 
 into the world, the question of habit-formation 
 
184 THE CAKE OF THE CHILD IN HEALTH 
 
 immediately becomes a burning one. Nothing 
 can possibly be more important than it is, for 
 it is a factor that is always active. This sweep- 
 ing ideal must never lose its hold on parents' 
 minds, and the more thoroughly they embody 
 it and live it out in their conduct, the more 
 deeply will they influence their children's 
 development. They must be constantly on the 
 watch for acts and tendencies that mark the 
 beginning of a habit, and must as constantly 
 be prepared to encourage the good and discour- 
 age the bad. The start is the important thing, 
 for more can then be done in one direction or 
 another than at any other time of life. A clear 
 conception of what constitutes good and bad 
 habits must be formed, and then the conduct 
 must, as far as possible, be made to square with 
 that conception. And not only is such a course 
 beneficial in regard to the particular matters in 
 question, but also it has a definite use in pro- 
 moting a disciplined and orderly budding out 
 of the faculties that have been latent. 
 
 For instance, one of the first things in the 
 way of habits that a baby must learn is to lie 
 quiet when he is awake and not nursing. The 
 practice of carrying a child about, of tossing 
 him in the air, of rocking and dandling him, is 
 
HABITS 185 
 
 absolutely superfluous. There can be only two 
 excuses for it: either the child is sick in some 
 degree, and thus is restless and feels pain, or 
 his relatives and attendants desire to amuse him 
 and themselves by treating him as if he were a 
 doll to be played with. If the first supposition 
 is true, then he should without delay receive 
 such medical treatment as will restore his 
 health; if the second is the case, then the 
 child is being trained to be restless, desirous 
 of excitement, wanting in repose. These 
 are some of the unfavorable characteristics of 
 our time, and are responsible to no small extent 
 for the wear and tear from which the modern 
 person suffers. The custom of adding to the 
 baby's tossing by making uncouth noises, pull- 
 ing grotesque faces, and cutting capers in order 
 to make him laugh is likewise unnecessary and 
 doubtless harmful. To a child of this tender 
 age everything is new, and the ordinary events 
 of his little existence are certainly novel. The 
 contortions and gymnastics that people com- 
 monly believe amuse him must certainly be 
 exciting for his small mind, must carry him 
 away from the perfect restfulness which consti- 
 tutes the best atmosphere for the full develop- 
 ment of his body and mind. At this period of 
 
186 THE CARE OF THE CHILD IN HEALTH 
 
 his life he should vegetate, he should nurse, 
 sleep, breathe, and fulfil his primary physical 
 functions. And everything else is beyond the 
 mark. 
 
 The circumstances of nursing and sleeping 
 should be as simple and as natural as a due 
 respect for sanitary and hygienic laws permits. 
 Not only need he not be rocked to sleep, nor 
 walked up and down the room to make him 
 quiet, but also he should not be temporarily 
 soothed by means of sugar teats, empty rubber 
 nipples, rubber "comforters" or "pacifiers." 
 The habit of using these articles is a thoroughly 
 bad one, and should by all means be abolished. 
 All infants possess the sucking reflex in so 
 acute a degree that, as a rule, very little is 
 needed to develop exaggerations and distortions 
 of it. Thus, one may start some of the vicious 
 sucking habits, such as finger sucking, clothes 
 sucking, attempting to use any and every article 
 for this purpose. By such means the fingers 
 may become wasted and shrunken, and the 
 mouth lose its shape; in addition, the habit 
 of tongue sucking (doubling the fore part of 
 the tongue back toward the pharynx and then 
 sucking), or even tongue swallowing, may be 
 thus encouraged. Possibly the most imminent 
 
HABITS 187 
 
 danger of all is the likelihood of infecting the 
 contents of the stomach and intestines with 
 harmful bacteria. There is little doubt in my 
 mind that a noteworthy proportion of the cases 
 of summer derangements of these organs, of 
 unexpected diarrhoeas and vomitings, and even 
 some cases of bronchitis are so caused. For 
 whether the child sucks on his fingers, or on 
 the corner of a pillow, or a rubber "pacifier," 
 or a home-made sugar teat, the result may be 
 much the same: he takes repeatedly into his 
 mouth articles that are not surgically clean, 
 that may be polluted with pathogenic germs, 
 and that, therefore, may threaten the child's 
 nutrition, health, or even life. 
 
 While such training is in its nature prohibi- 
 tive and, therefore, negative, a bit of positive 
 habit formation may be begun at a very early 
 age. Most children, as a rule, do not develop 
 habits of cleanliness until an unnecessarily pro- 
 tracted period. This time often extends to the 
 fifteenth month, the eighteenth month, and even 
 the twentieth month. No mention need be 
 made of children who do not obtain control of 
 the bladder and rectum until they are two and 
 a half or three years of age, for they are either 
 pathologically deficient in control or suffering 
 
188 THE CARE OF THE CHILD IN HEALTH 
 
 from actively bad training. One may find that 
 the bladder sphincter is somewhat harder to 
 train than that of the rectum; but both are 
 sufficiently amenable to constructive teaching. 
 If from the third or, at the latest, the fourth 
 month the child be supported on the chamber 
 vessel at regular intervals, and especially if he 
 is held in the crouching position that is essen- 
 tial to real ease in defecation, he will in a sur- 
 prisingly short time respond in a satisfactory 
 manner. These intervals should be decided by 
 the approximate times when the spontaneous 
 movements have appeared. At first it will be 
 necessary to make the intervals at least four 
 times a day; in a short time three will be 
 enough, and, in most cases, the child will end 
 by having two regular movements daily. Of 
 course, one cannot expect success immediately 
 in this any more than in other important 
 matters. But a logical persistence will, within 
 two or three months, give a gratifying result. 
 To control urination will take a considerably 
 longer time; although it is not hard to convince 
 sensible parents, if they follow out the plan, 
 that an element of regularity will soon appear, 
 and that their work will thereby be lessened 
 while the baby's comfort is materially increased. 
 
HABITS 189 
 
 The habit of regularity should be employed 
 in all the details of the day's routine: the child 
 should awake or be awakened at a certain hour; 
 his feeding must come at a definite time, and if 
 at that time he is asleep he must be roused; 
 the time of his bathing should likewise be fixed; 
 his trips into the open air demand an equal care- 
 fulness — in short, the child's whole life should 
 be laid out by the clock. This will be his first 
 lesson in obedience, which should represent a 
 recognition of a necessary law of conduct. The 
 question of obedience should have something 
 logical in it, and the source of that logical 
 quality must be in the demands of the parent. 
 There is really no reason why parents should 
 not be entirely logical in their demands ; even 
 young children respond to a conscientious man- 
 ner of forming one's opinions as well as to arbi- 
 trary and thoughtless ruling. And if they can 
 be subjected to some carefully ordered plan in 
 the changing affairs of their daily life, there 
 will certainly be less friction and commotion 
 than otherwise. At all events, however, they 
 must learn to obey; and obedience that comes 
 readily and spontaneously is worth more than a 
 tardy and partial compliance. They must from 
 the very first realize that the controlling power 
 
190 THE CARE OF THE CHILD IN HEALTH 
 
 resides in the parents, and that whatever power 
 exists is being humanely and deliberately exer- 
 cised. At the same time, they must know that 
 humane and deliberate principles are thoroughly 
 consistent with firmness. This firmness pre- 
 supposes so much forethought, self-denial, and 
 struggle against indulgent affection that it may 
 occasionally be difficult to embody in action. 
 But whether or no it is hard, it must assuredly 
 be acted out. No child is benefited by over- 
 indulgence, and most children find their best 
 preparation for mature life in a consistent dis- 
 cipline that demands unqualified obedience to 
 reasonable rules of conduct. 
 
 While the habit of obedience is a valuable 
 one, it must not be expressed in such rigid 
 forms as to lead to the evils of exaggeration. 
 A child that is ruled and governed too much is 
 apt to have a cowed and deceitful mind. The 
 logical outcome is an imitation of the harsh 
 qualities of cruelty and tyranny. Children, 
 somewhat like savages, fall very easily into 
 these vices, partly on account of thoughtless- 
 ness, and partly because their faculty of imag- 
 ination is not well directed. No matter what 
 the nature of the predisposition may be, we all 
 know that it exists. To restrain his tendency 
 
HABITS 191 
 
 while conserving the normal amount of aggres- 
 siveness and independence may be a difficult 
 task; but no matter how difficult it is, it should 
 be undertaken with as devout a sense of obliga- 
 tion as the parents can command. A cruel 
 child, although answering closely to a natural 
 type, is, and must be, thoroughly offensive to 
 the best aspirations of a civilized parent; and 
 with every manifestation of such a tendency a 
 definite retrogression from a laudable spiritual 
 condition has been made. A healthy spiritu- 
 ality is not necessarily God-given; its origin 
 may be distinctly earthly. Not counting the 
 cases of special predisposition toward it, the 
 quality exists, in some degree, in all persons. 
 Extraneous circumstances according to their 
 nature encourage or discourage it. And one 
 of the factors that most surely make it wither 
 is the utter disregard for another's personality, 
 which we call cruelty. 
 
 Viciousness rarely appears in a single form, 
 and an unfortunate habit is usually founded 
 upon so many different factors that various 
 related habits increase by a simultaneous con- 
 struction. As an example, one may cite the 
 close relationship between cruelty and cow- 
 ardice. Some of the constituent factors of the 
 
192 THE CARE OF THE CHILD IN HEALTH 
 
 former, such as seeking an advantage over per- 
 sons who are unable to resist or defend them- 
 selves, fear of discovery, secretiveness, and a 
 disposition to evade consequences, are likewise 
 characteristic components of the latter. In fact, 
 the relation between the two is so intimate that 
 the existence of one is often a safe indication 
 of the other. As a matter of practical experi- 
 ence, the habit of fear, of being cowardly, is in a 
 normal child quite unnecessary. It grows from 
 repeated impressions which are generally made 
 upon the mind of the child for the purpose of 
 enforcing discipline. To the charge of com- 
 mitting this weak and vicious mistake, parents 
 as well as nurses must often plead guilty. We 
 are too much in the habit of attributing to the 
 " ignorant nurse-maid " the practice of frighten- 
 ing children by stories of ghosts, "the black 
 man," "the boogy man," and the mythical 
 policeman who is supposed to take bad little 
 boys and girls away. And, as a matter of real 
 experience, many mothers do the same thing. 
 In addition they bolster up the habit by express- 
 ing fears in their own person; and this leads 
 to the same inevitable result. The woman who 
 is afraid to go into dark rooms and places, who is 
 afraid of the thunder or the lightning, who falls 
 
 i 
 
HABITS 193 
 
 into a paroxysm of terror at the sight of a mouse 
 or a rat, who shivers and cries at the touch of 
 a caterpillar or a beetle, who fears dogs, cats, 
 cows, or other harmless animals, is much to 
 blame in making her children timid, suspicious, 
 weak-souled, and apprehensive. Cowardice 
 and bravery may be congenital qualities ; but 
 more often they represent an acquired tendency, 
 a condition of mind that has grown up from 
 small beginnings, a process of evolution that 
 tends to become crystallized in the matured 
 person, who finds himself unable to escape from 
 the stigmata of early training. 
 
 What is true of cowardice, of cruelty, of obe- 
 dience, of regularity, is equally true of the 
 other habits which lend distinctiveness to the 
 individual character. Courtesy is taught with 
 difficulty to grown-up children, and it is as 
 hard to assume good manners after childhood has 
 passed into youth as it is to acquire a clean-cut 
 taste in regard to dress or household decoration. 
 With most people the impress that is made upon 
 them in their early years lasts for the greater 
 part of their lives, and in many cases forever. 
 They may, with the passing years, obtain 
 worldly experience, they may acquire the polish 
 which social intercourse and thought give; 
 
194 THE CARE OF THE CHILD IN HEALTH 
 
 nevertheless, the common rule demonstrates 
 that they rarely obtain the perfect ease, repose, 
 and finished culture of manner which distin- 
 guish the man who is born and brought up in a 
 home of refinement and good breeding. The 
 peasant's cottage may contain as many sterling 
 virtues as exist in a house which has sheltered 
 generations of scholars and gentlemen; but 
 peasants come forth from the former, and gen- 
 tlemen from the latter. We are too apt in the 
 present day — the time of the so-called common 
 people — to deride the advantages of birth and 
 to exalt unduly the rough and ready manner 
 that, fortunately enough, may sometimes go 
 hand in hand with sterling and manly qualities ; 
 but the fact remains that the habit of gracious 
 and modest bearing, of sweet-toned and har- 
 monious demeanor, cannot be put on like a 
 garment. One must grow into it, one must 
 incorporate it as an integral part of oneself, one 
 must breathe it in as one breathes the air that 
 cleanses the blood. 
 
 Yet another habit that grows with the child's 
 growth is his use of language, and the accent 
 that marks his speech. As the parents talk, so 
 will the child talk. The ear becomes so habitu- 
 ated to certain sounds and inflexions, the eye 
 
HABITS 195 
 
 becomes so used to certain motions of the lips 
 and face, the muscles of the tongue and lips 
 become so accustomed to certain movements, 
 that they finally come to act in these ways as a 
 sort of second nature. Parents who are scru- 
 pulous of the exactness of their phrases, of the 
 correctness of their grammar, of the purity of 
 their expression, are providing a daily training 
 that will be of invaluable assistance to their 
 offspring. Colloquial speech must be taken 
 seriously, for the child is unable to distinguish 
 between good and bad usage. Slovenly Eng- 
 lish is as good in his ears as exact English, and 
 the only absolute standard for him is present 
 usage. It is as easy in early childhood to 
 obtain a large and carefully differentiated 
 vocabulary as a small and undiscriminating 
 one ; but the difference between the two in later 
 life, when success depends to so large a degree 
 upon spoken intercourse, is very great. In 
 childhood the acquirement of language and its 
 refinements is a matter of unconscious develop- 
 ment; later on it is an act of conscious effort 
 which consumes both time and energy. For 
 such reasons parents must watch their words, 
 the framing of their sentences, and the faith- 
 fulness with which the words express their 
 
196 THE CARE OF THE CHILD IN HEALTH 
 
 meaning, as they would their acts and the inter- 
 pretation which children would naturally place 
 upon them. 
 
 So far we have been considering general 
 habits, which have much to do with giving 
 character to speech. In addition there are par- 
 ticular and peculiar habits which, although they 
 have a more individual bearing, are worthy of 
 careful attention. The usual habit of speech is 
 an approximately even flow of words which more 
 or less closely express the child's meaning. 
 But there are exceptions where the flow of words 
 may not be even, or where they express little or 
 no meaning. Some children have difficulty in 
 uttering the syllables of words. The trouble 
 is not plainly associated with particular sounds, 
 but rather with the clear, sharp, and unob- 
 structed attack with which syllables and words 
 are begun and the continuity which binds them 
 together. No more than the first sound is 
 made, and this is repeated with growing rapidity 
 and embarrassment as the speaker's nervous 
 spasm increases; finally, the whole word may 
 come out as if forced by a strong effort against 
 an obstacle. This habit is what people call 
 stuttering. It has no connection with defects 
 of the speech organs, but rather should be 
 
HABITS 197 
 
 regarded as a combination of nervous poverty, 
 lack of self-control, and, in many cases, imita- 
 tion. It has no more reason for existence than 
 other habits of defective speech, such as drawl- 
 ing, hurrying, senseless and wearisome repe- 
 titions of sounds, words, or phrases, or the 
 prolonged use of babyish pronunciations. The 
 stutterer can be cured of his fault both easily 
 and quickly, if he is taken in hand at the out- 
 break of the habit. He must be made to speak 
 slowly and evenly; he must, as soon as he starts 
 to stutter, be stopped, quieted, and told to 
 begin again. He must be faithfully drilled in 
 repeating words and sentences until ease of 
 speech is as inevitable as lack of ease formerly 
 was. The parent or teacher must be patient, 
 gentle, and persevering ; and outbreaks of tem- 
 per will do more to confirm the bad habit than 
 can be undone by half a dozen lessons. 
 
 A related habit that is often confounded with 
 stuttering is stammering. This shows itself in 
 an inability to pronounce individual syllables or 
 sounds readily and distinctly. It may be the 
 result of imitation alone, but often that effect is 
 augmented by nervous poverty and exhaustion. 
 There may, likewise, be some defect or disability 
 of the organs of speech which limits the func- 
 
198 THE CARE OF THE CHILD IN HEALTH 
 
 tional activity. Thus, the child may have a 
 tongue-tie, or hare-lip, and cleft palate ; or the 
 pharyngeal tonsil may be hypertrophied, and, 
 as a result, the normal development and shape 
 of the nose and upper jaw may be arrested or 
 deflected. This small list is no more than a 
 part of what may exist, but it is capable of 
 showing how varied may be the influences 
 which interfere with ordinary speech. There- 
 fore, when a child begins to stammer he should 
 first be taken to a skilled physician for examina- 
 tion and, if necessary, treatment. After that, 
 one may begin with careful instruction in cor- 
 rect speech. Instead of purely physical dis- 
 abilities or the influence of bad example, there 
 occasionally occurs a case of defective speech 
 habit that is due to nothing except mental and 
 nervous deficiency. As an example, one may 
 take the curious phenomenon of echolalia, in 
 which the child will repeat again and again a 
 word or phrase that has happened to strike his 
 attention. Such manifestations, and those more 
 startling ones, like functional aphasia, should be 
 immediately referred to the skilled specialist. 
 
 In the same manner that a child may contract 
 bad habits of speech, he may also learn unfor- 
 tunate customs in other respects. At times the 
 
HABITS 199 
 
 origin of them is mysterious, and their persist- 
 ence is often equally noteworthy. In this cate- 
 gory one may include the vicious practice of 
 nail biting, the evils of which are so plain that 
 they need no demonstration. The children 
 who practice it are almost always nervously 
 depressed, or even congenitally asthenic; and 
 therefore, outside of any measures which one 
 may adopt to discourage them, the broader idea 
 of the systemic need of treatment should always 
 be kept in mind. To paint the nails with 
 bitter solutions in order to give a bad taste to 
 them is good enough in its way, but it does not 
 go as deeply into the matter as it ought, nor 
 does it search out the root of the trouble. This 
 attempt at a radical rather than a provisional 
 cure falls in line with the main thesis of this 
 chapter: that habits are the expression of 
 repeated impresses upon the mind, and to make 
 or unmake them one must steadily keep before 
 one's eyes the fundamental laws of psychology 
 instead of a merely unreasoning encouragement 
 of this manifestation or an irrational dis- 
 couragement of that symptom. 
 
 The need of a definite plan is especially to 
 be seen in such a deplorable habit as that of 
 masturbation. This is an especially good 
 
200 THE CARE OF THE CHILD IN HEALTH 
 
 example, because it must seem to everybody 
 unnatural, destructive, and utterly vicious. It 
 is more common than parents are usually will- 
 ing to confess, and in many instances it flour- 
 ishes for years before the mother discovers it. 
 In many cases which have come under my notice 
 the practice existed from a very early age, and 
 some have begun very shortly after infancy. 
 Such children should not be regarded as natu- 
 rally depraved and vicious, nor should their 
 unfortunate habit be hidden and left unex- 
 plored. On the contrary, all the details and 
 aspects of the case must be fully investigated, 
 and a searching inquiry into the probable cause 
 of the defect must be made. A mere forbidding 
 of the practice or the infliction of a punishment 
 is neither rational nor effective ; one can hope 
 for much greater ultimate success if one will 
 carefully and patiently try to pick out the factor 
 that is making the undesirable impressions upon 
 nerve-cells. In some cases it is a deformity or 
 physical peculiarity, such as a long and tight 
 foreskin in a boy, or an adherent clitoris in a 
 girl; in others it is the bad example of vicious 
 nurses or companions ; in yet others it may be 
 some lesion in the central nervous system. In 
 the first case, surgical measures will give relief; 
 
HABITS 201 
 
 in the second, changed environment, firm but 
 kind correction, and tireless watchfulness will 
 be of distinct service; and in the third, medical 
 treatment or the use of hypnotism may diminish 
 or obliterate the evil. But in every case one 
 of the main factors is the recognition of what a 
 habit really is, as well as the earnest attempt to 
 provide a cure that is as insistent and stead- 
 fast as the impressions which it is intended to 
 remove. 
 
 If one would embody such an ideal in the 
 standards that are placed before children, the 
 benefit which they would obtain must be really 
 great. The habits of persistence, of concentra- 
 tion, of self-control, are unquestionably suscep- 
 tible of being taught and being learned. And 
 in most cases this method is the surest means 
 of inculcating such characteristics. A few ex- 
 ceptional persons may arrive at the same result 
 spontaneously or by experience ; but as a rule, 
 the most reliable way of obtaining desirable 
 mental conditions is the slow and positive one 
 of imitative habit. In the little affairs of a 
 child, he can, in his small way, exhibit quali- 
 ties that will in later times make him a better, 
 stronger man than the average, and the world a 
 better one for his having lived in it. There is 
 
202 THE CARE OF THE CHILD IN HEALTH 
 
 no reason why his youthful disposition should 
 be allowed to vacillate in its native unsteadi- 
 ness; and at the same time these habits need 
 bring no burden of crushing discipline upon 
 him. On the contrary, if he sees these habits 
 in his environment, in the characters of his 
 parents and guardians, and in the applications 
 of stories and tales to ordinary life, he will, 
 unconsciously or sub-consciously, take them to 
 himself as he takes any less laudable conceptions 
 of conduct. The habits of a child or a youth, 
 looked at from this view-point, are not entirely 
 due to himself; and whatever praise or blame 
 they provoke belong only in part to him. The 
 parents and guardians are fully as responsible 
 as he, and possibly more responsible than he. 
 If he is industrious, law-abiding, and decent in 
 demeanor, they may feel a reasonable amount of 
 self-congratulation. If he is deceitful, lazy, 
 and vicious, they should look well into their 
 own lives for the controlling factors. They do 
 only a part of their duty if their external life 
 is what the world calls respectable while their 
 private and intimate deeds and thoughts are 
 faulty. A child cares very little about respect- 
 ability; he is strikingly direct in forming his 
 ideas and estimations. And what affects him 
 
HABITS 203 
 
 most is intrinsic intentions rather than extrin- 
 sic appearances. The care of a normal child 
 consists of much more than providing shelter, 
 food, clothing, and conventional instruction; 
 fully as much, it includes the living of such 
 lives by the parents as will approximate in the 
 closest possible degree to the ideal which they 
 hope to see in him. The parents must look to 
 it that their days must be times of high think- 
 ing, of clean and pure living, of strenuous en- 
 deavor, of devotion to what they consider noble 
 and fine ; for by means of their offspring they 
 project their own individualities upon the 
 world. They may be satisfied to have low 
 aims for themselves ; but they have no right to 
 impose similarly poor aspirations upon their 
 child, and condemn him to a grovelling exist- 
 ence. 
 
CHAPTER X 
 
 RELATION OF PARENTS TO CHILDREN 
 
 The proper care of a child is a method of 
 higher education for the parents. The subject- 
 matter is so various, the attention to details is 
 so exact, and the self-devotion is so constant, 
 that one cannot be far wrong in calling it the 
 highest education. This standpoint, if logi- 
 cally adhered to, will create a distinction 
 between the poorer methods of rearing children 
 that were in use in the past and the better ones 
 toward which the thought of to-day is moving. 
 In past times children were taught to regard 
 themselves as being troublesome, stupid, with- 
 out knowledge, judgment, or tact. The rule 
 that children should be seen and not heard car- 
 ried its crushing influence through all their 
 little lives. They were excluded from family 
 and social functions, they were allowed to take 
 no more than a very small part in the domestic 
 councils and confidences, and their personal 
 affairs were deemed too unimportant to admit 
 
 204 
 
RELATION OF PARENTS TO CHILDREN 205 
 
 of much notice. In a word, they were made to 
 feel that their existence demanded an excuse, 
 and that assertion of their individualities was 
 almost domestic treason. In families of limited 
 means they were made to work beyond their 
 capacity, and their duties were turned into bur- 
 dens ; among the wealthy the custom of handing 
 them over to the care of nurses and governesses, 
 so that the parents saw little of them, and had 
 less to do with their rearing, was almost univer- 
 sal. If one looks at such customs objectively 
 and frankly, one would think that children were 
 some sort of semi-civilized animal, whose nat- 
 ural wildness required strong measures for its 
 control, and whose companionship was to be 
 endured and not desired. 
 
 We have come to regard these things some- 
 what differently now. We realize that children 
 are fully as human as their elders, that they 
 have hopes and aspirations, fears and doubts, 
 joys and sorrows, in much the same way as their 
 parents. It is true that their lack of experience 
 gives them a deficient sense of proportion, and 
 that their ignorance of worldliness leads them 
 to make curiously literal interpretations of 
 persons and things. But these characteristics 
 are in many ways advantages rather than dis- 
 
206 THE CARE OF THE CHILD IN HEALTH 
 
 advantages. The children are placed in their 
 parents' hands not only helpless, but also 
 unformed; not only dependent, but also claim- 
 ing progressively greater attention; not only 
 possessing possibilities of good, but also possi- 
 bilities of evil. The choice of these alternatives 
 does not lie with them, but with the parents. 
 The children must submit to whatever decision 
 is made for them, and the unfolding of their 
 lives depends upon the fitness of the father and 
 mother to direct, encourage, and repress the 
 various characteristics that have need of such 
 control. 
 
 In order to do this work, thoughtfulness and 
 devotion are absolutely essential. Good inten- 
 tions are a meagre foundation for the noble 
 superstructure of requirements which the cir- 
 cumstances demand. A woman might as well 
 try to substitute good intentions for a knowledge 
 of cooking when preparing a meal, or a man for 
 the ordinary information of commercial forms 
 when trying to conduct a business. Intuitive 
 feeling and hearsay instruction are a poor 
 enough makeshift for a knowledge of how to 
 feed and clothe and dress a child ; but when they 
 presume to dictate the manner of building up a 
 definitely good relation between child and 
 
RELATION OF PARENTS TO CHILDREN 207 
 
 parent, as well as the formation of a clear, 
 healthy atmosphere in the home, the task imme- 
 diately becomes greater than reasonable expec- 
 tation can hope to see fulfilled. So long as this 
 is true, there is an obligation for the parent to 
 consider the subject in all its aspects, and to 
 ascertain how far he must progress beyond his 
 existing limitations in order to satisfy the 
 rightful claims of the situation. 
 
 First of all, he should consider what the child 
 is, what he ought to become, and what are the 
 means at hand to bring about the desired end. 
 The little one comes unformed, unwitting of 
 every fact of life, absolutely ignorant of what 
 this world, in all its myriad manifestations, 
 really is. These things and many more he must 
 learn from his parents and the environment 
 which they provide. What they are to teach 
 him is not only what they have learned, but 
 what they themselves are. And the environ- 
 ment means much more than the apartments in 
 which they live and the furniture which they 
 use; in addition, it means the spirit which 
 pervades the home, the intentions that lie at 
 the basis of their action, and the self-control 
 by which they maintain a nice equilibrium of 
 heart and mind in all the varying and trying 
 
208 THE CARE OF THE CHILD IN HEALTH 
 
 circumstances that are incidental to ordinary 
 life. This conception includes within its 
 bounds all people — the rich and poor, the igno- 
 rant and the learned, the resident of the city 
 and the dweller in the country. It embodies a 
 truth of human nature which is so broad that it 
 admits of universal application. By such a 
 method of reasoning we arrive at a wide gener- 
 alization, which is the beginning and the end 
 of the art of wise parenthood: the influence of 
 parents is the direct reflection of their lives and 
 thoughts. Here is a field where deceit cannot 
 long abide, where in the long run honesty 
 counts for a quality of unlimited value, where 
 sacrifice to a healthy ideahbrings its rewards in 
 progressively increasing amounts. 
 
 It is very hard to deceive a child, although 
 he is young and simple. Indeed, even at the 
 earliest age, and when he is far from being capa- 
 ble of analysis, he shows a marked adaptability 
 in receiving impressions. His plasticity is so 
 great that it assumes the likeness of an active 
 influence, as a sponge fills out with the water 
 in which it floats. Therefore, the time to begin 
 forming a child's disposition or character is 
 really at birth, or even before birth. Do the 
 parents wish him to be kind-hearted, gentle, 
 
RELATION OF PARENTS TO CHILDREN 209 
 
 frank, and honest; do they wish him to be 
 deferential to women, sturdy to the world, 
 hearty and unselfish in his manner to compan- 
 ions? Then they themselves must consider 
 what these qualities are, they must incorporate 
 them in their own thoughts and acts, and finally, 
 they must demonstrate them in the big and the 
 little details of everyday life. 
 
 In order to clear the ground for more particu- 
 lar considerations, another preliminary fact 
 must be disposed of. The place and importance 
 of the nurse-maid are commonly exaggerated. 
 She is regarded as being more necessary than 
 she really is, and, in the ordinary case, she is 
 too much depended upon as well as too much 
 courted. In the families of the poor, or those 
 of ordinary means, the choice is made from the 
 least experienced and helpful girls; for the 
 parents believe that anybody is good enough to 
 wheel a baby-carriage or carry the baby. In 
 the wealthiest families a somewhat more sophis- 
 ticated person is demanded; but the sophisti- 
 cation usually concerns matters of externals 
 rather than real fitness. It is undoubtedly true 
 that the large majority of these servants have 
 very little real fitness for their work. They 
 have received no real and efficient training, 
 
210 THE CARE OF THE CHILD IN HEALTH 
 
 they are commonly ignorant, and the most 
 favorable thing that one can say for them is 
 that they may be actuated by a decent amount 
 of good intentions. The incongruity of the 
 whole situation is remarkably striking: the mis- 
 tress of the house will often assume the personal 
 care and supervision of her fine china or a fine 
 picture, and she would never think of putting 
 a piece of old lace in the custody of a chance 
 servant; but a child is evidently considered 
 less valuable or less susceptible to injury. 
 Since every mother naturally believes that her 
 baby is the most precious thing on earth, the 
 conclusion naturally follows that she does not 
 realize how intimately he may be and is influ- 
 enced by early companionship. 
 
 This touches the very root of the whole 
 matter: the child is susceptible to impressions 
 of one sort or another from the earliest age. 
 That is the time when the forming of his char- 
 acter and his distinctive traits begins. The 
 mere fact that he does not immediately demon- 
 strate the effects has little to do with the case. 
 An illustration of a similarly slow but sure 
 effect may be seen in the unconscious growth 
 of speech. A very young infant who hears a 
 certain language or dialect is naturally uncon- 
 
RELATION OF PARENTS TO CHILDREN 211 
 
 scious of its character is tic peculiarities, but, 
 nevertheless, within a few weeks or months he 
 begins with inevitable certainty to use that 
 language or dialect. If this were the place to 
 go into the discussion of the physiology of 
 nerve-impressions, it would be no difficult 
 matter to demonstrate how the same rule applies 
 to the other factors involved in growth. And, 
 without argument, any one can see that what 
 is true of learning words and accent is, in a 
 similar way, true of the elements of conduct; it 
 is no more than another step to recognize that 
 the elementary parts of conduct — the motives, 
 feelings, and passions of the person — may like- 
 wise be transmitted. And thus we arrive at 
 the conclusion that the earliest companionship 
 of a child is a matter of grave importance. To 
 place such responsibility upon an uninstructed, 
 uncultured, unthinking young girl is reckless ; 
 it is wilful extravagance of the worst sort ; it 
 means throwing away the opportunity of pro- 
 ducing the highest results, of making the closest 
 bonds between child and parent, and really 
 invites' indifference, misunderstanding, and 
 division of purposes to be permanent residents 
 in the home. 
 
 The care and rearing of a child are matters of 
 
212 THE CARE OF THE CHILD IN HEALTH 
 
 such importance that the mother alone should 
 be intrusted with them. It is not out of the 
 way for her to take an assistant to do the rough 
 work, the fetching and the carrying. But the 
 personal part of the service belongs only to her. 
 She is the one who will ultimately reap the 
 rewards of good or bad training, and she is like- 
 wise the one who must provide the essentials 
 of that training. She must enter into the prob- 
 lem so earnestly that her duties will at the 
 same time be pleasures. Even if she were so 
 abnormally constituted that parental love did 
 not impel her to work out all the possibilities 
 of the situation to their full extent, neverthe- 
 less, there is a sufficient field for the exercise 
 of finished powers of observation, of fertile 
 suggestion, of ready tact, of logical reason- 
 ing — enough to busy a thoroughly active 
 mind. 
 
 From the earliest months she must live with 
 her child; she should wash him, nurse him, put 
 him to sleep, take him in the air for his exercise. 
 As he grows older she must provide and direct 
 his amusements, from the earliest time, when 
 every sound and sight are new facts to his 
 unfolding senses, to the period when his pleas- 
 ures and duties resemble those of adults. She 
 
RELATION OF PARENTS TO CHILDREN 213 
 
 must guard him from careless or rough handling, 
 must enforce a kind but firm discipline, must 
 teach him to be dependent upon her more than 
 upon any other person in the household. At this 
 time the father cannot expect to take a large 
 share in the baby's training, for the necessities 
 of his business will keep him away during most 
 of the little one's waking hours, and, in addi- 
 tion, he cannot be expected to have the deft 
 touch and the intuitive knowledge of an infant's 
 needs that a normal mother possesses. But he 
 can be of decided use in maintaining a quiet, 
 peaceful, cheerful atmosphere in the home; he 
 can give efficient help by keeping tempers 
 unruffled and minds cheerful ; and, most of all, 
 he can develop a spirit of courtesy, of sweetness 
 of manner, even of chivalry. Such things are 
 more than mere counsels of perfection; they 
 should rather be called practical directions for 
 the building up of strong nerves, normal bodies, 
 and healthy minds. And the man who con- 
 scientiously endeavors to embody them will find 
 that they react upon him, and serve to ennoble 
 his own disposition. 
 
 When the child is old enough to run about, 
 he should live a large part of the day in the air, 
 and all confinement must be reduced to the 
 
214 THE CARE OF THE CHILD IN HEALTH 
 
 minimum. To follow this idea to its fullest con- 
 clusions, he should, if possible, be taken to a 
 home in the country or the suburbs. While it 
 is obviously impossible for the large majority of 
 people to have a home in both city and country, 
 it is plainly feasible for almost anybody who is 
 sufficiently thoughtful of the interests of his 
 offspring to reside where the houses are not 
 packed together, where there is an abundance 
 of air and light, where there is no continuous 
 rumble and roar of a big city's traffic. The 
 modern means of communication are so excel- 
 lent that a man who works in the heart of a 
 great city may reach his home outside of that 
 city's limits without undergoing too much 
 strain and exertion. People of limited means 
 can live as well and as cheaply in the suburbs 
 or country as in town, and at the same time 
 have advantages of healthfulness, quiet, and 
 recreation which can in no other way be ob- 
 tained. The strongest objection that can be 
 urged against a country or suburban home is 
 the one of overcoming the city habit or the leav- 
 ing of a social circle — both of which are of 
 little importance in comparison to the benefits 
 to be obtained by the change. 
 
 After this matter has been settled, the parents 
 
RELATION OF PARENTS TO CHILDREN 215 
 
 must make up their minds that the family must 
 be united, not only in the sense of mutual affec- 
 tion, but also in daily interests, in studies, in 
 pleasures. Of all these items the one of pleas- 
 ures most concerns the growing child. It 
 stands, in his estimation, for the greater part of 
 life, and by means of it his parents must come 
 closely in touch with him. Many of their own 
 amusements may have to be thrown over : they 
 may go less to the theatre, may indulge less in 
 social pleasures, they may have less personal 
 quiet than they formerly had; but the exchange 
 will be a richly profitable one. There is no 
 reason why parents should not find as interest- 
 ing material in their own children as they do in 
 strangers or acquaintances; there is no reason 
 why they should not take as lively an interest 
 in the conversation of their offspring as they do 
 in that of their neighbors or their ministers, 
 their doctor or their lawyer. Often the little 
 ones are not too deficient in the reasoning 
 quality, and commonly they possess more than 
 the adult share of lively imagination. At all 
 events, parents can find in intimate intercourse 
 with their children much to learn, much to 
 stimulate them and keep them fresh, much to 
 lend a zest to life. They can thus review their 
 
216 THE CAKE OF THE CHILD IN HEALTH 
 
 youth, and, by combining the spontaneity of the 
 little ones with their own more mature powers, 
 they need have no fear of growing old, or of find- 
 ing time hang heavily on them. 
 
 To do all this there must be similar objec- 
 tive points in the domestic life for the various 
 members of the family. Each one must feel 
 that there are certain duties and pieces of work 
 which he must perform, and that every other 
 one has obligations which are arranged accord- 
 ing to his capacity. Children, even those of a 
 very youthful age, can understand this to a sur- 
 prising extent. In almost all instances they 
 respond remarkably well to appeals, especially 
 those which are made by conduct and example, 
 rather than words, to their sense of justice and 
 fair play. And, from the earliest possible time, 
 each boy or girl must feel that he is a factor in 
 the household, that he can and does render 
 some sort of valuable aid, that he is a respon- 
 sible person whose presence is worth being 
 taken into account. The value of his actual 
 work may be little, but that of his potential 
 accomplishment is truly great. And no time 
 is too soon to teach him to live on a high plane. 
 Such teaching can easily and naturally be com- 
 bined without any stiffness of attitude in the 
 
RELATION OF PARENTS TO CHILDREN 217 
 
 ordinary affairs of the day. When the father 
 returns from his work he may participate in con- 
 versations, games, or readings in which he may 
 ingeniously weave amusement and instruction. 
 And if he feels that he has insufficient funds of 
 thought and experience for the task, let him set 
 out as a serious matter to obtain what is lack- 
 ing. Children are tolerant critics, and fre- 
 quently are satisfied with a wholesome intention 
 even when performance is bungling. 
 
 On half-holidays and Sundays he should be 
 with his little ones in the open; in summer 
 there are rambles in the woods, in the fields, 
 along the roads, he may suggest fishing, flower- 
 picking, butterfly-hunting excursions ; and 
 many a time he will find that the questions 
 which are thrown at him will encourage him 
 to increase his store of knowledge. In autumn 
 they may go nut-gathering, leaf -collecting. In 
 winter there are skating, coasting, snow-ball- 
 ing, the construction and manning of snow 
 forts, and all the other sports that are dear to 
 children's hearts. And in all of them he 
 should take a hearty part, while at the same 
 time he acts as a judge, a moderator, an ex- 
 ample of fairness, of chivalry, and of courage. 
 The girls as well as the boys should be his 
 
218 THE CARE OF THE CHILD IN HEALTH 
 
 companions, and they need have no distinctly- 
 separate lives until they are about twelve 
 years old. They have as keen a need as their 
 brothers for strong bodies and free minds, and 
 until the approach of puberty they should not 
 be too forcibly reminded of the difference in sex. 
 This question brings up the weighty matter 
 of how the parents may control the dawning 
 knowledge of what sex is, and what the mean- 
 ing of puberty is. In most families the subject 
 is avoided, and both girls and boys are allowed 
 to find out for themselves the changes that sep- 
 arate the child from the youth. The main rea- 
 sons which govern such a policy of laissez-faire 
 are the parents' unwillingness from consider- 
 ations of modesty to touch on the subject too 
 prematurely, and the general unfitness which 
 they usually feel to handle the details in a sat- 
 isfactory way. The first reason is not well 
 grounded, because the question of modesty con- 
 sists largely in how the communications are 
 made ; and no one doubts that a father or a 
 mother will use much more delicacy, will try 
 infinitely harder to give the requisite infor- 
 mation, than servants, young companions, or 
 chance acquaintances. In most cases when 
 parents are forced to explain, they find that 
 
RELATION OF PARENTS TO CHILDREN 219 
 
 their children have already a surprising and 
 occasionally an appalling amount of knowledge. 
 And the impressions which are the first to be 
 received are commonly the last to be lost. The 
 question of inability or unfitness to state the 
 details is a more practical one, but it is by no 
 means unsurmountable. A man or woman of 
 fair intelligence, culture, and tact ought after 
 some thought to be able to inform the child of 
 how he is constructed, how his body and mind 
 develop, and how the development fits into 
 the scheme of nature. If this is impossible the 
 family physician is usually able to supply the 
 deficiency. Commonly he has a sufficient knowl- 
 edge of natural history to give, in the course 
 of a walk or a series of walks, a rapid account 
 of the development of plants, with illustrations 
 from the flowers and trees which he encounters; 
 then to progress to the growth and generation 
 of fishes, then of animals, and finally of human 
 beings. And by the exercise of good judgment 
 and a fair amount of delicacy he cannot only 
 present the subject in a pure light, but also he 
 can impress the child's mind with the idea of 
 maternal self-sacrifice, devotion, and love which 
 are the necessary factors of the mother's relation 
 to her offspring. Thus, instead of this com- 
 
220 THE CAKE OF THE CHILD IN HEALTH 
 
 munication being the cause of misgiving and 
 dread, it may easily be turned into an oppor- 
 tunity of cementing ties of affection and pro- 
 moting in the child's mind the sense of life-long 
 obligation. 
 
 This is the spirit that should underlie the 
 intercourse between parent and child, a spirit 
 of carefulness, of frankness, of willing teaching, 
 and equally willing learning. The child must 
 under no circumstances be forced to feel that in 
 any respect the full sympathy and cooperation 
 of his parents are lacking. He must be made 
 to believe that there is no concern so trivial, no 
 secret so profound, no event so momentous that 
 his parents are not the first to recognize and 
 appreciate his emotions, his natural or acquired 
 impulses, his triumphs and defeats. He must 
 be made to feel that his home is the place where 
 he is most welcome, where he can obtain most 
 enjoyment. The opportunity of having fun is 
 one of the mainsprings of youthful life, for it 
 represents the possibility of the easy and pleasant 
 discharge of youthful energy, of the exercise of 
 expanding capabilities. Therefore it is in this 
 direction that as much of the home life as possible 
 should be directed; and at the same time the nec- 
 essary duties which every person, according to 
 
RELATION OF PARENTS TO CHILDREN 221 
 
 his age, should undertake must be so bound up 
 with these pleasant features, that a flush of enjoy- 
 ment spreads over the whole course of the day. 
 It is not hard to apply the same plan to the 
 companionships which every child is bound to 
 make. Let him feel that his friends are wel- 
 come, let him invite them to take part in his 
 walks, games, and his rainy afternoons in-doors. 
 The parents should become acquainted with these 
 children, should exercise a wise choice among 
 them, not so much by condemning some as by 
 praising others. Among children even more 
 than among adults the generalization holds true 
 that those of like disposition and training will 
 flock together ; for children have less of the 
 ulterior and worldly to influence their choice. 
 And if they are well directed, their companions 
 are apt to be unobjectionable. At all events 
 these friends are, as far as is feasible, to be taken 
 into the family circle; they must be made to feel 
 the heartiness of sentiment, the frankness, the 
 lack of suspicion and prejudice that characterize 
 the ideal home. They should be invited to par- 
 ticipate in the games, rambles, and excursions 
 that the children of the house enjoy, they must 
 be encouraged to form clubs of various sorts, 
 they must be instructed in what ways to direct 
 
222 THE CARE OF THE CHILD IN HEALTH 
 
 their attention, and how to maintain a sense of 
 good fellowship and chivalry. In all these 
 enterprises the heads of the house must take 
 part ; not for a single day may they allow their 
 interest to flag. This last admonition is, in a 
 way, unnecessary ; for if they have carried out 
 such a plan during their children's early years 
 the habit will have grown so strong, the enjoy- 
 ment will have been so keen, and the freshness 
 of their later years will be so striking that the 
 possibility of adopting a different mode of life 
 is barely possible. 
 
 The gist of the matter lies in the doctrine of 
 unselfishness. It is only by giving up the 
 narrow, egoistic traits in one's character that 
 one can develop a strong tendency toward gen- 
 erosity in one's children ; it is only by extin- 
 guishing whatever of the boor is in one that 
 chivalry in one's offspring can be elicited ; it is 
 only by crushing out the sullen and sulky parts 
 of oneself that the full joy and beauty of life 
 can be brought out in others. Children are 
 exquisitely human, delicately sensitive to im- 
 pressions, acute in detecting shams. And if 
 one hopes to make them loving and lovable, 
 respecting and respectable, brave and gentle, 
 one must as a fundamental preliminary live out 
 
RELATION OF PARENTS TO CHILDREN 223 
 
 these qualities in one's own life, and simultane- 
 ously try to crush out their antitheses. A child 
 may be deceived once or twice or thrice ; but 
 he cannot be fooled for years; he knows and 
 cares nothing about expediency, but acts out 
 the thoughts and emotions which his environ- 
 ment awakens. The parents are the head and 
 the centre of that environment, their animus is 
 the greatest force which forms the growing 
 character, and their success as rearers of off- 
 spring are usually to be measured by the intrinsic 
 worth of their own souls. We have been told 
 that men who desire immortality must, by a con- 
 scious effort, throw off the characteristics of 
 mortality; and it is fully as true that those who 
 wish to live again in children of noble minds 
 must first of all lose the traits which seem to 
 wise men ignoble. This constant training in 
 the search of an ideal is one of the finest things 
 that human minds can conceive, this strenuous 
 effort to stamp out the vicious parts of one- 
 self is the real salvation in this world. It may 
 be a good enough thing to try to save one's 
 soul, especially if the saving be not too exclu- 
 sive ; but it is far better to try to mould one's 
 life so that one's children may be saved. The 
 standard of effort has happily changed within 
 
224 THE CARE OF THE CHILD IN HEALTH 
 
 the last two or three centuries. Men do not, 
 as formerly, seek a selfish beatitude ; they have 
 substituted for that a broader charity, a more 
 inclusive love. And whatever they owe to 
 their children is better expressed in terms of 
 daily life and immediate home influence than 
 distant deeds of valor and pauperizing obedience 
 to heavenly laws which bear the smell of earth. 
 It is a good thing to change the tense of our 
 endeavors: to strive for present happiness and 
 joy and love, instead of looking for some future 
 bliss which stands out in a black background of 
 others' damnation. 
 
CHAPTER XI 
 
 EDUCATION 
 
 Education, as we commonly know it, is a 
 purely formal matter that is encouraged for the 
 double purpose of conventionality and conven- 
 ience. We take it for granted that every person 
 should receive a school training ; that is the 
 custom of the time, and unconsciously we con- 
 cede the rightfulness of it. We likewise be- 
 lieve it is a profitable thing to have, because it 
 makes the possessor more capable of advance- 
 ment in the world than he otherwise would be. 
 The added reason of obtaining an education for 
 its own sake, for the purpose of obtaining cul- 
 tural influences, is often regarded as superfluous 
 or at best as rightfully belonging to youth and 
 adult life, and more especially to those persons 
 of demonstrated ability or of fortunately large 
 financial resources. Very often the cultural 
 element is regarded as a detriment, because it is 
 supposed to render the possessor less hardy and 
 aggressive than he otherwise would be, and 
 q 225 
 
226 THE CARE OF THE CHILD IN HEALTH 
 
 therefore less able to fight his way through the 
 world. Since there is plainly some error in- 
 volved in these views, and especially as there 
 seems to be no common factor which unites 
 them, it is worth while to examine the subject 
 and attempt to clear the way for the forming of 
 more worthy opinions. 
 
 The discussion rests mainly upon the ques- 
 tions involved in what constitutes a desirable 
 course of instruction, what is the age when 
 instruction should begin, and what should be 
 the order of the prescribed studies. All this 
 takes for granted the elementary facts that all 
 children need to be taught, and that the teach- 
 ing of comparatively young children should be 
 the same in all classes of society without regard 
 to future work. For, whether the child is des- 
 tined to be a banker, a merchant, a clergyman, 
 or a bookkeeper, he needs the primary training 
 which will serve to shape his mental growth in 
 a healthful and profitable fashion. In consid- 
 ering the present methods one is immediately 
 impressed with the idea that with most people 
 the first year or two of schooling are really not 
 intended for any more serious purpose than to 
 occupy the child's attention, and to keep him 
 quiet. What he learns in the lowest primary 
 
EDUCATION 227 
 
 grade is the merest conventionality, which, on 
 account of his extreme immaturity, means abso- 
 lutely nothing to him more than learning a cer- 
 tain number of sounds by rote. Whether he 
 learns the alphabet in the old-fashioned way or 
 the phonetic sounds in the newer fashion, the 
 same idea holds good. If instead of being 
 started in the primary grades at five or six years 
 of age, he is put in the kindergarten at three 
 and a half, four, or five years, the same remark 
 may truthfully be made. Children are sent to 
 this latter institution to be amused, to play with 
 others of their age, to be exercised in songs 
 and games. The instruction — whatever there 
 is of it — really is a secondary consideration. 
 Indeed, that part which pretends to some merit 
 in the way of formal instruction is least worthy 
 of commendation. 
 
 Since this has already been treated in another 
 place l it need not be taken up here. It will be 
 sufficient to say that if amusing the child and 
 occupying his attention are the desired objects, 
 they can best be obtained by the mother. She 
 is the person who knows the little one most 
 thoroughly, and she ought, more than any mer- 
 
 1 "The Development of the Child," by Nathan Oppen- 
 heim, The Macmillan Company, 1898. 
 
228 THE CARE OF THE CHILD IN HEALTH 
 
 cenary person, to be able to sympathize with 
 him, to recognize his needs as well as his pecul- 
 iarities. The main objection that can be urged 
 against her undertaking this work is ignorance 
 of its technique. That objection is easily over- 
 come by learning the principal practices of the 
 kindergartnerin. This would not necessarily 
 be a heavy task, and certainly it does not 
 require the same amount of time that the learn- 
 ing of a profession or a complicated business 
 demands. On the other hand, if it is really of 
 use in helping the child's development, its 
 value is notably greater than any ordinary pro- 
 fessional or business career. Under all circum- 
 stances, the first years of a child's life should 
 be spent in the companionship and under the 
 control of the mother, who should endeavor to 
 acquire sufficient training to give her confi- 
 dence in her fitness for the work. 
 
 This preparation should not be left until the 
 child is old enough to attend the kindergarten, 
 but rather should be acquired long before he is 
 born. The mother must be ready to instruct 
 her child as soon as he is susceptible of instruc- 
 tion. This time is never fixed. In some chil- 
 dren it begins at the age of a few weeks, in 
 others when they are a few months old. At all 
 
EDUCATION 229 
 
 events, it does not logically begin at the usual 
 school age. There is only one way in deciding 
 what the right time is, and that is by deciding 
 what we mean by education. Is it to prepare 
 the child to support himself, to give him the 
 means to become a bread-winner? Then the 
 training should come comparatively late, when 
 his body, as well as his mind, is sufficiently 
 matured to hold a recognizably approximate 
 relation to its final and adult form. Is it to 
 serve as mental training, to fit the child's 
 intelligence for its later problems? Then 
 the methods and curriculum must be changed, 
 must be adapted to the stage of the child's 
 development and his personal traits. Is it to 
 amuse him, to keep him occupied and out of 
 mischief? Then the widest liberty of choice 
 must be the rule; rigid duties do not exist, 
 strict teleological calculations are superfluous, 
 and most of the routine of the ordinary school 
 life is not required. In all likelihood the 
 majority of mothers would not say that the 
 earliest teaching was to be guided by any one 
 of these plans, and probably they would be of 
 the opinion that the training should include all 
 three. 
 
 But such catholicity is too comprehensive. 
 
230 THE CARE OF THE CHILD IN HEALTH 
 
 It prescribes more than an ordinary child should 
 absorb, or is able to absorb. We must recog- 
 nize as thoroughly as may be that he represents 
 a varying condition, a course in evolution from 
 an almost rudimentary to a highly complex 
 state. In his earliest condition the only teach- 
 ing which should be given him is the teaching 
 of precept and example. This is the time when 
 he should learn the lessons of imitation, such 
 as speaking one or more languages, funda- 
 mental rules of manner, and elementary ideas 
 of morals and ethics. Likewise, one may create 
 a slowly growing, but really cumulative, effect 
 in general aesthetics and in the growth of 
 special tastes by arranging the nursery and 
 the most frequented rooms of the house in ac- 
 cordance with the impression that is desired. 
 Formal instruction by the ordinary didactic 
 methods should not be employed, and the habit 
 of teaching babies to recite the alphabet, to 
 count, to recite little poems and stories, has no 
 good reason for justification. The common 
 excuse that these things are not taught, but 
 rather "picked up" by the child on account of 
 his unusual aptitude is generally a figment of 
 the imagination instead of cold fact. Very 
 often it is possible that the mother may con- 
 
EDUCATION 231 
 
 sciously not do the teaching; but if she does 
 not, then the nurse or some relative does. It 
 does not require much perspicacity to recognize 
 that whatever teaching is to be done belongs in 
 the earliest age to the creating of general and 
 massive impressions ; there should be little or 
 no attempt to particularize, to impart details, 
 nor to elicit exactness. By setting an example, 
 by creating an atmosphere which is honestly 
 fashioned in the way we wish the child to grow, 
 and by honestly endeavoring to embody in our 
 everyday lives the ideal which we want the 
 child to absorb, is the simplest and best train- 
 ing for the under-kindergarten age. 
 
 While the demands of the time do not allow 
 the child to go without formal instruction of 
 some sort, one should certainly keep in mind 
 the tendency toward a premature beginning. 
 This is to be feared for the double reason that 
 many teachers are becoming disposed to accept 
 children who are under the kindergarten age, 
 and that some unwise parents want to see some 
 educational result which the teaching is sup- 
 posed to bring about. But at this early age 
 very little excepting the most general employ- 
 ment should be given. Games, songs, and con- 
 versations may be very useful, especially if they 
 
232 THE CARE OF THE CHILD IN HEALTH 
 
 are not too heavily laden with a didactic import. 
 Attempts to explain the meaning of occupations, 
 which the games may typify, are very apt to be 
 useless, if only for the reason that the child- 
 mind is unable to grasp the fundamental facts 
 and necessities for them. The main objective 
 point in the games and conversations is the 
 directing of the imagination and the emotions 
 within such limits as may define what mature 
 persons call the normal, the righteous, and the 
 generous. At the early age in question the 
 child is probably receptive to such training, but 
 scarcely to any other. His sense organs are 
 not well matured, and with the passage of suffi- 
 cient time they will develop far enough to be 
 susceptible of keen cultivation. The apprecia- 
 tion of the differences between colors, of various 
 degrees of hardness and weight, of tenacity and 
 resistance of one object and another, may well 
 be left to a future time, to the experience which, 
 comes with added years. And all efforts to 
 develop the reasoning powers are yet more 
 futile, for the fact of pure intelligence can 
 scarcely be called existent in the brain which 
 lacks many of the anatomical features that later 
 in life are bound to appear. But the control of 
 the emotions, conduct, and the imagination is 
 
EDUCATION 233 
 
 an elementary principle that comes into being 
 with the first flourishing of human life, and 
 continues to a greater or less extent while life 
 continues. This is the true function of the 
 kindergarten, and if rightly administered it 
 may be of the highest importance. The ability 
 to restrain anger is infinitely more valuable than 
 skill in passing colored wools through holes in 
 a piece of cardboard; and learning to be cheer- 
 ful, frank, and honest is not to be compared 
 with ability to weave strips of colored paper. 
 Teaching the motions which a blacksmith uses 
 at the forge may be interesing enough, if noth- 
 ing better is at hand; but it certainly is less 
 valuable than guiding the mind by practical and 
 interesting illustrations toward the beauties of 
 filial and parental love, of the obligation of 
 duty, of the excellences of normal subordination. 
 The functions of the kindergarten are largely 
 concerned with ethics. The relation of the 
 child to society at large depends upon the ethi- 
 cal sense of the community, of which he, in 
 time, must form an active member. The task 
 of acquiring a healthy, normal, ethical feeling 
 is a difficult one, but it may be taught as surely 
 as other modes of personal expression. The 
 learning of such tendencies belongs to the period 
 
234 THE CARE OF THE CHILD IN HEALTH 
 
 of early childhood, when the impressions which 
 are most easily received are the general and 
 massive ones. And while they are being 
 acquired the child undergoes no danger of 
 being harmed by a routine that is not fitted for 
 the degree of his evolution. There is no pos- 
 sible danger of straining weak eyes, of filling 
 the immature head with temporary and ofttimes 
 useless memories, or of giving to artificial edu- 
 cational concepts the all-important place that 
 really should be held by ideas of duty and 
 dependence. 
 
 In the primary school a notable change could 
 likewise be made with advantage to the child's 
 growth of mind and the amount of his informa- 
 tion. Under the present circumstances the 
 number of subjects in the curriculum is too 
 great, the subjects themselves are not carefully 
 enough selected, and their relative importance 
 has not been rightfully determined. Parents 
 have been going in the same path that their 
 ancestors took, in believing that one subject 
 was as valuable and as necessary as another, and 
 that the knowledge which is desirable for a 
 youth or an adult must likewise be desirable for 
 a child. In this way the daily routine has been 
 overburdened; and as the requirements of the 
 
EDUCATION 235 
 
 times have increased, the increased load has 
 been put upon the young child, the representa- 
 tive of the weakest part of life. Thus, instead 
 of lessening his work, the authorities, spurred 
 on by a mistaken sense of duty, have been 
 enlarging it. They have reasoned that because 
 the man must know arithmetic, the young boy 
 must as early as possible take it up; that 
 because the one must know how to spell cor- 
 rectly, the other must as soon as possible load 
 his memory with combinations of sound that 
 usually mean nothing to him; that because the 
 former should speak correct English, the latter 
 must be tormented with the abstract rules of 
 theoretical grammar that never yet have made 
 him see the error of his youthful speech. 
 
 As a mattter of fact, the studies should be 
 arranged according to the child's state of men- 
 tal growth; topics which are beyond his years 
 should be put to one side until such times when 
 he is easily able to master them, and his general 
 work should be made as inviting as possible, 
 rather than the opposite. As an example, one 
 may quote the case of arithmetic, probably the 
 worst offender in the whole list. The intelli- 
 gent study and comprehension of this subject 
 are obtained only in the presence of considerable 
 
236 THE CARE OF THE CHILD IN HEALTH 
 
 intellectual power of a certain sort. It repre- 
 sents abstractions that are difficult to grasp; 
 and it becomes of use, both as mental train- 
 ing and as matter of information, only when 
 it is plainly grasped as an abstraction. In 
 all other circumstances the act of learning 
 numbers, or arithmetic, is merely memorizing, 
 — a parrotlike performance that is both weaiy- 
 ing and debilitating. The child that begins 
 to stud)'- arithmetic at five or six years of 
 age really wastes both time and energy for the 
 next five or six years. For if the subject were 
 begun when he had reached the age of eleven 
 or twelve, he would, under proper instruction, 
 progress as far in one and a half or two years as 
 he would under the other plan have taken about 
 seven to accomplish. Here is a clear waste of 
 time, but it is exceeded by the waste of mental 
 energ}^, interest, and spontaneity, which is of 
 much more account. 
 
 Equal fault may be found with the studjr of 
 grammar. It is too theoretical, too abstract, 
 and, in addition, it exerts no influence on the 
 scholar's language. It is a type of wrong and 
 difficult methods of teaching: the use of the 
 abstract before the concrete has been used and 
 understood. A boy may learn every rule con- 
 
EDUCATION 237 
 
 cerning subject and object, predicate and adjec- 
 tive; but the language which he uses will be 
 what he has been hearing. On the other hand, 
 he may be absolutely ignorant of rule or excep- 
 tion ; and in the same manner he will take his 
 speech from the people with whom he passes his 
 time. The children of cultured parents will 
 speak correctly and with a good accent; the 
 children of crude parents will speak incorrectly 
 and with a bad accent. And a pile of grammars 
 as high as a house will never change these 
 facts. The only time when the study of gram- 
 mar may be expected to do real good is when 
 the student is old enough to have an active self- 
 control and analysis, when his self-conscious- 
 ness is great enough to restrain his acts, speech, 
 and even his thoughts. Then, when pride is 
 awake and ambition is stirring, when self-inter- 
 est has aroused all the energy of endeavor, the 
 study of grammar may be both profitable and 
 useful. In earlier times it is, like arithmetic, 
 as useless as it is burdensome. 
 
 In all likelihood the conservative reformer 
 may find fault with the use of the spelling- 
 book. The learning of the literal composition 
 of a word is a form of memory which is made 
 up of repeated visual and auditory impressions. 
 
238 THE CARE OF THE CHILD IN HEALTH 
 
 Such impressions are most easily received and 
 retained if they occur in connection with known 
 facts and ideas, such as are obtained in the 
 course of reading an interesting narrative; and 
 the hardest way to acquire them is the bare and 
 unassociated act of memory. The act of learn- 
 ing the appearance of isolated words and memo- 
 rizing the separate sounds that constitute them 
 is a thoroughly laborious one ; and the results 
 do not justify the expenditure of time and 
 energy expended. If this study were postponed 
 until the faculty of observation had been fairly 
 well exercised, and until experience in reading 
 had made a comparatively large number of words 
 familiar to eye and ear, the process of knowing 
 how those words looked and sounded would be 
 much more easily and rationally acquired. If 
 we follow such a method of thinking to its ap- 
 plication in other directions, we shall be forced 
 to lay less stress than we now do on the early 
 teaching of penmanship according to a rigid 
 copy. When the fingers and eyes are inexpe- 
 rienced and weak, the recognition of the essen- 
 tial points in writing are apprehended with 
 difficulty and expressed very poorly. More- 
 over, minute and slavish copying is hard on the 
 young child's undisciplined faculties. There 
 
EDUCATION 239 
 
 is a general rule in human development which 
 covers the fact that the inhibitory centres are 
 among the latest to attain flourishing strength; 
 if this idea is translated into more common 
 phraseology it might read: the power to restrain 
 comes later than the ability to act or express 
 motion. This statement corresponds to the 
 common experience of children in the hardship 
 of exact imitation of a small copy. Not only 
 theoretically, but also practically, it would be 
 easier for a young child to learn to draw simple 
 and large objects free-hand than to acquire 
 facility in neat and graceful writing. 
 
 The study of geography is taken up too early 
 in the routine of school work; and, as a result, 
 the effects which it produces upon the ordinary 
 child's mind is a confused one, a matter of ill- 
 assorted patches. A young boy or girl is un- 
 able to appreciate the striking nature of the 
 earth's rotundity, of the correct inter-relation- 
 ship of parallels of latitude and longitude as 
 depicted on maps, of the physical disposition 
 of land and sea. The usual plane maps mean 
 very little to such a scholar, whose imagination 
 is not sufficiently trained to translate the plane 
 surface into terms of the shape and form of the 
 earth. The boundaries of the various coun- 
 
240 THE CARE OF THE CHILD IN HEALTH 
 
 tries are learned as rigid divisions, in the 
 same artificial way that one house is marked 
 off by its walls from another. No efficient 
 means are generally used to convey a satisfac- 
 tory conception of these political communities, 
 their distinctive traits, their resources and in- 
 dustries, their physical relations to one another, 
 and the main facts of information concerning 
 their peoples. The true view of a country, in 
 the light of its organic growth, is practically 
 never held by young school children. 
 
 It is easy enough to verify these statements. 
 In order to do so parents should occasionally 
 visit their children's classes. I have done this 
 fairly often, and have always had profitable 
 experiences. One of the occasions which im- 
 pressed me was a visit to a public school in 
 New York City, where I listened to a boy of 
 about eight years, who, in the course of his 
 recitation, said that Pennsylvania was the 
 capital of Philadelphia, and that George Wash- 
 ington was "a brave British general." When 
 the teacher was asked whether that was a 
 type of all the recitations, she retorted, " What 
 can you expect of a child of eight ! " At 
 other times and in other schools I have heard 
 recitations that were no more exact, and I have 
 
EDUCATION 241 
 
 always murmured to myself the exclamatory 
 quotation given above. Although the illustra- 
 tion may seem an extreme one, nevertheless, it 
 does not misrepresent the mental condition of a 
 large part of the primary scholars in regard to 
 this subject. In some respects it is character- 
 istic of what an observer will meet in most of 
 his visits. 
 
 Geography, then, like the other studies men- 
 tioned, does not belong in the curriculum of the 
 primary grade. But, if it is to be retained, its 
 present form and method of teaching should be 
 altered. It would be quite in place to teach 
 young children what the physical divisions of 
 land and water are, what the differences in cli- 
 mate are, what the characteristic occupations 
 and manner of life are that belong to each, and 
 what sort of people is to be found in each. All 
 this should be taught in a practical fashion 
 rather than by words alone. If a large room 
 were fitted up to represent continents, islands, 
 peninsulas, oceans, lakes, and rivers; if the 
 different zones were depicted in gross present- 
 ments with satisfactory examples of their inhab- 
 itants, their occupations, the fauna, the flora, 
 and the distinctive geological formation, the 
 child's mind might be pleasantly occupied, — 
 
242 THE CARE OF THE CHILD IN HEALTH 
 
 as it would be with a story, — and some funda- 
 mental information might be imparted that 
 would require comparatively little discrimina- 
 tion, little rote memorizing, and almost no 
 fatigue. Upon such a foundation a solid 
 superstructure of geographical information 
 might be built when the child is twelve, thir- 
 teen, or more years of age, which would be 
 durable and at the same time easily reared. 
 
 If the ordinarily intelligent parent will take 
 the trouble to examine the course of study in 
 the primary grade, and if he will allow himself 
 to think fearlessly and unrestrainedly, he will 
 soon be convinced that many of the studies may 
 not only without detriment, but also with bene- 
 fit, be dropped. And when he has reached this 
 conclusion, he will invariably want to know 
 what is to fill the gaps. This is not hard to 
 decide upon, so long as the general condition of 
 the child is understood. One must keep in 
 mind the scholar's disinclination to bear long- 
 continued restraint, his lack of concentration, 
 lack of mental self-control, his inability to deal 
 with abstractions, the lack of the reasoning 
 faculty, his deficient store of memories and as- 
 sociations, and his love of novelty and change. 
 All this would require the teaching to be as little 
 
EDUCATION 243 
 
 formal as possible, "would diminish the desira- 
 bility of rigid recitations from memory, would 
 increase the amount of narrative work, and of 
 instruction that was susceptible of the story- 
 telling form. Languages that were taught by 
 the so-called natural method wxmld have a more 
 important place, and would be taken up at an 
 earlier age than is now the custom; and all 
 studies that could be prosecuted in the practical 
 manner which was suggested when speaking 
 of geography, would have a welcome. In addi- 
 tion, some studies should be held out of doors, 
 or on roof-gardens, with which schoolhouses 
 could easily be provided. The teaching should 
 be made a pleasure, a form of instructive recrea- 
 tion, of useful pastime that involves movement, 
 frequent change of occupation and subject, and 
 of the vigorous exercise of the imagination. 
 
 In this connection it is pertinent to speak of 
 the ethical and religious, as well as the so-called 
 common education ; for it is hard to separate the 
 three, unless one means creed when one says 
 "religion." Ethical training may be regarded 
 as defining the attitude which a person holds 
 toward his fellow-men; religious training as 
 defining the attitude which he holds toward the 
 Deity or his conception of the Deity. The one 
 
244 THE CARE OF THE CHILD IN HEALTH 
 
 is a material relation illumined with a spiritual 
 glow, the other is an expression of a spiritual 
 effort that is dulled and weakened by the mate- 
 rial self of the believer. Both are modes of 
 projecting the personality, of expressing a men- 
 tal impulse which varies according to circum- 
 stances of environment and opportunity — 
 possibly of natural disposition. Both have a 
 soft and mellow hue which at times makes it 
 hard to distinguish between them; and under 
 all circumstances the penumbra which they 
 throw impinge upon one another, causing a 
 blending which cannot be called by one name 
 or another. Under such an aspect they are 
 admirable, most of all when they originate in a 
 spontaneous or purposeful movement of one's 
 mind, which is no more than a reflection of one's 
 best intentions. 
 
 Unfortunately, the usual interpretation of 
 religion does not very closely coincide with this. 
 On the other hand, it is often no more than a 
 hard distortion of it, which involves many 
 unfavorable traits in its developed form. And 
 the mental attitude of a child is such as to show 
 these unfavorable traits in a repulsive light. 
 The child is unable to grasp the full spiritual 
 import of religion, he sees none of its possible 
 
 
EDUCATION 245 
 
 excellences of typification, none of its poten- 
 tialities of endeavor, none of the opportunities 
 of restfulness, of hope, and of satisfied longing. 
 Instead, he grasps no more than a complicated 
 system of admonitions and commands, which is 
 commonly exercised with the expectation of 
 possessing a correctional value. The behests 
 of religion are for him negative in their nature : 
 they prescribe what he may not do ; and even if 
 they are put in a positive form, they stand for 
 the negation of what he wants to do. His idea 
 of the Deity is a purely anthropomorphic one. 
 He conceives of God as a huge man whose power 
 to punish bad children is frightful, and whose 
 promise to reward good children bears no imme- 
 diate likelihood of fulfilment in a form that is 
 appreciable. As a result, the control which 
 such an influence comes to have over him may 
 be aptly compared to the terror inspired by a 
 threat to call the "black man," the "big police- 
 man," or the "boogy man." It is a low form of 
 suasion, a confession of inability in the parents 
 to control their child's behavior, and a reliance 
 upon means of restraint that are equally deroga- 
 tory to them and debasing to him. The forms 
 of religion he regards as a mere show or display, 
 to be put on the same plane as any other exhi- 
 
246 THE CAKE OF THE CHILD IN HEALTH 
 
 bition that is attractive when it is novel, and 
 tiresome when it is no longer new. For him 
 the rite of baptism holds no meaning, the eleva- 
 tion of the host — a deeply impressive ceremony 
 — carries no significance; he sees the accom- 
 paniments of fine buildings, notable congrega- 
 tions of men and women, and the imitation 
 by all of a formula which he cannot under- 
 stand. 
 
 This factor of imitation is one of the main 
 traits with which we must reckon in our efforts 
 to produce a commendable moral or spiritual 
 tone. This plainly does not apply to the teach- 
 ing of a creed; for such a matter has no uni- 
 versal truth or fitness. The teaching of one sect 
 is fully as likely to be desirable or undesirable 
 as another. And a formula that fits the needs 
 of one person may bear quite the opposite re- 
 lation to his brother or his neighbor. More- 
 over, we can never know whether the creed 
 in question has a final value in the potential 
 development of a certain child, or whether it 
 may not act as a hindrance to him, whether 
 it is not an artificial creation which, in later 
 years, may provoke the sentiments of rebel- 
 lion, distrust in his estimate of his parents' 
 honesty, and discord with the whole idea of 
 
EDUCATION 247 
 
 spiritual control. But in the sphere of ethics, 
 of pure morals, there exists a field for instruc- 
 tion that is perfect in its possibilities. It is 
 applicable to every family, to every community, 
 to every nation. It is the standard of conduct 
 by which the civilized world marks its progress 
 from a lower to a higher grade of organized cul- 
 ture. Above all, it is a code which applies as 
 well to the ignorant as the enlightened, to the 
 adult as to the child, to all creeds and all 
 peoples. It is the gist of all religions, without 
 which they represent no more than a mere shell 
 that is hard, unyielding, and unpalatable. A 
 child may be unable to appreciate the esoteric 
 symbolism of the immaculate conception, or the 
 Trinity, the doctrine of total depravity, or the 
 regenerating power of baptism; but he surely 
 is capable of knowing the import of the golden 
 rule, of mercy, of charity, of good intention, of 
 honesty, and of kindly deeds. He may be infi- 
 nitely far from highly appreciating the worth of 
 a torturing hell, of infant damnation, of escha- 
 tology, of demonology, or angelology; but he 
 certainly, and without much delay, can recog- 
 nize the power of virtue, of forbearance, of 
 loyalty, of truth, and of modesty. The one is 
 an abstraction which belongs to a later age, 
 
248 THE CARE OF THE CHILD 1ST HEALTH 
 
 when the reason should make its choice of 
 beliefs that are to act as the immaterial guide 
 to a definite tendency of spiritual life. The 
 other is or may be represented as a concrete 
 formation of acts that may be learned as any 
 other method of conduct, the repeated perform- 
 ance of which inevitably tends to create a 
 mental condition that is its analogue. 
 
 And one of the principal advantages of such 
 training is the necessity of the parents and 
 guardians to live up to a similar standard. 
 Such conduct is learned by example and prac- 
 tice more than by preaching. A man may be a 
 pillar of the church, but if his daily life is not 
 entirely in accord with his theoretical profes- 
 sions, he will create upon his child the bad 
 effect of insincerity in place of the desired 
 effect of holiness. This is undoubtedly at the 
 root of the strange and seemingly unnatural 
 deviations from a much emphasized plan of life, 
 which every one has noticed in the families of 
 certain ministers and other pious people. The 
 parents may be good enough men, as men go ; 
 their professions and public acts may be highly 
 commendable, and to the eyes of their little 
 world they may seem to be models of thought 
 and action. But in their private and intimate 
 
EDUCATION 249 
 
 lives one usually may find the elements of cant, 
 of insincerity, of make-believe, of a weak grasp 
 on material and immaterial things, of mild 
 regrets and halting endeavor. 
 
 This brings to a clear focus the idea of edu- 
 cating a child. It is not necessary to cram his 
 head with many facts, most of which he cannot 
 use, and for which he is not prepared. Nor is 
 a rigid curriculum, which may merit our respect 
 on account of its antiquity, necessarily the best. 
 Most of all it is futile to gauge a child's needs 
 by an adult's. The child's business is no more 
 than to prepare for his work and his struggles 
 in life; but the adult's is to grapple with the 
 work and the struggles in an aggressive, mas- 
 terful, and intelligent manner. The best 
 foundation for an efficient training is the pos- 
 session of a vigorous mind and body that have 
 not been divorced from their native strength by 
 artificial methods which have been devised upon 
 a misapprehension of what the child's condition 
 really is. The child should not be forced into 
 a Procrustean mould ; rather he should be nour- 
 ished, he should be strengthened, and his bud- 
 ding functions should be guided within the 
 limits of their own natural channel. His imi- 
 tative faculty must be used instead of his 
 
V 
 
 250 THE CARE OF THE CHILD IN HEALTH 
 
 reason ; for the former is present from the ear- 
 liest age, while the latter is the gradual growth 
 of his later development. The education of a 
 child, considered from this standpoint, means 
 the continuous education of every member of the 
 whole race. It stands for the development of 
 every better feeling of which man is capable, 
 of the self-restraint that marks him off from 
 lower orders of animal life, of the hope, and the 
 living in the future, that is an index of his best 
 aspirations. The true teacher is the parent, 
 who should be as unwilling to resign this func- 
 tion as he would to lose his most precious birth- 
 right. Parenthood includes within its wide 
 confines the teacher's place as surely as it 
 includes the generator's, the protector's, and 
 the advisor's. And too much may not with 
 safety be left to bought assistance. 
 
CHAPTER XII 
 
 DEFECTIVE CHILDREN 
 
 It would be out of place in a book on the care 
 of the normal child to describe and discuss all 
 the marked deficiencies which exist in idiocy, 
 insanity, and radical perversions from the nor- 
 mal; but between the two extremes there are 
 a large number of degrees of imperfection which 
 are commonly misunderstood, neglected, or hid- 
 den. Indeed, one might truly say that parents 
 can have no logical idea of what a normal child 
 is unless at the same time they possess some 
 knowledge of what is meant by abnormality. 
 This is a matter in which the greatest frank- 
 ness should be used; for in order to correct 
 the deficiencies, one must thoroughly under- 
 stand their causation, nature, extent, and 
 probable outcome. It is undoubtedly true 
 that most families that have a deficient child 
 hide the fact as much as possible, believing that 
 by such means they are preventing the outside 
 world from interfering with his future work 
 
 251 
 
252 THE CARE OF THE CHILD EST HEALTH 
 
 and prospects. Most of all, they fear that the 
 reputation of having a defective in the family 
 would interfere with the estimation in which 
 the world holds the other children, would 
 diminish their opportunities of forming advan- 
 tageous commercial and matrimonial engage- 
 ments. 
 
 This wish for secrecy is its own worst enemy. 
 It perpetuates a blind belief in the unchange- 
 able nature of a defect, of its probable existence 
 in the whole family, of the likelihood of its 
 reappearance in offspring. Moreover, it deters 
 from seeking advice and relief, and of necessity 
 causes the condition to remain unchanged. 
 This is infinitely unfortunate, for there is no 
 doubt that many of the defects and their sequels 
 can be ameliorated, even if they cannot abso- 
 lutely be cured. The methods are not gener- 
 ally understood, for the double reason that too 
 little discrimination is commonly employed in 
 ascertaining the cause and the exact amount of 
 damage, and because the treatment is neither 
 radical nor startling, but slow, long drawn out, 
 and, possibly, discouraging. Nevertheless, so 
 long as there is a rational hope of ultimate 
 improvement, the parents have a duty to per- 
 form in using every possible means to obtain it. 
 
DEFECTIVE CHILDREN 253 
 
 In trying to understand the facts of physical 
 and mental defectiveness, one must, first of all, 
 recognize its modes of occurrence. The injury 
 may be congenital or may occur after birth. 
 The congenital cases include microcephalus, 
 hydrocephalus, cretinism, birth-paralysis, gen- 
 eral disturbance of nervous equilibrium, and a 
 wide range of intellectual hebetudes associated 
 with the tuberculous diathesis, or certain low 
 forms of development which are known by the 
 name of "mongol" or "kalmuc." In micro- 
 cephalus the brain is much smaller than usual; 
 its arrangement of convolutions is too simple, 
 and its texture is doubtless coarser than it ought 
 to be. The skull is small, it tends to come to 
 a point at the top, and possesses a receding 
 forehead and a flattened occipital portion. The 
 chin, as a rule, recedes sharply, and the gen- 
 eral expression is one of vacuity and weakness. 
 This condition has no sharply defined limits, 
 but exists in so many grades that not a few 
 microcephalic children are susceptible of enough 
 improvement to give them a bearable position 
 in the world. Under this heading one would 
 place those children in whom some part of the 
 brain is absent, atrophied, or impaired. The 
 scope is thus very wide, and actually should be 
 
254 THE CARE OF THE CHILD IN HEALTH 
 
 made to include persons who are said to be 
 "slightly backward," "not over bright," or 
 " simple-minded." 
 
 " Congenital hydrocephalus " means a brain 
 that at birth contains a relatively large quantity 
 of water or serum. The head is large, especially 
 above the upper level of the ears, the forehead 
 is high and bulging, the occipital portion may 
 be notably increased, the fontanelle remains 
 patent, and the bones of the skull are very soft 
 and yielding. The abnormal amount of fluid 
 causes general pressure, retards growth, inhibits 
 nutrition, and prevents normal functioning. 
 The result is a curious combination of a huge 
 head and a really small brain. Associated with 
 this deformity is a general weakness of the 
 body, a liability to wasting diseases, and a 
 comparatively small resistance against convul- 
 sions and other cerebral symptoms which are 
 due to pressure. 
 
 Cretinism is a remarkable condition which 
 occurs endemically in certain localities of Swit- 
 zerland and France. In the last few years an 
 increasing number of cases have appeared in 
 this country. The disease is associated with an 
 atrophy or absence of the thyroid gland, and 
 has as its apparent symptoms a dwarfing of the 
 
DEFECTIVE CHILDREN 255 
 
 body and mind, thick and flabby skin, a protu- 
 berant belly, a large and projecting tongue, 
 broadly set and full eyes, undeveloped face, and 
 thick cranial bones. The subjects of congenital 
 cretinism do not seem to have much vitality, 
 and easily fall into conditions of marked weak- 
 ness. The sporadic cases are oftener seen in 
 this country than the congenital, and have a 
 better chance of life. But the general dwarfing 
 is fully as marked in the former as in the latter, 
 so that a cretin of twenty years of age may look 
 no more than six, eight, or ten years old. In 
 all these cases the wonderful improvement 
 which modern methods of treatment have made 
 possible is a standing rebuke to those who 
 despair of helping defectives. 
 
 Birth-paralysis results when some part of the 
 body has, during or shortly before parturition, 
 been subjected to long-continued pressure. 
 There is a widespread belief among anxious 
 mothers that the obstetric forceps is responsible 
 for a large proportion of these unfortunate con- 
 ditions. As a matter of fact the opposite is true. 
 The instrument shortens the duration of tedious 
 labors for hours or even days, thereby reducing 
 the amount of danger. Moreover, if it is prop- 
 erly used, the amount of strain which it puts 
 
256 THE CARE OF THE CHILD IN HEALTH 
 
 upon the child is not great enough to be in- 
 jurious. A labor that is long drawn out, that 
 depresses the mother's physical resources to or 
 past the point of toleration, has an equally bad 
 effect upon the child. And he will feel these 
 unfortunate conditions in proportion to the 
 weakness and immaturity of his organism. In 
 the obstetric forceps we have an immediate 
 means of relief, whose value cannot be too 
 highly estimated. 
 
 The tubercular diathesis is responsible for a 
 large proportion of the deficiencies in children. 
 The process is one of general impoverishment, 
 of weakened cerebral circulation, of depraved 
 nutrition. There is no classic form which it 
 assumes, nor is there any limit at which it must 
 necessarily stop. Just as the arms and legs 
 may waste away, the power of digestion dimin- 
 ish, and the general vitality sink to a low level, 
 in the same way the mental force may decrease 
 until the intellectual status is a pitiable one. 
 In somewhat analogous ways a defective cir- 
 culation, which is dependent upon some form 
 of congenital heart disease, may occasion an 
 impoverishment of the cerebral tissues that 
 shows itself in some degree of feeble-mindedness 
 as well as muscular weakness. Yet another 
 
DEFECTIVE CHILDREN 257 
 
 type which doubtless originates in perverted or 
 deficient nutrition is the so-called mongol or 
 kalmuc; it gets its name from the resemblance 
 to the designated races which the facial appear- 
 ance suggests, and may be regarded as an in- 
 stance of arrested development. The head is 
 not large, and the transverse diameter is almost 
 as long as the longitudinal. The eyes are apt to 
 be obliquely placed, and shaped like an almond; 
 the hair is harsh and wiry, the skin is coarse, 
 the tongue is rough and marked by transverse 
 furrows. Such children represent a condition 
 of general incompleteness, which may be illus- 
 trated in a partial way by such local deficiencies 
 as cleft palate, hare-lip, and the many rarer de- 
 formities that result from unfinished growth. 
 
 Under the heading of non-congenital defi- 
 ciencies, the main causes of impaired growth 
 are the results of violence, disease, nervous 
 shock, and serious or long-continued poisoning. 
 The traumatic cases may follow a blow or fall 
 on the head or spine; those dependent upon 
 disease are the ones that have suffered from 
 meningitis, scarlet fever, and other disorders 
 that may affect the brain and its membranes, 
 as well as the organs of special sense. Nervous 
 shock may follow marked terror or fright, such 
 
258 THE CARE OF THE CHILD IN HEALTH 
 
 as is produced by ghost stories, imminent injury, 
 pretended apparitions of the " boogy man, " or 
 even confinement in the dark. The philosophy 
 of these cases is hard to understand, especially 
 as we have no standard by which to ascertain 
 the amount of disturbance, nor even do we 
 know in what organic changes that disturbance 
 resides. We are in an almost equally poor way 
 concerning the so-called toxic cases, such as 
 follow a large use af alcohol, opium, and other 
 powerful drugs. And the most that we can 
 safely conclude is that in some way the circula- 
 tion is weakened, nutrition becomes perverted, 
 and local or general starvation follows. 
 
 When we look at these conditions in large 
 numbers, we are generally able to recognize 
 some common factors which may reasonably 
 have acted as the exciting and active cause. 
 And there is a great need for a clear view of 
 the subject in order that the blame will be 
 rightly placed, and also that there shall not be 
 a false opinion hanging upon the efforts to im- 
 prove or cure. For such a reason there is some 
 keen pleasure in being able to condemn the 
 likelihood of "maternal impressions" having 
 an appreciable share in the causality. The 
 tenacity with which this reputed factor main- 
 
DEFECTIVE CHILDREN 259 
 
 tains its hold upon the popular belief and 
 imagination is truly remarkable. And at the 
 same time there are almost no good reasons to 
 fortify the belief. If it were possible by a 
 single impression upon the mother's mind dur- 
 ing the period of pregnancy to give an enduring 
 character to the child's body or mind, or both, 
 an easy way would simultaneously have been 
 discovered to influence every unborn child. If 
 the sight of some startling animal, the news of 
 some striking event, the appearance of some 
 unfortunate cripple, can blight or harm the 
 foetus, why should it not be possible to direct 
 one child to be a musician, another to be an 
 orator, another to be a mechanician, by allowing 
 the mother to hear respectively a burst of music 
 or a powerful speech, or giving her the oppor- 
 tunity to witness a fine piece of mechanical 
 ingenuity ? Since in every household the busi- 
 ness of the family head is apt to take up a large 
 part of the wife's attention and thoughts, there 
 ought to be as an inevitable consequence an 
 almost certain bending of the children's minds 
 in the way of the father's business. But as a 
 matter of fact we know that a minority of all 
 children adopt their father's vocation; and 
 when they do, it is rather because of unusual 
 
260 THE CARE OF THE CHILD IN HEALTH 
 
 advantages which the inertia of the parent's 
 success may give them than a congenital liking. 
 Let us go yet further and inquire whether, even 
 in cases of marked preference of the parents 
 for a certain business or profession, the children 
 do not show a smaller amount of love or ability 
 for the work in question ? Perhaps of all voca- 
 tions the one that tinges most strongly every 
 circumstance of the family's household and 
 general life is the ministerial. And yet it is 
 comparatively rare to find a preacher's son 
 loving the life and work of a preacher, and 
 longing to adopt them. Indeed, in the various 
 callings it is a comparatively common thing to 
 find that a man's family evince no taste for his 
 occupation, or at most that their approbation is 
 no more than toleration. 
 
 The plain fact is that the whole subject of 
 parental impressions is very misty, without 
 well-defined limits, or clearly understood laws. 
 Vigorous parents, who are well nourished, are 
 very likely to bear vigorous offspring. And 
 persons of weak vitality, especially if thej^ are 
 poorly nurtured, generally have weakened chil- 
 dren. We are able to hand on to our children 
 a legacy of our physical constitution and pecu- 
 liarities, or those of our ancestors; or possibly 
 
DEFECTIVE CHILDREN 261 
 
 the combination of the innumerable factors in 
 heredity may give a resultant which is different 
 from any one of them. The main element in 
 all cases is the quantity and quality of nutri- 
 tion; and the influence of adventitious effects 
 lies in the way of increasing or decreasing that 
 nutrition, of keeping it within straight or 
 crooked lines. It is not radically different 
 from the manner in which children may be 
 manipulated and influenced after birth. 
 
 Maternal impressions usually come in the 
 form of a single thought, or perception, or 
 shock; but we rarely find that such a single 
 event can do much toward making or marring 
 the mind of a child. If the opposite were true, 
 it would be hard to find a normal or healthy 
 person ; for the exigencies of ordinary life make 
 the occurrence of some sort of shock or unde- 
 sirable maternal impression practically unavoid- 
 able. "So strong, indeed, is the tendency of 
 nature to revert to a healthy type, that the soli- 
 tary infraction of physiological law is not often 
 visited by the penalty of mental abnormality ; 
 and if we only look back far enough we shall 
 probably find that such a culmination is reached 
 by the gradations of repeated transgressions." 
 This statement bears at once a hope and a warn- 
 
262 THE CARE OF THE CHILD IN HEALTH 
 
 ing. One single act may not be exceedingly- 
 important in itself, but that act may be the 
 individual expression of a general tendency 
 which must, with each repetition, exaggerate 
 the tendency to recurrence, or the producing of 
 the characteristic effects. 
 
 This idea is regularly proved in our common 
 experience. We know quite definitely that 
 a tuberculous ancestry diminishes a child's 
 vitality to such an extent as to create a pre- 
 disposition to contracting local or general 
 tuberculosis; at the same time we know that 
 a single instance of tuberculosis in a father, or 
 mother, or grandparent, does not inevitably 
 assure the breaking out of the disease in a child 
 or grandchild. Likewise, although we know 
 that a majority of defective children have a his- 
 tory of tuberculous ancestry, the fact of a single 
 case of the disease does not at all mean that 
 every child who descends from such a stock 
 must be feeble or abnormal in mind. And, 
 also, in the same way that we know the possi- 
 bility of building up and developing the body 
 of a child with a tuberculous predisposition, so, 
 likewise, we may reason that the weak-minded 
 offspring of a family which is similarly con- 
 taminated may be carried past the limits of 
 
DEFECTIVE CHILDREN 263 
 
 intellectual poverty into the confines of com- 
 parative intellectual prosperity. 
 
 Almost the same train of thought applies to 
 the defectives whose disabilities have been 
 traced to parental or ancestral tendencies 
 toward drunkenness. "Not every drunken 
 parent procreates an idiot; but when inherited 
 nervous instability from this or other causes is 
 intensified in the next generation by inju- 
 dicious marriage, or by unfavorable environ- 
 ment, instances of mental degeneracy are apt 
 to occur." A single occasion of excessive 
 drinking would in all probability have very 
 little to do with depressing a future child's 
 mental or physical constitution; but habitual 
 excesses, in parents or ancestors, or even the 
 habitual use of alcohol to more than a very mod- 
 erate degree, might bring about the most un- 
 fortunate results. If it did occur, the rational 
 cause would not be the mysteriously blighting 
 effects of alcohol in itself, but rather the gradual 
 and steady deterioration of nervous equilibrium 
 which excesses entail. Since the use of alcohol 
 lends itself easily to excess, — more so than most 
 drugs or foods, — inordinate and unusual drink- 
 ing has come to bear its present bad reputation. 
 
 In analogous ways unfortunate circumstances 
 
264 THE CARE OF THE CHILD IN HEALTH 
 
 during gestation, such as poor maternal health 
 or a violent accident, may operate. These 
 factors are efficient only in the degree in which 
 they are able to lower the child's nutrition, as 
 well as the source from which that nutrition has 
 its origin. Similarly we can account for the 
 occasionally evil results of consanguineous mar- 
 riages: here the simple fact of relationship is 
 not the all-important consideration. In fact, 
 there are many instances of comparatively close 
 intermarriage, such, for instance, as those of 
 first cousins, whose offspring have been suffi- 
 ciently normal. But such marriages have a 
 tendency to exaggerate whatever weaknesses of 
 body or brain and whatever environmental 
 peculiarities the family may have. 
 
 Quite a different principle comes into play 
 when the deficiency follows disease. Here 
 an inflammatory process is at work which causes 
 organic changes in the nervous system. Thus 
 a lobar pneumonia may be followed by a men- 
 ingitis, and on account of it the meningeal 
 membranes may be thickened, their blood-vessels 
 may be congested, the products of inflammation 
 may accumulate in considerable amounts, and, 
 consequently, there is a continuous nervous 
 irritation, the normal development is impeded, 
 
DEFECTIVE CHILDREN 265 
 
 and symptoms of corresponding intensity may 
 appear. In an entirely different set of cases a 
 new growth, perhaps of syphilitic origin, may 
 press upon the surrounding brain tissue; or, 
 again, a minute fragment of bone, which has 
 been broken off by some accident, may pierce 
 the cerebral structures, and cause mental defi- 
 ciency, convulsions, and similarly alarming 
 manifestations. It is obviously unnecessary to 
 go through the whole list of possibilities and all 
 their myriad aspects; the great thing which 
 we must keep in mind is that commonly enough 
 there is an ascertainable cause, and that the 
 finding of it is the first step to a logical method 
 of improvement. Likewise, as the knowledge 
 of cerebral localization and functions grows, 
 there is an increasing chance of knowing what 
 area is affected, of finding means to increase its 
 efficiency, or so far developing some other por- 
 tion that it may, in part at least, attend to the 
 neglected work. 
 
 The outlook, in all these various cases, dif- 
 fers according to the particular circumstances 
 involved. As far as a very general rule may 
 go, one may safely say that the congenital cases 
 offer a better opportunity for successful treat- 
 ment than the acquired ones do. For in the 
 
266 THE CARE OF THE CHILD EST HEALTH 
 
 first class there is generally an unfinished con- 
 dition, a state of incompleteness, that is, as 
 it were, waiting for an adequate force to give 
 the needed impetus toward normal growth. If 
 the weakened brain has not been allowed to 
 remain too long unhelped, there is a distinct 
 possibility of improvement. On the other hand, 
 the second series presents a more discouraging 
 state of affairs ; for instead of there being merely 
 a negative condition, there is a positive organic 
 change that may be almost insurmountable. 
 Nevertheless, expert information should be 
 obtained in regard to every case, and under no 
 circumstances should any deficiency, excepting 
 capital ones, be accepted as irremediable. 
 
 Thus, as an example, let us take the case of 
 a young child who has been afflicted with deaf- 
 mutism after scarlet fever. A part of that 
 disease is a severe inflammation of the throat. 
 As a sequel to this disorder an inflammation of 
 the Eustachian tube may begin, which develops 
 into some form of middle-ear disease, the result 
 of which is deafness. The child, consequently, 
 is unable to hear himself or other persons speak, 
 he forgets the sound of words, and, finally, is 
 unable to use them at all. In children under 
 two years of age, the normal limit at which 
 
DEFECTIVE CHILDREN 267 
 
 speech may be expected, the sounds may never 
 have been sufficiently learned, so that deafness 
 even more readily than in older children causes 
 mutism. Such patients are often thought to 
 have suffered an injury to the brain ; but as a 
 matter of fact the trouble is a purely local one, 
 and may occasionally be relieved or compen- 
 sated for by appropriate special instruction, or, 
 in some few cases, by treatment of the ear. This 
 is by no means the only instance in which a hope- 
 ful persistence may be of the greatest benefit. 
 
 It is unfortunate that most cases of defective 
 mental condition cannot be treated at home. 
 As a rule, the treatment is so wide, it should 
 include the oversight of so many parts of the 
 child's life, that observation and control must 
 be undivided. And each factor may be so 
 important that it should not be left to the lib- 
 eral interpretation that it usually would receive 
 in the ordinary household. Moreover, such a 
 household is primarily designed for the needs, 
 comforts, and pleasures of normal persons; it 
 can only with difficulty subordinate its natural 
 usefulness to the needs of an abnormal child. 
 These needs are incessant, they must be watched 
 day and night. Thus the diet in such cases is 
 very important, for a poorly developed or weakly 
 
268 THE CARE OF THE CHILD IN HEALTH 
 
 balanced brain is more easily affected by an 
 imperfect digestion and assimilation than a 
 normal pne. The exercise is likewise very 
 important, and must be designed for the par- 
 ticular child in question. The instruction 
 must by all means have the special character 
 which the condition of the child demands, and 
 it should be prosecuted under the direction of 
 expert medical, as well as pedagogical, control. 
 Even the child's amusements should be carefully 
 regulated and prescribed. In fact, there is no 
 item of his whole existence that is too small to 
 require careful and conscientious direction. 
 
 The ordinary nurse-maid is unable to do all 
 this intelligently and faithfully. In most 
 cases she is a somewhat rudimentary person 
 herself, whose real and suitable function would 
 be as the keeper rather than the nurse of chil- 
 dren. While it is true enough that most 
 children would be benefited by having less 
 expensive clothes and a better qualified nurse, 
 nevertheless, in a case of a defective child the 
 requirements are so great that a capable person 
 is under ordinary circumstances very hard to 
 obtain. The natural choice must therefore be 
 some form of institution which may not have the 
 disadvantages of the usual large asylum in the 
 
DEFECTIVE CHILDREN 269 
 
 great cities. The proper institution must be 
 situated in the country, in a community of its 
 own ; it must be built on the cottage or colony 
 plan, where only a small number of children 
 live in one home, and, therefore, are under the 
 direction of one cottage-mother. The amuse- 
 ments, the exercises, the instruction — in fact, 
 the general life of the child — should be passed, 
 as far as possible, in the open air under circum- 
 stances which do not bring abnormal children 
 in competition with normal boys and girls, 
 which would allow an elastic grading, which 
 would decrease to the last degree the morbid 
 influences that are inseparable from the stress 
 and strain of ordinary life. In addition, the 
 corps of attendants and instructors should be 
 selected for the especial work in hand on other 
 principles of choice than those which unfortu- 
 nately are too often in vogue. The abnormal 
 child is so frequently met, he represents under 
 present conditions so much of a loss to himself 
 and the world, and his prospects of usefulness 
 are so limited, that any change is apt to be for 
 the better. And if the improvements are able 
 to elevate the condition of only a small percent- 
 age, the gain to the world would of necessity be 
 immeasurably great. 
 
CHAPTER XIII 
 
 COMMON DISEASES 
 
 No child can be expected to go through life 
 without some deviations from the normal con- 
 dition of health; and a general understanding 
 of how the main deviations show themselves is 
 of so much help in obtaining a return to health 
 that every mother should have some information 
 on the subject. It is not desirable that she 
 should make an absolute diagnosis and conduct 
 the treatment without skilled help ; on the con- 
 trary, no matter how much experience she may 
 have had in her household, she cannot expect 
 to have the acquaintance with sickness that a 
 trained physician possesses. At the same time 
 there is a very important place in the care of 
 children for the intelligent mother who has 
 sufficient knowledge to prevent her from falling 
 into simple errors, to give her the calmness of 
 mind in the presence of disease that is so valu- 
 able for her child's comfort and welfare, and to 
 contribute to her own comfort, efficiency, and 
 
 270 
 
COMMON DISEASES 271 
 
 ability to care for her household. There are 
 the best of reasons why she should have some 
 general knowledge of the principal varieties of 
 sickness, how they occur, what their general 
 course is, and what the logical way of regard- 
 ing them is. The knowledge is not especially 
 hard to assimilate, and it will undoubtedly 
 justify itself. 
 
 The first thing to know and always to keep 
 in mind is that disease never comes without a 
 definite cause, it never "happens." A child 
 may fall and break his arm, or may be struck 
 with a ball or a stone, and thus injured; such 
 accidents may occur to any one, even if every 
 reasonable precaution for his safety has been 
 conscientiously observed. But the disorders 
 known as definite diseases do not happen in this 
 manner; in a large majority of the ordinary 
 cases sickness results from the combination of 
 two factors : a lessened physical resistance and 
 vitality in the child on the one hand, and, on 
 the other, the attack by agents of disease that 
 are lying in wait for the opportunity to find 
 suitable conditions of growth. The deficient 
 resistance and vitality may be congenital or ac- 
 quired, but usually they arise from errors in the 
 general mode of life, or in the failure to obtain 
 
272 THE CARE OF THE CHILD IN HEALTH 
 
 the requisite degree of health after sickness. 
 There is no doubt that some children have 
 received the heritage of weakness, of suscepti- 
 bility to pathological conditions ; but such chil- 
 dren are in the minority. Even in the case of 
 the diseases that were commonly supposed to be 
 hereditary, the fulfilment of the sinister promise 
 is often the result of personal circumstances. 
 No disease has had a worse reputation in this 
 respect than tuberculosis. It has been so wide- 
 spread, so persistent, and so merciless, that its 
 occurrence in one member of a family threw a 
 shadow of doubt upon the physical stability of 
 every other member. It may have appeared as 
 pulmonary consumption, as scrofula, as disease 
 of the bones ; but under all circumstances it has 
 cast a blight upon the confidence which the 
 affected families had in themselves, as well as 
 that which the public had in them. 
 
 As a matter of cold fact, the heredity of tuber- 
 culosis has of late years been doubted and prac- 
 tically disproved. And we have found that the 
 whole of the matter is contained in the word 
 "predisposition." The child of tuberculous 
 descent is not born with the germs of the disease 
 in him; but his forbears, on account of the 
 ravages which the disease accomplished in 
 
COMMON DISEASES 273 
 
 their bodies, have handed on to their offspring 
 a weakened vitality, especially to the disease in 
 question. The tubercular condition has sub- 
 tracted something from the sum of their physi- 
 cal assets, and they bequeath no more than they 
 possess. But — and this is a factor of mighty 
 import — the human organism has a wonder- 
 ful quality of elasticity, a natural tendency to 
 revert to health, as in a staple commercial 
 enterprise the natural process of physical de- 
 velopment always leans toward improvement, 
 toward recovery from misfortunes, if abnormal 
 losses are curtailed. Thus, although a child 
 may be born with a tuberculous history, he is 
 almost always susceptible of such development 
 of health and strength that his predisposition 
 will be overcome, and he will go through life 
 unscathed. 
 
 The same idea is true concerning other dis- 
 eases which are commonly regarded as hered- 
 itary. People at large are very apt to regard 
 such disorders as cancer, as insanity, as rheuma- 
 tism, as heart disease, in the light of family 
 failings which necessarily constitute a standing 
 menace against the health and the potential 
 activity of each individual concerned. But 
 this is not the best way of regarding these 
 
274 THE CARE OF THE CHILD IN HEALTH 
 
 complaints. At their worst they can leave no 
 more persistent trace than tuberculosis, which 
 can be guarded against and overcome. In all 
 these instances a hopeless pessimism is entirely 
 out of place. There is, very probably, a weak- 
 ened general resistance, or a weakened resist- 
 ance to the attacks of the disease in question. 
 But that fact should stimulate the affected fami- 
 lies to vigorous efforts whose object is the 
 attainment of such robust health that the 
 individual as well as the family weakness is 
 practically obliterated. 
 
 The second factor in the causation of disease 
 is the one of outside agency. This is usually 
 of one sort, although it may have many phases. 
 The deleterious influence of unfavorable envi- 
 ronment is so well known that it scarcely needs 
 elaboration. Everybody is so thoroughly ac- 
 quainted with the ordinary effects of injudicious 
 eating and drinking, poorly arranged clothing, 
 irregular habits of rest, recreation, and activity, 
 and deficient measures of hygiene, that an ex- 
 tended mention of them is unnecessary in this 
 place. But another phase of the question — that 
 of the invasion of germ life or the micro-organ- 
 isms of disease — is not so clearly understood. 
 These bacteria are, for the most part, exceedingly 
 
COMMON DISEASES 275 
 
 low forms of animal life that exist in great quan- 
 tities wherever civilization flourishes. There is 
 a vast number of these organisms, some of which 
 are of use, some of which are harmless, and 
 some dangerous to life. The useful ones may 
 be concerned in those processes of fermentation 
 which are so extensively employed in many 
 commercial and domestic activities; the harmful 
 ones are active causes of disease. The one sort 
 may be concerned in the making or the marring 
 of food-stuffs ; the other in the destruction of 
 tissue or the production of poisonous matters or 
 toxines, the objective manifestations of which 
 we call the symptoms of disease. But with all 
 of them there must be certain attendant cir- 
 cumstances, the existence of which precedes 
 their development and growth. These are the 
 presence of moisture, warmth, and a suitable 
 culture ground. 
 
 In the human body heat and moisture are 
 always present ; and the suitable culture 
 medium exists in some condition of local or 
 general loss of vitality or tone. The body 
 when in a perfectly healthy state has a won- 
 derful faculty of warding off disease, because 
 it has a quality which does not allow the 
 peculiar reaction which makes the favorable 
 
276 THE CARE OF THE CHILD IN HEALTH 
 
 culture medium. A really healthy person does 
 not contract consumption, or typhoid fever, or 
 measles, or erysipelas, or lobar pneumonia ; not 
 because he escapes contact with the provoca- 
 tive germs, but because the condition of his 
 body does not favor their growth. A person 
 whose general strength is intact and whose 
 respiratory mucous membranes are quite nor- 
 mal is in no danger of consumption ; a child 
 who is similarly disposed, whose nutrition is 
 unimpaired, whose excretion is normally active, 
 does not contract whooping cough, scarlet 
 fever, or mumps ; a baby whose vitality is 
 not depressed, whose alimentary tract is in a 
 vigorous, healthy condition, whose food is 
 properly controlled in regard to quality, quan- 
 tity, and purity, and who is kept sweet and 
 clean, has no likelihood of suffering from 
 sprue, stomach troubles, summer complaint, 
 or cholera infantum. The equation is one 
 that is not hard to understand, for the fac- 
 tors are quite evident. And where the patho- 
 logical process has once begun, no one is able 
 to say where it will stop. 
 
 The characteristic effect of all these diseases 
 is the production of some sort of poison, which 
 varies according to the manner and source of 
 
COMMON DISEASES 277 
 
 its production and its particular nature. The 
 toxines that are developed during an attack of 
 diphtheria are quite different from those which 
 follicular tonsillitis produces, and the poison- 
 ous effects of typhoid fever bear very little 
 relation to those of summer complaint. This, 
 naturally, does not prevent two or more of 
 these diseases and their respective toxines from 
 being simultaneously present in the body, and 
 they often are. Thus it is no very rare thing 
 for typhoid fever to be complicated by pneu- 
 monia, or diphtheria by broncho-pneumonia, 
 or lobar pneumonia by meningitis. Indeed, 
 the presence of one disease, by weakening the 
 body's vital tone, makes the process of con- 
 tracting further diseases more easy than it 
 otherwise would be. And at the same time 
 one can easily see that the outlook, on account 
 of the added wear and tear, is correspond- 
 ingly more gloomy. But the essential nature 
 of these various infections is so different that 
 attempts have for some time been made to find 
 whether one might not be used to antagonize 
 another. So far this line of work has not been 
 very successful. 
 
 But another method of treatment has been 
 discovered which in the future will unques- 
 
278 THE CAKE OF THE CHILD IN HEALTH 
 
 tionably be developed to wonderful limits. 
 This method recognizes the poison as the main 
 part of the disease, and regards the external 
 symptoms as merely concomitant facts. Under 
 the name of the " antitoxic serum " the world 
 has become familiar with this view in the treat- 
 ment of diphtheria. The philosophy of it is 
 seemingly simple, and consists in the effort to 
 familiarize the body with the specific toxines 
 by means of injections of them in an attenu- 
 ated form. Diphtheria is not the only disease 
 in which it is being used. For generations 
 we have been employing an analogous treat- 
 ment, which is called vaccination, to ward off 
 the possible attacks of smallpox. And of 
 late, intelligent efforts have been made to pro- 
 duce antitoxic serums for lobar pneumonia, 
 tetanus (lockjaw), yellow fever, erysipelas, 
 blood poisoning, and similar diseases. The 
 success has been variable, depending upon the 
 ability to obtain the specific micro-organisms in 
 pure cultures, upon the experimenters' ability 
 to obtain suitable culture media, and other 
 related facts in the technique. The main idea 
 that is of use to us in this connection is that 
 most diseases have as their principal factor 
 the direct or indirect production of toxines or 
 
COMMON DISEASES 279 
 
 poisons which have a dangerous effect upon 
 the body in proportion to their virulence. 
 
 The lesson is of universal application in the 
 treatment of disease, and applies with the great- 
 est force to the care of children. In all their 
 sicknesses the first step to take is the thorough 
 emptying of the stomach and intestines by 
 means of cathartics ; and one of the principal 
 details of treatment is the use of such medicines 
 and therapeutic measures during the process of 
 the disease as will keep up a moderate but 
 effectual excretion through the lungs, the in- 
 testines, the kidneys, the glands, and the skin. 
 Excretion by means of the lungs is promoted 
 through the inhalation of pure air, and the 
 action of a vigorous circulation; that by means 
 of the intestines through medicines, special 
 foods, and water ; that by means of the glands 
 through medicines ; and that by means of the 
 skin through medicines, the action of heat, and 
 the use of water. It is obviously impossible to 
 define and describe all these various agencies, 
 for that would be tantamount to converting 
 this book into a treatise on materia mediea and 
 the practice of medicine. But out of the mass 
 of details we may select a few fundamental facts 
 in treatment that are of paramount importance 
 
280 THE CARE OF THE CHILD IX HEALTH 
 
 in the task of restoring ailing children to 
 health. 
 
 All medicines should be as few in number 
 and as simple in combination as possible. All 
 opiates should be used for children with great 
 caution, and opium or its derivatives — such as 
 morphine — should practically never be used, 
 excepting under unusual circumstances where a 
 physician believes them necessary. This rule 
 applies with especial force to the employment 
 of sleeping mixtures, soothing syrups, and teeth- 
 ing syrups which depend for their effect upon 
 brutally stupefying the child, without regard to 
 the serious consequences that the drugging may 
 entail. 
 
 In sickness the food should almost always be 
 fluid, should be easily digested, and never given 
 in large amounts. It is well to remember that 
 the amount of nourishment which the child 
 obtains from his food depends less upon the 
 quantity which he swallows than upon the 
 amount which he digests and assimilates. The 
 habit of forcing a child to eat against his will 
 is thus a bad one, for he is rarely benefited by 
 food which he does not care to take. During 
 an acute sickness he does not need a great deal 
 of nourishment; and in chronic disorders one 
 
COMMON DISEASES 281 
 
 can manage by means of tonic medicines, a good 
 choice of food, as well as a dainty preparation 
 of it, to increase his appetite. It ought not to 
 be hard to understand that food may have as 
 definite a composition and physiological effect 
 as drugs, and that a similar care should be em- 
 ployed in its use. Under all circumstances the 
 attending physician should be asked to specify 
 the exact kinds of food, the manner of prepara- 
 tion, the quantity, and the intervals of feeding. 
 This is fully as important in most cases as the 
 giving of certain prescriptions ; the whole ques- 
 tion of diet for ailing children has not been 
 receiving the serious attention which it merits. 
 Another subject which is almost equally 
 important is that of bathing and the action of 
 water in sickness. The use of this agent is not 
 nearly common enough, nor need it be regarded 
 with the distrust and apprehension that solici- 
 tous mothers so often feel in connection with 
 the treatment of a delicate child. It provides 
 our most excellent methods of lowering a high 
 temperature, very much better than any coal-tar 
 product or fever powder that has ever been dis- 
 pensed. It is almost as good for raising a sub- 
 normal temperature; and at the same time it is 
 noticeably useful as a diaphoretic, as a means of 
 
282 THE CARE OF THE CHILD IN HEALTH 
 
 relieving local congestions, as a controller of 
 defective circulation, and as a capable agent 
 of stimulation. In any sickness the treatment 
 may well begin with the administration of a 
 warm bath in addition to the cathartic ; and 
 thereafter the child should be regularly bathed 
 at least once a day. The details of duration of 
 bath, temperature of the water, and solution of 
 medicinal substances in the water, will be in- 
 cluded in the directions of the attending physi- 
 cian. During the course of the sickness no other 
 means will give the same satisfactory results in 
 the reduction of temperature; and the graduated 
 bath of 100° F. reduced to 80° F., the cool sponge 
 bath, and the wet pack will always give far 
 better results than any other antipyretic. In 
 addition, the value of an ice-bag to an aching 
 head, or to a nervously excited heart, is too 
 well known to need special mention. Likewise, 
 hot- water bags or bottles to the extremities are 
 both valuable and comforting when the child is 
 suffering from a chill or from a poor circulation. 
 Even in the eruptive fevers or in diseases of the 
 lungs, the daily warm bath will contribute ease, 
 comfort, and a more rapid progression toward 
 health. 
 
 In considering the ordinary diseases to which 
 
COMMON DISEASES 283 
 
 children are subject, one inevitably divides them 
 into a few distinct groups, according to the 
 functional divisions of the body. Such a view 
 is very useful in determining the treatment 
 which they should receive. For usually a dis- 
 ease cannot be regarded as a distinct entity and 
 separated from every other disease. Thus the 
 disorders of the alimentary track include those 
 of the mouth, the stomach, and intestines ; and 
 commonly one leads to another. A child may 
 have an attack of sprue or thrush which always 
 begins in the mouth. It originates in a lack of 
 cleanliness, and if the defect is not remedied 
 the parasitic growth may spread to the stomach, 
 and convert a trivial disorder into a serious one. 
 In the same way, the disorders of the stomach 
 may, and commonly do, lead to derangement of 
 the intestines. And it requires no more than 
 a cursory view of them to show how true this is. 
 Most of the gastric disorders in children are 
 functional ; that is, they result from interfer- 
 ences with the normal work and action of the 
 organ, and occur without the presence of defi- 
 nite organic changes. As an example, let us 
 take the case of an ordinary attack of indiges- 
 tion. Such a state generally follows over- 
 eating, or eating food which the stomach is 
 
284 THE CARE OF THE CHILD IN HEALTH 
 
 unable to digest. In well-grown children it 
 commonly follows excesses such as are com- 
 mitted during holidays, parties, large dinners, 
 or any occasion when they are allowed to eat 
 cakes, pies, fruits, and candies. In infants it 
 may be caused by excessive quantities of milk, 
 or milk of an improper composition. The food, 
 not being changed and absorbed, remains in 
 the stomach, irritates it, undergoes fermen- 
 tation and putrefaction. From this process 
 poisonous products are formed which bring on 
 various degrees of intoxication. Consequently 
 we see such symptoms as gastric pain, fever, 
 lack of appetite ; the organism tries to free 
 itself from the harmful influences by vomit- 
 ing or even by diarrhoea. And this imme- 
 diately suggests the proper treatment, which 
 accords perfectly with the general principle 
 mentioned above. Our first duty is to stop 
 the food, to give liberal cathartics to clear away 
 the offending matter, and then to keep the 
 patient as quiet and the nourishment as simple 
 as possible in order to allow him to regain his 
 physical tone. The fever may be safely and 
 efficiently dispelled by baths ; and in many 
 cases very little or no additional treatment is 
 required. 
 
COMMON DISEASES 285 
 
 In a comparatively small proportion of cases 
 there is a real inflammation of the mucous mem- 
 brane of the stomach. Here the pain, vomit- 
 ing, fever, headache, and prostration do not 
 come on so suddenly, but rather result from 
 repeated attacks of functional disorders, or 
 possibly from the absorption of notable quan- 
 tities of toxic materials. Although the disease 
 is comparatively severe and prolonged, never- 
 theless the treatment is to be conducted on 
 similar lines. The organ is to be thoroughly 
 emptied, the diet is to be restricted to such 
 easily digestible foods as milk, or clear soups 
 without fat. The same principles of rest and 
 temperature-reduction hold good in this case 
 as in the other; but there may be a necessity 
 for the employment of other methods. It may 
 be necessary to wash out the stomach, to pre- 
 scribe bismuth, or dilute hydrochloric acid, or 
 an alakli, such as the bicarbonate of soda. 
 These agents need the experience and skill of 
 a physician, and never otherwise should they 
 be used. 
 
 The disorders of the intestines may like- 
 wise be functional or organic. The first may 
 follow similar conditions of the stomach, may 
 originate from analogous causes even when 
 
286 THE CARE OF THE CHILD IN HEALTH 
 
 the stomach is not involved, or may result from 
 germ infection of the intestinal contents. The 
 course of the disease is apt to be longer than 
 that of gastric disorders, partly because the con- 
 dition is of slower growth, and partly because 
 the intestines are hard to clear out. The same 
 general plan of emptying the intestine by 
 means of cathartics is used, and sometimes is 
 supplemented by washing or flushing the lower 
 bowel with a large quantity of boiled water by 
 means of a rubber tube and a fountain syringe. 
 This is the main part of the treatment in the 
 summer diarrhoeas of children ; but it may be 
 aided, and its benefits increased, by the restric- 
 tion of the food to clear soups and broths, and 
 the administration of bismuth and tonics. In 
 these conditions the need of tonics is unques- 
 tionably great, for the loss of flesh and strength 
 is always marked. Full baths or sponge baths 
 are of use, but all further details of treatment 
 must be supplied by the attending physician. 
 
 The organic diseases of the intestines are 
 commonly called inflammation of the bowels, 
 and are very serious diseases. Not only is the 
 digestive and excretory function seriously inter- 
 fered with or abolished, but also there is a very 
 large amount of pain and prostration. The 
 
COMMON DISEASES 287 
 
 intensely sensitive intestinal walls are swollen, 
 congested, and infiltrated with new elements; 
 and every movement of the body and every bit 
 of motion which the intestines undergo produce 
 keen agony. The treatment of these conditions 
 is too complicated to have a place in this 
 chapter. The inflammations of the peritoneum, 
 or membrane which lines the abdominal cavity, 
 are of much the same nature, they have some- 
 what related symptoms and treatment, and 
 likewise are scarcely susceptible of interesting 
 exploration for the general reader. 
 
 So much of late years has been said about 
 appendicitis that some description of it is de- 
 sirable. It is commonly spoken of as a "new 
 disease " ; but in reality there is nothing new 
 about it, excepting that we are now able to recog- 
 nize and treat it, while formerly it ran its course 
 unrecognized. The appendix is a small process, 
 shaped like the finger of a glove, which is given 
 off from the large bowel. It is a blind pouch, 
 situated in the lower right side of the abdomen, 
 and is evidently a vestigial structure which 
 serves no useful purpose. On account of any 
 injury from violence, or the irritation of in- 
 testinal contents, it may fall into a state of 
 inflammation. This condition constitutes a fer- 
 
288 THE CARE OF THE CHILD IN HEALTH 
 
 tile culture ground for germ life, the natural out- 
 come of which is the production of pus. If this 
 happens, one of two things occurs : the abscess 
 may be shut in by adhesions, and may gradually 
 be absorbed; or it may break, and flood the per- 
 itoneal cavity with pus. From the first con- 
 dition the patient may recover, but the disease 
 will in all likelihood occur again and again until 
 the second condition exists. The usual outcome 
 of this is death. The disease should be re- 
 garded as an internal abscess which, if it is al- 
 lowed to break, causes an active blood-poisoning. 
 Every abscess, no matter where it occurs, 
 demands opening and the draining off of its 
 poisonous contents ; and in appendicitis there is 
 no exception to the rule. In case the abscess 
 is shut in by adhesions, the operation may be 
 postponed until the first acute symptoms have 
 passed. But then it should be performed with- 
 out delay. The removal of the appendix is 
 always a conservative matter, for it removes 
 a danger whose gravity cannot be well over- 
 estimated. 
 
 Another group of organs which is the seat 
 of many common disorders is the respiratory 
 system. This includes the nose, larynx, trachea, 
 lungs, bronchi, and pleura. The purposes and 
 
COMMON DISEASES 289 
 
 physical conditions of this system naturally con- 
 trol the disabilities to which its various parts 
 are subject. Its work consists in drawing into 
 the intimate structure of the lungs a certain 
 amount of air, from which the oxygen may be 
 taken, sucked through the wonderfully fine 
 blood-vessels into the blood, where it burns up 
 the impurities, and allows the blood stream to 
 return, cleansed and rejuvenated, to the heart. 
 In the nose the air is filtered and warmed ; it 
 is conducted by way of the throat to the trachea 
 or wind-pipe, then to the large bronchi, which 
 divide into progressively small ramifications 
 that resemble the branches of a tree. In the 
 throat there are two glands called tonsils, and 
 in the back of the nose is a third one, called the 
 pharyngeal tonsil, whose function is to lubricate 
 the surrounding mucous membrane. These 
 tonsillar tissues may become enlarged as the 
 result of atmospheric irritations or the action of 
 disease, so that the available space through 
 which the air passes is markedly decreased. 
 The enlargement of the throat or f aucial ton- 
 sils is familiar to every one ; but that of the 
 third or pharyngeal tonsil, while it occurs fre- 
 quently, is not by any means so well known. 
 One is very apt to be accompanied by the other. 
 
290 THE CARE OF THE CHILD IN HEALTH 
 
 At all events, the inevitable result is that the 
 amount of air that reaches the lungs is dimin- 
 ished, the oxygen is correspondingly decreased 
 in quantity, and the burning up of impurities 
 in the blood is lessened in equal amount. Here, 
 again, we come to a condition of intoxication, 
 of poisoning, which shows itself in poor nutri- 
 tion and development, in lessened resistance to 
 disease, in abnormal conditions of mind. Some 
 of the apparent symptoms are tonsillar hyper- 
 trophy, and especially the enlargement of the 
 pharyngeal tonsil, mouth-breathing, snoring 
 during sleep, broadening of the bridge of the 
 nose, and a constant recurrence of coughs and 
 colds in the head. There is one and only one 
 sure remedy for this condition — removal of the 
 offending growths. 
 
 There is a certain disease of the faucial ton- 
 sils that is sufficiently interesting to require a 
 special mention ; and it acquires a part of its 
 interest from its liability to be mistaken for 
 diphtheria. This disease, on account of its 
 manner of occurrence, is called follicular ton- 
 sillitis. At the beginning the follicles become 
 deeply inflamed as the result of germ infec- 
 tion, and their mouths are filled with small 
 plugs of membrane. The tonsil now looks 
 
COMMON DISEASES 291 
 
 red, large, and studded with small patches or 
 dots of cream-colored membrane. If these 
 patches are large in number they may coa- 
 lesce, and form a continuous membrane. The 
 behavior of the sickness is alarming ; there is 
 increasing difficulty in swallowing, there is 
 great depression and general pain, and the tem- 
 perature mounts to startling heights, as high as 
 105° F. or even more. The severity of the 
 symptoms is, curiously enough, not at all in con- 
 sonance with the danger of the disease ; for the 
 children practically always recover, and are 
 very little the worse for their sickness, with the 
 exception of a temporary weakness. This dis- 
 ease, which in its extrinsic character bears a 
 resemblance to diphtheria, is in reality not at 
 all like it. The latter is a serious disorder, has 
 a moderate or low temperature, not so much 
 pain, and its membrane may appear on any part 
 of the throat or nose as well as on the tonsils ; 
 but if it does begin on the last named structures, 
 it steadily spreads to the adjacent parts. The 
 treatment of follicular tonsillitis is simple, and 
 is really directed most of all to the relief of the 
 general distress. It consists in the adminis- 
 tration of a brisk cathartic, followed by the ad- 
 ministration of small doses of phenacetine and 
 
292 THE CARE OF THE CHILD IN HEALTH 
 
 saiol in frequent doses ; a cleansing spray to the 
 throat and an ice-bag to the neck will increase 
 the patient's comfort and hasten recovery. But 
 while the treatment of this disorder is simple 
 enough, one should not undertake it unless the 
 diagnosis is quite correct. No one but a medi- 
 cal man should assume the responsibility of 
 making the distinction between follicular ton- 
 sillitis and diphtheria, and even he may at 
 times be enough in doubt to need the aid of 
 a bacteriological culture. 
 
 Colds in the head are irritations or inflam- 
 mations of the mucous membranes of the nose. 
 They may follow harsh atmospheric conditions, 
 exposure to draughts, or attacks by certain 
 germs. Although they are not in themselves 
 serious, they cause considerable discomfort and 
 open a way to more dangerous disorders. They 
 may be mitigated or driven away by the use 
 of cathartics, hot baths, and continuously spray- 
 ing the nose with an alkaline, antiseptic solution, 
 such as may be obtained at any drug-shop. If 
 they are neglected, they commonly extend along 
 the nose to the throat, and then into the large 
 bronchi, where they start an inflammation called 
 bronchitis. When they settle in the throat, 
 they often affect the larynx, and produce symp- 
 
COMMON DISEASES 293 
 
 toms of cough, hoarseness, and loss of voice. 
 Sometimes the larynx becomes so sensitive that 
 small irritations bring on a spasm which we call 
 croup. This condition is temporarily relieved 
 by the inhalation of steam, the application of 
 heat to the neck, and the use of hot baths. 
 The medical treatment, which is important, 
 must be left to the attending physician. 
 
 In the treatment of bronchitis the parents 
 must by all means free themselves from certain 
 time-honored beliefs which should be called 
 superstitions. Children suffering from this 
 disease need not be swathed in blankets and 
 pads until they resemble mummies, they need 
 not be kept unwashed during the course of the 
 sickness, and they will not be killed by a breath 
 of fresh air. On the contrary they should be 
 kept comfortably warm, but not hot ; they may 
 with advantage have a warm bath morning and 
 night ; and the sick-room should always be well 
 ventilated. One should keep in mind that most 
 of these cases are examples of germ infection, 
 and that they require a vigorous excretion, a 
 satisfactory stimulation, and a bland soothing of 
 the cough and pain. The same requirements 
 are needed in lobar pneumonia, which must be 
 treated as an acute, infectious disease. Here 
 
294 THE CARE OF THE CHILD IN HEALTH 
 
 the chief danger is not primarily due to the 
 cough or the interference with the breathing, 
 but rather to the strain which is put upon the 
 heart by the impeded circulation and the poison- 
 ous effect of the characteristic germs. Therefore 
 the treatment is one of excretion and stimu- 
 lation, the drawing off of waste products, and 
 the maintaining of strength until the disease 
 has subsided. The use of plasters, poultices, 
 and pneumonia jackets serves no good end, 
 but on the other hand may easily delay 
 recovery, or increase the danger of the dis- 
 ease. 
 
 Broncho-pneumonia is a compound disease 
 made up of a combined attack of a bronchi- 
 tis and a pneumonia. This also is practically 
 always caused by the invasion of micro-organ- 
 isms ; and the essential nature of the complaint 
 is the same, in general ways, as the separate 
 disorders. The danger, especially for infants, 
 is an imminent one, and cannot well be over- 
 rated. The successful treatment of this con- 
 dition, with its exhausting inroads upon the 
 child's vitality, calls for the exercise of the phy- 
 sician's best efforts. And while the parents 
 may not hope to do more than appreciate the 
 gravity of the situation, their intelligent efforts 
 
COMMON DISEASES 295 
 
 to carry out his directions may make his task 
 easier and possibly more successful. 
 
 With any of these diseases an attack of 
 pleurisy may be associated, or it may occur 
 alone. This inflammation has certain points of 
 resemblance to that of the peritoneum. Both 
 diseases attack serous membranes, both may 
 be simple, or characterized by the presence of 
 serum or water, or by the additional factor 
 of pus. In the simple, or dry, form the main 
 requirement is the easing of pain and the main- 
 tenance of strength ; in the serous form there is 
 the additional necessity of eliminating the fluid. 
 This serum, if moderate in amount, may be 
 disposed of by absorption or may call for the 
 operation of tapping or draining the chest. 
 But the third form, which is characterized by 
 the presence of pus, is really a large abscess, and 
 demands an immediate incision in the chest 
 wall, the evacuation of the pus, and the con- 
 tinued drainage of the cavity until all septic 
 matter has been thoroughly removed. 
 
 There is only one other class of diseases that 
 should be considered in this place, and that is 
 the eruptive fevers, such as measles, scarlet 
 fever, chicken-pox, typhoid fever. Each one 
 is caused by a specific germ, and represents 
 
296 THE CARE OF THE CHILD IK HEALTH 
 
 a form of poisoning. Here again the main 
 necessities which the treatment must meet are 
 sustaining the patient's strength, getting rid of 
 waste products, diminishing as much as possi- 
 ble the amount of work which the body has to 
 do, and relieving the unpleasant symptoms in 
 every possible direction. One can easily see 
 how important it is to clear the alimentary 
 track, to use frequent baths, to allow enough 
 drinking water for the quenching of thirst and 
 the flushing out of the kidneys, to make the 
 diet as nutritious and as easily digestible as 
 possible, and at the same time to maintain as 
 high a degree of strength as the patient's cir- 
 cumstances will permit. The mucous mem- 
 branes of the nose, throat, and eyes must be 
 kept as clean as possible. For this reason they 
 should be douched and bathed as often as cir- 
 cumstances demand ; and as a reward the 
 parents will have a much smaller percentage 
 of complications in these and the neighboring 
 parts to contend with. There is no need for 
 the various teas that formerly were so plenti- 
 fully used nor for the burdensome swathing in 
 many flannels that is almost as hard to bear as 
 the disease itself; the patients must be made 
 comfortably cool, should be allowed to drink a 
 
COMMON DISEASES 297 
 
 sufficient quantity of pure water, and should 
 be kept in a cool, dark room, where their nerv- 
 ous irritability will have the least provocations 
 to get beyond control. In all these diseases 
 rigid isolation of the patient is most important, 
 and the parents must willingly cooperate with 
 the physician in checking the spread of the 
 sickness. In many homes, in the presence of 
 a contagious disease, the custom exists of put- 
 ting the uncontaminatecl children in the sick 
 room or even in the bed of the patient in order 
 to have the sickness become general, and thus 
 be done with it. The practice is most heartily 
 to be condemned. It increases the amount of 
 sickness and the risk of unfortunate results, 
 while it gives no positive assurance that the 
 children will be protected against future at- 
 tacks. Indeed, these illnesses may occur more 
 than once in the same child, and do so with a 
 fair amount of frequency. In addition, such 
 lax ideas make the whole plan of rational isola- 
 tion void, they foster the belief in the necessity 
 of sickness, and really have no rational thought 
 to justify them. In the whole matter of sick- 
 ness, the tendency of endeavor should be in 
 the way of directness, common sense, and 
 plain thinking. The care of the sick child 
 
298 THE CARE OF THE CHILD IN HEALTH 
 
 is really that of his healthy brother, some- 
 what developed in a special direction to meet 
 special exigencies. In both there is need of 
 devotion, clear-sightedness, patience, and self- 
 denial. And in both the rewards of successful 
 effort are doubtless more satisfactory and prof- 
 itable than those in any other sort of work. 
 
 Not every one has the privilege of partici- 
 pating in such work ; but those who have the 
 opportunity should call themselves fortunate. 
 To such is intrusted the making of the present 
 and the future. The mother, if she only knew 
 the length and breadth of her possible influ- 
 ence, might be the grand and beneficent figure 
 in our society. Her body and mind are the 
 patterns of future generations ; by her thoughts 
 and deeds she can control and modify the effects 
 of long-past times. Her aspirations and ideals 
 are the standards by which the world is moved. 
 Her life, no matter how hard and common-place 
 it may be in its outer aspects, is capable of 
 beautiful expression. Real sordidness inheres 
 in the characteristic spirit of one's heart and 
 soul, rather than in the physical environment 
 of one's daily activity. Viewed in this light 
 the ordinary, and possibly monotonous, care of 
 a child may take on a great significance. His 
 
COMMON DISEASES 299 
 
 clothing, his bathing, his food, his rest, his 
 exercise, become matters of paramount impor- 
 tance. To watch the blossoming of his body 
 and mind gives an indication of munificent 
 potentialities, a vision of never-ending develop- 
 ment. To control these things is to have a 
 sovereign power over events both great and 
 small. This is the greatest career in the 
 world ; it provides boundless opportunities for 
 the exercise of thoughtfulness, wisdom, affec- 
 tion, careful preparation, and discretion. Its 
 rewards are as great as its opportunities ; and 
 the proportion between these opportunities, 
 when they are rightly used, and these rewards 
 is exact and never-failing. 
 
 The contemplation of such conditions is truly 
 inspiring, for the range of the ideal mother's 
 activity is scarcely to be limited. There is no 
 chance of business failure, no likelihood of un- 
 appreciated or misunderstood motives, no possi- 
 bility of crushing competition. On the contrary, 
 the active creator of a wise environment, the 
 steadfast disciple of adequate methods of child- 
 rearing must necessarily live in an atmosphere 
 of altruistic endeavor, of normal strength, of 
 satisfied desires, of the consciousness of definite, 
 human ambitions whose ends are always worthy. 
 
300 THE CARE OF THE CHILD IN HEALTH 
 
 The air of strenuous, long-continued devotion 
 is a healthy one for human beings, and the 
 development which it perforce entails lies all 
 in the way of ideal growth. This is the foun- 
 dation of civilization, the very essence of the 
 best part of our modern culture. Those who 
 wilfully neglect such a career not only are 
 lacking in sense of duty, but also map out for 
 themselves a life of pettiness, of unprofitable 
 struggling, of unsatisfying pleasures. Here is 
 a difference such as exists between beauty and 
 ugliness, between right and wrong, between 
 life and death. 
 
INDEX 
 
 Abdomen, pendulous, 44. 
 Abdominal band, 52. 
 Adenoid vegetations as cause 
 
 of defective sleep, 44. 
 Afternoon nap, 132. 
 Alcohol, 258. 
 Alcohol rubbings, 117. 
 Ankle shoes, 177. 
 Antipyretics, 281-282. 
 Antitoxines, 278. 
 Aphasia, functional, 198. 
 Appendicitis, 287. 
 Arithmetic, study of, 235-236. 
 Artificial foods, 89-92. 
 
 Baby's outfit, 47. 
 Bacteria, 274-276. 
 
 conditions for growth of, 275. 
 Band, abdominal, 52. 
 Barrow coat, 55. 
 Base-ball, 159. 
 Basket-ball, 159. 
 Bassinet, 51. 
 Bath, in eruptive fevers, 282. 
 
 sponge, 282. 
 
 temperature of, 115. 
 
 time for, 115. 
 Bath apron, 116. 
 Bathing, 111. 
 
 at three and one-half years, 
 120. 
 
 Bathing, freedom from draughts 
 during, 115-116. 
 
 in second year, 119. 
 
 in sickness, 281. 
 
 in summer, 118. 
 
 method, 116. 
 Bath-tub in nursery, 65-66. 
 Bib, infant's, 59. 
 Bicycle saddle, 155. 
 Bicycling, 154. 
 Birth-paralysis, 255. 
 Bladder, control of, 187, 188. 
 Blanket, pinning, 55. 
 Boogy man, 192, 245. 
 Booties, 55. 
 
 Bottles, nursing, care of, 86-87. 
 Bronchitis, 293. 
 Broncho-pneumonia, 294. 
 
 C 
 
 Cancer, heredity of, 273. 
 Cape for pregnant women, 42. 
 Carbohydrates, function of, 98. 
 Carnrick's Soluble Food, 91. 
 Cattle, inspection of, 79. 
 Changing ideals of women, 10- 
 
 11. 
 methods in commercial life, 
 
 7. 
 Chicken-pox, 295-296. 
 Chinese method of dressing, 
 
 167. 
 Cleanliness of nursery, 65. 
 Cloak for pregnant women, 42. 
 
 301 
 
302 
 
 INDEX 
 
 Clothing, color of, 169. 
 
 for children, 163. 
 
 for play, 174. 
 
 for sensitive skins, 167. 
 
 for summer, 169. 
 
 for winter, 169. 
 
 function of, 164. 
 Cold in throat, 292-293. 
 Colds in head, 292. 
 Colors of clothing, 169. 
 Comforter, artificial, 136. 
 Comforters, 186-187. 
 Common diseases, 270. 
 Companions, 221. 
 Concentration, 201. 
 Condensed milk, 91. 
 Conditions for sleep, 131. 
 Conduction, 164. 
 Consanguineous marriages, ef- 
 fects of, 264. 
 Constipation, habitual, 105. 
 Control of bladder and rectum, 
 
 187-188. 
 Cool baths, 121. 
 Cooperation of parents and 
 
 children, 220. 
 Corsets for pregnant women, 
 37, 39. 
 
 use of, during exercise, 158. 
 Corset waists for pregnant 
 
 women, 37. 
 Cotton, nature of, 167. 
 Country, living in, 214. 
 Courtesy in children, 193. 
 Cowardice in children, 191-192. 
 Creed, 246. 
 Cretinism, 254-255. 
 Cruelty in children, 190. 
 
 D 
 
 Dancing, 156. 
 
 Da Vinci, Leonardo, example, 
 of, 2. 
 
 Deaf-mutism, 266. 
 Decoration of nursery, 63. 
 Defective children, 251. 
 cause of, 253. 
 institution for, 269. 
 Deflected nasal septum as 
 
 cause of disturbed sleep, 
 
 144. 
 Devotion of parents, 206. 
 Diaper, material for, 51. 
 
 size of, 52. 
 Diaper-cover, impervious, 58. 
 Diet for child of fifteen months, 
 
 96. 
 Difficulties in home making, 
 
 12-13. 
 Disease, always has a cause, 
 
 271. 
 effects of, 276. 
 Diseases of stomach and intes- 
 tines, 283. 
 Domestic careers, 15-16. 
 Douche baths, 121. 
 Dreams, 142. 
 
 Dress, simplicity in, 178-179. 
 Dressing, Chinese, method of, 
 
 167. 
 Driving, 160. 
 
 Drunkenness, inherited, 263. 
 Duty of father, 212-213. 
 
 E 
 
 Ears, cleanliness of, 117. 
 
 Echolalia, 198. 
 
 Economy of time in arranging 
 
 daily work, 33. 
 Education, 225. 
 
 age for, 225-228, 229. 
 
 by example, 230. 
 
 for children under kinder- 
 garten age, 231. 
 
 in kindergarten, 232-234. 
 
 in primary school, 234. 
 
INDEX 
 
 303 
 
 Education, of the home, 230. 
 
 plan of, 242-243, 249. 
 Effect of disease, 276. 
 Elements of food, 98. 
 Enlarged tonsils, 290. 
 Enthusiasm in work, 1-2. 
 Environment, meaning of, 207. 
 Equestrian tights for pregnant 
 
 women, 37. 
 Ethics, 243. 
 Evaporation, 164-165. 
 Excretion, in medical treat- 
 ment, 279. 
 Exercise, 146. 
 
 a necessity, 148-149. 
 
 for child of five years, 152. 
 
 for child of ten years, 159. 
 
 for child of three years, 151. 
 
 for girls, 157. 
 
 girls' costume for, 158. 
 
 of infants, 150. 
 Exposure of nursery, 59. 
 Eyelids, cleanliness of, 116. 
 
 Fabrics, difference between va- 
 rious, 166. 
 Family pleasures, 217. 
 Fats, function of , 98. 
 Fear, of darkness, 192. 
 of lightning and thunder, 
 192-193. 
 Feather beds, use of, 137. 
 Feeding, during second year, 
 95 et seq. 
 for child over three years, 103. 
 for child of one and one-half 
 
 years to three years, 102. 
 for child over fifteen months, 
 
 101. 
 infant, by teaspoon, 89. 
 infant, intervals, 84. 
 infant, quantities, 84. 
 
 Feeding in sickness, 280-281. 
 
 of infant, 70. 
 Fencing, 159. 
 
 Fermentation of food, 284. 
 Fever powders, 281. 
 Filtered water, 108. 
 Flax, nature of, 167. 
 Floor of nursery, 62. 
 Follicular tonsillitis, 291. 
 Food and sleep, comparative 
 
 value of, 129. 
 Food, best, for infant, 71. 
 
 elements of, 98. 
 Foods, artificial and proprie- 
 tary, 89-92. 
 Foot-ball, 159. 
 Fun, love of, 220. 
 Function of the pregnant wo- 
 man, 23. 
 Furnishing of nursery, 59. 
 
 G 
 
 Garters, round, 173. 
 
 Gastric disorders, 283. 
 
 Gastric juice in infancy, 99. 
 
 Geography, study of, 239-241. 
 
 Gerber's Food, 91. 
 
 Germs, 274-276. 
 
 Ghost stories, 192. 
 
 Golf, 160. 
 
 Grammar, study of, 236-237. 
 
 Gymnasium at home, 161. 
 
 H 
 
 Habit, and heredity, 181. 
 
 and plasticity, 181. 
 
 force of, 180. 
 
 of being quiet, 184. 
 
 of cleanliness, 187-188. 
 
 of nail biting, 199. 
 Habits, 180. 
 
 of courtesy, 193. 
 
304 
 
 INDEX 
 
 Habits, of cowardice, 191. 
 
 of cruelty, 190. 
 
 of obedience, 189. 
 
 of regularity, 189. 
 
 of restlessness, 184-185. 
 
 of speech, 194-195. 
 
 of sucking, 186. 
 
 of tastefulness, 193. 
 
 of tongue sucking, 186. 
 
 of tongue swallowing, 186. 
 
 of tyranny, 190. 
 
 time for forming, 184. 
 Habitual constipation, 105. 
 Hamper, 51. 
 Hawley's Food, 91. 
 Heart disease, heredity of, 273. 
 Heat depression, relieved by 
 
 baths, 118. 
 Hernia, umbilical in infants, 
 
 53. 
 Home gymnasium, 161. 
 Horlick's Food, 90-91. 
 Hour for retiring, 133. 
 HubbelPs Prepared Wheat, 91. 
 Hydrocephalus, congenital, 254. 
 
 Ice-box for nursery, 65, 68. 
 
 Imitation, 246. 
 
 Imperial Granum, 91. 
 
 Impressibility of children, 210- 
 211. 
 
 Inebriety, inherited, 263. 
 
 Inefficiency of women in house- 
 hold, 10. 
 
 Infant-feeding, intervals, 84. 
 quantities, 84. 
 
 Inherited weakness, 272. 
 
 Insanity, heredity of, 273. 
 
 Insomnia, 138. 
 
 Inspection of cattle, 79. 
 
 Intestinal disorders, 285. 
 
 Irrigating bowels, 286. 
 
 Isolation in communicable dis- 
 ease, 296. 
 
 K 
 
 Kalmuc type, 253, 257. 
 Kindergarten, 232-234. 
 Knickerbockers, boys', 173. 
 Knowledge of sex, 218. 
 
 Lactated food, 91. 
 
 Lactopreparata, 91. 
 
 Language, study of, 243. 
 
 Laryngitis, 292. 
 
 Late age of marriage, 7. 
 
 Layette, list of articles in, 49. 
 
 Leather for shoes, 178. 
 
 Leggings for pregnant women, 
 43. 
 
 Liebig foods, 90-91. 
 
 Life-work of women, 4-5. 
 
 Light in sleeping-room, 138. 
 
 Lime-water in milk modify- 
 ing, 86. 
 
 List of articles in layette, 49. 
 
 Lobar pneumonia, 293-294. 
 
 Long dresses for infants, 55-56. 
 
 Lying-in, utensils for, 45. 
 
 M 
 
 Mackintosh for clothing, 168. 
 Malted milk, 91. 
 Management of household 
 
 duties, 33-34. 
 Mastication, slow, 109. 
 Masturbation, 199, 201. 
 Maternal duties, necessity of, 5. 
 Maternal impressions, 27-30, 
 
 258. 
 Matting for nursery, 62. 
 Measles, 295-296. 
 
 
INDEX 
 
 305 
 
 Medicines, 280. 
 Mellin's Food, 90-91. 
 Microcephalia, 253. 
 Milk, analysis of human and 
 cow's, 80. 
 
 as carrier of infection, 79. 
 
 cow's, boiled, 77-78. 
 
 cow's, cleanliness of utensils, 
 77. 
 
 cow's, raw, 77. 
 
 cow's, sterilized, 77-78. 
 
 human, physiological value 
 of, 71-72. 
 
 laboratories, 81. 
 
 modification of, 81-86. 
 
 modification of, with lime- 
 water, 86. 
 Moccasins for children, 176. 
 Modification of milk, 81-86. 
 Mongol type, 253, 257. 
 Morris, William, example of, 2. 
 Mother, as educator, 227-228. 
 
 duty of, 211-212. 
 
 function of, 298-300. 
 Mother's milk, value of , 71. 
 
 when deficient, 73. 
 Mouth, cleanliness of, 117. 
 
 N 
 
 Nail-biting, 199. 
 
 Nap, afternoon, 132. 
 
 Natural wool, 165. 
 
 Navel, rupture of, in infant, 53. 
 
 Need of rest greatest in young 
 
 children, 132. 
 Nervous shock, 257-258. 
 Nestle's food, 91. 
 Nightgown, infant's, 57-58. 
 Nightgowns, 133. 
 Night lamp, 138. 
 Nightmare, 140. 
 Night terrors, 141. 
 Nipples, care of, 87-88. 
 
 Nitrogeneous foods, 98. 
 Nose-picking, 144. 
 Nurse-maids, function of, 209. 
 Nursery, bath-tub in, 65-66. 
 
 cleanliness of, 65. 
 
 decoration of, 63. 
 
 exposure of, 59. 
 
 floor of, 62. 
 
 furnishing of, 59. 
 
 ice-box for, 65, 68. 
 
 matting for, 62. 
 
 rugs for, 62. 
 
 screen for, 65, 67. 
 
 the, 47. 
 
 toilet chair in, 65. 
 
 ventilation of, 60. 
 
 wall-paper for, 63. 
 
 wash-basin for, 65, 67. 
 Nursing, position of infant dur- 
 ing, 88. 
 Nursing-bottles, care of, 87-88. 
 
 O 
 
 Obedience, 189. 
 
 Obstetric forceps, value of, 255. 
 
 Opiates, 280. 
 
 Opium, 258. 
 
 Outfit, for infant, 47. 
 
 list of articles for, 49. 
 Overalls for girls and boys, 
 
 174. 
 Over-indulgence, 190. 
 
 Pacifiers, 136, 186, 187. 
 Paralysis, birth-, 255. 
 Parental impressions, 260. 
 Parent, the true teacher, 250. 
 Partial sleep, 141. 
 Participation in family life, 216. 
 Pasteurized milk, 77, 79. 
 
306 
 
 INDEX 
 
 Pendulous abdomen, 44. 
 Penmanship, 238. 
 Peptogenic Milk Powder, 91. 
 Persistence, 201. 
 Pinning blanket, 55. 
 Plasticity of children, 208. 
 Pleurisy, 295. 
 
 Pneumonia, lobar, 293-294. 
 Position during sleep, 137. 
 Precocity, a cause of, 133. 
 Pregnancy, 23. 
 
 Pregnant women, arrangement 
 of duties of, 32. 
 
 cape and cloak for, 42. 
 
 corsets and corset waists for, 
 37, 39. 
 
 diet of, 31. 
 
 dressing for, 34. 
 
 equestrian tights for, 37. 
 
 leggings for, 43. 
 
 shoe for, 42. 
 
 skirts for, 40, 41. 
 
 stockings for, 37. 
 
 underclothes for, 35. 
 
 underskirts for, 36. 
 
 waists for, 40, 41. 
 
 wrappers for, 41. 
 Pre-marital training, 19, 20. 
 Prenatal effects, 27, 30. 
 Preparation for child-birth, 
 
 25-26. 
 Primary school, 234. 
 Proprietary foods, 89-92. 
 Proteids, function of, 98. 
 Putrefaction of food, 284. 
 
 Radiation, 164. 
 Raw milk, 77. 
 
 Rectum, control of, 187-188. 
 Regularity in habits, 189. 
 Relation between unborn child 
 and mother, 24-25. 
 
 Relation of parents to children, 
 
 204. 
 Religious training, 243. 
 Respiration, function of, 289. 
 Respiratory diseases, 289-295. 
 Responsibility, for children's 
 habits, 202-203. 
 
 in men and women, 4. 
 
 sense of, 3. 
 Retiring, time for, 133. 
 Rheumatism, heredity of, 273. 
 Ridge's Food, 91. 
 Riding, 160. 
 
 Robinson's Patent Barley, 91. 
 Rocking child asleep, 135. 
 Rubber cloth for clothing, 168. 
 Rubber shoes, 178. 
 Rugs for nursery, 62. 
 Rules for infant's garments, 48. 
 Rupture of navel in infant, 53. 
 
 Salt baths, 123. 
 Scarlet fever, 295-296. 
 School, primary, 234. 
 Screen for nursery, 65, 67. 
 Sea baths, 125. 
 Self-control, 201. 
 Sex, knowledge of, 218. 
 Shock, nervous, 257-258. 
 Shoes, ankle, 177. 
 
 for children, 175, 177. 
 
 knitted, for infants, 55. 
 
 for pregnant women, 42. 
 
 rubber, 178. 
 Sickness, cause of, 271. 
 Silk, function of, 111, 113. 
 
 nature of, 167. 
 Simple domestic conditions, 
 
 necessity of, 13-14. 
 Singing child asleep, 135. 
 Skirts, infant's, 53. 
 
 for children, 172. 
 
INDEX 
 
 307 
 
 Skirts for pregnant women, 
 
 40-41. 
 Sleep, 129. 
 
 and food, comparative value 
 of, 129. 
 
 conditions for, 131. 
 
 partial, 141. 
 
 physiology of, 129-130. 
 
 position during, 137. 
 Sleeping garments, 133. 
 Sleeping mixtures, 280. 
 Slip, infant's, 56, 57. 
 Snoring, 144. 
 
 Soap for infant's use, 116. 
 Somnambulism, 143. 
 Soothing syrups, 280. 
 Sparring, 160. 
 Specialization in work, 8. 
 Speech, habits of, 194-195. 
 
 normal limit of acquiring, 
 266. 
 Spelling, study of, 237-238. 
 Sphere, women's, 21. 
 Spices, use of, 99. 
 Sponge bath, 282. 
 Sponge baths in hot weather, 
 
 118. 
 Sprue, 283. 
 Sucking habits, 186. 
 Sucking reflex, 136. 
 Sugars, function of, 98. 
 Sugar teat, 136. 
 Sugar teats, 186, 187. 
 Summer clothing, 169. 
 Stammering, 197, 198. 
 Starches, function of, 98. 
 Sterilized milk, 77-78. 
 Stockings, for children, 171. 
 
 for pregnant women, 37. 
 
 infant's, 54. 
 Stuttering, 196, 197. 
 Swimming, 153. 
 Swiss foods, 91. 
 
 Table manners for children, 
 
 109. 
 Talking in sleep, 144. 
 Teeth, care of, 120. 
 Teething syrups, 280. 
 Tennis, 159. 
 Thrush, 283. 
 Thumb sucking, 137. 
 Toilet chair in nursery, 65. 
 Tongue sucking, 186. 
 Tongue swallowing, 186. 
 Tonsil, pharyngeal, 289. 
 Tonsillar hypertrophy, 290. 
 Tonsillitis, follicular, 291. 
 Tonsils, 289. 
 
 enlarged, 290. 
 Toxines, 275, 277. 
 Treatment, general, of disease, 
 
 279. 
 Tub-bath, 123. 
 Tubercular diathesis, 256. 
 Tuberculosis, 272. 
 
 heredity of, 272. 
 Typhoid fever, 295, 296. 
 Tyranny in children, 190. 
 
 U 
 
 Umbilical hernia in infant, 
 
 53. 
 Unborn child, 24. 
 Underskirts for pregnant 
 
 women, 36. 
 Underwear, for children, 170, 
 
 171. 
 for pregnant women, 35, 36. 
 Union in family, 214, 215. 
 Union underwear, 170. 
 Unselfishness, 222. 
 Utensils for lying-in, 45. 
 
308 
 
 INDEX 
 
 Ventilation of nursery, 60. 
 Vermiform appendix, 287. 
 Vocation, women's, 4-5. 
 Vulva, cleanliness of, 117. 
 
 W 
 
 Waist for children, 171. 
 Waists for pregnant women, 40, 
 
 41. 
 Walking, correct, 153. 
 Wall-paper for nursery, 63. 
 Wash-basin for nursery, 65, 67. 
 Washing, occasional, of child, 
 
 118. 
 Washing out bowel, 286. 
 
 Water filter, 108. 
 Waterproofed wools, 170. 
 Weaning, 92, 95. 
 Wet-nurse, 75-76. 
 Wet pack, 282. 
 Winter clothing, 169. 
 Women's life-work, 4-5. 
 Women's sphere, 21. 
 Women's work usually subor- 
 dinate, 9. 
 Wool, absorbability of, 187. 
 
 natural, 165. 
 
 use of, 165, 168. 
 
 washing of, 168. 
 Wrapper for infant, 57. 
 Wrappers for pregnant women, 
 
 41. 
 Wrestling, 160. 
 Writing, 238. 
 
THE DEVELOPMENT OF THE 
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 THE MACMILLAN COMPANY 
 
 66 FIFTH AVENUE, NEW YORK 
 
THE MEDICAL DISEASES OF 
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 By NATHAN OPPENHEIM, 
 
 A.B. (Harv.), M.D. (Coll. P. & S., N. Y.), 
 
 Attending Physician to the Children's Department of Mt. Sinai Hospital 
 
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