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Care— Feeamg or the Baby, 
 
 '^S^' 
 
 A Handbook 
 
 -FOR- 
 
 Motners, Mid^vives and Nurses. 
 
 BY- 
 
 FERDINAND HERB, M. D. 
 
 PUBLISHED BY 
 
 THE Iv. ^ O. PUBL. CO. 
 
 SUPERIOR, - WISCONSIN. 
 
UBRARY of CONGRESS 
 Two Cooles Recdved 
 MAY 15 190r 
 
 <. Copynjht Esfry 
 
 CLASS^/\ XXci.No. 
 COPY B. 
 
 
 Copyright, 1907, 
 
 BY 
 FERDINAND HERB. 
 
 All Rights Reserved. 
 
TO 
 
 THE MEMORY OF 
 
 MY DECEASED MOTHER 
 
 IN DEEPEST VENERATION 
 
 THIS BOOK IS 
 
 MOST AFFECTIONATELY 
 
 DEDICATED. 
 
PREFACE. 
 
 The trend of human endeavor now-a-days is to 
 prevent rather than to cure sickness. To this end it 
 proved necessary, first of all, to educate the masses. 
 Great strides have been made in this direction. The 
 nature and prevention of tuberculosis, malaria, yellow 
 fever and other pestilences are becoming more and 
 more widely known. Curiously, however, little, com- 
 paratively very little, knowledge, indeed, has found 
 its w^ay to the people as to that part in the field of 
 prevention which in fact requires the most urgent 
 attention, namely, the care and feeding of infants. 
 It is at this tender age that the foundation for the 
 future health and happiness of the individual is laid, 
 but it is also at this time that the gravest and most 
 serious mistakes are constantly made. This state- 
 ment may seem exaggerated. But it is not! Daily 
 experience shows it to be correct. Amazing is the 
 imprudence, to say the least, with which the care and 
 feeding of infants is handled in the average family. 
 
 It is, however, not the mother who is to be 
 blamed for this unfortunate condition. In the over- 
 whelming majority of instances, she is eager to learn. 
 It is the lack of proper sources wherefrom informa- 
 tion and sound knowledge can be gathered. Many 
 books, we admit, are on the market, but few meet the 
 wants of an enlightened public. They either teach 
 only general principles and advise ''to call the doctor" 
 for every, even the most trifling, ailment, or give in a 
 crude and uninspiring way a multitude of prescrip- 
 tions which a conscientious public does not care or 
 dare use for want of proper instructions. 
 
 Either book is, of course, unsatisfactory to that 
 class of the people who most urgently need the in- 
 
VUl 
 
 formation, as the practical benefits derived therefrom 
 do not seem to warrant the expenditure necessary to 
 procure a copy. Most of those who buy such books 
 are not wilHng to call the doctor for every little 
 matter, nor do they want to take the risk of using 
 remedies without specific information. They expect, 
 and have a right to expect, that a book worth buying 
 should give instructions up-to-date, clear and in 
 simple, plain English — instructions which include not 
 only prevention but also treatment, so that they may 
 be followed and made use of when difficulties arise. 
 
 Such a book we have endeavored to give, treating 
 of the life of the child from birth to the end of the 
 second year. It includes the care and feeding of in- 
 fants and those disturbances of digestion closely con- 
 nected therewith that should be known to every 
 mother. All technical expressions have been avoided 
 as far as possible. The language has been chosen so 
 as to be easily understood by every mother. Frequent 
 hints as to the prevention and recognition of diseases 
 and full details as to the treatment of existing ail- 
 ments are special features. Always, however, has 
 attention been called to the seriousness of the trouble, 
 if it seemed warranted. All prescriptions are given 
 in such a form that any druggist can fill them. 
 
 The last feature of the book, we expect, will 
 arouse some opposition from medical quarters. The 
 majority of physicians, who in their present struggle 
 with the manufacturers of patent medicines demand 
 the abolition of secrecy and a fair play above board, 
 will not object to be measured with the same stick 
 with which they measure others. Some of them, 
 however, will raise their voices and denounce the so- 
 called "Self-Drugging." This, of course, is done 
 for selfish purposes only. We consider an intelli- 
 gent public, if carefully instructed through the pages 
 of a reliable book, fully as competent to administer 
 remedies as if instructed by the physician in person. 
 
IX 
 
 Yes, we venture to assert that in many instances it 
 is better fitted to do so, since few physicians care to 
 spend the time for the minute details of instruction 
 so essential in the battle against disease. Therefore, 
 we would consider the book as incomplete and of 
 comparatively little value, especially for the farmer 
 for whom it is mainly intended, if the prescriptions 
 were omitted. 
 
 By the foregoing we do not mean to say that we 
 advise against the employment of the physician. By 
 no means ! The consultation of a competent and con- 
 scientious medical adviser will often lend stability to 
 the otherwise wavering mother. On the other hand, 
 his employment does not make the book superfluous. 
 Both supplement each other. The book relieves the 
 busy practitioner of the burden of giving time-con- 
 suming details and allows the mother to control and 
 pass judgment upon the carefulness and thorough- 
 ness of the medical attendant, two advantages which 
 commend the book to every mother, rich or poor. 
 
CONTENTS. 
 
 PART I— CARE OF THE INFANT. 
 
 CHAPTER 1. 
 First bath. Pages 3 to 4. 
 
 CHAPTER 2. 
 Care of the rest of the navel-string. Inflammation of the 
 navel: cause, prevention and treatment. Bleeding of the navel: 
 treatment. Discharges from the navel: treatment. Rupture of 
 the navel : causes, prevention and treatment. Pages 5 to 18. 
 
 CHAPTER 3. 
 Care of the eyes of the new-born. Inflammation of the 
 eyes of the new-born. Simple catarrh of the eyes of the new- 
 born: prevention, symptoms, treatment. Specific inflammation 
 of the eyes of the new-born: cause, prevention, symptoms, treat- 
 ment. Pages 23 to 32. 
 
 CHAPTER 4. 
 
 Appearance of the child after birth: children born at term, 
 born too early, color of the skin, length of the body, form of the 
 head, navel, genitals, opening of the bowels, back. Pages 33 to 
 35. 
 
 CHAPTER 5. 
 
 Functions of the body of the child: crying, coughing and 
 sneezing, muscular movements, eyes, position of the legs, hic- 
 cough, evacuation of the bowels, black disease of the new-born, 
 urine, changes in the skin after birth, swelling of the breasts, 
 sleep. Pages 36 to 4L 
 
 CHAPTER 6. 
 
 Nursing of the child. Nursery: choice of the room, light 
 and sunshine, walls, floor, furniture, toys, bed of the baby, play- 
 ground, temperature of the air, humidity of the air, heating, 
 ventilation, cleaning, danger from insects. Pages 42 to 49. 
 
Xll 
 
 CHAPTER 7. 
 Care of the skin. Baths. Care of those places of the skin 
 that are predisposed to sickness — skin between the legs and the 
 seat. Head: care and treatment, if diseased. Pages 50 to 58. 
 
 CHAPTER 8. 
 Care of the mouth. Pacifiers. Thrush: causes and treat- 
 ment. Pages 59 to 64. 
 
 CHAPTER 9. 
 Quiet life for babies. Sleep at night. Regularity in tak- 
 ing nourishment. Regularity as to the secretions of the body 
 (stool and urine) : education to cleanliness. Hardening of chil- 
 dren. Outdoor life. Physical exercise. Pages 65 to 71. 
 
 CHAPTER 10. 
 Crying of children. Soothing syrups. Pages 72 to 75. 
 
 CHAPTER 11. 
 Signs of a normal development. Increase in weight. De- 
 velopment of the head. Development of the muscles : lifting up 
 of head, standing, walking, etc. Development of the teeth. Too 
 early and too late development of the teeth and their significance. 
 Teething sicknesses. Pulse : how to feel and where to feel, num- 
 ber of beats, etc. Breathing. Temperature: importance, where 
 to measure, reading of the instrument, normal temperature, treat- 
 ment of the thermometer, advantages derived from the use of 
 the thermometer in case of sickness. Appearance and consist- 
 ency of the evacuations of the bowels : with breast-fed infants, 
 with infants fed on cow's milk, buttermilk, proprietary foods, 
 dark or green passages, slime or slime and blood in passage, 
 dyspeptic passages, foul smelling passages, thin and watery pass- 
 ages. Pages 7(^ to 100. 
 
 PART II— FEEDING OF THE INFANT. 
 
 CHAPTER 12. 
 
 Importance of breast-feeding. Insufficient development of 
 
 the breast and nipples. Sore nipples : cause, prevention and 
 
 treatment. Inflammation of the breast: cause, prevention and 
 
XUl 
 
 treatment. Sicknesses of the mother that forbid nursing. Condi- 
 tions of the infant that interfere with nursing. Pages 103 to 121. 
 
 CHAPTER 13. 
 
 Mother's mode of Hfe and regularity of habits. What a 
 nursing mother should eat. What a nursing mother should not 
 eat. Pages 122 to 127. 
 
 CHAPTER 14. 
 
 Normal function of the breast. Insufficient milk-supply : 
 cause, signs and treatment. Excessive milk secretion: cause, 
 signs and treatment. Faulty composition of the milk of the 
 mother : causes and treatment. First nursing of the baby. How 
 often shall the child be nursed? How much nourishment shall 
 the child receive at each meal? How long shall the child nurse? 
 Shall the child have one or both breasts at each feed? Pages 
 128 to 148. 
 
 CHAPTER 15. 
 
 Weaning. When to wean. How to wean. With what to 
 wean. Pages 149 to 154. 
 
 CHAPTER 16. 
 Selection of a wet-nurse. Page 155. 
 
 CHAPTER 17. 
 Hand-feeding. Points of distinction between cow's and 
 mother's milk. Requirements of a good milk. Signs of a good 
 milk. Pages 156 to 160. 
 
 CHAPTER 18. 
 How to produce a good milk. The cow must be healthy. 
 The cow must be properly fed. The time elapsed since calving 
 must be right. The cow must be properly housed and cared for. 
 The cow must be treated gently. Pages 161 to 164. 
 
 CHAPTER 19. 
 Milking and care of the milk. Microbes and poisons in 
 spoiled milk. Transmission of infectious diseases in the milk 
 from one person to another. How to avoid diseases that may be 
 transmitted in milk. Milking. Further treatment and storage 
 of the milk. Delivery of the milk. Disinfection of the milk 
 vessels. Pages 165 to 171. 
 
XIV 
 
 CHAPTER 20. 
 Care of the milk at home. Addition of chemicals. Steril- 
 ization. Disadvantages of sterilization. Pasteurization. Steril- 
 ization or pasteurization? Raw or heated milk? Is the milk of 
 one cow or the mixed milk of a herd preferable? Pages 172 
 to 179. 
 
 CHAPTER 21. 
 
 How to prepare the milk according to the age of the child. 
 Dilution of the milk for the different ages. Addition of fat. 
 Addition of sugar. How to change the curdling of the milk. 
 Addition of gruels of oatmeal, barley or rice. Addition of lime- 
 water. Addition of Sodium Citrate. Preparation of the baby- 
 food in short outlines. Pages 180 to 187. 
 
 CHAPTER 22. 
 
 Changes in the composition of the nourishment necessitated 
 by disturbances of digestion. Nourishment too much diluted : 
 signs and treatment. Nourishment too concentrated : signs and 
 treatment. Percentage of fat too high: signs and treatment. 
 Percentage of fat too low: signs and treatment. Percentage of 
 sugar too high: signs and treatment. Percentage of sugar too 
 low: signs and treatment. Pages 188 to 194. 
 
 CHAPTER 23. 
 
 Number, intervals and quantity of feeds. How to feed the 
 baby! Page 195. 
 
 CHAPTER 24. 
 
 Selections of nursing bottles and nipples. Collapsing of the 
 nipples : cause and how to avoid it. Cleaning of bottles and nip- 
 ples. Pages 196 to 203. 
 
 CHAPTER 24. 
 
 Other substitutes for mother's milk. Goat's milk. Ass's 
 milk. Mare's milk. Condensed milk. Buttermilk. Peptonized 
 milk. Kefir. Kumiss. Whey. Beef juice. Pages 204 to 211. 
 
 CHAPTER 26. 
 Proprietary foods. Pages 212 to 213. 
 
XV 
 
 CHAPTER 27. 
 Feeding after the first year. Additions. Farinaceous foods. 
 Meat and meat soups. Vegetables. Eggs. Fruit. Beverages. 
 Alcoholic drinks. Pages 214 to 216. 
 
 PART III— DISTURBANCES OF NUTRITION. 
 
 CHAPTER 28. 
 Delicate infants : causes, prevention, symptoms, treatment. 
 Pages 219 to 222. 
 
 CHAPTER 29. " 
 
 English Disease or Rickets : causes, symptoms, prevention, 
 treatment. Pages 223 to 233. 
 
 CHAPTER 30. 
 Acute Indigestion: causes, symptoms, complications and 
 sequelae, prevention, treatment. Pages 234 to 250. 
 
 CHAPTER 31. 
 
 Chronic Diarrhea: causes, symptoms, prevention, treatment 
 Pages 251 to 254. 
 
 CHAPTER 32. 
 
 Constipation : causes, symptoms, treatment. Pages 255 to 
 
 260. 
 
 CHAPTER 33. 
 Colics: causes, prevention, treatment. Pages 261 to 264. 
 
 
To Our Readers. 
 
 The never resting zvheel of progress brings 
 continually, in quick succession, new devices, 
 medicines, etc., to the surface. This renders 
 obsolete within a rather short space of time any 
 medical book, however carefully written and up- 
 to-date at the time of its publication. We, there- 
 fore, have decided to furnish, free of charge, 
 every year or two,. as conditions may demand, a 
 supplement to those mothers who zvill Hie with the 
 publishers their exact address and notify them of 
 any change made. 
 
 All prescriptions in this book are given in 
 such a form that any druggist can fill them. We, 
 therefore, advise to have them put up at your 
 local drug store, provided the druggist is trust- 
 worthy and reliable. 
 
 But as many of our readers live on farms 
 far away from the nearest drug store but within 
 easy reach of postoMce communications ; and as 
 many of the prescriptions call for drugs of the 
 very latest invention, which are kept in but a few 
 stores and cannot be procured from the whole- 
 saler but with a great loss of time, or are likely 
 to be substituted on account of their high price, 
 zve have arranged with the F. H. Rheno Co. of 
 Superior, Wis., to furnish the remedy desired, 
 either by Mail or Express, as the case may de- 
 mand. This, we believe, increases greatly the 
 value of this book, as it insures prompt delivery, 
 proper composition, pure and highly efficient 
 drugs and lozvest possible prices. 
 
 THE AUTHOR. 
 
PART I. 
 
 '\ Care of the Infant. 
 
CHAPTER I. 
 
 FIRST BATH. 
 
 As soon as the child is born and the navel-string 
 cut, the new-born must be taken away from the bed 
 of the mother and wrapped in flannels, which have 
 been warmed beforehand. There it should remain un- 
 til the water for the bath is prepared, when the clean- 
 ing may proceed. 
 
 The temperature of the water should be between 
 ninety-eight and one hundred degrees Fahrenheit, 
 that is, about as warm as the blood of the mother. 
 It must be measured with a bath thermometer, such 
 as is shown in Figure i, which can be bought at any 
 drug store. It is not advisable to measure the temper- 
 
 Figure 1. Bath Thermometer. 
 
 ature with the finger or the elbow. Though often 
 done, this is dangerous, since a mistake in the temper- 
 ature of the water may cause serious consequences. 
 
 The white, cheesy, smeary substance, which cov- 
 ers more or less the different portions of the body of 
 the child, is very difficult to remove. To do this 
 more easily, it is advisable to clean first the places 
 which are lined thickest with a cloth dipped in oil 
 or vaseline and then proceed with the washing. 
 
 The soap to be used for the bath must be 
 mild, that it will cause no undue irritation of the 
 tender skin. A good grade of castile soap answers 
 the purpose. For wiping, use a soft sponge or flan- 
 nel cloth; either will do. Still better, is a thick pad 
 of absorbent cotton. Special care, however, must be 
 
taken to see that these utensils are used for the baby 
 alone. They should never corr^e in contact with the 
 mother. The use of the same bath cloths and towels 
 for both mother and child may result in carrying dis- 
 ease germs from the former to the latter and entail 
 serious consequences. These can and must be 
 avoided. 
 
 The new-born, just after leaving the warm body 
 of the mother, is very sensitive to low grades of tem- 
 perature. Even a slight cooling ofif is harmful. For 
 this reason the first bath should be given near a 
 warm stove, on the lap of the nurse. The baby should 
 not be placed into the water. For this there are two 
 good reasons, that is, to avoid: 
 
 First, the contact of the navel-stump. 
 
 Second, the contact of the eves with the bath 
 water. 
 
 Why these contacts are to be avoided, we shall 
 see in the following pages. 
 
 After the bath is finished and the skin gently but 
 thoroughly dried, the child is wrapped in cloths, pre- 
 pared and well warmed beforehand. Then it is laid 
 in its little cradle and warmly covered. It should not 
 be placed in the bed of the mother, except for a short 
 visit . 
 
— s- 
 
 CHAPTER 11. 
 
 CARE -OF THE REST OF THE NAVEL-STRING. 
 
 The rest of the navel-string, remaining on the 
 child after it has been severed from the mother, soon 
 mortifies. It is a dead tissue and adheres until Nature 
 has closed the large blood vessels v^hich are contained 
 in the navel-string. Then it falls off. This generally 
 takes place v^ithin a space of from five to eight days, 
 sometimes as early as the fourth day, quite often as 
 late as the ninth or tenth day. The remaining- wound 
 heals in a few days. 
 
 In order to avoid the serious consequences de- 
 scribed in the chapter on the inflammation of the 
 navel, the greatest care should be taken in treating 
 the stump. 
 
 Above all, it must not be allowed to come in 
 contact with the bath water. This contains millions 
 upon millions of dangerous germs which come prin- 
 cipally from the secretions of the mother, adhering to 
 the body of the child, and threaten to infect the fresh, 
 open wound of the navel. 
 
 Furthermore, all dampness and moisture must 
 be kept scrupulously away from the stump, since 
 moisture promotes, while dryness prevents, the 
 growth of microbes. The sooner it is dry, therefore, 
 the less is there danger of disease. For this reason 
 all salves, oils and fats, still used to-day by some im- 
 prudent and irrational persons, are strictly forbidden. 
 Such substances do not allow the moisture to evapor- 
 ate and hinder that which we most desire, namely, 
 the drying up of the stump. 
 
 Proceed, therefore, as follows: Immediately after 
 the navel-string has been cut, wrap the remaining end 
 in a piece of sterilized gauze. If this is not obtainable, 
 take a piece of linen, if it is newly washed and abso- 
 
lutely clean. Allow this wrapping to remain until the 
 chila is cleaned. When this is done replace it by a 
 fresh one, turn the stump upward towards the breast 
 and a little to the left side, cover it with an additional 
 pad of dry, clean cotton and apply bandaofe. 
 
 If the navel has been treated with the necessary 
 care and cleanliness and the bandage been protected 
 against wetting and soiling at the time of the daily 
 bath, this second dressing will remain dry and need 
 not be changed until it falls off w^ith the stump. But 
 the bandage must be watched carefully. If moisture 
 appears thereon, the dressing has to be taken off im- 
 mediately and replaced by a fresh one. The change 
 is made in the following manner: Remove sfently of 
 the bandage all that comes off easily. Soak the rest, 
 which generally sticks tightly to the enclosed cord, 
 with freshly boiled water until it is loose. Then re- 
 move it. While doing this avoid carefully all pulling 
 and tugging, since a dangerous bleeding may be the 
 consequence. If the old material has been removed, 
 disinfect with a solution of Boric Acid (Prescription 
 i) or better Rhenolin (Prescription 2), dry gent- 
 ly and apply fresh gauze and cotton. Then close with 
 the navel-bandage. 
 
 Prescription 1. 
 Boric Acid 3 ounces 
 
 Prepare the solution of Boric Acid in the follow- 
 ing manner: Boil two teaspoonfuls of the white 
 powder with a pint of pure, soft water in a clean, 
 enameled vessel for several minutes, remove from the 
 stove and use the solution lukewarm. It is not 
 necessary to use the entire pint at every dressing. 
 Take what is sufficient for cleaning and preserve the 
 rest in a clean, white, well-corked bottle. If used 
 again, the solution must be warmed by placing the 
 bottle in a vessel of warm water. 
 
 Stronger as an antiseptic, more reliable in its 
 
— 7— 
 
 work and easier to prepare is a solution of Rhenolin 
 (Prescription 2) and should, therefore, be preferred. 
 
 Prescription 2. 
 
 Rhenolin 4 ounces 
 
 One-half teaspoonful to a pint of boiled water. 
 The warmer the solution, the better the effect. 
 
 After the stump is detached, all that is required 
 further is to keep the little wound in a clean con- 
 dition by washing it with freshly boiled water and 
 covering it with sterilized gauze or clean, dry linen 
 once a day. 
 
 If the secretion is profuse, it is best to powder 
 the wound, after being cleaned (preferably with 
 Rhenolin) and dried thoroughly, with a mixture of 
 Salicylic Acid, Bismuth Subnitrate and Purified Talc 
 (Prescription 3), or a twenty per cent mixture of Zinc 
 Peroxide (Prescription 4), and proceed as before. 
 
 Prescription 3. 
 
 Salicylic Acid 18 grains 
 
 Bismuth Subnitrate lYz drachms. 
 
 Purified Talc 2-3 ouncft 
 
 Prescription 4. 
 
 Zinc Peroxide 1% drachms 
 
 Purified Talc 6 drachms 
 
 In this instance the dressing should be renewed 
 oftener, that is, once or twice a day, according to 
 the amount of the discharge. Sterilized gauze and 
 absorbent cotton can be obtained at any drug store. 
 
 If the little wound, in spite of this treatment, 
 does not heal ; if it continues to secrete and shows no 
 tendency to close, the following salve (Prescription 5) 
 
 Prescription 5. 
 
 Silver Nitrate 2 % grains 
 
 Balsam of Peru % drachm 
 
 Hydrous Wool-Fat, Petrolatum, each % ounce 
 
 will be found effective. It is spread thicklv on gauze 
 or linen and applied twice a day after the sore has 
 been cleaned thoroughly but gently with a solution 
 of Rhenolin. 
 
Sometimes a lump of so-called ''proud flesh/' 
 which bleeds very easily upon bein^ touched, forms 
 on the wound. If this lump be small, the same salve 
 will, in most instances, suffice. But if it be large, it 
 must be destroyed with the caustic pencil (Prescrip- 
 tion 6), whereupon the sore will quickly heal under 
 the application of the above given medicines, either 
 salve or powders. 
 
 Prescription 6. 
 
 One Caustic Pencil. 
 
 The pencil, when bought, is generally covered 
 with wax and of a light gra}^ color, but darkens grad- 
 ually upon exposure to air and light until it becomes 
 black. This change does not interfere with its effi- 
 ciency, because it is only the outer layer which dis- 
 colors, the inner parts remaining the same. The proud 
 flesh turns white when it is touched with this stick. 
 There is hardly any pain connected with this pro- 
 cedure and no harm can be done, if the healthy flesh is 
 carefully avoided. 
 
 Gauze, linen, and cotton can be discarded as 
 soon as the navel is healed and perfectly dry. The 
 use of the navel-bandage, however, should be con- 
 tinued for two or three months more. This is done to 
 prevent a rupture of the navel. The recently healed 
 wound is still soft and yielding and cannot as yet 
 withstand a strong pressure from within, such as 
 is brought to bear upon it when the child presses, 
 cries, coughs, vomits, etc. Under these circumstan- 
 ces, the navel bandage is a valuable protection and 
 support. It can be dispensed with as soon as the 
 scar becomes strong and firm. This mav safely 
 be assumed to be the case after the fourth month 
 of life. 
 
 INFLAMMATION OF THE NAVEL. 
 
 Like any other dead tissue so also the rest of the 
 navel-string is apt to rot and to decompose, if it is 
 
— 9— 
 
 not properly treated and disease germs are allowed 
 to settle on it. The consequences are serious. The na- 
 vel inflames, the stump discolors andbeg'ins to smell. 
 If the latter is already detached, when infection de- 
 velops, the remaining open sore begins to send forth a 
 thin and acrid fluid. The corrosive secretions irri- 
 tate the surrounding skin. It becomes red and in- 
 flames and soon is changed to an angry looking, pain- 
 ful sore, if nothing is done at the very beginning to 
 prevent it. The consequences are still worse, if the 
 disease germs find opportunity to penetrate from the 
 outer surface into the circulating blood. A more or 
 less progressive blood poison follows. The child 
 loses its appetite, becomes feverish, restless, it frets 
 and cries much, the niovements of the bowels, normal 
 in the beginning, soon become irregular and bad 
 smelling, the strength decays and the general condi- 
 tion grows worse as time goes on. 
 
 The situation is dangerous. Many a child has 
 lost its life under such circumstances. If life is 
 spared, a weakness often remains for months or years 
 to come. 
 
 Prevention — No evil events need be feared 
 during the time the navel is healing, if the directions 
 given in the former chapter are faithfully carried out. 
 
 Treatment — Whenever possible a physician 
 should be called in all more serious cases. If this is 
 beyond reach and the mother must undertake the 
 treatment, she should be conscious that the respon- 
 sibility is great and that the life of the child depends 
 on the carefulness with which she performs her duty. 
 
 The handling of the sore is similar to the hand- 
 ling of the normal navel-wound. All that we have said 
 on former pages is true here also, especially as 
 to the removal of the old bandage. Emphasis must 
 be laid upon scrupulous cleanliness. Everything that 
 comes in contact with the wound or the dressing 
 must be carefully prepared. The scissors, with which 
 
—10— 
 
 the gauze and the bandage is cut, should be boiled 
 for ten to fifteen minutes and the hands be thorough- 
 ly washed with hot water and soap, before anything 
 else is done. Then the old dressing is taken away, the 
 sore washed with Rhenolin, dried, etc. (see page 4). 
 As a dusting powder upon the sore itself a very 
 thin layer of Iodoform (Prescription 7), or of the 
 next powder (Prescription 8), is recommendable, 
 while the irritated skin of the surroundino: is covered 
 with a powder which is made of Zinc Oxide and Puri- 
 fied Talc (Prescription 9), or, if it is very much in- 
 flamed, is dusted with the same powder as given in 
 Prescription 8. 
 
 Prescription 7. 
 Iodoform 1 drachm 
 
 Prescription 8. 
 
 Zinc Peroxide 2 drachms 
 
 Purified Talc 6 drachms 
 
 Prescription 9. 
 
 Zinc Oxide 2 drachms 
 
 Purified Talc 6 drachms 
 
 If the attendant notices that under the dressing, 
 thus applied, the secretions accumulate and form 
 crusts, which retain the discharges, it becomes neces- 
 sary to keep the gauze in a wet condition. To this 
 end it must be dipped into the cleaning- solution — 
 either Boric Acid, or better Rhenolin — wrung out 
 tightly, laid upon the wound and covered with a 
 piece of oil-silk or oil-cloth, overlapping the gauze 
 sufificiently, that is, two or three fingers broad, to 
 prevent the latter from drying out. Through this 
 precaution the absorption of the secretion into the 
 dressing is promoted, the evaporation of the anti- 
 septic solution prevented, the gauze kept moist, the 
 formation of noxious crusts obviated and the sticking 
 of the dressing rendered impossible. It is necessary, 
 however, to state that some cases will progress more 
 favorably under the dry than under the wet dressing. 
 If this is observed, the former must be returned to. 
 
—11— 
 
 If the inflammation has subsided, but the healing 
 of the wound is delayed, the application of the oint- 
 ment given in Prescription 5 is often of decided ad- 
 vantage. 
 
 The healing v^ill require from a few days to 
 several weeks, according to the severity of the case. 
 
 BLEEDING OF THE NAVEL. 
 
 Bleeding of the navel may occur either before or 
 after the navel-string has been detached. If before, 
 it must be tied anew; if after, or if the new tying does 
 not suffice and the bleeding is not too profuse, the 
 attendant may try a remedy which is at hand in near- 
 ly every household. This is gelatine. It is kept in al- 
 most every kitchen for the preparation of puddings. 
 A great many different kinds are on ihe market, 
 partly colored, partly uncolored, partly with, partly 
 without the addition of citric acid, phosphates, etc. 
 Of these the pure, uncolored, and unmixed gelatine 
 should have the preference. Any other, however, may 
 be used in case of emergency. 
 
 This gelatine is to be prepared in the following 
 manner: Place one-half or one teasponful into a 
 small, clean enameled vessel and add so much water 
 that there remains after one-half hour's boiling a 
 slightly thickish, viscid fluid. If the solution g^ets too 
 thick and tenacious, dilute with boiling water out of 
 the steaming tea kettle. 
 
 With the gelatine, thus prepared, saturate a 
 piece of sterilized gauze or clean linen and apply it 
 directly to the bleeding surface. If the bleeding stops, 
 allow this cloth to remain until the next dav, when 
 the ordinary dressing may be employed again. 
 
 One precaution, however, must be emphasized. 
 The gelatine sometimes contains disease germs 
 which, when coming in contact with an open sore, are 
 apt to produce the dreaded lockjaw. In order to 
 avoid this danger, the above directions must be 
 
—12— 
 
 scrupulously followed and the gelatine be rooked well 
 for at least one-half hour. This will kill the germs, 
 should they be present, and render them harmless. 
 
 Gelatine tends to arrest a bleeding- on any part 
 of the body also when taken by mouth and absorbed 
 into the blood. The bleeding baby should, therefore, 
 have some of it to drink. To prepare it for this 
 purpose a teaspoonful of the substance is boiled with 
 four to six ounces of water until the fluid is reduced 
 to half of this quantity. When cooled it is ready to 
 be fed either clear or mixed with water or milk or 
 sweetened with sugar. One teaspoonful from time 
 to time is the proper dose. The more it bleeds, the 
 more should be given. In severe cases, it is advisable 
 to administer half of the solution, which has been 
 prepared, at once. Gelatine is no poison; it is a 
 nourishment. It cannot injure, if care is taken that 
 the movement of the bowels is not retarded or 
 checked. If this should happen, an injection with 
 lukewarm soap water (see chapter on "Constipation") 
 will speedily remedy the trouble. 
 
 If, in spite of all these efforts, the bleeding does 
 not cease, or if it is very severe from the beginning, 
 it is best to call a physician. If this cannot be done, 
 the mother may emplo}^ one of the following rem- 
 edies : 
 
 The simplest and best is a solution of Adrenalin. 
 
 Prescription 10. 
 
 Solution Adrenalin Chloride (1:1000) % drachm. 
 
 This can be had at any drug store. A small piece of 
 absorbent cotton or clean linen, just big: enough to 
 cover the blood exuding surface, should be saturated 
 with a few drops of this solution and pressed gently 
 upon the bleeding place. The effect is nearly al- 
 ways immediate, that is, the bleeding stops. The 
 drug is not corrosive but, if taken internally, is a 
 severe poison. It should, therefore, be handled with 
 great caution. 
 
13— 
 
 Physicians use frequently powerful caustics with 
 which to stop the oozing blood. If this be done, care 
 must be taken that only the bleeding- surface and not 
 the surrounding skin is cauterized, or the wound will 
 be enlarged tmnecessarily. 
 
 To these drugs belong the Tincture of Ferric 
 Chloride (Prescription ii) and the caustic pencil 
 (Prescription 6, page 8). 
 
 Prescription 11. 
 Tincture of Ferric Chloride 1-3 ounce 
 
 The former is to be applied with a camel's hair 
 brush or with a small pad of absorbent cotton, wound 
 around the end of a match or a toothpick. The lat- 
 ter will burn the surface and will turn the tissue 
 into a crust, which obstrticts the bleedinsf vessels. 
 
 DISCHARGES FROM THE NAVEL. 
 
 When the navel-wound is healed, the resulting 
 scar begins to contract and the navel sinks below the 
 surface, forming, under ordinary circumstances, a 
 small pit. Rarely the navel remains prominent, ^^^ith 
 some children, especially with those who have an ex- 
 tra amount of fat, the ordinaril}^ superficial pit be- 
 comes a deep recess. In stich instances it" may hap- 
 pen that the secretions of the skin are retained at 
 the bottom of this recess. They graduallv decom- 
 pose and by their irritating qualities cause the parts 
 to inflame and to send forth an acrid and pungent 
 secretion. The navel reddens, gets sore and tender 
 and the surrounding skin becomes affected. The 
 condition is not dangerous, but always indicates a 
 certain degree of neglect, since such secretions never 
 develop if at every bath the navel has been cleaned 
 down to the bottom. 
 
 Prevention — As every other part of the body, 
 so also the navel should be cleaned in all its 
 nooks and nicks at every bath. If it is deeply re- 
 tracted and the bottom of the recess cannot be 
 
—14— 
 
 reached with the finger, a pad of absorbent cotton, 
 wound around the end of a match or toothpick, is to 
 be employed for cleaning. If this be done, abnor- 
 mal secretions will never develop. 
 
 Treatment — A discharging or red and in- 
 flamed navel must be cleaned twice a day thoroughly 
 with a solution of Boric Acid, prepared as described on 
 page 6. After drying, a small pad of cotton should 
 be inserted and left in the pit intended to absorb the 
 secretions, as they form, and to lead them to the sur- 
 face. If this is done and the pad renewed as soon 
 as damp, a few da3^s will suffice to effect a cure. 
 
 RUPTURE (HERNIA) OF THE NAVEL. 
 
 We will take up in this treatise this disorder also, 
 since its prevention is closely connected with the care 
 
 Figure 2. (a) bowels, (b) mouth of rupture, (c) muscular layer of the 
 abdominal walls, (d) inner membrane, covering the abdominal organs, (e) 
 outer skin, (f) sack of the rupture, consisting of outer skin, inner membrane 
 and connective tissue, (g) neck of the rupture. 
 
 of the baby and should be known to every mother. 
 We learned on page 8 that the newly formed and 
 soft scar is, directly after the closure of the 
 wound, still very yielding and unable to withstand 
 any lasting or violent pressure from within. Precau- 
 tions were suggested. But in spite of their observation 
 a mother should ever be on the alert against this evil 
 and not overlook or neglect its early beginning, since 
 the sooner it is recognized and treated the better for 
 the baby. 
 
—15— 
 
 Detection is easy. If a rupture develops, a slight 
 bulging can at times be noticed in the region of the 
 navel. Upon examination it is easy to find at this 
 place a round opening, leading into the abdominal 
 cavity. This is small at first, receiving but 
 the tip of the little finger, becomes, hov^ever, larger 
 in later stages, allowing sometimes even the thumb to 
 pass. 
 
 As said, this opening leads directly into the 
 abdominal cavity and is called the mouth of the rup- 
 ture (Fig. 2 b). Trough this mouth the contents 
 of the abdomen protrude under the skin, forming the 
 bulging, and retreat again to their normal position 
 w^ith a gentle gurgling as soon as the pressure is re- 
 lieved. By the repetition of this incident of pro- 
 trusion the mouth gradually w^idens, more and more 
 intestines slip into the sack and the rupture en- 
 larges. 
 
 Causes — A tendency to rupture is sometimes 
 inherited. This is demonstrated by the fact that there 
 are families in which every child is affected by the 
 malady. Far oftener, however, it is not an inherited 
 predisposition, but an unnatural increase of the pres- 
 sure in the abdomen that leads to the rupture. This 
 increase of pressure may be brought about bv differ- 
 ent causes In some instances it is due to the ex- 
 tension of the bowels by gases. Faulty nutrition and 
 especially too early feedin^s^- of flour and foods pre- 
 pared from unconverted starch (see chapter on ''Pro- 
 prietary Foods") cause the abdomen to swell, in ag- 
 gravated cases to such an extent that the abdominal 
 walls look and feel like a drum-skin. In other in- 
 stances the pressure is not lasting, but verv violent 
 and in jerks instead; so in persistent and continuous 
 crying, dry, irritating, and hacking coughs, recurrent 
 vomiting and strenuous pressing on account of con- 
 stipation or difficult urination, etc. 
 
 Prevention — All the causes, above enumer- 
 
— 16— 
 
 ated, must be avoided or be removed, if they are pres- 
 ent. Hov^^ this is done, must be ,8:leaned from the 
 respective chapters of this book. It will suffice to 
 have attention drawn to them. 
 
 Treatment — We are happy in being' able to 
 give to those mothers whose children are afflicted 
 with ruptures of the navel the consolins: assurance 
 that the malady, if properly treated, nearlv always 
 heals voluntarily. Only in rare instances is an 
 operation required. It takes, of course, considerable 
 time with larger ruptures. But no mother should 
 despair and continue the treatment cheerfully. Suc- 
 cess will crown the efforts. 
 
 The first requisite for a cure is the removal of 
 the cause, that is, the accumulation of gases must be 
 relieved by proper nourishment (see ''Feeding of Chil- 
 dren"), the reason for the crying (see "Crying of Chil- 
 dren") be discovered and set aside, the irritating 
 cough be allayed, the bowels be regulated and the dis- 
 charge of urine be rendered easy. 
 
 The cause being removed, further treatment is 
 simple. Above all, it is necessary to keep the contents 
 of the rupture within the abdominal cavity. To 
 this end proceed as follows : Reduce what is out, ap- 
 ply a pad of clean absorbent cotton over the open- 
 ing and lift from each side a fold of the skin over the 
 cotton so that they meet in the middle line. In 
 this position fasten with strips of adhesive plaster, 
 which, in order to accomplish their purpose, must 
 reach around the body to the spinal column. Either 
 two strips cross-wise, or three to four strips over- 
 lapping like the shingles on a roof, or one strip around 
 the body and crossing in the front, as seen in Fig. 3, 
 can be used, depending upon the size of the rupture. 
 If it be small, one single strip about one and one-half 
 inches wide will generally suffice. If it be larger, 
 two strips crosswise are preferable, and, if it be very 
 large, the overlapping strips are best employed. 
 
—17— 
 
 Adhesive plaster, as commonly used, is apt to 
 irritate the skin to which it is attached. Oxide of 
 Zinc plaster is, therefore, preferable. This has proved 
 reliable and effective in the author's hands. Its stick- 
 ing and non-irritating qualities can alv^ays be relied 
 upon. A bandage made w^ith this material need not 
 be removed, until the strips begin to loosen. 
 
 If, hov^ever, for some reason an irritation of the 
 skin develops, the bandage must be removed and 
 should not be re-applied until the skin returns to 
 
 f 
 
 Figure 3. Application of Adhesive Plaster, according to Trumpp. 
 
 normal. If it seems inadvisable to wait that long, care 
 ought to be taken that all the secretions, arising 
 from the irritated surface, are freely drained and 
 frequently removed. 
 
 The treatment just given is the best, cheapest 
 and most effective for all ordinary cases. It not 
 only retains the rupture, but also diminishes the 
 tension of the abdominal walls, a benefit, which is of 
 the utmost curative importance. 
 
 However, the application of this kind of bandage 
 
—18— 
 
 is somewhat difficult and many a mother finds it more 
 convenient and easier to treat the rupture in the 
 old-fashioned way, using the strips of adhesive plas- 
 ter and a button. This manner is also good and ef- 
 fective. The procedure is as follows: Reduce the 
 contents of the sack, close the opening with a flat, 
 cotton-covered button or any other fitting object, as, 
 for instance, a properly cut cork or piece of wood, and 
 fasten with strips of adhesive plaster in the same 
 manner as shown before. In using this kind of 
 bandage one should take care that the object applied 
 is flat and so large that it cannot project into the 
 opening and press the edges apart (Fig. 4). If this 
 should be allowed to happen, the button will increase. 
 
 Figure 4. (a) button as it should be. (b) button as it should not be. 
 
 rather than diminish, the size of the rupture and 
 make a cure impossible. 
 
 This point has also to be taken into consideration 
 when purchasing a ready-made truss or bandage. But 
 too often instruments are offered to the public which 
 are faulty in construction and wholly unfit for use. 
 
19- 
 
 CHAPTER III. 
 
 CARE OF THE EYES OF THE NEW-BORN. 
 
 While after birth the body of the child is to be 
 cleaned with soap and water, it is advisable to wipe 
 the eyelids only with dry, clean cotton or linen. 
 Under no circumstances should the water of the bath 
 be allowed to come in contact wnth those delicate or- 
 gans. 
 
 To follow this advice is of the utmost importance, 
 if one wants to guard the eyes of the child against ser- 
 ious consequences. On page 5 we have learned that 
 millions upon millions of microbes are washed from 
 the body of the baby and mix with the water. Some 
 of them are harmless, but others are very dangerous 
 and may. if inoculated into the eye, give rise to a 
 most serious inflammation, yes, may lead to blind- 
 ness. 
 
 Similar precautions as advised for the first should 
 be taken during subsequent baths. Never let the eyes 
 be washed with the same water which has been used 
 for the body. A separate dish with clean absorbent 
 cotton and freshly boiled water is required for the 
 care of the eyes and ought always to be placed ready 
 for use before the bath is commenced. 
 
 INFLAMMATIONS OF THE EYES OF THE NEW-BORN. 
 
 We will here treat also more fully of those dis- 
 eases of the eyes of the ncAV-born which may follow as 
 a consequence of w^ant of proper instruction or 
 indifference in the care of the child. We do 
 this for the same reason which prompted us 
 to describe the diseases of the navel, namely, 
 because they are easy to prevent, if the mother's or 
 nurse's attention has been called to them. Should 
 
—20— 
 
 they, however, develop, in spite of careful nursing, a 
 well instructed attendant will know from the be- 
 ginning where she is. She will do what is proper 
 at once and not wait until the eye is lost and the 
 child crippled forever. No greater sin, yes, crime, can 
 be committed against the innocent nursling than to 
 allow the time of salvation to pass in idle expectation 
 of spontaneous improvement. Hundreds, yes thou- 
 sands and hundreds of thousands, of cases of blind- 
 ness and impaired vision, infinite calamity and mis- 
 ery, can and will be averted, if it be possible to edu- 
 cate the broad masses of the people as to the vast 
 importance of an intelligent prevention and an early, 
 proper treatment of all inflammations arising in the 
 eyes of the new-born. 
 
 In order to demonstrate the seriousness of this 
 scourge, it will not be amiss to digress from our topic 
 and cast a quick glance over the future life of those 
 unfortunate children who fall victims to this disease 
 because their parents and attendants neglected the 
 proper precautions or early treatment, by reason of 
 want of enlightenment or of indifference and care- 
 lessness. 
 
 We take from statistics that from 30,000 blind 
 people in Germany about 10,000, and from 50,000 in 
 the United States, about 15,000 have to blame the 
 loss of their precious eye-sight to the specific inflam- 
 mation of the eyes of the new-born. These appalling 
 figures cannot fail to touch the heart of thinking peo- 
 ple, if they but dissect the terrible, little word "blind" 
 and its consequences. We are aware, indeed, that 
 only those persons can comprehend its full meaning 
 who have had the opportunity of seeing the pitiful and 
 heart-rending sights afforded in institutions devoted 
 to the education of the ''eyeless" children or of ob- 
 serving the terrible burden imposed upon a family by 
 a blind member. And yet those figures are far from 
 expressing the real extent of the misery wrought by 
 
—21— 
 
 this horrible and odious malady. Not every child 
 taken ill becomes blind. In most instances, in which 
 evil consequences remain, the vision of but one eye 
 is diminished or lost. The multitude of those un- 
 fortunates who are more or less restricted in their 
 capacity of earning a livelihood and who are set back 
 in their competition with their fellow-men, dragging 
 out a miserable existence, because of their "weak 
 eyes," are not included in this enumeration. If it 
 were possible to ascertain their numbers, we think 
 that 100,000 or even 200,000 would not reach the 
 mark for the United States alone. 
 
 May these terrible truths stimulate every mother 
 to the utmost precaution. The welfare not only of 
 the child, but also of the whole family, may de- 
 pend on the heeding of these warnings. 
 
 SIMPLE CATARRH OF THE EYES. 
 
 Not every inflammation, arising in the eyes of the 
 new-born, is as dangerous as the one just hinted at. 
 This is because a number of them are not brought 
 about by the gonococcus, the producer of the specific 
 inflammation of the eyes (see next chapter), but by 
 less harmful microbes or by other irritants, such as 
 too bright light, mechanical insults, etc., which also 
 may sometimes cause the eyes of the new-born to 
 inflame. 
 
 Prevention — The non-specific inflammation of 
 the eyes of the new-born can be prevented by follow- 
 ing the directions given in the different chapters of 
 this book as to the care of the eyes, that is, the pro- 
 tection of the eyes against too bright light in the first 
 few days after birth, the prevention of the contact of 
 the bath water with eyes, especially at the first bath- 
 ing, and the employment of clean utensils, such as 
 sponges, wiping cloths, etc. 
 
 Symptoms — The symptoms of the non-specific 
 inflammation of the eyes are, in the beginning. 
 
—22— 
 
 similar to those of the specific. They are, 
 however, rarely so violent. The eyes redden, 
 the eyelids swell. A secretion, more or less 
 purulent in character, comes forth; it dries up 
 and forms crusts in the outer and inner corners. The 
 eyelids stick together, especially in the morning, so 
 that it is sometimes difficult, if not impossible, for 
 the baby to open them. Beyond that the inflamma- 
 tion seldom proceeds. Those dangerous conditions 
 which threaten the eyesight with destruction, as de- 
 scribed in the following chapter, are possible in very 
 much neglected cases, but are extremely rare. 
 
 After one or two weeks the discharges begin to 
 lessen; the irritation and swelling subside, and the 
 redness disappears. Soon the conditions are nor- 
 mal and the baby opens the eyes again with the 
 same brightness as it did before the trouble began. 
 
 Treatment — Since it is difficult for the mother to 
 decide if the inflammation in the eyes of her darling 
 is a simple catarrh or of specific nature, it is best 
 to call the physician in all aggravated cases. Light 
 cases may be treated by the mother herself. Rinsing 
 the eyes with a solution of Boric Acid (see page 6) or 
 with a solution of Potassium Permanganate (Prescrip- 
 tion i6), as given in the following chapter, will prove 
 to be sufficient. The rinsing should be repeated as 
 often as matter accumulates — every hour, if neces- 
 sary. Three or four treatments a day, however, will 
 generally suffice. The mode of rinsing is the same 
 as that described in the following chapter. 
 
 If the inflammation has subsided and there re- 
 mains a kind of chronic irritation with slight redness 
 and slimy secretion, as may happen, the following 
 medicine (Prescription 12) should be used. One 
 
 Precrlption 12. 
 
 Zinc Sulphate Vz grain 
 
 Cocaine Hydrochloride 1% grains 
 
 Solution of Boric Acid (3 per cent.). -.1-3 ounce 
 
—23— 
 
 drop of this solution, instilled into the eyes of the baby 
 three or four times a day, will speedily remove the 
 last vestige of the disease. 
 
 SPECIFIC INFLAMMATION OF THE EYES OF THE NEW-BORN. 
 
 The specific inflammation of the eyes of the new- 
 born is that dreadful disease to which our description 
 on page 20 refers. 
 
 The view commonly held by the laity that this 
 disease is brought about by too bright light, catching 
 cold, etc. is absolutely false. Specific disease germs, 
 known as ''gonococci," are the cause, and the only 
 cause. These germs are definite little beings, so small 
 that they can only be seen under a powerful micro- 
 scope. Figure 5 shows their picture. Two are al- 
 
 - - ' { W If -"^ = " " ^ «> / 
 
 Figure 5. (a) gonococci free in the secretion, (b) pus cells including 
 gonococci. (c) pus cells without gonococci. 
 
 ways lying together and they look like coffee-beans. 
 
 In many instances, in which the mother in her 
 former life has been infected with these germs, they 
 are contained in the discharges coming from the 
 vagina and enter the eyes of the child, either. 
 
 First, during the time of the passage of its head 
 through the vagina, if it happens to separate its eye- 
 lids at that period. 
 
 Second, during the time of the first bath, if the 
 microbes are wiped directly into the eye with the 
 wiping cloth or are inoculated with the bath water 
 (see page 5), or, 
 
—24— 
 
 Third, during the time of one of the subsequent 
 baths, if the fingers, linen, sponges, cloths or other 
 utensils used were soiled with the discharges of the 
 mother. This mode of transmission is found most 
 frequently in families in which the bath utensils are 
 used for both mother and child, as it may happen if the 
 care of the house is left to some ignorant and im- 
 prudent person. 
 
 These three different modes of transmission have 
 been enumerated because they have to be separated 
 while treating of prevention. 
 
 Prevention — After learning how and at what 
 time the specific microbes may enter the eyes of the 
 new-born, it is easy to understand what should be 
 done to prevent the infection. 
 
 In order to keep the disease germs from entering 
 the eyes of the new-born, while its head is passing 
 the mother's genitals, it is necessary to thoroughly 
 disinfect, shortly before the birth begins, the vagina 
 of every mother who can be "suspected" of harbor- 
 ing the germs. This is done by injections. The best 
 remedy to be used is Rhenolin in the strength of two 
 teaspoonfuls to a quart of water, or a solution of Cor- 
 
 Prescription 13. 
 Rhenolin 4 ounces 
 
 rosive Mercuric Chloride in the strength of i to 4000. 
 This latter is prepared by dissolving one of the fol- 
 lowing tablets (Prescription 14) in two quarts of 
 
 Prescription 14i 
 
 Corrosive Mercuric Chloride 7 1-3 grains 
 
 Sodium Chloride 2-3 grain 
 
 water. The injection is made as follows: Prepare 
 two or three quarts of the solution with warm water; 
 hang up the syringe (Fig. 6) one to one and one-half 
 feet higher than the hips of the mother; place a bed 
 pan or other vessel under her; disinfect her outer 
 parts thoroughly with the same solution; insert the 
 
-25- 
 
 freshly boiled endpiece of the syringe (Fig. 6 d.) into 
 the vagina and allow the solution to flow out slowly 
 until the bag is empty. Then the cleansing is finished. 
 ''Suspected" should be every mother whose for- 
 mer children have passed through the same disease 
 or who either during the time of her confinement suf- 
 fers from a sharp, corrosive, and acrid discharge or 
 sometime in her former life has suffered from sud- 
 denly appearing, disagreeable ''whites," which made 
 thick, greenish-yellow spots in the underwear, and 
 were associated with painful urination. It does not 
 matter how long the discharge has ceased. For years 
 
 Figure 6. Fountain Syringe, (a) rubber bag. (b) stop cock, (c) end piece 
 for rectum, (d) end piece for vagina, made of glass. 
 
 and years these microbes remain virulent, lurking in 
 the folds of the generative organs for an opportunity 
 to resume their harmful work. It does not matter 
 to which class of society the mother belongs. Neither 
 the house of the poor nor that of the rich is free 
 from this pernicious microbe. The innocent and edu- 
 cated woman has equal chance to be infected with the 
 morally defective and uneducated, for, in the over- 
 whelming majority of cases, it is not the wife but 
 the husband who has to shoulder the blame. He, as 
 a rule, brings home the germs; wife and children do 
 the suffering. 
 
—26— 
 
 As a further precaution, it is advisable, in such 
 "suspected" cases, to drop, after the first bath, one 
 drop of the following solution (Prescription 15) into 
 each eye of the baby. This remedy kills the specific 
 germs, should some, in spite of all precaution, have 
 been inoculated. 
 
 Prescription 15. 
 
 Silver Nitrate 3 grains 
 
 Distilled Water 1-3 ounce 
 
 The process is called ''Crede's process," after its 
 inventor, Crede, a German physician. It has proved 
 to be a blessing to humanity. Thousands, yes, hun- 
 dreds of thousands of children have thus been saved 
 from visual disability and blindness. It is in use in 
 nearly all of the European clinics; that is, as a matter 
 of routine precaution, a drop of this solution is in- 
 stilled into the eye of every child which is born in 
 these institutions. The beneficial results are un- 
 mistakable. The number of children, blind from this 
 cause, has decreased enormously. 
 
 The instillation of the solution is not always easy 
 to perform. It requires the help of a second person. 
 This latter must instill the drop, while the first attend- 
 ant separates the eyelids in exactly the same man- 
 ner as described later on. It does not matter if two 
 drops should happen to fall into the e3^e, for the ex- 
 cess will flow out immediately. 
 
 In some instances a slight irritation follows the 
 instillation. This is of no consequence. If the eye 
 is kept clean, it will disappear rapidly. 
 
 In order to avoid the infection of the eyes during 
 the first bath, it is necessary to follow strictly the 
 directions given in a former place (see page 19). 
 The only difference is that in ''suspected" cases the 
 lids, after being cleaned with dry cotton, are wiped 
 once more with cotton dipped into the solution given 
 in Prescription 17. 
 
 It is still easier to avoid the infection of the 
 
—27— 
 
 eyes in subsequent baths. If the bath utensils are 
 not used but for the child alone; if an extra dish with 
 clean cotton and freshly boiled water is always pre- 
 pared for the eyes separately; if the hands of the 
 attendant are always well washed and cleaned before 
 the bath begins no accident will happen. 
 
 Symptoms — One to four days after birth the eyes 
 of the nursling begin to redden. The upper lids 
 swell; secretion begins. This is watery in the be- 
 ginning and scanty. Soon, however, it becomes pro- 
 fuse and mattery. The swelling of the lids increases, 
 their movement becomes difficult and finally impos- 
 sible, so that the eyes can no longer be opened volun- 
 tarily. The difficulty is increased by a spasm of the 
 eyelids, which closes them so tightly that the es- 
 cape of the discharge is rendered impossible, in spite 
 of the continued accumulation. High pressure de- 
 velops within. If at this stage the eyelids are 
 opened by force, the matter comes out in a jet. The 
 inner membranes are in a condition of the highest in- 
 flammation; they are dark red, swollen, puify, rough 
 and often sprinkled with small, dark spots of blood. 
 
 If the inflammation has advanced so far and 
 the proper treatment has not as yet begun, the cornea, 
 that clear, transparent, crystal-like membrane in the 
 front part of the eyeball, soon begins to become 
 cloudy. It will then look like opaque glass. Sooner 
 or later one or more yellow spots appear thereon. 
 They d'evelop into small abscesses, which in most in- 
 stances, break to the surface and form ulcerations. 
 
 Now the eye is lost. Rarely, if ever, the contents 
 of the eyeball flow out through the perforating ulcer. 
 But the healing abscess leaves a scar which makes the 
 cornea cloudy and sight dim or impossible, so that 
 vision is spoiled, never to be repaired. 
 
 Treatment — This dangerous disease shoald never 
 be treated by the mother herself, if the services of a 
 good and reliable physician can be obtained. But 
 
—28— 
 
 another, we will proceed to describe the treatment 
 which is best to be employed. 
 
 But first let us utter a word of warning. The mat- 
 ter which comes from the eyes of the infant is ex- 
 tremely poisonous. Should it happen that the smal- 
 lest quantity of it, say one-tenth or one-twentieth of 
 a drop, gets into the eye of the attendant, it will there 
 produce an inflammation of the same, or even greater 
 severity, than exists at the place it comes from. 
 Therefore, precaution! The attendant should never 
 hold her head close to the nursling while caring for its 
 eye, but always keep it at such a distance that it can- 
 not be reached by the matter, should this spurt out 
 in a jet. Furthermore, she should wash her hands 
 carefully with soap and hot water after every treat- 
 ment and never touch any object around the room 
 until this is done. 
 
 To begin the treatment, it is necessary, first of 
 all, to remove thoroughly the matter enclosed in the 
 eye. This is best done by rinsing the cavity in front 
 of the eyeball. The process is thus : 
 
 The mother or nurse takes the child on her lap, 
 turning it a little upon that side on which the eye 
 to be washed is located, that is, upon the right side, if 
 the right eye, upon the left side, if the left eye is to 
 be cleaned. Why this is done will appear later. 
 Then she proceeds to open the tightly closed eye- 
 lids, a task difficult to perform and requiring patience 
 and perseverance. To this end she places the thumb 
 of the one hand upon the one, and the second or mid- 
 dle finger of the other hand upon the other eyelid 
 in such a manner that the tips of the fingers meet, 
 that is, that they lie as near as possible to the edge 
 of the lid. Now she pulls apart, carefully watching 
 that no pressure is exerted upon the eyeball. This 
 would be dangerous. If the fingers or the skin of the 
 lids are wet and slippery, the attempt will fail. For 
 this reason it is necessary to dry both fingers and skin 
 
—29— 
 
 since this is not always within reach for one reason or 
 thoroughly with absorbent cotton before the work be- 
 gins. 
 
 As soon as the eyelids are opened the matter 
 comes forth. The rinsing should now begin. The help- 
 er takes the solution and pours it slowly upon the 
 space between the nose and the inner corner of the 
 eye, or directly into this corner. It is forbidden to 
 direct the fluid into the middle of the eye, since evil 
 consequences may follow. 
 
 Instead of pouring the solution out of a vessel, 
 it is also allowable to press it out of a pad of absorbent 
 cotton, which has previously been dipped into the 
 medicine. Either way will answer the purpose. 
 
 If, as recommended, the child is not placed flat on 
 its back, but turned slightly upon the side on which 
 the eye to be cleaned is located, the medicine will flow 
 through the whole of the eye. It enters at the inner 
 and leaves at the outer corner, taking along all the 
 matter contained in the cavity. After some experi- 
 ence has been gained, it is advisable to close and open 
 the eyelids a few times, while the solution is flow- 
 ing. The expulsion of the matter is thereby facilitat- 
 ed. But where experience is lacking this is rather 
 to be omitted. 
 
 Extraordinary precaution must be taken if only 
 one eye is attacked by the disease. This happens 
 rarely, but it does. The position on the side, while 
 rinsing, is under such circumstances of still greater 
 importance. Only thus is it possible to avoid the in- 
 fection of the healthy eye by the matter, which other- 
 wise could run, by misfortune, across the nose during 
 the process of cleaning. It is a task difficult to 
 perform, especially with restless and resisting chil- 
 dren, but it must be accomplished. 
 
 The same calamity, that is, the escape of dis- 
 charge from the sick into the healthy eye, may also oc- 
 cur during sleep, if by gravitation the poisonous secre- 
 
—30— 
 
 tions are forced to take their way in this direction. 
 To avoid this misfortune, the child has to be put to 
 sleep in its cradle in the same position in which the 
 rinsing is done, that is, upon the same side on 
 which the diseased eye is located. 
 
 As a further precaution against infection from 
 the other side, the healthy eye should be closed with a 
 bandage. This is done by placing upon it a thick 
 pad of clean, absorbent cotton and fastening it with 
 a cloth without exerting any pressure. The only dif- 
 ficulty arising lies in getting a gool closure next to the 
 nose. The cotton is to be removed three to four times 
 a day in order to inspect closely the underlying eye 
 and to allow its natural secretions to escape. It is 
 only in this way that an unpleasant surprise can be 
 avoided. 
 
 According to the severity of the inflammation 
 and the quantity of the secretion, the eye should be 
 rinsed every two or one or one-half or even one-quar- 
 ter of an hour, if necessary. The rule applies to rinse 
 whenever matter has accumulated. If the child is 
 sleeping, it should not be disturbed, if it does not sleep 
 too long. 
 
 In severe cases it is advisable to apply ice com^ 
 presses to the lids between the rinsings, if ulcera- 
 tions do not exist on the cornea. Ice compresses 
 are made by laying upon the inflamed eyes small 
 pieces of linen, folded several times, which have been 
 dipped in ice water, or which were kept on a block 
 of ice. If renewed every one or two minutes, that 
 is, as soon as they begin to get warm, they ease the 
 inflammation, reduce the fever and promote the heal- 
 ing. 
 
 If the cornea is cloudy and ulcerations have de- 
 veloped, the cold compresses are not well borne and 
 warm ones must be substituted. This is done by ap- 
 plying the rags after being dipped in a hot fluid. 
 The same solution of Boric Acid as used for rinsing 
 
—31— 
 
 or a hot chamomile tea are best suited for this pur- 
 pose. 
 
 It is very difficult, if not impossible, for an in- 
 experienced mother to treat, or to recognize, such sad 
 complications as the participation of the cornea in 
 the inflammation. Therefore, let us urge once more 
 upon the parents to obtain the services of a skilled 
 physician in all such cases whenever possible. But 
 skilled and experienced he must be. Not every phy- 
 sician is qualified to properly handle such cases. But 
 if the latter by his skillful work has saved the child 
 from disability and blindness, he deserves his pay.. It 
 is much, very much cheaper to pay the bill of a suc- 
 cessful physician, yes, to travel for dozens or hun- 
 dreds of miles, than to be forced to raise a child that 
 in consequence of its impaired or lost vision will be 
 a burden to the family so long as it lives. 
 
 As rinsing fluid, either the solution of Boric Acid, 
 described on page 6, or a solution of Potassium 
 Permanganate, eight grains to a pint of freshly boiled 
 
 PRESCRIPTION 16. 
 
 Tablets of Potassium Permanganate (2 grains) No. 100 
 Pour tablets to a pint of water. 
 
 water, may be used. This latter solution is reddish- 
 purple and looks like wine. It is cheap and easily pre- 
 pared, since the remedy dissolves very readily in 
 water. 
 
 If neither medicine is obtainable, as it may hap- 
 pen on the farm, a simple salt solution can be substi- 
 tuted, one teaspoonful of common table salt to a 
 quart of water. Water alone without the salt will 
 irritate the eye and should not be used. This salt 
 solution has also proved to do well. It should, how- 
 ever, not be employed, if one of the two above men- 
 tioned remedies can be procured. 
 
 All these solutions must be absolutely clean and 
 should be used lukewarm. 
 
 The rinsings alone, however, are not sufficient. 
 
—32— 
 
 Besides these there should be instilled into the eyes, 
 after a thorough cleaning, three times a day one or 
 two drops of the following medicines (Prescriptions 
 17, 18 and 19). 
 
 Prescription 17. 
 
 •Arg-entum Colloidale 3 grains 
 
 Distilled Water 1-3 ounce 
 
 Prescription 18. 
 
 Protargol 8 grains 
 
 Distilled Water 1-3 ounce 
 
 Prescription 19. 
 
 Argyrol 8 grains 
 
 Distilled Water 1-3 ounce 
 
 These medicines are arranged according to their 
 efficiency. The first is far the best, then comes the 
 second and last the third. 
 
 If this treatment is faithfully pursued, an eye 
 will hardly ever be lost. One or two weeks are 
 generally sufficient to effect a cure, if the treatment 
 is begun immediately after the appearance of the in- 
 flammation. 
 
 In some few instances the improvement, 
 though rapid at first, stops at a certain point and will 
 not progress any further. If this should happen, the 
 medicine must be changed and either of the two fol- 
 lowing solutions should be used (Prescription 20 and 
 Prescription 21). Also of these one drop is instilled 
 three times a day. 
 
 Prescription 20. 
 
 Zinc Sulphate Vz grain 
 
 Cocaine Hydrochloride 1% grains 
 
 Solution of Boric Acid (3 per cent.). . .1-3 ounce 
 
 Prescription 21. 
 
 Ichthyol 3 g-rains 
 
 Distilled Water 1-3 ounce 
 
-33- 
 
 CHAPTER IV. 
 
 APPEARANCE OF THE CHILD AFTER BIRTH. 
 
 After mother and child are cared for, and their 
 most urgent needs satisfied, the relatives are at 
 leisure to inspect somewhat closer the newly arrived 
 member of the family. Not only for the satisfaction 
 of their own curiosity but also in the interest of the 
 nursling is it necessary that this inspection be made 
 with accuracy and intelligence. Eyes, ears, nose, 
 arms, legs and the different parts of the trunk must 
 be subjected to the scrutiny. Genitals and the ex- 
 terior opening of the bowels demand the closest in- 
 spection, since on these places abnormities are most 
 frequently met with. 
 
 In order to facilitate and render intelligent this 
 inspection, we will more minutely describe the prin- 
 cipal things to which attention should be paid. 
 
 CHILDREN BORN AT TERM— Their weight 
 is on an average y% pounds. Boys are a little 
 heavier than girls. The hair of the head is i% to 
 i^ inches long. Fluffy and downy hair is to be found 
 only on the shoulders, back and upper arms. The 
 forms are full and round. The fingernails are well 
 hardened and over-reach slightly the tips of the 
 fingers. The nails of the toes, however, do not reach 
 the end of the nail-bed. The bones of the head are 
 hard and lie close together. They allow to remain 
 open only those places which we describe as ''fon- 
 tanels" in the later chapter, "Signs of Normal Devel- 
 opment of Children.'' The muscular movements are 
 vigorous and the voice strong. 
 
 CHILDREN BORN TOO EARLY— They are 
 smaller, their weight is less. The forms are not 
 rounded, the skin is thin and flabb}^ The hair on the 
 head is shorter, but nearly the whole of the body is 
 
—34— 
 
 covered with a fluffy, downy growth. The fingernails 
 do not over-reach the tips of the fingers. The bones of 
 the head are soft and impressible and the fontanels 
 unusually large. The muscular movements are weak 
 and the voice is feeble. 
 
 THE COLOR OF THE SKIN is pale-reddish 
 with a shade of yellow. The changes which the skin 
 undergoes in the next davs are described later. 
 
 THE LENGTH OF THE BODY is on an aver- 
 age 20 to 21 inches. 
 
 THE FORM OF THE HEAD is somewhat ab- 
 normal and strange directly after birth. This is 
 caused by a swelling on that part of the skin of the 
 head which comes first. The swelling is the strong- 
 er the longer the labors lasted and the more effort 
 it took to develop the head. If the swelling is lo- 
 cated on the posterior parts, it makes the head appear 
 abnormally long; if it be located on the anterior parts, 
 it makes the head appear abnormally high. This 
 swelling is caused by a disturbance of the cir- 
 culation of the blood in those parts and is 
 of no consequence. It should be left alone. It serves 
 no purpose to try to correct this seeming malform- 
 ation by massaging and bandaging. The swelling will 
 disappear spontaneously in a few hours or days, with- 
 out leaving any bad effects whatever. 
 
 Sometimes it happens that the swelling is caused 
 by a clot of blood under the skin. This also is gener- 
 ally of no consequence. The only difference is that 
 the disappearance of the swelling will be slower, 
 and that it will take four to six weeks instead of a 
 few days to vanish. 
 
 NAVEL — All that is necessary to know about 
 the navel has already been said. 
 
 THE GENITALS are fully developed with nor- 
 mal children. In the case of a boy the testicles 
 should be both in the scrotum, that is, that pouch 
 which contains them with normal adults. The con- 
 
—35— 
 
 dition of the toreskin is of importance. It should be 
 easily retractable and should leave an opening large 
 enough for an easy passage of the urine. Defects, 
 if present, should be remedied. 
 
 OPENING OF THE BOWELS— In rare in- 
 stances it happens that the opening of the bowels is 
 closed and the excrements cannot be discharged. In 
 such cases an operation is necessary to save the life 
 of the child. 
 
 THE BACK is flat. However, there exist some- 
 times along the spinal column bulgings, which slowly 
 increase in size as the child grows older. They are 
 mostly on the lower end of the spine, but are also 
 found on the upper end and even on the back of the 
 head. The cause is a malformation of the spinal 
 column. The bones are open and allow the skin of 
 the spinal cord to bulge. Bandaging is useless, even 
 dangerous. Cramps may develop if its pressure is 
 too strong. A cure can be expected only by an oper- 
 ation. 
 
-36— 
 
 CHAPTER V 
 
 FUNCTIONS OF THE BODY OF THE CHILD. 
 
 CRYING OF THE CHILD— The first thing 
 which signalizes the arrival of the new-born into 
 this world is a vigorous crying. This disposition of 
 the baby to try its voice is not caused by hunger, as 
 some mothers ma}^ think, but is the effect of a num- 
 ber of unused-to irritations perceived by eyes, skin, 
 etc., to which the infant is so suddenly exposed. It 
 is a wise arrangement of Nature. A quicker and more 
 complete unfolding and development of the lungs 
 could in no other way be accomplished. Crying is, 
 therefore, not an unwelcome but a welcome event. 
 If it does not come spontaneously, it is generally in- 
 duced by physicians and midwives deliberately by 
 subjecting the child to different kinds of irritation of 
 the skin, mostlv bv a gentle slapping of its seat. 
 
 COUGHING AND SNEEZING— These occur 
 sometimes, caused by small particles of slime which 
 happen to find their way into the nose or throat of 
 the child during its passage through the parts of the 
 mother. 
 
 The MUSCULAR MOVEMENTS of a healthy 
 new-born babe are vigorous and in jerks. They 
 are induced by the same unused-to irritations of 
 the skin that cause the first crying, and should not 
 be restricted by too tight clothing. It is perfectly 
 proper that opportunity be granted to the little one 
 to make a full and free use of its muscles. 
 
 The EYES are opened only for a short while 
 at the beginning. Even the dim light of a half dark- 
 ened room is too strong an irritant for the delicate 
 eyes of the baby. It takes time to get accustomed to 
 the daylight. 
 
 With some children the eyelids are swollen 
 
—37— 
 
 slightly at first. Their movements are thereby inter- 
 fered with. It need not cause any anxiety, since the 
 trouble will soon disappear spontaneously. 
 
 The POSITION OF THE LEGS is habitually 
 the same after birth as it was before, that is, the 
 knees are drawn up and the feet turned inward with 
 the soles towards each other. This abnormal position 
 of the legs will correct itself in time. 
 
 Some new-born get HICCOUGHS after birth. 
 They are the same as with adults and last from ten 
 to fifteen minutes. Directly after drinking is the time 
 they occur. Significance need not be attached to 
 them. 
 
 The first EVACUATION OF THE BOWELS 
 occurs soon after birth. The excrements are tarlike, 
 black, sticky, but without smell. They are called 
 "meconium." The quantity is considerable. This 
 appearance and quality of the stools continue up to 
 the third day when they assume the gold-yellow 
 color, usual with healthy babies. 
 
 The number of evacuations is from five to six 
 in the first few days of life, until the meconium has 
 been discharged, and a regular digestion been estab- 
 lished. Then it is reduced gradually. We find, there- 
 fore, with healthy nurslings generally only two to 
 three passages a day up to the sixth month of life 
 and only one or two from that time to the end of the 
 second year. 
 
 At this juncture we will not neglect to describe 
 a disease the principal symptom of which is the 
 appearance of blood in the stools. It is the so-called 
 ''Melaena, or Black Disease of the New-born,'' a rare 
 but dangerous illness. The treatment is simple. It 
 can and should be instituted by every mother at once 
 and will prove life-saving in most instances. It is, 
 of course, best to call a physician to the assistance 
 of the mother. 
 
—38— 
 
 BLACK DISEASE OF THE NEW-BORN. 
 
 There occur sometimes with new-born babies in 
 the first days of their lives hemorrhages from the 
 stomach and the bowels, manifested by the vomiting 
 of blood and bloody passages. The blood may be 
 bright or dark, it may be fluid or lumpy, depending 
 upon the length of time it was retarded in the in- 
 testinal canal. The quantity of blood varies also con- 
 siderably. In some instances it is so small that it can 
 hardly be noticed, consisting of only a few drops; 
 in other instances, however, it is so great that it 
 seems rather astonishing that such a little creature 
 can lose so much. 
 
 If the bleeding is small, the child recovers quick- 
 ly; but if it is copious and re-occurs often, the child 
 is lost, if help is delayed. 
 
 Treatment — Above all, the child should be kept 
 warm and perfectly quiet. It should not be bathed, 
 to avoid exertion, nor should it nurse. Cold, properly 
 prepared cow's milk must be fed (see ''Artificial Feed- 
 ing of Infants"). This for two reasons: First, the ef- 
 forts while sucking may start the bleeding anew; and 
 second, the laxative qualities of the mother's milk 
 (see "First Nursing of the Child") are, under such cir- 
 cumstances, dangerous. Not until the bleeding has 
 stopped for two or three days may mother's milk be 
 cautiously tried again. 
 
 A great number of remedies have been suggested 
 and new ones are steadily added to the list. They 
 are, however, all unreliable and should not be em- 
 ployed, except upon the recommendation of a phy- 
 sician. 
 
 The most reliable remedy, and at the same time 
 the only one which can safely and effectively be used 
 by the mother herself, is gelatine. On page ii we 
 have already spoken of it and have emphasized its 
 peculiar and remarkable quality of stopping a bleed- 
 
—39— 
 
 ing. For the manner of preparing, the mode of ad- 
 ministration and the dose, we refer the reader to the 
 page just mentioned. 
 
 The URINE is emptied for the first time soon 
 after birth. It has generally a light color. Ten to fif- 
 teen discharges a day are the average. There are 
 sometimes in the diaper, wetted by the urine, small 
 quantities of a reddish-yellow powder, consisting of 
 uric acid. They are of no significance and indicate 
 no trouble. 
 
 CHANGES IN THE SKIN AFTER BIRTH— 
 With nearly all children the skin begins to undergo 
 changes a few days after birth. The faint shade of 
 yellow, present at birth in most instances, becomes 
 more pronounced after the third day, turning into a 
 reddish-yellow color. Weak children and those born 
 too early show this change more distinctly than 
 healthy ones. 
 
 So long as the child feels well and is lively, 
 this change of color is of no consequence. The yel- 
 low tint disappears spontaneously after eight to four- 
 teen days without any further treatment. It suffices 
 to keep the child warm, to feed it properly and 
 to regulate its bowels. 
 
 If the change becomes so pronounced that the 
 skin looks like a lemon; that the white of the eyes is 
 tinted dark yellow, and that the urine assumes a 
 brownish-black color, the jaundice is developed be- 
 yond the normal limits. We must then con- 
 clude that a serious internal sickness exists, which 
 must be located and treated. 
 
 A peculiar phenomenon is the SWELLING OF 
 THE BREASTS OF THE NEW-BORN. It begins 
 about the third or fourth day, increases up to the 
 eighth or tenth day and gradually disappears. Most 
 children are thus affected, boys and girls alike. The 
 degree of the swelling is, of course, varying. In some 
 instances the swelling is hardly visible, in others it 
 
is so large that the breasts are converted into com- 
 paratively big, hard lumps. On pressure there exudes 
 from the nipples a milk-like fluid. The sensitiveness 
 varies also. Some children do not seem to mind the 
 swelling at all; with others it is so painful that the 
 slightest pressure causes them to cry. 
 
 Special treatment is not necessary. It is ordi- 
 narily sufficient to protect the breasts against pres- 
 sure and to handle them gently. If the swelling is 
 large and the skin tight, a gentle application of warm 
 olive oil will relieve the tension. Rubbing and mas- 
 saging is not advisable. 
 
 In some rare instances the tissue of the breast 
 turns into matter. The resulting abscess must be 
 opened by a physician. 
 
 SLEEP OF THE CHILD— The sleep of the 
 new-born is nearly uninterrupted in the first weeks 
 of its life. It awakens only to nurse and the efforts, 
 while nursing, throw it back into the arms of the 
 sleep. Not until the end of the first month does the 
 child begin to keep awake for a few minutes. At the 
 end of the first quarter of the year, it is strong enough 
 to look around for two or three hours at a time. At 
 the end of the first year its desire for sleep has de- 
 creased to about sixteen hours. But still in the second 
 year the time spent in sleeping is longer than the 
 time spent awake. 
 
 The sleep is deep and quiet. A child can be car- 
 ried from one place to another without its slumber 
 being interrupted. Its position is characteristic. It 
 always lies on the back, elbows bent so that the 
 little fists reach up to the neck. 
 
 A deviation from this rule always points to sick- 
 ness. If the nursling does not promptly fall asleep 
 after nursing, if its sleep is restless, if it awakens at 
 unusual hours and is peevish, fretful, or cries, one 
 must take these symptoms as indications that some- 
 thing is wrong, even though no other signs of sick- 
 
—41— 
 
 ness may as yet be present. In most instances the 
 digestion is at fault. Either the quaHty or quantity 
 of food does not correspond to the needs of the baby 
 and should be remedied at once. The sooner this is 
 done, the better for the child (see "Insufficient or too 
 Great Quantity, or Faulty Composition of the Milk"). 
 
-42- 
 
 CHAPTER VI. 
 
 NURSING OF THE CHILD. 
 
 We will begin the nursing of the child with the 
 description of its domicile, "the nursery." Not all 
 parents live in such pecuniary circumstances that 
 they can afford to follow the advices here given in 
 every detail. Yet, we will describe the nursery as 
 it should be, without regard to the money involved. 
 Be it, however, expressly understood, that elegance 
 and luxury are not only immaterial but usually in- 
 jurious. Cleanliness is the principal thing. Those 
 in less easy circumstances may do what they can. 
 Many an improvement, which costs but little or noth- 
 ing, can also be made by them, if the good will is at 
 hand. 
 
 CHOICE OF THE ROOM— The largest and 
 most spacious room of the house is the best adapt- 
 ed to the nursery. It is none too good for the 
 rising youth. Narrow, dark, and stuffy rooms are 
 hot-beds of consumption, anemia, English disease and 
 innumerable other sicknesses. The location should, 
 if possible, be in one of the upper stories, where the 
 air is purer and freer from dust, and on the south or 
 southeast side of the building. It should be remote 
 from the kitchen. At least two large windows are 
 required, so arranged that both the lower and upper 
 sash can be opened. 
 
 LIGHT AND SUNSHINE should be admitted 
 freely. It is only in the first week after birth that 
 the room may be slightly darkened, to allow the 
 eyes of the new-born to gradually get accustomed 
 to the light. Against the direct sunshine the chil- 
 dren have to be protected. 
 
 WALLS — The walls should not be covered with 
 paper, but be tinted with lime or kalsomined, or, best. 
 
—43— 
 
 painted with oil. Many wall papers, especially the 
 green ones, contain strong poisons; they are dusty 
 and can only be cleaned imperfectly and with diffi- 
 culty. 
 
 The FLOOR should be made of hardwood 
 and should be free from cracks and crevices. It 
 should be oiled and varnished with a material which 
 hardens well and does not stick. If the floor is made 
 of softwood, it is best to cover it with linoleum or 
 paint it with an oil-color after all crevices have been 
 carefully filled. This is the only way which allows 
 it to be kept clean and in a hygienic condition. 
 
 Carpets are strictly forbidden. Nothing is more 
 dusty, dirty, unhealthful and unhygienic. A rug, 
 which can easily be taken up, cleaned and aired, is al- 
 lowable in the middle of the room. To be sure that 
 also from this no harm can come, it is best to keep it 
 covered with a clean bedsheet. In this way it is 
 impossible for dust to rise, or for the rug to be infect- 
 ed by the child while coughing, sneezing, etc., 
 should this latter happen to be sick. The rug will 
 thus afford an excellent cushion, on which the child 
 may play without being exposed to the danger of sub- 
 sequent infection. 
 
 The FURNITURE should be simple, so that it 
 may easily be cleaned and disinfected. The smaller 
 the number of pieces, the better for the child. All or- 
 naments, carvings, etc., which catch and harbor dust 
 and are difficult to clean, should be avoided. Plain 
 goods are preferable. Upholstered furniture is prohib- 
 ited unless the pieces are few and are covered with 
 smooth and washable leather. The best, most ap- 
 proved and hygienic furniture is that made of 
 enameled iron. It is quickly and easily cleaned and 
 withstands disinfectants. 
 
 TOYS — Care should be taken that toys are not 
 painted with dangerous colors, and that they are 
 not made of lead. It is impossible to prevent chil- 
 
-44- 
 
 dren from putting them into their mouths and from 
 poisoning themselves, if the opportunity is present. 
 
 The most important furniture of the nursery is 
 the BED OF THE BABY. Under no circumstances 
 should the nursling be allowed to sleep in the bed of 
 the mother. A separate crib must be provided for. 
 It has happened very often that babies were found 
 dead in the morning, suffocated or crushed by their 
 own unfortunate mothers. 
 
 ^^^f 
 
 ' -.-#■ 
 
 
 f- 
 
 -«mm^fr:i| 
 
 
 
 ^ ''^" M 
 
 
 
 
 
 _.,^^ 
 
 
 Figure 7. Baby crib, according to Holt. 
 
 The best sleeping place for the infant is an iron, 
 white enameled, stable, latticed bedstead as shown in 
 Fig. 7. The lattice must be so high that the child, 
 when growing older, cannot fall out, should it erect 
 itself after awakening. Rockers, such as were in gen- 
 eral use in former years and are still in use today with 
 the poor and ignorant classes of our immigrants, are 
 objectionable. Rocking, indeed, quiets the baby, but 
 
—45— 
 
 at the same time unfortunately conceals the cause of 
 its restlessness. We say ''unfortunately" because chil- 
 dren never cry without a reason. This should not 
 be hushed over but should be removed. If this is 
 done, the little creature will soon be in peaceful 
 slumber without the rocking- of its bed. 
 
 The best base is a horse-hair mattress. Over 
 this comes a piece of oil cloth, over this a flannel cloth, 
 and the whole is covered with a bed sheet. 
 
 The covering of the bed should be very warm 
 in the beginning, since new-born babies are very sen- 
 sitive to low temperatures. A feather bed serves the 
 purpose best. Later, in the second half of the first 
 year, especially in the warmer season, the feather 
 bed should be withdrawn and woolen blankets sub- 
 stituted. 
 
 PLAYGROUND — It is unwise and impossible 
 to keep the baby continually on the arm or on the 
 lap when the time has arrived that it desires to take 
 its first lessons in standing and walking. Then it is 
 necessary to provide a place where it can creep, tum- 
 ble and toss about according to its own fancy. 
 
 The place best adapted for the purpose is the bed 
 sheet-covered rug in the middle of the room. It is not 
 permissible to allow children to roll around on dirty 
 floors over which relatives and attendants walk with 
 dirty shoes. We all know that babies at this tender 
 age do not as yet consider the consequences of filthy 
 habits. The little fist which is now busy in mopping 
 the floor, is a minute later delightfully sucked and 
 cleaned with lips and tongue. If no precautions have 
 been taken, can we wonder if disease germs of all 
 descriptions, such as the microbes of consumption, 
 scrofula, and other filth diseases, infect the baby? 
 
 In order to limit the child to its hygienic play- 
 ground, it is necessary to prevent it from crawling or 
 stepping over the edges of the rug. In Fig. 8 we 
 see a fence, constructed for this purpose. The same 
 
contrivance, improvised with chairs and boards, is 
 considerably cheaper and serves the purpose fully as 
 well. A further advantage of this device is the splen- 
 did support and hold it affords the baby in its un- 
 tiring attempts at standing and walking. 
 
 The TEMPERATURE OF THE AIR should be 
 about 66 degrees Eahrenheit. It must be measured 
 with a thermometer. No nursery is complete without 
 this instrument. 
 
 HUMIDITY OF THE AIR— A proper amount 
 of humidity in the air is of the highest importance to 
 the welfare of human beings. In summer Nature her- 
 
 Figure 8. Fence around the playground. 
 
 self makes the necessary provisions. In winter, how- 
 ever, in houses heated artificially, the necessary in- 
 crease in humidity is generally neglected. The air re- 
 mains too dry. This is injurious to our respiratory 
 organs and favors catarrh of the bronchial tubes and 
 inflammation of the lungs. The dryness of the air 
 extracts the moisture from the bronchial secretions 
 and makes them tenacious and sticky. It thus takes 
 more effort to expectorate and as a consequence the 
 cough becomes violent and hacking. A great many 
 of the catarrhs and colds, which are so frequently met 
 
—47— 
 
 with in winter, are precipitated by this cause as well 
 as aggravated and delayed in healing. 
 
 There are instruments to measure the humidity 
 of the air. They are called ''Hygrometers" (Fig. 9). 
 
 Figure. 9. Hygrometer. 
 
 Every druggist can procure one. For the benefit of 
 those who possess or are going to possess such an 
 instrument, it may be said that the proper amount 
 of humidity is about 60 per cent. 
 
 HEATING — The best heating apparatus is an 
 open fireplace or a stove. Both, if used, should be 
 encased, that no accident can happen. 
 
 Less favorable is the heating of the room with 
 hot water and steam radiators. The reason is 
 this: Fireplaces and stoves are splendid ventila- 
 tors. They constantly draw bad air out of the room, 
 which is supplanted by fresh air coming from outside. 
 Hot water and steam radiators warm up the air 
 without promoting an exchange. A dead and op- 
 pressive atmosphere is, therefore, found in most 
 buildings heated by radiators. 
 
 VENTILATION— No nursery is healthful with- 
 
" —48— . 
 
 out a good and perfect ventilation. When the child 
 is out of the room, all windows should be 
 opened as wide as possible in warm weather. In 
 summer time the upp^er sashes may be lowered when 
 the child is in the room, day and night. In the winter, 
 however, the little one must be removed until the 
 aeration is completed and the temperature of the air 
 is raised again to 66 degrees Fahrenheit. 
 
 If the nursery is heated by a fireplace or stove, 
 ventilation will be sufficient if the windows are 
 opened for a short while several times a day. If the 
 room is warmed with hot water or steam radiators, 
 efficient ventilation can not be obtained except by 
 special ventilating shafts built during the construc- 
 tion of the house. They are found in most newer 
 buildings. 
 
 From the above it may be learned that it is 
 much more healthful to heat the house by fireplaces 
 or stoves than by a hot water or steam plant. The 
 temperature, however, produced by the latter is more 
 even and steadv. 
 
 The CLEANING of the nursery should be done 
 in a proper manner. All brushing, sweeping and dust- 
 ing with brooms, dusters and dry cloths is forbidden. 
 Thus the dust is raised and disease germs, if they 
 are present, distributed over the entire room. The 
 cleaning is properly done with damp cloths. The 
 dust adheres to them and can be removed effectively. 
 This method should be followed, especially in clean- 
 ing floors. 
 
 Soiled diapers have to be removed from the nur- 
 sery immediately. It is a filthy habit to throw dirty 
 napkins in some corner, where they lie until their 
 smell offends the nose. Night vessels must also be 
 removed immediately and cleaned. 
 
 In order to facilitate the cleanliness in the nur- 
 sery and protect the child from infection coming 
 from outside, it is well to watch carefully that no 
 
street dirt is carried into the room on shoes and 
 dresses. If one considers what this street dirt is 
 composed of, that it consists of kitchen refuse, excre- 
 ments of men and beasts, expectorations of consump- 
 tives, discharges of people who are suffering from 
 diseases of nose, mouth, etc., the importance of the 
 advice will easilv be understood. 
 
 DANGER FROM INSECTS— Space does not 
 permit discussion of this highly interesting and emin- 
 ently practical point at such length as would do it 
 justice. It must suffice to have attention drawn to it. 
 
 Day by day our knowledge is increasing as to the 
 surprising role the insects, especially flies and mos- 
 quitoes, play in the transmission of diseases. The 
 spread of scourges such as scarlet fever, measles, 
 diphtheria, typhoid fever, influenza, etc., have in many 
 instances been traced with certainty to the mediation 
 of flies; malaria, the yellow fever, and others, to the 
 mediation of mosquitoes. The mode of transmission 
 is different. Mosquitoes transfer the poison with 
 their sting. Flies carry it from place to place, either 
 having the disease germs clinging to the wings, body 
 and feet, or depositing them with their excrements. 
 These little mischief bringers are, therefore, not as in- 
 nocent as they look to be. Where it smells, yes, 
 where it stinks, there they go. Bad odors attract them. 
 Loaded with deadly material, be it from a nearby sick- 
 room or an adjacent toilet, they return and by stroll- 
 ing about and lighting either on a piece of bread or 
 sugar or on a cup of milk or on the baby's face and 
 hands, clothing, toys, bedclothes, etc., distribute the 
 disease germs. 
 
 From this we can see that no child is safe from 
 infection if flies are allowed to enter the nursery 
 where catching disease prevail in the neighborhood, 
 or open closets and pits offer opportunity for these 
 pestiferous insects to be infected. It is well to re- 
 member this mode of transmission, if the origin of a 
 case of infectious disease is difficult to explain. 
 
—50— 
 
 CHAPTER VII 
 
 CARE OF THE SKIN. 
 
 A well functionating skin is essential to the well- 
 being and comfort of the individual. Neglect in its 
 care leads to discomfort and sickness. 
 
 BATHS — To promote the healthful function of 
 the skin of the baby, baths must be given. In the 
 first weeks after birth, so long as the stump of the 
 navel-string remains on the child, the bathing should 
 be done on the lap of the attendant (see page 4). 
 Later, after the navel is healed, the nursling should 
 be put into the water. 
 
 Let bathing be daily in the first year, every sec- 
 ond day in the second 3^ear. The best time is in the 
 forenoon, always before meals, never with a full 
 
 Figure 10. Bath Thermometer. 
 
 stomach. The temperature of the water should be 
 98 degrees Fahrenheit for the first two weeks, 95 de- 
 gree for the rest of the first year, and 90 degrees after- 
 wards. With weak children the temperature is best 
 taken a little higher. The water is to be measured 
 with a bath thermometer, such as shown in Fig. 10. It 
 can be bought at any drug store and costs 25 cents. 
 
 The bath should be given in a warm room, in 
 the first weeks near a warm stove. Its duration ought 
 not to exceed ten minutes. While bathing the baby, 
 the mother supports its neck and head with the left 
 hand so that the head is kept above the surface of 
 bath water and its eyes can at no time come in con- 
 tact with it (see page 19). The procedure is 
 
—51^ 
 
 as follows : First wash the face and pay special at- 
 tention to the cleaning of nose and ears. For the eyes 
 use an extra dish with clean, absorbent cotton and 
 freshly boiled water. AVhen the face is clean and 
 dried with a soft towel, soap the head, wash and dry. 
 Then clean the body, taking one part after another. 
 Pay special attention to the cleaning of armpits, 
 groins, the bend of the knees, opening of the bowels 
 and genitals. Retract foreskin, if possible, and clean 
 under it. 
 
 When the bath is finished, everything must be 
 clean and dry. 
 
 All bath utensils, such as sponges, cloths, rags, 
 etc., should be used for the child alone, and be thor- 
 oughly boiled twice a week in a solution of washing 
 soda, one heaping teaspoonful to a quart of water. 
 The mother must have her own utensils, lest she 
 runs the risk of transferring disease from her own 
 body to that of the child (see pages 4 and 19). For 
 those who can afford it, it may be said that clean, 
 absorbent cotton is preferable to all sponges, cloths, 
 rags, etc. It is thrown away after every bath. The 
 use of cotton is more expensive, but safer for the 
 child and less troublesome for the mother. 
 
 The soap employed should be non-irritant. A 
 good grade of castile soap answers the purpose. 
 
 After the bath the child is quickly dried and 
 clothed. 
 
 CARE OF THOSE PLACES OF THE SKIN 
 THAT ARE PREDISPOSED TO SICKNESS— 
 To these places belong principally the skin in the 
 fold of the seat and that between the thighs. The 
 predisposing cause is the macerating effect of the 
 moisture retained in these creases and the frequent 
 contact of the skin with the excretions of the body. 
 
 The way these two factors predispose to sickness 
 can easily be understood from the following: The 
 soreness and the inflammation of the parts men- 
 
—52— 
 
 tioned, from which so many babies suffer, is invariab- 
 ly caused by the invasion of microbes into the skin. 
 Different kinds are at w^ork in different cases, but the 
 two, pictured below, are chiefly responsible. The 
 one is the chain coccus (Fig. ii), and the other is the 
 
 Figure 11. Chain coccus. 
 
 Figure 12. Grape coccus. 
 
 grape coccus (Fig. 12). They are named because of 
 their grouping together in these specific forms. 
 
— S3— 
 
 Under normal conditions microbes have no 
 chance to penetrate. The outer part of our skin is 
 formed by a tough, horny layer (Fig. 13 b), which 
 protects the lower and tender layers (Fig. 12 a) 
 against the invasion of disease germs. If, by the action 
 of excrements, urine and sweat, this protecting layer 
 is softened and macerated, or if it is injured by me- 
 chanical insults, such as rubbing with coarse sponges, 
 cloths, etc., the microbes gain entrance into the lower 
 layers and inflame the skin. The consequences are 
 reddening, swelling and soreness. 
 
 In order to avoid this outcome it is necessary to 
 clean with warm water and to dry the places in ques- 
 tion immediately after being soiled with the dis- 
 charges from the bowels or the bladder, since these 
 discharges are very irritating and are swarming with 
 
 Figure 13. Section of the skin as seen under microscope, (a) lower, 
 tender layers, (b) outer, horny layer. 
 
 microbes. Absorbent cotton for wiping is here of 
 special advantage (see page 51). The use of sponges 
 and rags is forbidden and nothing but cotton allowed 
 for cleaning, wherever the skin is reddened and in- 
 flamed, for the former are too rough and cannot, un- 
 der such circumstances, be kept in a satisfactory, 
 clean condition. 
 
 Not only cleanliness as to the wiping material, 
 but also as to everything else which comes in contact 
 with the baby, is essential. The water for the bath 
 must be freshly boiled, the hands of the attendant be 
 clean and the bath tub be scalded at least once a week 
 with bofling water or, better, disinfected with a solu- 
 tion of Rhenolin (see Prescription 2), two to three 
 teaspoonfuls to a quart of hot water. 
 
 Next to cleanliness comes gentleness of the 
 
—54— 
 
 treatment. The gentler the skin is handled, the 
 better it will preserve and withstand the attacking 
 microbes. In drying these places it is, therefore, ad- 
 visable to absorb the moisture by patting, and not by 
 rubbing, with the drying material, be it absorbent cot- 
 ton or a soft, pliable towel. 
 
 When the cleaning and drying is finished, the 
 parts must be powdered. Care should be exercised as 
 to the kind of dusting powder used. As long as the 
 skin is normal, the ordinary Borated Talcum Powder 
 will, in most instances, suffice (Prescription 22). 
 
 Prescription 22. 
 Borated Purified Talc 2 ounces 
 
 Better is a mixture of Zinc Oxide, Lycopodium 
 and Talcum, equal parts (Prescription 23). 
 
 Prescription 23. 
 
 Zinc Oxide 
 Lycopodium 
 Purified Talc, each 2-3 ounce 
 
 Corn starch is also frequently used for dusting. 
 It is, however, inferior to the above mentioned prep- 
 arations, because it lumps quickly, and its drying 
 quality is insufficient. 
 
 All of the above mentioned preparations do not 
 suffice if the skin has been infected, that is, if it is 
 red, tender and sore. Then the following powder had 
 better be chosen (Prescription 24). 
 
 Prescription 24. 
 
 Zinc Dioxide 3 drachms 
 
 Purified Talc 1% ounces 
 
 This powder is strongly antiseptic and is well 
 adapted for removing the poison from the skin. 
 
 There are cases in which no powder is able to 
 fill the bill, in spite of conscientious treatment. A 
 protecting layer of a fatty substance seems to be what 
 is wanted. Vaseline is frequently used, but seldom 
 effective, in many instances aggravating the condi- 
 
—55— 
 
 tion. Under such circumstances the following com- 
 bination will prove to give excellent satisfaction. 
 
 Prescription 25. 
 Zinc Oxide 
 
 Corn Starch, each 4 drachms 
 
 Paraffin 
 
 Hydrous Wool-Fat, each 3% drachms 
 
 The best soap is sometimes irritating if sore 
 places have devloped. Even plain water may make 
 the condition worse, should the skin of the baby be 
 very tender. Under such circumstances, it is best to lay 
 the soap aside entirely and bathe the child in oat- 
 meal water, prepared in the following manner: One 
 to two pounds of oatmeal, bagged in cloth, are 
 soaked in hot water for one-half to three-quarters of 
 an hour, then the oatmeal is removed and enough 
 water added to bathe the baby. 
 
 Large, reddened, and sore places, as they are 
 most frequently found with weak and emaciated 
 babies, always bear witness to the fact that either 
 the care of the child has been very much neglected or 
 the excretions from the bowels or the bladder con- 
 tain abnormally acrid and corrosive substances, 
 which do not allow the healing to advance. In the 
 latter instance.it is necessary to first set aside the 
 cause — the disease of the bowels or bladder — before 
 the effect, that is, the soreness, can be removed. 
 
 The HEAD of the baby is also a place where 
 diseases readily develop, if its care is neglected. 
 
 The secretion of a greasy substance is abundant 
 in all places covered with hair. So especially on the 
 head. This leads, in many cases, to the formation 
 of scales and crusts on this spot. They should always 
 be carefully removed. But, as in many other in- 
 stances in which superstition interferes with health, 
 so also in this. The removal of the dirt is by some 
 persons considered dangerous. Old nursery tales 
 tell that the affliction will go down to the eyes, if 
 driven away from the head, and imprudent mothers 
 
—56— 
 
 and attendants believe it. While cleaning the baby 
 they anxiously avoid the places where the filth-dis- 
 ease is established, believing that they are doing good 
 work for the helpless infant. Nothing, of course, is 
 more absurd and preposterous. The places covered 
 with scales or crusts not may, but must, be treated 
 or the health of the child will suffer. 
 
 In slight cases, so long as the formation of scales 
 and crusts is still limited and the skin itself is not yet 
 affected, it suffices to soak the scalp in the evening 
 with olive oil, cover it with a piece of oil-silk or gutta- 
 percha paper, fasten this with a hood and allow to 
 soften over night. A gentle wash with soap and 
 warm water in the morning will remove the dirt and 
 clean the scalp. 
 
 If, however, the secretions have irritated the skin 
 and led to eczema, the use of soap and water is no 
 longer allowed, as soap is now harmful. One can 
 easily recognize the development of this disease by 
 inspecting the skin. If, under the crusts, this looks 
 reddish and inflamed and sends forth a thin, watery 
 fluid, eczema is in existence. In neglected cases the 
 formation of crusts gradually becomes more plentiful 
 and sometimes so abundant that the entire head is 
 covered with a bark-like, adherent layer, consisting of 
 hair, grease and dirt. 
 
 The further the sickness has progressed, the more 
 tedious and difficult is the treatment. The first step 
 is to clear the field for action. To this end proceed as 
 follows: Dip a cloth, large enough to cover all parts 
 afflicted, in olive oil or salad oil, apply to the head, 
 cover with oil-cloth, oil-silk or guttapercha paper, and 
 fasten with a hood. Two to four applications, made 
 in one or two days, are required to remove the crusts. 
 When this is done, clip the hair as short as possible 
 and keep it so until healing is completed, the purpose 
 being to prevent the retention of secretions in bundles 
 of entangled hair. 
 
Now the treatment proper can begin. It is to 
 no purpose to do this sooner, since no medicine can 
 work until it can be brought in direct contact with 
 the diseased skin. 
 
 In order to avoid a failure the remedy must be 
 applied under a bandage similar to the one required 
 for the removal of the crusts. The only difference is 
 that instead of the olive oil a thick layer of one of 
 the following ointments is taken (Prescriptions 26, 27 
 and 28). 
 
 The dressing should be renewed twice a day, in 
 the morning and at night. It is important that the oint- 
 ment be applied thickly, so that, so to speak, the in- 
 flamed skin is bathed in it. In no other but in this 
 manner the formation of new crusts and a relapse in- 
 to the old condition can be prevented. 
 
 The best remedy is Tolutin (Prescription 26). 
 
 Prescrption 26. 
 
 Tolutin 2 ounces 
 
 Next comes a lo per cent ointment of Ichthyol 
 (Prescription 2y). 
 
 Prescription 27. 
 
 Ichthyol . . . : 2 drachms 
 
 Hydrous Wocl-Fat 
 
 Petrolatum, each 1 ounce 
 
 Third is the following ointment (Prescription 
 
 28). 
 
 Prescription 28. 
 Diachylon Ointment 2 ounces 
 
 The third salve is sometimes more effective than 
 the second, but contains lead and its use should 
 not be continued too long. 
 
 Tolutin should .alw^ays be tried first. If it can 
 not be obtained or, as it rarely happens, if it refuses to 
 give satisfaction, one of the others may be em- 
 ployed. 
 
 The treatment must be continued until the last 
 
—58— 
 
 vestige of the disease has disappeared and the skin 
 has again assumed its natural color and appearance. 
 The affliction will surely return if the treatment is 
 stopped too early. 
 
 The skin will itch and by scratching the disease 
 may be carried on the fingers from one place to an- 
 other. It often descends to the face by creeping 
 down from the forehead. The same ointments will 
 also suffice in this emergency. No bandage is re- 
 quired for the face. Simple applications of the oint- 
 ment, after the crusts have been removed, will prove 
 sufficient in ordinary cases. Should the disease re- 
 main unyielding, the same dressing as on the head 
 may be applied but must be provided with holes for 
 the eyes, nose and mouth. 
 
 Children afflicted with the above described ail- 
 ment are generally of low vitality and suffer from 
 scrofula, anemia, English disease or other debilit- 
 ating constitutional troubles. These must be treated 
 at the same time in order to advance the cure as 
 quickly as possible. For more detailed instructions 
 we refer to the chapters at the end of this book. 
 
—59- 
 
 CHAPTER VIII 
 
 THE CARE OF THE MOUTH. 
 
 The care of the mouth should begin at the earli- 
 est days of life. In former times it was advocated by 
 most physicians to clean the mouth of the baby after 
 every meal. This practice has been abandoned. The 
 mucous membrane of the mouth is too tender at this 
 age to stand the somewhat rough procedure without 
 injurious results. It is entirely sufficient, accord- 
 ing to the newest investigations, to give the baby 
 after feeding a teaspoonful or two of freshly boiled 
 water in order to wash down the remnants of the 
 milk. 
 
 Far more injurious than these small particles of 
 food are the filthy objects, such as dirty fingers, dirty 
 bread, dirty fruit, etc., which the child busies itself in 
 putting into its mouth at every occasion, or which are 
 given by the mother or nurse as pacifiers. These are 
 dangerous, very dangerous, and have caused the 
 death of many an infant. We caution against them 
 in the most emphatic manner. 
 
 The child, we admit, requires something to bite, 
 on, especially at the time of teething. To satisfy its 
 wants, a teething ring may be employed, made of 
 ivory and fastened on a ribbon. This, if hung around 
 the neck, will prevent the instrument from falling to 
 the floor and being soiled. Rings made of soft rub- 
 ber are to be rejected. They do not fulfill the purpose 
 and cannot be kept clean. 
 
 PACIFIERS — At this juncture we cannot help 
 saying a few words about the much condemned and 
 yet so frequently used pacifiers. 
 
 A clean, unperforated, well cared for nipple 
 would do but little harm. But this is not what is 
 
—60— 
 
 generally used by the masses of the people. The old, 
 worn-out rubber that is no longer fit for the bottle 
 seems always just the thing to pacify. And how 
 about its cleanliness? While the nipple used for the 
 nursing bottle is generally kept in a fairly decent 
 condition, the attendants, in most instances, seem to 
 have forgotten every principle of hygiene as to the 
 pacifiers. If the baby gets restless or begins to cry, 
 the pacifier goes quickly into the mouth. The baby 
 sucks a few times, swallows the air and, dissatisfied 
 with the poor treat, spits the pacifier out. It rolls 
 about on the floor. The child again begins to cry. 
 The mother, in her despair, picks up .the sacred peace- 
 maker and returns it hurriedly into the mouth of her 
 darling, sometimes even taking the precaution to 
 clean it on her clothes. The same play! After suck- 
 ing for a time, the child drops it or spits it out again. 
 Again it rolls to the floor, again it is picked up and 
 placed into the mouth of the infant, etc. 
 
 It seems impossible that such a story could be 
 true. But it is. A score of times it has been wit- 
 nessed by the horrified author of this book in families 
 of ignorant people or in instances where babies were 
 left to the care of irresponsible servants. 
 
 In cases in which little linen bags containing 
 flour, bread dough, etc., are being employed as paci- 
 fiers, matters are still worse. They also fly about 
 the floor or, if not in use, are laid aside on any box 
 or piece of furniture, to be picked up and used 
 again, if needed. It does not matter if the material 
 enclosed in the bag begins to rot and decompose; it 
 does not matter if it is covered with dirt and filth, or 
 if flies, attracted by the odor, have used it as their 
 dumping ground. The ignorant mother, nurse or ser- 
 vant does not know or care to know that the contents 
 of the pacifier, by the action of countless microbes, 
 have been turned into veritable poison. The child is 
 
—61— 
 
 pacified! That's what she wants. What comes later 
 is not thought of. 
 
 Is there any wonder that, under such circumstan- 
 ces, a multitude of mouth, stomach, and bowel diseases 
 follow? Certainly not! Therefore, away with all 
 pacifiers! Get rid of them! They are not necessary 
 in any case, but harmful in many. The quicker they 
 disappear, the better for humanity. If the child is rest- 
 less or cries, inquire into the cause of the disturbance 
 and remove it. That is better, much better, than to 
 pacify. It is the only proper thing to do. 
 
 Figure 14. Pacifier. 
 
 Figure 15. Pacifier with ivory ring. 
 
 If, however, in spite of all admonition, a mother 
 thinks that she, as a baby, had a pacifier and that her 
 baby shall have it also, let her select a pacifier as 
 shown in Figs. 14 or 15, with an unperforated mouth- 
 piece and fastened on a ribbon. If this is sucked, it will 
 not fill the baby's mouth with air; if this is spit out, 
 it will not roll to the floor and get dirty. If at the 
 same time proper care is taken that the pacifier is 
 frequently changed and sterilized in boiling water, we 
 may accept with resignation what seems impossible 
 to change. 
 
—62- 
 
 THRUSH. 
 
 Thrush is a mouth disease in babies, which is 
 well known to nearly every mother. It occurs prin- 
 cipally in infants that are born with low vitality or 
 have been reduced in their vital forces by long con- 
 tinued ailments, such as stomach and bowel diseases, 
 English disease, etc. It is rarely met with in older 
 children. 
 
 The disease is caused by a fungus, which grows 
 in long threads. It is represented in Fig. i6 as seen 
 under a powerful microscope. If this fungus comes 
 into the mouth of weak children, be it with dirty 
 
 Figure 16. Fungus which is cause of thrush. 
 
 fingers or dirty objects such as pacifiers or with un- 
 clean food, it settles, grows and multiplies. 
 
 If this has happened, the mucous membrane at 
 once begins to undergo characteristic changes. It 
 becomes dry, sticky, and a little darker than normal. 
 Tiny, white spots appear on the tongue, the inner sur- 
 face of the cheeks, the gums and in the throat in smal- 
 ler or greater numbers, which adhere tightly to the 
 underlying tissue. If removed by force, they leave a 
 sore and bleeding surface. These spots represent 
 colonies of the above described parasites. Enlarging 
 in size and increasing in number they gradually 
 spread and, in neglected cases, cover the mucous 
 
—63— 
 
 membrane of the mouth in a more or less continuous 
 layer, as the grass covers the ground. 
 
 A few, isolated spots make no annoyance. They 
 are often found accidentally by the mother. If the 
 mouth is affected to a large extent, the mucous mem- 
 brane becomes painful, the baby cries much, is rest- 
 less, its sleep is disturbed, it takes its food with 
 reluctance and suffers sometimes with slight fever. 
 
 Treatment — Breastfed children should drink 
 through a nipple shield (Fig. 17) as soon as the 
 thrush has been detected. This precaution is taken 
 for the protection of the mother or wet nurse, since 
 the breast, under such circumstances, is exposed to 
 the danger of being infected by the baby and of be- 
 coming sore and inflamed (see "Inflammation of the 
 Breast'O- 
 
 Figure 17. Nipple shield. 
 
 Food which contains flour and is very sweet is 
 injurious, since the growth of the parasite is thereby 
 facilitated. Otherwise the kind of food is dictated 
 by the condition of the stomach and the bowels with- 
 out reference to the mouth disease. 
 
 Borax is the remedy most employed by both 
 physicians and mothers. It is a good and effective 
 medicine. It should, however, not be dissolved in 
 honey as is generally done, but in water and glycer- 
 in, since honey favors the growth of the fungus. The 
 proportions are: One to two heaping teaspoonfuls of 
 Borax to two ounces of water and one ounce of gly- 
 cerin (Prescription 29). 
 
Prescription 29. 
 
 Sodium Borate % ounce 
 
 Glycerine 1 ounce 
 
 TVater 2 ounces 
 
 With this remedy or with the following solution 
 (Prescription 30), the mouth of the child should be 
 
 Prescription 30. 
 
 Potassium Permanganate 2 ^ains 
 
 Distilled Water 1-3 ounce 
 
 washed several times a day, especially after every 
 meal. The washing is done with a pad of absorbent 
 cotton, tied around the end of a little, smooth stick, 
 and saturated with the medicine. 
 
 In addition to this the white spots should be 
 touched once or twice a day with the following solu- 
 tion in Prescription 31, or with the milder but not 
 quite as effective remedy in Prescription 32. 
 
 Prescription 31. 
 
 Tincture of Iodine % drachm 
 
 Glycerin Z^ drachms 
 
 Prescription 32. 
 
 Sodium Borate 45 grains 
 
 Glycerin 1-3 ounce 
 
 These two remedies are best, but also the follow- 
 ing are used (Prescriptions 33 to 35). 
 
 Prescription 33. 
 
 Silver Nitrate 5 grains 
 
 Distilled Water 1-3 ounce 
 
 Prescription 34. 
 
 Protargol 10 grains 
 
 Distilled Water 1-3 ounce 
 
 Prescription 35. 
 
 Solution of Hydrogen Dioxide 1-3 ounce 
 
 Distilled Water 2-3 ounce 
 
 If these instructions are followed, the white spots 
 will disappear in a very short time. 
 
-65- 
 
 CHAPTER IX. 
 
 QUIET LIFE FOR BABIES. 
 
 The nervous system of new-born children is as 
 yet very weak and sensitive to even slight irritation. 
 They should, therefore, be treated with the greatest 
 gentleness. iVll sudden and violent movements, 
 frightening and rough handling, either in joy or in 
 anger, are forbidden. Even the noise and bustle of 
 other older children in the presence of the new-born is 
 to be avoided as much as possible. Also the carry- 
 ing around of the little creature to relatives and 
 friends, in order to make a show, and the kissing and 
 fondling of it by anybody and everybody, who hap- 
 pens to visit, can bring nothing but detriment. Not 
 only is the rest disturbed thereby, but the child is also 
 exposed to infection with different kinds of sickness, 
 should one of the visitors happen to be suffering from 
 a cold, inflammation of the throat or any other com- 
 municable disease. 
 
 It is, therefore, best to ahow the nursling to re- 
 main quiet at home with its mother or nurse. We 
 say quiet. By this is meant that also at home the 
 baby should have its rest and not be handled and 
 carried all day on the arm of the attendant. Nor 
 should it sleep except in its cradle. Soon, very soon, 
 the infant learns what it can demand and what it can 
 force. If the parents do not show in time that they 
 are the masters, they will soon be compelled by piti- 
 ful crying to accede to the wishes of their offspring 
 and dance to its piping (see ''Crying of Children"). 
 
 This danger of submission to the beloved darling 
 is still more to be feared in times of sickness. But 
 let us sound a note of warning. It is just at such 
 times that the wisdom of the parents will be brought 
 to a test. They should neither dope aAvay and hush 
 
—66— 
 
 over the pains of the child imprudently and carelessly 
 with soothing syrups, pacifiers, etc., nor allow it to 
 become the tyrant of the house. Not what the child 
 wants but what is best for its recovery should be 
 done. 
 
 SLEEP AT NIGHT. 
 
 The mother should begin immediately after birth 
 to regulate the sleep of the child at night-time. It 
 is astonishing how easy it is, on the one hand, to teach 
 even new-born babies that no nourishment will be 
 given between lo or ii p. m. and 5 a. m., or, on the 
 other hand, to spoil infants, if they learn that by crying 
 they can force the mother to give either breast or 
 bottle. 
 
 The interest of both mother and child requires 
 that the rest at night be not disturbed. If the crying 
 cannot be avoided, it is better, therefore, to endure it 
 for a few nights and get the child broken than to 
 allow bad habits to be established and to lay a founda- 
 tion for years of broken rest at night. 
 
 REGULARITY IN THE TAKING OF NOURISHMENT. 
 
 We need not here enter at length upon this sub- 
 ject, since it will be gone into more fully in the chap- 
 ter on "Feeding." Be it here only emphasized that as 
 with adults so also with children, big and little, they 
 must be educated to the necessity of regularity at 
 meals. When it is time, they should have their 
 nourishment, not otherwise. Neither by crying nor 
 by begging should the parents be induced to yield to 
 the demands of their child at improper times. 
 Much sorrow and chagrin will be saved for father 
 and mother, much pain and suffering for the babv. 
 
 REGULARITY AS TO THE SECRETIONS OF THE BODY (STOOL 
 AND URINE): EDUCATION TO CLEANLINESS. 
 
 After the sixth month, one can begin to teach the 
 new-born to become regular with the discharge of its 
 excretions, that is, of stool and urine. To this end 
 
—67— 
 
 the baby should be held over a vessel, in the beginning 
 each time after awakening, before the bath and be- 
 fore going to sleep, and later at regular intervals, at 
 always exactly the same time. Sounds imitating the 
 noises while discharging, such as ws, ws, ws, ws, ws, 
 greatly facilitate the child's understanding of what is 
 wanted. Very soon it grasps the idea of what is 
 desired and gets used to discharging regularly. 
 
 When the child reaches the age at which it be- 
 gins to reason, it should be guided to empty the 
 bladder four times and the bowels twice a day, the 
 latter best in the morning after breakfast and in the 
 evening before retiring. Regularity, once established 
 at such an age, generally continues throughout life 
 and is conducive to health and happiness. 
 
 HARDENING OF CHILDREN. 
 
 The hardening of the child must begin in the first 
 year of life. On page 50 we advised to reduce the 
 temperature of the bath water after the first week 
 from 98 degrees to 95 degrees and after the first year 
 from 95 degrees to 90 degrees Fahrenheit. This is 
 the first step in hardening. Later the child should be 
 allowed to kick about in the air for five to ten min- 
 utes, unclothed, several times a day in a well warmed 
 room. It seems to enjoy it and is comforted thereby. 
 The air, while flowing freely about the naked skin, 
 slightly cools the blood and strengthens the nerves. 
 
 Still later, at the end of the second and in the 
 third year, it is advisable, after the bath, to let the wet 
 skin come in contact with the air for a short time. 
 The evaporation of the water is more cooling than the 
 dry atmosphere and affords a more effective means of 
 strengthening and hardening the skin as a protection 
 against the disposition to catch cold. 
 
 Besides these bathing procedures, the time spent 
 in the open air will do a great deal towards invigorat- 
 ing the little body. The change in the baby's bed 
 
—68— 
 
 coverings as suggested on page 45 also aims at the 
 same thing. 
 
 OUTDOOR LIFE. 
 
 Fresh, pure air is one of the first requirements for 
 the sustenance of health and life. Therefore, the 
 child should have it in abundance. 
 
 If the baby is born in summer and the weather is 
 warm and calm, it should be carried into the open air 
 three to four weeks after birth, having head and eyes 
 protected against direct sunshine and too bright light. 
 If born in winter, it should not leave the house until 
 it is three months old and then only when the weather 
 is fairly mild and, above all, windless. 
 
 From this time on frequent outings are very 
 beneficial so long as the weather is favorable. If the 
 weather is unfavorable, as on windy and rainy days — 
 the degree of temperature being of less importance 
 than the windiness — and the child cannot be carried 
 or wheeled in the open, an extra good ventilation of 
 the rooms should not be neglected. 
 
 If the child has become accustomed to the out- 
 side air, little fear need be entertained as to its catch- 
 ing cold. 
 
 The following pictures show babies of a German 
 hospital for sick children, enjoying the fresh, pure air 
 of the forest, and may brush aside the hesitations of 
 mothers, too timid as to the exposure of children 
 to the open air. 
 
 PHYSICAL EXERCISE. 
 
 It may seem strange that anyone should advo- 
 cate physical exercise for such a tiny and puny little 
 creature as a baby in the first and second year of life. 
 And yet it is proper and reasonable. Every mother 
 who ever observed how delighted her darling, after 
 being undressed, kicked with its little arms and legs 
 about the air, must have come to the conclusion that 
 
—69— 
 
 Figure 18. Sick babies enjoying a sand bath. 
 
 Figure 19. Baby-cribs on balcony for open-air treatment of sick babies. 
 
—70— 
 
 there was something in it which was pleasurable to 
 the little one. If she does not know it, we will tell 
 her that it was the unrestricted use of its limbs that 
 excited the feeling of comfort and satisfaction. And 
 this it should have. It should be granted the op- 
 portunity to exercise and strengthen its muscles ac- 
 cording to its own desire. To this end it is absolutely 
 necessary that the clothing be not too narrow and 
 tight around the body. Enough space should be left 
 for a satisfactory, free movement of arms and legs. 
 The baby knows well that it has a right to 
 demand this and many a careless nurse has 
 been reminded by persistent crying that the 
 clothing was too tight (see ''Crying of Babies''). 
 In this light one can recognize that the exer- 
 cises with the naked body as recommended above 
 (see page 67) serve a double purpose — to harden 
 and strengthen the skin and the nerves, and at the 
 same time to give an opportunity to the muscles to 
 develop. They should, therefore, not be forgotten. 
 
 Later, towards the end of the first year, the play- 
 ground, as described on page 45, affords a splendid 
 opportunity to satisfy the desire of the baby for phy- 
 sical exercise. It will use the fence to erect itself 
 and to support the body while standing and walk- 
 ing — exercises which, if taken voluntarily, are 
 very beneficial to the development of the muscles and 
 of the inner organs. We say "voluntarily" advisedly, 
 because exertions to which infants are coaxed too 
 early are harmful. Children should not be urged by 
 ambitious mothers to sit up, stand and walk before it 
 is time and before Nature has prepared the body. This 
 holds true especially with babies that are backward 
 in their development and whose mothers believe they 
 are doing good work in coaxing them to keep up with 
 the others of their age. This is wrong, very wrong. 
 Such practices may lead to the bending of the soft 
 bones of the legs and arms or to curvature of the 
 
—71— 
 
 spine (see chapter on ''English Disease") and should 
 be omitted. If development and strength have suffi- 
 ciently progressed, the baby will, v^ithout urging, be- 
 gin to lift up the head and make attempts at standing 
 and walking. Until this is done, the mother should 
 wait. 
 
—72— 
 
 CHAPTER X. 
 
 CRYING OF CHILDREN. 
 
 We here devote a special chapter to the "Crying 
 of Children," since the proper interpretation of 
 this "symptom" is of utmost importance in ^ the care 
 of the child. We must, therefore, urgently request 
 every mother to study and take to heart all we have 
 to say about it. Much trouble will therebv be avoid- 
 ed. 
 
 The crying of children is an expression of dis- 
 pleasure and indicates that something is wrong. Just 
 what is wrong the child cannot express in words. It 
 is the duty of the attendant to find this out. 
 
 But the finding out requires thinking and this 
 many mothers dislike to do. In their imprudence 
 they simply take it for granted that the child is 
 hungry, and act accordingly. 
 
 This conclusion is, however, very dangerous. It 
 is by no means always hunger that causes the child 
 to cry. There are many other reasons. It certainly 
 does not spell hunger if the child cries immediately 
 after being fed; it certainly does not spell hunger if 
 in spite of the constant offering of nourishment the 
 crying becomes more persistent. In these instances 
 there generally exist disturbances of digestion asso- 
 ciated with colics which the child tries to indicate. 
 The thoughtless mother does, therefore, a great in- 
 justice to the child if she thinks of nothing else but 
 to put the nipple of her breast or of a well-filled nurs- 
 ing bottle into the mouth of the baby, should it for 
 some reason or other begin to cry. The infant, we 
 admit, generally quiets down for a short while, but, 
 after a short period, starts lamenting louder than 
 before. 
 
—73— 
 
 Such a mother may consider what she would do if 
 she herself were suffering pain in her abdomen. 
 Would she fill up her stomach? By no means! She 
 would take no nourishment, or very little, until the 
 pain had disappeared. But why should the baby be 
 treated dift'erently? It is but a human being, and a 
 small one at that, made of the same flesh and blood 
 and subjected to the same diseases as the adult. Why, 
 therefore, treat it dift'erently and fill its stomach with 
 nourishment if it has pain in the abdomen? Breasts 
 and nursing bottles are no pacifiers. They will, if 
 given at improper times, increase the dift'iculty rather 
 than diminish it. 
 
 A great many other causes besides disturbances 
 of digestion may, under different circumstances, be ex- 
 pressed in tones of displeasure, such as wetted and 
 soiled napkins, uncomfortable position, bothering 
 creases in the bed clothes, too narrow dresses, irri- 
 tations of the skin of all descriptions, too bright light, 
 fissures at the opening of the bowels, prolapse of the 
 bowels, difficult urination or the beginning of one of 
 the many diseases that afflict the human race. 
 Thosej red and inflamed places in the crease of the 
 seat gifi between the legs (see page 51) need be men- 
 tioned pj^ominently as a further, very frequent cause 
 for cryir^ They become hot and begin to pain, if 
 not properly attended to, and should always com- 
 mand first attention. 
 
 If the child begins to cry, a prudent mother will, 
 therefore, first think and investigate and act after- 
 wards. If, in spite of faithful research, it is impos- 
 sible to find a cause, she should consider if it be not 
 spite and caprice that prompts the spoiled darling to 
 roar. If this seems to be the case, obedience must be 
 forced. 
 
 Now, what is to be done if the nursling cries? 
 
 If it is time for feeding, the child should have the 
 
—74— 
 
 breast or the bottle ; if it is not and something must be 
 given, the mother may try first some boiled water 
 or fennel tea slightly sweetened with sugar. They 
 are equally as effective as milk, but harmless. If 
 this does not work and the mother is sure that it 
 is not spite and caprice that is provoking the noisy 
 conduct, she must see if the diapers are dry and 
 clean, if the dresses are not too tight, if they do not 
 pinch, or if one of the other above mentioned causes 
 is prevailing. 
 
 Whatever cause or irregularity is found, must be 
 removed. Red and sore places, if present, should al- 
 ways be dressed anew. If no cause can be detected 
 and the mother knows that the darling cries because 
 it is spoiled and wants to be taken up, she should let 
 it lie and cry. The little mischief soon finds out 
 that crying does not help and calms down. In a very 
 few days it is subdued for the good of its parents and 
 of itself. Many a bad hour, much chagrin and many 
 a punishment is spared. But if ill-will and caprice 
 have to be excluded ; if the crying is more penetrating, 
 pitiful and lamentable; if the child draws the leg^ up 
 in seeming pain; if it has shown at the last ijieal 
 that the appetite was impaired; if the movement^ ^df 
 the bowels were not as good as before; if they weiffe 
 too hard or too loose or green — then a beginning in- 
 digestion must be thought of. An injection with very 
 weak peppermint tea, a slight laxative, a hot linseed 
 poultice upon the abdomen and withdrawal of all 
 nourishment for a short time (see "Acute Indiges- 
 tion") will, in most instances, afford the desired relief 
 and prevent troublesome and dangerous disease. 
 
 CONSEQUENCE OF CRYING. 
 
 Annoyance for those around is about the only bad 
 effect from crying. No consequences are to be feared 
 for the child unless there exists a disposition to rup- 
 ture, navel or inguinal. The increased pressure in the 
 
—75— 
 
 abdomen accompanying the crying causes the bowels 
 to force into the rupture, thereby enlarging its size 
 (see page 15). 
 
 SOOTHING SYRUPS. 
 
 On page 60 we called attention to the dangers 
 threatening from the use of pacifiers. These are, how- 
 ever, innocent things in comparison with those deadly 
 poisons which are sold in drug stores under the name 
 of "soothing syrups," "baby friends," etc. We cannot 
 be too emphatic in the condemnation of those rem- 
 edies. It may seem impolite and harsh, but we can- 
 not help saying that any mother who gives such 
 medicines to her helpless baby proves by this deed 
 to be either an ignorant or a careless and frivolous 
 person. All these preparations, without exception, 
 contain opium or morphine or one of its derivatives, 
 substances which are extremely dangerous to the ten- 
 der organism of a child. 
 
 It happens, we know, that pleasure-seeking 
 mothers, in utter neglect of their duty, sometimes 
 drug their babies into sleep with such remedies in or- 
 der to be able to go to concerts, theaters and dances. 
 But how they ease their consciences after such brutal 
 deeds, we cannot comprehend. 
 
 An intelligent and conscientious mother, of 
 course, will never use such remedies. But let every 
 woman make it her duty to draw the attention of her 
 friends and neighbors to the character of those prep- 
 arations, which shame humanity. 
 
■76— 
 
 CHAPTER XL 
 
 SIGNS OF NORMAL DEVELOPMENT OF THE CHILD. 
 
 A mere glance generally suffices to assure the 
 onlooker of the wellbeing or the non-wellbeing of a 
 child. The round, fresh cheeks, the lustre of the eye, 
 the pleasurable laugh, the roundness of the body, the 
 full, plump limbs and the shiny skin — all bear witness 
 that the health of the baby is satisfactory. 
 
 This satisfies most mothers, especially if the 
 functions of the body take their normal course, that 
 is, if the appetite is good, if the bowels move regular- 
 h^ and the sleep is undisturbed. 
 
 And yet this is not suft'icient. The mother, while 
 guarding the health and life of her baby, should not be 
 like the young sailor, who, in making his first trip, 
 does not notice the storm until it is over the ship, but 
 like the old, experienced seanian, who, in spite of the 
 clear sky and the sunshine, recognizes the approach- 
 ing storm in the little, white cloud arising on the 
 horizon. 
 
 The necessary instructions are given in this 
 chapter. For, if she is familiar with what is normal, 
 it is not difficult for her to detect the abnormal. If 
 she takes the trou1)le to study carefully the following 
 pages and follows their teachings, she will be able to 
 recognize with ease and certainty the alarming cloud 
 on the horizon of the health of her baby; she will be 
 able to recognize with ease and certainty the earliest 
 beginning of a disease, long before an uninstructed 
 mother becomes aware of the approaching evil. At 
 such times it is still easy to meet the threatening 
 storm. A mother whose superior knowledge en- 
 ables her to suppress a sickness before it has succeed- 
 ed in taking root, is rewarded a thousand times for 
 the labor necessary to acquire the information. 
 
—77— 
 
 The principal signs of a normal development are: 
 
 1. The baby should increase in weight regu- 
 larly. 
 
 2. Its organs should develop and functionate 
 properly — head, muscles, teeth, temperature, breath- 
 ing, pulse. 
 
 3. It should have from one to three daily move- 
 ments of the bow^els, which should be of uniform, 
 paste-like consistency and of gold-yellow color in 
 breast fed and a little harder and whiter in hand fed 
 babies. 
 
 4. It should have neither vomiting nor diarrhea. 
 
 5. It should fall into a deep and quiet sleep 
 after drinking. 
 
 INCREASE IN WEIGHT, 
 
 The observation of the weight of the nursling 
 gives extremely valuable and important information 
 as to its thriving. Every disturbance of health is 
 manifested by a standstill or a diminution of the 
 bodily weight. B}^ comparing cause and effect one 
 can further draw valuable inferences as to the vitality 
 and the resisting power of the child. This means 
 that the weaker the child, the more it will lose and 
 the slower it will regain, and the stronger the child, 
 the less it will lose and the quicker it will' regain a 
 loss caused by a like disturbance. If, therefore, a 
 child from slight cause loses considerably in weight, 
 and regains slowly what it lost, it is necessary to take 
 special precautions in its care; for a more serious 
 sickness, which is easily overcome by a strong child, 
 may lead to death on account of the existing low vi- 
 tality. 
 
 If at any time the weight of the child remains 
 stationary or goes back, it is, as said, a sign that 
 something is wrong. This is a hint which comes to 
 the wary mother long before any other indication of 
 sickness appears, at a time in which the baby may 
 
—78— 
 
 still seem to be in the best of health. She sees the 
 little cloud arising on the horizon and avoids the dan- 
 ger; the unwary one is surprised by the storm and in 
 many instances can save the child from death only 
 by untiring and devoted efforts during a long siege 
 of sickness. 
 
 In order to control the weight it is necessary to 
 weigh the child at regular intervals. The instrument 
 to be used is either a scale especially made for the 
 purpose (Fig. 20) or a decimal balance (Fig. 21). 
 
 Figure 20. Scales for weig-hing babies. 
 
 The ordinary kitchen scale is too inaccurate and not 
 suitable for the purpose. 
 
 The child is to be weighed always on the same 
 day or days of the week, exactly at the same time of 
 the day, best at noon before nursing. It is also per- 
 missible to choose any other hour, if it is more con- 
 venient. But it should always be the same hour, be- 
 fore the meal and either before or after a passage. 
 
79- 
 
 The reason for being so particular is this: Every 
 meal and every passage has a great influence on the 
 weight of the body. It is increased exactly as many 
 ounces, drachms and grains' as the nourishment 
 weighs, which has been taken, and decreases exactly 
 as many ounces, drachms and grains as the passage 
 weighs, which has been discharged. If, therefore, the 
 child is weighed the one time before, the other time 
 after a meal, the one time before, the other time after 
 a passage, great differences in weight must appear, 
 
 Figure 21. Decimal Balance. 
 
 which amount to nothing and confuse. Such annoy- 
 ances can and will be avoided if the above instruc- 
 tions are followed. 
 
 Under ordinary conditions it suffices to weigh 
 about once or twice a week. Delicate children may 
 be weighed more often. The weight is taken either 
 while the child is undressed or dressed. In the lat- 
 ter instance the clothing must be weighed separately 
 and its weight deducted from the total. 
 
 The figures so found would best be written down 
 in the following manner: 
 
 Weeks After Birth 
 
 Date 
 
 Weight of 
 Child with Clothes 
 
 Weight of 
 Clothes 
 
 Weight Proper 
 of Child 
 
 END OF 
 
 I Week 
 
 
 
 
 
 
 2 Week 
 
 
 
 
 
 L^l 
 
 3 Week 
 
 
 
 
 
 
-80— 
 
 In figure 22 we see a chart representing- the aver- 
 age weight of a healthy infant from the first day to 
 the end of the first year. From this chart one can 
 easily take the average weight of a child of any age. 
 If, for instance, one wants to find the weight of a 
 child eight months old, it is but necessary to go down 
 the line under eight until it strikes the weight curve, 
 and to follow from this point the line going to the 
 left. If this is done, number 17 is found. Seventeen 
 
 ^«1 
 
 MONTH OF AGE. 
 
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 Figure 22, Weigh Chart, according to Holt. 
 
 pounds is, therefore, the average weight of a child 
 eight months old. 
 
 By average weight is meant the weight as it is 
 found when an average is taken from many children. 
 If the child is heavier at birth than the average 
 weight given, it generally stays ahead just that much 
 over the average weight ; if it is less in weight at birth 
 than the average weight given, it often lags behind 
 that much during the entire first year. 
 
 Every new-born, as demonstrated by the 
 
— Sl~ 
 
 weight chart, loses one-tenth of its weight during the 
 first days of its Hfe by the excretion of the urine and 
 the great quantity of meconium (see page 37) ac- 
 cumulated in the bowels. On the third day it begins 
 to gain. On the tenth day the weight is as great as 
 it was directly after birth, that is, about seven and 
 one-half pounds (see ''First Nursing of the Child''). 
 
 From now on the weight increases gradually and 
 steadily, the aA^erage gain being four to five ounces 
 a week during the first six months and three to 
 four ounces during the following six months. An in- 
 crease of less than four ounces a week for the first 
 four to five months is insufficient and indicates either 
 that the child is sick or that it does not get the proper 
 amount or properly prepared nourishment. 
 
 Towards the end of the fifth month the child has 
 doubled its weight and has tripled it in the fourteenth 
 to fifteenth month. 
 
 A small decrease in weight should not cause the 
 mother any worry. This cannot fail to occur, since the 
 scales indicate the slightest disturbance in nutrition 
 with exactly the same precision as a fine thermometer 
 indicates the oscillations of the temperature. As an 
 estimate one should always take the weekly increase. 
 In this the smaller oscillations are eliminated. 
 
 If, however, there is a permanent standstill or 
 even a loss of weight, it indicates an approaching ill- 
 ness. Then it is time to investigate, even if the child 
 shows no other sign of sickness. The perusal of the 
 following chapters on the development of the head, 
 muscles, teeth and on the nature and quality of 
 the breathing, temperature, pulse, movements of the 
 bowels, etc., etc., will give the necessary information. 
 
 DEVELOPMENT OF THE HEAD. 
 
 The different bones of the head of a baby are at 
 birth still movable toward each other (Fig. 23). They 
 are separated from one another by ''sutures'' leaving 
 
-82- 
 
 two large openings, called ''Fontanels," a larger one 
 on the front of the head (Fig. 23a), and a smaller one 
 on the back of the head (Fig. 23b). This larger, an- 
 terior fontanel can easily be felt by the mother. It is 
 the soft, square place over the forehead. There the 
 outer skin lies directly upon the brain and the pulsa- 
 tion of the brain vessels can be felt. It is i to ij4 
 inches long and about i inch wide. 
 
 The smaller fontanel, located at the back of the 
 head, closes toward the end of the second month and 
 can be felt no longer after that time. The sutures 
 
 Figure 23. Baby Skull, showing Bones, Sutures and Fontanels. 
 
 close and ossify in the sixth to seventh month, where- 
 by the different bones become immovable towards 
 each other. The larger fontanel in the front remains 
 open the longest. It does not close until the four- 
 teenth to twenty-second month, when it becomes im- 
 perceptible to the touch. 
 
 If the closure and ossification of the bony capsule 
 of the head occurs sooner than stated, it is of no sig- 
 nificance. If, however, the larger, anterior fontanel 
 remains open until after the second year, that is, if its 
 place stays soft and the pulsation of the blood vessels 
 
—83— 
 
 of the brain continues to be perceptible to the touch, it 
 is safe to conclude that the English Disease is in ex- 
 istence. 
 
 Under such circumstances it is best to look at 
 once for the further symptoms of this disease to con- 
 firm the diagnosis and, if necessary, to institute the 
 proper treatment immediately (see chapter on ''Eng- 
 lish Disease" at the end of this book). 
 
 DEVELOPMENT OF THE MUSCLES. 
 
 The ability of the nursling to make use of its 
 muscles, that is, to move its body and its limbs, serves 
 as a guide in judging the development of the muscles. 
 Note the following landmarks : 
 
 The child begins to erect its head in the third to 
 fourth month ; it can sit up erect for a f ev^ minutes in 
 the eighth month ; it makes its first attempts at walk- 
 ing in the ninth to tenth month; holding on to a chair 
 or some other object, it is able to stand in the eleventh 
 to twelfth month. But not until the fourteenth to 
 fifteenth month do the legs grow strong enough to 
 carry the body with some degree of safety and en- 
 able the child to walk a few steps without support. 
 
 In some families the children begin to walk much 
 earlier. If this is done voluntarily, it is safe to allow 
 it. No mother, however, should urge her child to sit 
 up, to stand or to walk, before its natural instinct 
 prompts it to do so. If the bones and muscles are suf- 
 ficiently strong, the baby begins of its own accord. 
 If it does not, but is urged in spite of the unprepared- 
 ness of nature, the child is in danger of bending its 
 bones or of acquiring a curvature of the spinal col- 
 umn, which can be cured only with difficulty, or not 
 at all (compare with this what is said about this point 
 in the chapter on the ''English Disease"). 
 
 More often we meet with a belated rather than 
 a too early development of the muscular system. In- 
 stead of at the fourteenth to fifteenth, the children be- 
 
-8 
 
 gin to walk at the twentieth to twenty-fourth month 
 or even later. In such cases the cause should be look- 
 ed for. It may lie in a simple malnutrition or in an 
 arrested development, left as a result of a preceding 
 sickness, or in the existence of the English Disease. 
 This latter is most frequently the case. The j^ymp- 
 tom is a conspicuous hint of Nature and should never 
 be neglected. Whatever trouble the investigation dis- 
 closes, immediate treatment is necessary. 
 
 DEVELOPMENT OF THE TEETH. 
 
 The first set of teeth consists of twenty so-called 
 "milk-teeth." They always erupt in groups, several 
 at a time, in the following succession: 
 
 In the sixth to ninth month the lower, central 
 incisors erupt. 
 
 Figure 24. .Number of teeth in sixth to ninth month. 
 
 In the eighth to thirteenth month the four upper 
 
 Figure 25. Number of teeth in eighth to thirteenth month. 
 
—85— 
 
 incisors erupt, the central first, the lateral later. 
 
 In the twelfth to fifteenth month the four anter- 
 ior molars and the two lateral incisors erupt. The 
 succession is — molars in the upper jaw, incisors in the 
 lower jaw molars in the lower jaw. 
 
 Figure 26. Number of teeth in twelfth to fifteenth month. 
 
 In the eighteenth to twenty-fourth month the 
 four canines erupt. The upper ones are called eye 
 teeth. 
 
 Figure 27. Number of teeth in eighteenth to twenty-fourth month. 
 
 Finally, in the twenty-fourth to thirtieth month 
 the four posterior molars erupt (Figure 28). 
 
 Children have, therefore: 
 
 At I year 6 teeth 
 
 At I ^ years 12 teeth 
 
 At 2 years 16 teeth 
 
 At 2^ years 20 teeth 
 
-^6— 
 
 TOO EARLY AND TOO LATE DEVELOPMENT OF TEETH. 
 
 The eruption of teeth before the sixth to seventh 
 month is seldom, but happens sometimes. A number 
 of cases have been reported where children have 
 been born with teeth. Delicate and sickly children 
 get their teeth somewhat later than healthy and 
 strong ones. 
 
 A great and harmful influence upon the eruption 
 of the teeth is exerted by the English Disease (see 
 chapter on this disease at the end of the book). If it 
 develops early, that is, in the first months of life, the 
 eruption of all the teeth is postponed, which means 
 that the child begins to teeth too late; if it develops 
 
 Figure 28. Number of teeth in twenty-fourth to thirtieth month. 
 
 later, after the first teeth are out, the eruption of the 
 teeth which are still coming is delayed, which means 
 that the child stays unusually long on a certain num- 
 ber of teeth. 
 
 Any delay in the development of the teeth at 
 once suggests, therefore, the existence of the English 
 Disease and invites the study of the chapter devoted 
 to it. It must be taken as a further hint that the Eng- 
 lish Disease exists, if the teeth which come normally 
 in groups, erupt singly, or if the child remains for a 
 long time with an uneven number of teeth. 
 
 TEETHING SICKNESSES. 
 
 We will not allow this opportunity to pass with- 
 
- —87— 
 
 out saying a few words about the so-called ''teething 
 sicknesses." 
 
 Teething is a normal process and as such is ac- 
 companied neither by fever, nor diarrhea, nor cough, 
 nor any other sign of serious illness. The conduct 
 of the child, of course, varies according to conditions. 
 
 Sometimes the eruption passes so easily that the 
 mother fails to notice it and some day is surprised by 
 the presence of the tooth. Slight disturbances, how- 
 ever, develop in most instances. There will be a 
 swelling, redness and sensitiveness to the touch at 
 the place the tooth is coming; the secretion of spittle 
 is increased and sometimes is so abundant that it 
 flows constantly from the mouth of the baby, wetting 
 bibs and clothes and giving cause for catching cold. 
 The appetite is decreased and the passages are some- 
 what oftener and thinner. The reflex irritation em- 
 anating from the tooth throws the nervous system of 
 the child into a state of greater irritability. The in- 
 fant becomes disquieted, restless, cries more than 
 usually, and does not sleep so well. Even cramps 
 are sometimes brought on with children of a nervous 
 nature. Whether the teething can be blamed direct- 
 ly for eruptions of the skin and inflammations of the 
 eyes, as is often done, re.mains doubtful. 
 
 At this juncture, let us give the urgent ad- 
 vice to be extremely cautious in blaming dentition for 
 all abnormal symptoms which may arise during the 
 time of the eruption of the teeth. Many a child, that 
 would have certainly been saved by a timely treat- 
 ment, had to pay the penalty with its life for the im- 
 prudence of its mother, who did not want to interfere 
 because she considered the ailment but a teething sick- 
 ness and waited for voluntary improvement until the 
 time for salvation had passed. 
 
 If, therefore, the above mentioned slight disord- 
 ers do not stop with the eruption of the tooth, or if 
 from the beginning serious symptoms prevail, such 
 
—88— 
 
 as diarrhea, vomiting, coughing, fever, etc., a consci- 
 entious and faithful mother will not satisfy herself 
 with the explanation that the ''trouble comes from 
 teething." She will inquire into the cause and, fol- 
 lowing our most urgent advice, attend also at the 
 time of teething to all sicknesses with the same cir- 
 cumspection and carefulness as she would at any oth- 
 er time. It is, indeed, better to call the physician in 
 time than to mourn a death which could have been 
 prevented. 
 
 Proper observation of pulse, breathing and tem- 
 perature is essential to enable one to pass judgment 
 on the well-being of a child. These are those phe- 
 nomena of life which manifest the earliest and most 
 conspicuous changes in case of sickness and which at 
 the same time can easily be studied and understood 
 by every mother. 
 
 PULSE. 
 
 The condition of the pulse gives an approximate 
 idea as to the condition of the general health. If the 
 pulse is good, regular and strong and the number of 
 its beats normal, we know that no serious disease can 
 prevail. If, however, the pulse is weak, soft and ir- 
 regular and the number of its beats increased, we 
 should take this as a sign that danger is either pres- 
 ent or coming. 
 
 Every mother can easily feel the pulse of the in- 
 fant by placing her middle or index finger gently up- 
 on the lower arm a little above the wrist and near 
 the thumb side. 
 
 The place where the pulse can best be felt is not 
 the same in all persons. It depends upon the location 
 of the large blood vessel coming down the arm. 
 Where this lies nearest to the skin, there is the best 
 place for feeling, since it is the pulsation of the blood 
 in this blood vessel that causes the pulse. If the 
 pulse cannot be felt on the above mentioned spot, it 
 
is advisable to feel gently a little higher or lower or 
 to try the other arm, for both arms are not always 
 alike. The pulse may be plainly palpable on the one 
 arm and only with difficulty on the other. 
 
 It needs, of course, a little practice as in all other 
 things. If the mother cannot find the pulse at once, 
 she should not give up in despair. She should try to 
 find ,it on older children, or better still, on adults or 
 on herself. If she has once found the pulse, she will 
 be amazed to see how easy it is to find it again either 
 on the same person or on the baby. Therefore, pati- 
 ence and perseverance! 
 
 --CK 
 
 Figure 29. The black line (a) represents the blood vessel commg down 
 the arm and marks the place where the pulse should be felt. 
 
 If the mother feels the pulse of her baby often, 
 its normal condition will soon be so distinctly im- 
 pressed upon her mind that she will easily detect ab- 
 normal deviations. 
 
 As said, it is necessary to feel gently. By strong 
 pressure the blood vessel is compressed and no pulse 
 can be felt. 
 
 The number of the beats is found by counting 
 them for one minute. This number varies directly 
 after birth between 130 and 140. It soon declines and 
 is on an average 120 to 130 during the first year of 
 life, 105 to no in the second, 100 to 105 in the third 
 year, etc. With adults it is reduced to from 70 to 80. 
 
 These are averages, that is, pulses as they are 
 generally found in healthy human beings. The num- 
 
—90— 
 
 ber may be a little higher or lower without indicat- 
 ing illness. It is not only different with different peo- 
 ple but also different with the same person under 
 different circumstances, as for instance, higher after 
 bodily and mental efforts, awakening from sleep, etc., 
 and lower after bodily and mental rest, during sleep, 
 etc. 
 
 If, however,, the number of the beats is much 
 higher than stated above; if the pulse is not as strong 
 and regular as it should be, but weak and irregular, 
 it indicates sickness. For this reason the mother 
 should not only count the beats but also pay attention 
 to the regularity and the quality of the pulse. A nor- 
 mal pulse is as regular as the swinging of the pendu- 
 lum of a clock or the tick of a watch so that devia- 
 tions in this respect cannot be overlooked. 
 
 BREATHING. 
 
 As with the pulse so it is with the breathing. 
 This is also changed with increasing age and the oc- 
 currence of sickness. The mother should, therefore, 
 be acquainted with the normal condition also in this 
 respect. 
 
 The observation of the breathing offers no dif- 
 ficulty. The number of breaths is found by counting 
 them for one minute. It is from thirty-five to forty 
 with children in the first year of life but sinks gradual- 
 ly to from sixteen to twenty in adults. 
 
 The number of breaths is increased by bodily 
 and mental efforts, during fevers and especially in 
 sicknesses of the lungs. 
 
 The breathing is perfectly regular only during 
 sleep, somewhat irregular in the waking state. This 
 is of no consequence. , 
 
 There are normally no breathing noises, except 
 that soft and even sound which is heard when the ear 
 of the examiner is pressed against the breast of a 
 healthy child. Whistling, wheezing and snoring 
 
—91— 
 
 tones coming from the breast always point to sick- 
 ness. They are heard in diseases of the larynx, bron- 
 chial tubes and the lungs. 
 
 TEMPERATURE. 
 
 Most ailments afflicting the human body raise 
 the heat of the blood. The observation of its tem- 
 perature is, therefore, of the utmost importance. It at 
 once reveals the beginning of diseases and is one of 
 the most important measures v\^hich assist in passing- 
 proper judgment during existing fevers. The instru- 
 ment used for this purpose is called "fever ther- 
 mometer" (see Fig. 30). 
 
 
 "'"■— ' - - ■^- 
 
 Figure 30. Fever Thermometer. 
 
 We regard it as an indispensable equipment of 
 every mother and cannot urge too strongly that one 
 be procured, if there is none in the house. 
 
 The taking of the temperature need not be done 
 with the same regularity as the taking of the weight. 
 If, however, there arises a suspicion that the child 
 is sick, it becomes indispensable. No mother should 
 ''guess" so long as we have or can have at our com- 
 mand means to ''know" with certainty if the baby 
 has fever or not. Even the most experienced physi- 
 cian will make grave mistakes if he attempts to judge 
 the temperature of the body by the tolich of his fin- 
 gers. And how much more is a mother liable to do 
 this? Every attendant, even the most unexperi- 
 enced, however, can ascertain definitely if the heat, 
 the child seems to be suffering from, is fever or not, 
 if she takes the time and trouble to use the thermom- 
 eter. And this should be done. 
 
 If there is no fever, it disperses and relieves the 
 existing anxiety; if there is fever, a disease is in ex- 
 istence which calls for immediate interference. 
 
—92— 
 
 Fever thermometers differ from ordinary ther- 
 mometers. They register only the temperature be- 
 tween 90 or 95 and no degrees F. Furthermore, 
 their quicksilver does not retract, but remains at the 
 highest point reached, when the instrument has been 
 used. It is, therefore, not necessary to read the tem- 
 perature hurriedly. The instrument can be taken 
 away from the child and studied with leisure. If all 
 information that can be gotten has be^n obtained, 
 the quicksilver is brought down. The proper way to 
 do this is by taking hold of the instrument in the way 
 as shown in Fig. 31, and giving it a full arm down- 
 
 Figure 31. Shows how to hold the instrument while bringing down 
 
 the quicksilver. 
 
 ward swing ending with a jerk. In this way two or 
 three swings will, in nearly all cases, be sufficient to 
 place the quicksilver column down and in position for 
 further use. 
 
 The shaking down of the quicksilver is some- 
 times somewhat difficult in new instruments. This 
 is no detriment. It will be easier, the longer the in- 
 strument is in use. It may also happen that after 
 long usage the quicksilver does not remain at the 
 highest point but retracts spontaneously as soon as 
 the thermometer is taken away from the patient. 
 This does not render the instrument useless. The 
 measuring of the temperature will be correct never- 
 theless. The onh^ inconvenience, caused thereby, is 
 that the temperature has to be studied before the 
 thermometer is removed from the sick person. 
 
 There are a good many kinds of fever thermom- 
 eters on the market, good ones and bad ones, prac- 
 
—93— 
 
 tical ones and impractical ones. What is good and 
 what is bad, what is practical and what is imprac- 
 tical is rather difficult for a layman to decide. The 
 buying of a thermometer is, therefore, just as much a 
 matter of confidence as the buying of pure, unadulter- 
 ated drugs. One must buy under guarantee from a 
 reliable firm in order to be sure to get a correct and 
 reliable instrument. 
 
 Place Where to Measure: The best and most reli- 
 able results are obtained if the quicksilver container 
 of the thermometer is placed into the rectum, that is, 
 into the lowest part of the bowels. But this place is in- 
 convenient, distasteful and, with restless and restive 
 children, somewhat risky, since there is danger that 
 the glass may break. The mother, therefore, may 
 better select another place, that is, the mouth with 
 older and more reasonable children, the legs or 
 the armpit with smaller and refractory ones. 
 Both places will do under ordinary circumstances, if 
 the necessary precautions are taken. In the mouth the 
 instrument is to be placed under the tongue and care 
 to be taken that the lips are tightly closed. As a fur- 
 ther precaution it is required that the child does not 
 eat or drink for at least ten to fifteen minutes before 
 the temperature is tested. The contact of cold or hot 
 food or drinks changes the temperature of the muc- 
 ous membrane of the mouth and may lead to mis- 
 takes. 
 
 Taking the temperature between the legs is the 
 most convenient way with small children but is also 
 most likely to lead to errors, if certain precautions are 
 not taken. If the child has been lying for a long time 
 with legs. apart, the skin of the legs may have cool- 
 ed so considerably that a correct temperature can not 
 be obtained. This pitfall should be avoided and with 
 boys the fever be tested only if the legs have been 
 closed for a long time. With girls the matter is sim- 
 pler. It is always possible to take their temperature 
 
—94— 
 
 sible, that means, the temperature is not always 
 the outer genitals, so that the quicksilver container 
 is entirely hidden. 
 
 It is needless to say, of course, that, while the 
 temperature is being taken, the legs of the child, boy 
 or girl, must be pressed together. 
 
 What is said of the legs is also true of the arm- 
 pits. 
 
 The thermometer is left in position for two or 
 three minutes and then read. High grade instru- 
 ments rise in one minute, but two to three minutes 
 generally give better results. 
 
 Reading the Thermometer — The reading of the 
 thermometer seems, in the beginning, to be a some- 
 what difficult task for many mothers. It is, however, 
 a very simple matter, as soon as it is understood. 
 
 To facilitate the understanding let us study such 
 an instrument somewhat closer. We find on its up- 
 per surface two different kinds of division lines, long 
 ones and short ones. The space between two long 
 lines is one degree and the space between two small 
 lines is one-fifth of a degree. When this is understood, 
 one must try to find the quicksilver column, that sil- 
 very thread in the middle between the outer longitu- 
 dinal edges of the instrument (the black middle lines 
 in Fig. 32 represent the quicksilver columns). Its 
 end is higher or lower according to the temperature 
 last taken. The number it stands on gives the temper- 
 ature measured. If the end stands on 96, it means a 
 temperature of 96 degrees; if it stands on 104, it 
 means a temperature of 104 degrees, etc. Fig. 32 
 may serve as an illustration. 
 
 Normal Temperature: The arrow, which stands 
 between 98 and 99 mostly at 98 3-5, means nor- 
 mal, that is, . normal with adults. The average 
 normal temperature of a nursling is a little high- 
 er, usually between 99 and 99 2-5 degrees. But 
 with both babies and adults oscillations are pos- 
 
—95— 
 
 sible. that means, the temperature is not always 
 the same even under normal circumstances. It 
 may be a little higher or a little lower. If, however, 
 
 
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 Figure 32. Shows different degrees of temperature, the middle black 
 
 line representing the quicksilver column. 
 
 In No. 1 its' end stands on 99 1-5, indicating a temperature of 99 1-5. 
 
 In No. 2 its end stands at 100 3-5, indicating- a temperature of 
 100 3-5. 
 
 In No. 3 its end stands at 102 4-5, indicating- a temperature of 
 102 4-5. 
 
 In No. 4 its end stands at 98 1-5, indicating a temperature of 
 98 1-5, etc. 
 
 the temperature of a nursling is higher than loo de- 
 grees, it has fever. Then sickness exists and immed- 
 iate steps must be taken to ward off the imminent 
 
danger. As to the cause of the frequent rise of tem- 
 perature in the new-born, compare the chapter fol- 
 lowing later: "The First Nursing of the Child." 
 
 Treatment of the Thermometer: Immediate- 
 ly after using, the thermometer must be cleaned with 
 lukewarm water and soap or disinfected in an anti- 
 septic solution, if it has been used with a child afflict- 
 ed with a catching disease. The antiseptic best to be 
 employed is Rhenolin (Prescription 36), one tea- 
 spoonful to half a pint of water. A five per cent solu- 
 tion of Carbolic Acid or a solution of Corrosive Mer- 
 curic Chloride (see page 24), are also reliable. Hot 
 water should not be employed for cleaning' since it 
 will. burst the instrument. After cleaning, the quick- 
 silver should be brought down and the instrument is 
 ready to be laid aside. 
 
 Advantages Derived From the Use of the Ther- 
 mometer in the Hands of the Mother in Case of 
 Sickness: A reliable control and a proper and effec- 
 tive treatment of a sick baby can only be instituted 
 and carried through if the temperature is taken at 
 regular intervals. And who else shall take it outside 
 of the hospital but the natural attendant of the child, 
 the mother? Only a comparatively few can afford to 
 hire a trained nurse. A repeated daily reading by the 
 physician is still more expensive, since every call has 
 to be paid for. And yet the taking of the tempera- 
 ture should not be neglected. It is absolutely indis- 
 pensable for the proper information of the attend- 
 ing physician. The oscillations of the temperature at 
 different hours of the day are so great in many in- 
 stances that one daily test will not, and should not, sat- 
 isfy a conscientious and careful medical attendant. A 
 perfect control over the case is not possible under 
 such circumstances. If, however, the mother takes 
 the temperature and pulse at regular intervals and 
 puts them down on paper, the physician on his daily 
 visit can look over the record, so compiled, and is 
 
—97— 
 
 thus enabled to get a clear idea as to the happenings 
 during his absence. This is of great benefit not only 
 to the little patient but also to the parents if they are 
 not so fortunate as to belong to that class of society 
 to whom money is no object. Many times, indeed, 
 the hiring of a costly, trained nurse can thus be 
 avoided and many a call of the physician be saved. 
 And yet the case is not neglected, for the great help 
 thus rendered by the mother more than compensates 
 a less frequent calling of the doctor. 
 
 APPEARANCE AND CONSISTENCY OF THE EVACUATIONS OF 
 
 THE BOWELS. 
 
 "The daily control of the passage combined with 
 an exact report as to the number of passages, food 
 and weight of a child is far more important than the 
 daily inspection of an infant. And yet, many physi- 
 cians do the latter with devotion, the first not at all," 
 says Prof. Biedert, one of the most prominent special- 
 ists on diseases of children in Europe, in his book on 
 ''Feeding of Infants." And he is perfectly correct. Too 
 little attention is paid, not only by the laity but also by 
 the medical profession, to the conditions of the pas- 
 sages during infancy in spite of the important hints 
 which can be taken therefrom. The discharges from 
 the bowels are certainly the best indicators as to the 
 progress of the digestion, their abnormalities point- 
 ing out beginning illnesses which otherwise would 
 elude an early detection. 
 
 We will, therefore, describe not only the differ- 
 ences in the appearance and consistency of normal, 
 healthy evacuations caused by different kinds of 
 food, but also the miost important changes in case 
 of sickness. The contrast affords a better elucida- 
 tion and will make a deeper and more lasting impres- 
 sion upon the mind of the mother. 
 
 The passage of a breast-fed, healthy baby is of a 
 golden-yellow color similar to that of the yolk of an 
 egg, and of a smooth, soft consistency. It is not lumpy 
 
—98— 
 
 nor mix£d with white flakes. It smells slightly and 
 agreeably sour. 
 
 The passage of a baby fed on cow's milk is of a 
 light yellow to whitish color and slightly thicker. Its 
 smell is not sour but somewhat flat and stale. 
 
 The passage of a very young baby fed on butter- 
 milk looks greenish-yellow, but assumes a more 
 straw-yellow color as the latter grows older. It is al- 
 so somewhat thicker than the passage of a breast- 
 fed baby, but not formed and has a slightly flat odor. 
 
 The passage of a baby fed on proprietary foods 
 is brown even with infants under one year of age. 
 The same color obtains if plenty of oatmeal, barley, 
 rice or other cereals have been added to the milk. 
 
 The passage is dark brown to black if children 
 get bismuth, tannin or iron medicines. 
 
 The passage is green only with babies suffering 
 from digestive disturbances, the green color being 
 caused by a change of the admixed gall. The greener 
 the passage, the worse the condition of the bowels. 
 The passage now and then turns green after being 
 exposed to the air for some time. This indicates a 
 slight disturbance and may be heeded as a warning. 
 The administration of calomel also turns the color 
 of the passage green. 
 
 Slime in the passage indicates a catarrh of the 
 bowels. If the slime is well mixed with the -rest, the 
 catarrh is higher up ; but if it is in lumps, very abun- 
 dant and not well mixed with the fecal matter, the 
 catarrh is lower down near the outlet. 
 
 Blood and slime appear in the passage if there 
 exists a more severe catarrh of the large intestines or 
 an invagination, that is, the slipping of one part of the 
 bowels into another as of the hand into a glove. In the 
 first instance the trouble begins with a diarrhea, 
 which is followed by slimy and later by bloody dis- 
 charges; in the second instance slime and blood ap- 
 pear suddenly without preceding diarrhea. This 
 
—99— 
 
 latter condition is very serious and calls for the im- 
 mediate employment of a physician. 
 
 Passages containing white undigested flakes are 
 called ''dyspeptic passages." The flakes consist of 
 either casein, that is, small particles of cheesy sub- 
 stance, or of fat. In the first instance they are hard, 
 yellowish and smell foul; in the second instance they 
 are soft, smooth and smell like sour cream or rancid 
 butter. The flakes indicate that the child receives 
 more than it can digest either of casein or fat accord- 
 ing to circumstance, The dyspeptic passages are 
 generally increased in number, three to eight a day, 
 sometimes more fluid than normal and of white or 
 whitish-yellow color or more or less green. 
 
 As to the treatment, it is of utmost importance to 
 ascertain positively if the flakes consist of casein or 
 fat. The following simple test clears the matter in 
 doubtful cases : Take some of the flakes and mix 
 them with one-half or one tablespoonful of strong, 
 undiluted alcohol or, still better, ether which is ob- 
 tainable in any drug store. If the flakes dissolve, they 
 consist of fat; if they do not dissolve, they consist of 
 casein. In the first instance the amount of fat, in the 
 second instance the amount of casein in the nourish- 
 ment must be diminished. For particulars see ''Arti- 
 ficial Feeding of Infants." 
 
 Foul smelling and offensive passages indicate a 
 rottening of the contents of the bowels. Too much 
 or an unsuitable nourisment has been given. 
 
 Thin and watery passages are met with in diar- 
 rhea. The number of the evacuations is not always 
 increased. One or two passages a day constitute a 
 diarrhea if the consistency of the discharge or dis- 
 charges is watery instead of being pasty. Generally, 
 however, the number of the evacuations is increased 
 under such circumstances. Errors in diet are as a 
 rule the cause. 
 
 Lora 
 
—100— 
 
 Very frequent and watery passages, generally 
 associated with fever, accompany infectious diseases 
 of the boweis, such as summer diarrhea, cholera, etc. 
 
PART IL 
 
 Feeding of trie Infant. 
 
—103— 
 
 CHAPTER XII. 
 
 IMPORTANCE OF BREAST FEEDING. 
 
 No food is so wholesome for the new-born as 
 mother's milk. It is, therefore, the duty of every 
 woman to nurse her child, if she is able to do so, that 
 is, if her breasts and nipples are well developed and 
 if the milk is sufficient in quantity and of proper 
 quality. 
 
 Unfortunately, however, many mothers do not 
 respond to this dictate of Nature. With the greatest 
 regret we have to note that, in spite of all efforts of the 
 government and of the medical profession, the number 
 of those mothers who nurse their babies is steadily de- 
 creasing. Unfortunately, we say; for both mother and 
 child have to suffer fom this anomaly. As to the chil- 
 dren, the truth of this assertion is forcibly demonstrat- 
 ed by the much greater mortality among infants fed 
 by hand as compared with nursing infants. Mortuary 
 statistics of larger cities, compiled with the greatest 
 care and conscientiousness, have proved that of loo 
 breast-fed babies, as an average, ten to fifteen die; 
 that of lOO hand-fed babies fifty die in the first two 
 years of life. The difference is appalling. Three out 
 of every four artificially fed infants who are now 
 doomed to perish could be saved, if fate would allow 
 them to partake of the blessings of mother's milk. 
 
 May this saddening fact serve as an impressive 
 object lesson and solemn warning to such mothers as 
 might otherwise neglect or seek to avoid this first 
 and most sacred of maternal duties. 
 
 Not only the child, as stated, but also the mother 
 is greatly benefited by the process of nursing. The 
 irritation of the nipple, caused by the sucking of the 
 child, promotes contractions of the womb, felt by 
 every mother and commonly known as afterpains. 
 
10 
 
 These afterpains are of incalculable value to the fu- 
 ture well-being of the mother. The diminution of the 
 womb, which is left in an enormously enlarged con- 
 dition after the expulsion of the child, is their work. 
 In the absence of this irritation through failure to 
 nurse, it often happens that the womb does not con- 
 tract and shrink sufficiently but remains in a state 
 of chronic enlargement. A train of ailments peculiar 
 to women is the consequence: bearing down feelings, 
 pains in the sides, pains in the back, pains in the legs, 
 pains between the shoulder blades, disturbances of 
 the monthly period, nervous troubles of all varieties, 
 etc., etc. In this connection it may also be mention- 
 ed that displacements of the womb are found twice as 
 often with women who did not nurse their babies as 
 with those who did nurse them. 
 
 If, therefore, mothers do not care to nurse their 
 children for the children's sake, let us urge them to 
 do it for their own sake. Much pain and misery can 
 and will be avoided; many advantages will be won 
 if Nature is allowed to have her proper and regular 
 course as to the feeding of infants. 
 
 There are, however, numerous conditions and 
 circumstances that may prevent a mother from nurs- 
 ing her child, even if she desires to do so. Among 
 such may be enumerated: 
 
 INSUFFICIENT DEVELOPMENT OF THE BREASTS AND NIPPLES. 
 
 Some mothers, owing to an insufficient develop- 
 ment of the mammary glands, are unable to furnish 
 any nourishment to the child. With others the milk, 
 flowing sparingly at first, fails altogether in a few 
 weeks or months. 
 
 If this anomaly is known from previous experi- 
 ence, sometimes it may be improved upon by a daily, 
 vigorous massage of the breasts during the latter 
 part of pregnancy. If, however, this defect does not 
 
—105- 
 
 become apparent until after the birth of the child, 
 there is no present remedy and the mother is per- 
 force compelled to submit to the inevitable — to feed 
 her child by hand. 
 
 In other instances it happens that, although the 
 breasts are full of milk, the mother cannot nurse, be- 
 cause the nipples are buried so deeply that the child 
 can not get a proper hold. 
 
 This defect also must be remedied during preg- 
 nancy. It is easy to do. All that is necessary is to 
 seize the nipples with the tips of the fingers and draw 
 them sharply outward several times a day. Before 
 long the nipples, heretofore deeply buried, become 
 
 Figure 33. Nipple Shield. 
 
 gradually more prominent and will be found in a 
 normal condition and easily accessible at the time the 
 child is born. 
 
 Confining pressure of wearing apparel, such as 
 corsets, etc., which is generally considered the cause of 
 the anomaly, will interfere with the success of the 
 treatment, if allowed to continue. It is, therefore, in- 
 dispensable to relieve this pressure. To this end the 
 clothing should be loosened and the nipples surround- 
 ed by a ring of soft rubber, or cloth, or felt, similar to 
 that used for corns, fastened with a strip of adhesive 
 plaster. 
 
 If these eilorts, faithfully made, fail to produce 
 the desired result, the mother should not give up in 
 despair and abandon her intention of nursing the 
 child. The feeding through a shield, such as is shown 
 in Fig. 33, will adjust the difficulty. Thus the rem- 
 
■106— 
 
 edy is easily provided without depriving the child of 
 the blessings of mother's milk, which Nature seemed 
 to be inclined to withhold. 
 
 SORE NIPPLES. 
 
 The repeated and long continued moistening of 
 the nipples by the lips of the child is followed by a 
 loosening and shedding of the upper layers (Fig. 34 b) 
 of the skin and a partial exposure of the lower 
 tender layers (Fig. 34 a). This process of disso- 
 
 Figure 34. Section of the skin as seen under microscope, (a) lower, 
 tender layers, (b) outer, horny layer. 
 
 lution advances, under normal circumstances, no 
 further than that Nature, if proper care is taken, is 
 able to restore the diminished resisting power of the 
 nipples between the nursings sufficiently to prevent 
 bad consequences. If, however, abnormal conditions 
 prevail, as for example, if the skin of the nipples is 
 thin and vulnerable, or if the nipples are so small and 
 drawn in that the child is forced to pinch and to bite 
 them in order to maintain its hold, small tears and 
 and cracks are unavoidable. Similar lesions on other 
 parts of the body that can be kept clean and undis- 
 turbed are generally of slight consequence and heal 
 rapidly, but on the nipple they may become very seri- 
 ous. The reason is twofold: First, the process of 
 nursing, repeated at regular intervals, irritates the 
 sore and keeps it open; second, the danger of infec- 
 tion is great, since the mouth of a child, be it appar- 
 ently ever so clean, is a breeding place for countless 
 germs, which, should they find lodgment in the lacer- 
 ation of the skin, will produce an inflammation of 
 more or less serious nature. 
 
—107— 
 
 The conclusion follows that the liability to dis- 
 ease is proportionately greater where the nipple is 
 tender and where it is less accessible to the child. An 
 extra amount of caution is, therefore, necessary un- 
 der such circumstances. 
 
 The first indication of a diseased condition of the 
 nipples is the pain felt during nursing. At such time 
 the lesion of the nipple, which later results in ulcer- 
 ation, may be so slight as to be as yet imperceptible 
 to the naked eye. It is, therefore, usually not mind- 
 ed. The mother thinks that she is making a laudable 
 sacrifice in continuing the nursing in spite of the 
 pain. This is a mistake. The pain is a warning 
 which should be heeded. If this is not done, there 
 become visible gradually distinct reddish or yellow- 
 ish looking sores which group in a halfmoon forma- 
 tion around the base of the nipple. They bleed freely 
 during nursing and often discharge a mattery fluid. 
 But, even in spite of these, many mothers continue 
 nursing and do not think it time to attend to the mat- 
 ter until the pain becomes unbearable or fever de- 
 velops. 
 
 In the light of the facts given in the following 
 pages and considering the danger, pain, and suffer- 
 ing which may arise from a lesion so easily treated 
 and removed in its initial stages, we must say that 
 this practice is inexcusable and should be discour- 
 aged as much as possible. 
 
 Prevention — Prevention is easy. Above all, the 
 nipple should be hardened and its skin vitalized. This 
 can be done by bathing the nipple every morning and 
 evening with brandy or a mixture of alcohol and wat- 
 er equal parts, using a soft, clean cloth or, better, ab- 
 sorbent cotton for the purpose. The treatment should 
 be applied during the last two or three months of 
 pregnancy and thereafter continued after each nurs- 
 ing. 
 
 All wearing apparel which may cause pressure on 
 
—108— 
 
 the breast should be avoided and depressed nipples be 
 treated according to the instructions given on page 
 105. The nipple should never be allowed to come in 
 touch with the daily clothing. A soft, freshly wash- 
 ed rag, which is frequently to be changed, must cover 
 the breast and keep it from coming in contact with 
 the dressing. 
 
 If the skin is dry and brittle and cracks easily, a 
 thin coat of Hydrous Wool-Fat (Prescription 37), 
 applied once or twice a day or after each nursing, 
 will make it soft and pliable. 
 
 Prescription 37. 
 
 Hydrous Wool Fat 1 ounce 
 
 Treatment — Any pain arising during nurs- 
 ing calls for immediate attention, even though no sore 
 may as yet be visible to the naked eye. The first 
 thing to do is to employ a nipple-shield (Fig. 33 on 
 page 105) and to continue its use until the nipple is 
 perfectly healed. This preventive measure avoids the 
 contamination of the nipple and of the sore, should 
 one develop, by the lips of the child, a very essential 
 thing in order to avoid infection. 
 
 By this precaution the very first stages of the 
 sore often heal without any further treatment than 
 the regular care as outlined above. If they do not, or 
 if a visible ulcer has developed, the nipple should be 
 bathed after each nursing with a solution of Boric 
 Acid (Prescription 38), dried gently with absorbent 
 
 Prescrpltlon 38. 
 
 Boric Acid 3 ounces 
 
 cotton, spread with one of the following ointments, 
 covered first with surgical gauze or a piece of clean 
 linen and then with absorbent cotton and bandaged 
 (see Fig. 35). 
 
 The ointment best to be used is given in Prescrip- 
 tion 39. 
 
—109- 
 
 Prescription 39. 
 
 Zinc Peroxide •. % drachm 
 
 Petrolatum 1 ounce 
 
 If this cannot be procured, one of the two others 
 may be employed (Prescriptions 40 and 41). 
 
 Prescription 40. 
 
 Boric Acid % drachm 
 
 Petrolatum. 
 
 Hydrous Wool-Fat, each V^ ounce 
 
 Prescription 41. 
 
 Resorcin % ounce 
 
 Petrolatum. 
 
 Hydrous Wool-Fat, each i/^ drachm 
 
 Figure 35. Bandaging of Breast. 
 
 Before nursing the remainder of the ointment 
 must be removed with dry absorbent cotton. 
 
 If the nipple is reddened and inflamed, applica- 
 tions with the following solution (Prescription 42), to 
 
 Prescription 42. 
 Solution of Lead Subacetate 4 ounces 
 
 be made three to four times a day for one-half to 
 three-quarters of an hour, are very beneficial. Proceed 
 as follows: Mix from one-half to one ounce of the 
 medicine with a pint of -water which has been boiled 
 and cooled again. Then take a piece of linen, fold it 
 over several times, dip it into the solution, press it out 
 
—110- 
 
 slightly and apply to the sore, changing every five to 
 ten minutes. 
 
 If, in spite of this treatment, recovery is retarded 
 or no progress is made, the child must be removed 
 from the affected breast, when the rest thus given, 
 will bring about a speedy cure in most instances. 
 
 If, by neglect, the ulceration becomes chronic and 
 shows no tendency to heal, the ointment given in Pre- 
 scription 43 is very effective. 
 
 Prescription 43. 
 
 Silver Nitrate 2% grains 
 
 Balsam of Peru % drachm 
 
 Hydrous Wood Fat 
 
 Petrolatum, each % ounce 
 
 Only in rare and ycvj obstinate cases is the 
 stimulating effect of this ointment not sufficient. An 
 application of pure, undiluted Balsam of Peru (Pre- 
 scription 44), repeated once a day as long as neces- 
 
 ' Prescription 44. 
 
 Balsam of Peru 1-3 ounce 
 
 sary, will then start the healing. If this is done, the 
 ointment given in Prescription 43 can finish the rest. 
 
 INFLAMMATION OF THE BREAST. 
 
 Much more serious than the ulceration of the 
 nipple is the inflammation of the breast, which finds 
 its inception almost invariably in these very ulcera- 
 tions. This is because the latter serve in the majority of 
 cases as a portal of entry for the disease germs, which 
 are the actual producers of the trouble. In very rare 
 instances the micro-organisms find their way into the 
 interior of the breast through the outlets of the milk 
 producing glands. 
 
 As soon as disease germs have settled in the 
 breast, their pernicious work begins and inflammation 
 follows. A hard and painful lump develops. At once 
 the danger of an abscess is very near. If no corrective 
 is employed, the lump increases in size and inter- 
 grows gradually with the outer skin, which becomes 
 
Ill- 
 
 reddened in appearance. The movements of the arm 
 grow painful. The glands in the armpits swell and 
 may be felt as Httle, round, sore, movable knots. Red 
 streaks on the skin lead from the breast to the arm- 
 pit, indicating the road on which the poison, from 
 the original seat of the infection, is progressing to in- 
 vade the general circulation of the blood. In the 
 same direction shoots the pain. Fever prevails. In 
 many instances it is ushered in with a chill and often 
 rises up to 104 or 105 degrees Fahrenheit. The pain is 
 severe and the suffering great. 
 
 The lump, which was hard so far and has in- 
 creased to a considerable size in the meantime, begins 
 now to soften in the center. An abscess forms. The 
 adjacent skin inflames still more, bulges and finally 
 breaks, discharging freely a thick, greenish-yellow 
 matter. This brings relief. The fever lessens, the 
 pains diminish and the breast begins to heal. 
 
 Prevention — The means of prevention are self- 
 evident inasmuch as this painful and oftentimes 
 dangerous inflammation of the breast almost invari- 
 ably has its origin in sores of the nipple, however 
 small they may be or however innocent they may 
 look. Whatever tends to prevent these sores (see 
 previous chapter), serves, therefore, also to prevent 
 the inflammation. If, at the same time, fissures, 
 should they develop, are treated early and properly, 
 and if the mouth of the child is kept scrupulously 
 clean, a safe protection is afforded and no mother 
 need fear the dreaded malady. 
 
 To further increase the safety of the mother it is 
 urged to handle also the healthy nipples with clean 
 fingers only, since, perchance, microbes, under favor- 
 able circumstances, may find their way to the interior 
 of the breast through the outlets of the milk produc- 
 ing glands, as stated above. For the same reason, all 
 wearing apparel, coming in contact with the nipples, 
 must be absolutely clean and harbor no disease germs. 
 
112- 
 
 It is an evil habit of mothers of the lower walks of 
 life to simply slip the breast back into the corset after 
 nursing the baby without any precaution whatever. 
 This habit is to be condemned. The least that can 
 be expected is that a clean, freshly boiled flannel cloth 
 is steadily interposed between breast and shirt as a 
 protection for the nipple. 
 
 The old view, held by the laity, that inflamma- 
 tions of the breast are caused by catching cold, stag- 
 nation of milk, etc., is not correct, as shown in the 
 foregoing. With these foul excuses negligent at- 
 tendants try to shirk responsibility and to place the 
 blame upon the innocent mother. No sufferer should 
 be satisfied with such an explanation. If she will look 
 for the cause of the trouble, she will find it and can 
 place the responsibility where it belongs. Not until 
 we know and understand the workings, is an intelli- 
 gent prevention possible. 
 
 Treatment — The treatment varies with the stage 
 of the disease. If suppuration has not yet set 
 in and the earlier stage has to be dealt with, that is, 
 the hard and painful lump, every effort should be bent 
 towards preventing such suppuration. If we suc- 
 ceed, the inflammation will subside in a much shorter 
 time and much misery will be averted. To this end 
 ice is to be employed in the following manner: The 
 stricken mother lies down, lays upon the breast a 
 cloth dipped in cold water and pressed out tightly, 
 places upon this an ice-bag, such as can be bought at 
 any drug store, filled with finely crushed ice and tight- 
 ly closed that no water can escape. Close attention 
 should be paid that the ice cools but the diseased spot, 
 the surrounding parts being protected by a flannel 
 cloth, laid around the seat of the inflammation. If 
 the ice is too cold, there should be interposed between 
 the skin and the ice-bag two, three or four layers 
 of wet linen instead of one. The more layers, the less 
 the cold is felt, but the less also the efficiency and the 
 
113- 
 
 curative effect of the ice-bag. It is, therefore, neces- 
 sary to allow the ice to work as strong as can. be 
 borne. Never, however, should an ice-bag made 
 of uncovered rubber, be placed upon the bare body, 
 since it may freeze the skin; nor should it ever be 
 placed upon a dry cloth. A dry cloth does not per- 
 mit the cold to penetrate and renders the whole pro- 
 cedure useless. 
 
 The best results are achieved if the skin under the 
 bag is just as cold as ice to the touch. If it is not, the 
 ice works insufficiently and the fault must be rem- 
 edied. A control is, therefore, necessary, and should 
 be had by feeling from time to time of the skin of 
 the breast. 
 
 This treatment with ice is extremely beneficial 
 in all those cases which are taken care of at the very 
 beginning before any suppuration has started. The 
 pain ceases, the inflammation subsides, the fever les- 
 sens and disappears and the lump dissolves without 
 turning into an abscess. 
 
 As soon as matter has formed, be it ever so little, 
 the ice is not well borne. If applied, the pain in- 
 creases. The case now calls for hot applications in- 
 stead of cold Hot linseed poultices are best to be 
 used and should be renewed night and day as soon 
 as they begin to cool. Linseed poultices hasten the 
 process of ripening and the formation of the abscess 
 in the same degree as the ice delays it. 
 
 As to the choice of the application, if cold or 
 hot, the following general outline ma}^ serve as a 
 guide. Cold should first be tried in all cases which are 
 in the initial stages, since, if efficient, it cuts short the 
 disease and saves an operation and much suffering. 
 Hot applications are to be employed if the ice in- 
 creases the pain, or if the softening of the lump has 
 already begun. 
 
 For those mothers who cannot lie down, a third 
 way of treating an inflammation of the breast may be 
 
—114— 
 
 mentioned. This is the treatment with an alcohol 
 bandage. It allows the mother to be up and has 
 the further advantage of assuring an effective result 
 under all circumstances. It will prevent suppuration, 
 if preventable, and if not, it will hasten it and quickly 
 ripen the abscess. 
 
 The alcohol bandage is made in the following 
 manner: A piece of absorbent cotton, large enough 
 to cover the breast, is moistened with alcohol, placed 
 upon the breast and covered with a piece of oil-cloth 
 or oil-silk which must over-reach the cotton to all 
 sides to the extent of the width of four to five fingers. 
 Thus the alcohol, contained in the cotton, cannot eva- 
 porate and is forced to penetrate, a point which is of 
 the utmost importance. The dressing is fastened 
 with a bandage in the way as shown in Fig. 35 on 
 page 109. that is, the right breast over the left shoul- 
 der and the left breast over the right shoulder. If pro- 
 perly applied, it wlil help considerably to ease the 
 pain. It should lift the breast as high as possible 
 without pressing upon the swelling as sagging in- 
 creases the suffering. Instead of a bandage a towel or 
 a bedsheet may profitably be used. 
 
 The pain starts anew when the cotton begins 
 to dry. This is a sign that it must be moistened again. 
 If the alcohol causes a burning sensation of the skin, 
 as it sometimes does, it is well to dilute it some- 
 what with water, or to cut a few little holes in the oil- 
 cloth so as to give the air a chance to withdraw 
 some of the fluid. Then the burning ceases. 
 
 Although the alcohol bandage proves most bene- 
 ficial in many instances, it sometimes becomes unbear- 
 able after a few applications which helped very nicely. 
 This happens especially when the ripening of the 
 abscess has begun. The substitution of hot linseed 
 poultices is indicated under such circumstances. 
 
 What should be done in a given instance has to 
 be decided from case to case. Enough has been 
 
—115- 
 
 said to enable the mother to use proper judgment. If 
 she finds that she was mistaken, she must change. No 
 harm is done. The pain should be her guide. What 
 hurts the least, is best adapted. 
 
 When suppuration has progressed to the point 
 where the swelling has sufficiently softened, the 
 abscess should be lanced. To wait until it breaks and 
 discharges of its own accord, a too common occur- 
 rence, is dangerous and ill advised. The destruction 
 of the tissue in the interior of the breast becomes too 
 extensive and pain and fever are unnecessarily pro- 
 longed. The lancing of the abscess clears away all 
 annoyances in the shortest possible time and hastens 
 the cure considerably. 
 
 If the abscess is open, its cavity must be thor- 
 oughly rinsed once a day with a solution of Rheno- 
 
 Figure 36. Ear and Ulcer Syringe. 
 
 lin, a very recommendable, effectice, and non-poison- 
 ous disinfectant (Prescription 45), in the strength of 
 
 Prescription 45. 
 Rhenolin 4 ounces 
 
 one teaspoonful to a pint of boiled water, the solu- 
 tion to be used as hot as possible. The instrument 
 employed for the purpose is either a small rubber bulb, 
 as shown in Fig. 36, or, better, an ordinary fountain 
 syringe, preferably with a glass nozzle (Fig. 37). 
 This instrument must be kept scrupulously clean. 
 Its nozzle should be boiled every day or at least every 
 second day and be kept wrapped in a clean towel, 
 when not in use. If Rhenolin cannot be procured in 
 time. Boric Acid may be substituted (Prescription 
 46), prepared in the manner as described on page 6, 
 
■116- 
 
 Prescription 46. 
 Boric Acid 3 ounces 
 
 or a solution of Corrosive Sublimate. To prepare this 
 latter medicine, dissolve one of the following tablets 
 (Prescription 47) in a quart of freshly boiled water. 
 
 Prescription 47. 
 
 Corrosive Mercuric Chloride 7 1-3 grains 
 
 Sodium Chloride 7 2-3 grains 
 
 We emphatically warn against Carbolic Acid, al- 
 though it has been and is still used extensively. A 
 weak solution of it is perfectly ineffective, a strong 
 solution is efficient but highly poisonous. 
 
 The breast should be supported continually dur- 
 
 Figure 37. Fountain Syringe, (a) rubber baj 
 for rectum, (d) end piece made of glass. 
 
 (b) stop cock, (c) end piece 
 
 ing the entire treatment by a bandage in the way 
 before suggested. 
 
 As in all other infectious diseases so also in the 
 case of an inflammation of the breast, there circulate 
 millions upon millions of harmful microbes with the 
 flowing blood through the entire system, under- 
 mining its resisting power and making disturbances 
 and annoyances of the most varied kind. The local 
 treatment, of course, is powerless against these tiny 
 miscreants. In order to reach them a disinfection 
 of the entire blood must be effected. This can be 
 done with Silver Crede. The remedy is perfectly 
 harmless to the human organism but very hostile and 
 
—117— 
 
 deadly to the disease germs. 1'he results, obtained 
 therewith in the hands of the writer, are so remark- 
 able that he does not hesitate to pronounce it one of 
 the most important, yes, an indispensable remedy in 
 the treatment of the ailment in question. 
 
 The form in which Silver Crede is generally and 
 best used, is that of an ointment. This is called 
 "Unguentum Crede," according to its inventor, Dr. 
 Crede, a German physician. The ointment is 
 
 Prescription 48. 
 Unguentum Crede V2 ounce 
 
 divided into five doses 
 
 black. It must be rubbed into the skin and is sup- 
 posed to go through the pores into the blood. The 
 black color, the greasy consistency, the besmearing 
 of the body and the work of the rubbing, are in- 
 conveniences, we admit, but are insignificant as com- 
 pared with the splendid results achieved by this 
 remedy in times of danger and distress. 
 
 One of the packages, prescribed in the foregoing 
 prescription, is used at each rubbing and massaged in- 
 to the skin for twenty to twenty-five minutes. Immedi- 
 ately after the application the place of the inunction 
 is black as coal. It lightens, however, in the course 
 of the next few days as the remedy is absorbed gradu- 
 ally into the blood. In order to facilitate this absorp- 
 tion and not to overload the already filled pores, a 
 different place is chosen for every rubbing until the 
 entire body is covered. 
 
 The procedure is as follows: After a thorough 
 bath with hot water and soap, in order to open the 
 pores, the skin is allowed to dry for a few hours. 
 Then the rubbing begins. It is done in the following 
 order : 
 
 The first package is rubbed all over the entire 
 back from the neck down to the end of the spine. 
 
 The second is rubbed all over the chest and the 
 abdomen, avoiding only the afflicted breast. 
 
—118— 
 
 The third is rubbed all over one leg from the 
 groin down to the ankles, in front and behind 
 
 The fourth is rubbed all over the other leg in the 
 same manner. 
 
 The fifth is rubbed all over both arms from the 
 shoulder dow^n to the wrist. 
 
 The rubbing must be done twice a day, morning 
 and evening, in all dangerous cases in which a quick 
 and energetic action is required. One a day, either 
 in the morning or in the evening, is sufficient in all 
 other cases. 
 
 One-half day after the last rubbing a bath is 
 taken and the underwear is allowed to be changed, 
 not before. Although the body looks like that of a 
 negro and the underwear like that of a coalheaver, 
 one must take these inconveniences into the bargain 
 if such a precious thing as life and health is at stake. 
 
 After the bath, if necessary, the entire treatment 
 must be repeated in the same succession. Gold rings 
 on the fingers of the patient or on those who do the 
 rubbing turn white and should be removed before 
 the work begins. 
 
 As stated above, the ointment is perfectly harm- 
 less to mother and child. It is not to be confounded 
 with the quicksilver ointment, which looks very much 
 the same but is very poisonous. 
 
 A substitute for the ointment is a i per cent solu- 
 tion of Soluble Silver. It is, to be sure, less effective 
 but also excellent in its results. One tablespoonful of 
 this solution is taken three or four times a day at 
 the most convenient time (Prescription 49). 
 
 Prescription 49. 
 
 Argentum Colloidale 20 grains 
 
 Distilled Water 4 ounces 
 
 The effect of the remedy is generally as follows : 
 Even after the first rubbing the patient, who before 
 was restless, in pains and misery, begins to get quiet, 
 rests easier, feels better. After a few more doses the 
 
—119— 
 
 fever declines, the hard and painful lump loses its ten- 
 derness and disappears, or the matter forms and 
 breaks through quickly and with less pain. Instead of 
 a protracted illness, the cure is speedy and recovery 
 rapid. 
 
 The local treatment, of course, should not be 
 neglected but be faithfully employed at the same time. 
 
 SICKNESS OF THE MOTHER. 
 
 Nursing is forbidden : 
 
 A. In cases of acute diseases of the mother ac- 
 companied by fever, such as typhoid fever, small pox, 
 diphtheria, scarlet fever, pneumonia, etc., if they are 
 very severe. If they are slight, the nursing need not 
 be interrupted, but the child should be kept separated 
 from the mother during the intervals in order to pro- 
 tect it against the disease. 
 
 B. In cases of serious chronic ailments, such as 
 exhausting kidney-diseases, extreme anemia, serious 
 heart trouble and, above all, consumption. Even a 
 suspicion of, or a tendency to, consumption in the 
 mother is sufficient to make nursing prohibitive, as 
 the latter exercises a dangerous and deleterious in- 
 fluence upon the mother and exposes the child to. the 
 danger of infection. 
 
 On the other hand, a slight anemic condition is 
 no reason why a mother should not nurse her child, 
 as it can easily be remedied by the use of proper 
 nourishment and medicines. If, however, this condi- 
 tion does not yield to treatment and the trouble in- 
 creases; if the mother grows weaker, loses her appe- 
 tite, suffers with continual headache, dizziness or 
 sharp, darting pains in the breasts and in the back, 
 and if she becomes subject to palpitation of the heart, 
 — then, for the mother's sake, the baby must be 
 weaned and artificial feeding resorted to. 
 
 C. In cases of chronic nervous troubles and af- 
 fections of the mind, such as epilepsy, hysteria, insan- 
 
—120— 
 
 ity, etc. Slight nervousness is no contra-indication 
 for nursing. 
 
 For particulars as to the continuation or non- 
 continuation of the nursing during the monthly pe- 
 riod or an occasioned new pregnancy see the chapter 
 on "Weaning." 
 
 CONDiTIONS OF THE INFANT INTERFERING WITH NURSING. 
 
 New-born infants will occasionally refuse the 
 breast. This is in most instances in consequence of an 
 aggravated catarrhal conaition of the mouth, which 
 in a less pronounced degree is common to most new- 
 born babies. In such cases the mucous membrane of 
 the mouth is abnormally red and sensitive; the child 
 will take the breast, but, owing to the pain, immedi- 
 ately quits. After repeated similar attempts, it final- 
 ly ceases its efforts and cannot be induced to renew 
 them again. 
 
 This condition need not cause alarm. The milk, 
 pumped or massaged out of the breast, should be fed 
 with a spoon until the inflammation has subsided, 
 when nursing can be resumed. This will ordinarily 
 take place in a week or ten days. 
 
 A further interference with nursing is sometimes 
 caused by a clogging of the nose in consequence of a 
 catarrh or a tumor of the nasal passages. In such in- 
 stances breathing becomes difficult or impossible 
 while nursing, since the inhaled and exhaled air has to 
 take this route during that time. The infant's con- 
 duct is quite characteristic. It begins to nurse, draws 
 two or three times and lets the breast go. After sev- 
 eral deep breaths it starts again and so on, repeating 
 its efforts until it becomes tired and by pitiable crying 
 indicates its displeasure. 
 
 The treatment is simple in case of catarrh. A 
 little cotton is wrapped around the end of a match or 
 a toothpick, dipped into the following ointment (Pre- 
 scription 50), introduced into the nostril and spread 
 
—121- 
 
 Prescription 50. 
 
 Adrenalin Ointment (1: 1000) one tube 
 
 as much as possible. In a few minutes the sweUing 
 subsides and the passage gets free. The same is done 
 with the other nostril and the treatment repeated, if 
 necessary, before each nursing. If too much of the 
 ointment is taken, it may become poisonous. It is, 
 therefore, advisable to use as little as possible for ac- 
 complishing the purpose. 
 
 At times certain malformations are the root of 
 the evil. Among these are tongue-tie, harelip and 
 cleft palate. They must be operated upon. 
 
 In a comparatively small number of cases no rea- 
 son whatever can be discovered. The child simply 
 will not nurse. It also sometimes happens that the 
 child will take one breast with avidity and refuse the 
 other with energy. Here also the cause may remain 
 in doubt. 
 
122- 
 
 CHAPTER XIII. 
 
 MOTHER'S MODE OF LIFE AND REGULARITY OF HABITS. 
 
 As both the quantity and quahty of the mother's 
 milk are of the greatest importance to the well-being 
 of the child and as they are more or less dependent 
 upon the mode of life and the nourishment of the 
 mother, a more intimate knowledge of these matters 
 becomes imperative. 
 
 A mother, while nursing, should lead a simple 
 and retired life. All exciting diversions, such as the 
 theater, concerts, balls, etc., as well as undue social 
 activity in general had better be avoided. Unusual ex- 
 hilaration, keen disappointment, great fear or sudden 
 fright, all exercise a decidedly unwholesome influence 
 upon the mother's milk. Many cases are on record 
 where a sudden strong emotion of the mother so 
 changed her milk that serious illness of the child re- 
 sulted in consequence. 
 
 In addition to mental peace and quietude, bodily 
 rest and comfort, if it can be obtained, should also be 
 provided for. A plentiful rest, at night especially, is 
 of the highest importance. The sleep of the mother 
 as well as that of the child should, therefore, be dis- 
 turbed as little as possible. 
 
 However, though mental and physical rest is 
 highly recommended, it is not meant by any means 
 that wholesome exercise in the open air should be 
 abandoned. On the contrary, it should be encour- 
 aged. The care of the child will of necessity tie the 
 mother more than usually to her house and the daily 
 walk is likely to be neglected. This must not be 
 done. A walk should be regularly taken in winter as 
 well as in summer so long as the weather will permit 
 
—123- 
 
 it. This is essential for the aeration of the blood and 
 the proper performance of the intestinal functions. It 
 is the excessive or violent exercise that is to be dis- 
 couraged. 
 
 A regular, daily, substantial movement of the 
 bowels is of prime importance to nursing women. If 
 the mother is costive, the child is thereby affected. 
 The abnormal, morbid condition is often transmitted 
 to the latter and lays the foundation of a tendency 
 to indigestion, which may adhere to the offspring 
 throughout its entire life. 
 
 In case of existing costiveness natural means 
 such as exercise in the open air, proper food, etc., and 
 even enemas are far better than drugs for nursing 
 mothers. For special information as to this point 
 we refer to a later chapter on "Constipation," which 
 may be taken as a guide for the mother as well as 
 for the child. 
 
 NOURISHMENT FOR NURSING MOTHERS. 
 
 A. What a nursing mother shall partake of: 
 It is only during the first two or three days after the 
 birth of the child that the mother should be confined 
 to the more restricted diet of milk, boiled eggs, gruels 
 of rice or oatmeal or barley, chicken or other meat- 
 soups, toast, bread and butter and cooked fruit. 
 After the third day the diet can be more liberal and 
 fowl, fish, veal, etc., be included. 
 
 As soon as the mother has left the bed her former 
 ordinary diet should be resumed. Substantial changes 
 are not desirable. As proof hereof may be cited the 
 cases of such wet-nurses as may have been called to 
 the city from the country and who sometimes, as 
 the result of the novel surroundings and entire change 
 of diet, suddenly lose their milk, but at once regain 
 it when returned to their rural home and plain diet. 
 
 The ordinary mixed diet furnishes the best and 
 the greatest quantity of milk. Easily digested meat 
 of all kinds, fish and fowl included, furthermore eggs, 
 
■12 
 
 bread and butter, honey, milk, buttermilk, potatoes, 
 farinaceous foods, puddings, gruels of rice, barley, 
 flour or oatmeai, etc., pea and bean-soups, cooked 
 fruit, all breakfast foods, the fresher and softer kinds 
 of cheese, etc., — all produce a milk that is good and 
 wholesome to the child. As a general outline it de- 
 serves emphasis, however, that a meat diet will pro- 
 duce a thicker and more substantial milk, w^hile a pre- 
 ponderance of vegetables in the diet will render the 
 milk proportionately thinner and more watery. 
 
 The best beverage is fresh, pure water. Coffee 
 and tea in limited quantities are also permissible but 
 should preferably be taken with a large admixture of 
 milk. Beer and wine had better be avoided. The 
 less alcoholic drinks are indulged in, the better it is. 
 If something must be taken, extract of malt, as made 
 in breweries, is preferable. It contains the smallest 
 amount of alcohol, is richest in nourishment, stim- 
 ulates the appetite, and acts as a gentle laxative. The 
 particular brand is a matter of individual choice, as 
 they are all made along similar lines. Every mother 
 may, therefore, select one according to her own taste. 
 
 Tonics: The efforts during confinement, the 
 great loss of blood during this period, and the loss of 
 vital force caused by the nursing, tax the mother above 
 the normal limit. What wonder, therefore, that it is a 
 frequent question, heard from mothers: "What shall 
 I take to build me up again and give me strength? 
 Which is the best tonic?" In answer we must state 
 that a good and relished food and a plentiful amount 
 of pure, fresh air are the best reconstructives. 
 
 But in many cases the blood is poor in iron and 
 the regeneration of the loss and the formation of new, 
 pure, and healthy blood is very slow without an ade- 
 quate supply of properly prepared iron, especially if 
 the appetite is wanting. A good, reliable tonic will, 
 therefore, prove welcome in many instances. In or- 
 der, however, to answer its purpose it must fulfil cer- 
 
—125— 
 
 tain requirements. It must contain all those ele- 
 ments which are necessary for the formation of new 
 blood; it must stimulate the appetite and the diges- 
 tion and must, above all, contain no ingredients 
 which, like alcohol, are injurious to the child, since 
 they may, as we shall see later, go over into the milk 
 and injure the baby. 
 
 Only a very few preparations do, in fact, fulfill 
 these requirements. Far the most remedies, which 
 are recommended for nursing mothers and are offered 
 to the public through the medium of the daily press, 
 are either worthless or detrimental. They contain, in 
 the majority of instances, no such ingredients as are 
 required for the formation of blood but instead great 
 quantities of alcohol and are stimulants or drinks 
 rather than tonics. 
 
 Of the few that are recommendable Iro-Tonic 
 (Prescription 51) is the best. It contains iron in 
 
 Prescription 51. 
 Iro-Tonic 16 ounces 
 
 abundance and in easily digestible form, will not cor- 
 rode the teeth, is very nourishing, an excellent ap- 
 petizer and entirely free from alcohol. These prop- 
 erties make Iro-Tonic an ideal tonic for debilitated 
 women, no matter whether the weakness is caused 
 by the confinement or by exhausting diseases. These 
 same properties make it also the best tonic in all 
 debilitated conditions of children. It builds up and 
 reconstructs wherever new tissue is needed or wasted 
 substances must be replaced. It is absolutely non- 
 injurious and can, without hesitation, be given to the 
 youngest infant. The writer has used it for many 
 years with the most gratifying results both for women 
 and children. 
 
 For the greater convenience in handling and 
 taking, Iro-Tonic Tablets (Prescription 52) have been 
 
 Prescription 52. 
 Iro-Tonic Tablets No. 150 
 
 prepared. They are equally effective and should be 
 
—126— 
 
 preferred in all cases except for small children and 
 for those older children and adults who cannot swal- 
 low pills. 
 
 Wine is no reconstructive. It contains no nour- 
 ishment but plenty of alcohol. It is more of a stimu- 
 lant and not to be recommended under ordinary cir- 
 cumstances. 
 
 Kephir, however, is an excellent reconstructive 
 and deserves the highest recommendations. More 
 about it can be found in one of the later chapters. 
 
 B. What a nursing mother shall not partake of : 
 All beverages containing larger proportions of alco- 
 hol, such as whisky, brandy, gin, etc., should be 
 avoided. The alcohol passes over into the milk and 
 injures the child. All sharp as well as highly sea- 
 soned or salted eatables such as game, oysters, crabs 
 or other shellfish, salted or pickled herring, as also 
 onions, garlic, radishes, etc., are likewise objection- 
 able. They give the milk a pungent and disagreeable 
 tast'e. 
 
 The mother should be particularly careful in the 
 use of drugs and medicines as many of them pass over 
 into the milk and may prove harmful to the baby. 
 Among these may be mentioned: All volatile oils, such 
 as anise oil, wintergreen oil, spirit of camphor, as well 
 as turpentine, castor oil, quinine, potassium iodide, 
 strychnine, antipyrine, chloral hydrate, morphine, 
 opium, belladonna and many others. For example, 
 turpentine may give the mother's milk such a sweetish 
 taste that the child will often refuse it. Castor oil 
 thus acts on the child and produces diarrhea. And 
 yet castor oil is better for nursing mothers than 
 Rochelle, Glauber or Epsom Salt. 
 
 Most dangerous is the use of morphine, opium 
 and other narcotics and soporifics. Even if taken by 
 mothers in moderate doses, the drug is frequently 
 transmitted through the milk to the child in such 
 quantities as to render it costive, sleepy, soggy and 
 almost intoxicated. 
 
—12; 
 
 It follows that nursing mothers should exercise 
 more than ordinary care in what they partake of and 
 should particularly avoid patent medicines of doubt- 
 ful nature, almost all of which contain the very ele- 
 ments of danger to which reference has been made. 
 
—128— 
 
 CHAPTER XIV. 
 
 NORMAL FUNCTION OF THE BREAST. 
 
 Before we enter upon the description of the dis- 
 turbances in the function of the breast it will be neces- 
 sary to first get acquainted with the normal con- 
 ditions. 
 
 • Already in the second half of pregnancy the 
 breasts begin to swell. They become harder and 
 slightly painful. On strong pressure there exudes 
 from them a little watery fluid. This status remains 
 until after birth, when within a few hours the secre- 
 tion begins to increase. The increase continues gradu- 
 ally. Already in the second day the milk can be 
 pressed out in a stream. Not, however, until the third 
 or fourth day the milk ''shoots in," that is. comes in in 
 larger quantities. Then the breasts heretofore soft 
 and flabby, become hard, their base lumpy . The 
 secretion grows abundant. But even at this time 
 the fluid, coming from the breast, has not as yet as- 
 sumed the nature of the finished product. On close 
 inspection one can see that it does not look uniform 
 and glaringly white as normal milk but more watery 
 and uneven. So the milk remains until the child, by 
 its repeated and vigorous sucking, brings the breast 
 to its full secretive power, which generally occurs 
 between the eighth and fourteenth day. When this 
 is done, the milk flows in abundance and is of normal, 
 uniform quality. 
 
 The co-operation of the child is, as we see from 
 the foregoing, indispensable in order to prepare the 
 breasts for nursing, that is, the irritation of the nipple 
 by the energetic and vigorous sucking of a hungry 
 baby is of prime importance for the development of 
 the breast. If, therefore, the child is weak, or if the 
 nipples are drawn in, or if there exists any other rea- 
 
—129— 
 
 son which hinders a vigorous sucking, the milk pro- 
 ducing glands will not develop sufficiently. The con- 
 sequence is an insufficient milk, supply. This ex- 
 plains the following seemingly curious phenomenon 
 which sometimes can be observi^d. Mothers, who did 
 not seem to have sufficient milk for their own emaci- 
 ated, puny little babies, produce in a short time an 
 abundance of milk after vigorously sucking children 
 of other mothers were regulariv laid to their breasts, 
 and this in spite of the fact that their diet and mode 
 of living remained unchanged. 
 
 There is, besides the irritation of the nipple, an- 
 other factor which has a great influence upon the 
 quantity of milk secreted. This is the complete or 
 incomplete emptying of the breast. If the breast is 
 only partially relieved of its contents and the re- 
 maining milk becomes stagnant in the glands, the 
 secretion of new milk is hindered, the secreting cells 
 slacken in their activity and as a consequence the out- 
 put is diminished; but if the breast is completely 
 emptied, way is given for new milk, the glands are 
 stimulated to higher activity and as a consequence 
 the output is increased. 
 
 Both a vigorous sucking and a complete empty- 
 ing are, therefore, indispensable to the full develop- 
 ment of the breasts and should be aspired by every 
 mother. 
 
 The foregoing discussion gives satisfactory proof 
 that not always is the breast at fault, if the secretion 
 of milk is insufficient. The cause for the trouble may 
 also lie with the child. It is important to know this. 
 The remedy to be applied under such circumstances 
 will be given later. 
 
 INSUFFICIENT MILK SUPPLY. 
 
 It seldom happens that no milk can be obtained 
 from the breasts. In such cases there exists an inher- 
 ited defect, which cannot be remedied. 
 
 More frequently it occurs that the milk, abund- 
 
—130— 
 
 ant at first, fails entirely in a few weeks or months, 
 or that it is secreted in an insufficient quantity during 
 the entire time of nursing. 
 
 The question now arises, how is a mother able to 
 find out if the quantity of her milk is sufficient or 
 insufficient for the baby? The answer is very easy. 
 With the greatest accuracy it can be given by the 
 mother herself without the counsel of a physician. 
 It is done with the scale. On page 78 we have already 
 pointed out the great importance of this instrument 
 during the rearing of children. Here is one of the 
 many occasions where it proves indispensable. 
 
 If a mother suspects that her milk is not suffi- 
 cient for her offspring, she should weigh the chlid 
 carefully before and after nursing. The difference in 
 weight gives exactly the quantity of milk taken (see 
 page 79). A comparison with the table given in the 
 chapter "How Much Shall the Child Have at Every 
 Meal?" which states how much a child of the age of 
 her baby normally drinks, furnishes at once the de- 
 sired information. If the baby has taken the quantity 
 corresponding to its age and does so again during 
 subsequent examinations, the mother may ease her 
 mind as to this point. If, however, it received too lit- 
 tle, the question will be whether the infant is too 
 weak to empt}^ the breast, or if the breast produces 
 an insufficient amount of milk. An examination will 
 decide. If after nursing the breast is completely 
 empty, the child has done its duty and the breast is at 
 fault. But if plenty of milk is left in the gland, the 
 breast is all right and the child is to be blamed. Not 
 until this decision has been made can the proper rem- 
 edy be decided upon. 
 
 In examining the breast one is apt to make a 
 serious mistake. It is not sufficient to squeeze a little 
 around the nipple. This is not the place where the. 
 remnants of the milk are hidden. They are at the 
 base of the breast. It is, therefore, necessary to 
 
131- 
 
 massage thoroughly the entire breast from the base 
 to the nipple in order to arrive at a correct conclusion. 
 
 There are a number of symptoms in the mother 
 and the child which lead a keen observer to suspect 
 an insufficient milk supply, without the test given 
 above. They will be enumerated here. It will serve 
 to facilitate the detection of the troubles and prevent 
 the mother from mistaking them for real ailments. 
 
 Indication of insufficient milk supply: 
 
 (a) In the mother: The breasts of the mother 
 who is usually living in poverty or is enfeebled by 
 grief, misery, or sickness are small and flabby. The 
 glands are poorly developed. On pressure there 
 exude only a few drops of thin, watery milk. Pains 
 arise during nursing in the breast, the head, the back 
 and between the shoulder blades. The stomach be- 
 comes disturbed. 
 
 (b) In the child: The child does not gain suffi- 
 ciently in weight (see page 8i). The usual fullness 
 and plumpness of infants is lacking, the skin hangs 
 loosely, the arms and legs are thin and the face is pale. 
 The sleep is disturbed, the child cries a great deal and 
 awakens after short naps, as the empty and gnawing 
 stomach dispels the rest. The time of nursing is too 
 long (see chapter "How Long Shall the Child 
 Nurse?"). Its manners are characteristic. Under 
 normal conditions the child swallows after sucking 
 two to three times. If the supply is inadequate, it 
 sucks five, six, seven and even up to eight times 
 or more before it swallows. It is plainly evident that 
 the child is doing its best in vain efforts. When it 
 finally is exhausted and ceases to nurse, another drop 
 cannot be pressed out. 
 
 In other instances the child will do just the op- 
 posite. It sucks vigorously at the breast a few times 
 and then, evidently discouraged and aware that its 
 efforts are in vain, will drop the nipple and can not 
 be induced to take it again. Upon examination the 
 
—132- 
 
 breast is found empty. Vomiting does not exist. 
 
 Treatment — The treatment must correspond 
 to the cause of the trouble. If the diet of the 
 mother is insufficient or faulty, or if her mode of life 
 is too exciting, it must first be changed. Good, 
 wholesome, and sufficient food, especially meat (see 
 page 124), a quiet, regular mode of life, and plenty of 
 undisturbed sleep (see page 122) are the first requis- 
 ites for the production of a good and sufficient supply 
 of milk. The amount of fluids and especially of milk 
 is also of great importance. The more fluids (at 
 least 2^ quarts are necessar}^) are taken, the more 
 abundant the milk will flow. Light exercise in the 
 open air is also essential. 
 
 If, notwithstanding the careful observation of 
 the foregoing suggestions, the quantity of milk does 
 not increase, this should not serve as an inducement 
 to add at once artificial food. Such a mistake would 
 tend to decrease the flow of milk still more (see page 
 128). On the contrary, the baby should be laid to the 
 breast regularly but, in order to stimulate the gland 
 to higher activity, be forced to suck more vigorously. 
 This can easily be accomplished in most instances by 
 allowing the child to grow real hungry. The more 
 hungry the child is, the more forcefully will it tackle 
 the breast. The more forcefully it tackles the breast, 
 the stronger will be the irritation on the nipple and 
 the more abundant the flow of milk, since there is no 
 better stimulant for a sluggish breast than the vigor- 
 ous sucking of the child. But can a child get hungry 
 if it be put to the breast every hour or two or even 
 oftener? No! Will it suck forcefully if the stomach 
 is half filled? No! It will sip off what comes easily 
 and let the rest remain in the breast. This adds to 
 the first cause for the decrease in the production of 
 milk a second one, namely, to the lack of irritation of 
 the nipple comes the stagnation of milk in the milk 
 producing glands (see page 128). 
 
—133— 
 
 An attempt to remedy the fault should be made 
 by putting the baby to the breast at longer intervals 
 and by giving it only one breast at a time (see chap- 
 ter: "Shall the Child Have One or Both Breasts at 
 Each Nursing?"). Then there is left for it no other 
 choice but to work strenuously to appease the stom- 
 each, giving thereby a stronger stimulus to the breast 
 to do its duty. 
 
 If, in spite of this, the baby is unable to empty 
 the breast, indicating that it is really too weak, it is 
 necessary to relieve the stagnation of milk by mas- 
 saging out all that the nursling left in the gland and 
 feeding it with a spoon. The proceeding helps both. 
 The baby gets what belongs to it and the breast is 
 stimulated to higher production. 
 
 If the ration proves to be still too short, pro- 
 perly prepared cow's milk should be substituted for 
 the wanting mother's milk. It is not permissible 
 to give breast and cow's milk alternately for the rea- 
 son above referred to. 
 
 The massage of the breast must be made in such 
 a way that, while kneading and rubbing, the fingers 
 gradually move from the base, that is, the periphery 
 of the breast, towards the nipple. This should be 
 continued until all the milk is thoroughly emptied. 
 Also in those instances in which the production of 
 milk is insufficient, although the nursling succeeds 
 in emptying the breast fairly well, a massage per- 
 formed two or three times a day for ten to fifteen 
 minutes will be very beneficial, and, in most instan- 
 ces, be followed by an increase of production. A 
 trial is, therefore, always desirable. 
 
 If circumstances allow, mothers may take a hint 
 from the custom of physicians who work at clinics or 
 practise in large cities where ample opportunity is 
 offered. They put weakly babies to the well devel- 
 oped and abundantl}^ secreting breasts of healthy 
 wet-nurses and the forcefully sucking, vigorous child 
 
—134— 
 
 of the wet-nurse to the insufficiently developed breast 
 of the mother of the weak baby. In this way the lat- 
 ter profits doubly. Her child gets an abundant sup- 
 ply of wholesome milk and to her own breast is 
 given the stimulus for a better development. By 
 the time that her own child is strong enough to suck 
 forcefully, the milk producing glands of her breasts 
 are generally sufficiently developed to meet fully the 
 requirements of the nursling. 
 
 There are also recommended a number of rem- 
 edies, claimed to have a direct influence upon the 
 secretive power of the mammary glands. They are 
 not entirely reliable, but shall be enumerated for 
 those mothers who want to try them. 
 
 The one is Somatose (Prescription 53). It comes 
 in I ounce packages and is taken in doses of a tea- 
 spoonful three to four times a day, in milk or some 
 other fluid. 
 
 Prescription 53. 
 Somatose 1 ounce 
 
 The other is Lactogol (Prescription 54). It also 
 comes in i ounce packages and is taken in the same 
 dose and in the same way. 
 
 Prescription 54. 
 Lactogol 1 ounce 
 
 Both preparations are made in Germany. The 
 latter is prepared from linseed meal. A soup made 
 of this meal will do the same as the expensive 
 proprietary article but is not as tasteful. No harm 
 can be done with either preparation. A trial is ad- 
 vised if the mother can afford the price. 
 
 Not long ago an Italian physician praised highly 
 anise seed for the same purpose. He advised several 
 women to make an infusion by pouring one quart of 
 boiling water over one ounce of the seeds and to drink 
 a part of it, using the rest for external applications 
 upon the breasts. Both had sufficient milk in five 
 days. They had taken internally five quarts and used 
 
— 135-- 
 
 two quarts for the applications. On the sixth day 
 they discontinued the medicine but the supply of milk 
 remained sufficient. 
 
 More confidence than in the foregoing prepara- 
 tions can be placed in those remedies which serve to 
 cure morbid conditions of the body. They help in 
 many cases considerably by removing existing dis- 
 eases, such as watery blood, dyspepsia, etc. Especial- 
 ly those remedies which tend to mcrease the appe- 
 tite and stimulate the formation of blood often bring 
 about very happy results. Care, however, must be 
 taken to avoid such drugs as might go over into the 
 milk and harm the baby (see pages 124 and 126). 
 
 EXCESSIVE MILK SECRETION. 
 
 It is also detrimental if the breast produces 
 more milk than the child requires. Only in rare in- 
 stances is the mother harmed thereby, very often, 
 however, the child. 
 
 Signs of a superabundance of milk supply: 
 
 On the mother: The breasts of the mother, who 
 generally is healthy and lives in plenty and particu- 
 larly on meats, are well developed and at the time ot 
 nursing full and tense, even hard to painfulness. Up- 
 on slight pressure they discharge several strong 
 streams of milk. Plenty of milk is left after the child 
 is satisfied. 
 
 Though ordinarily the condition described is of 
 no serious consequence to women, there are instances 
 in which the excessive production becomes injurious 
 to the mother. This happens in such cases in which 
 the flow can no longer be controlled. The milk trick- 
 les constantly from the large, heavy, and overloaded 
 breasts. The clothing gets wet and disposes to colds. 
 The excessive secretions gradually undermine the 
 health of the mother. She loses her appetite, gets 
 drawing pains in the back, grows weak, faint, nervous 
 and emaciated, and may even become seriously ill, if 
 
-136- 
 
 the excessive production of milk is not controlled in 
 time. 
 
 On the child: It swallows after every draught 
 and is quickly satisfied. When the meal is finished, 
 an examination shows that the supply is by no means 
 exhausted. Notwithstanding the abundance of milk, 
 the nursling does not thrive. It often vomits. It is 
 inclined to accumulation of gas in the bowels, costive- 
 ness and colic. Instead of falling into a deep and 
 peaceful slumber after nursing, as a healthy child will 
 do, it is restless and uneasy during sleep. 
 
 The disturbances are caused partly by too great 
 a quantity of nourishment, partly, however, by too 
 hasty a filling up of the stomach. This latter is done 
 without exertion and, in consequence, not followed, as 
 it should be, by fatigue. For it often happens that 
 the milk comes so easily and quickly out of the breast 
 that the nursling gets hardly time to swallow (see 
 chapter on ''Nursing Bottles and Nipples"). Under 
 these circumstances there befalls the baby what be- 
 falls the adult if he eats too hastily and bolts down 
 his food — disturbances of nutrition. 
 
 Of course. Nature helps out for a while by the 
 vomiting above referred to, giving up what is ''too 
 much." 
 
 How long a child can stand the continuous over- 
 loading of the stomach depends upon its power of 
 resistance and recuperation. Some can stand it all 
 the time; most, however, grow ill sooner or later in 
 spite of the provisions for ready and convenient 
 relief, if no redress is offered. The burden gradually 
 becomes too great for Nature. Indigestion begins. 
 The character of the vomiting changes. The simple 
 regurgitation of food develops into a morbid vomit- 
 ing. The difference is easily detected. In the first in- 
 stance, the child throws up a part of the contents of 
 its stomach soon after nursing, apparently without 
 
■137- 
 
 effort, remains cheerful and contented and has regular 
 and well digested stools. The ejected milk is curdled 
 but little, if at all. In the second instance, however, 
 the vomiting does not occur until one to one and one- 
 half hours after nursing. The child is restless, dis- 
 torts the face and cries. The ejected milk has a 
 strong, sour smell, is curdled and in lumps and often 
 mixed with mucous. The stools become irregular. 
 They begin to smell and show undigested particles. 
 
 These are the first signs of indigestion. Worse 
 ones will soon follow if the warning, thus given, is 
 not heeded. 
 
 Treatment: The mother should, first of all, 
 take as little fluid as possible and decrease the total 
 amount of nourishment. A vegetable diet is prefer- 
 able to a meat diet. The use of beer, wine, or extract 
 of malt is forbidden. The bowels must be kept so 
 loose that two to three passages a day result. 
 
 Such dieting, coupled with plenty of exercise in 
 the open air, long walks or drives or light gymnastics, 
 where practicable, will usually suffice to reduce the 
 amount of milk to a normal quantity. 
 
 In order to relieve the distressing tension it is 
 best to bandage the breasts up in the same manner 
 as described on page 114. Then the pain will soon 
 diminish. Pumping out should not be practised 
 except in cases of urgent necessity for reasons ex- 
 plained on previous pages. 
 
 In order to guard the child against harm while 
 the mother is undergoing the treatment, it is neces- 
 sary to shorten, as a precautionary measure, the time 
 of nursing. How short this time should be in a given 
 case depends upon conditions. It should be so short 
 that vomiting ceases. As an additional measure, a 
 reduction in the frequency of nursing is also required. 
 
 The milk coming first is, however, less nourish- 
 ing than that coming later (see next chapter on 
 ''Faulty Composition of the Milk''). The digestive 
 
—138— 
 
 disturbances of the child must often, in part at least, 
 be attributed to this cause. It is, therefore, some- 
 times necessary to pump the first milk out and leave 
 about enough in the breast to satisfy the child. 
 Threefold are the advantages for the baby: It gets 
 the more creamy part of the milk, swallows more 
 slowly, and is forced to exert itself sufficiently to fall 
 into the necessary healthy slumber after nursing 
 (compare here the chapter on "Nursing Bottles and 
 Nipples"). This procedure, of course, is detrimental 
 to the mother, since the breasts are thereby stimulated 
 to a still higher activity. For this reason it should 
 not be chosen except the condition of the child de- 
 mands this sacrifice on the part of the mother, and it 
 does not seriously interfere with the latter's health. 
 
 In those rare instances only in which the milk is 
 constantly trickling from the breasts, may this 
 method of treatment be not sufficiently effective. In 
 such cases the mother should wean the child as soon 
 as she observes that her strength is failing. The 
 breasts should be covered with belladonna plasters, 
 provided with a hole for the nipples, and fastened 
 tightly upward in the manner described above. The 
 result is speedy. In a short time the breasts are dry, 
 to the great relief of the mother. 
 
 FAULTY COMPOSITION OF THE MILK. 
 
 Although the weighing of the child furnishes 
 very valuable information in regard to its feeding, the 
 data gathered therefrom may lead to serious mis- 
 takes, if additional circumstances are left out of con- 
 sideration. If, for instance, a nursling does not thrive 
 and is troubled with indigestion, although the scale 
 shows that the quantity of nourishment is right at 
 every meal, we must not jump at the conclusion that 
 the composition of the milk is at fault. There are 
 other circumstances which may lead to the same dis- 
 turbance, although the quality and quantity of the 
 food correspond to the normal. To these belong 
 
—139— 
 
 hasty swallowing, insufficient exertion during nurs- 
 ing (see chapter on ''Nursing Bottles and Nipples"), 
 untimely nursing, too frequent nursing, bad hygienic 
 surroundings, want of fresh air, etc. 
 
 The composition of the milk becomes unsuited by 
 the fault of the mother rather than that of Nature if 
 the child is allowed to enjoy both breasts at each 
 nursing. This is a bad habit and should be aban- 
 oned. An exception must be made if the first breast 
 does, in fact, not give sufficient milk and is completely 
 emptied when the child stops nursing it. We have 
 touched upon this point already on one of the fore- 
 going pages, but will here dwell upon it somewhat 
 longer, since we consider it important that mothers 
 should know about these things. 
 
 Exact investigations have disclosed the fact, and 
 everyone who ever milked a cow knows, that there 
 exists a great difference in the composition of the 
 milk according to the time it is taken, that is, if it is 
 taken at the beginning or at the end of the milking. 
 The difference is so great that the percentage of fat is 
 in the last portion of the milk about three times as 
 large as in the first portion. The same holds true 
 with the mother. It is, therefore, evident that the 
 nursling, for whom Nature intended the entire con- 
 tents of the breast, will receive a nourishment unsuit- 
 ed to its digestive organs if it gets the first halves of 
 both breasts. It is also evident that as a consequence 
 disturbances of nutrition may spring into existence in 
 spite of the fact that the scales show a correct quan- 
 tity of food taken at each meal and in spite of the fact 
 that Nature had prepared the proper nourishment. 
 Under such circumstances the trouble does not lie 
 with a faulty function of the breast, but with an im- 
 proper management of it. 
 
 Of course, it suits the baby eminently well to 
 receive both breasts. at each meal. It does not know 
 as yet what is good for it and what not. It makes 
 
—140— 
 
 the same mistake which is made by many adults — the 
 easier it fills its stomach, the better it likes it. And it 
 is certainly easier to sip off the first portions of both 
 breasts than, in order to appease the appetite, to 
 empty under exertion one breast to the last drop. If, 
 however, such a bad habit has been established once, 
 it is difficult to discard it. Mothers are too readily 
 induced by the crying of their darlings to relapse 
 into the old error. 
 
 If a nursling, therefore, gives up one breast in 
 order to continue on the other, the mother should ex- 
 amine the first one carefully (see pages 130 and 133) 
 and see if it is completely emptied. If it is not, she 
 should not give the second breast, but offer the first 
 one again and let the child go hungry if it refuses to 
 retake it (as to weak children see page 133). The next 
 lime it knows better and will hesitate tu drop the nip^ 
 pie so long as there is something to be gotten out of it. 
 For hunger hurts. It helps better than all persuasion 
 and admonition to force the spoiled darling into sub- 
 mission. 
 
 If all the possible faults above referred to have 
 been considered and those found been removed; if, in 
 spite of all efforts to do what is correct, the child does 
 not thrive though the scales show that the quantity 
 of nourishment is sufficient — then and not until then 
 is it proper to assume that the quality of the milk does 
 not meet the requirements of the child, provided that 
 not one of the chronic diseases of childhood prevails 
 (see chapter on ''English Disease"). What the fault 
 consists of has not been told. Careful deliberation is 
 needed to find this out. It should be investigated if 
 the mother's mode of life and her diet is right, if her 
 state of health is satisfactory or needs to be im- 
 proved, if her bowels move properly, if she takes 
 medicine which goes over into the milk and harms the 
 child, etc., etc. It requires some thinking and delib- 
 eration. But they are necessary.. Only a minute dis- 
 
bi- 
 
 section and a close investigation of all conditions will, 
 under difficult circumstances, lead to the disclosure 
 of the fault. A close inspection of the discharges 
 from the bowels (see pages 97 to 100) and the stud} 
 of the information given in the chapters on "Artificial 
 Feeding" as to the "too much'' or the "too little" of 
 casein, fat, or sugar in the food, will help a great deal 
 to shed the indispensable light. 
 
 Only in rare instances is a chemical analysis of 
 the milk required in order to get the requisite hints 
 and, if deemed necessary, should not be neglected. 
 
 Treatment: The treatment must begin with 
 the removal of the cause. All that has been said in 
 the different chapters of this book as to the surround- 
 ings of the child, its care and nursing, and as to the 
 mode of life, diet, etc. of the mother must be closely 
 adhered to. If there is a valid reason to believe, or if 
 a chemical analysis has demonstrated it to be a fact 
 that the milk of the mother is too poor, her diet should 
 be enriched and the amount of nourishment in- 
 creased; if it is believed or has been proved that the 
 milk is too rich, the diet of the mother should be less 
 rich and the ration shorter. It is well nigh impossible 
 to give precise instructions. The cases are too dif- 
 ferent. But enough has been said in the chapters of 
 this book to enable any mother to do the right and 
 proper thing, if she will take the trouble to study all 
 that is said about the rearing and feeding of children. 
 
 Determined and earnest efforts to correct faulty 
 conditions must be made in every instance before the 
 nursing at mother's breast is allowed to be stopped. 
 Thoroughly objectionable, yes unpardonable, is the 
 course of many mothers who, upon slight ground and 
 without further investigation, will wean their babies 
 if they do not appear to thrive at once at the breast. 
 Mother's milk, under ordinary circumstances, is and 
 always will be the best and most satisfactory nour- 
 ishment for a nursling. No child should be deprived 
 
142— 
 
 of this priceless blessing until all efforts to render the 
 same suitable and wholesome have proved unavailing. 
 The temporary variations in the composition of 
 the milk that are sometimes occasioned by sudden 
 shock, pain, joy, anger, etc., or by the monthly period 
 have, as a rule no permanent ill-effect on the health 
 of the child. They pass over quickly. The mother, 
 therefore, should continue the nursing v^ithout inter- 
 ruption. 
 
 FIRST NURSING OF THE BABY. 
 
 After the shock and pains of labor the mother 
 needs rest. She should have it without restriction. 
 The child requires no nourishment until it indicates 
 its hunger by a lively crying. This usually happens 
 at from six to twelve hours after birth. Until that 
 time mother and child should be left alone. 
 
 When the signal is given to begin the feeding, 
 the nipple is cleaned and prepared (see page 107) 
 and the new-born laid to the breast. It is sometimes 
 difficult to induce it to suck; it is not used to the 
 business and must learn it first. But with the aid of 
 a few drops of sweetened water on the nipple and the 
 support of the now growing hunger the efforts are 
 soon crowned with success, if the necessary patience 
 and perseverance are practised. 
 
 It is a grave mistake to fill in the first days of life 
 the stomach of the little baby with all kinds of soups, 
 teas and concoctions, prompted by the belief that the 
 few drops of milk the mother is producing could not 
 satisfy the hunger of the darling. The need of nour- 
 ishment of a new-born is, at this stage of its career, 
 very little, and the contents of the breast, under nor- 
 mal conditions, are ample to satisfy its requirements. 
 The feeding of other nourishment except the moth- 
 er's milk is injurious in two ways : First, the foreign 
 substances a;re not suited to the tender stomach and 
 are liable to cause indigestion from the start. Second, 
 the sensation of hunger in the nursling is suppressed.. 
 
—143— 
 
 The consequence is that the bal)y does not feel like 
 sucking. But a forcible and vigorous sucking is, as 
 we have seen on page 128, indispensable to the de- 
 velopment of the milk-producing glands. An insuf- 
 ficient development of these glands is followed by an 
 insufficient milk supply. Instead, therefore, of help- 
 ing the child with these foreign substances, the im- 
 prudent attendant inflicts upon it the greatest injury 
 she can, that is, she delays the production of milk and 
 deprives the nursling of its natural food, which is 
 supposed to come from the breast of its mother. 
 
 It is another very bad, though unfortunateh^ not 
 infrequent, practice to treat the infant upon its first 
 days on earth with all sorts of purgatives and patent 
 medicines on the theory that it is necessary to deliA^er 
 as soon as possible the bowels from those black and 
 pasty masses with which they are filled. This pro- 
 ceeding also is harmful and must be condemned. 
 Nature needs no assistance in this direction. In her 
 wise providence she has provided for her own laxa- 
 tive in the form of the unfinished, saltv milk of the 
 mother as it comes in the first davs after birth (see 
 page 128). It is the height of folly to pump this 
 from the breast and throw it away, as is sometimes 
 done ignorantly. The child needs it and must have it, 
 must have it in the same quality and quantity as it is 
 produced, unaltered and undiluted. 
 
 There are sometimes cases, it is true, in which the 
 contents of the breasts are insufficient for the support 
 of the baby. Then, of course. Nature must be assist- 
 ed. These cases are indicated: 
 
 First- bv a loss of weight after the third day. On 
 page 81 we have learned that every new-born loses 
 in weight the first davs of its life, that its weight be- 
 gins to increase again on the third da}^ and that it 
 is at the eleventh or twelfth day as high as at the 
 moment of birth. Anv deviation from this rule must 
 arouse suspicion, and if the weight is still decreasing 
 
—144- 
 
 on the fourth or fifth day or even later, one can safely 
 assume that the quantity of breast milk is deficient. 
 
 Second, by a rise of temperature. This is another 
 important sign that the breast milk does not suffice. 
 A healthy child which gets its nourishment in suffi- 
 cient quantity has a normal temperature (see page 
 94). A rise above the normal, if no sickness — in- 
 flammation of the navel, the e3^es, the mouth, the 
 throat, the nose, furthermore cough, vomiting, diar- 
 rhea, etc. — exists, should always suggest that the 
 mother's milk may be lacking. An examination with 
 the scales and a comparison with the table on page 
 147 often confirms the suspicion. 
 
 The administration of plent}^ of cooked water 
 soon reduces the fever in such instances. To compen- 
 sate for the wanting mother's milk, a proper amount 
 of artificial food should be granted, prepared accord- 
 ing to the instructions given in the chapters on ''Arti- 
 ficial Feeding." If milk does not agree, whey or pep- 
 tonized milk or buttermilk must be substituted (see 
 respective chapters). 
 
 HOW OFTEN SHOULD THE CHILD BE NURSED? 
 
 Regular intervals between the nursings are not 
 yet necessary in the first two or three days after 
 birth. The nursling awakens every four to six hours 
 and should then be fed. From now on, however, com- 
 mencing with the third or fourth day, regular inter- 
 vals must be kept and the child be fed every two and 
 one-half hours for the first two months, every three 
 hours from the third to the sixth month, every three 
 and one-half hours from the sixth to the ninth month 
 and every four hours from the ninth to the twelfth 
 month. 
 
 These intervals should be regularly and scrupu- 
 lously kept. No mother should allow herself to devi- 
 ate from this fundamental rule induced by the crying 
 
145— 
 
 of the child (see "Crying of Children", page y2^. 
 Nothing but harm can result therefrom. 
 
 More detailed information relative to the hours 
 of nursing will be found in the following table. 
 
 TIME OF NURSING. 
 
 From the 
 
 First to Second 
 
 Month 
 
 From the 
 
 Third to Sixth 
 
 Month 
 
 From the 
 
 Sixth to Ninih 
 
 Month 
 
 From the 
 
 Ninth to Twelfth 
 
 Month 
 
 5:00 a. m. 
 
 5:00 a. m. 
 
 5:00 a. m. 
 
 6:00 a. m. 
 
 7:30 a. m. 
 
 8:00 a. m. 
 
 8:30 a. m. 
 
 10:00 a. m. 
 
 10:00 a. m. 
 
 11:00 a. m. 
 
 12:00 noon 
 
 2:00 p. m. 
 
 12:30 p. m. 
 
 2:00 p. m. 
 
 3:30 p. m. 
 
 6:00 p. m. 
 
 3:30 p. m. 
 
 5:00 p. m. 
 
 8:30 a. m. 
 
 10:00 p. m. 
 
 5:30 p. m. 
 
 8:00 p. m. 
 
 12:00 noon 
 
 
 8:00 p. m. 
 
 11:00 p. m. 
 
 
 
 10:30 p. m. 
 
 
 
 
 As the foregoing table indicates, it is now re- 
 emphasized that the child should not be nursed be- 
 tween the hours of 11 p. m. and 5 a. m. During this 
 interval both mother and child should sleep. The 
 stomach as well as the body needs rest at night. 
 
 If the child is uneasy and something must be 
 given to quiet it, it may have come boiled w^ater or 
 fennel tea, slightly sw^eetened, if at all. These are 
 harmless and answer as pacifiers just as well as the 
 harmful milk 
 
 The child should not be aroused from sleep to 
 nurse, though some imprudent doctors recommend it. 
 It is wisest to allow Nature to take her course. A\^hat 
 she seems to demand should not be interfered with. 
 When the child awakens, it is early enough to feed it. 
 
 HOW MUCH NOURISHMENT SHALL A CHILD 
 
 EACH MEAL? 
 
 RECEIVE AT 
 
 In the case of nursing infants the quantity of 
 nourishment taken at each nursing is ordinarily reg- 
 ulated by Nature, as the normal breast contains just 
 
—US- 
 sufficient nourishment to meet the requirements of 
 the child. It is a self-regulating process under which 
 the supply adapts itself to the demand. This is 
 brought about thus in the wonderful economy of 
 Nature. If the child is big and strong and needs 
 much nourishment, it will suck long and vigorously — 
 this stimulates the production and increases the sup- 
 ply. If the child is small and puny and needs little 
 nourishment, it will suck less vigorously and a 
 shorter time — this diminishes the production of milk 
 and decreases the supply (see pages 128 and 129). 
 
 Experience has, in the main, established the 
 correctness of this theory. But there are exceptions 
 to the rule, as we shall see later. 
 
 However, in order to furnish the mother with 
 some definite data as to the amount consumed by a 
 normal child at each nursing, the following table 
 is herewith submitted. 
 
 The numbers in the first column give the age of 
 the child. 
 
 The numbers in the second column give the 
 capacity of the infant's stomach, that is, the quantity 
 of milk necessary to fill the stomach. They give 
 further the quantity of milk which a child takes at 
 every meal, since healthy infants fill their stomachs 
 up at every meal. These same numbers indicate 
 thirdly how much heavier a child should be after the 
 meal than it was before the meal, and fourthly how 
 much milk should be prepared for the average hand- 
 fed child for every meal. 
 
 The numbers in the third column give the num- 
 ber of meals during the day. 
 
 The numbers in the fourth column give the 
 length of the intervals between the meals expressed 
 in hours. 
 
 The numbers in the fifth column give the total 
 amount of nourishment taken by the average infant 
 in 24 hours. This is the same amount which should 
 
—147— 
 
 be prepared for a hand-fed baby as nourishment for 
 a day. 
 
 Capacity of stomach 
 in ounces. 
 . , . With nursing infants: 
 
 Age of the Difference in weight 
 
 <^n''<^- before and after 
 
 nursing. 
 With hand-fed Infants: 
 Quantity of milk to be 
 prepared for each 
 meal. 
 
 1 week I to i}( ozs._. 
 
 2 '' ...Ii< to I^ '' 
 
 3 '' I ^ to 21^ " 
 
 4 " 2}i to 3 
 
 ■ 2 months...3 to 3>^ '* 
 
 3 " -3)4 to 4 
 
 4 " -4 to4>^ " 
 
 5 " 4>^ to 5 
 
 6 " 5 to 5>^ '' 
 
 7-9 " 6 to 7 " 
 
 10-12 " j}^ to 9 '' 
 
 No. 
 
 Intervals 
 
 Total amount 
 
 of 
 
 between 
 
 of nourishment 
 
 meals. 
 
 meals 
 
 
 for 
 
 
 in 
 
 twenty- four 
 
 
 hours. 
 
 
 hours. 
 
 .......8 
 
 -2^/^ 
 
 hrs... 
 
 ... 8 
 
 to 10 ozs 
 
 8.... 
 
 -2^ 
 
 
 ...lO 
 
 to I4 ** 
 
 .......8... 
 
 ...2% 
 
 
 -14 
 
 to 20 
 
 ...8..._ 
 
 -.2% 
 
 
 ...20 
 
 to 24 " 
 
 ........8... 
 
 --2% 
 
 
 ....24 
 
 to 28 
 
 7- 
 
 -3 
 
 
 -2S^ 
 
 to 28 " 
 
 ........7-- 
 
 ....3 
 
 
 ....28 
 
 to 31^ " 
 
 ........7- 
 
 -3 
 
 
 -31^/^ 
 
 to 35 " 
 
 ......7-- 
 
 -3 
 
 
 -35 
 
 to 38^ '' 
 
 6... 
 
 --3/2 
 
 
 ...36 
 
 to 42 " 
 
 ---5- 
 
 4 
 
 
 -37^ 
 
 to 45 " 
 
 HOW LONG SHOULD THE CHILD NURSE? 
 
 Under normal conditions a child will drink ten 
 to fifteen minutes. 
 
 If the quantity of milk in the breast is very great, 
 the child is satisfied in six to ten minutes. 
 
 If a child nurses habitually longer than twenty 
 minutes or even from one-half to three-quarters of an 
 hour, it is evident that the quantity of milk is insuf- 
 ficient. 
 
 SHOULD THE CHILD HAVE ONE OR BOTH BREASTS AT EACH 
 
 FEED? 
 
 From what is said in previous chapters it fol- 
 lows that, under normal conditions, the child should 
 have only one breast at each nursing. This is, as 
 stated, necessar}/- because the child will thus get a 
 properly composed nourishment and at the same time 
 keep the productiveness of the milk-producing glands 
 at the necessary height. Only if necessity demands, 
 
•148— 
 
 is this rule allowed to be deviated from. So in the 
 first and second week after birth, when the quantity 
 of milk in one breast is insufficient; so also later on 
 if the contents of one breast continue to be insufficient 
 (see page 133). Precaution, however, should always 
 be taken to control the nursling. The mother should 
 not give the second breast without being convinced by 
 an examination that the first one is really empty. If 
 this is neglected, the child is likely to acquire the 
 habit of sipping off only the first easily coming por- 
 tions and to grow a lazy nurser and harm the breast 
 (see pages 128 to 129). If the child gets both breasts 
 as a matter of necessity, it is necessary to begin the 
 second time with that side which previously was 
 given first. In this way the breasts are alternately 
 completely emptied and their productiveness is not 
 impaired. 
 
 If the lack of milk is caused by the mother's sick- 
 ness or debility, it is best not to give the second breast, 
 but to substitute the wanting mother's milk by prop- 
 erly prepared cow's milk. This gives the mother a 
 better chance to recuperate. Instructions how to pre- 
 pare the milk are given in the chapter on "Artificial 
 Feeding." 
 
•149- 
 
 CHAPTER XV. 
 
 WEANING. 
 
 WHEN TO WEAN— The weaning of the child 
 should begin at the eighth to tenth month. The old 
 adage ''nine months carry, nine months nurse'' is 
 correct and, no doubt, the outcome of centuries of 
 practical experience. It also coincides with the conclu- 
 sions drawn from modern science. The foUowingtable 
 may serve as an elucidation. It shows the normal 
 weekly increase in weight of a child at mother's breast 
 as compared with that of a hand-fed baby. 
 
 INCREASE IN WEIGHT WITH 
 
 Breast-fed Hand-fed 
 
 Infants Infants 
 
 In first month 6^ ozs 5^ ozs. during a week 
 
 In second month 7 ozs 6^ ozs. during a week 
 
 In third month 6 ozs. „ -5^ ozs. during a week 
 
 In fourth month 6 ozs. 5^ ozs. during a week 
 
 In fifth month 4;^ ozs. 4^ ozs. during a week 
 
 In sixth month ......3^ ozs .......3^ ozs. during a week 
 
 In seventh month... 3^ ozs. 3^ ozs. during a week 
 
 In eighth month 23^ ozs. 4 ozs. during a week 
 
 In ninth month 2^ ozs. 4^ ozs. during a week 
 
 In tenth month _ 2 ozs. 3>^ ozs. during a week 
 
 In eleventh month.... i^ ozs. 3 ozs. during a week 
 
 In twelfthjmonth lyi ozs 3 ozs. during a week 
 
 Thus, we see that during the first five or six 
 months the infant at the mother's breast increases 
 faster in weight than the one brought up artificially. 
 In the sixth to seventh month they hold about equal. 
 After the eighth month, however, the hand-fed child 
 thrives better, because after that time the elements of 
 mother's milk are no longer sufficient to supply the 
 physical demands of the child. 
 
ISO- 
 
 Numerous other signs are exhibited by Nature 
 which show that there should be a change in the 
 nourishment of the child around the eighth to the 
 ninth month: The stomach and the bowels are now 
 sufficiently developed and prepared to digest other 
 kinds of food than the milk of the mother (see chap- 
 ter on "Proprietary Foods"); the teeth, the instru- 
 ments for mastication of more solid nourishment, are 
 in the state of eruption; the milk of the mother be- 
 gins to decrease in quantity; the sucking grows pain- 
 ful because of the child's making use of its teeth, etc. 
 
 Therefore, at this time, that is, in the eighth to 
 ninth month, the weaning should begin. 
 
 It must be borne in mind, however, that there are 
 exceptions to this rule. A great deal depends on the 
 circumstances of the particular case. If the mother is 
 weak, sickly, and anemic, but the child strong and 
 healthy, the weaning may be commenced as early as 
 the sixth to eighth month. If, on the contrary, the 
 mother is strong and healthy, but th*e baby weak and 
 sickly, the nursing should be continued until the 
 health and the digestion of the child have improved 
 sufficiently that the weaning can be done with im- 
 punity. 
 
 To continue the nursing of the child until the 
 sixteenth or twentieth or even the twenty-fourth 
 month without urgent cause or excuse, is very ob- 
 jectionable. It is usually done not for the benefit of 
 the child, but in the selfish interest of the mother, who 
 is induced by the general but erroneous belief that 
 conception will not take place so long as nursing is 
 continued and menstruation does not return. Such, 
 however, is not always the case. Conception may take 
 place whether the periods have returned or not. 
 
 This unpardonable lengthening out of the nurs- 
 ing period is of no benefit to the child and often very 
 harmful to the mother. To furnish the large and con- 
 tinued milk supply drains the vitality of the mother 
 
—151— 
 
 beyond the normal limits. The vital organs debilitate, 
 the womb shrinks abnormally, the blood becomes 
 watery, general weakness, loss of appetite, sleepless- 
 ness and nervousness develop, and the mother, who 
 at the birth of her child was healthy and vigorous, 
 becomes a mere shadow of her former self. This, we 
 admit, does not happen in every instance. Some 
 women can stand this abuse of Nature better than 
 others. But this practice, persisted in at repeated nurs- 
 ing periods, almost invariably will ultimately result 
 as stated. 
 
 If the monthly period returns before the proper 
 time of weaning arrived, the nursing should not be 
 interrupted. Even though the inevitable changes in 
 the composition of the milk, occasioned by this event, 
 are at times somewhat disturbing to the child, the 
 effects are but temporary and will disappear as soon 
 as menstruation is ended. 
 
 Should the mother, however, again become preg- 
 nant, a different rule applies. In this case the wean- 
 ing must be commenced at once. The drain on the 
 system is, under such circumstances, too great for 
 most mothers. Besides, it is possible that the con- 
 tractions of the womb, caused by the irritation of 
 the nipple in consequence of the sucking (see page 
 103), may result in miscarriage and its possible ser- 
 ious consequences. 
 
 The child should not be weaned during the hot 
 summer months. If the regular time of weaning falls 
 into this season, it is better to continue nursing until 
 cooler weather arrives. The change at that critical 
 period from the pure and wholesome milk of the 
 mother to an artificial food would endanger the life 
 of the child. 
 
 HOW TO WEAN— When the time arrives to 
 wean the child, care should be taken to do this gradu- 
 ally. The proper course to pursue is as follows : Dur- 
 ing the first week artificial food should be substituted 
 
—152— 
 
 for mother's milk at one of the five meals, namely at 
 midday; in the second week at two of the five meals, 
 at noon and evening; in the third week at three of the 
 five meals ; in the fourth week at four and finally in the 
 fifth week at all of the five meals — the weaning being 
 then complete. 
 
 A sudden weaning is not justified unless con- 
 ditions arise suddenly that forbid the continuance of 
 the nursing. 
 
 The breasts of the mother adapt themselves to 
 the changing circumstances. In consequence of the 
 lessened irritation of the nipple the production 
 of milk decreases, yes, in some cases, decreases so 
 rapidly that weaning must be hastened. 
 
 In other cases, however, the supply of milk re- 
 mains as abundant as before. The partially weaned 
 child cannot master it; the breasts swell up and be- 
 come painful. The more sudden the weaning, the 
 oftener this occurs. 
 
 The remedy is simple and easily applied. The 
 management of the breasts should be the same as 
 laid down on pages 135 to 138, wath the one exception 
 that so long as the child nurses the belladonna plaster 
 must not be used, for a portion of the drug will be 
 absorbed into the milk and might injure the child. 
 The milk should not be pumped out except as a last 
 resort, if the pain from the distention becomes un- 
 bearable. The pumping acts somewhat in a similar 
 way as the sucking of the child, that is, it tends to 
 increase the secretion of the milk. 
 
 By tying up the breasts, decreasing the fluids in 
 the nourishment, and using a light laxative, the diffi- 
 culty ordinarily yields promptly. 
 
 SUBSTITUTES FOR MOTHER'S MILK DURING THE WEANING 
 PERIOD AND AFTERWARDS. 
 
 The best substitute for mother's milk is cow's 
 milk, prepared as described in the chapters on "Arti- 
 ficial Feeding." The only difference is that during 
 
•153— 
 
 the first weeks of weaning the dikition of the food 
 should be slightly greater than is prescribed for the 
 corresponding age of hand-fed children. If the wean- 
 ing be sudden, the beginning should be made with 
 only one-half of the ordinary strength of the mixture, 
 and this be increased gradually during the next few 
 weeks to normal proportions. 
 
 It is, however, not always easy to induce the child 
 to take cow's milk. It soon discovers that mother's 
 milk is a more palatable and far more precious bever- 
 age and will refuse the substitute in spite of all per- 
 suasion. In such instances the hunger is mother's 
 best ally. By allowing the rebellious little one to fast 
 for from twelve to twenty-four hours, its gnawing 
 stomach will soon bring it to terms and convince it 
 that cow's milk is better than nothing. Once the ice 
 is broken, no further difficulty need be feared. 
 
 But cow's milk alone without further additions 
 does not suffice after the sixth or seventh month and 
 should be supplemented by other kinds of nourish- 
 ment. 
 
 As the time for the beginning with additions may 
 be put the time after the eruption of the first teeth. At 
 this stage the digestive organs of the child become 
 capable of mastering farinaceous foods, and it is 
 mainly upon these that dependence should at first be 
 placed. Toast and crackers, dry or scalded in slightly 
 sweetened water, can be given, also weak veal and 
 chicken broth in small quantities, either alone or with 
 the white of an tgg added, furthermore gruels of oat 
 meal or rice, mush of corn meal, or any other of the 
 breakfast foods. It is also at this period that the 
 numerous food preparations, known to the trade un- 
 der the names of Nestle's Food, Mellin's Food, Hor- 
 lick's Malted Milk, etc., etc., are most advantageousl}^ 
 used. The better of these foods are splendid aids in 
 bridging the transition from mother's milk to the or- 
 dinary, every-day nourishment. They also merit re- 
 
—154— 
 
 cognition as a partial diet for older children, more 
 especially for those whose digestive organs for one 
 reason or another are debilitated and weak. 
 
 In conclusion it must be added that, after wean- 
 ing is completed, great care should be taken not to 
 overfeed the child either in giving too much at a time 
 or in feeding too often. Even slight irregularities are 
 often followed by very serious consequences. 
 
—155- 
 
 CH AFTER XVI. 
 
 SELECTION OF A WET NURSE. 
 
 The selection of a proper wet-nurse cannot be 
 made except by a physician. A mere enumeration of 
 the most cardinal points may, therefore, be sufficient. 
 
 A wet-nurse should not be younger than eighteen 
 nor older than thirty-five years; she should be able to 
 furnish at least three-fourths to one quart of milk a 
 day; she should have no catching disease, and her own 
 baby should not be older than six or eight weeks. 
 
 Further details under this head will be omitted. 
 
—156^ 
 
 CHAPTER XVII. 
 
 HAND-FEEDING. 
 
 If human milk cannot be granted to the child, the 
 milk of a domestic animal must be selected as the best 
 substitute, be it that of a cow, or an ass, or a goat, or 
 a mare. For, in spite of the great efforts made in 
 recent years by scientific investigators and by the 
 spirit of commercial enterprise, no preparation has as 
 yet been placed upon the market that can properly 
 be designated a satisfactory substitute for good, fresh 
 and pure milk. 
 
 It is not intended, hereby, to detract from the 
 value of those proprietary baby-foods which are on 
 the market. By no means! Though by far the largest 
 percentage of hand-fed children thrive best on fresh 
 animal milk, there remain some few cases where it 
 cannot be digested. For these and for older children 
 such preparations are sometimes most welcome sub- 
 stitutes for fresh milk. The most desirable of these 
 will, therefore, receive more detailed attention in a 
 later chapter. 
 
 Of the product of the different kinds of animal, 
 enumerated above, cow's milk is the only one which 
 can be procured by the masses of the people. To this, 
 therefore, refers all that is said in the following chap- 
 ters. 
 
 POINTS OF DISTINCTION BETWEEN COW'S MILK AND MOTHER'S 
 
 MILK. 
 
 It may seem useless to many mothers to pene- 
 trate deeper into the secrets of nutrition of babies. 
 But it is absolutely necessary. The more light is shed, 
 the plainer the workings of Nature present them- 
 selves and the more thorough the conditions which 
 
157- 
 
 influence the digestion and assimilation of the baby's 
 food are understood, the better can an intelligent 
 mother overcome difficulties that are insurmountable 
 to an unintelligent and uninstructed attendant. We, 
 therefore, urgently advise to study carefully the fol- 
 lowing differences betv^een mother's and cove's milk. 
 They must be known in order to master the situation. 
 Before, however, we enter upon the explanation 
 of the differences of the two kinds of milk, it becomes 
 
 Fig. 38 — Represents milk as seen under the microscope, 
 represent the fat-globules. 
 
 The little droplets 
 
 necessary to say what, in the main, are the constitu- 
 ents of milk. 
 
 The milk consists, stated roughly, of 
 (i). A proteid substance, called casein. It is 
 that substance which forms the clots when the milk 
 sours, and from which the cheese is made. It is the 
 
158— 
 
 most important part of the milk and has the greatest 
 value as a nourishment. 
 
 (2). Fat. The fat exists in the milk in the form 
 of an emulsion, that is, it is split up into minute parti- 
 cles, which are kept apart and are prevented from 
 uniting by a cover of proteid substance (see Fig. 38 
 on preceding page). 
 
 If this separating cover is broken by agitating, 
 as it is done in churning, the little globules of fat unite 
 and form the butter. 
 
 (3). Sugar. The sugar contained in the milk is 
 the so-called "milk-sugar." It is different from the or- 
 dinary cane-sugar, as it is less sweet and less soluble. 
 
 (4). 
 (5)- 
 
 Salts. 
 Water. 
 
 TABLE SHOWING THE PERCENTAGE OF THE DIFFERENT CON- 
 STITUENTS OF MOTHER'S AND COW'S MILK. 
 
 
 Mother's Milk 
 
 Cow's Milk 
 
 Proteid Substance (casein, cheese) 
 
 Fat....... 
 
 Sugar 
 
 Water 
 
 1.5 per cent. 
 
 4 per cent. 
 
 7 per cent. 
 
 87 per cent. 
 
 4 per cent. 
 
 4 per cent. 
 
 4 per cent. 
 
 87 per cent. 
 
 From this table we can see that cow's milk con- 
 tains about 4 per cent each of casein, fat and sugar, 
 while mother's milk contains much less casein, but 
 much more sugar, the percentage of fat being about 
 the same. 
 
 This difference in constitution is the first and 
 most important point of distinction between cow's 
 and mother's milk, 
 most important point of distinction between- cow's 
 
■1 sp- 
 
 in which the milk curdles in the stomach of the child. 
 Cow's milk turns into big, tough lumps, while moth- 
 er's milk forms fine, light flakes. The finer the flakes, 
 the better the digestion, for the stomach juice can 
 dissolve the fine flakes much easier than the big, 
 tough lumps. 
 
 A third essential point of distinction, also in fav- 
 or of mother's milk, lies in the purity and cleanliness 
 of the product. From mother's breast the milk flows 
 directly into the mouth of the baby and from there in- 
 to the stomach, clean, pure and unadulterated. Cow's 
 milk, however, is on its way from the udder of the cow 
 to the consumer subjected to the grossest changes 
 and contaminations. Not only is the milk frequently 
 diluted with water or adulterated with chemicals, but 
 also, on account of negligence, delay in transit, insuf- 
 ficient icing in warm weather, etc., delivered to the 
 mother in such a condition that it is practically unfit 
 for human use. This happens most often in large cities 
 where the milk has to be transported for many, many 
 miles, and where it passes through the hands of a 
 number of dealers before it reaches the child. The 
 much higher mortality of hand-fed children in cities 
 as compared with those of rural communities bears 
 witness to this fact. 
 
 Great efforts, indeed, have been made by the 
 health authorities of many cities to watch over, and 
 improve, the supply of milk, but, in spite of the string- 
 ency of the regulations and the severity of the pun- 
 ishment inflicted upon the transgressors of the law, 
 we are as yet far away from a satisfactory solution of 
 this important problem. 
 
 It follows from the foregoing that cow's milk, 
 although the best substitute for mother's milk, is far 
 from being a perfect substitute. It behooves, there- 
 fore, to explain what had best be done to overcome 
 the above mentioned disadvantages of cow's milk as 
 much as possible. This, we shall do later. 
 
—160— 
 
 REQUIREMENTS OF A GOOD FOOD. 
 
 . ■ . n 1 
 - A nourishment which is good and suitablevfor 
 infants must fulfil the following requirements: 
 '/ (i). It must be pure and unadulterated. 
 
 (2). It must be as near to mother's milk as pos- 
 sible in its constitution. 
 
 SIGNS OF A GOOD MILK. 
 
 ( I ) . Color glaringl}^ white with a tinge of yel- 
 low — not transparent or iDluish white. 
 
 (2). Entire freedom from odor. A so-called 
 "cow smell" is objectionable, as it indicates gross con- 
 tamination. . 
 
 (3). Mild but substafitial taste. A so-called 
 "cow. taste" is also objectionable, as it indicates the 
 same gross contamination. 
 
 (4). A drop, placed, upon the finger nail, should 
 arch and not spread, \r 
 
 (5).. A drop, falling into water, should become 
 immediately dififused and not sink down to the bot- 
 tom as a coherent mass. 
 
 (6). The settlings should contain neither dirt, 
 slime, nor other foreign substanj^es. 
 
 
161- 
 
 CHAPTER XVIII. 
 
 HOW TO PRODUCE A GOOD MILK. 
 
 A number of requirements must be fulfilled in 
 order to produce a good and wholesome milk. We 
 have to discuss these matters more minutely be- 
 cause a great number of families, even in cities, keep 
 their own cow for the purpose of assuring themselves 
 fresh and unadulterated milk, and further because 
 familiarity with these requirerhents enables every 
 mother to form her own opinion about the quality of 
 the milk she is buying, if she has opportunity to in- 
 spect the cow and her keeping. 
 
 A COW MUST BE HEALTHY— This is very 
 important. Only a healthy cow can furnish whole- 
 some milk. It is, however, not always easy to deter- 
 mine if the cow is healthy or not. In many instances, 
 it requires a careful examination by a trained veter- 
 inary surgeon to make the decision. 
 
 Foot-and-Mouth Disease as well as diseases of 
 the udder can easily be detected on careful inspection 
 — not so tuberculosis, the most common and wide- 
 spread of cow diseases. In order to exclude this 
 scourge with certainty, a subcutaneous injection of 
 tuberculin is required. If this is properly made and 
 the animal remains free from fever, the evidence is 
 conclusive that the cow is also free from that disease. 
 
 More recent investigations along this line have 
 demonstrated the fact that tuberculosis is enormously 
 prevalent in milch cows. In the state of New York 
 seven per cent were found affected, in other states 
 more, and in some even up to fifty per cent. The 
 battle against the scourge is being fought energet- 
 ically and universally. Many dairymen test their 
 
—162— 
 
 cows voluntarily; upon others, who supply the milk 
 to certain large cities, it has been made compulsory 
 to have their herds examined once a year by state 
 authorities, who kill every cow found infected and 
 reimburse the owner. 
 
 Such examinations are of the utmost importance 
 for the welfare of the infants. The germ which 
 causes tuberculosis of the cow is the very same mic- 
 robe that causes consumption and scrofula in human 
 beings. It goes over into the milk of stricken animals 
 and infects the child that consumes this contaminated 
 milk in a raw condition. 
 
 Figure 39. (a) Bacillus Tuberculosis, that is, the germ which causes 
 consumption, (b) Pus Cells. 
 
 It goes without saying that the milk of cows 
 afflicted with Foot-and-Mouth Disease should not be 
 used. Nevertheless numerous instances are on re- 
 cord where unscrupulous dairymen, in spite of know- 
 ing of the existence of the disease, sold the danger- 
 ous milk. As a consequence, a number of widespread 
 epidemics of serious mouth and intestinal diseases in 
 human beings developed, which, upon investigation, 
 were traced back to the diseased cows. 
 
 The following example may serve as an illus- 
 
—163— 
 
 tration. In the second half of April, 1905, there 
 were at Colchester, England, five to six hundred per- 
 sons suddenly taken ill, suffering with a violent in- 
 flammation of the throat with high fever. Suspicion 
 fell upon the milk. An investigation disclosed the 
 fact that all families in which the sickness developed 
 received their milk from the same large dairy firm. 
 This led to an examination of all the farms from 
 which this firm was supplied and subsequently to the 
 detection of a cow suffering with an inflammatory 
 process of the udder. No new case developed after 
 the milk of this animal had been suppressed. 
 
 The milk of a cow only slightly affected with 
 tuberculosis can safely be consumed if it is cooked. 
 Cooking destroys the bacillus of tuberculosis. The 
 milk of cows with far advanced tuberculosis, however, 
 is unfit for use and should be condemned. 
 
 THE COW MUST BE PROPERLY FED— 
 The best food for cows, the milk of which is supposed 
 to be consumed by infants, is the so-called "dry food'V 
 consisting of hay, bran, etc. Also the milk of those 
 cows is good that for some time have been grazing 
 if at least a part of their food consists of dry fodder. 
 The milk of cows that are wholly fed on fresh grass 
 is not recommendable for babies. Objectionable is 
 the milk of animals fed on brewery or distillery slop, 
 refuse of starch and sugar factories, potato-mash, oil 
 cakes, rape seed cakes, kitchen swill, etc. Objection- 
 able is further the milk of cows that have just been 
 changed from dry food and turned loose into the pas- 
 ture, or of cows the fodder of which has otherwise 
 been changed suddenly. 
 
 The reason why such milk is unwholesome for 
 the baby lies in the fact that a number of pungent 
 chemical substances as well as dangerous microbes, 
 contained in such foods, pass unchanged over into 
 the milk and may cause serious sicknesses. 
 
■164— 
 
 THE TIME ELAPSED SINCE CALVING 
 MUST BE RIGHT— The best and most uniform 
 milk is obtained from cows that have come in not less 
 than two and not more than six months ago. Be- 
 fore the second and after the sixth month the milk 
 is not as good and should not be used if another kind 
 can be obtained. • 
 
 THE COW MUST BE PROPERLY HOUSED 
 AND CARED FOR— To obtain a good and whole- 
 some milk it is necessary that the cow should be 
 properly cared for. She must have a roomy, light, 
 airy, and well ventilated stable and a clean, dry bed. 
 Cleanliness, air, light and ventilation are as essential 
 to the health of the animal as they are to the health 
 of the human being. A cow kept in a dark, damp, 
 and filthy corner cannot produce a good, wholesome 
 milk. No mother should buy her product. It cannot 
 be good. 
 
 THE COW MUST BE TREATED GENTLY 
 — Maltreatment and abuse of the cow must be avoid- 
 ed. As the milk of the mother (see page 122), so the 
 milk of the cow will be influenced by emotions and 
 affections. An irritated and embittered cow furnishes 
 bad milk. Many cases are on record where the milk 
 of maltreated cows sickened previously healthy 
 babies. 
 
—165- 
 
 CHAPTER XIX. 
 
 MILKING AND CARE OF THE MILK. 
 
 Supposing that the cow is heakhy, and that her 
 feeding and care is properly handled, it does not fol- 
 low that the milk, when it comes in the hands of 
 the mother, fulfils the requirements of a standard 
 product. Cleanliness in milking and proper transpor- 
 tation are fully as important as a proper production. 
 
 MICROBES AND POISONS IN SPOILED AND IMPURE MILK. 
 
 Everywhere on earth, in the air, the water and 
 the ground, there are teeming millions, yes billions, 
 of infinitesimal beings, which are only visible under 
 the microscope. They are most numerous and re- 
 productive in badly ventilated, dark and damp places, 
 where the air is musty and filth abounds. These 
 little beings are called ''microbes or germs." They 
 are the cause of decay and destruction and also of 
 many diseases. If they come into the milk in great 
 numbers, they cause disintegration and putrefaction. 
 Children fed with such contaminated milk will grow 
 sick invariably. Colic, vomiting, diarrhea, summer 
 cholera and many other, even fatal, diseases develop. 
 But there is no warning for the mother. It is im- 
 possible in most instances to recognize these gross 
 contaminations. The milk is not soured or coagulated. 
 It may resemble in appearance, taste and smell a 
 faultless product and 3^et contain deadly poisons. 
 
 The ability of these microbes to grow and multi- 
 ply is almost incredible. It is checked by cold and 
 is favored by warmth. For this reason milk keeps 
 longer in winter and on ice, and spoils more readily 
 in summer and in warm places. 
 
—166— 
 
 Some data on these points will be of interest to 
 the reader and very instructive. 
 
 Dr. Miquel in France found 
 
 In 16 drops of fresh milk direct after milking- 9,000 microbes 
 
 In 16 drops of the same milk after 1 hour 21,700 
 
 2 •' 36,250 
 
 7 " 60,000 
 
 " 9 " 120,000 
 
 " 25 " 5,600,000 
 
 The same authority found in i6 drops of milk 
 after standing for 15 hours at a temperature of 
 
 59 degrees Fahrenheit 100,000 microbes. 
 
 77 degrees Fahrenheit 72,000,000 
 
 95 degrees Fahrenheit 165,000,000 " 
 
 These figures illustrate that milk offers to mic- 
 robes a very favorable soil to grow in and is, in con- 
 sequence, a very perishable food. 
 
 Infection lurks everywhere. Not only hay, 
 straw, dust and insects with their millions of adhering 
 microbes fall into the milk, if handled carelessly, but 
 also cow dung, this most dangerous of all materials, 
 is a very frequent addition. It contains enormous 
 numbers of microbes. Experiments have shown 
 that every sixteen drops of a quart of milk to 
 which the minute, hardly visible quantity of 
 one third of a grain of cow dung had been 
 added contained seven millions of microbes, that is, 
 about the same number as contained in ordinary sew-, 
 age. It seems horrible , but such contaminations 
 are by no means infrequent. Examinations made in 
 Berlin, Germany, have demonstrated the fact that 
 the inhabitants of that city consume daily about 300 
 pounds of cow dung in their milk. The same holds 
 true with our large cities. In these it is certainly not 
 better, rather worse. 
 
 The microbes are dangerous to the human organ- 
 ism in two different ways. First, by their presence. 
 If swallowed, they multiply in the stomach, the 
 bowels or the blood and produce the disease specific 
 
—167— 
 
 to their kind. Second, by the productions of poisons, 
 so-called ''ptomains". 
 
 The killing off of the microbes by boiling does, 
 therefore, not free a contaminated milk from its dan- 
 gerous character, just as the cooking of decomposed 
 eggs, fish or meat does not make them fit for eating. 
 Even if the microbes are dead, the poisons produced 
 by them are not changed by the cooking. They 
 remain in the milk just the same and make it unfit for 
 use. 
 
 TRANSMISSION OF INFECTIOUS DISEASES IN THE MILK FROM 
 ONE PERSON TO ANOTHER. 
 
 There are a great number of infectious diseases 
 which may be transmitted from one person to another 
 in the milk without the latter being visibly affected. 
 A great many epidemics of scarlet fever, measles, 
 diphtheria, typhoid fever and other scourges have 
 come to notice in recent years which could be traced 
 with absolute certainty to sick persons in the family 
 or among the employes of the dairymen. Some may 
 be enumerated. 
 
 In August, 189s, eighteen cases of typhoid fever 
 developed suddenly in a certain district of Buffalo in 
 families that, without exception, took their milk from 
 a certain dairyman. An investigation disclosed the 
 fact that his wife suffered from typhoid fever, and 
 that he nursed her without taking any precaution 
 whatever to prevent the spread of the disease. No 
 new case developed after the sale of the milk of this 
 dairyman was forbidden. 
 
 In February, 1899, twenty cases of scarlet fever 
 developed in the same city within a period of four 
 days. Here also the families in which the disease 
 broke out bought their milk from the same dairyman. 
 Upon investigation it was found that one of the em- 
 ployes, who did the milking and also handled the 
 milk, was a convalescent from scarlet fever. No new 
 
■168— 
 
 case developed after the sale of the infected milk had 
 been prohibited. 
 
 Hundreds of other instances could be cited. 
 These two may suffice to call the attention of the 
 mothers to such possibilities. It is always safest to 
 hold in suspicion the milk of such dairymen as have 
 infectious diseases in their homes. 
 
 HOW TO AVOID DISEASES THAT MAY BE TRANSMITTED IN 
 
 MILK. 
 
 To this end care must be taken: 
 
 First, that as few microbes as possible find their 
 way into the milk. 
 
 Second, that those germs which succeed in get- 
 ting there are rendered harmless before they spoil 
 the milk or do damage otherwise. 
 
 The observation of the following instructions 
 will avoid the danger. 
 
 Persons who handle milk should neither be sick 
 themselves nor nurse nor come in contact with others 
 suffering from catching diseases. Cases of infectious 
 diseases, developing in the house of the dairyman, 
 should be removed from the vicinity of the stable and 
 the milkhouse. No one who has to do with the milk- 
 ing or the handling of the milk or the milk cans should 
 come in contact with the diseased or his nurse or 
 with the utensils used in the sickroom. Mothers 
 should watch over these things and inquire from time 
 to time whether sickness prevails in the house of the 
 milkman. If this be the case, it is safer to get the 
 milk from another place. 
 
 All utensils, such as cans, bottles, etc., which 
 come in contact with diseased persons or come from 
 houses in which catching diseases prevail, must be 
 thoroughly sterilized either by boiling or with a solu- 
 tion of formalin (Prescription 54), one-half teaspoon- 
 ful to a gallon of water, before they are placed to- 
 
 Prescription 54. 
 Formalin 4 ounces 
 
—169— 
 
 gether with the non-infected bottles. V^iolations of 
 this rule are frequent and happen most often with 
 dealers who deliver their milk apportioned in sealed 
 bottles to the houses of their customers taking the 
 container back when empty. 
 
 A wary and well instructed mother will not 
 forget to ask her dairyman occasionally some perti- 
 nent questions as to these matters. The direct demand 
 of an intelligent public and the danger of losing his 
 customers, if the sanitary rules are not strictly com- 
 plied with, will do more to stimulate the dairyman to 
 do what is right than all the regulations of health 
 departments. 
 
 MILKING. 
 
 Milking had best be done outside of the 
 stable in a separate room, set aside and intended 
 for this purpose. Both the hands of the milker and 
 the udder and the teats of the cow should be thor- 
 oughly cleaned with warm water and soap before 
 milking begins. The first jets of milk should be 
 thrown away, since they contain the greatest num- 
 ber of microbes. All vessels for the reception of 
 milk should be scrupulously clean and should, w^hen 
 filled, be promptly removed to the storage room. 
 
 FURTHER TREATMENT AND STORAGE OF THE MILK, 
 
 In this storage room, the so-called ''milkhouse'', 
 the milk is strained through a fine cloth or better 
 through a layer of absorbent cotton and at once cool- 
 ed down in cold water or better on ice to a tempera- 
 ture of 45 degrees Fahrenheit or below. Thus it 
 must be kept. The quicker the cooling is done, the 
 better for the milk, since cold checks the growth of 
 microbes (see page 165) and hinders the spoiling of 
 the milk. 
 
 The milkhouse should be connected neither with 
 the stable nor with the house, nor should it be located 
 in the neighborhood of cess-pools, closets or any other 
 
—170— 
 
 depository for refuse matter. Exhalations from man 
 or beast and from depositories of such refuse matter 
 are all alike contaminating. It goes without saying 
 that utmost cleanliness must be practised in such stor- 
 age rooms and that they should be well screened and 
 protected against the invasion of flies. 
 
 DELIVERY OF MILK. 
 
 Also during delivery the milk should be iced and 
 kept at a temperature of 45 degrees Fahrenheit. If 
 this is beyond reach, it should be delivered as soon as 
 possible and the suggested precautions be taken by 
 the mother. Milk that has been dragged and jolted 
 around on the wagon for many hours in warm weath- 
 er or stood in the store all day without being iced is 
 unfit for use and dangerous for the infant. 
 
 DISINFECTION OF THE MILK VESSELS. 
 
 All vessels used by the dairyman during milking, 
 storing and delivering of milk should, directly after 
 emptying, be thoroughly cleaned and disinfected with 
 the solution of Formalin given in prescription 54. 
 Bottles and jars, used in the house of the consumer, 
 should also be cleaned immediately after emptying 
 and, if they belong to the dealer, thus be returned. If 
 they come in contact with persons suffering from 
 catching diseases, a sterilization by boiling is required 
 before they are set aside. In this way only can the 
 decomposition of infected remnants, their cling- 
 ing to the walls of the vessel and the infection of the 
 fresh milk be avoided. 
 
 Here we will end our short sketch outlining the 
 production and the proper management of the milk on 
 its way from the udder of the cow to the hands of the 
 mother. The latter knows now what she can and 
 should expect from a standard product and is able to 
 define her demands intelligently and judiciously. 
 
 If the milk is delivered to the house of the custo- 
 
■171- 
 
 mer, pure and unadulterated, the responsibility of 
 the dairyman ends; that of the mother begins. It is 
 now her duty to see that the milk, she received in 
 good condition, remains so until it is consumed by 
 the child. How this is done, we shall see in the fol- 
 lowing pages. 
 
172— 
 
 CHAPTER XX. 
 
 CARE OF THE MILK AT HOME. 
 
 In spite of all precautions, it is impossible to get 
 a wholly germ-free milk from the cow; it is still less 
 possible to deliver such a product into the hands of 
 the mother. For, on the one hand, a certain number 
 of microbes always pass with the milk from the cow 
 and, on the other hand, the necessary contact of the 
 milk with the vessels and its exposure to the air will 
 result in the lodgement of others. These germs may, 
 under certain circumstances, become harmful to the 
 child and endanger its health. In order to avoid 
 this possibility, the milk must be prepared by the 
 mother so that danger is excluded. 
 
 This can be done either by the addition of chemi- 
 cals or by sterilization or pasteurization. 
 
 ADDITION OF CHEMICALS. 
 
 The addition of chemicals to the milk is general- 
 ly considered harmful, although some, even promi- 
 nent, physicians recommend it. It is practised daily by 
 many dairymen without the knowledge of their cus- 
 tomers. The drugs usually employed are: Boric Acid, 
 Borax, Salicylic Acid and Formaldehyde. The latter 
 has, of late, again been strongly advocated by Prof. 
 Behring of Germany, one of the foremost investiga- 
 tors and scientists in the field of medicine. We do 
 not recommend its use save in cases where pasteur- 
 ized milk does not agree with the child and cannot be 
 made to do so, and the raw milk cannot be relied upon 
 or cannot be kept from spoiling on account of unfav- 
 orable conditions, caused, for instance, by want of 
 ice, etc. The proportion of Formaldehyde to the milk 
 is 1:5,000 to 1:10,000. Formalin (Prescription 54), 
 
-173— 
 
 which can be bought in any drug store, is a 40 per 
 cent solution of Formaldehyde. Five to ten drops of 
 this solution to a quart of milk will yield the above 
 named proportion. This percentage of Formalin 
 keeps the milk from souring for a number of days. 
 
 Prof. Behring, supported by a large experience, 
 claims that Formaldehyde in these quantities is per- 
 fectly harmless to infants. His recommendation, 
 however, is disapproved by others on the ground that 
 mothers are likely to place too much reliance upon 
 this drug and to neglect the indispensable precautions 
 and cleanliness. This, of course, should not happen 
 and cannot be an objection against the use of Form- 
 aldehyde, if the need of it is indicated. 
 
 STERILIZATION. 
 
 By the term ''sterilization" is meant the killing 
 off of germs. It can be done either by heat or by 
 drugs. If ''sterilization" is spoken of in connection 
 with milk, it is generally meant "sterilization by cook- 
 ing", since cooking. is the method most commonly em- 
 ployed. In that sense of the word "sterilization" is 
 used in the following pages. 
 
 The time of cooking is five to ten minutes. It is 
 done either in a simple earthen or enameled pot, fitted 
 with a cover, or in a special instrument, first devised 
 by Prof. Soxhlet of Germany. This instrument con- 
 sists of a kettle and a number of bottles. The milk is 
 mixed according to the need of the child, filled into 
 the bottles in the proper quantity and sterilized. Pre- 
 cautions are taken that after sterilization the milk is 
 protected against spoiling. All that is further needed 
 is to take for each feeding a bottle out of the instru- 
 ment, to place it in warm water until its contents have 
 reached a temperature of about 95 to 100 degrees 
 Fahrenheit, to shake it well and to give it to the baby. 
 More exact instructions accompany each instrument. 
 
 No matter how the milk is sterilized, whether in 
 the apparatus described or in an ordinary cooking 
 
■174— 
 
 utensil, the after-treatment remains the same, that is, 
 the milk must be cooled immediately and placed on 
 ice for keeping. For, in spite of the boiling, the milk 
 would spoil in many instances if kept in a warm place 
 and at a temperature favorable to germ life (see page 
 165), since there remain always some germs alive, 
 ready for propagation and multiplication, if favorable 
 conditions are allowed to prevail. 
 
 Disadvantages of Sterilization — Sterilization 
 has, besides its advantages, some disadvantages. 
 The boiling changes somewhat the constituents 
 of the milk, the taste suffers and the digestibility is di- 
 minished. Many children, therefore, refuse boiled 
 milk, others take it and thrive well, but are always 
 troubled with constipation. 
 
 PASTEURIZATION. 
 
 In order to avoid these disadvantages and yet not 
 lose the advantages of sterilization. Prof. Pasteur of 
 France developed a process which is called after its 
 inventor ''Pasteurization." It is a partial steriliza- 
 tion, that is, the milk is not heated to the boiling point 
 but only to a temperature of 165 to 170 degrees Fahr- 
 enheit for twenty to thirty minutes. By this lower de- 
 gree of temperature most of the microbes dangerous 
 to human life are killed, such as the bacillus of tuber- 
 culosis, typhoid fever, diphtheria, cholera, mange, etc., 
 while the less dangerous but more resistant germs re- 
 main alive. Pasteurized milk, therefore, does not keep 
 so long as sterilized milk, that is, on an average only 
 twenty-four hours. But it has the great advantage 
 that the undesirable chemical changes therein, which 
 result from boiling, are almost entirely avoided, that 
 its taste is changed but slightly, that the children 
 like it better and that its digestibility is scarcely de- 
 minished. 
 
 Pasteurization can be done either in the appar- 
 atus ordinarily used for sterilization or in an instru- 
 
—175- 
 
 ment specially designed for the purpose. The latter 
 can easily be made at home. It needs 
 
 First, a tin pail or pot about ten inches deep and 
 nine inches in diameter, fitted with a tightly closing 
 cover, which must contain eight holes, one inch in 
 diameter and arranged in a circle midway between 
 the border of the cover and its center. The latter 
 should also be perforated with a hole of the same size. 
 
 Second, a wire basket of sufficient size to hold 
 several nursing bottles and provided with feet about 
 three inches high. 
 
 Figure 42. Basket for Sterilization or Pasteurization. 
 
 Directions: Fill the milk, properly mixed and in 
 the proper quantity, into the bottles and close them 
 with a plug of fresh, clean absorbent cotton. Cover 
 the bottom of the tin pot with about one and one-half 
 to two inches of water and bring to the boiling point. 
 Then lower slowly the basket containing the bottles 
 into the steaming pail. Do not allow the bottles to 
 touch the boiling water or they will burst. Place 
 the cover in position and cook for twenty-five min- 
 utes in winter and thirty minutes in summer. Then 
 remove the bottles, place them in warm water and 
 cool gradually but quickly. To place the bottles di- 
 rectly into cold water would cause them to burst. 
 After cooling place and keep on ice. 
 
 Allow the cotton to remain until the bottles are 
 used. Then remove it. Feed after warming and 
 
—176— 
 
 shaking the milk. Whatever the child does not drink, 
 throw away. 
 
 Pasteurization should be done as soon as the milk 
 arrives in the house. The quantity for the day may 
 be prepared at once. 
 
 STERILIZATION OR PASTEURIZATION? 
 
 For those who have no special apparatus the best 
 way is to let the milk come to the boiling point, cool 
 it, place and keep it on ice. 
 
 If an apparatus be at hand, the use of the one or 
 the other method depends on circumstances. 
 
 A milk treated at the dairyfarm, directly after 
 milking, as it is done frequently nowadays, should be 
 pasteurized not sterilized. Pasteurization is also to 
 be preferred at home if it is reasonably sure that the 
 milk comes from a healthy animal and is not older 
 than a few hours. 
 
 Sterilization should be practised if the child suf- 
 fers from diarrhea, or if, as usually in large cities, the 
 milk is not delivered until twelve to eighteen hours 
 after milking, or if there is room for doubt as to the 
 health of the cow, or if catching diseases prevail in 
 the house of the milkman and a change in the source 
 of the supply cannot well be made. 
 
 RAW OR HEATED MILK? 
 
 Both raw and heated milk have their advantages 
 and disadvantages. While the raw milk is better to 
 the taste, more easily digested and less apt to cause 
 constipation, it is also a frequent source of disease. 
 Its use, therefore, is to be recommended only in such 
 instances where the child refuses the heated milk, or 
 does not thrive on it, or suffers from an obstinate con- 
 stipation, which will not yield to the proper changes 
 in the nourishment (see chapter on "Constipa- 
 tion"), and where the quality of the milk as to purity, 
 cleanliness and freshness is beyond doubt and prop- 
 er means for icing are at hand. 
 
—177— 
 
 If the cooling cannot be properly done and raw 
 milk must be given, an addition of Formaldehyde is 
 permissible (seepage 172). 
 
 As a rule, sterilized or pasteurized milk is pre- 
 ferable. This is true especially in large cities and in 
 summer, when so many, many children die from dis- 
 eases of the bowels that can be prevented by the heat- 
 ing of the milk. 
 
 The author is well aware that his recommenda- 
 tion of sterilization and pasteurization does not re- 
 ceive the support of all physicians; but a large exper- 
 ience and a close observation, made on a great number 
 of children, has again and again convinced him that 
 the advantages of sterilization and pasteurization by 
 far outweigh the disadvantages. 
 
 Exact investigations, made in New York by an 
 eminent specialist in the year of 1903, led to the same 
 conclusions and shall be briefly referred to in support 
 of the above stated opinion. 
 
 Fifty infants, living under practically the same 
 conditions, were selected. Twenty-seven were fed 
 on raw milk, while the remaining twenty-three re- 
 ceived milk pasteurized at 165 degrees Fahrenheit. 
 After but one week twenty of the twenty-seven fed 
 on raw milk were affected with more or less serious 
 derangement of the bowels ; their milk had to be 
 pasteurized in order to save their lives. Of the twenty- 
 three fed from the beginning on pasteurized milk all 
 but five remained entirely well, these five being troub- 
 led only with a slight diarrhea. 
 
 As a further illustration of the great value of 
 pasteurization a paragraph will be copied which ap- 
 peared in the Journal of the American Medical Asso- 
 ciation of January 6th, 1906. Under the head "Results 
 of the Use of Pasteurized Milk" we read as follows: 
 
 "The records of the Health Department of New 
 York show that in 1892 there were in the city 194,214 
 children under the age of five years and that 18,684 
 
—178— 
 
 died in the year the rate being 96.2 per 1000. Pas- 
 teurized milk began to be used and in 1894 out of 
 256,137 children there were only 16,137 deaths, or 63 
 per 1000. At the death rate of 1892 with the present 
 population there would have been 24,640 deaths, 
 whereas there were actually only 16,137, so that ap- 
 parently there were 8,503 lives saved. Estimated on 
 this basis, it is claimed that there were 4,025 lives 
 saved last summer. On Randall's Island, where the 
 city's children are cared for, the death rate prior to 
 1898 was 41.83 per cent. After Nathan Strauss es- 
 tablished a pasteurizing plant on the island the death 
 rate was cut down to 20.75 P^^ ^^^^ ^^^ ^he past seven 
 years. Last year the rate among children was only 
 16.52 per cent. This reduction in the mortality is 
 caused entirely by the pasteurized milk, as other con- 
 ditions were unchanged." 
 
 The lesson to be taken from these and similar 
 observations is too plain to require more detailed ex- 
 planation, and the results are the more noteworthy 
 when we consider that the disadvantages arising from 
 the heating of the milk, such as diminished digesti- 
 bility, constipation, etc., can easily be overcome in 
 most instances by the addition of cream, gruels, lime 
 water, sodium citrate, etc., as we shall see later. 
 
 But let us also sound a note of warning. The 
 striking advantages of pasteurization and the great 
 safety guaranteed thereby should not blind a mother 
 to her duty to procure a clean, pure and unadulter- 
 ated milk. She must not think that it does not matter 
 what kind of milk she buys and how many microbes 
 it contains so long as pasteurization is practised. It 
 is true that the dangerous microbes are killed by the 
 process of heating, but it is also true that the poisons 
 which were already developed are not removed there- 
 by. They remain in the milk and are just as injur- 
 ious, yes sometimes even more injurious, than the 
 germs themselves (see page 167). 
 
■179- 
 
 IS THE MILK OF ONE COW OR THE MIXED MILK OF A HERD 
 
 PREFERABLE? 
 
 No objection can be made against the milk of one 
 cow if she is healthy, if she is properly fed, well 
 cared for and well treated. 
 
 As a rule however, the mixed milk of a herd is 
 preferable. It secures a more uniform product. For 
 the changes in the milk of one cow, occasioned by the 
 hour of milking, food, mental affections, etc., are 
 equalized in the mixture. 
 
 A further advantage is this : Should the cow hap- 
 pen to be sick, the child is much more endangered 
 if it receives the milk of this one than if it receives 
 same mixed with the milk of other healthy animals. 
 
ISO- 
 
 CHAPTER XXL 
 
 HOW TO PREPARE THE MILK ACCORDING TO THE AGE OF THE 
 
 CHILD. 
 
 This chapter is one of the most important in the 
 book. To it is called the particular attention of 
 mothers and others upon whom the rearing of child- 
 ren may devolve. Its careful study is earnestly re- 
 commended. 
 
 As stated on page 158, there exist substantial 
 differences in the constitution of mother's and of 
 cow's milk. These differences must be equalized. To 
 do so, the excess of proteid substance (casein or 
 cheese) in cow's milk must be diminished by dilution 
 with water and fat and sugar be added to make up 
 their deficiency. 
 
 DILUTION OF THE MILK. 
 
 Complicated formulas have been advanced for 
 the dilution of cow's milk in order to bring its com- 
 position as near as possible to that of mother's milk. 
 These, of course, can not be given. Few mothers 
 would understand them. We regard it far more prac- 
 tical to give simple and plain rules. If they are 
 grasped, it will be easy to find and make the changes, 
 necessary in each particular case. 
 
 The following table gives the percentage of water 
 and milk to be used in the mixture for children of the 
 different ages. 
 
 IT IS TO BE MIXED FOR AN INFANT 
 
 1 month old i part of milk with 3 parts of water 
 
 2 to 3 months old i '' " 2 *' 
 
 3 to 6 months old.... i " " i *' 
 
 6 to 9 months old........ 2 " " i " 
 
 9 to 12 months old 3 " " i " " 
 
—181— 
 
 Children over one year old can stand the clear 
 milk and should, therefore, have it undiluted. 
 
 The term "part" used above may indicate any 
 given measure, as a tablespoon, an ounce, a teacup, 
 etc. It is intended to express that the same measure 
 must be used for both milk and water. For instance, 
 if we say: one part of milk and three parts of water, 
 it means, one tablespoonful of milk and three table- 
 spoonfuls of water, or one ounce of milk and three 
 ounces of water, or one teacupful of milk and three 
 teacupfuls of water, etc. 
 
 The foregoing figures represent average propor- 
 tions, that is, they are adequate to the average normal 
 infant. Exceptions are frequent. Some children 
 seem to thrive better on a more concentrated, others 
 on a more diluted food. The weight of a child must 
 serve as a guide under such circumstances. If the 
 child is heavier than it should be according to its 
 age, a stronger mixture, and if it is lighter, a weaker 
 mixture than its age would otherwise demand is gen- 
 erally required. 
 
 An intelligent mother should, therefore, go not 
 only by the age but also by the weight of her child in 
 deciding upon the strength of the mixture. In ab- 
 normal cases, the table on page 80 tells her which 
 age corresponds to the weight and the table on page 
 180 which mixture is best suited for the age so found. 
 
 As a rule, however, the average proportions given 
 above, will prove to be right. A mother should 
 always begin with these. If the child thrives well (see 
 weighing of the child page JJ^, there is no reason 
 to change. If it does not thrive well, if its weight 
 does not increase satisfactorily, although digestion 
 seems normal and the passages look well, a trial 
 with a more concentrated nourishment is indicated. 
 But if it suffers from indigestion and derangement of 
 the bowels, such as diarrhea, constipation and colic, 
 a trial with a weaker mixture should be made. More 
 
—182— 
 
 detailed instructions are found in the chapter on 
 ''Changes in the Composition of the Nourishment 
 Necessitated by Disturbances of Digestion." 
 
 ADDITION OF FAT. 
 
 The diluted cow's milk contains far less fat than 
 the child requires. The deficiency must be made up 
 by the addition of enough cream so that the food con- 
 tains about 4 per cent of fat. This is accomplished 
 by adding two and one-half ounces of a i6 per cent 
 cream to one pint of the mixture. 
 
 In cities, it is easy to get a cream of this per- 
 centage. Every creamery keeps a 20 per cent cen- 
 trifugal cream. Four parts of this with one part 
 of milk will yield the 16 per cent cream, that is, 
 to four tablespoonfuls of 20 per cent cream must be 
 added one tablespoonful of milk to get the 16 per cent 
 cream. If the 20 per cent cream is not obtainable or 
 cannot be relied upon as pure and fresh, the 16 per 
 cent cream can be made at home in the following 
 manner. One quart of good, rich milk is poured in a 
 flat, covered vessel and cooled well either in cold 
 water or, better, on ice. The low temperature pre- 
 vents the spoiling of the milk and facilitates the sep- 
 aration of the cream. Aft^r standing for twelve 
 hours, best over night, the cream is taken off. If 
 the milk is allowed to stand only four or five hours, 
 a quart of milk will yield ten ounces of an 8 per cent 
 cream; if allowed to stand six hours, it yields six 
 ounces of a 12 per cent cream. If this cream of lower 
 percentage is used, comparatively more must be add- 
 ed, that is, five ounces of the 8 per cent cream and 
 three and three-quarters ounces of the 12 per cent 
 cream to the pint of mixture. 
 
 This amount of two and one-half ounces of a 16 
 per cent cream to the pint of mixture is suitable to 
 the average normal infant. Under abnormal condi- 
 tions it is often necessary to change this proportion. 
 
—183— 
 
 as, for instance, the amount of cream must be in- 
 creased in constipation, decreased in diarrhea. 
 
 ADDITION OF SUGAR. 
 
 To every pint of mixture, that is, milk plus di- 
 luent, there should be added two teaspoonfuls of or- 
 dinary granulated sugar. This, as a rule, will ans- 
 wer the purpose. Some physicians prefer the milk 
 sugar, a sugar which is naturally contained in the 
 milk (see page 158). Every drug store keeps it, but 
 it is generally very impure and adulterated. If this 
 milk sugar, which is less sweet, is used, twice as much 
 must be taken, that is, four teaspoonfuls to the pint 
 of mixture. Milk sugar makes the bowels loose. It 
 is, therefore, of advantage in constipation, of disad- 
 vantage in diarrhea. 
 
 Many children, especially those who suffer from 
 chronic diarrhea, and those who are below the nor- 
 mal weight, seem to do eminently better on Rheno's 
 Fattening Sugar. Of this Fattening Sugar the fol- 
 lowing quantities should be given to a pint of mix- 
 ture: 
 
 Children from i to 5 months old 4 teaspoonsfuls 
 
 '' 5 to 7 " " 4>^ to 5 
 
 '^ 7 to 9 " '' 3}4 
 
 '' 9 to 12 *' " 2 to 2}4 
 
 The Fattening Sugar is to be discarded when 
 undiluted milk is given. 
 
 By "teaspoonful" is understood a heaping tea- 
 spoonful, representing in weight about one-third of 
 an ounce. 
 
 The results from this Fattening Sugar are some- 
 times surprising. Children who would not thrive in 
 spite of all efforts and those who suffered from mal- 
 nutrition and chronic diarrhea, which seemed incur- 
 able, often pick up in the shortest possible time and 
 increase in weight rapidly. Children, however, who 
 suft'er from constipation had better not get this sugar 
 
•184— 
 
 or have one-third to one-half of it substituted by 
 sugar of milk. 
 
 HOW TO CHANGE THE CURDLING OF THE MILK. 
 
 One open question still remains, namely, what 
 shall we do to cause cow's milk to curdle in as fine 
 flakes as mother's milk does? This can be accotn- 
 plished by: 
 
 (i). DILUTING THE MILK WITH GRUELS 
 OF OATMEAL, BARLEY OR RICE, INSTEAD 
 OF WATER. 
 
 The gruels are prepared in the following manner. 
 A heaping tablespoonful of the finely ground sub- 
 stance is mixed with a quart of water and cooked 
 until the quantity has been reduced to a pint. The 
 rest is strained through a fine, clean cloth in order to 
 remove the coarser particles and filled up again to a 
 quart with cooked water. For older children the 
 gruels may be stronger. One to two to three table- 
 spoonfuls can be used if it proves to do well. To- 
 wards the end of the first year, some jelly prepared 
 from these meals, given after the feed, is advantage- 
 ous. 
 
 As to the choice to be made between the three 
 cereals, we must say that the oatmeal should gener- 
 ally be preferred. It is most nourishing, its taste 
 seems to be most acceptable to the baby, and it has a 
 slight tendency to keep the bowels open. Where, 
 however, the bowels are already too loose, barley or 
 rice-water should be used instead. 
 
 (2) ADDITION OF LIMEWATER. 
 
 It is a traditional custom of many mothers to 
 add lime water to the milk, believing that the digesti- 
 bility of the food is thereb}^ increased. This belief 
 is supported by the observation, made innumerable 
 times, that some children thrive better in every re- 
 spect with this addition than without it. Also science 
 has of late found an explanation for this undeniable 
 
—185— 
 
 fact. It has been proved that the addition of lime- 
 water to the milk, prevents entirely or retards the 
 formation of curds, according to the quantity added. 
 If clotting results, the flakes are much finer and less 
 tenacious and can be much more easily melted by the 
 juices of the stomach. The addition of lime v^ater 
 works, therefore, in this respect similar to the gruels 
 described in the former chapter. 
 
 But while the gruels contain plenty of nourish- 
 ment and should always be used as a diluent instead 
 of water, lime water contains no food and should not 
 be used except in such cases where the stomach 
 of the nursling can do the work imposed upon it only 
 with difficulty or not at all. The principal symptoms 
 that this is the case are: Vomiting of sour masses, 
 containing firm, tenacious milk-clots, constipation, 
 and white shreds and flakes of casein in the stools 
 (see page 99). 
 
 Under ordinary circumstances, therefore, the 
 addition of limewater is unnecessary. If, however, 
 suspicion arises that the stomach of the baby is labor- 
 ing under too big a load, a trial with lime water is 
 indicated. The proportion is one ounce of lime water 
 to a pint of mixture. Many physicians prescribe 
 Sodium Bicarbonate instead of limewater, in the 
 amount of one grain to each ounce of food, that is, 
 ten grains to ten ounces, twenty grains to twenty 
 ounces, etc. Double doses are seldom required. This 
 may, however, be necessary if the milk is already be- 
 ginning to sour, which, of course, should not, but 
 will happen. These additions are, therefore, required 
 more often in southern countries and in summer, less 
 often in northern countries and in winter. 
 
 (3). ADDITION OF SODIUM CITRATE. 
 
 Also the addition of Sodium Citrate has a marked 
 effect in breaking up the solid and tenacious clots 
 into finer particles. It is similar in its action to the 
 
—186— 
 
 gruels and especially to the lime water and the Sod- 
 ium Bicarbonate. 
 
 The preparation of the food is the same as given 
 above v^ith the difference that to each ounce of milk 
 which goes into the mixture one grain of Sodium 
 Citrate is added. Only in cases of habitual vomiting 
 may the dose be increased to two or even three grains 
 of the remedy to each ounce of milk. 
 
 An easy way of getting the proper proportion is 
 to dissolve so much of the salt in four ounces of water 
 that each teaspoonful of the solution contains the 
 amount required for each feed. If, for instance, 
 it takes three ounces of milk for each meal, take three 
 grains of Sodium Citrate to the teaspoonful; if it 
 takes five ounces of milk for each meal, take five 
 grains to the teaspoonful, etc. Four ounces average 
 thirty-two teaspoonfuls. The quantity of salt to be 
 dissolved in four ounces of water is, therefore, so 
 many times thirty-two as ounces of milk go into the 
 mixture at every meal, that is, in the first instance 
 three times thirty-two, that is, 96 grains to the four 
 ounces, and in the second instance five times thirty- 
 two, that is, 160 grains to the four ounces. 
 
 The required amount had best be added imme- 
 diately before feeding. 
 
 The addition of Sodium Citrate is of. particular 
 benefit in cases where sour, tough clots of milk are 
 vomited, or white flakes of casein appear in the stools 
 (see page 99). It is, however, worth while trying 
 also in cases of dyspepsia and indigestion without 
 the above named symptoms, and furthermore in cases 
 where babies do not thrive and are undersized and 
 underweight. The effect must be watched with the 
 scales (see pages JJ to 81). 
 
 If improvement is established the amount of So- 
 dium Citrate had better be reduced gradually; it can, 
 however, profitably be increased again, should signs 
 of indigestion recur. 
 
187- 
 
 PREPARATION OF THE BABY-FOOD IN SHORT OUTLINES. 
 
 In order to facilitate the practical application of 
 the foregoing lessons, we will repeat here in short 
 outlines how to proceed in preparing the nourishment 
 for the baby.. 
 
 The gruel, made either of oatmeal, barley or rice 
 according to the needs of the baby, should be pre- 
 pared first and to this added the necessary amount 
 of sugar. The milk, as soon as it is delivered, should 
 be diluted with the gruel in the proper proportion, the 
 cream added, the mixture be divided in bottles and 
 placed on ice, either raw or after pasteurization or 
 sterilization according to circumstances. 
 
 Before using the milk, the bottle is set in warm 
 water and given to the child after the contents have 
 the proper temperature. 
 
 It is most practical to prepare the food for the 
 whole day at once. If the necessary precautions are 
 taken, spoiling of the milk need not be feared. 
 
—188— 
 
 CHAPTER XXII. 
 
 CHANGES IN THE COMPOSITION OF THE NOURISHMENT 
 NECESSITATED BY DISTURBANCES OF DIGESTION. 
 
 The following survey may serve as a guide in 
 deciding v^hat changes must be made in the compo- 
 sition of the food if disturbances of nutrition arise. 
 
 NOURISHMENT IS TOO MUCH DILUTED. 
 
 The child does not sufficiently increase in v^eight, 
 although disturbances of digestion are apparently 
 absent, that is, although the stools have a normal ap- 
 pearance and a normal odor. 
 
 Treatment: More concentrated food. 
 
 NOURISHMENT IS TOO CONCENTRATED. 
 
 White flakes of casein are in the stools (see page 
 99); colics exist in most instances; diarrhea is sel- 
 dom, constipation very frequent. Stools smell foul 
 and offensive. 
 
 Treatment: Food less concentrated, less in quan- 
 tity and less often. 
 
 PERCENTAGE OF FAT IS TOO HIGH. 
 
 Frequent sour vomiting, diarrhea often, consti- 
 pation seldom. Stools smell rancid-sour, like spoiled 
 butter, containing sometimes v^hite flakes consisting 
 of fat (see page 99). Child is often very nervous and, 
 in rare instances, has cramps. 
 
 Treatment: Less cream. It is sometimes nec- 
 essary to v^ithdraw the cream entirely, yes, to omit 
 the milk for a while and to feed either buttermilk(see 
 later) or nothing but barley, or rice gruel, or, if the 
 diarrhea is strong, best, Rheno's Fattening Sugar. 
 
—189— 
 
 PERCENTAGE OF FAT IS TOO LOW. 
 
 Weight of child is too low, bowels are consti- 
 pated, stools without extra bad smell. 
 
 Treatment: More cream. 
 PERCENTAGE OF SUGAR IS TOO HIGH. 
 
 Stools thin, green, smelling strongly fresh-sour, 
 not rancid sour like spoiled butter. 
 
 Treatment: Less sugar, especially no milk 
 sugar. Rheno's Fattening Sugar preferable. 
 PERCENTAGE OF SUGAR IS TOO LOW. 
 Child seems normal, but does not sufficiently 
 increase in weight. Bowels somewhat constipated. 
 
 Treatment: More sugar. 
 
 It may sometimes prove a little difficult to inter- 
 pet correctly these many different symptoms. We 
 will, therefore, lend a helping hand and outline how 
 a mother should proceed if trouble arises. 
 
 However, before we enter upon the subject of 
 how to change the nourishment, be it emphasized 
 that all efforts to improve digestion fail in many 
 instances because the surroundings of the child are 
 unhygienic. Disturbances of nutrition of the most 
 varied kind may exist without the food being at fault. 
 Unhealthy environment, want of fresh air, damp 
 dwellings, etc., may spoil the results of the best 
 feeding. These faulty conditions are by no means 
 to be found only in the house of the poor, who can- 
 not afford to offer the child all that it needs ; they also 
 exist in the house of the rich, who, overanxious in 
 his care and from sheer fear that he might harm, 
 denies the child what its body needs. 
 
 Therefore, before a mother proceeds to change 
 the food, she should ask herself if the child is prop- 
 erly taken care of, if it has a sufficient amount of 
 fresh air, if the air of the nursery is clean and suited 
 to the needs of the child as to temperature and humid- 
 ity, if the child has sufficient rest and sleep, if it re- 
 ceives its nourishment at the proper time and in the 
 
—190— 
 
 proper quantity if it is not overfed, if the milk is 
 pure and unadulterated, if the cow from which the 
 milk comes is properly fed, housed and treated, etc. 
 These and a many other questions must first be ans- 
 wered; and they can be answered if the preceding 
 chapters of this book have been carefully studied and 
 digested. 
 
 If in one of these points a mistake has been made, 
 it must be corrected before the food is changed, since 
 therein may lie the cause of the trouble. But, if after 
 careful investigation and reflection, it is found that 
 the child has been properly cared for, or if after the 
 correction of the detected fault no improvement fol- 
 lows, the mother is justified in trying to modify the 
 food. 
 
 The first change to be taken into consideration 
 is in the quantity of nourishment, since in most in- 
 stances of digestive disturbance the trouble lies in a 
 "too much". Many mothers, we know, can only be 
 convinced with difficulty that this is true. They be- 
 lieve it to be the only salvation for their non-thriving 
 babies to have their stomachs stuffed with food as 
 nutritious and as much as possible. Nothing worse, 
 of course, can be done. If the digestive organs are 
 habitually overloaded, they break down just as sure 
 as a horse will which is constantly overworked and 
 gets insufficient rest. 
 
 The ''too much" is generally a too much in quan- 
 tity, the food being given too plentifully at a time or 
 too often. In other cases, however, the quantity at 
 each feeding and the number of feeds are right, but 
 there is a "too much" of one of the ingredients, 
 mostly casein, more seldom fat and still more seldom 
 sugar. This happens the easier, the weaker the bow- 
 els are. If, therefore, digestive disturbances arise, 
 such as diarrhea, belching, vomiting, colic, foul 
 smell of the stools, etc., under which circumstances 
 the digestive power is almost always impaired, the 
 
—191- 
 
 food should be adapted to the diminished power of 
 digestion, that is, the food should be more diluted. 
 
 If -the child fares better, the diluted nourishment 
 should be continued until digestion is perfectly nor- 
 mal. Then, and not until then, can the strength of 
 the mixture gradually be increased. If, in spite of 
 the greater dilution of the food, the digestive disturb- 
 ances continue, if habitual vomiting of big, tenacious 
 milk-clots exists and the stools are badly digested, 
 an addition of limewater (see page 184) or, better. 
 Sodium Citrate (see page 185) should be tried. If 
 this also fails to help, the quantity of milk in the food 
 must be still more reduced, yes, the milk must even- 
 tually be omitted entirely and only gruels be fed, 
 barley or rice gruel in case of diarrhea and oatmeal 
 gruel in case of constipation. But since gruels alone 
 will not suffice to support the body of the child for 
 a greater length of time, it is necessary to return to 
 milk as soon as Nature allows. In order to counter- 
 act the loss of weight which invariably follows if 
 the milk is entirely withdrawn, an addition of Rheno's 
 Fattening Sugar is very beneficial (for quantity see 
 page 183), except in those cases where constipation 
 exists. 
 
 If again and again on return to milk the child 
 begins to vomit or its stools grow worse, the milk 
 should be substituted by another food. 
 
 The first to be tried under such circumstances is 
 buttermilk, either with or without the addition of 
 Sodium Carbonate (see chapter on ''Buttermilk"). 
 This, in most instances, removes the trouble. 
 
 If, as it seldom happens, the buttermilk does not 
 answer the purpose, or if after an initial improve- 
 ment the condition grows worse, or if a good and 
 fresh buttermilk cannot be obtained, whey should be 
 tried or peptonized milk or kefir or malted foods or 
 an addition of one teaspoonful to one tablespoonful 
 of fresh meat-juice to the gruels. Also an addition of 
 
■192- 
 
 a little meat soup is sometimes beneficial, if the bow- 
 els are not too loose. 
 
 The preparation of all these different kinds of 
 nourishment can be found in a later chapter. 
 
 It depends upon the condition of the stools what 
 should be tried first. If their odor is offensive and 
 foul, or if they are mixed with white flakes of cheesy 
 substance (see pages 99 and 188), indicating that 
 the food contained too much casein, gruels do best 
 for the beginning, either clear or mixed with a little 
 cream as explained in the chapter on buttermilk. 
 After improvement began, first peptonized and after- 
 wards plain milk in gradually increasing quantities 
 should be given. 
 
 If the stools have a fatty appearance, contain 
 white flakes consisting of fat (see page 99) and 
 have a sour-rancid smell, indicating that the food con- 
 tains too much fat, buttermilk without the addition 
 of cream may be tried. If this fails, gruels with the 
 addition of meat-juice or meat-soups are advised. 
 Peptonized or skimmed milk with an addition of 
 Rheno's Fattening Sugar in diarrhea or milk sugar in 
 constipation is used for bridging over to the ordinary 
 food. 
 
 If the stools are sour, but neither rancid nor foul 
 in smell, and are very thin and greenish, indicating 
 an excess of sugar, starch, or flour in the former food, 
 very diluted milk with a proportion of cream some- 
 what greater than usual, or peptonized milk, or kefir, 
 or kumyss should be given and, as soon as improve- 
 ment is established, the child gradually be returned 
 to the ordinarv milk-food. 
 
 With special emphasis it must be added that un- 
 der no circumstances should babyfoods that contain 
 large amounts of unconverted starch (see ''Proprie- 
 tary Foods") be given to babies under six months of 
 age. They are, however, suitable as thin soups for 
 infants over six months of age suffering from de- 
 
rangements of the bowels, caused by an excess of fat. 
 
 Whatever the child is fed, with whatever it may 
 have been tided over the critical period, it is always 
 necessary to return to milk as soon as conditions al- 
 low. But carefully, very carefully should it be done. 
 In tablespoonful, yes teaspoonful, doses the milk 
 must be added, groping along until it has been found 
 that the tolerance of the child for milk has been re- 
 established, that is, that the improvement is so far 
 advanced as to enable it to digest again this, its prin- 
 cipal food. 
 
 How often the nourishment should be given, 
 when disturbances of nutrition prevail, depends upon 
 conditions. As a rule, it is best to keep the same in- 
 tervals as advised for healthy infants (see page 145). 
 If but very little nourishment is taken at each meal, 
 food can be given oftener, if necessary as often as 
 every two hours, even with older children. No 
 mother, however, should make the mistake of feeding 
 her darling all the time. The sick stomach requires 
 rest for recuperation, requires it more than a healthy 
 one. But rest is impossible if no time is granted. 
 
 During the entire time of the disturbance, the 
 scales (see page 78) should be used regularly and 
 the thermometer (see page 91) also not be forgot- 
 ten; the scales because they point out promptly either 
 progress or regress, that is, if the nourishment suits 
 or does not suit; the thermometer because it draws 
 attention to certain dangers. For it may happen that, 
 in consequence of the diminished appetite, the child 
 takes too little fluid, or that too much fluid is wasted 
 from the body through thin and frequent passages 
 Both causes lead to the same effect, nameh^ the blood 
 grows too thick, the products of decomposition ac- 
 cumulate in the body and poison the vital organs. The 
 result is danger for life or death. Harm can be avoid- 
 ed by the frequent use of the thermometer. If dan- 
 ger threatens, the temperature rises, but goes quickly 
 
—194— 
 
 down again as soon as water is administered plenti- 
 fully. 
 
 The child should, therefore, during such times 
 of stress be often allowed to drink small quantities 
 of fluids, either of light tea or boiled water. The 
 more irritable the stomach, the less must be given at 
 a time. Harm cannot be done so long as the doses 
 are sufficiently small and the stomach retains without 
 trouble what is offered. Instructions as to the treat- 
 ment of acute intestinal indigestion and vomiting are 
 given in a later chapter. 
 
 If a child has gradually been returned to milk, it 
 depends upon the condition of the digestion how the 
 addition of cream and sugar should be regulated. The 
 proportions given on pages 182 and 183 will usually be 
 right. Deviations, if necessary, are required either 
 by too soft or too hard consistency of the passage. 
 Details as to these matters are. found in the chapters 
 on "Chronic Diarrhea" or ''Constipation." 
 
 To some mothers these instructions may perhaps 
 seem rather complicated and difficult to follow. This 
 is, however, not the case. The mother who learns to 
 observe, to think and to interpret the different symp- 
 tom does not fare worse than the physician who, 
 following the same general principles, uses his best 
 judgment and "tries." No mortal, not even the most 
 learned professor, can say in advance with certainty 
 in every case what will suit best. The only advant- 
 age which an experienced physician has over the 
 mother is that in doubtful cases a chemical analysis 
 of the passage will give him pointers which a mother 
 will not be able to find. 
 
—195- 
 
 CHAPTER XXIII. 
 
 NUMBER, INTERVALS AND QUANTITY OF FEEDS. 
 
 Number, intervals and quantity of feeds are ex- 
 actly the same as with nurslings. All that is requir- 
 ed to know can be learned from the table on page 147. 
 
 As to the quantity of nourishment which, as stat- 
 ed on page 146 regulates itself with nursing babies, 
 the mother must be guided by experience. Begin- 
 ning with the amount given on page 147, she soon 
 sees how much is needed. If the baby is not satis- 
 fied with the contents of the bottle, it should have 
 a little more the next time. If it does not empty the 
 bottle, it should have a little less the next time. Un- 
 der no consideration should leavings of milk be 
 saved for the next meal. What the child does not 
 drink must be thrown away. A mother can make no 
 more serious mistake than to fill the bottle up to the 
 top and allow the child to drink whenever it 
 pleases. This bad habit, to which so many impru- 
 dent mothers still cling, cannot be condemned too 
 strongly. We caution urgently against it. It is a 
 custom which has, and still does, cost the life of many 
 children. 
 
 HOW TO FEED THE BABY. 
 
 While feeding the baby the mother should hold 
 the bottle in her hand until the child has finished. 
 Never should she allow herself to carelessly lay the 
 bottle upon the pillow beside the child, while she is 
 continuing her housework. Manyfold are the disad- 
 vantages. The meal is frequently interrupted, the 
 time of feeding lengthened and the normal process of 
 digestion disturbed. 
 
—196— 
 
 CHAPTER XXIV. 
 
 SELECTION OF NURSING BOTTLES AND NIPPLES. 
 
 Any number of nursing bottles and nipples are 
 on the market. Some are good, some are bad. A few- 
 hints are, therefore, not amiss to help the mother 
 in her selection. 
 
 BOTTLES — Of the nursing bottles only those 
 are practical which have a graduation blow into the 
 glass, so that at any time it can be seen without meas- 
 
 Flgure 44. Shape of bottle which should not be used. 
 
 iiiilillB 
 
 Figure 45. Best form of Nipple. 
 
 Figure 46. Nursing Bottle Fitting 
 which should not be used. 
 
 uring how much is in the bottle and how much has 
 been taken by the baby. The shape of the bottle 
 makes no difference so long as it can be cleaned eas- 
 ily. A bottle with a curved neck, as shown in Fig. 44, 
 is, therefore, not recommendable; the brush has no 
 ready access to all parts of its interior. 
 
 NIPPLES — Only those nipples should be used 
 
—197— 
 
 which are pulled over the neck of the bottle (see 
 Fig. 45), Those shown in Fig. 46 must be con- 
 demned strongly. It is impossible to keep them thor- 
 oughly clean. They are positively dangerous, so dan- 
 gerous that in some European states their sale is pro- 
 hibited by law. 
 
 But also those nipples which have been recom- 
 mended must meet certain requirements in order to 
 fulfill their purpose. 
 
 In the first place, they should be made of the very 
 best rubber, to stand repeated boiling. 
 
 In the second place, the hole or holes should be 
 sufficiently small. 
 
 The reason is this: The strong development of 
 those muscles in the cheeks of the new-born which 
 are used for sucking bears witness to the fact that 
 already as a nursling the human being has to begin 
 to earn his food under exertions of the body. 'Tn the 
 sweat of thy face shalt thou eat bread," says the Bible 
 meaning also the infant, and this for its benefit. 
 Threefold are the advantages. The efforts required 
 at nursing prevent the milk from flowing too freely 
 and quickly into the mouth of the baby and from 
 overfilling the stomach; they further promote diges- 
 tion and, last but not least, cause the infant to fall 
 into a peaceful slumber, often before its lips leave the 
 nipple of the breast. 
 
 These provisions of nature must be duplicated 
 as closely as possible if the best results of artificial 
 feeding shall be obtained. 
 
 How different, however, are the conditions if the 
 hole in the nipple is too big. Even without pulling, 
 or, at any rate, with the slightest effort, the milk pours 
 out of the bottle. The nursling is forced to swallow 
 hurriedly in order to keep up with the flow. The fa- 
 tigue, which is so indispensable for the promotion of 
 sleep, is wanting; the stomach, overfilled in a few 
 minutes, cannot cope with the burden; the child feels 
 
—198— 
 
 uncomfortable, cannot sleep, is restless and cries. Di- 
 gestion becomes impaired and serious disturbances 
 follow if the mother does not recognize the cause of 
 the trouble and remedy the fault. 
 
 It is, therefore, necessary to select a nipple with 
 a hole so narrow that it costs the child some effort to 
 withdraw the milk from the bottle. A test can be 
 made by turning the bottle upside down. If the milk 
 but trickles out, the nipple is all right ; if it comes in a 
 stream, the nipple is useless. In consequence of usage 
 the hole enlarges after some time in every nipple. It 
 is, therefore, necessary to exchange nipples frequent- 
 ly, about every one or two weeks. 
 
 COLLAPSING OF THE NIPPLES. 
 
 Every mother who has had the misfortune of 
 being compelled to bring up one or more children on 
 the bottle is, no doubt, acquainted with the disturb- 
 ances caused by the collapsing of the nipple. The 
 conduct of the child is well known. It begins to suck. 
 The milk comes in the beginning easily, too easily. 
 After a few draughts it comes harder, then still 
 harder, and finally not at all. The nipple collapses 
 and in consequence the bottle refuses to work. After 
 some further fruitless attempts the child gives up its 
 efforts. Indignant at the disturbance, it opens the 
 mouth for crying. At once the air shoots through 
 the mouth of the baby and through the nipple into 
 the bottle. Again the milk begins to flow, but again 
 the bottle fails, etc. 
 
 The collapsing of the nipple is no fault of the lat- 
 ter, but is the inevitable consequence of a physical law 
 which tries to balance the pressure inside and outside 
 of the bottle. The process is this: If a part of the 
 milk is withdrawn, the air in the bottle above the milk 
 is thinned, since it has to occupy a larger space. The 
 consequence is that there begins a suction toward the 
 interior of the bottle. To explain this phenomenon 
 let us take the example of a common glass syringe. 
 
—199— 
 
 If its point is dipped into water and the piston pulled 
 up, the fluid rises immediately into the barrel of the 
 syringe. It does this because the raising of the piston 
 creates an air-free space in the barrel. An air-free 
 space, however, causes a strong suction toward the 
 place the air is missing, in this case to-ward the barrel 
 of the syringe. The same holds true with the nurs- 
 ing bottle. In the beginning, of course, the rarifica- 
 tion of air, that is, the thinning out of air and with 
 it the suction, is but slight in this instance. The more 
 milk, however, is withdrawn, the more will the air in 
 the bottle above the milk be thinned; the more the 
 air is thinned, the stronger grows the suction; the 
 stronger the suction grows, the slower flows the milk 
 and the more effort does it require to withdraw a 
 further amount of milk. If, finally, the air gets 
 thinned too much, the suction gets so strong that the 
 soft nipple cannot withstand it and collapses. As 
 soon, however, as air is admitted into the bottle and 
 the pressure within and without is balanced, the nip- 
 ple unfolds and the milk flows anew. 
 
 So we find conditions with the ordinary nursing 
 bottle. Its disadvantages are numerous : 
 
 First, the collapsing of the nipple is an incon- 
 venience to the mother and a disadvantage to the 
 child, as it interrupts the feeding. 
 
 Second, the admission of air through the mouth 
 of the child is not without danger. Frequently a part 
 of it is swallowed, hinders digestion and causes colics. 
 
 Third, the great oscillations in the efforts re- 
 quired to withdraw the milk from the bottle are harm- 
 ful. In order to understand this point better let us 
 investigate the process of nursing somewhat closer. 
 If a child takes the nipple and begins to nurse, one can 
 observe that, under normal conditions, it requires a 
 certain amount of effort to withdraw the milk from 
 the breast. This amount of effort is always the 
 same. It is increased but slightly at the end of the 
 
—200— 
 
 nursing, when the breast begins to grow empty. At 
 no time does the milk flow out of a normal breast so 
 easily that it requires no effort to withdraw it and at 
 no time does it come so hard that the child needs all 
 its strength to reach it. 
 
 The process of feeding with an ordinary nursing 
 bottle is entirely different. The first draughts come 
 easily. The milk pours from the bottle into the 
 mouth of the baby. Then it comes harder and harder 
 and finally fails entirely in spite of strenuous efforts. 
 
 We see from this that feeding wnth an ordinary 
 nursing bottle is far from corresponding to the con- 
 ditions in nature. It is a cliff on which the success of 
 many cases of hand-feeding has been and will still be 
 wrecked. For not only a proper composition, but 
 also a proper administration of the food, is required 
 to bring about happy results in artificial feeding. 
 
 Different ways have been tried to solve the prob- 
 lem. As a result many kinds of nipples and nursing 
 bottles have been placed upon the market. But all 
 have failed to be to the point, most of them because 
 they did not attack the root of the evil, that is, the 
 rarification of air in the bottle. Of late a very simple 
 device has been invented which works admirably in 
 overcoming the difficulty. It is a groove in the neck 
 of the bottle as shown in Fig. 47. The advantages 
 gained thereby are as follows: 
 
 First, the collapsing of the nipple is impossible, 
 since air enters the bottle in a continual stream as 
 fast as the milk is withdrawn. 
 
 Second, the air does not enter the mouth of the 
 child; it can, therefore, not be swallowed and cause 
 wind colic. 
 
 Third, the admission of air can be regulated in 
 such a manner that the milk flows easily or hard as 
 one wishes. 
 
 This is a very important feature for the follow- 
 ing reason: The strength of children is not always 
 
-201— 
 
 the same; some are vi^s^orous and others weak. Ac- 
 cording to their strength the milk should flow . If the 
 milk comes easily, healthy and strong children will 
 swallow too quickly and face all the inconveniences 
 and dangers which a too hasty swallowing and an 
 over-filled stomach bring about (see page 197). If 
 the milk comes hard, weak and debilitated children 
 do not get sufficient food or exhaust their strength 
 beyond the normal and healthy limit. The regulation 
 
 Figure 47. Shows the groove in the neck of the bottle for the admission of 
 air. (R) rim. (N) neck. (I) groove. 
 
 of the flow of the milk is, therefore, an indispensable 
 requisite in order to make a nursing bottle suitable to 
 all children alike, to tl;ie strong and to the weak, to 
 the healthy and to the sick. 
 
 Fourth, the efforts necessary to withdraw the 
 milk are always the same, exactly as on mother's 
 breast. 
 
—202— 
 
 Fifth, the device is neither difficult to understand 
 nor to handle; it is easy to clean and cannot be put 
 out of order. 
 
 The bottle provided with this groove is sold un- 
 der the name of "Tearless Nurser." 
 
 When using this bottle the mother proceeds as 
 follows : 
 
 The nipple is pulled over the neck of the bottle so 
 far that the end of the groove is just visible under the 
 rubber. In this manner the air finds the greatest pos- 
 sible resistance in entering the bottle. As a conse- 
 quence it requires some effort to withdraw the milk. 
 If the nipple is pressed a little bit further toward the 
 mouth of the bottle, the groove opens wider, and in 
 consequence the air enters easier and the milk flows 
 freeer. Care, however, must be taken not to open the 
 groove too wide, as the milk, under such circum- 
 stances, will leak out. This never happens if the bot- 
 tle is handled properly. 
 
 It remains now to explain how far the groove 
 should be opened. This, of course, is different, as we 
 have stated before, with vigorous and with weak 
 children and even with the same child according to 
 the state of its health. But in spite of these varia- 
 tions it can easily be established. In order to find 
 some guiding points it is necessary to return once 
 more to the infant on the breast. If a nursling is ob- 
 served drinking on a normal breast, it will be noticed 
 that he swallows after pulling two or three times and 
 that it takes him ten to fifteen minutes to finish his 
 meal (see page 147). These conditions should be 
 imitated in feeding with the bottle. The nipple must, 
 therefore, be placed over the neck of the bottle so far 
 that the child pulls two or three times before it swal- 
 lows and that it needs ten to fifteen minutes to empty 
 the bottle. Much experience is not necessary. Any 
 mother will soon find out how to manipulate the nip- 
 ple. With strong babies, it is best, as a rule, to close 
 
—203— 
 
 the groove as much as possible, so that the nipple is 
 just prevented from collapsing. With very weak 
 children, it is necessary not only to open the groove as 
 v^ide as is allowed without leakage, but also to make 
 the hole in the nipple larger. If this is done, it is pos- 
 sible to make the milk flow out of the bottle almost as 
 easily as out of a spoon. 
 
 No other bottle should be used. The advantages 
 offered by the "Tearless Nurser" are so many that 
 no mother can afford to be without it. 
 
 CLEANING OF BOTTLES AND NIPPLES. 
 
 The greatest care must be taken that bottles and 
 nipples are thoroughly cleaned after each feeding. 
 The well-being of the child depends to a large extent 
 on the thoroughness with which this is done. 
 
 If the child is through with the bottle, the rest of 
 the milk, if there be any, must be thrown away. Then 
 the nipple should be turned inside out and together 
 with the bottle be carefully cleaned with a brush in 
 boiled water. To allow the nipple and bottle to lie or 
 stand around after the meal is finished, is to invite 
 danger of even the death of the child. Particles of 
 milk, when dry, cling very tightly to the rubber or the 
 glass and are difficult to remove. The smallest bit, 
 however, if decomposed is liable to infect the milk of 
 the next meal and to cause a serious digestive disturb- 
 ance. . 
 
 When both nipple and bottle are clean, they 
 should be placed and kept in a i per cent solution of 
 washing soda (one heaping teaspoonful to the quart 
 of water) and boiled in same once a day. 
 
 The soda is strongly disinfecting and besides dis- 
 solves all and every remnant of milk, should one be 
 left, so that the bottle is in perfect condition as soon 
 as the soda is carefully removed with boiled water. 
 
 It is best to have a number of nipples and bottles 
 at hand and to use them in rotation. 
 
—204— 
 
 CHAPTER XXV. 
 
 OTHER SUBSTITUTES FOR MOTHER'S MILK. 
 
 GOAT'S MILK— Goat's milk has been used as 
 a substitute for mother's milk in a number of in- 
 stances. It agreed well with most children, but, as it 
 has no advantage over cow's milk, it is not necessary 
 to dwell upon it any longer. Should goat's milk be 
 more accessible than cow's milk, it may be tried. It is 
 prepared in exactly the same manner as cow's milk, 
 but the dilution does not need to be so strong. Goat's 
 milk has a peculiar, somewhat sour taste and is re- 
 fused by many babies. 
 
 ASS'S MILK — Ass's milk comes in its composi- 
 tion nearest to mother's milk. Experiments with a 
 great number of children have demonstrated the fact 
 that they thrive well on it. It is best given the way it 
 comes from the animal, undiluted and raw. It can- 
 not be cooked as it curdles upon heating. No hesita- 
 tion need be felt in feeding it thus, as the ass is not 
 subjected to so many diseases as the cow is and, above 
 all, is free from tuberculosis. 
 
 If ass's milk is obtainable, it should be given pref- 
 erence over cow's milk. 
 
 MARE'S MILK— Mare's milk also is an excel- 
 lent substitute for mother's milk. It, too, should be 
 given undiluted and raw. Children seem to like it 
 and seldom refuse it. The number and quantity of 
 feeds are the same as with cow's milk. 
 
 CONDENSED MILK— Condensed milk is the 
 most common substitute for mother's milk. This is 
 not because it is best, but because it is easiest acces- 
 sible and cheap. Its use, however, is not recommend- 
 able. Some children, it is true, seem to thrive well 
 on it. They are plump and fat. But all is not gold 
 
-205- 
 
 that glitters. Observations on large numbers of 
 children have proved the fact that infants brought up 
 on condensed milk suffer very frequently from mal- 
 nutrition, digestive disturbances, anemia, and above 
 all from Rickets or English Disease. In spite of their 
 full and round cheeks and forms, they are pale, suffer 
 alternately from diarrhea and constipation, get their 
 teeth late, are slow in learning to v\^alk, etc. But, 
 above all, it is notew^orthy that their number dying 
 from acute febrile diseases, such as pneumonia, diph- 
 theria, scarlet fever, etc., is appalling. If epidemics 
 arise, death, with unfailing certainty, picks out first 
 those babies that are brought up on condensed milk; 
 a sure sign that, notwithstanding the plumpness, the 
 vitality is low. 
 
 Condensed milk is, therefore, not recommend- 
 able as food for infants. It has many disadvantages, 
 but no advantage over cow's milk. Of course, a good 
 condensed milk is preferable to a bad fresh milk and 
 finds its proper place where fresh cow's milk cannot 
 be had or only in a doubtful condition. 
 
 BUTTERMILK— Buttermilk, as infant food, is to 
 be prepared in the following manner: One table- 
 spoonful of. rice meal or, if this is not obtainable, 
 wheat flour is rubbed with a little buttermilk to a 
 smooth paste. With this is mixed two to three table- 
 spoonfuls of sugar, and buttermilk slowly added suf- 
 ficient to make a quart. The whole is placed upon the 
 fire and, while being continually stirred, is cooked for 
 ten to fifteen minutes. Then the mixture is taken off 
 from the fire and a full point of a knife full of fresh 
 butter added. Now the food is ready. It is stirred 
 thoroughly once more, divided into bottles, cooled 
 and placed on ice To the child it is given in the same 
 manner as the ordinary food. 
 
 By buttermilk we understand that fluid which is 
 left from the sour cream after churning. It is, if 
 fresh, pleasantly sour. 
 
—206— 
 
 Buttermilk has proved to be an excellent food for 
 both healthy and sick children. It is surprising how 
 well it is borne in cases of dyspepsia and summer 
 diarrhea, after the digestive organs have been clean- 
 sed with Calomel and rested a day or two on a diet of 
 water (see "Acute Indigestion"). In a great number 
 of cases of chronic catarrh of the stomach and bow- 
 els it has been life-saving. Without the use of addi- 
 tional remedies the disease disappeared. The stools 
 resumed a normal appearance, their foul smell passed 
 away and the children became bright and lively. 
 
 Buttermilk has also done splendidly as an addi- 
 tional food for nursing babies that did not thrive on 
 the breast and suffered from constipation and colics. 
 More detailed instructions as to this point will be 
 found in the chapter on ''Constipation." 
 
 But notwithstanding the great services it ren- 
 ders, buttermilk has not done well in all cases. A num- 
 ber of children did not like it at first, but became used 
 to it very soon; others vomited it in the beginning, a 
 disturbance which, however, also soon disappeared. 
 Again others suffered from constipation, and some 
 children who improved beautifully in the beginning, 
 increased in weight rapidly and had a good diges- 
 tion, lost their appetite after five to six weeks, became 
 stationary or even decreased in their weight. 
 
 In order to remedy these drawbacks and make 
 the buttermilk more dig-estible, an addition of three- 
 quarters drachm of Sodium Carbonate to the quart of 
 food has been tried and found advantageous in many 
 cases. 
 
 Prescription 55. 
 
 Sodium Carbonate 1^ ounces 
 
 Distilled Water 4 ounces 
 
 Two teaspoonfuls of this solution contain % 
 drachm of Sodium Carbonate. 
 
 If this addition is made, a somewhat different pre- 
 paration of the food is necessitated. Instead of a full 
 tablespoonful of flour, one-half or three-quarters is 
 
—207— 
 
 sufficient, and instead of two or three tablespoonfuls 
 of sugar, only one is required. The Sodium Carbonate, 
 dissolved in water, should not be added to the paste 
 • made of buttermilk, flour and sugar, but to the full 
 quart of the mixture and be followed by four to seven 
 ouncesofai6per cent cream (see page 182), the quan- 
 tity to be chosen according to the condition of the 
 bowels (see page 188). The mixture is now finished. 
 It is placed upon the fire and, while being stirred con- 
 tinually, is brought to a boil. Then it is taken off 
 from the stove, stirred for five to ten minutes longer, 
 filled into bottles, cooled and placed on ice. 
 
 The Sodium Carbonate takes the acid out of the 
 buttermilk and improves its digestibility. Taste and 
 odor are also bettered. Vomiting is rare, the bowels 
 are more regular and fewer cases fail after thriving 
 for a while. 
 
 As it was intimated in different places in this 
 book, there are instances in which buttermilk does 
 not agree with the babies. These latter were, as a 
 rule, previously fed on food too rich in unconverted 
 starch or casein and suffered from thin, green pass- 
 ages mixed with flakes and shreds. 
 
 Under these circumstances a food rich in fat is 
 necessary. If, therefore, buttermilk fails, a trial with 
 the gruels, described on page 184, enriched with 
 cream, is indicated. This latter is added to the food 
 at first in tea or tablespoonful doses, but its quantity 
 IS increased as it proves beneficial. 
 
 Intervals of four hours between the feeds are 
 best if the infant is not too young. 
 
 PEPTONIZED MILK— By peptonized milk is 
 understood an artificially digested milk. It i^ indi- 
 cated where the stomach is unable to digest the food, 
 as, for instance, in cases of acute and chronic catarrh 
 of the stomach, dyspepsia, etc., if white flakes of un- 
 digested milk appear in the stools (see page 99). 
 
 Peptonized milk should not be used for a long 
 
—208- 
 
 time, but only as a temporary relief. As soon as the 
 stomach improves, the child should return to the or- 
 dinary nourishment, as otherwise the stomach will 
 lose the power of digesting. 
 
 There are different degrees of peptonization: 
 
 (a) Partial Peptonization. Partially peptonized 
 milk is prepared as follows : Take one quarter pint of 
 boiled water and mix with three-quarters pint of fresh 
 milk. In the mixture dissolve a powder composed of 
 Pancreatin and Sodium Bicarbonate (Prescription 
 56). Then heat for ten minutes to a temperature of 
 
 Prescription 56. 
 
 Pancreatin 5 grains 
 
 Sodium Bicarbonate 15 grains 
 
 from 100 to 115 degrees Fahrenheit, preferably by pre- 
 paring the food in a bottle and placing this in water 
 so hot that the hand can just be kept in it. When 
 the ten minutes are over, take the bottle out of the 
 water, cool and place on ice. If ice is not at hand, the 
 milk must be heated quickly to the boiling point in 
 order to destroy the peptonizing ferment, as other- 
 wise the peptonization will continue. Then take from 
 the fire and cool immediately. 
 
 Milk partially peptonized in this way is changed 
 in taste but very little or not at all. 
 
 (b) Complete Peptonization. The completely 
 p'eptonized milk is prepared in the same manner as 
 the partially peptonized milk, the only difference is. 
 that the bottle is allowed to remain in the warm 
 water from one to two hours instead of ten minutes. 
 
 Between these two degrees of peptonization 
 there are a great mau}^ intermediate stages, as the 
 milk is peptonized more, the longer the bottle is left 
 in the hot water. 
 
 The partially peptonized milk is to be used in 
 slight cases, the completely peptonized milk in cases 
 of complete loss of the digestive power. The latter 
 has a bitter taste and is often rejected, but, after some 
 
-209— 
 
 opposition at the start, it is soon taken readily by 
 most children. 
 
 KEFIR — Kefir is a fermented milk. The fer- 
 mentation is produced by so-called kefir kernels, com- 
 posed of fermenting microbes, which are imported 
 from Asia. They digest the casein (see page 158) and 
 the milk sugar. Kefir is a very nutritious food and 
 very easily digested and assimilated. It has a some- 
 what sour taste and contains carbonic acid gas and a 
 small amount of alcohol in consequence of the fer- 
 mentation. It is indicated in all cases of weakness, 
 caused by tuberculosis, scrofula, rickets, anemia, etc. 
 In many diseases it is easily borne where other kinds 
 of food are rejected. 
 
 On account of its sour taste it is sometimes con- 
 sidered unplatable at the start. But most children 
 soon become accustomed to it and many prefer it to 
 all other nourishment. 
 
 It is generally prescribed for older children and 
 adults, but can also be given to children under one 
 year of age if diluted with an equal amount of water. 
 
 If the stomach is very sensitive, it is best to give 
 kefir cold and in small doses, a tea or a tablespoonful 
 every ten to thirty minutes. 
 
 Full directions for the preparation of kefir come 
 with the kernels. These latter can be bought in any 
 drug store. Care, however, should be taken to get a 
 good article, as only good kernels will produce a good 
 kefir. 
 
 KUMYSS — Kumyss, too, is a fermented milk. 
 The fermentation is, however, in this case not 
 brought about by Kefir kernels, but by ordinary 
 yeast. The mode of preparing is, according to Holt, 
 as follows : "One quart of fresh milk, half an ounce 
 of sugar, two ounces of water, a piece of fresh yeast 
 cake half an inch square; put into wired bottle, keep 
 at a temperature between 60 and 70 degrees Fahren- 
 
—210— 
 
 heit for one week, shaking five or six times a day, and 
 then put upon ice." 
 
 Kumyss is used for the same ailments as kefir. 
 It differs from the latter only in taste; the changes in 
 the milk are about the same in both instances. Kefir 
 is more pleasant to take and is, therefore, preferred 
 by most people. 
 
 Both preparations, kefir and kumyss, deserve a 
 much more general use than they have at present. 
 They are cheap, are not patented, but offer a nourish- 
 ment which is hardly equaled by any other. On ac- 
 count of their cheapness they are also within reach of 
 people of moderate means. 
 
 WHEY — By this term is understood a milk from 
 which all casein (see page 157) and the greatest part 
 of fat has been removed. It still contains all the milk 
 sugar and about i per cent of albumen. 
 
 How to prepare: Heat a pint of milk, skimmed 
 or unskimmed, up to 100 degrees Fahrenheit; add two 
 teaspoonfuls of Essence of Pepsin (Prescription 57), 
 
 Prescription 57. 
 
 Essence of Pepsin . 4 ounces 
 
 or Liquid Rennet (Prescription 58) ; stir quickly with 
 
 Prescription 58. 
 
 Liquid Rennet 4 ounces 
 
 a spoon and allow the mixture to stand until all 
 casein is curdled. Then break up the cheesy mass 
 into small particles with a fork and strain through a 
 cloth. The clear fluid thus obtained is the whey. 
 
 This product is especially recommendable for 
 children whose digestive organs are very weak. 
 
 BEEF JUICE— How to prepare : Grind the de- 
 sired amount of meat, say one-half to one pound, as 
 fine as possible in a meatgrinder. Place in the inner 
 part of an oatmeal steamer, cover and put on stove. 
 Allow the water in the outer vessel to get so warm 
 that the hand can just be held in it, about 120 degrees 
 
—211— 
 
 Fahrenheit, and keep it so for two to three hours. 
 Then press out the juice. 
 
 Two or three times as much juice as with any 
 other method can thus be obtained from the same 
 amount of meat. If the water in the outer vessel gets 
 too hot, the juice coagulates and can no longer be ex- 
 pressed. 
 
 Meat juice is a very, very perishable fluid. It 
 must, therefore, be used at once or placed on ice im- 
 mediately. Without ice it spoils in a few hours. 
 
 The child can receive one to two teaspoonfuls of 
 this juice in milk about three times a day where indi- 
 cated. 
 
 The meat juice thus prepared should not be con- 
 founded with the extract of beef bought in the drug- 
 store. The former contains an abundance of nourish- 
 ment, the latter none at all. The extract of beef is 
 nothing but a stimulant and its value is grossly over- 
 estimated by the public. 
 
-212- 
 
 CHAPTER XXVI. 
 
 PROPRIETARY FOODS. 
 
 The number of these preparations on the market 
 is so great that the attempt to enumerate them all 
 would be idle. Moreover, we consider them as en- 
 tirely unnecessary for the great majority of infants 
 and for many as harmful. Mothers are too readily in- 
 duced by the glaring claims of the manufacturers to 
 substitute them for the fresh, pure milk to the great- 
 est disadvantage of their babies. 
 
 We will, therefore, dismiss these preparations 
 with a short notice. 
 
 The proprietary foods may be divided into two 
 classes. To the first class belong those which do not 
 contain unconverted starch, and to the second class 
 those which do contain unconverted starch, that is, 
 flour. 
 
 The infant's ability to digest starch or flour is en- 
 tirely wanting in the first six months of its life, or, at 
 any rate, so small that it need not be considered. All 
 foods that are made up therefrom, or contain large 
 proportions thereof, are, therefore, prohibited for in- 
 fants below six months of age. They make such 
 babies sick and are liable to produce chronic digestive 
 disturbances which lead to invalidism and death (see 
 "English Disease"). 
 
 (A) Proprietary foods with very little or no un- 
 converted starch, which may, if circumstances de- 
 mand, be given to infants under six months of age. 
 
 1. All malted milks, be it Borden's Malted Milk 
 or Horlick's Malted Milk or others. 
 
 2. Mellin's Food. This is also almost complete- 
 
—213— 
 
 ly soluble in water and does not contain any uncon- 
 verted starch. 
 
 (B) Proprietary foods with plenty of uncon- 
 verted starch, which should not be given to infants 
 under six months of age. 
 
 1. Nestle's Food. It contains about 70 per cent 
 of unconverted starch. 
 
 2. Imperial Granum and others. 
 
—214— 
 
 CHAPTER XXVIL 
 
 FEEDING AFTER THE FIRST YEAR. 
 
 In the second year as well as in the first, the 
 child's nourishment should in the main consist of 
 milk. Not until in the third year can the daily quan- 
 tity of this food be lessened. 
 
 ADDITIONS. 
 
 FARINACEOUS FOODS— These, as stated on 
 page 153, should first be given as a substitute for milk. 
 They are a splendid nourishment for children after 
 the sixth to seventh month of age, when the digestive 
 organs have developed the ability to master them. 
 But in spite of their merits they should at first be 
 given sparingly. Children of this age that consume 
 too much of them, or those that begin too early (see 
 page 212), are likely to suffer from dyspepsia, chronic 
 catarrh of the bowels, diarrhea, anemia, rickets, etc. 
 
 Of the farinaceous foods, the first ones to come 
 into consideration are those already mentioned on 
 page 153 in the chapter on "Weaning,'' namely, oat- 
 meal, wheat and barley gruels, bread soups, etc, etc. 
 Oatmeal is the most nourishing and is usually prefer- 
 red. Bread crusts, crackers, rusk, toast and others 
 can now be given dry, so the children have something 
 to gnaw on. 
 
 Allowed are further: Mashed potatoes with 
 plenty of milk and a little butter or, perhaps, with a 
 little gravy, easily digestible puddings of milk and 
 starch flour, farinaceous soups and breakfast foods of 
 the different kinds, etc. 
 
 Not allowed are: Rich cakes and pies, freshly 
 baked bread, pancakes, fried potatoes, as well as far- 
 inaceous dishes fried with butter or fat. 
 
—215— 
 
 MEAT AND MEAT SOUPS— Meat and meat 
 soups are generally not considered proper articles? of; 
 diet during the first year unless specially indicated, as 
 in cases of indigestion, scurvy, rickets, etc., and then 
 only in small quantities. ^, 
 
 After the first year, however, meat and meat pre- 
 parations, given moderately, are conducive to a. vig- 
 orous development of the child. 
 
 Meat is most easily digested if given raw, either 
 chopped very fine or, better, in the form of the meat 
 juice, described on page 210. Of the latter once or 
 twice or three times a day a teaspoonful or two may 
 be given mixed with the other nourishment. 
 
 It is also allowable to give children a little meat 
 to chew, advising them to spit out what does not melt. 
 
 Not until after the second year are somewhat 
 larger quantities of meat permissible. 
 
 VEGETABLES — The beginning with vege- 
 tables should not be made until after the middle of 
 the second year. Then are allowed: All cooked 
 green vegetables, such as spinach, peas, green beans, 
 etc. Forbidden are: All fried and raw vegetables, 
 such as lettuce, celery, as well as radishes, onions, cu- 
 cumbers, etc. 
 
 Green vegetables favor the formation of healthy 
 blood and keep the bowels open. But only very mod- 
 erate quantities should be given until after the second 
 year, when the quantity may be somewhat increased. 
 
 EGGS — It is best to give no eggs to children un- 
 der one year of age. Those in the second year may 
 receive one mixed with their food every day or every 
 second day. Still older children may eat them soft 
 boiled or poached. Fried eggs are not suitable for 
 children. 
 
 It is well to feed eggs sparingly, since, fed too 
 frequently, they may lead to digestive disturbances. 
 Besides, it may be said that the amount of nourish- 
 
—216— 
 
 ment contained in an tgg is not by far so large as is 
 generally believed. 
 
 FRUIT — Cooked fruit, such as apple, pear, 
 plum-sauce, etc., is suitable for children over one year 
 of age. It is to be recommended particularly in 
 cases where constipation or a tendency to this condi- 
 tion exists. Raw fruit should never be given. 
 
 BEVERAGES — The main beverage for children 
 at meals will always be milk. If during the warm 
 weather there is a desire for more fluid, fresh, pure 
 water is best. This should be given freely. 
 
 ALCOHODIC DRINKS— Alcoholic drinks of 
 any form or description are strictly forbidden except 
 where given as medicines. 
 
 What was said at the end of the chapter on 
 "Weaning" must here be repeated: Children should 
 not be fed too much at a time or too often. It is al- 
 ways to their detriment to break this rule. Piecing 
 between meals should not be allowed under any con- 
 sideration. It is a most pernicious habit. Many 
 children suffer from chronic loss of appetite, stomach 
 aches, constipation, etc., because weak parents can- 
 not deny the little beggars the dainties, cakes, etc., 
 they want between the meals. Temperate and well 
 regulated habits in eating are as essential to the sus- 
 tenance of health as properly regulated intervals of 
 work and rest. 
 
PART III 
 
 Disturbances of Nutrition, 
 
-219- 
 
 CHAPTER XXVIII. 
 
 We cannot enter here upon all the many diseases 
 of childhood as this does not belong to the scope of 
 our treatise. We will speak only of those deviations 
 from the normal which require proper care rather 
 than remedies, and with which a mother should be 
 acquainted, as it lies in her hands to avoid the serious 
 consequences arising therefrom. 
 
 DELICATE INFANTS. 
 
 A certain class of infants do not thrive in spite 
 of all efforts of their parents. They are not sick, nor 
 are they well. Their weight does not increase; their 
 muscles are flabby; their skin hangs loose around the 
 limbs and their digestion is unsatisfactory, as disturb- 
 ances arise continually. 
 
 Causes: The causes are different. With some 
 children the trouble is inherited. They come from 
 parents who are not healthy themselves and suffer 
 from consumption, poor blood, and other weakening 
 diseases, especially irom syphilis and alcoholism. 
 Syphilitic folks and those who are addicted to drink- 
 ing are often cursed with delicate children. It is es- 
 pecially pernicious for the offspring if the mother 
 during pregnancy indulges in intoxicating bever- 
 ages. To these latter belong not only those alcoholic 
 drinks which are known as such, but also a great 
 number of patent medicines which, although made 
 and sold as remedies, are in reality nothing but dis- 
 guised eye openers and bracers (see page 124). 
 
 A further cause lies in the insufficient develop- 
 ment of the body on account of premature birth. The 
 organs are not sufficiently prepared for the battle of 
 
—220— 
 
 life. Although some of these children, if nursed with 
 special devotion, overcome the disadvantages of their 
 birth and grow big and strong, most infants of this 
 class succumb, as can be seen from the mortuary sta- 
 tistics of children prematurely born. 
 
 A third cause lies in chronic digestive disturb- 
 ances, especially when arising in the first months of 
 life. At this time it is of special importance that di- 
 gestion be good and regular, for it is at this time that 
 the infant lays the foundation for its future health. 
 If, however, the foundation is weak, the structure 
 erected upon it must necessarily be weak also. From 
 this it is clear that even a short period of nursing on 
 mother's breast after birth — mother's milk being the 
 most suitable of all nourishments — is of the greatest 
 benefit to the child, and that every day this nursing 
 period can be lengthened is another solid stone in the 
 structure of the baby's bodily welfare. The diges- 
 tive disturbances are in some instances caused by an 
 improper composition of either the artificial food or 
 the mother's milk, oftener, however, by the improper 
 administration of the nourishment and overfeeding. 
 We have mentioned this latter point already several 
 times and need not here dwell upon it any longer. We 
 refer to previous pages of this book for further infor- 
 mation and advise those mothers who have not as yet 
 realized the enormous importance of this cause of 
 sickness to study it carefully. 
 
 A fourth cause lies in the insufficient supply of 
 fresh air, dark, damp and overcrowded dwellings, in- 
 sufficient care and neglect of the child, or in overzeal- 
 ous nursing, overheated rooms, insufficient ventila- 
 tion, too warm dressings, etc. 
 
 A fifth cause lies in the exhaustion which acute 
 and chronic diseases sometimes leave behind. Many 
 a child that up to the time of the beginning of the ail- 
 ment was vigorous and healthy withers after it is 
 
-221- 
 
 over like a cut flower. Its physical strength is lost, 
 its vitality is gone. 
 
 Besides these principal causes, there are many 
 others which, either alone or in connection with each 
 other, work in the same direction. 
 
 Prevention: Prevention consists in the avoid- 
 ance of the cause. 
 
 Symptoms: With children of inherited debil- 
 ity the weight at birth is usually below the normal, 
 sometimes even as low as four pounds. The skin is 
 cool, the movements of the limbs are slow, the bod}^ is 
 held motionless for hours at a time, the strength is so 
 little that sucking sometimes is impossible, the bow- 
 els are constipated and the excretion of urine is re- 
 tarded. 
 
 If, however, the physical weakess of the child is 
 not inherited, but develops later in consequence of one 
 or the other cause mentioned above, the first sign of 
 coming trouble is an insufficient increase, standstill 
 or a loss in weight (see page yy). Not until later 
 do other symptoms develop, namely, withered, dry 
 skin, flabby muscles, insufficient increase in height, 
 poverty of blood, swollen glands around the neck and 
 all those different signs which characterize the "Eng- 
 lish Disease" (see next chapter). 
 
 Treatment: The most difficult task in the 
 treatment of delicate infants is the selection and man- 
 agement of the food. The slightest mistake is usually 
 followed by comparatively serious consequences and 
 one attack of indigestion follows another in rapid 
 succession. 
 
 If the child is too weak to suck, the milk should 
 be pumped or massaged out of the breast and given 
 thus until the infant is strong enough to nurse. Arti- 
 ficial food, if necessary, should be prepared as de- 
 scribed in previous chapters. Two fundamental rules 
 shall be emphasized : First, regularity in the admin- 
 istration of nourishment and avoidance of overfeed- 
 
—222— 
 
 ing (see pages 144 and 190) ; second, greater dilution 
 of the nourishment than is required under normal cir- 
 cumstances. To find the degree of dilution, the 
 weight of the child should be taken into considera- 
 tion rather than its age (see page 181). If the di- 
 gestive organs are very weak and ordinary cow's milk 
 is not stood, buttermilk or whey or peptonized milk 
 should be tried. 
 
 Instructions as to the management of an acute 
 indigestion will follow in a later chapter. 
 
 Equal in importance to proper nourishment is 
 proper care. Children weak by birth must be kept 
 very warm for a long period. The lighter the weight 
 and the cooler the skin, the greater must be the supply 
 of warmth. Wrapping in absorbent cotton, warming 
 up with warmed woolen covers, hot water bottles, hot 
 flatirons, hot stones, etc., are used by the poor, while 
 by the rich and in clinics so-called "incubators'' are 
 employed, instruments so designed and constructed 
 that any desired temperature can steadily be main- 
 tained. 
 
 Cleanliness and an abundance of fresh air are in- 
 dispensable. Special strengthening remedies are usu- 
 ally not required. A properly prepared nourishment, 
 given at the right time and in the right quantity, if 
 well digested and absorbed, invigorates and strength- 
 ens the little body better than any artificial prepara- 
 tion. However, if in spite of good digestion the for- 
 mation of blood is retarded on account of the lack of 
 proper elements for building up, or if digestion is ir- 
 regular, the cheeks and lips pale, the sleep not refresh- 
 ing and other signs of impoverished blood be pres- 
 ent — a good and reliable tonic must be looked for (see 
 page 125). 
 
 Against the English Disease, which sooner or 
 later attacks nearly all of those weak and debilitated 
 infants, all that is said in the following chapter should 
 be heeded. 
 
-223- 
 
 CHAPTER XXIX. 
 
 ENGLISH DISEASE OR RICKETS. 
 
 The English Disease, also called Rickets or 
 Rachitis, is a systemic disease, that is, it is a disease 
 which may attack any and all organs of the body, al- 
 though it affects some of them in a peculiar degree, 
 as, for instance, the bones. This singular change in 
 the bones has given the disease also the name of ''Soft 
 Bone Disease." It is, however, by no means the 
 bones alone that suffer. The muscles, sinews, liver, 
 spleen, stomach, bowels, brain and, above all, the 
 blood are also injured, as we shall see in the follow- 
 ing description. 
 
 Causes: One of the most important causes is 
 the want of fresh air. The disease is, therefore, sel- 
 dom found in the country, but very frequently in 
 cities, and it comes into evidence principally in the fall 
 and in winter, when children are anxiously kept at 
 home. Want of light and unsanitary, damp dwell- 
 ings usually co-operate. 
 
 A further cause is improper and insufficient 
 nourishment. The disease is, therefore, seldom found 
 with nursing infants, more frequently with those fed 
 on cow's milk and most frequently with babies reared 
 on proprietary foods and especially condensed milk 
 (see page 204). 
 
 A third cause is brought about by the weakening 
 influence of acute and chronic diseases. The English 
 Disease follows, therefore, frequently after measles, 
 diphtheria, influenza, etc. 
 
 Heredity also is considered a cause for the Eng- 
 lish Disease, since it often attacks all children of even 
 well-to-do families. 
 
—224^ 
 
 Symptoms: The symptoms of this ailment 
 are manifold and vary according to the place where 
 the disease has settled. Only in far advanced cases 
 are they present in great numbers. But the better the 
 examiner is acquainted with the ailment, the more 
 signs will he find. 
 
 GENERAL SYMPTOMS— The English Dis- 
 ease usually develops slowly. The child, previously 
 cheerful and lively, gets uneasy, peqvish, nervous and 
 fretful. Its sleep is disturbed and restless. It kicks 
 off the bed clothes, throws its little hands around and 
 rubs the back of the head in the pillows, sometimes so 
 continually and vigorously that the hair is lost by the 
 friction. A bald space on the back of the head of 
 babies is, therefore, a conspicuous sign of the exist- 
 ence of the English Disease. A sign of equal prom- 
 inence, pointing to the disease, is the sweating of the 
 head . As soon as the child falls asleep, the scalp be- 
 gins to get wet. Smaller or larger drops appear on 
 the forehead and the pillow becomes damp or even 
 wet from the ooze. A sharp contrast is offered by the 
 body, which is nearly or perfectly dry. 
 
 At this time digestive disturbances are usually 
 fully developed. The abdomen is bloated and often- 
 times presents the appearance of a barrel, a so-called 
 'Tot-belly" (see Fig. 4Q). The appetite is wanting. 
 The bowels are irregular, soon too loose, soon too 
 hard, diarrhea changing with constipation. This lat- 
 ter symptom is so characteristic that its presence 
 should always arouse suspicion and suggest a search 
 for further signs of Rickets. Belching and colics are 
 rarely missing. 
 
 The weight is stationary or goes back. The for- 
 mer plumpness begins to vanish, the blood grows 
 poor, the skin pale, the muscles flabby. The child re- 
 fuses to use its limbs in the usual wa}^ The learning 
 of standing and walking is delayed. If the baby has 
 already begun to walk, it gives up again. It wants 
 
—225— 
 
 to lie down or to be carried and the former desire for 
 playing disappears. 
 
 Figure 49. Rickety child, according to Holt. 
 
 Everyone of the above symptoms is so character- 
 istic that no mother can fail to recognize the exist- 
 
—226— 
 
 ence of the English Disease after her attention has 
 been called to them. If her suspicion is aroused, any 
 one or a combination of several of the special signs 
 now following will confirm the diagnosis. 
 
 SIGNS ON THE HEAD— On page 82 we have 
 seen that the anterior fontanel is usually closed 
 around the twentieth month. If this is not true after 
 the completion of the second year, it must be taken 
 as a sign of the existence of the disease in question. 
 Under such circumstances the head is often found to 
 be larger than that of healthy children and assumes a 
 somewhat flattened or square form (see Fig. 49 and 
 51). The back of the head is sensitive to pressure. In 
 consequence children are restless when lying on the 
 back and calm down when taken up or laid on the side, 
 so that the back of the head is relieved. Very char- 
 acteristic is the erupting of the teeth. With rickety 
 children they come late and irregularly (see "Devel- 
 opment of the Teeth" on pages 84 to 86). In some 
 cases the eruption of every tooth takes a very long 
 time. The mother sees the gum bulging, the child is 
 restless, cries much, is fretful and may have slight or 
 serious cramps. All symptoms indicate that the 
 tooth will soon be through. But in spite of this it 
 does not come. Finally the physician is sent for to 
 cut the gum. It is, however, not the toughness of the 
 gum that retains the tooth, but, in consequence of the 
 disease, the tooth has not the push behind it for cut- 
 ting through. If in such instances the proper treat- 
 ment is begun, the tooth will soon be through with- 
 out the use of the knife. 
 
 It is necessary, therefore, in all cases in which the 
 teeth come too late, or their eruption is delayed, or 
 the child remains too long on an uneven number of 
 teeth (see page 86), that the mother search for fur- 
 ther signs of Rickets and, if she finds such, begin the 
 treatment at once. 
 
—227— 
 
 SIGNS ON BREAST AND ABDOMEN— At 
 
 the junction of the bony and the cartilaginous parts 
 of the ribs (Eig. 50), there develop with rickety child- 
 
 Figure 50. The black dots represent the junction of the bony and the cartil- 
 aginous parts of the ribs where the "Rhachitic Rosary" develops. 
 
 Figure 51. 
 
 Advanced case of Rickets with well developed 
 "Rhachitic Rosary." 
 
-228— 
 
 ren nodular swellings. They are easily felt by shift- 
 ing the skin over these places with the fingers back 
 and forth and, in advanced cases, may even be visible 
 to the eye, as can be seen in figure 51. The string of 
 these swellings or beads is called "Rachitic Rosary." 
 From its existence alone a diagnosis of the English 
 Disease is justified. In still more advanced cases the 
 ribs soften in their entire length. If the mother is in 
 a habit of lifting the child with her hands layed under 
 its arms, the ribs are pressed together by this lateral 
 pressure. By and by they flatten at the sides and 
 grow pointed in the front, developing a so-called 
 "Chickenbreast" (see Fig. 52). The lateral pressure 
 
 Figure 52. The full line represents the outline of a normal breast, 
 
 the dotted line that of a rhachitic, deformed breast. 
 
 on the breast is also painful to babies. They cry, if 
 thus raised, showing their distress, but are usually 
 misunderstood by uninformed mothers, who wonder 
 why the child whines every time it is lifted up. May 
 this hint suffice to explain to our readers this other- 
 wise curious phenomenon and cause them to refrain 
 from lifting their rickety children in the manner above 
 described. 
 
 In very neglected cases the spinal column also 
 suffers. The vertebrae become soft, and distortions 
 and curvatures of the most varied kind develop. 
 
—229— 
 
 SIGNS ON LEGS AND ARMS— The signs on 
 the legs are usually most pronounced if the child is 
 taken ill at a time when it already has begun to walk. 
 The bones, lacking sufficient firmness and hardness, 
 bend under the load of the body. The result is either 
 a bow-leg (Fig. 53) or a knock-knee (Fig. 54). 
 
 Figure 53. Bow-Liegs. 
 
 Figure 54. Knock-Knee. 
 
—230— 
 
 The arms are rarely curved, since they need not 
 carry a load. But also on these are conspicuous signs 
 in advanced cases, namely, the swelling of the bones 
 of the lower arm at their extremities forming the 
 wrist. In Fig. 49 these swellings are easily visible. 
 
 Prevention: Abundance of fresh air, well venti- 
 lated, dry, light dwellings and proper nourishment, 
 are the chief preventives. Particulars about these 
 will be found in the following lines: 
 
 Treatment: CARE. Plenty of fresh, clean air 
 must first be provided for. Nothing worse can be 
 done than to keep afflicted children anxiously at home 
 in overheated rooms for fear they might catch cold. 
 They should be carried or wheeled out whenever the 
 weather permits. The more fresh air, the quicker the 
 recovery. If it be possible, close, dark, and damp 
 rooms should be exchanged for spacious, light, and 
 dry ones. The windows must frequently be opened 
 and the rooms aired. If the parents can defray the 
 expenses, a change from a colder to a warmer climate, 
 from the city to the country, is very recommendable. 
 Sea air is of special curative value. 
 
 Rickety children of the more advanced class are 
 best kept in a recumbent position, but should not lie 
 too long in the same posture in order to avoid an un- 
 symmetrical growth of the bones of the head. They 
 should, further, not be carried too long in an upright 
 position, since curvatures of the spine may develop. 
 Also the lifting up of the child with hands layed un- 
 der the little arms is injurious, as explained before, 
 and may lead to disfigurement of the breast and to 
 the compression of lungs and heart. Finally, child- 
 ren of this class should not be coaxed to stand on 
 their feet until the ailment is nearly cured and the 
 bones are well hardened (see page 83). 
 
 Very beneficial are salt baths, given two or three 
 times a week. They are prepared by adding one- 
 quarter to one pound of sea or rock salt to the water 
 
—231— 
 
 of the bath, according to the age of the child. It is al- 
 lowed to add still more if it appears to agree. Let the 
 temperature of the water be 90 degrees Fahrenheit 
 and the duration of the bath ten to fifteen minutes. 
 Given at bed time, it will induce a refreshing sleep. If 
 the bath seems to weaken or to exhaust, it should be 
 given less often, with less salt, or be of shorter dura- 
 tion, according to conditions. 
 
 DIET — Nursing at the breast of the mother or a 
 wet-nurse is an excellent remedy against the English 
 Disease. Human milk should, therefore, be obtained 
 wherever possible. With older and with hand-fed 
 children, all nourishment made of flour or starch and 
 proprietary foods and especially condensed milk, 
 must strictly be avoided. Good, fresh, rich cow's 
 milk, undiluted or properly mixed according to the 
 age of the baby, is better than any other food. An 
 extra addition of cream after each meal is often very 
 advantageous and well borne in most instances. 
 Whether this latter should be given and how much of 
 it, depends upon the condition of the stomach and the 
 bowels (see page 188). Fresh eggs with children 
 after the first year (see page 215), the yolk of an tgg 
 with younger children, furthermore fresh meat juice 
 (see page 210), a little fresh cooked fruit and a few 
 teaspoonfuls of fresh, sweet orange juice, are also 
 very recommendable. 
 
 MEDICINES— An easily digestible fat has, in 
 most instances, a very favorable influence upon the 
 disease. For this reason, we have already recom- 
 mended an extra addition of cream to the meals. An- 
 other fat of this kind is cod liver oil, which, by the 
 public at large and also by physicians, is highly 
 praised as an efficient remedy for Rickets. The 
 dose is one to two teaspoonfuls before going to bed. 
 It is usually given one teaspoonful three times a 
 day after meals. We do not approve of this method 
 of administration because in many instances appetite 
 
—232— 
 
 and digestion suffer thereby. A full dose, that is, one 
 to two teaspoonfuls, given at bed time, is sufficient. 
 Many children take cod liver oil v^ell from the be- 
 ginning, others take it v^ath reluctance at first, but get 
 used to it very soon, few reject it continually. With 
 those latter an emulsified cod liver oil may be tried. 
 Many emulsions are on the market as proprietary 
 medicines. We do not advise to take them. It is best 
 to have the remedy freshly made according to the for- 
 mula given in the U. S. Pharmacopoea, where every 
 druggist can find it. 
 
 Prescription 59. 
 
 Emulsion of Cod Liver Oil with Hypophos- 
 
 phites 4 ounces 
 
 One teaspoonful three times a day after meals. 
 
 Extracts of cod liver oil, as they are offered to 
 the public in the daily newspapers, claimed to con- 
 tain all the curative ingredients of the oil without the 
 fat, are unreliable. The easily digestible fat is that 
 which heals. If this be taken awa}^ the rest is worth- 
 less. 
 
 The most important remedy in the treatment of 
 the English Disease is Phosphorus. It is considered 
 a specific by physicians. The fact is that it works ad- 
 mirably in most instances. The mode of administra- 
 tion is different. In Germany, it is generally admin- 
 istered dissolved in cod liver oil, according to the for- 
 mula given in prescription 60. This preparation, how- 
 ever, is very difficult to make and is absolutely re- 
 
 Prescription 60. 
 
 Phosphorus 1-6 grain 
 
 Cod Liver Oil SV2 ounces 
 
 One teaspooniul twice a day after meals. 
 
 fused by many children. American physicians pre- 
 scribe, therefore, frequently the so-called ''Thomp- 
 son's Solution,'' made according to the formula given 
 in prescription 6i. 
 
 Prescription 61. 
 
 Phosphorus 1 grain 
 
 Absolute Alcohol 350 minims 
 
 Spirit of Peppermint 10 minims 
 
 Glycerin enough to make 2 ounces 
 
 Six to twelve drops three times a day after meals. 
 
—233— 
 
 Much easier to make and to take, but good and 
 effective too, is the powder made according to the 
 formula given in prescription 62. 
 
 Prescription 62. 
 
 Precipitated Calcium Phosphate 
 
 Iron Lactate 
 
 Sugar of Milk, each 1-3 ounce. 
 
 An improvement on this latter is the pov/der sold 
 under the name of Ricketol (Prescription 63). 
 
 Prescription 63. 
 Ricketol 1% ounces 
 
 Of both powders, a small quantity is given in the 
 beginning, the quantity being increased gradually un- 
 til a good sized point of a knifeful, that is, about six- 
 teen to twenty grains, is reached. It is best to admin- 
 ister it in the morning and in the evening, mixed with 
 milk or, better, with oatmeal jelly. The thicker the 
 medium in which it is offered, the easier is it swal- 
 lowed. 
 
 The curative effect of all these remedies is in- 
 creased by giving at the same time Iro-Tonic (see 
 page 125). Besides a certain amount of phosphorus, 
 it contains an abundance of iron in the most digest- 
 ible form. This element also is indispensable in the 
 treatment of the English Disease, because most child- 
 ren affected have a poor, watery blood and look pale 
 and sallow. Iro-Tonic alone is, in many instances, 
 sufficient to bring about a cure if supported by the 
 proper care described above. The dose is from one 
 teaspoonful to one-half tablespoonful three times a 
 day before meals, according to the age of the child. 
 
 If these recommendations are followed, the ef- 
 forts will be crowned with success. Patience, how- 
 ever, is necessary. Although improvement begins 
 soon, it often takes considerable time, perhaps many 
 months, until the last traces of the disease have dis- 
 appeared. 
 
—234— 
 
 CHAPTER XXX. 
 
 ACUTE INDIGESTION. 
 
 (CHOLERA INFANTUM, SUMMER DIARRHEA, WINTER DIAR- 
 RHEA, SUMMER COMPLAINT.) 
 
 Causes: This sickness is caused either by over- 
 feeding or by the taking of spoiled or infected 
 food. The latter is more often the case. With small- 
 er children, nearly always the milk must be blamed; 
 with older children, a great variety of other food- 
 stuffs comes also into consideration. Very dangerous 
 is fruit, especially berries and grapes when eaten in 
 an unripe and unclean condition. 
 
 The disease is most frequent in summer. At this 
 time the continuous high temperature of the air 
 makes fluid nourishments, such as milk, a hotbed for 
 microbes. It takes but a few hours to convert this 
 otherwise excellent food into veritable poison, if the 
 necessary precautions are neglected (see page i66). 
 
 These facts explain why acute indigestion is so 
 much more seldom with nursing infants and such 
 babies as live in the country, where a clean, fresh, 
 wholesome food can easily be obtained, than with 
 hand-fed children and those living in large cities. 
 
 If nursing infants are taken ill with acute indi- 
 gestion, the trouble comes either from unclean water 
 or, more often, from overfeeding. The rests of undi- 
 gested milk decompose and cause the disease. 
 
 Symptoms: The beginning of the disease is 
 sometimes slow, in most cases, however, sudden. 
 
 In the first instance, the child grows restless, 
 loses its appetite, becomes feverish, cries, and finally 
 begins to vomit. 
 
 In the second instance, the vomiting commences 
 suddenly with high fever after taking spoiled milk or 
 
—235— 
 
 eating grapes or berries or other unpeeled fruit. It is 
 vehement, exhausting, persistent. Everything, even 
 v^ater, comes back in a moment. Digestion, of course, 
 is impossible. The more unreasonable, yes unpar- 
 donable, are the doings of many mothers v^^ho, in 
 spite of the persistent vomiting, try again and again 
 to fill the stomach of the infant with milk. Unneces- 
 sary v^ork is, thereby, imposed upon this sick organ. 
 For, instead of getting rest, it has to battle not 
 only with the sickness, but also with the impru- 
 dence of the mother and is forced to empty again as 
 soon as possible by the act of vomiting what is being 
 stuffed into the child. But not always are mothers 
 able to impose this unnecessary burden upon Nature. 
 Instinct prompts the child to do what is right. It 
 often refuses the injurious milk and takes with avid- 
 ity the non-injurious water. 
 
 The stools, retarded in the beginning, soon get 
 loose, their consistency grows thinner, their number 
 greater. Gradually they become watery. A bad odor 
 is seldom present, except in the beginning. The ab- 
 domen, bloated at first, sinks in and is painful to the 
 touch. The opening of the bowels is reddened and 
 sore. 
 
 If the inflammation spreads to the lower part of 
 the bowels, that is, to the large intestines, the char- 
 acter of the discharges changes. They grow slimy, 
 bloody and their smell gets fouL The pressing at 
 stool becomes more distressing and is in many cases 
 almost continual and accompanied by pitiful crying. 
 
 The fever is very high only in the first days, 
 oscillating between 102 and 105 degrees Fahrenheit. 
 It soon, however, goes down, if no complications 
 arise, especially if the proper treatment is instituted 
 at once. 
 
 In consequence of the enormous loss of fluid 
 through the bowels, which is partly only made good 
 by drinking, the blood thickens. The excretion of 
 
—236— 
 
 the waste of the body is hindered. The weakness be- 
 comes great, the skin cool, the tongue dry, the eyes 
 sink in and are surrounded by deep blue-black rings, 
 the nose grows pointed, the voice low and whining, 
 and the hands and feet cold and blue. In a few days, 
 even in a few hours, the formerly blooming child as- 
 sumes the appearance of an old person. 
 
 If the sickness has progressed so far, death will 
 soon follow. 
 
 If, however, the case is properly treated and the 
 tide stemmed, the vomiting ceases, the number of 
 stools decreases and the cool limbs grow warmer. In 
 a few days the child resumes its former cheerfulness 
 and, though weak and enfeebled, goes on to conval- 
 escence. 
 
 In other cases recovery is slow. It proceeds to a 
 certain point and stops. The bowels represent a con- 
 dition of chronic indigestion, which seems impossible 
 to overcome. The weight of the body does not in- 
 crease, the strength will not return, the bowels are 
 still somewhat loose, the paleness does not improve, 
 and the solicitous mother needs all the strength, pa- 
 tience, and perseverance of her devoted love to make 
 good the damage brought on by a seemingly small 
 error. 
 
 Complications and Sequelae — Of the complica- 
 tions two principally are worthy of note, namely, 
 catarrh of the large intestines and inflamma- 
 tion of the brain. The former has been mentioned 
 above; the latter may still set in when improvement 
 is far advanced. It is very dangerous and leads often 
 to death when recovery seems certain. 
 
 The sequelae are of the most varied kind: 
 Chronic indigestion, poverty of blood, rickets, scro- 
 fula, tuberculosis, etc. 
 
 Prevention: Cleanliness and careful super- 
 vision of all foodstuffs, especially in summer, and a 
 close adherence to the directions given in former 
 
—237— 
 
 chapters as to the quahty and quantity of food, are 
 of prime importance. Fruit should not be given to 
 children below one year of age; older ones should 
 have it cooked. Berries and grapes are strictly forbid- 
 den, since their outer surface cannot be cleaned. 
 
 To quench the thirst in summer, clean, fresh 
 spring v^ater is best. If this cannot be had and the 
 water obtainable is of doubtful character, a weak 
 lemonade, made with cooked water, or a very weak 
 tea are proper substitutes. 
 
 Treatment: CARE. Three to four times a 
 day the temperature should be taken with a thermom- 
 eter (see pages 91 to 97) ; if it is very high and the 
 skin hot, bathing in cool water will diminish it. The 
 bath can be repeated several times a day, if necessary. 
 However, it is seldom required if Calomel has been 
 used in the beginning of the sickness according to 
 the instructions following later. 
 
 So long as fever, vomiting and diarrhea last, the 
 little patient belongs in bed. Hot linseed poultices 
 upon the abdomen will ease the pain in the beginning 
 of the trouble. The head must be kept cool. It should 
 not be covered. In case of high fever, frequent wash- 
 ings with alcohol or the application of rags, dipped 
 in- cold water and pressed out again, upon the front 
 part of the head are very refreshing and tend to pre- 
 vent the inflammation of the brain. 
 
 If hands and feet grow cold, a mustard bath 
 should be given, prepared in the following way: Two 
 handfuls of mustard meal are inclosed in a bag and 
 swung around the water for a few minutes, until the 
 latter becomes turbid and yellowish-green. In this 
 the child is placed, allowed to remain for five to eight 
 minutes, taken out again, dried, rubbed down thor- 
 oughly all over the body, placed in its bed and sur- 
 rounded by warm bottles, stones, etc. Let the tem- 
 perature of the bath water be around 98 degrees 
 
—238— 
 
 Fahrenheit. If necessary, bathing can be repeated 
 once or twice a day. 
 
 Diapers must be taken off as soon as soiled. Be- 
 fore the clean cloth is applied, the child should be 
 washed with freshly boiled, warm water, dried thor- 
 oughly and dusted with one of the antiseptic baby 
 powders given on page 54. It is important that dirty 
 napkins be placed immediately in water or, better, in 
 a solution of Rhenolin (Prescription 64) and be boiled 
 as soon as opportunity is offered. The microbes 
 which caused the sickness are contained in the dis- 
 
 Prescriptlon 64. 
 Rhenolin 4 ounces 
 
 charges from the bowels and may sicken other child- 
 ren if they become infected. 
 
 DIET — The first and most important requisite 
 for a successful treatment of all acute indigestions of 
 the above described type is the withdrawal of all 
 nourishment for one or two days. Without this, no 
 medicine will operate satisfactorily. It may seem ter- 
 rible to a loving mother to starve the suffering dar- 
 ling. But it is necessary, absolutely necessary, to fol- 
 low this advice if she wants to save the baby. It 
 shows no sense to stuff the stomach of a child full of 
 nourishment so long as it cannot digest it. The in- 
 flamed organs need rest, rest to heal. But how can 
 rest be had for the digestive organs if they are both- 
 ered with nourishment? Away, therefore, with all 
 milk, away with all soups and foods ! Only one thing 
 can and should be given and that is freshly boiled 
 water, at the temperature the child seems to like it 
 best. It should be given freely. In short intervals it 
 must be offered to the little patient, who generally 
 takes it eagerly, since diarrhea makes thirst. In the 
 beginning, it is allowable to give all the water that is 
 taken, even if it is thrown up again. The copious 
 fluid cleans the stomach and replaces the washing-out, 
 done by physicians. But as soon as the stomach is 
 
-239- 
 
 clean and the water returns free from all particles of 
 nourishment, the amount of water should be restrict- 
 ed in order to avoid any further strain. Then, a tea- 
 spoonful every two to five minutes may suffice for a 
 while. The amount, however, must be increased as 
 soon as the fluid is borne without further irritation. 
 
 The administration of plenty of water is of the 
 utmost importance. It reduces the fever and in- 
 creases the comfort. If an insufficient amount be 
 given, the child must die. The blood grows too thick 
 in consequence of the great loss of fluid through the 
 bowels, the waste products cannot be cast off and ac- 
 cumulate, and life is impossible. 
 
 If the weakness is very great, boiled water or a 
 light fennel tea with an addition of whisky or brandy 
 should be given. The dose of the latter is for child- 
 ren from 
 
 I to 14 days 10 to 30 drops in 24 hours 
 
 14 to 30 days 40 to 50 drops *' 
 
 1 to 2 months i to i^ teaspoonfuls '' 
 
 2 to 6 '* i>^ to 2^ 
 
 6 to 12 ** 2>^ to 4 
 
 I to 6 years ._ )^ to i ounce.. *' 
 
 It is best to feed in the beginning out of a spoon 
 and later, when the vomiting has ceased and if the 
 weakness is not too great, out of a bottle (see page 
 203). 
 
 Should water either alone or mixed with brandy 
 be thrown up continually, water with an addition of 
 limewater or Citrate of Sodium may be tried, in the 
 same proportions or a little stronger, as recommend- 
 ed on page 185. 
 
 Not until the vomiting ceases for twelve to twen- 
 ty-four hours and the diarrhea begins to improve, can 
 the first nourishment be g-iven. 
 
 Nursing infants receive the breast. They should, 
 however, at first nurse not longer than three minutes 
 and not oftener than every four to five hours. If the 
 
—240— r 
 
 vomiting does not return and the child shows no sign 
 of distress, the time of feeding can gradually be 
 lengthened and the intervals shortened. Oftener than 
 every four hours, the breast should not be given until 
 the sickness is entirely over and normal digestion re- 
 stored. 
 
 Hand-fed children receive as first nourishment 
 freshly prepared rice or barley water (see page 184). 
 Far better, yes admirably, works Rheno's Fattening 
 Sugar in cases where diarrhea still persists (see page 
 183). Also a thin solution of ^^g albumen, that is, 
 the white of one ^^% to one-half to three-quarters of 
 a pint of freshly boiled water with or without the ad- 
 dition of brandy, is often prescribed by physicians 
 and agrees well. 
 
 If this nourishment is relished, the time arrives 
 for an addition of fresh, boiled milk or buttermilk, 
 prepared as described on page 205. With very weak 
 children and with those who did not improve consid- 
 erably as yet, the beginning should not be made too 
 early and very cautiously. The amount of milk must 
 be small at first, perhaps only a few drops. If mat- 
 ters run along smoothly, more can be given. By and 
 by the strength of the mixture and the quantity of 
 food is increased until normal percentages are 
 reached. 
 
 Milk or buttermilk, alone or with an addition of 
 cocoa or chocolate, if relished, should remain the only 
 food until stomach and bowels regain their strength. 
 If they are not well borne, the instructions given on 
 pages 191 to 192 will be guiding. Meat soups and oat- 
 meal are forbidden. They increase the diarrhea. 
 
 The treatment of chronic diarrhea, which some- 
 times remains after an acute attack, is given in the 
 following chapter. As to the treatment of a subse- 
 quent general weakness and exhaustion or poverty of 
 blood see page 22. 
 
—241— 
 
 DRUGS — Of all remedies no one has such an 
 excellent effect as Calomel. There are only a few 
 drugs in the whole domain of medicine which achieve 
 such splendid results as this, if applied at the right 
 time and in the right way. It works in many cases 
 like a charm. And yet some laymen who may have 
 seen or heard of some ill by-effects of this drug are 
 opposed to its use, but without justification. It is not 
 the Calomel that harms but the improper manage- 
 ment of it. Calomel is insoluble in water and only 
 slightly soluble in the secretions of the stomach and 
 bowels. It is a strong disinfectant, that is, germ 
 killer and a mild laxative. It stimulates liver and 
 kidneys to higher activity and promotes the expul- 
 sion of the waste products from our body. All these 
 properties are of highest importance and inestimable 
 value in the battle against disease. 
 
 In order to avoid ill by-effects two requisites 
 must be fulfilled: 
 
 First, the dose must be large enough to move the 
 bowels. If this is not the case. Calomel remains too 
 long in the intestines. It is dissolved in a larger 
 measure and passes over into the blood. But even 
 then, one dose would do no harm. If, however, the 
 remedy is given too often or in small quantities for a 
 long period uninterruptedly, symptoms of poisoning 
 may develop, such as increased flow of spittle, inflam- 
 mation of the gums, loosening of the teeth, etc. If 
 administered properly, Calomel does not have suffi- 
 cient time to be dissolved and to be absorbed. It 
 comes out again with the passage and is perfectly 
 harmless. 
 
 Second, it must be given divided into small frac- 
 tional doses, which follow each other in short but reg- 
 ular intervals. The laxative effect is thereby not di- 
 minished, but the disinfecting power increased, since 
 the medicine has a better chance to work upon the 
 microbes which cause the disease. 
 
—242— 
 
 Powders or pills containing Calomel should, 
 therefore, never be given at long intervals nor for a 
 long period, in order to avoid absorption. If this is 
 done and bad effects follow, the mode of administra- 
 tion, not the remedy, should be blamed. 
 
 As stated, all fractional doses, belonging to one 
 treatment, must be given at regular intervals, that is, 
 in one stretch. If the child falls asleep before all are 
 gone, it should be awakened to take the rest. Under 
 such circumstances, an exception must be made from 
 the rule which prescribes that a patient should never 
 be aroused from sleep in order to take medicine or 
 food. It is done in this instance because the proper 
 effect of Calomel is lost if it is given in an improper 
 way. 
 
 The dose is for children: 
 
 to I year old. .^ of a grain divided into 4 powders 
 
 1 to 2 years old i to iji grains divided into 6 powders 
 
 The entire amount should be given in about two 
 to two and one-half hours. This requires the adminis- 
 tration of one-sixth grain of the drug about every 
 one-half hour for smaller children and a little oftener, 
 that is, about every one-quarter to one-half hour for 
 older ones. 
 
 If vomiting is persistent, it is advisable to give 
 still smaller doses by dividing the little tablets con- 
 taining one-sixth of a grain (Prescription 65) into 
 two parts and giving only one of these at a time. 
 
 The administration of the remedy is easy. One 
 of the tablets is crushed in a tea or tablespoon with 
 the handle of a knife, reduced to a fine powder, mixed* 
 with water and given. 
 
 If four to five hours after the last dose of Calomel 
 the bowels do not move, an injection of soap water 
 or a dose of Castor Oil should follow (see chapter on 
 "Constipation'') to help along the passage. 
 
 Bad by-effects from Calomel are thus impossible. 
 The results, however, are in most instances so splen- 
 
-243— 
 
 did that we cannot but urge every mother to have the 
 remedy in the house, ready for emergency. It is very 
 cheap and can be had at any drugstore in any de- 
 sired strength. Tablets containing one-sixth of a 
 grain, as called for in prescription 65, are handiest. 
 
 Prescription 65. 
 Calomel Tablets (1-6 grain) No. 50 
 
 They keep indefinitely, if kept in a w^ell corked bottle 
 and guarded against moisture. 
 
 With these Calomel tablets the treatment of 
 every case of acute indigestion of infants should be- 
 gin. The first doses are often vomited. Soon, hov^- 
 ever, the stomach settles down and keeps the rest. If 
 too many tablets are thrown up, it is necessary to give 
 as many more as have been ejected. 
 
 It usually does not take long and the child, rest- 
 less and crying previously, becomes quiet and begins 
 to sleep; the fever goes down and the diarrhea dimin- 
 ishes. 
 
 If no Calomel is at hand, a dose of Castor Oil is 
 best to initiate the treatment. 
 
 In many instances, one treatment with Calomel, 
 if given right at the beginning of the trouble, is suffi- 
 cient to cure the child, provided the nourishment be 
 managed properly. 
 
 If, after an initial improvement, the case grows 
 worse, a second treatment with Calomel may be given 
 after two to three da3^s and a third one after four to 
 six days. Castor Oil or an injection must be used, 
 should a laxative be required in the meantime. 
 
 In such cases where the Calomel does not prove 
 entirely sufficient, that is, where the diarrhea con- 
 tinues and the bad smell persists, another disinfecting 
 remedy should follow. The best is a solution of Tinc- 
 ture of Iodine and Tincture of Benzoin in alcohol 
 (Prescription 66). 
 
 Prescription 66. 
 
 Tincture of Iodine 80 minims 
 
 Tincture of Benzoin 1-3 ounce 
 
 Alcohol y^ ounce 
 
—244— 
 
 Of this should be given six times a day one drop 
 to children under one year of age and six times a day 
 two drops to children of from one to two years of age. 
 
 The drops are mixed with a suitable amount of 
 water and administered according to convenience, 
 either at one draught or a little at a time. 
 
 Instead of the drops, many physicians employ 
 Salol as a disinfectant for the bowels. It is also good, 
 but not quite as efficient. 
 
 Its dose is for children : 
 
 I to 6 months old y^, grain 3 times a day 
 
 6 to 12 '' I " 
 
 I to 2 years old 2 " '' ** 
 
 Far more efficient than Salol, yes often more effi- 
 cient than the solution given in prescription 66, are 
 either Magnesium Peroxide or Calcium Peroxide. 
 Both give excellent satisfaction wherever the fever 
 and the foul smell of the passage persist. The first is 
 preferable where the bowels are sluggish, the second 
 where they are still loose. 
 
 Prescription 67. 
 
 Magnesium Peroxide 
 
 Sugar of Milk, each 2 grains 
 
 One powder four to five times a day. 
 
 Prescription 68. 
 
 Calcium Peroxide 1 grain 
 
 Sugar of Milk 2 grains 
 
 One powder four to five times a day. 
 
 If the exhaustion be great, the pulse (see page 
 89) weak, and hands and feet cold, the mustard bath, 
 described on page 237, should be given and internal- 
 ly of the medicine in prescription 69 three times a day 
 two to three drops to children in the first year, four to 
 six drops to children in the second year. So much 
 water must be added to these drops as to render their 
 taste sufficiently mild. 
 
 Prescription 69. 
 
 Spirit of Peppermint 
 
 Spirit of Camphor 
 
 Tincture of Capsicum, each 1-3 ounce 
 
—245— 
 
 As soon as the laxative has done its work and the 
 stools have lost their initial bad odor, indicating that 
 most of the injurious substances have been expelled, 
 checking remedies can be employed to master the 
 diarrhea. For ordinary cases a powder made of Bis- 
 muth Subnitrate and Flowers of Sulphur (Prescrip- 
 tion 70), given every two hours, will suffice. 
 
 Prescription 70. 
 
 * Bismuth Subnitrate 8 grains 
 
 Sublimed Sulphur 5 grains 
 
 If it does not and the diarrhea continues. Cam- 
 phorated Tincture of Opium (Prescription 71) will do 
 the work. 
 
 Prescription 71. 
 Camphorated Tincture of Opium (Paregoric) 
 
 Yz ounce 
 
 Of this can be given to a child : 
 
 to I year old -.- 4 to 8 drops 3 times a day 
 
 1 to 2 ** „ 8 to 16 '* 
 
 Opium is a very powerful remedy and should not 
 be given to infants but with the greatest caution. It 
 is best to begin with the smallest amount and increase 
 the dose as necessity seems to demand. As soon as 
 the number of stools has decreased to three or two a 
 day. Opium should be omitted, while the Bismuth 
 powders, which are harmless, can be continued until 
 the bowels are entirely well. 
 
 A remedy frequently used by the public is Black- 
 berry Brandy. It, too, is very effective in many cases. 
 
 Improper treatment sometimes turns diarrhea 
 quickly over into constipation. If this should happen, 
 an injection (see chapter "on "Constipation") or Cas- 
 tor Oil must be used at once. To wait longer than 
 twenty-four hours for a passage is dangerous. It is 
 also dangerous, very dangerous, to stop the diarrhea 
 before the injurious contents of the bowels have been 
 removed by the use of either Calomel or Castor Oil, 
 or to check the discharges too suddenly. Diarrhea is 
 
—246— 
 
 Nature's own remedy by which she tries to rid the 
 body of all that is injurious. This endeavor should 
 be supported and not hindered. The diarrhea ought, 
 therefore, not be checked until its purpose, that is, the 
 expulsion of the poisons, has been accomplished. If 
 these latter are retained, they are absorbed into the 
 blood and may cause death. 
 
 No injurious consequences follow if the diarrhe^ 
 stops suddenly after the use of Calomel. Calomel is 
 no constipating remedy; it is a laxative. And yet, it 
 acts often, very often, checking by removing the 
 cause of the diarrhea. This is the most ideal way a 
 remedy can work. 
 
 With Opium, however, matters are different. It 
 does not remove the poisons from the body. On the 
 contrary, it keeps them in by quieting the excited 
 bowels. It should, therefore, as said before, not be 
 used until the poisons are out and then only in such 
 doses that the diarrhea is checked gradually and slow- 
 ly, and opportunity is given to injurious substances 
 still remaining to be expelled. With large doses of 
 this remedy any diarrhea can be stopped immediately, 
 but not without endangering the life of the child. 
 
 From this it can be seen, how dangerous conse- 
 quences may follow the indiscriminate use of so- 
 called "Diarrhea Mixtures," sold as patent medicines, 
 as their working substance is Opium. They have 
 brought and are still bringing every year death to 
 thousands of babies that would have been saved un- 
 der proper treatment. 
 
 Slimy and bloody stools are, as stated above, al- 
 ways a sign that the inflammation has spread to the 
 large intestines and the rectum, that is, to the lowest 
 parts of the bowels. If they occur, the treatment 
 must be changed, since medicines, taken by mouth, 
 have to travel a long distance before they reach the 
 affected membranes and are, as a rule, not very effect- 
 
-247— 
 
 ive. The best way to proceed against the complica- 
 tion is to make injections. 
 
 The instruments, necessary for the purpose, are: 
 A two or four.-quart fountain syringe (Fig. 55) and a 
 soft Nelaton catheter No. 14 (Fig. 56). 
 
 Figure 55 — Fountain Syringe. End piece F to be connected with the catheter. 
 
 Figure 56— Soft Nelaton Catheter No. 14. 
 
 Proceed thus : Fill the bag of the syringe with 
 the water and hang it up on a nail one and one-half 
 to two yards high. Attach to the rubber tube (c) the 
 smallest end piece F, connect with the catheter and 
 place the latter, well greased with vaseline or lard, 
 within easy reach. 
 
 Now sit down, place the right foot on a foot-stool 
 and the child on the lap in such a way that its hips 
 lie on the right elevated leg, while its head hangs 
 down over the left, lower leg, which rests on the floor. 
 The legs of the child should be bent in the knees and 
 drawn up to the body. In this position introduce the 
 point of the catheter into the rectum of the child, after 
 a little water has been allowed to flow out in order 
 
-248— 
 
 to expel the air from the tube. When the catheter 
 has entered about one or two inches, open the stop- 
 cock (D) and allow the water to flow slowly into the 
 bowels, closing the tube from time to time. As soon 
 as one or two ounces are in, push the catheter slowly 
 up into the rectum, rotating the tube, until about one- 
 half of it is in the bowels. Fear need not be enter- 
 tained that it hurts the child. The continually flow- 
 ing water presses the walls of the intestines apart and 
 makes room for the point of the instrument, which 
 penetrates without touching the mucous membrane. 
 
 As soon as the child begins to press, interrupt at 
 once the flow of the water and wait until the press- 
 ing is over. Then allow the water to flow again, in- 
 terrupt again when the pressing returns, etc., until 
 the bowels are full. This moment is signified by the 
 fact that the pressing is now continual and that the 
 water spurts out aside of the catheter in spite of the 
 seat being pressed together. 
 
 Now it is time to stop. Remove the end piece 
 of the syringe from the catheter, place right foot on 
 floor and left foot on footstool, so that the hips of the 
 child are now low and its shoulders high. Then al- 
 low the water to return from the bowels through the 
 catheter. While the water is flowing pull the latter 
 out slowly so far that about two inches remain inside. 
 Do not remove it entirely. 
 
 As soon as the water is all out, set right foot back 
 upon the footstool, lower left foot to the floor, connect 
 end piece of syringe with the catheter and allow the 
 water to flow again in and out of the bowels in the 
 same manner as described before. 
 
 The injections are repeated until the water re- 
 turns clean, which is generally the case after two or 
 three rinsings. Then, the catheter is entirely re- 
 moved and the child put to bed. 
 
 The position of the legs as described above is 
 very important. The elevation of the right foot, and 
 
—249— 
 
 with it of the hips of the child, allows the water to 
 flow in easily and high up into the intestines; the ele- 
 vation of the left foot and with it of the upper part of 
 the child and the lowering the hips, facilitate the re- 
 turn flow of the water. 
 
 In order to avoid the spurting out of the water at 
 slight pressing, the seat of the child should be pressed 
 together around the catheter while the water is flow- 
 ing in. 
 
 Salt \yater is best for rinsing, two drachms of 
 table salt, that is, a slightly heaping teaspoonful, to a 
 quart of freshly boiled water or, if much slime is pres- 
 ent, a solution of Bicarbonate of Sodium (Prescrip- 
 tion 72), one-half to one teaspoonful to a pint of wa- 
 ter. The solution of soda dissolves the slime better 
 than the salt water. 
 
 Prescription 72. 
 Sodium Bicarbonate 2 ounces 
 
 Of these solutions about two quarts are filled into 
 
 the syringe. Let the temperature of the water be 75 
 degrees Fahrenheit in light cases, a little lower, about 
 60 to 70 degrees Fahrenheit, in aggravated ones, 
 which are accompanied by high fever. 
 
 After the first rinsing the relief soon becomes 
 apparent. The pressing subsides, the passages de- 
 crease in number or stop entirely for a shorter or 
 longer time, and the child is eased for hours, perhaps 
 for half a day or a day. If the characteristic stools 
 return, the rinsing must be repeated. Two or three a 
 day can be made, if necessary. 
 
 In aggravated cases these rinsings with salt 
 water are not entirely sufficient. As soon as the fluid 
 returns clean, they must be followed by an injection 
 with one of the solutions in prescriptions 73 and 74. 
 
 Prescription 73. 
 
 Tannic Acid 1 ounce 
 
 Distilled "Water enough to make 2 ounces 
 
 One to two teaspoonfuls to a pint of water. 
 
—250^ 
 
 Prescription 74. 
 
 Tannic Acid ^ 
 
 Zinc Sulphate 
 
 Exsiccated Alum, each 1-3 ounce 
 
 Distilled Water enough to make 2 ounces 
 
 One to two teaspoonfuls to a pint of water. 
 
 These latter should remain about one to two minutes 
 in the bowels and then be allowed to flow out com- 
 pletely through the catheter in the same manner as 
 the salt water did. 
 
 If very much blood is in the passage, t'he medi- 
 cine in prescription 75 is rather preferable. 
 
 Prescription 75. 
 
 Fluidextract of Hamamelis Leaves .... 2 ounces 
 One teaspoonful to a pint of water. 
 
 Also the addition of gelatine to the water and the 
 drinking of a gelatine solution (see page 12 and the 
 following chapter) is very beneficial under such cir- 
 cumstances. 
 
 If, however, a bad odor of the passage indicates 
 that there still exists decomposition and fermentation 
 in the bowels, one of the following disinfecting solu- 
 tions should be used (Prescriptions 76 and yy). 
 
 Prescription 76. 
 
 Solution of Aluminum Acetate 2 ounces 
 
 One and one-half drachms (1-2 tablespoonful) 
 to a pint of water. 
 
 Prescription 77. 
 
 Potassiuni Permanganate 5 grrains 
 
 Distilled Water 8 ounces 
 
 One to two tablespoonfuls to a pint of water. 
 
 Should there remain a condition of chronic diar- 
 rhea after the acute symptoms are over, a special diet 
 and internal remedies are required. They will be de- 
 scribed in the following chapter. 
 
—251— 
 
 CHAPTER XXXI. 
 
 CHRONIC DIARRHEA. 
 
 Chronic diarrhea seldom occurs with nursing in- 
 fants, very frequently, however, with those that are 
 fed by hand. Of 1,943 fatal cases of this disease, 
 which were collected by Hold of New York, only 3 
 per cent belong-ed to the first, all others to the second 
 class. In winter, with well-to-do people and in the 
 country, the disease is rare, but in summer, with un- 
 educated and poor people and in cities, it is very fre- 
 quent. 
 
 Causes: The cause lies in a diseased condition 
 of the intestinal canal, brought about by improper 
 nourishment, bad hygienic surroundings, improper 
 care and by acute infectious diseases, such as summer 
 diarrhea, influenza, measles, etc. 
 
 With nursing infants, chronic diarrhea may de- 
 velop if the milk of the mother is too rich in fat; with 
 hand-fed children, if the nourishment is too rich in fat 
 or sugar or additions of unconverted starch (see 
 pages 188 and 189). 
 
 Symptoms: Either suddenly or gradually, with 
 or without vomiting, the stools, heretofore normal, 
 grow softer and more frequent in number. Although 
 very thin, they are in the beginning still yellow and 
 smell sour, but change in the course of the next few 
 days, become watery, are mixed with shreds and 
 flakes and have a bad odor. The color is generally 
 greenish-yellow. Their number is two to five to ten 
 a day and their quantity as a rule the smaller, the oft- 
 ener they come. 
 
 Although in the case of an ordinary chronic diar- 
 rhea the passages come often, sometimes very often, 
 
—252— 
 
 they are far from being so weakening and exhaust- 
 ing as in the case of an acute indigestion or cholera 
 infantum. Indeed, it does not seldom happen that 
 children suffer from such a diarrhea for two or three 
 weeks and yet are comparatively well looking, play 
 and do not seem to be very sick. This, of course, is 
 the exception. As a rule they begin to fail soon after 
 the commencement of the disease. They grow thin- 
 ner, lose their appetite, have pains in the stomach, be- 
 come restless, cry and complain much, cannot sleep 
 and are fretful. The eyes sink in, dark, deep-blue 
 rings develop around them, cheeks and lips grow pale 
 and the tongue dry. Fever is present in the begin- 
 ning in most instances; later on the temperature be- 
 comes normal or rises slightly in the evening. 
 
 In more advanced stages of this ailment, other 
 sicknesses usually develop : Thrush, English Disease, 
 Scrofula and many others. They combine their forces 
 to destroy all that is left of the vitality of the child. 
 
 Prevention: Chronic diarrhea can be prevented 
 only if disturbances of digestion are avoided by prop- 
 er feeding, and if acute diarrhea, summer cholera, 
 etc., are carefully treated. Uncleanliness and dark, 
 damp dwellings assist much in bringing about the 
 trouble. A change of climate is very beneficial. It is, 
 therefore, advisable, if it can be done, to send children 
 who are disposed to diarrhea to the country or, bet- 
 ter, to the seashore. Special stress should be laid 
 upon a supply of fresh, pure, clean water to be at hand 
 during the warm season. 
 
 Treatment: CARE. The abdomen of a child, suf- 
 fering from diarrhea, should always be kept carefully 
 warm with a woolen or flannel bandage. Pains are 
 best relieved with hot linseed poultices. 
 
 DIET — Nursing infants should receive less food 
 by shortening the time of nursing ^nd lengthening 
 the intervals. If the milk of the mother is too rich in 
 
—253— 
 
 cream, as it may happen with women who Hve in 
 luxury and have too little exercise, the fat content 
 can be diminished by observing the rules laid down 
 on page 124. 
 
 Hand-fed children under one A^ear of age should 
 have a carefully selected and carefully prepared boil- 
 ed milk. Raw milk increases the diarrhea. In order 
 to ease the work of the weakened bowels and give 
 them more rest, it is advisable to dilute the milk with 
 barley or rice water (see page 184) twice as much 
 as corresponds to the age of the child. 
 
 Cane sugar and especially milk sugar are loosen- 
 ing. They should, therefore, under such circum- 
 stances always be substituted by Rheno's Fattening 
 Sugar (see page 183), which itself acts as a check 
 and is at the same time a splendid nourishment to 
 prevent further waste of tissue. 
 
 The amount of cream in the milk must be dimin- 
 ished if the passage shows (see page 99) that the fat 
 is not well digested. Sometimes it is best to omit it 
 entirely, or even to give skimmed milk. 
 
 Gelatine has proved to be an excellent food and 
 remedy in cases of chronic diarrhea. One and one- 
 half to two drachms are given during the day either 
 as jelly or dissolved in milk (for further information 
 see pages 11 and 12). If it is prepared at home by 
 boiling fresh calf bones and feet, it tastes better and 
 is easier to take. Also cocoa or chocolate, given in 
 milk, act similarly. 
 
 If milk is not well borne, or if improvement does 
 not rapidly set in, buttermilk (see page 205) should 
 be tried or Kephir or Kumyss. 
 
 MEDICINES — If the passage smells foul, it is 
 best to begin with a dose of Calomel (see page 242) 
 or, if this is not at hand, of Castor Oil. If the bad 
 odor continues, there should follow in all cases in 
 which the bowels are very loose a powder of Calcium 
 Peroxide four or five times a day, one grain to the 
 
—254— 
 
 dose (Prescription 78) or, in cases where the stools 
 
 Prescription 78. 
 
 Calcium Peroxide 1 grain 
 
 Sugar of Milk 2 grains 
 
 are not very frequent, a powder of Magnesium Perox- 
 ide four or five times a day, two grains to the dose 
 (Prescription 79). Also one of the other disinfectants 
 (see pages 243 to 244) will do if the former cannot 
 be had. 
 
 Prescription 79. 
 Magnesium Peroxide 
 Sugar of Milk, each 2 grains 
 
 Should slime and blood be mixed with the pass- 
 age, injections are best (see page 247). 
 
 If dyspepsia exists (no appetite and characteris- 
 tic stools, see page 99), Essence of Pepsin (Prescrip- 
 tion 80) should be given. The mixture in prescription 
 81 works better, but is not so easily taken. Its results 
 
 Prescription 80. 
 
 Essence of Pepsin 4 ounces 
 
 One-half to one teaspoonful three times a day 
 after meals. 
 
 Prescription 81. 
 
 Pepsin 15 grains 
 
 Glycerin % ounce 
 
 Diluted Hydrochloric Acid % drachm 
 
 Distilled Water enough to make 2 ounces 
 
 Ten to twenty drops in a tablespoonful or two 
 of water after each meal. 
 
 are splendid in most cases but in order to reap lasting 
 benefits, it must be given for a long time. 
 
 Calomel and the last mentioned mixture should 
 never be fed together. If both are used. Calomel 
 must be given first and six hours after the last powder 
 is gone the mixture is begun. 
 
 As soon as the bad odor discontinues, checking 
 remedies can be employed. Particulars as to these 
 will be found in the preceding chapter. 
 
 In nearly all cases of chronic diarrhea, a change 
 of climate is of decided favorable influence, in fact, in 
 some cases the only thing which brings about a per- 
 manent cure. 
 
-255— 
 
 CHAPTER XXXII. 
 
 CONSTIPATION. 
 
 The normal condition of the passage has been 
 referred to on pages 37, 97 and 98. 
 
 If at any time the bowels move less than once a 
 day, or if the passage of a baby under one year of age, 
 in spite of a daily movement, is hard and crumbling, 
 it must be regarded as constipation and set aright. 
 
 Constipation seldom happens with nursing in- 
 fants. It is frequent with children fed on cow's milk 
 and still more so with those fed on proprietary foods. 
 
 To facilitate the understanding of the following 
 lines, we will make a distinction between constipation 
 of nursing and constipation of hand-fed infants. ' 
 
 Causes: (i) In nursing infants. Faulty composi- 
 tion of the milk of the mother is one of them. Insuffi- 
 cient or faulty nourishment, constipation, bodily or 
 mental overexertion, and all those diseases which 
 weaken the body and make the blood poor, are likely 
 to change the milk of the mother to the effect that the 
 child becomes constipated. 
 
 More frequently, however, than faulty composi- 
 tion of the milk is bad managemxcnt of the feeding the 
 cause of constipation. If a mother is so unreason- 
 able as to neglect the proper intervals (see page 144) 
 and to use the breast as pacifier (see pages y2. to 74) 
 should the baby, for some reason or another, be rest- 
 less or begin to cry, it cannot fail but that the child 
 will take more nourishment into its stomach than it 
 can digest. The undigested rests remain in the bow- 
 els, rot, and cause first constipation and later on in- 
 flammation and diarrhea. 
 
—256— 
 
 (2) With hand-fed infants. Here both causes, 
 faulty composition of the milk and overfeeding, are 
 equally frequent. All foods rich in flour and uncon- 
 verted starch, such as potatoes, bread, proprietary 
 foods, etc., if taken at improper times or in abund- 
 ance, cause first constipation and later diarrhea. 
 
 A constipating effect upon both nursing and 
 hand-fed infants have all diseases which undermine 
 the resisting power and vitality of the body, espe- 
 cially poverty of blood and the English Disease. In 
 the latter ailment constipation usually alternates with 
 diarrhea (see page 224). The number of babies suf- 
 fering from constipation is further increased by child- 
 ren who receive habitually of those patent medicines 
 which are sold as laxatives and soothing syrups. This 
 form of constipation is the result of a drug habit. 
 
 Symptoms: The most conspicuous sign of con- 
 stipation is the missing of the passage. The feces are 
 usually hard, whitish; more rarely soft, with hard 
 lumps. The appetite is poor, the tongue coated, the 
 sleep restless. Belching, rolling noises in the abdo- 
 men, badly smelling evacuations and gases from the 
 bowels, indicate the abnormal decomposition and fer- 
 mentation of the contents of the intestines. 
 
 Slowly the infant begins to fail. It stands still 
 or loses in weight, becomes nervous, irritable, cries 
 much and is sometimes subjected to more or less se- 
 vere cramps. 
 
 Treatment: The removal of the trouble is not 
 always so easy as it seems to be. There is more to it 
 than the selection of a laxative. A laxative is for the 
 bowels what the whip is for a tired horse; it helps for 
 the moment, but is followed by an increase of relaxa- 
 tion and sluggishness. Laxatives, therefore, do not 
 meet the demands of an ideal treatment. The more it 
 is to be regretted that even otherwise reputable physi- 
 cians, in utter neglect of their sacred duty, set a bad 
 example to mothers by prescribing laxatives or even 
 
—257— 
 
 patent medicines, the composition of which they are 
 totally ignorant of, without inquiring into the cause 
 of the abnormity. An intelligent mother should, there- 
 fore, never be satisfied with a laxative, even if pre- 
 scribed by her physician. She should set to thinking 
 and studying until she finds the cause of the trouble, 
 and act accordingly. And not only that ! She should 
 also persist in her endeavors. Even if they seem 
 fruitless in the beginning, she should not give up. The 
 reward follows in most instances, although some- 
 times rather late. 
 
 It is best to initiate the treatment by regulating 
 first the habits of the child and educating it to an at- 
 tempt at evacuation of the bowels at regular times 
 (see pages 66 and 67). Then comes: 
 
 (a) With nursing infants. Regulation of the 
 number of meals (see page 144) and withdrawal of 
 all additions of food, such as bread, cakes, potatoes, 
 etc. When this is done, it should be ascertained with 
 the scales how much the child takes at every meal 
 (see page 79). If it takes more than it should have, 
 as it may in the case of an overabundance of milk 
 supply (see page 135), the time of nursing must be 
 shortened; but if it gets less than is coming to it (see 
 page 129), a fault which also may lead to constipa- 
 tion, it must have so much additional, properly pre- 
 pared cow's milk, or rather butterm.ilk (see page 205), 
 as mother's milk is lacking. 
 
 If the quantity of nourishment is regulated with- 
 out sufficient improvement, its quality must be in- 
 fluenced. This cannot be done but by treating the 
 mother. She must provide for a suitable nourish- 
 ment for herself, exercise in the fresh air, regular 
 movements of her own bowels, etc. (see pages 122 
 to 142). In doubtful cases an examination of the milk 
 is advisable. 
 
 Besides this regulation of the quantity and qual- 
 ity of the milk, the child should have before each meal 
 
—258— 
 
 some fresh, sweet cream. A teaspoonful at first and, 
 if required, more and more at each or at every other 
 nursing may be given until the desired effect is ob- 
 tained. The cream is a natural laxative. It oils the 
 bowels and serves at the same time as food. If no 
 cream can be had, fresh unsalted butter, one-half to 
 one teaspoonful once, twice or three times a day, can 
 be substituted. Instead of cream, one or two table- 
 spoonfuls of sour buttermilk has in a number of in- 
 stances proved excellent. Cod Liver Oil also, one to 
 two teaspoonfuls before going to bed, or a teaspoon- 
 ful of fresh, sweet orange juice, three to five times a 
 day, or one-half to one teaspoonful of extract of malt, 
 work well. 
 
 If occasionally a laxative is required, an injection 
 or one of the remedies enumerated at the end of this 
 chapter will do what is necessary. 
 
 (b) With hand-fed infants. Here also the reg- 
 ulation of the quantity and quality of the nourish- 
 ment is of prime importance. If the dilution with oat- 
 meal (see page 184) is a little greater than normal 
 and the addition of cream a little larger, the purpose 
 is usually accomplished. It is best to give the extra 
 cream separately before meals until it is found how 
 much is needed to move the bow^els. When this is 
 learned, it may be mixed with the milk. The begin- 
 ning is made with a teaspoonful and the dose in- 
 creased as necessity demands. 
 
 If the increase of fat is ineffective or does not 
 agree, an addition of limewater (see page 184) brings 
 in some cases the desired result and should be tried. 
 
 It goes without saying that fresh, unsalted but- 
 ter. Cod Liver Oil, orange juice and extract of malt, 
 are just as recommendable for hand-fed babies as for 
 nurslings. Fresh green vegetables and fruit sauces 
 are also helpful where the age permits them (see page 
 
 215)- 
 
 All side dishes, such as bread, potatoes, cakes or 
 
—259- 
 
 any other nourishment rich in unconverted starch and 
 flour and, last ,.but not least, all doubtful patent medi- 
 cines and all soothing syrups are forbidden. 
 
 If the English Disease is in existence (see pages 
 224 to 230), it must be treated. 
 
 In very obstinate cases it is best to make, for a 
 trial, a complete change and substitute for the milk 
 buttermilk, prepared according to the directions 
 given on page 205. The results as to the effect on 
 the passage and the general well-being of the child 
 are oftentimes surprising. 
 
 What was said of laxatives before, is true here 
 also. 
 
 Injections: Injections will not cure chronic con- 
 stipation. They are advised only where the bowels 
 must be emptied quickly and completely. Further- 
 
 Figure 57 — Syringe as it should not be used for injections. 
 
 more, they may be employed to force the passage dur- 
 ing the dietetic treatment so long as the latter does 
 not bring the desired result. If used for this purpose, 
 that is, as a temporary relief, the quantity of water 
 should be as small as possible. Large quantities will 
 relax the walls of the intestines and increase rather 
 than improve the difficulty. In order to make the 
 smallest quantity most effective, an addition of cas- 
 tile soap or of a tea to a tablespoonful of glycerin is 
 recommendable. For irritable intestines, the salt 
 water described on page 249 is preferable. It works 
 mildest, but is also least effective. 
 
—260— 
 
 The instruments necessary for the purpose are 
 the same as described on page 247. Syringes with a 
 hard rubber nozzle or those shown in Fig. 57, which 
 are operated by pressing with the hand, are danger- 
 ous and should not be used. 
 
 Laxatives : The}^ should not be employed ex- 
 cept in cases of emergency, when one or two thor- 
 ough actions are required. 
 
 Prescription 82. 
 
 Castor Oil 2 ounces 
 
 One to two teaspoonfuls as a dose. 
 
 Prescription 83. 
 
 Syrup of Senna 2 ounces 
 
 One teaspoonful once, twice or three times 
 a day. 
 
 Prescription 84. 
 
 Syrup of Manna 2 ounces 
 
 One teaspoonful once, twice or three times 
 a day. 
 
 Prescription 85. 
 
 Compound Powder of Rhubarb 2 ounces 
 
 Two to four times a day a smaller or larger 
 point of a knifeful mixed with water. 
 
 Prescription 86. 
 
 Syrup of Rhubarb 2 ounces 
 
 One teaspoonful once, twice or three times 
 a day. 
 
 Prescription 87. 
 
 Light Magnesia 2 ounces 
 
 One-half to one teaspoonful mixed with water 
 or milk. This remedy is recommendable es- 
 pecially if two to three hours after meals pains 
 arise in the abdomen which cause the child to 
 cry. 
 
 Prescription 88. 
 
 Aromatic Fluidextract of Cascara Sagrada 
 
 2 ounces 
 
 From a few drops to 1-3 of a teaspoonful three 
 times a day according to the age of the child. 
 
 This selection may suffice. Experience must 
 teach which of the remedies is best, since, as with 
 adults so with babies, peculiarities must be met. 
 
 Other diseases, if in existence, such as poverty 
 of blood, anemia, English Disease, scrofula, etc., 
 must be treated at the same time, if a lasting benefit 
 is desired. 
 
-261- 
 
 CHAPTER XXXIII. 
 
 COLICS. 
 
 Causes: (i) Gases in the bowels. They get 
 there either by the swallowing of air (see page 199) 
 or by the decomposition and fermentation of the con- 
 tents of the stomach and the bowels in consequence 
 of disturbed digestion. The same causes which lead 
 to digestive disturbances lead, therefore, also to col- 
 ics, namely, too hasty swallowing (see page 197 ), 
 faulty composition of the food, too heavy and indi- 
 gestible food and especially overfeeding, for the "too 
 much'' of nourishment (see page 190), which cannot 
 be mastered by the digestive organs, rots and devel- 
 ops the gas. 
 
 With nurslings colics develop sometimes if the 
 milk of the mother suddenly changes in consequence 
 of the appearance of the monthly period or of emo- 
 tions and affections of the mind, such as fright, joy, 
 anxiety, etc. 
 
 (2) Cramps in the bowels without gases. They 
 occur if the abdomen is kept insufficiently warm dur- 
 ing digestion as a consequence of faulty dressing 
 and undue exposure, or if the little ones catch cold, 
 lie in wet diapers, get wet feet, etc. This condition is 
 characterized by the fact that in spite of the colics no 
 gases escape from the bowels. 
 
 Symptoms: Colics are easily recognized. The 
 child, quiet before, becomes suddenly restless. It dis- 
 torts the face, cries sharply, draws the little legs up 
 and grasps with the hands toward the belly. Upon 
 examination the abdomen is found to be distended 
 and hard, and in aggravated cases arms and legs 
 cold. After the escape of gases from the bowels, the 
 
—262— 
 
 pains cease and the child calms down. As soon, how- 
 ever, as new gases develop, the performance is re- 
 peated, etc. Nervous children may get cramps in 
 consequence of the pains, especially during the time 
 of teething, when the nervous system is at a higher 
 pitch and more excitable than under normal circum- 
 stances. 
 
 The conduct of the child, when hungry, may per- 
 haps be confounded with colics. Distinct differences, 
 however, exist. The cry of hunger is not so intense 
 but longer and is silenced for a long time by the giv- 
 ing of nourishment, hands and feet are warm, the ab- 
 domen is not distended; in colics, the cry is pene- 
 trating and louder, the giving of nourishment will 
 silence only for a short while, hands and feet are cold 
 during the attack and the abdomen is usually dis- 
 tended. The escape of gases relieves the child. 
 
 Prevention: All digestive disturbances must be 
 avoided by regulating the number, quantity and qual- 
 ity of the feeds according to the instructions given in 
 previous chapters. A nursing mother should bear in 
 mind that mental emotions (see page 122) have a 
 bad effect upon her milk and that her own constipa- 
 tion and the taking of improper medicines for herself 
 (see page 126) may bring colics to the child. Hand- 
 fed babies should have no other nursing bottle than 
 the ''Tearless Nurser,'' since this is the only nursing 
 bottle which prevents the swallowing of air. Chil- 
 dren disposed to colics should wear a warm bandage 
 around the abdomen, especially after meals, to aid di- 
 gestion. Wet diapers, which chill the body, must be 
 removed immediately and be replaced by dry and 
 warm ones. 
 
 Treatment: The 'pain demands immediate help. 
 Hot applications upon the abdomen wnll bring it. 
 They are made either with a hot water bag or hot 
 sand or a hot linseed poultice or a hot plate wrapped 
 in cloths or any other hot object, so long as it is not 
 
—263— 
 
 too heavy. In the same way the hands and especially 
 the feet are warmed. A hot bath also will answer 
 the purpose. To facilitate the escape of the gases, 
 nothing is better than an injection of a few ounces of 
 good warm soap water. 
 
 Internally should be given one drop of Spirit 
 of Peppermint (Prescription 89) in warm water 
 
 Prescription 89. 
 
 Spirit of Peppermint 1 ounce 
 
 whenever necessary, either with or without the addi- 
 tion of whisky or brandy (for dose see page 239), 
 or a pinch of Sodium Bicarbonate (Prescription 90). 
 
 Prescription 90. 
 
 Sodium Bicarbonate 1 ounce 
 
 For an immediate relief the milk of Asafetida 
 (Prescription 91) has proved to answer well. 
 
 Prescription 91. 
 
 Emulsion of Asafetida 1 ounce 
 
 One-third to one-half teaspoonful, repeated, 
 if necessary, once more after ten to fifteen 
 minutes. 
 
 The following solution (Prescription 92) is splen- 
 did too. 
 
 Prescription 92. 
 
 Emulsion of Asafetida 1-2 ounce 
 
 Syrup of Manna 1-3 ounce 
 
 Spirit of Anise 1-2 drachm 
 
 Aromatic Syrup of Rhubarb 1 drachm 
 
 One teaspoonful as a dose. A tablespoonful 
 of warm fennel tea, given afterwards, takes the 
 bad taste away and increases the effect. 
 
 In those cases in which colics come on regularly 
 about two or three hours after meals, caused by an 
 excess of acid in the stomach, the next remedy (Pre- 
 scription 93) wnll give a speedy relief. 
 
 Prescription 93. 
 
 Sodium Bicarbonate 40 grains 
 
 Aromatic Spirit of Ammonia 40 minims 
 
 Glycerin 30 minims 
 
 Peppermint Water enough to make... 2 ounces 
 One teaspoonful between meals. 
 
—264— 
 
 If the above mentioned medicines do not suffice, 
 very sensitive children may, in exceptional cases only, 
 receive some Opium in the form of the Camphorated 
 Tincture of Opium (Prescription 94), provided that 
 
 Prescription 94. 
 
 camphorated Tincture of Opium (Paregoric) 
 
 1-2 ounce 
 
 all precautions, advised on page 246, be taken. The 
 dose is the same as given on page 245. This Cam- 
 phorated Tincture of Opium is a definite mixture, al- 
 ways the same and everywhere obtainable. It is, 
 therefore, in cases where Opium must be given far 
 better than the soothing syrups sold in the open mar- 
 ket, since the quantity of Opium contained in these 
 secret medicines is uncertain and uncontrollable. 
 
 In order to prevent further attacks, the cause 
 must be looked for and removed. 
 
IN 
 
 X 
 
 Alcoholics, after the first year, 216; 
 influence upon child if taken by 
 the mother during pregnancy, 
 219; doses in case of sickness, 
 239. 
 
 Ass's milk, 204. 
 
 B. 
 
 Barley gruel, as diluent for milk, 
 184; in diarrhea, 240. 
 
 Bath, first, 3; later, 50; oatmeal, 55; 
 salt, 230; mustard, 237. 
 
 Beef juice, 210. 
 
 Black disease of the new-born, 38. 
 
 Bleeding, from the navel, 11; from 
 the bowels direct after birth, 38; 
 in inflammation of the bowels, 
 98, 235. 
 
 Boric Acid, how to prepare solution, 
 6. 
 
 Bottles for nursing, selection, 196; 
 cleaning, 203. 
 
 Bowels, opening, 35. 
 
 Breast-feeding, importance, 103. 
 
 Breast, of the new-born, swelling di- 
 rect after birth, 39; of the 
 mother, insufficient develop- 
 ment, 104; inflammation, 110; 
 normal function, 128. 
 
 Breathing, 90. 
 
 Brown and black passages, 98. 
 
 Buttermilk, 205. 
 
 Calomel, doses, 242. 
 Casein, 158. 
 
 Chemicals, addition to milk, 172. 
 Cholera infantum, 234. 
 Condensed milk, 204. 
 Colics, 261. 
 
 Collapsing of nipples, 198. 
 Constipation, 255. 
 
 Coughing and sneezing, direct after 
 birth. 36. 
 
 Cow, must be healthy, 161; proper- 
 ly fed, 163; properly housed and 
 cared for, 164; treated gently, 
 164. 
 
 Crying, direct after birth, 36; later, 
 72; consequences, 74. 
 
 D. 
 
 Delicate children, 219. 
 
 Delivery of milk, 170. 
 
 Diarrhea, acute, 234; chronic, 251. 
 
 Dilution of milk for different ages, 
 
 180. 
 Disinfection of milk vessels, 170. 
 Discharges from the navel, 13. 
 Dusting powders, 54 to 55. 
 
 Eggs after the flrst year, 215. 
 
 English Disease or Rickets, 223. 
 
 Eczema on the head, 57. 
 
 Evacuations of the bowels, direct 
 after birth, 37; in health and 
 disease later on, 97 to 100. 
 
 Eyes, care, 19; inflammation, 19 to 
 21; simple catarrh, 21 to 23 
 speciflc inflammation, 23 to 32 
 opening direct after birth, 36 
 swelling of the eyelids direct 
 after birth, 36. 
 
 F. 
 
 Farinaceous foods after the first 
 
 year, 214. 
 Fat addition to milk, 182. 
 Feeding after the first year, 214. 
 Fruit after the flrst year, 216. 
 
 G. 
 
 Gelatine, how to prepare for bleed- 
 ing, 11 to 12; in bloody dis- 
 
-266^ 
 
 charges from the bowels, 250; in 
 
 chronic diarrhea, 253. 
 Genitals after birth, 34. 
 Goat's milk, 204. 
 Green passages, 98. 
 Gruels addition to milk, 184. 
 
 H. 
 
 Hand-feedings, 156. 
 
 Hardening of infants, 67. 
 
 Head, form after birth, 34; treat- 
 ment if diseased, 57; develop- 
 ment, 81. 
 
 Hiccough after birth, 37. 
 
 How to feed, 195. 
 
 Indigestion acute, 234. 
 Inflammation of the navel, 8 to 11. 
 Injections, in catarrh of the bowels, 
 
 247; in constipation, 259. 
 Intervals between feeds, 195. 
 
 K. 
 
 Kefir, 209. 
 Kumyss, 209. 
 
 Legs, position after birth, 37. 
 Lime water, as addition to milk, 184; 
 in vomiting, 239. 
 
 M. 
 
 Mare's milk, 204. 
 
 Meat and meat soups after the first 
 year, 215. 
 
 Meconeum, 37. 
 
 Microbes in spoiled and impure milk, 
 165. 
 
 Milk, faulty composition, 138; care 
 at home, 172; how to change ac- 
 cording to the age of the child, 
 180; dilution, 180; addition of 
 fat, 182; addition of sugar, 183; 
 addition of gruels, 184; addition 
 of limewater, 184; addition of 
 Sodium Citrate, 185. 
 
 Milking, 165, 169 
 Milk sugar, 158. 
 
 Milk supply, insufficient. 129; ex- 
 cessive, 135; faulty, 138. 
 Mode of life for nursing mothers, 
 
 122. 
 Movements of the body, 83. 
 Mouth, care, 59. 
 Muscles, development, 83. 
 Mustard bath, 237. 
 
 Navel, inflammation, 8 to 11; bleed- 
 ing, 11 to 13; discharges, 13 to 
 14; rupture, 14 to 18. 
 
 Navel string, care, 5 to 8; when it 
 falls off, 5. 
 
 Nipples of the mother, insufficient 
 development. 104; sore, 106. 
 
 Nipples of the nursing bottle, 196; 
 how to clean, 203. 
 
 Nourishment for nursing mothers, 
 123. 
 
 Nursery, 42 . 
 
 Nursing bottles, 196; how to clean, 
 203. 
 
 Nursing, forbidden, 119 to 120; first, 
 142; time, 145; how much, 145; 
 how long, 147. 
 
 O. 
 
 Oatmeal gruel as addition to milk, 
 
 184. 
 Opium, 245. 
 Outdoor life, 68. 
 
 P. 
 
 Pacifiers, 59. 
 
 Passages, difference in appearance, 
 
 consistency and color, 97 to 100. 
 Pasteurization, 174. 
 Peptonized milk, 207. 
 Physical exercise, 68. 
 Poisons in spoiled and impure milk, 
 
 165. 
 Premature birth, signs, 33; influence 
 
 upon future life, 219. 
 Proprietary foods, 212, 213, 192. 
 Proteid substance, 158. 
 
-267— 
 
 Rheno's Fattening Sugar, 1S3; 
 
 diarrhea, 240. 
 Rice water, as diluent for milk, iS- 
 
 in diarrhea, 240. 
 Rickets, 223. 
 Rupture of the navel, 14 to 18. 
 
 S. 
 
 Salt bath, 230. 
 
 Scales, 76. 
 
 Skin, color after birth, 34: changes 
 
 after birth, 39. 
 Sleep, direct after birth. 40: at night, 
 
 66. 
 Sodium Citrate, as addition to milk. 
 
 185; in vomiting, 239. 
 Soothing syrups, 75. 
 Sugar addition to milk, 183. 
 Sugar of milk, 158. 
 Storage of milk, 169. 
 Sterilization, 173. 
 
 T. 
 
 Teeth, development, 84; too early 
 and too late development, 86. 
 
 I Teething sicknesses, 86. 
 
 I Temperature, of first bath, 3; later 
 baths, 50; taking, 91; normal, 94. 
 
 Thermometer for bath, 3. 
 
 Thermometer for fever, 91. 
 i Thrush, 62. 
 
 Time of feeding, 145. 
 
 Tonics, 124. 
 
 Transmission of diseases in milk, 
 167. 
 
 Treatment of milk after milking, 169. 
 
 U. 
 
 Urine direct after birth, 39. 
 
 V. 
 
 Vegetables after first year, 215. 
 
 W. 
 
 Waking, beginning, S3. 
 
 Weak children, 219. 
 
 Weaning, when to wean, 149: how 
 
 to wean, 151: with what to wean 
 
 152. 
 Weighing, 78. 
 Weight, increase, 80. 
 Wet-nurse, 155. 
 Whey, 210. 
 
 
For Weak and Nursing Mothers and for Pale, Non- 
 thriving, Sickly Babies, the Very Best is 
 
 IRO-TONIC. 
 
 It makes Blood, gives Strength and Appetite. 
 
 It is a harmless, yet powerful, Tonic with remarkable stimu- 
 lating properties; an unsurpassed Blood-Maker, Flesh-Developer, 
 Tissue and Nerve-Builder, containing the Iron for the Blood, the 
 Phosphorus for the Nerve and the Albumen for the muscle. 
 
 Absolutely uninjurious to the youngest infant, as it contains 
 no alcohol. 
 
 Iro-Tonic is recommended in all conditions in which the 
 blood needs to be improved, the muscles strengthened and the 
 nerves steadied. To these belong: 
 
 Diseases of the Blood — Anemia, 
 Pale and Sallow Complexion, 
 Headaches, Dizziness, General 
 Weakness, Shortness of Breath, 
 Palpitation of the Heart, Night 
 Sweats, Etc. 
 
 Chronic Catarrh of the Stomach 
 and the Bowels — Loss of Appe- 
 tite, Fullness of the Stomach 
 after Eating, Hearttourn, Bilious- 
 ness, Vomiting, Constipation, etc. 
 
 Wasting Diseases — Consump- 
 tion, Syphilis, Scrofula, Chronic 
 Bronchitis, Chronic Malaria, Run- 
 ning Sores, Swollen and Enlarg- 
 ed Glands, etc. 
 
 Debilitated Conditions follow- 
 ing Acute Diseases, as: Pneu- 
 monia, Typhoid Fever, Influenza, 
 or LaGrippe, Hay Fever, Scarlet 
 Fever, Measles, Diphtheria, Etc. 
 
 Exhaustion of the Nervous 
 System — Neurasthenia, Nervous 
 Debility, Nervous Prostration, 
 Hysteria, Sleeplessness, Irritabil- 
 ity, Palpitation of the Heart, Etc. 
 
 Female Diseases — Whites or 
 Leucorrhea, Irregular, Suppress- 
 ed, Scanty or Excessive Menstru- 
 ation, Change of Life, Etc. 
 
 Great Loss of Blood during 
 Confinement, Excessive Menstru- 
 ation, Accidents, Etc. 
 
 Malnutrition of Nursing Mothers. 
 
 Children's Diseases — Scurvy, 
 Scrofula, Rickets or English Dis- 
 ease, Difficulty in Teething or 
 Walking, Retarded Growth, Mal- 
 nutrition, Insufficient Formation 
 of Blood, Chronic Constipation, 
 Loss of Appetite, Etc. 
 
 Iro-Tonic is marketed in Fluid and Tablet-Form. The Tab- 
 lets are recommended for adults, the Fluid for children and those 
 adults who cannot swallow Tablets or prefer a fluid medicine. 
 
 At all drug stores, or the remedy will be sent, carriage pre- 
 paid, upon receipt of price ($i.oo). Address the 
 
 F. H. RHENO CO. 
 
 SUPERIOR, - WISCONSIN. 
 
 Distributors and Sole Agents for the United States. 
 
IT'S SOMETHING UNUSUALLY FINE THIS 
 SIROM'S 
 
 MEDICATED 
 
 TOOTH POWDER. 
 
 Whenever a powerful disinfectant is needed or a reliable tonic 
 for the mucous membrane of the mouth is required, none gives 
 the eminent satisfaction that Sirom's Medicated Tooth Powder 
 offers. It heals existing diseases and gives the teeth that pearly 
 shirie which is an ornament to any person. In 
 
 Fetid Breath, Decaying and Loosening Teetli, 
 Soft, Bleeding and Painful Gums 
 — there it shines. The severer the test, the better we like it. 
 Give it a trial by sending for a sample. See how quick the fetid 
 odor stops, the decay is arrested, the teeth become soHd, the gums 
 loose their soreness, harden and cease to bleed ! Its work is 
 quick, delightful and before the sample is gone you will agree with 
 us that Sirom's Medicated Tooth Powder is, indeed, something 
 "unusually fine." 
 
 50 CENTS THE CAN. 
 
 Do not allow the price to stop you from trying the powder. It al- 
 ways pays to get the best. You may, yes you can, get cheaper goods, 
 some flavored chalk, but — the best has always proved to be the cheapest 
 at the end. The ingredients of SIROM'S MEDICATED TOOTH 
 POWDER are expensive, but the powder is certainly fine. Those 
 who have trouble with their teeth and are forced to seek the best 
 that can be made, and those who can and will afford to spend a few 
 cents more for a preparation so much better than those ordinarily sold, 
 should not miss to try a sample. Nothing is lost, as the sample is free. 
 It is worth while to get a conception of the comfort and relief in the 
 mouth that can be had from a SUPERIOR article. Not cheapness but 
 quality should be the point at issue and will be it with those who value 
 their bodily welfare and comfort higher than a trifling expense, as per- 
 fect teeth are not only an ornament but also a necessity for the preserva- 
 tion of health. 
 
 Trying is convincing, and once tried Sirom's Medicated Tooth 
 Pozvder becomes indispensable where excellence is appreciated. 
 SEE HOW IT WHITENS YOUR TEETH! 
 NOTICE ITS REFRESHING TASTE! 
 
 Guaranteed to be absolutelv uninjurious to the teeth. 
 At all druggists, or a can will be sent, carriage prepaid, upon 
 receipt of price. Address the 
 
 F. H. RHENO CO. 
 
 SUPERIOR, - WISCONSIN. 
 
 Distributors and Sole Agents for the United States. 
 
SIROIVI'S 
 
 HAND-CREAM 
 SKIN-FOOD 
 
 Most Elegant for Chapped Hands and Face or 
 any Roughness of the Skin. 
 
 It heals and soothes the painful, cracked and 
 bleeding hands and keeps them soft and pleasant in 
 spite of wind and weather or the roughest kind of 
 work. 
 
 The following claims of superiority we make : 
 
 First, the Cream is a splendid Skin Food and disappears rapidly 
 from the surface leaving- the hands, immediately after the application, 
 dry and smooth, so that gloves can be put on immediately. 
 
 Second, its beneficial effects are lasting and will not be de- 
 stroyed by washing the hands in soap and water. 
 
 Third, it whitens the hands by changing the erstwhile yellow 
 and hard skin and giving it a youthful appearance. 
 
 Let us urge you to tr}^ a tube and not be discour- 
 aged if you have tried others and were disappointed. 
 This preparation is so unlike others, so much 
 superior to anything you may have used before that 
 after a thorough trial you, undoubtedly, will admit 
 that there is nothing on the market that gives such 
 eminent satisfaction as our 
 
 SIROIVI'S HAND-CREAM and SKIN-FOOD. 
 
 50 Cents the Tube. 
 
 At all druggists, or a tube will be sent, carriage 
 prepaid, upon receipt of price. Address the 
 
 F. H. RHENO CO. 
 
 SUPERIOR, - WISCONSIN. 
 
 Distributors and Sole Agents for the United States. 
 
^C^ for the ^^O 
 
 € 
 
 COMPLEXION. 
 
 VEN IN ancient times, in the days of the 
 old Greeks and Romans, face lotions and 
 powders were in common use among 
 the people of every walk of life. Such was also the 
 fact in medieval times and later at the higher, fashion- 
 able courts of France. It is the case today, and it will 
 be as long as the human race exists and the gentler 
 sex seeks to win the admiration of their friends. 
 
 Thus we see that the desire to enhance one's 
 charms is natural, as it is pardonable. Only such 
 ''Beauty-preparations," however, can win the favor 
 of the refined woman of today as will accomplish their 
 purpose and yet, if possible, remain invisible to the 
 eye. 
 
 Beauto-Cream- is such a preparation. It is the 
 result of extensive investigations. Many points of 
 advantage and superiority we claim for it. 
 
 Above all, it does not dry, roughen and harden the skin, as, with- 
 out exception, all other face powders do, if used for any length of time. 
 
 It is invisible to the eye even on close inspection. Yet, it never 
 fails to produce that dainty and perfect complexion which is the pride 
 of every woman. 
 
 It is a splendid protection against the glare of the sun and the 
 tanning influence of light, wind and weather. 
 
 It removes the oily shine which is a source of continual annoy- 
 ance. 
 
 It removes sunburn, tan, freckles, blotches and all other blemishes 
 of the skin. 
 
 Last, but not least, it can be applied to the most tender skin where 
 no other powder can be used. 
 
 Large Size, $i.oo. Small Size, 50c. 
 
 At all Druggists, or Beauto-Cream will be sent, 
 carriage prepaid, upon receipt of price. Address the 
 
 F. H. RHENO CO. 
 
 SUPERIOR, - WISCONSIN. 
 
 Distributors and Sole Agents for the United States. 
 
W^Y 10 1907 
 
 (Trade Mark Registered.) 
 FOR 
 
 SWEATY FEET 
 
 SWEATING UNDER THE ARMPITS 
 
 AND ALL OTHER 
 
 Abnormal Sweats. 
 
 DESTROYS BADlODORS. 
 
 A remarkable remedy which will cure, without injury to health, the 
 worst cases of Sweaty Feet in three to four days and will stop effective- 
 ly the excessive sweating under the armpits, no matter what has been 
 tried before. 
 
 It dispels bad odors as if by magic. It saves costly garments and 
 makes rubber shields unnecessary. It reduces the disposition to, and 
 prevents, those ailments which arise from cold, damp and macerated 
 feet and armpits. 
 
 50 Cents the Bottlew 
 
 At druggists, or the remedy will be sent, carriage prepaid, upon re- 
 ceipt of price. Address the 
 
 F. H. RHENO CO. 
 
 SUPERIOR, - WISCONSIN. 
 
 Distributors and Sole Agents for the United States. 
 
LIBRARY OF CONGRESS 
 
 022 216 374 2 
 
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