THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 OF CALIFORNIA 
 
 LOS ANGELES
 
 STATE NORMAL SCHOOL 
 
 LOS ANGELES, CALIFORNIA 

 
 THE LIBRARY 
 
 OF 
 
 HOME ECONOMICS 
 
 A COMPLETE HOME-STUDY COURSE 
 
 ON THE NEW PROFESSION OF HOME-MAKING AND ART OF RIGHT LIV- 
 ING ; THE PRACTICAL APPLICATION OF THE MOST RECENT AD- 
 VANCES IN THE ARTS AND SCIENCES TO HOME AXD HEALTH 
 
 PREPARED BY TEACHERS OF 
 RECOGNIZED AUTHORITY 
 
 FOR HOME-MAKERS, MOTHERS, TEACHERS, PHYSICIANS, NURSES, 
 DIETITIANS, PROFESSIONAL HOUSE MANAGERS, AND ALL INTER- 
 ESTED IX HOME, HEALTH, ECONOMY AND CHILDREN- 
 TWELVE VOLUMES 
 
 NEARLY THREE THOUSAND PAGES, ONE THOUSAND ILLUSTRATIONS 
 
 TESTED BY USE IN CORRESPONDENCE INSTRUCTION 
 
 BEVISED AND SUPPLEMENTED 
 
 CHICAGO 
 
 AMERICAN SCHOOL OF HOME ECONOMICS 
 1911
 
 COPYRIGHT, 1907 
 
 BY 
 HOME ECONOMICS ASSOCIATION 
 
 Entered at Stationers' Hall. London 
 
 <Ul PdyhU Reserved
 
 M 
 
 AUTHORS 
 
 Butmcdical 
 
 ytoiy 
 
 C V&c 
 
 ISABEL BEVIER, Ph. M. 
 
 Professor of Household Science, University of Illinois. Au- 7 C 
 thor U. S. Government Bulletins, "Development of the Home 
 Economics Movement," "Selection and Preparation of Food," 
 etc. President American Home Economics Association. 
 
 ALICE PELOUBET NORTON, M. A. 
 
 Assistant Professor of Home Economics, School of Education, 
 University of Chicago : Director of the Chautauqua Schoel of 
 Domestic Science ; Author "Teaching of Home Economics." 
 
 S. MARIA ELLIOTT 
 
 Instructor in Home Economics, Simmons College ; Formerly 
 Instructor School of Housekeeping, Boston. 
 
 ANNA BARROWS 
 
 Teacher of Cookery, Teachers' College, Columbia University , 
 Director Chautauqua School of Cookery : formerly Editor 
 "American Kitchen Magazine" ; Author "Home Science Cook 
 Book." 
 
 ALFRED CLEVELAND COTTON, A.M., M.D. 
 
 Professor Diseases of Children, Rush Medical College, Uni- 
 versity of Chicago : Vis'ting Physician Presbyterian Hos- 
 pital, Chicago ; Author of "Diseases of Children." 
 
 BERTHA M. TERRILL, A.B. 
 
 Professor of Home Economics and Dean of Women, Univer- 
 sity of Vermont : Author of U. S. Government Bulletins. 
 
 KATE HEINTZ WATSON 
 
 Formerly Instructor in Domestic Economy, Lewis Institute ; 
 Lecturer University of Chicago. 
 
 MARION FOSTER WASHBURNE 
 
 Editor "The Mothers' Magazine ;" Lecturer Chicago Froebel 
 Association ; Author "Everyday Essays," "Family Secrets," 
 etc. 
 
 MARGARET E. DODD 
 
 Graduate Massachusetts Institute of Technology ; Teacher of 
 Science, Woodward Institute. 
 
 AMY ELIZABETH POPE 
 
 With the_ Panama Canal Commission ; Formerly Instructor 
 in Practical and Theoretical Nursing, Training School for 
 Nurses, Presbyterian Hospital, New York City. 
 
 MAURICE LE BOSQUET, S. B. 
 
 Director American School of Home Economics ; Member 
 American Public Health Association and American Chemical' 
 Society.
 
 CONTRIBUTORS AND EDITORS 
 
 ELLEN H. RICHARDS 
 
 Author "Cost of Food," "Cost of Living," "Cost of Shelter." 
 "Food Materials and Their Adulteration," etc., etc. ; Chair- 
 man Lake Placid Conference on Home Economics. 
 
 MARY HINMAN ABEL 
 
 Author of U. S. Government Bulletins, "Practical Sanitary 
 and Economic Cooking," "Safe Food," etc. 
 
 THOMAS D. WOOD, M. D. 
 
 Professor of Physical Education, Columbia University. 
 
 H. M. LUFKJX, M.D. 
 
 Professor of Physical Diagnosis and Clinical Medicine, Uni- 
 versity of Minnesota. 
 
 OTTO FOL1X, Ph.D. 
 
 Special Investigator, McLean Hospital, Waverly, Mass. 
 
 T. MITCHELL PRUDDEX, M. D., LL. D. 
 
 Author "Dust and Its Dangers," "The Story of the Bac- 
 teria," "Drinking Water and Ice Supplies," etc. 
 
 FRANK CHOUTEAU BROWN 
 
 Architect, Boston, Mass. : Author of "The Five Orders of 
 Architecture," "Letters and Lettering." 
 
 MRS. MELVJL DEWEY 
 
 Secretary Lake Placid Conference on Home Economics. 
 
 HELEX LOUISE JOHNSOX 
 
 Professor of Home Economics, James Millikan University, 
 Decatur. 
 
 PRANK W. ALLIN, M. D. 
 
 Instructor Rush Medical College, University of Chicago. 
 
 MANAGING EDITOR 
 
 MAURICE LE BOSQUET, S. B. 
 
 Director American School of Home Economics.
 
 BOARD OF TRUSTEES 
 
 OF THE AMERICAN SCHOOL OF HOME ECONOMICS 
 
 MRS. ARTHUR COURTENAY NEVILLE 
 President of the Board. 
 
 MISS MARIA PARLOA 
 
 Founder of the first Cooking School in Boston ; Author of 
 "Home Economics," "Young Housekeeper," U. S. Govern- 
 ment Bulletins, etc. 
 
 MRS. MARY HINMAN ABEL 
 
 Co-worker In the "New England Kitchen," and the "Rum- 
 ford Food Laboratory ;" Author of U. S. Government Bul- 
 letins, "Practical Sanitary and Economic Cooking," etc. 
 
 MISS ALICE RAVENHILL 
 
 Special Commissioner sent by the British Government to re- 
 port on the Schools of Home Economics in the 'United 
 States ; Fellow of the Royal Sanitary Institute, London. 
 
 MRS. ELLEN M. HENROTIN 
 
 Honorary President General Federation of Woman's Clubs. 
 
 MRS. FREDERIC W. SCHOFF 
 
 President National Congress of Mothers. 
 
 MRS. LINDA HULL LARNED 
 
 Past President National Household Economics Association ; 
 Author of "Hostess of To-day." 
 
 MRS. WALTER McNAB MILLER 
 
 Chairman of the Pure Food Committee of the General 
 Federation of Woman's Clubs. 
 
 MRS. J. A. KIMBERLY 
 
 Vice President of National Household Economics Associa- 
 tion. 
 
 MRS. JOHN HOODLESS 
 
 Government Superintendent of Domestic Science for the 
 province of Ontario : Founder Ontario Normal School of 
 Domestic Science, now the MacDonald Institute.
 
 ROCHE, SEATTLS 
 
 AN INDIAN BABY 
 Takima Papoose
 
 CARE OF CHILDREN 
 
 BY 
 
 ALFRED CLEVELAND COTTON, A. M., M. D. 
 
 PROFESSOR DISEASES OF CHILDREN 
 
 RUSH MEDICAL COLLEGE, UNIVERSITY OF CHICAGO 
 
 ATTENDING PHYSICIAN DISEASES OF CHILDREN 
 
 PRESBYTERIAN HOSPITAL
 
 COPYRIGHT, 1906 BY 
 HOME ECONOMICS ASSOCIATION 
 
 Entered at Stationers Hall, London 
 Ail Rights Reserved
 
 CM 
 
 CONTENTS 
 
 LETTER TO STUDENTS 
 
 HYGIENE OF THE BABY 
 
 NEW BORN BABY 
 
 CARE OF THE NEW BABY 
 
 BABY'S CLOTHES 
 
 CLOTHING FOR OLDER CHILDREN 
 
 SURROUNDINGS AND CARE . 
 
 SLEEP . . 
 
 EXERCISE .... 
 
 BATHING .... 
 
 REGULATION .... 
 
 DEVELOPMENT AND GROWTH 
 
 TEETHING .... 
 
 DEVELOPMENT OF SPECIAL SENSES 
 
 NUTRITION OF THE CHILD . 
 
 NATURAL FOOD 
 
 WEANING AND SUBSTITUTE FEEDING 
 
 ARTIFICIAL FEEDING 
 
 MODIFIED MILK 
 
 FOODS OTHER THAN MILK 
 
 FOOD DISORDERS 
 
 FOOD AFTER THE FlRST YEAR 
 
 FOOD RECIPES .... 
 
 THE SICK CHILD 
 
 THE CRY .... 
 
 COLIC ..... 
 
 CONSTIPATION .... 
 
 SUMMER DIARRHEAS 
 
 APNORMAL PASSAGES 
 
 RICKETS, MALNUTRITION, SCURVY . 
 
 COLDS
 
 iv CONTENTS 
 
 SORE THROAT . ... 142 
 
 CROUP .... 145 
 
 TEMPERATURE ...... 147 
 
 NERVOUS DISORDERS . . . . .148 
 
 CONVULSIONS, SPASMS, FITS, CRAMPS . . . j 49 
 
 CONTAGIOUS DISEASES . . . . J( -, 
 
 MEASLES ....... 154 
 
 SCARLET FEVER ..... . 155 
 
 CHICKEN POX ..... 156 
 
 DIPHTHERIA .... ^^ 
 
 WHOOPING COUGH .... 158 
 
 FOREIGN BODIES .... 150 
 
 EARACHE .... j6o 
 
 THE MEDICINE CHEST .... . ^3 
 
 HYGIENE OF THE CHILD AND YOUTH . . 165 
 EDUCATION ........ 167 
 
 PUBESCENCE ..... 171 
 
 BIBLIOGRAPHY . . . . . . . .174 
 
 SODIUM CITRATE IN INFANT FEEDING . . . 179 
 
 THE SOOTHER ...... 192 
 
 PROGRAM FOR SUPPLEMENTAL STUDY . 201 
 
 IN-HEX .... . . .205
 
 AMERICAN SCHOOL OF HOME ECONOMICS 
 CHICAGO 
 
 January 1, 1907. 
 My dear Madam: 
 
 In my private practice I meet 
 so many mothers, well educated otherwise, who 
 are profoundly ignorant of the care of children 
 that it is a pleasure to find one who is willing 
 to study something of the subject in a systemat- 
 ic way. 
 
 The feeding cf children, especially of 
 bottle babies, calls for the utmost skill of the 
 trained physician, while the responsibility of 
 a sick child is too great for any mother or 
 nurse. 
 
 It goes without saying that a subject 
 which oft tines taxes the knowledge of exper- 
 ienced physicians cannot be mastered in a few 
 short lessons by the average mother. It is only 
 in the hope that some of the fundamental prin- 
 ciples embodied herein may be impressed upon the 
 student mother's mind and lead to a better appre- 
 ciation of the importance of details in the man- 
 agement of the child that these lessons are of- 
 fered. 
 
 Children are not alike, nor can they be 
 classified according to their peculiarities 
 with a view to successful care or treatment of 
 their varying disorders. Each child has his 
 particular individuality, study and appreciation 
 of which marks the highest type of the success- 
 ful physician. The name of the disease or dis- 
 order is usually of less importance than the in- 
 dividuality or peculiarity of the child. 
 
 The dosing cf children according to any 
 stereotyped formula for real or imaginary ail-
 
 ments cannot be too vigorously condemned and 
 the wise mother will rarely administer medi- 
 cines except under the advice of the physician. 
 
 Prevention is always much easier than cure 
 and a mother's greatest opportunity comes in 
 so caring for her child that he may seldom re- 
 quire the services of the physician. 
 
 I regret that I shall not be able to ive 
 the time to look over your answers personally, 
 but my assistant will call upon me freely and 
 I shall be glad to give any personal assistance 
 that I can. 
 
 Very truly yours,
 
 THE FOLLOWING ARE A FEW PAGES FROM THE LESSONS 
 
 ONE OF DR. COTTON'S BABIES IN THE "BABY RAG"
 
 CARE OF CHILDREN 
 
 Hygiene of the Baby 
 
 " HE care of the infant should begin from the 
 moment of conception. So much does the 
 normal development of the unborn child depend 
 upon the physical vigor and mental balance of the 
 mother that her health during pregnancy is of the 
 highest importance. Everything that tends to im- 
 prove the mental and physical condition, such as 
 wholesome food, pleasant surroundings, congenial 
 associates, exercise, fresh air and sunshine should 
 be secured for the expectant mother. 
 
 Under favorable hygiene even the very delicate 
 woman may bear and nourish healthy children. 
 
 During pregnancy, especially in the advanced 
 stage, laborious occupation and violent exercise 
 must be avoided. The exercise involved in walking 
 and in the duties of light housework is beneficial 
 while the exertion incident to laundry work, pro- 
 longed use of the sewing machine, hill climbing 
 and driving over rough roads may be positively 
 injurious or even dangerous. 
 
 Corsets should be discarded upon the first evi- 
 dence of conception and loose clothing suspended 
 from the shoulders should be adopted, thus reliev- 
 ing the hips and abdomen of all weight and com- 
 pression. The ideal dress for this period is the union 
 
 Care of 
 the Baby 
 Before 
 Birth 
 
 Jare of 
 the Mother 
 
 Drsss
 
 CARE OF CHILDREN 
 
 A PRINCESS MATERNITY GOWN 
 
 Lartics' Home Journal Pattern.
 
 BEFORE THE BABY COMES 
 
 suit, a light petticoat fastened to a loose waist and 
 an empire gown. In cold weather wool tights may 
 be worn instead of additional skirts. 
 
 The process of making blood and tissue for the 
 unborn as well as for the mother makes heavy de- 
 mands upon her vital energy, hence not only in- 
 creased nourishment is necessary but extra sleep, 
 so that a daily nap should be secured unless it inter- 
 feres with the sleep at night. A liberal supply of 
 substantial but easily digested food should be pro- 
 vided and the appetite, if sluggish, stimulated by 
 outdoor exercise and tempting dishes. Fresh fruits 
 and vegetables in season should form part of the 
 dietary in the absence of which canned vegetables 
 and stewed fruits may be substituted. A heavy diet 
 of meats and rich foods which overtax the digestion 
 should be avoided. 
 
 The tendency to constipation at this time may 
 usually be relieved by a generous supply of juicy 
 fruits and the coarser cereals, such as oat meal, corn 
 meal, graham, whole wheat and brown bread. 
 
 The nausea and vomiting (morning sickness) so 
 common during the first months of this interesting 
 condition may occasionally be relieved by a cup of 
 hot coffee or broth taken before rising. Dry mag- 
 nesia will frequently relieve heart burn (sour stom- 
 ach) and may act as a mild laxative. If constipation 
 be obstinate a daily enema of from one to three 
 pints of soapy water may be necessary. 
 
 Food for 
 the Mother 
 
 Morning- 
 Sickness
 
 4 CARE OF CHILDREN 
 
 Gentle massage of the abdomen with olive oil, 
 cocoa butter or goose fat should be practiced daily, 
 not only for its nutritious effect but to facilitate 
 stretching of the tense skin. If the womb drags 
 heavily upon the abdomen great relief may be ob- 
 tained by a properly adjusted supporter so arranged 
 as to support the lower part of the abdomen. 
 Breasts The breasts so essential to the future sustenance 
 of the child, should be treated daily to the same 
 
 gentle massage while the 
 nipples should be gradu- 
 ally toughened by the ap- 
 plication of dilute alcohol 
 or equal parts of brandy 
 and water. If flat or de- 
 
 AN ABDOMINAL SUPPORTER, pressed the nipples should 
 From Griffith. k e developed by moulding 
 
 with the fingers or drawing out with a cupping 
 glass or breast pump. 
 
 Swelled feet and distended veins of the legs may 
 be due to pressure of the heavy womb and require 
 frequent rest in the horizontal position with the 
 feet elevated, while the limbs are gently stroked 
 towards the body. In severe cases bandaging may 
 be necessary which, however, should always be 
 done under the advice of the physician. 
 
 The urine A specimen of the urine should be furnished the 
 doctor from time to time for examination, especially 
 during the later months of pregnancy, as dangerous
 
 BEFORE THE BABY COMES 
 
 kidney complications may be thereby discovered 
 and relieved by timely treatment. 
 
 The teeth, which frequently soften and decay dur- 
 ing pregnancy, should be put in first class condition 
 by the dentist during the early months, thus pre- 
 venting much suffering and maybe serious shock. 
 
 The expectant mother should regard the coming 
 of her baby with feelings of happy anticipation 
 while dread of the ordeal should be kept sedulously 
 in the background. All means for promoting happi- 
 ness and contentment should be cultivated as de- 
 spondency, dread and discontent not only interfere 
 with the mother's physical well-being but may tend 
 to arrest or pervert development of the unborn 
 child. 
 
 The popular belief in birth marks as a result of 
 disagreeable or unusual occurrences or sights is not 
 well founded, but the hygiene of this period requires 
 that the mother be protected from undue mental 
 strain or intense emotional disturbances. 
 
 All preparation for the advent of the little one 
 should be simple, rational and complete long before 
 the last weeks of pregnancy thereby avoiding the 
 undue work and worry of hasty preparation. 
 
 The pregnant woman should be under the care of 
 a competent physician during the entire period of 
 gestation. 
 
 Since not only the life of the infant but his entire 
 
 The Teeth 
 
 Mental 
 Conditions 
 
 Preparations 
 
 Importance 
 of Early 
 Care
 
 6 CARE OF CHILDREN 
 
 future health is dependent upon the nature of his 
 early care, intelligent study of all that pertains to 
 the hygiene of this little being is the highest duty 
 of the young mother. The belief that instinct en- 
 dows motherhood with knowledge requisite to her 
 new responsibilities is not only erroneous but pro- 
 ductive of great mischief, as the lost or ruined lives 
 of thousands of mismanaged infants will att'est. 
 Im ofinfant Viewed in this light a knowledge of the slightest 
 Hygiene details of the infant's anatomy, physiology and 
 hygiene assumes a new significance and may prove 
 of inestimable Value in conserving his health and 
 insuring his normal development. The startling 
 death rate in early infancy calls loudly for a more 
 thorough study of the causes of poor development 
 and disease most of which might be prevented by 
 a better understanding of the infant and his re- 
 quirements. It is evident that the simplest method 
 of studying the new born infant is to become famil- 
 iar with the details of his normal form and propor- 
 tions, for in this way only may departures from the 
 normal be recognized. 
 
 THE NEW BORN BABY 
 
 skin The infant's skin at birth is usually covered with 
 a thick whitish substance (vernix caseosa) which 
 is most abundant in the creases and depressions and 
 upon the scalp. At birth the color is a dusky hue, 
 which after a few full inspirations changes to the
 
 TWO NEW BORN BABIES
 
 BACK 
 
 PROMT 
 
 INCH 
 
 ES V7IDE 
 
 PATTERN FOR A SIMPLE MUSLIN SLIP. 
 
 Drrxw 2-inch squares on a paper over 36 In. x 16 in. and sketch the 
 pattern as indicated. The gown is gathered at the neck and wrists 
 on very narrow bands. The back is like the front except at the neck. 
 (Only the top and bcttom of the pattern is shown.)
 
 THE NEW BORN BABY 
 
 "boiled lobster" red. About the third day a scaling 
 of the skin begins, which continues for a week or 
 ten days. The texture of the skin is very delicate 
 and is usually covered with a downy growth, called 
 lanugo. 
 
 The average weight at birth is about 7 pounds for 
 boys and 6 pounds for girls. The average length 
 is from 18 to 20 inches. 
 
 To anyone seeing a new-born infant for the first 
 time, the large head, small chest, enormous abdo- 
 men and insignificant extremities seem out of all 
 proportion. 
 
 A constant proportional relationship exists be- 
 tween the different members of the normal infant 
 at birth. The following simple rule will aid the 
 student in remembering this relationship. 
 
 Rule. Add 4 inches to half the baby's length for 
 the chest circumference ; the head is one inch larger 
 than the chest. The abdomen is l / 2 to 1 inch larger 
 than the head, e. g. : 
 
 Length 18 inches 
 
 Circumference of thorax 13 inches 
 
 Circumference of head 14 inches 
 
 Circumference of abdomen 14% inches 
 
 The head, being plastic, shows the pressure effects 
 of recent birth. If labor has been prolonged it 
 sometimes presents a great elongation and not in- 
 frequently there is a soft doughy swelling as large 
 as half an orange near the crown caused by the 
 
 Weight 
 
 Proportions 
 
 The Head
 
 10 
 
 CARE OF CHILDKLX 
 
 Fontanelles 
 
 recent pressure. By the end of the first week the 
 head should have resumed its normal shape. 
 
 Adjacent margins of the bones of the head are 
 separated by fibrous tissue continuous with the lin- 
 
 SKULL OF AN INFANT, SHOWING FONTANELLES. 
 
 ing internally and the covering externally. At the 
 places where three or more bones should come to- 
 gether are soft spaces called fontanelles. The larg- 
 est and most important of these is situated at the 
 top of the head well to the front, and is often called 
 the "soft spot". In this space there is a regular 
 pulsation corresponding in frequency with the heart
 
 THE NEW BORN BABY 
 
 ii 
 
 beats. The fontanelles should be carefully guarded 
 against injury. 
 
 The softness and elasticity of the bones of infancy 
 are due to their vascularity, the sponginess of their 
 texture, and from the layers of cartilage and mem- 
 brane not yet ossified. 
 
 The true bony structure of the new born baby 
 corresponds to the needs of the infant, e. g., the 
 bones of the lower jaw and ribs and collar bone 
 which renders possible respiration and suction from 
 birth, are well developed. 
 
 Over the cheek muscles, in addition to the ordi- 
 nary layer, of fat, there is an arrangement of fatty 
 lobules on either side, called "sucking cushions" 
 because they prevent the cheeks being pressed in- 
 ward between the jaws when nursing. 
 
 The eye at birth is anatomically incomplete, 
 which would prevent perfect sight even if the brain 
 were ready to receive^ and interpret impressions. 
 The color of the iris is a bluish gray and the pupils 
 are large and sensitive to light. 
 
 The lachrymal glands are not fully developed, 
 hence no tears before the third month. 
 
 The nose is relatively small, and the respiratory 
 portion is very small. 
 
 The tongue is rarely the seat of congenital defect 
 and tongue tied babies are not often seen. 
 
 The spine of the infant is extremely flexible. It 
 is, in fact, almost wholly cartilaginous at birth, the 
 
 Bones 
 
 Sucking 
 Cushions 
 
 The Eyes 
 
 The Spine
 
 12 
 
 CARE OF CHILDREN 
 
 The Lungs 
 
 Blood 
 Supply 
 
 Respiration 
 
 centers of ossification being present but the process 
 only slightly advanced. 
 
 The collar bone is the first bone of the skeleton 
 to ossify and is more frequently fractured during 
 delivery and in early childhood than is any other 
 bone. 
 
 Rapid, and remarkable changes occur in the lungs 
 after birth. During the first inspiration compara- 
 tively little air is taken into the lungs but as one 
 full inspiration follows another, inflation increases 
 more and more until full distension is accomplished 
 after which the lungs are never completely emptied 
 of #ir during life. 
 
 Growth and action of all the organs are entirely 
 dependant on the blood supply. As the blood sup- 
 ply not infrequently depends upon the muscular 
 activity of the parts, it is plain that restrained 
 activity or interference with circulation by any 
 means retards both function and growth. In the 
 care of the young infant too much stress can not 
 be laid upon the importance of freedom of motion 
 for all the members, and avoidance of anything that 
 tends to compress the vessels, such as long con- 
 tinued lying in one position, with possibly the addi- 
 tion of blood stagnation in the dependent parts. In 
 this respect, also, the clothing requires that no bands 
 nor seams may press upon the vessels of ditribution 
 or the return supply of blood. 
 
 From birth to death the oxygen necessary for the 
 vitality of the body is supplied through the air
 
 THE NEW BORN BABY 
 
 vesicles of the lungs. If any vital process is pre- 
 eminent in its importance, it is that of respiration. 
 Young children inhale more oxygen and exhale 
 more carbon dioxide, relatively, than adults. This 
 is a result of the more rapid tissue change in the 
 growing organism. 
 
 As respiration begins only after birth it is prob- 
 ably the least developed of the vital functions. Its 
 want of vigor is partly due to compressibility of 
 the chest walls, to the lack of full development of 
 the respiratory muscles and partly to the narrow- 
 ness of the upper air passages. Care of the nose and 
 throat is necessary to prevent accumulations or 
 growths which interfere with the free entrance of 
 air. 
 
 The average rate of respiration is from 30 to 60 
 per minute and during the early months may be very 
 irregular. 
 
 The yielding character of the chest renders the 
 baby very susceptible to disturbances by compres- 
 sion, so that great care should be exercised not only 
 in the handling of the infant but also in the clothing 
 so that no constriction of the chest be allowed. 
 
 The glands of the mouth of the new born secrete 
 mucus which serves for protection. The salivary 
 secretion is established but feebly and possesses 
 little, if any, power of changing starch to sugar. 
 
 The stomach at birth secretes pepsin in very 
 small quantity and at this early age is more of a 
 
 Chest 
 
 Digestive 
 Organs
 
 14 CARE OF CHILDREN 
 
 receptacle for food than a digestive organ. Coagu- 
 lation of milk by the rennet ferment represents 
 nearly the whole extent of its digestive function. 
 
 Shortly after birth meconium (a viscid, tarry, 
 odorless substance) is discharged from the bowels. 
 This continues until the feces are changed to a 
 canary yellow by the taking of milk. 
 
 Urine is normally present in the bladder at birth 
 and is usually voided within a short time, any delay 
 beyond twelve hours causing some anxiety. The 
 urine should be pale and odorless but it may con- 
 tain uric acid crystals which stain the diaper like 
 iron rust and are sometimes so abundant as to 
 completely obstruct the small tubes of the kidneys. 
 This uric acid is a frequent cause of colic in the 
 new born, 
 care of The delicate skin of the infant demands constant 
 
 the Skin 
 
 care to prevent irritation and excoriations especially 
 about, the buttocks, from the urine and feces. It 
 seems hardly necessary to remark that the diaper 
 should always be removed as soon as it is wet or 
 soiled and should never be used the second time 
 without thorough washing. 
 Nervous In regard to the functions of the nervous system 
 
 System 
 
 it may be said that at birth the infant is merely a 
 bundle of reflexes. Such reflex action however as 
 respiration, swallowing, winking, coughing, sneez- 
 ing, clinging, etc., shows a remarkable pre-natal 
 development of mechanism.
 
 CARE OF THE NEW BABY 15 
 
 The sense of hearing is probably not present at Special 
 birth, but is established within the first day or two, 
 as the middle ear fills with air and the congestion 
 of its mucous membrane subsides. 
 
 In all probability smell is the last of the special 
 senses to develop. 
 
 The sense of taste is evidently well developed 
 from birth, the young infant readily distinguishing 
 milk from water. 
 
 Tactile sensation is very acute in the lips, tongue 
 and eyes, although feebly developed in other areas. 
 
 CAEE OF THE NEW BABY 
 
 The newborn is entirely at the mercy of his sur- 
 roundings. In fact, of all the mammalia, the human 
 infant is the most helpless. 
 
 Immediately upon delivery the baby should be First 
 wrapped in a warm soft shawl or blanket. The eyes, 
 mouth and nose should be thoroughly cleansed of se- 
 cretions by the gentle application of sterilized gauze or 
 cheesecloth dipped in tepid boric acid solution. A 
 saturated solution of boric acid in boiling water, ca-re- 
 fully strained, cooled and bottled should be a part of 
 the equipment of the confinement room and nursery; 
 also a supply of sterilized gauze or cheesecloth cut in 
 three-inch squares and kept in sterilized wrapping. To 
 sterilize the cheesecloth or gauze it should be kept in 
 boiling water for forty minutes, dried in an oven and 
 at once wrapped in a sterilized cloth or wrapping.
 
 CARE OF CHILDREN 
 
 Gentleness 
 
 Care of 
 the Cord 
 
 The eyes should be cleansed with separate pieces of 
 gauze moistened with the boric solution by pouring 
 from the bottle. If a few drops of the solution find 
 their way between the lids so much the better. 
 
 The mouth may be freed of mucus by wrapping the 
 finger in dry sterilized gauze and gently wiping out the 
 secretion, after which the mouth should be washed 
 with the boric acid solution. Then it is well to give the 
 baby a teaspoonful or two of pure tepid water. 
 
 If necessary to free the nose from secretions it may 
 be done by gently squeezing it between the thumb and 
 finger from the top down, after which the solution 
 should be applied on a piece of twisted gauze. Ex- 
 treme gentleness must be observed in these manipula- 
 tions so as to leave no wound or abrasion upon the 
 delicate tissues which may give entrance to infective 
 germs. The nurse's hands and nails should be cleansed 
 beyond suspicion 
 
 The cord may be freely dusted with pulverized boric 
 acid and covered with dry absorbent cotton. Placing 
 the baby on the right side favors the new course of 
 blood through the heart. 
 
 The vernix caseosa with which the new born baby 
 is usually covered is best removed by a thorough rub- 
 bing with warm olive oil, or fresh lard, which forms 
 with it a soft lather and is easily removed by gentle 
 wiping with dry soft gauze. The next day's oiling and 
 wiping will remove from the creases and folds what
 
 CARE OF THE NEW BABY 
 
 little of the substance may have escaped the first 
 cleansing. 
 
 On the question of the first bath there is a decided 
 difference of opinion: Considering the temperature 
 from which the new comer has emerged (100 F.), 
 the transition to room temperature even, 78 F. 
 would seem to be sufficiently stimulating. There is a 
 growing opinion in favor of delaying the bath, and the 
 writer believes with others that this first water bath 
 should not be given for several days after birth. A 
 daily rubbing with warm olive oil is to be preferred as 
 affording less danger of shock. 
 
 The baby's brief toilet completed, the dressed navel 
 supported by a light flannel band, he should be 
 wrapped in a fresh dry blanket and allowed to sleep 
 in a warm, dark, quiet place for three hours, after 
 which he may be given another drink of pure water. 
 
 It is advisable to place the infant at the breast 
 within a few hours after birth as it is believed that 
 the colostrum or first milk secreted is adapted to the 
 needs of the infant's digestive tract. The mother's 
 nipples and the baby's mouth should be previously 
 cleansed with boric acid solution. 
 
 An infant's needs are few but imperative. They are 
 warmth, food and repose. 'It should be disturbed only 
 when necessary for drink, for its daily baths, change 
 of clothing, or for fresh diapers. It should be nursed 
 every two hours during the day and once at night. 
 
 First 
 Bath 
 
 First 
 Nursing 
 
 Imperative 
 
 Needs
 
 i8 CARE OF CHILDREN 
 
 The child should not sleep with the mother or nurse, 
 but in its own crib or basket from the first, 
 shock Too much stress cannot be laid upon the avoidance 
 of all that tends to shock or fatigue, and the observance 
 of absolutely antiseptic details. Could nurses and 
 mothers realize the need of absolute rest for the new 
 born, the advent of the baby would not be the signal 
 for the "rough house" procedures so frequently seen, 
 
 A RUBBER BATH TUB. 
 
 in the bath attended by admiring relatives, the dressing 
 in unsuitable garments, and the frequent exhibitions of 
 the baby to delighted neighbors and caressing friends. 
 
 Firgt The first general water bath may be given to vigor- 
 G water ous babies the fifth or sixth day, after which it may be 
 
 Bath a part of the daily toilet. In cases of premature or 
 very feeble infants the tub bath should be postponed 
 until there is no danger from shock or chill. The early
 
 CARE OF THE NEW BABY 
 
 A Double Ewer for Hot and Cold Water. 
 
 bathing should be done with the baby on the nurse's 
 lap, protected from drafts by a soft blanket. Each 
 part should be gently bathed with a cheese cloth 
 sponge and quickly dried by patting with a dry, warm 
 towel of the same material. New cheese cloth for 
 this purpose may be 
 rendered absorbent 
 by thorough boiling 
 in soda water, fol- 
 lowed by careful 
 rinsing. The animal 
 sponges should not 
 be used as they can- 
 not be properly 
 cleansed and quickly 
 
 become breeding places for germs of many kinds. A 
 full tub bath should not be given until the cord has 
 come off. 
 
 A good quality of castile soap is probably the best 
 to use, for many of the so-called "baby soaps" are too 
 irritating for the infant's delicate skin. After drying 
 the creases may be lightly dusted with a reliable baby 
 powder, using a box with a finely perforated top for 
 this purpose. The ordinary puff ball and powder box 
 should not be used because they are so easily con- 
 taminated with dust laden with bacteria. 
 
 Unremittent care is required to prevent accumula- 
 tions on the scalp. If crusts are once formed they must 
 be softened by frequent' applications of warm oil. 
 
 Soap 
 
 Care of 
 the Scalp
 
 20 
 
 CARE OF CHILDREN 
 
 Temperature 
 
 Weight 
 
 and 
 
 Texture 
 
 They should never be removed by use of the fine tooth 
 comb, in fact a comb should not touch the baby's scalp 
 during the early months and strong soap and friction 
 must be avoided in the removal of the accumulations. 
 The sensitiveness of infants to heat and cold is 
 not surprising when we consider the conditions, 
 viz., the relatively large radiating surface of the 
 body (50 per cent more than the adult), the thinness 
 of the skin, the distensibility of its blood vessels, and 
 the undeveloped state of the heat regulating centers. 
 The normal body heat is highest in the afternoon 
 and the lowest from 12 to 4 a. m. Rectal temper- 
 ature, as a rule, is the only reliable one, as in the 
 young infant the mouth can not be utilized for that 
 purpose, and the surface of the body, for reasons 
 above stated, shows a temperature two or three 
 degrees lower than that of the blood. 
 
 THE BABY'S CLOTHES 
 
 In the care of the baby uniformity of the sur- 
 rounding temperature should be maintained and the 
 child protected from excessive radiation by cloth- 
 ing. Nothing is more appropriate for this purpose 
 than wool and as lightness is desired two thick- 
 nesses are better than one containing the same 
 amount of material. Simply made clothing without 
 elaborate ornamentation and trimming designed for 
 the baby's comfort shows better taste in the mother.
 
 BABY'S CLOTHES 21 
 
 The clothing should not interfere with freedom of Freedom 
 
 from 
 
 muscular movement or blood circulation. This means Restraint 
 that it should permit unrestrained freedom of move- 
 
 BABY CLOTHED IN A SLEEVELESS SACK OR "BABY BAG." 
 
 ment of all the muscular structures, whether toes, 
 fingers, feet, hands, legs, arms, abdomen, back or chest. 
 The evils of the old fashioned pinning blanket, the 
 tightly drawn diaper, as well as bands about the chest
 
 22 CARE OF CHILDREN 
 
 and abdomen, and any tapes or strings which re- 
 strict the circulation should be apparent. 
 
 Since the object of clothing for the infant is to se- 
 cure uniform temperature the writer can conceive of 
 no reason why one portion of the body requires heavier 
 clothing than another, hence material of uniform thick- 
 ness is required for trunk and limbs. 
 
 OUTER AND INNER GARMENT OF THE SLEEVELESS SACK. 
 
 Inner garment shown closed at bottom with the draw string: outer 
 garment opens. Both garments are fastened at the neck in fnmi 
 with safety pins. 
 
 The The ideal protection would seem to be afforded by a 
 sack of light, flexible, nonconducting material, so con- 
 structed that it envelops loosely the entire body, closed
 
 BABY'S CLOTHES 
 
 Ill
 
 24 CARE OF CHILDREN 
 
 above by safety pins, below by a .draw string. Such an 
 arrangement was designed by the author and has been 
 successfully used in a number of hospitals in this coun- 
 try and abroad as well as in private homes. There is 
 good reason for including the hands in the covering 
 as a prevention of the habit of putting the fingers in 
 the mouth. This is a most unhygienic practice, first 
 because it favors introduction of infections ; second, be- 
 cause the subsequent chilling of the parts from rapid 
 evaporation of moisture induces local congestions, 
 causing symptoms of indigestion, colic, etc. The 
 author believes that the hands should be included in 
 the outer garment for the first five or six weeks of life 
 after which time the bag may be replaced by the usual 
 white nainsook or muslin slip. 
 
 The bag will then serve as an ideal night garment 
 for the first six months, and then the combination 
 night drawers with feet are recommended because with 
 these the lower extremities cannot be entirely un- 
 covered. An entire change of clothing should always 
 be made for the night. 
 
 When necessary under the sack, additional protec- 
 tion against cold is afforded by separate under gar- 
 ments, as a light knitted shirt of silk and wool and a 
 sleeveless slip of baby flannel. 
 
 under The best under garment for a baby is the knitted 
 Clothes long sleeyed shirt of mixed i am b' s wool and silk. This 
 
 shrinks less and is less apt to be irritating to the skin 
 than all wool, and is warmer than the all silk. The 
 same material, or a mixture of wool and cotton, is suit-
 
 BABY'S CLOTHES 25 
 
 able for the stockings, which should be long enough 
 to pin to the diaper, which in turn is pinned to the 
 shirt, thus leaving no portion of the child uncovered. 
 No socks or bootees are needed. Over this the baby 
 bag as described furnishes all the clothing necessary 
 for moderately warm weather. 
 
 A KNITWEAR INFANT SHIRT. 
 
 In winter, or where the baby cannot be protected In 
 from drafts, an additional garment without sleeves, 
 reaching from the neck to ten or twelve inches below 
 the feet, may be used next the shirt. Some mothers 
 prefer to close this garment with a draw string, leav- 
 ing the outer garment open and long enough to conceal 
 the draw string effect of the skirt. 
 
 Scotch flannel in its various dainty shades and pat- jc ate riai 
 terns is excellent unshrinkable material for the bag, 
 while soft, white baby flannel is suitable for the inter- 
 mediate garment. No other clothing is necessary for
 
 26 
 
 CARE OF CHILDREN 
 
 The 
 Diaper 
 
 the first few weeks, unless a light shawl or quilt for 
 carrying the baby from room to room, and a light silk 
 scarf for occasional use to protect the head from pos- 
 sible drafts. 
 
 " THE FIRST LAYER." 
 Diaper fastened to the shirt, and stockings with safety pins. 
 
 The diaper should be light with no more material 
 than is absolutely necessary for the absorption of the 
 discharges. Absorbent cotton, loose or in pads, pref- 
 erably the latter, retained by a loose cheesecloth 
 diaper, which is secured to the shirt by safety pins in
 
 BABY'S CLOTHES 
 
 front and behind, has been found to meet all require- 
 ments. Where economy prohibits the use of absorbent 
 cotton (which must be destroyed when soiled) a square 
 of folded cheesecloth which can be washed may be 
 substituted. 
 
 No mention is made of the belly band for the reason 
 that in the writer's opinion none is needed after the 
 dropping of the cord until which time the cord dress- 
 ing should be retained by a bias band of unhemmed 
 flannel. This should be from three to four inche^wide 
 and about twenty-four inches long. Small safety pins 
 may be used for fastening. 
 
 In dressing the child, its head and neck should al- 
 ways be supported by the hand or arm of the nurse. 
 The weight of the young infant should never be al- 
 lowed upon the unsupported spine as in the sitting 
 posture, until five months, even in rugged children, and 
 then only for a short time. Much harm results from 
 too early use of the high chair and modern perambula- 
 tor. 
 
 SHORT CLOTHES 
 
 Since all clothing limits to a certain extent the free- 
 dom of movement so essential to nutrition and growth, 
 the shortening of garments is obviou. ly a gain in the 
 child's hygiene. The careful mother will be governed 
 by the vigor of the child and its surroundings as well 
 as the season in the matter of shortening its clothes. 
 
 The first short clothes need differ in no material re- 
 spect from the long clothes except in the length of the 
 skirts. 
 
 No 
 
 Belly 
 
 Band 
 
 Care in 
 Dressing 
 
 Time 
 
 Dependent 
 on Climate
 
 28 
 
 CARE OF CHILDREN 
 
 Waist 
 
 and 
 
 Drawers 
 
 Foot 
 Covering: 
 
 Xoccasin 
 Shoe 
 
 When diapers are no longer necessary short knitted 
 drawers are substituted, which, with the stocking sup- 
 porters, are attached to a waist. In winter the waist 
 should be of flannel, with or without sleeves, and the 
 drawers of wool extending to the ankle. 
 
 The shortening of the skirts necessitates extra pro- 
 tection for the feet. Before the creeping time the 
 knitted shoes without soles should be used. Later the 
 more durable kid or chamois moccasins are neces- 
 sary4^Unwittingly, great cruelty is practiced in the 
 conventional baby foot covering. 
 
 Most of the prevailing deformities seen in the civ- 
 ilized foot have their origin in infancy at a time when 
 the rapid growth of this plastic member is easily re- 
 tarded or perverted by the slightest degree of persist- 
 ent pressure, as from a too short or too narrow stock- 
 ing. Chalk the sole of the baby's foot and press it 
 against a damp slate or hard black surface and com- 
 pare the impression with the outline of the ordinary 
 baby shoes sold in the shops. 
 
 The rapid growth necessitates frequent renewal of 
 the moccasin shoe, which should be made for the feet, 
 respectively, rights and lefts. They should fit the foot 
 firmly only about the ankle and instep leaving ample 
 room for the elongation and spreading of the toes. To 
 secure proper adjustment shoes should be laced rather 
 than buttoned. 
 
 In learning to walk all the separate muscles must be 
 educated to act in unison, hence every part of the foot
 
 BABY'S CLOTHES 29 
 
 and its toes must be allowed the utmost freedom. A 
 snug shoe deprives some of these muscles of their op- 
 portunity for education by binding the parts together 
 to act as a unit instead of in unison. A stiff, unyield- 
 ing sole interferes with the foot grasp of the ground. 
 
 SHAPE OF CHILD'S FOOT AND PROPERLY SHAPED SHOE. 
 
 As well might the child be taught to play the piano 
 with hands encased in husking gloves as to attempt 
 to gain perfect control of locomotion in the modern 
 shoe. Hard shoe soles, like ancient sandals, are merely 
 the outgrowth of the necessities of travel and have no 
 place in the hygiene of infancy.
 
 CARE OF CHILDREN. 
 
 No 
 Bands 
 
 No 
 Constrictions 
 
 Proper 
 Protection 
 
 Since vital capacity is best measured by lung expan- 
 sion anything- that interferes in the slightest degree 
 with the movements of the ribs or diaphragm limits 
 by so much vital capacity. A tight band around the 
 abdomen interferes with the normal muscular move- 
 ments of the stomach and bowels, weakens the ab- 
 dominal walls and is frequently the cause of rupture 
 both at the navel and groin. 
 
 A constriction around the hips, as from a tight 
 diaper, retards the growth of the pelvis at a time when 
 its substance is mostly cartilaginous and is undoubt- 
 edly one of the causes of the prolonged travail so 
 common to American mothers. 
 
 CLOTHING FOR OLDER CHILDREN 
 
 As the child grows older its style of dressing neces- 
 sarily changes but certain facts must still be borne in 
 mind. In the adult more than three-fourths of the heat 
 produced in the body is given off from the surface of 
 the skin. In children the per cent of loss is probably 
 still greater because the proportional surface of the 
 body exposed is larger. One of the important func- 
 tions of clothing is to regulate the movement of air 
 streaming to and from the surface of the skin so as 
 to retard the exchange of the warm air surrounding 
 the body with the outer atmosphere without preventing 
 it. The material, form and cut of the clothing all have 
 to do with the proper performance of this function. 
 
 All vital processes require a certain uniform tern-
 
 CLOTHING 31 
 
 perature and interference with these is especially dis- 
 astrous during the period of rapid growth. All en- 
 deavor is made to maintain this for the infant, but it is 
 often overlooked for the child, where the need still re- 
 mains as great. 
 
 Clothing may become the cause of disease, either be- Material! 
 cause of permitting sudden chilling of the body or be- 
 cause of checking the circulation, respiration or per- 
 spiration. The material should be selected with spe- 
 cial consideration for the constitution, sex and age of 
 the child ; its power of heat regulation, and should be 
 suited to the child's skin as well as so designed that 
 it may permit liberty of movement. 
 
 A word of caution should be given against the Bare ^*s 
 prevailing fad of bare legged children. The bare 
 footed country boy, living out of doors all the time, 
 clad only in shirt and trousers, may resist the ex- 
 posure ; but there is danger to the otherwise warmly 
 clad city child. When the stockings are left off and 
 socks and low shoes substituted, for the sake of 
 coolness near home, the custom is permissible ; but 
 in our fickle climate, when a change of weather or 
 a thunder storm may lower the temperature from 
 20 to 40 degrees, there is grave danger of a chill. 
 This disturbs the circulation and may induce digest- 
 ive disturbances, colds, or serious illness. A child's 
 health should not be endangered by fad or fashion.
 
 SURROUNDINGS AND CARE 
 
 Protection The absolute wants of the infant are few and simple, 
 and may be expressed in the two words Protection 
 and Food. 
 
 The infant must be protected from shock to which 
 he is peculiarly susceptible. Normal function, as di- 
 gestion, may be arrested by shock alone. Shock may 
 occur from sudden changes of temperature, from noise, 
 from blows or jars, from unaccustomed motion, from 
 fear or anger, from intense light, and from excessive 
 or prolonged pain. 
 
 Protection should be secured from infectious or ir- 
 ritating substances, either internal or external. The 
 baby should not be subjected to rough handling or 
 rough clothing; it should be protected from liability to 
 falls, or from blows especially on the head, and from 
 wounds, scratches, bites or abrasions of any kind. Its 
 surroundings should be as sanitary and antiseptic as 
 possible in all particulars. 
 
 THE NURSERY 
 
 The multiplicity of these needs, not to mention the 
 necessity of regularity in feeding, bathing, sleeping 
 and so forth demands a systematic regime. Obviously 
 this can best be scoured through a separate nursery 
 in which the means to the end are under full control. 
 The The room selected for this purpose should be in a 
 Boom q u i e t part of the house and should receive direct sun- 
 light during as much of the day as possible. It should 
 
 32-
 
 THE NURSERY 
 
 33 
 
 be of sufficient size to secure ventilation without notice- 
 able drafts, and furnished with special reference to an- 
 tisepsis, hence carpetless, except for rugs which may 
 be aired often; curtainless, except for light wash ma- 
 terials; devoid of moldings, pictures or fixtures which 
 invite the lodgment of dust. The walls should be 
 hard finished, preferably painted to permit of thorough 
 cleansing with water or antiseptic applications. Double 
 windows should protect against drafts and diminish 
 direct radiation, and the system of heating and ventila- 
 tion be under absolute control. The temperature 
 should be from 75 to 80 F. during the first week after 
 which time until the child is three months old about 
 75 is recommended. After that it may be gradually 
 lowered to 70 or even 65 at night. If the sleeping 
 room be too hot and the rarified air fails to furnish the 
 necessary amount of oxygen the child's vitality is low- 
 ered by copious perspiration and his susceptibility to 
 cold taking is increased. 
 
 The nursery should preferably not be upon the 
 ground floor, or on a level with the ground. Plumbing 
 of any kind, even the best stationary washstand, should 
 find no place in this room, and it is even better to se- 
 lect a room not having direct connection with the fam- 
 ily bathroom, as being more free from possible impure 
 gases. 
 
 In fact the room should contain nothing save the 
 furniture necessary for the care of the infant. The 
 metal crib should have a mattress filled with selected 
 
 Furnishing 
 
 Temperature 
 
 Furniture
 
 34 
 
 CARE OF CHILDREN 
 
 Simple 
 Articles 
 
 First 
 Year 
 
 hair, and if any pillow is used it should be a very thin 
 one of the same material. The mattress should be pro- 
 tected by a thin rubber sheet placed under a quilted 
 pad, and the covering should be of light wool. 
 
 The different articles necessary in a nursery should 
 be as simple, strong, light and plain as possible. Up- 
 holstery is not desirable, and the furni- 
 ture for the child should be suited to 
 it. That is, the tables, chairs, etc., 
 that it is to use should fit the child 
 not the older person. For the infant 
 a bath tub (flexible rubber preferred), 
 a bath thermometer, wall thermom- 
 eter, scales, a double ewer, soap dish, 
 on a low table, around which stand a 
 high folding screen, are requirements. 
 
 SLEEP 
 
 A very young baby should sleep 
 about twenty hours out of the twenty- 
 four, in fact all the time when not 
 being nursed, bathed or changed. Xo 
 definite statement can be made as to 
 the exact number of hours that a babe should sleep at 
 a given age. No error will be made if the child is 
 encouraged to sleep all that he will during the first 
 year, being guarded against all noise and disturbances. 
 Rocking and carrying are advised against as unneces- 
 sary and possibly harmful. Certainly the jumping up 
 and down of a tiny infant in the mistaken belief that 
 
 Weighing the 
 Baby.
 
 SLEEP 
 
 35 
 
 its comfort is thus increased is ridiculous and not 
 conducive to the best good of the baby. 
 
 The sleep during the first few days is profound, but 
 during the rest of the year it is easily disturbed. The 
 position of the child should be changed during the 
 longest sleep of the night. During the time when the 
 bones of the head are hardening it is necessary to 
 change the position of the baby, putting it first on one 
 side, then on the other, that its head may not exhibit a 
 flattening on one side. 
 
 It is important to preserve great regularity in the 
 hours of sleeping. No child under six years can 
 afford to forego the daily nap, for which the shoes 
 and outer clothing at least should be removed. 
 
 A normal healthy baby with wants satisfied will sleep 
 if comfortable and left alone. The fussy nurse or 
 mother too frequently interferes with this function 
 by over solicitude or mistaken notion that the baby 
 wants companionship. It is better to put tt in its 
 crib and if possible go into an adjoining room, to 
 accustom the child from the very beginning to sleep- 
 ing alone. A few experiences will establish the 
 habit and thus save the mother much time and 
 strength as well as give the child better and more 
 regular sleep. If the habit is fixed early no difficulty 
 will be experienced. 
 
 The custom of quieting the baby by the use of a 
 blank nipple "soother" is not only extremely un- 
 sanitary, but is positively injurious. No more effi- 
 cient means for introducing the ever present disease 
 
 Regularity 
 
 The 
 Soother
 
 CARE OF CHILDREN 
 
 Thumb 
 Sucking 
 
 Vicious 
 Circle 
 
 Disturbed 
 Sleep 
 
 germs into the system could be devised and many a 
 mysterious infection may be explained by this 
 practice. 
 
 The habit of thumbsucking, if long continued, very 
 commonly induces changes in the shape of the mouth, 
 teeth and jaws which amount in some cases to a de- 
 formity. 
 
 It is sometimes difficult to secure the necessary 
 amount of sleep for children of active mentality or 
 nervous temperament. Insufficient rest increases this 
 
 DEFORMITIES CAUSED BY PROLONGED THUMB 
 SUCKING. (Talbot.) 
 
 natural nervousness, which in turn, tends to prevent 
 sleep, thus establishing a "vicious circle" which robs 
 growth, arrests development and finally destroys the 
 child or wrecks his future life. 
 
 The causes of disturbed sleep are so numerous and 
 intricate that a brief enumeration of those most ap- 
 parent must suffice.
 
 EXERCISE 37 
 
 Besides the physical discomforts due to bed or cloth- 
 ing, insect bites, soiled diapers, constipation, skin irri- 
 tations, excess of heat or cold, the child may suffer 
 pain arising from internal conditions, such as earache, 
 headache, intestinal disturbance, kidney colic, rheuma- 
 tism (growing pains), sore mouth, or feverish condi- 
 tions from various infections to which he is especially 
 subject. Sleep disturbance is frequently due to inter- 
 ference with respiration from catarrh of the nose or 
 adenoid growths in the naso-pharynx or enlarged ton- 
 sils. Here, also, may be mentioned worms, intestinal 
 or rectal, and disorders of the genitals. 
 
 The most common cause of restlessness, however, is 
 indigestion due to improper food or methods of feed- 
 ing. 
 
 EXERCISE 
 
 Exercise is absolutely essential to the normal growth Cryinri 
 and development of all the muscular structures. Lusty ftc king 
 crying, if not prolonged, has a beneficial effect in the 
 deeper respiration thereby induced. So stretching, 
 kicking, squirming and waving of arms secure in a 
 measure the needed exercise. Occasional massage is 
 advised, the infant's expression of pleasure being one 
 of the immediate evidences of its beneficial effects. 
 After the creeping age the infant usually secures 
 enough muscular exercise. The creeping pen, raised 
 a few inches above the floor, is recommended for clean- 
 liness and protection against floor drafts. 
 
 It is essential that the baby have frequent change of Daily 
 
 Outing 
 
 air. Direct sunlight is needed, but it is advisable be-
 
 CARE OF CHILDREN 
 
 Temperature 
 
 Bran and 
 Salt Bath 
 
 fore taking the baby out of doors, that he be gradually 
 accustomed to the outside air by opening the windows 
 of the nursery for a short period each day, keeping in 
 mind the need of additional clothing in cold weather. 
 
 As a rule, the child should go out daily after the first 
 month. The more weakly the child the greater the 
 need. One caution should always be observed in his 
 outing, protection from disturbance in securing his re- 
 quisite amount of sleep. In fact, he may spend the 
 greater part of the day in the open air, if properly pro- 
 tected from wild and 
 
 BATHING 
 
 After the first week, the strong, healthy baby should 
 be bathed daily. The temperature of the first baths 
 should be about blood heat, 99 F. This may be re- 
 duced gradually so that at the end of the month the 
 temperature will be 95, at six months 90 and 
 by the end of the year 85 to 80. It is well to finish 
 bathing and drying the head before undressing the 
 baby. Little soap is required and if the skin is unusu- 
 ally delicate, that known as "superfatty" is advised. 
 The convenience of the double ewer is seen in having 
 a supply of water free from soap for rinsing. Unless 
 some irritation is present no powder need be used. 
 The addition of the bran bag to the bath for children 
 with a tendency to eczema, and of salt for its stimulat- 
 ing properties to the infants needing it, is recom- 
 mended. The daily bath should be given midway be- 
 tween feedings and should not last longer than five
 
 BATHING 
 
 39 
 
 minutes. The toweling, though thorough, must be 
 lightly and quickly done. 
 
 The special care of the eyes, nostrils and mouth 
 must never be omitted. As soon as the temporary 
 teeth have appeared, they should receive as faithful at- 
 tention as the permanent, since they are as subject to 
 decay, and effects of digestive disturbances are greater 
 in the child. Nothing should ever be introduced into 
 the external ear with the exception of a twisted bit of 
 gauze, gently applied for the purpose of drying. 
 
 Not only are the genitals subject to local disorders 
 but general mal-nutrition, obstinate reflex nervous dis- 
 turbances and injurious habits are too often the result 
 of their neglect. The daily bath should ensure 
 thorough gentle cleansing of the delicate parts, which 
 with the boy baby, should include the complete retrac- 
 tion of the foreskin. If this is not accomplished by 
 the end of the first month the physician should be con- 
 sulted. 
 
 In hot weather a rapid sponging with tepid water at 
 night will secure for the baby a more restful sleep. 
 
 The duration, as well as the frequency of the bath, 
 should depend entirely upon the reaction; blueness or 
 chilliness of the surface, or signs of exhaustion are 
 always indications of too frequent or too prolonged 
 bathing. 
 
 REGULATION 
 
 The structure of the rectum and lower bowel in in- 
 fancy, with the weakness of the abdominal walls, makes 
 
 Special 
 Care 
 
 Duration 
 
 and 
 
 Frequency
 
 40 CARE OF CHILDREN 
 
 extrusion of firm faces somewhat difficult. In the care 
 of the infant no day should be allowed to pass with- 
 out at least one free bowel movement. The establish- 
 ment of the habit of regular defecation is possible at 
 a surprisingly early age. The regular practice of hold- 
 ing the baby over the chamber before an evacuation 
 will soon, by association, lead to defecation when 
 placed in that position. If this practice is followed by 
 the end of a few months the nursery chair may replace 
 the diaper. 
 
 Constipation ^ n obstinate constipation the daily movement may be 
 secured only by the judicious use of the soap or glycer- 
 ine suppository, or preferably, a small soap and water 
 enema administered with the baby lying on his stomach 
 across the lap. A copious injection is best given with 
 the baby lying on his left side. 
 
 In older children the rectum is usually empty. When 
 the fecal mass descends into the rectum the uneasy 
 sensations are produced which precede a normal 
 evacuation. If this call is neglected the action of the 
 rectum is reversed and the fecal matter is forced back 
 again into the less sensitive portion of the large intes- 
 tine where it may remain and harden by the absorption 
 of its fluid constituents. By frequent repetition even 
 the rectum loses its sensitiveness so that large accumu- 
 lations of fecal matter may occur without exciting 
 evacuative desire. The calls of nature must be re- 
 garded as imperative. Their neglect may be the be- 
 ginning of grave and irremediable conditions, such as
 
 REGULATION 41 
 
 permanent distension of the lower bowel with loss of 
 evacuative power. 
 
 GIVING AN ENEMA. 
 
 The lower end of the rubber sheet is placed In a pail. The bag of the 
 fountain syringe should not be hung too high.
 
 DEVELOPMENT AND GROWTH 
 
 importance The importance of a familiarity with the rate of 
 growth during infancy and childhood can not be over 
 estimated, as the irregularities in the growth ratio are 
 frequently the first intimations of disturbed nutrition 
 or developing disease. 
 
 The following table shows the average heights and 
 weights from birth to fourteen years: 
 
 Table of Height and Weight 
 
 Boys. 
 
 Age. 
 
 Girls. 
 
 Height. 
 
 Weight. 
 
 
 Height. 
 
 Weight. 
 
 Inches. 
 
 Pounds. 
 
 
 Inches. 
 
 Pounds. 
 
 19.75 
 
 7.15 
 
 Birth. 
 
 19 25 
 
 6 93 
 
 24.75 
 
 14.30 
 
 5 months. 
 
 23.25 
 
 13.86 
 
 29.53 
 
 20.98 
 
 1 year. 
 
 29.67 19 80 
 
 33.83 
 
 30.36 
 
 2 years. 
 
 32.94 
 
 29.28 
 
 37.06 
 
 34.98 
 
 3 years. 
 
 36.31 
 
 33.15 
 
 39 31 
 
 37.99 
 
 4 years. 
 
 38 80 
 
 36 36 
 
 41 .57 
 
 41.00 
 
 5 years. 
 
 41.29 
 
 39.57 
 
 43.75 
 
 45.07 
 
 6 years. 
 
 43 35 
 
 43 18 
 
 45 74 
 
 48.97 
 
 7 years. 
 
 45.52 
 
 47.30 
 
 47.76 
 
 53.81 
 
 8 years. 
 
 47.58 
 
 51.56 
 
 49.69 
 
 59.00 
 
 9 years. 
 
 49.37 
 
 57 00 
 
 51.68 
 
 65.16 
 
 10 years. 
 
 51.34 
 
 62 23 
 
 53.33 
 
 70.04 
 
 11 years. 
 
 53.42 
 
 68.70 
 
 55.11 
 
 76 75 
 
 12 years. 
 
 55.88 
 
 78 16 
 
 57.21 
 
 84.67 
 
 13 years. 
 
 58.16 
 
 88.46 
 
 59 88 
 
 94.49 
 
 14 years. 
 
 59.94 
 
 98.23 
 
 Increase in body weight, length and the measure- 
 ments of the different members bear normally a cer- 
 tain constant relation at different periods of life. Xo 
 period compares in rapidity of growth with that of the 
 
 first three months. 
 
 42
 
 DEVELOPMENT AND GROWTH 
 
 43 
 
 The loss of weight in the first three days is about 
 ten per cent. This is usually regained by the end of 
 the first week. The reason for this early loss is due 
 partly to the loss of fluids from the interior as well as 
 from the surface of the body, and partly to the con- 
 Daily Weight Chart (Holt) 
 
 Lbs. 
 
 sumption of the stored body material before the first 
 feeding takes place. 
 
 The loss of weight is several ounces but at the end 
 of the first week the baby has usually regained most 
 
 First 
 Loss In 
 Weight 
 
 Rate of 
 Increase
 
 Gain in 
 
 Length 
 
 44 
 
 CARE OF CHILDREN. 
 
 of the loss. After this the gain should be steady. Dur- 
 ing the last three weeks of the first month and the en- 
 tire second, this gain is about an ounce a day. During 
 the third and fourth month's about three-fourths of an 
 
 Monthly Weight Chart (Holt) 
 
 MONTH OFAGE. 
 
 9 10 11 12 
 
 ounce a day, hence the normal infant has doubled its 
 birth weight by the end of the fifth or sixth month. 
 The gain decreases after this from two-thirds of an 
 ounce to one-half an ounce a day as the infant grows 
 older, until the weight has trebled at the end of the 
 first year. 
 
 The length of the average baby at birth is nineteen 
 inches ; this he doubles in four years. The increase
 
 45 
 
 during the first year (about half of the initial length) 
 being nearly double that of any succeeding year. The 
 average increase of the second year is about four 
 inches, and from that time on to the age of eleven or 
 twelve years from two to three inches annually. 
 
 As the weight and height increase there is also a rel- Relative 
 ative value of dimension of the various parts of the Growth 
 body. The legs grow much more rapidly than the 
 trunk but the girth of head and chest are of the great- 
 est moment in determining the normal growth. The 
 circumference of the chest, though smaller at birth, 
 should exceed that of the head before the end of the 
 second year. 
 
 On account of its compressibility the shape of the The 
 chest depends largely upon the continous action of the Chest 
 muscles, hence the deformities so frequently seen as 
 the result of retarded bone development. Any pro- 
 longed pressure from improper position or constrict- 
 ing clothing may add greatly to chest deformity. 
 
 The increase in the circumference of the head in 
 early life is remarkable and like that of the body weight Head 
 is more rapid during the first year, increasing three 
 inches during the first six months, a little more than 
 one inch the second six months, three-fourths of an 
 inch the second year and less than half an inch the 
 third year. By the seventh year the head has attained 
 nearly its full size. 
 
 The fontanel diminishes in size towards the end
 
 4 6 
 
 CARE OF CHILDREN 
 
 Development 
 of Powers 
 
 Capacity of 
 the Stomach 
 
 of the first year and is ordinarily completely closed 
 before the end of the second year. 
 
 This period of growth also shows a constant de- 
 velopment of acquisitions. The ability to shed tears 
 generally comes at the age of three or four months. 
 The new hair has begun to grow and increased pow- 
 ers of digestion are developed. This is the time when 
 the child begins to "drool," a sign not of irritation 
 caused by the cutting of teeth but merely an evidence 
 of the increased flow of saliva due to development of 
 digestive secretions. 
 
 The characteristic coating of the baby tongue per- 
 sists during the greater part of the nursing period. 
 The roof of the mouth gradually becomes more arched 
 with the development of the gums and teeth. The 
 soft palate becomes ampler as it descends to its more 
 verticle position, and the tonsils increase in size. 
 
 The growth of the stomach is most rapid in the 
 first half of the first year, of which the first three 
 months exhibit by far the greater rate of increase. 
 It maintains a very constant ratio of increase with 
 that of body weight in the first year of life. 
 
 The following table represents fairly the average 
 capacity of the stomach at different ages : 
 . . . . i 
 
 At birth 
 End of 1st month - 
 End of 2nd month 
 End of 3rd month - 
 End of 4th month 
 End of Sth month - 
 End of 12th month 
 
 ounce. 
 
 ounces. 
 
 ounces. 
 
 ounces. 
 
 ounces. 
 
 ounces. 
 
 ounces.
 
 TEETHING 
 
 47 
 
 TEETHING 
 
 The development of the temporary teeth begins with 
 the first formation of the jaws, about the sixth week 
 of intra-uterine life. At the time of birth the crowns 
 of all the temporary incisors and canines are fairly 
 advanced in calcification. 
 
 The gums at first are smooth and firm and of 
 a light pinkish color. The edges are rather sharp 
 but grow broader after a few months, as the time 
 of teething draws near. 
 
 Of the temporary or milk teeth as they are called 
 there are twenty, ten in each jaw; two central incisors, 
 two lateral incisors, two canines and four molars. The 
 lower canines are called the stomach teeth. 
 
 The teeth have a certain order of eruption, but 
 variation is not uncommon. It is not a contin- 
 uous process, but occurs in groups, with intervals 
 of repose between successive groups. The lower cen- 
 tral incisors appear from the sixth to the ninth month, 
 their coming being completed in about ten days ; then 
 follows a resting period of two or three months, after 
 which the upper incisors appear, both central and lat- 
 eral. After an interval of a few months come the 
 lower lateral incisors and first molars, four or five 
 months later the canines and finally, about the second 
 year, the second molars. 
 
 Milk 
 Teeth 
 
 Order o7 
 Eruption
 
 CARE OF CHILDREN 
 
 Order of the Eruption of the Temporary Teeth 
 
 Permanent 
 Teeth 
 
 Teething 
 Falacies 
 
 Lower central incisors 
 Upper incisors 
 Lower lateral incisors and 
 first molars ... 
 Canines - 
 
 6th to 9th month. 
 8th to 10th month. 
 
 15th to 21st month. 
 16th to 20th month. 
 
 Second molars - 
 
 - 20th to 30th month. 
 
 Scarcely a year elapses after complete eruption of 
 the milk teeth before absorption begins at the root and 
 advances towards the crown which either falls off or 
 is pushed out by the growth of the permanent tooth 
 below. 
 
 The permanent teeth, of which there are 32, may 
 be divided into two sets, the ten anterior which suc- 
 ceed the milk teeth and six others that are added 
 farther back in the jaw. During the growth of the 
 teeth the jaw increases in depth and length and under- 
 goes changes in form. 
 
 Order of Eruption of Permanent Teeth 
 
 First molars 6th year. 
 
 Central incisors ----- 7th year. 
 L/ateral incisors .... 8th year. 
 First bicuspids ... - 10th year. 
 Second bicuspids - - - llth year. 
 
 Canines ... - 12th to 13th year. 
 Second molars - 12th to 15th year. 
 
 Third molars (wisdom teeth) 17th to 25th year. 
 The lower teeth usually precede the upper. 
 
 The prevalent notion that the eruption of the teeth 
 is responsible for many of the disorders of infancy 
 is not only fallacious but is productive of considerable
 
 TEETHING 
 
 49 
 
 harm. The terms "teething fits," "teething diarrhoea," 
 "teething fever," etc., have no foundation in fact. 
 Many infants have been lost for want of professional 
 aid because of a mistaken notion that the acute dis- 
 order was a necessary accompaniment of teething. 
 Occasionally, however, the gum over the advancing 
 
 Milk Teeth 
 
 DIAGRAM SHOWING USUAL ORDER OP ERUPTION OF THE 
 
 TEETH, UPPER FIGURES REPRESENTING THE UPPER 
 
 JAW, LOWER FIGURES THE LOWER JAW. 
 
 tooth shows some swelling and the finger biting and 
 the general peevishness of the child finds relief with 
 the appearance of the tooth. As a rule, the so-called 
 symptoms of teething are the appearance of teeth. 
 
 The fact that the teeth make their appearance at a 
 time when the transitional condition of infant develop- 
 
 Coniusia*. 
 of Idea*
 
 CARE OF CHILDREN 
 
 He tar tied 
 Teething 
 
 Motor 
 Development 
 
 Taste 
 and 
 
 Touch 
 
 ment predisposes to a variety of disorders has led to a 
 confusion of ideas. The universal dread of the "second 
 summer" (teething summer) is the outgrowth of the 
 frequency of digestive disturbances at this time to 
 which the eruption of the teeth bear little or no causa- 
 tive relationship. 
 
 No tooth eruption is ever retarded by the toughness 
 of the gum. Its advance may be arrested by a tem- 
 porary cessation in its growth due to nutritional dis- 
 turbances, which of themselves produce the symptoms 
 frequently ascribed to the slow coming tooth. 
 
 DEVELOPMENT OF SPECIAL SENSES 
 
 Schiller's observations on the motor nerves of the 
 eye show the perfection not only of its mechanism, 
 but also of its function, at an early period of infancy. 
 This illustrates the method of growth in so much that 
 this mechanism furnishes one of the channels of in- 
 formation before the higher centers are capable of 
 utilizing it, the process being an educational one. 
 
 As the power and control of motion increases there 
 is a development of senses which are the pathways to 
 the mind. The nervous system of the infant shows 
 well developed sensory and motor tracts, but the con- 
 trol power of the higher centers is tardier in its 
 growth. 
 
 Taste and touch, especially of the lips and tongue, 
 are fortunately the first of the special senses to show
 
 DEVELOPMENT OF SPECIAL SENSES 51 
 
 activity, as these are necessary in the instinctive efforts 
 of the young to obtain sustenance. 
 
 Hearing, although demonstrated as present in the Hearing 
 first twenty-four hours, is not developed sufficiently to 
 differentiate between sounds before the end of the 
 third month. 
 
 Contemporary with the function of hearing is that y iglon 
 of vision. Although sensitiveness to light and blinking 
 on the near approach of objects has been observed 
 from the first weeks, still it is not until the end of the 
 second month that the infant may recognize his mother 
 by sight. 
 
 At first the infant's movements are automatic or 
 instinctive, the voluntary muscles showing only the 
 purposeless, irregular, and unsymmetrical movements 
 suggestive of the mere continuance of the intra-uterine 
 existence. Co-ordinate, voluntary movements are first 
 seen in the face and upper extremities, the hands in 
 addition to grasping showing prehensile tendencies by 
 the end of the third month. Objects are carried to the 
 mouth at about this time. The many ineffectual at- 
 tempts to locate the mouth indicate the vast amount of 
 energy necessary to develop co-ordination. Although 
 the apparatus including muscles and nerves is fairly 
 complete, it requires multiple repetitions of sensations, 
 impressions, volitions, and efforts at volition, before 
 the establishment of such co-ordination as will ensure 
 the performance of the most simple voluntary motion.
 
 CARE OF "CHILDREN 
 
 Expression 
 of Emotion 
 
 Sitting 
 
 Standing 
 
 Walking 
 
 About the end of the third month the voice is recog- 
 nized as expressing emotions such as anger, fear or 
 pleasure. About this time tears are observed to accom- 
 pany the crying. It is interesting to note that perspira- 
 tion is not common before the end of the third month. 
 
 Following the development of the senses of sight 
 and hearing to the extent of differentiating as to the 
 color and size of subjects and the quality and direction 
 of sound, we find co-operation of the muscles of the 
 neck to a degree that the infant's head is held erect, 
 balanced and turned at will. 
 
 After the eighth month the infant should be able to 
 sit for a short time without support and shortly after 
 he begins to creep, roll or hitch towards desired ob- 
 jects. About the tenth month he usually utters a few 
 indefinite syllables, singly or repeated, as da da, ma 
 ma, goo, etc. 
 
 Between the tenth and twelfth months he shows a 
 disposition to pull himself up on his feet, is usually 
 able to stand by a chair and, exceptionally, may walk 
 alone at the end of the first year. 
 
 Infants exhibit a marked variation as to the time 
 of these acquirements, dependent largely upon mus- 
 cular vigor and education. A child left much alone 
 will learn to develop his resources earlier. On the 
 other hand, he will talk earlier if associated with other 
 children. 
 
 The subject of infant hygiene should not be dis- 
 missed without reference to a practice that is as per-
 
 DEVELOPMENT AND GROWTH 53 
 
 nicious as it is common, viz., the custom of regarding TheBab 
 the baby as a plaything, an animated toy for the enter- j* a 
 tainment of the family as well as a large circle of 
 admiring friends. Children are fond of babies and 
 never tire of stimulating their funny performances. 
 The same is, unfortunately, true of parents and friends, 
 but from a purely economic point of view, such amuse- 
 ment is exceedingly expensive, and the mortality 
 statistics are constantly increased for the amusement 
 of the elders. Nervous and mental wrecks too fre- 
 quently owe the origin of their disorders to want of 
 repose in early infancy, due to injudicious stimulation. 
 In this connection let it be understood that all evi- 
 dences of mental precocity, called "smartness," should 
 be regarded as danger signals and call for repression, 
 rather than encouragement. Axiom An infant dur- 
 ing the first year should neither be amusing nor 
 amused.
 
 The following questions constitute the "written reci- 
 tation" which the regular members of the A. S. H. E. 
 answer in writing and send in for the correction and 
 comment of the instructor. They are intended to 
 emphasize and fix in the memory the most important 
 points in the lesson.
 
 CARE OF CHILDREN 
 
 Read Carefully. Place your name and address on the 
 first sheet of the test. Use a light grade of paper and write 
 o.n one side of the sheet only. Leave space between the 
 answers for the notes of the instructor. Use your own 
 words and answer fully. Read the lesson paper a uumber 
 of times before attempting to answer the questions. 
 
 1. What special precautions should the expectant 
 
 mother take? 
 
 2. What are fontanelles and why should they be 
 
 guarded ? 
 
 3. What can you say of the bony development of a 
 
 young baby? 
 
 4. Give a brief outline of the first three days' care 
 
 of the new born babe? 
 
 5. How would you sterilize gauze? Why is this 
 
 necessary ? 
 
 6. Yfhy is the baby so susceptible to temperature 
 
 changes ? 
 
 7. In clothing an infant what principles are to be 
 
 observed? 
 
 8. Describe the clothing suitable for baby's first six 
 
 weeks. 
 
 9. What may be the effects of tight clothing about 
 
 the chest? Abdomen? Hips? 
 
 10. How should a baby be put to sleep ? 
 
 11. Name some of the commonest causes of dis- 
 
 turbed sleep.
 
 CARE OF CHILDREN 
 
 12. What objections are there to the "soother"? 
 
 13. Give your ideas of a nursery. 
 
 14. What can you say of the effects of teething upon 
 
 the infant's health? 
 
 15. During what period is growth most rapid? 
 
 16. Why is familiarity with the rate of growth im- 
 
 portant ? 
 
 17. Name the milk teeth and give their order of 
 
 eruption. 
 
 18. Why should the temporary teeth be cared for and 
 
 how ? 
 
 19. How do you interpret the statement "The senses 
 
 are the pathways to the mind" ? 
 
 20. What objections are there to playing unduly with 
 
 with the baby? 
 
 21. Is any point not clear or are there any questions? 
 
 After completing the test sign your full name.
 
 CARE OF CHILDREN 
 
 PART II
 
 XATURK'S METHOD. 
 
 The act of nursing in its perfection is the result of the mutual co- 
 operation of mother and child."
 
 CARE OF CHILDREN 
 
 PART II 
 
 Nutrition of the Child 
 
 The subject of nutrition will always be of para- 
 mount importance in the care of infants and children. 
 As important as food is to supply energy for the mani- 
 fold functions of adult life, it is doubly important 
 during infancy, as during this period the demands 
 for material for growth are most imperative. Since, 
 therefore, the necessity for food is a double one dur- 
 ing the developing period the importance of a thor- 
 ough knowledge of all that pertains to foods and 
 feeding cannot be exaggerated. 
 
 Errors in diet, especially in infancy, are respon- 
 sible for more deaths and cases of imperfect develop- 
 ment than all other causes combined. In fact, the 
 highest degree of infant mortality, especially during 
 the summer months, is admittedly due to mismanage- 
 ment of the feeding. For this reason infants nursed 
 at the breast are fortunate, as they escape many of 
 the dangers to which artificially-fed infants are sub- 
 jected. 
 
 Children, as well as infants, require the best of 
 nutrition, not only to meet the demands for material 
 for growth, but also to furnish energy for the enor- 
 mous work of training and educating the muscles, as 
 well as for the development of the mind. The school 
 pupil is a machine which not only converts raw rnate- 
 
 55 
 
 Importance 
 
 Diet and 
 
 Infant 
 
 Mortality 
 
 Requirements 
 of the 
 Child
 
 CARE OF CHILDREN 
 
 Nature's 
 Supply 
 
 Early 
 
 Nursing 
 Advisable 
 
 rial (food) into ideas, but also utilizes the food to 
 construct the machine itself. What wonder, then, 
 that many failures in the educational scheme must be 
 attributed to the improper food supply. Because of 
 imperfect nutrition, the imperfect machine not only 
 furnishes unsatisfactory products, but is liable to mis- 
 hap from its inherent weakness, as in the case of 
 children who fall an easy prey to the various in- 
 fections against which a well-nourished constitution 
 would have proved a safeguard. 
 
 NATURAL FOOD 
 
 For the second "want" of the infant, namely, food, 
 ample provision has been made by nature in an ap- 
 paratus admirably adapted to its requirements. 
 
 It is evident from the anatomy of the infant that 
 he is especially adapted for the act of nursing. This 
 the infant does instinctively. 
 
 That no fully-developed milk is found in the 
 breasts at the time of birth has been generally ac- 
 cepted as conclusive evidence that the new-born child 
 is in no immediate need of food. In fact, his deport- 
 ment, if undisturbed, suggests the need of rest during 
 the first forty-eight hours after birth. This belief is 
 so universal that attempts at feeding before nature 
 has furnished the supply have not met with general 
 approval. 
 
 However, it is recommended that the child be put 
 to the breast early for two reasons: First, to stimu- 
 late milk secretion ; and, second, in the belief that the
 
 NATURAL FOOD 
 
 57 
 
 first secretion (colostrum) promotes early evacua- 
 tion of the bowel. Probably, by so doing, the child 
 secures a little of the water so much needed at this 
 time. 
 
 The infant's habitual loss in body weight during 
 the first days, as shown by tables on growth, has been 
 regarded by some as unnecessary. In fact, it is 
 claimed to be unfortunate, as interfering with the rate 
 of subsequent growth. On this account ^some physi- 
 cians recommend that nourishment be supplied during 
 the first two days. This is usually unnecessary, how- 
 ever. 
 
 If the milk is slow in coming the baby may be given 
 on the second day, every four hours, a tablespoonful 
 of boiled water slightly sweetened with milk sugar. 
 Caution: If this procedure lessens his eagerness for 
 the breast, it should be discontinued, as much depends 
 upon his early learning to nurse. 
 
 Intelligent control or supervision of the act of suck- 
 ling averts or corrects many evil effects of its abuse 
 when left entirely to instinct. A few rules may be 
 formulated, the observation of which is manifestly 
 important in the hygiene of nutrition. 
 
 (i) Asepsis must be observed, since one of the 
 commonest causes of infantile disorders is infections 
 introduced into the stomach. To this end the nipple, 
 as well as the infant's mouth, for the first few weeks, 
 must be cleansed before and after nursing. Milk re- 
 maining exposed to the air shortly swarms with micro- 
 
 Loss of 
 
 Weight 
 
 Rules for 
 Control 
 of Nursing
 
 58 CARE OF CHILDREN 
 
 organisms, many of which cause disease when intro- 
 duced into the digestive tract of the infant. Even 
 the milk in the orifices of the ducts often becomes in- 
 fected, hence the expression of a few drops is recom- 
 mended before each nursing. 
 
 In this connection it should be remembered that 
 little or no hydrochloric acid is secreted in the stom- 
 ach of the infant for several months. This acid in 
 the gastric 'juices of the adult kills almost all the 
 germs introduced with food. The absence of such 
 a safeguard necessitates special care to exclude the 
 germs of decomposition and disease from the intes- 
 tinal tract of the infant. 
 
 Frequency (2) The infant should be put to the breast every 
 two hours during the day and once or twice at night 
 during the first si.r weeks. From six weeks to three 
 months the interval between feedings should be in- 
 creased to two and one-half hours. Between the third 
 and sixth month the interval should be increased to 
 three hours, giving seven feedings from 5 A. M. to n 
 p. M., inclusive. Night feeding may be discontinued. 
 Six feedings a day should be sufficient for a child at 
 six months. By the end of the year he may be accus- 
 tomed to five. 
 
 If sleeping, he should be wakened at the proper 
 time for nursing until the habit becomes established. 
 
 If the milk is abundant the breasts should be used 
 alternately at first; later, the child may need both 
 breasts at a feeding.
 
 NATURAL FOOD 
 
 59 
 
 Disturbed digestion is the common result of too 
 frequent or irregular feeding. A certain definite time 
 is necessary for the disposition of an ingested meal. 
 After this an interval of rest is required for the proper 
 re-establishment of the digestive function. Nothing 
 is more abhorrent to nature than "meals at all hours." 
 The practice of the mother sleeping with the babe on 
 her arm and quieting his restlessness throughout the 
 night by offering the breast is, unfortunately, too 
 prevalent, the result being that instead of receiving 
 one definite feeding, the helpless infant is made the 
 victim of a perverted instinct, and sooner or later may 
 be permanently injured. 
 
 The digestive process is one of varied stages, each 
 dealing with a changed condition in the mass of food 
 taken. It is apparent from this that some of the 
 digestive secretions which make their appearance only 
 as certain stages of the digestive process are reached, 
 are not at all suitable for freshly ingested food. Prob- 
 ably no vicious practice presents such vexatious prob- 
 lems in our efforts at correction as the results of too 
 frequent feeding. 
 
 After convalescence, the night nursing, like that of 
 the day, should be accomplished with the mother 
 seated in a comfortable chair, and as soon as through 
 the baby should be "changed" if necessary, and re- 
 turned immediately to his crib. In this way, the 
 mother, as well as the baby, secures the maximum of 
 unbroken rest. 
 
 Meals at 
 all Hours 
 
 Position 
 in Nursing 1
 
 6o 
 
 CARE OF CHILDREN 
 
 Time of 
 Nursing 
 
 Mother to 
 
 Control 
 
 (3) The time occupied in nursing and the quan- 
 tity taken should be controlled by the mother. The 
 differences in the formation of the nipple and in the 
 supply of milk in different mothers affects nursing 
 more or less. There is a difference, too, in the nurs- 
 ing energy of different infants, so that one infant 
 will occupy half an hour in securing his dinner, while 
 another may gorge himself in ten minutes. The act 
 of nursing in its perfection is the result of the mutual 
 co-operation of mother and child. A child can not 
 properly nurse the passive breast of a sleeping or 
 even inattentive mother. 
 
 In breasts where the nipple formation is imperfect, 
 making the nursing laborious to the infant or painful 
 to the mother, or when milk secretion is tardy or in- 
 sufficient, the mother should aid and encourage the 
 babe by placing herself in full harmony with the 
 pleasurable duty of the moment, and endeavor to 
 sscure a full response to the stimulating appeal of the 
 tiny solicitor for a better supply. 
 
 When the milk flows too freely, or in case of in- 
 fants who nurse with such avidity that the process 
 from beginning to end resembles a struggle against 
 suffocation, the mother should control the outflow. 
 This may be done by dexterous manipulation of the 
 nipple between the fingers, by withdrawing from the 
 mouth, or by diverting the baby's attention. 
 
 It is safe to say that twenty minutes should be given 
 to each nursing. Too rapid feeding throws into the
 
 NATURAL FOOD 
 
 61 
 
 stomach a large quantity of food, with the result of 
 over-distention, and hasty feeding invariably means 
 01 'cri ceding. 
 
 Not infrequently the stomach resents this abuse by 
 immediate regurgitation of a portion of its contents, 
 which has led to the erroneous belief that the stomach 
 is endowed with some quality which enables it to re- 
 ject superfluous food. That this is a pernicious error, 
 the frequent occurrence of gastric dilatation and intes- 
 tinal indigestion is ample evidence. A little sterilized 
 water given before nursing frequently prevents the 
 over-ingestion of milk. Instinct is not always a guide 
 as to the amount a child should nurse. 
 
 (4) Give water systematically and freely. The 
 baby's food, as will be shown when we consider the 
 composition of milk, is made up of several widely 
 different constituents. Although all of them are 
 essential for perfect nutrition, one or more may be 
 temporarily omitted without any immediate percep- 
 tible interference with vital processes. In fact, one 
 only must be present under all circumstances, and 
 this is water. Without water no digestion, absorption 
 or elimination is possible. Water enters largely into 
 the composition of the infant's food, milk containing 
 about 88 per cent. Water is essential to peptone ab- 
 sorption, and many diseased conditions result from 
 an insufficient supply. 
 
 The restlessness of an infant is frequently only an 
 expression of his thirst. Often unrequired and inju- 
 
 Overf ceding 
 
 Water 
 
 Thirst
 
 62 CARE OF CHILDREN 
 
 rious food is forced upon an unwilling stomach in 
 response to the infant's appeal for water. 
 
 TTric Acid Evidences of pain, usually ascribed to intestinal 
 colic, are too frequently indicative of uric acid irri- 
 tation and point to a need for more water. Fortu- 
 nately the doping of the baby with carminative "teas" 
 for the supposed intestinal spasm occasionally fulfills 
 the needs of the child through the water of the de- 
 coction. There is very little danger of giving a baby 
 too much sterilized water, as it passes quickly out of 
 the stomach and is absorbed. The water should be 
 given at blood heat, either with a spoon or from a 
 nursing bottle. 
 
 Composition of Mother's Milk 
 
 Milk is an emulsion of innumerable minute globules 
 of fat floating in plasma. Among the globules are 
 smaller particles of proteid matter. 
 
 All the five principal classes of foods are found in 
 milk, viz.: water, fats, proteids, carbo-hydrates, (milk- 
 sugar), and salts. 
 
 A symmetrical development requires not only the 
 presence of all the constituents, but that they should 
 maintain a certain definite quantitative ratio, 
 importance Although perfect nutrition is dependent upon the 
 presence of all these food principles, life may be main- 
 tained for a longer or shorter time if one or more be 
 omitted from the diet, always excepting water. Thus 
 an infant may exist for a time on water and sugar, as 
 a solution of sugar of milk, or on water and proteids, 
 or on water and salts; the result, however, in each
 
 NATURAL FOOD 63 
 
 case invariably showing the deficiency of the constit- 
 uents in impaired nutrition. (This is so well recog- 
 nized that the absence of one or more'of these essen- 
 tial constituents is not infrequently determined by the 
 condition of the infant.) 
 
 The proteids furnish the only source from which Protei** 
 the tissues obtain nitrogen, without which no proto- 
 plasm can exist, nor cell life be possible. Insufficient 
 nitrogen means interrupted gain in body weight, les- 
 sened muscular force, anaemia with the weakened 
 heart's action, arrested secretions and all the evi- 
 dences of lowered nutrition. 
 
 The fats are necessary, not only to maintain the Fats 
 body heat, but to aid in the formation of bone and 
 nerve tissue. Fat also maintains the healthy function 
 of the lower bowel by promoting the passage of the 
 faeces. A deficiency of fat produces icsults distinctly 
 characteristic of impaired nutrition so uniform as to 
 have been classified under the one term, rachitis. 
 
 Sugar furnishes muscular energy and heat and in- sugar 
 creases the formation and deposition of fat, sugar- 
 fed babies frequently showing a remarkable plump- 
 ness, even though fat and proteids are low in the food. 
 
 The fourth group the salts principally those of salt* 
 lime, phosphorus, potash, soda and a trace of iron, 
 forms a small but fairly uniform and very important 
 percentage of the total constituents. 
 
 A deficiency in any of these salts shows quickly in 
 the impairment of the child's bony, nervous, muscular, 
 circulatory or digestive system.
 
 CARE OF CHILDREN 
 
 Water 
 Absolutely 
 Necessary 
 
 Variation 
 in Quality 
 
 Test of 
 Food 
 
 Were all the other ingredients present in normal 
 mother's milk in proper proportions, the absence of 
 water would render them valueless for food. It is 
 only in a state of solution that these substances can 
 undergo digestion in the intestines of the infant. The 
 normal secretions of the digestive tract are relatively 
 scant in proportion to the enormous work accom- 
 plished during the growing period. Hence, the neces- 
 sity for water at all stages. Attention is again called 
 to what has been said in the preceding pages, as the 
 importance of the demand for water can hardly be 
 overestimated. 
 
 As before stated, normal mother's milk is made up 
 of these five constituents ; moreover, they maintain 
 a fairly constant percentage relationship. Frequent 
 variations, however, are observed in normal milk, as 
 in different mothers, or in the same mother at different 
 times, or in the same mother in the different breasts, 
 or in the same breast at the same nursing drawn at 
 different times, as fore, middle and last milk. 
 
 Of these constituents the percentage of fat is sub- 
 ject to the widest variation ; next, the proteids ; the 
 milk sugar and salts showing little change. Nor 
 would these variations be considered as indications of 
 abnormality, the only criterion being its effect upon 
 the child. An infant at the breast, digesting well, 
 gaining steadily in weight and strength, is getting 
 good milk, regardless of what the analysis may show. 
 It is a fact of common observation that the breast at
 
 CHANGING QUALITY OF FOOD 
 
 65 
 
 which one infant thrives may not meet the require- 
 ments of another child of the same age. 
 
 CHANGING THE QUANTITY AND QT7ALITY OF THE MILK 
 
 Milk secretion is subject to variations in quantity 
 as well as in quality. In the majority of mothers it 
 is regulated to meet the requirements of the infant, 
 although instances are not uncommon in which the 
 quantity is insufficient. On the other hand, it fre- 
 quently occurs that the mother may successfully nurse 
 two infants, as in cases of twins, or in wet-nursing in 
 foundlings' homes. From this it may be inferred that 
 in some mysterious way, and to a limited extent, the 
 supply is regulated by the demand. The growth of 
 large babies is relatively more rapid than that of 
 smaller ones, and it would appear that to a certain 
 degree there is an automatic adjustment of the quan- 
 tity of milk to the needs of the child. 
 
 It is a question whether the daily quantity of milk 
 can be increased by any medical agent. However, the 
 milk secretion is quite sensitive to many influences, 
 both as to its quantity and composition. 
 
 A so-called "dry diet" in which there is a deficiency 
 of water, usually diminishes the secretion, while, on 
 the other hand, it may be increased by a liberal allow- 
 ance of water, milk and other fluids. 
 
 The secretion of milk, when scanty, may be in- 
 creased by any agency that increases normal meta- 
 bolism (digestion and assimilation) ; as diet, exercise, 
 massage, electricity, fresh air, sunlight, congenial 
 
 Variations 
 in Quantity 
 
 Increasing 
 Quantity
 
 66 
 
 CARE OF CHILDREN 
 
 Mental 
 Attitude 
 
 Changing 
 the Fats 
 
 surroundings, freedom from physical discomfort and 
 an equable temperament. 
 
 Sudden emotion, as grief, anxiety, anger, fear, or 
 anything that produces shock or profoundly impresses 
 the nervous system, may not only diminish the secre- 
 tion, but occasionally cause total suppression. 
 
 Regularity should be observed in putting the child 
 to the breast, even though there be little evidence of 
 milk as the secretion is undoubtedly promoted by the 
 act of nursing. 
 
 Attention is again called to the mental attitude of 
 the mother during nursing, as influencing the quan- 
 tity of milk. It must not be forgotten, however, that 
 over-anxiety to produce defeats its very object. 
 
 Loss of fluids from any cause, as copious perspira- 
 tion, menstruation or diarrhoea, may lessen the 
 amount of the milk. 
 
 The relative proportion of the constituents of the 
 milk may be influenced by variations in the hygiene 
 of the mother, especially in the diet. The former be- 
 lief that the fat of the milk was increased by the fat 
 eaten has been repeatedly disproved by actual experi- 
 ment. It is believed to-day that the proportion of fat 
 in the milk depends largely upon the amount of pro- 
 teid in the mother's food, increase or decrease in the 
 latter causing a like change in the former. The mere 
 eating of proteid food, however, is not sufficient to 
 produce a "rich milk," since thorough digestion and 
 assimilation are essential to fat production.
 
 CHANGING QUALITY OF FOOD 
 
 67 
 
 Fat may be scanty in the milk, not only from an in- 
 sufficiently nitrogenous diet, but also as a result of 
 excess of fats in the food. Examples are not wanting 
 of mothers who in their efforts to enrich their milk 
 defeat this object by drinking too much rich milk or 
 cream. 
 
 A poorly nourished or rachitic infant is frequently 
 seen at the breast of the mother whose diet consists 
 largely of starchy foods. The substitution in this 
 case of a diet of eggs for breakfast, meat for dinner 
 and supper, with a cup of beef broth between times, 
 and a limited supply of vegetables and sweets will 
 almost invariably show an increased percentage of fat 
 in the milk, with subsequent improvement in the 
 nutrition of the child. 
 
 It occasionally occurs that the infant shows the 
 effects of excessive fat in the so-called "fatty diar- 
 rhoeas," in which fat is seen in the diapers in glisten- 
 ing masses or floating on the surface of the washing 
 water. Again, in the "spitting babies," who regurgi- 
 tate their food shortly after nursing, analysis of moth- 
 er's milk shows sometimes as high as seven or even 
 nine per cent fat. In such cases meats should be re- 
 stricted and vegetables and breadstuff's substituted in 
 the mother's diet. 
 
 The proteids are rarely low except in cases of ex- 
 haustion or debility, as from sickness or insufficient 
 food. In this condition the milk is poor and watery, 
 there being a deficiency in all the solids. In such 
 
 Too Much 
 Fat 
 
 Changing 1 
 the Proteids
 
 68 
 
 CARE OF CHILDREN 
 
 Excessive 
 Proteids 
 
 Colostrum 
 
 Milk 
 
 cases the hygiene of the mother requires a liberal diet 
 with all the accessories for the improvement of her 
 general nutrition. Here nitrogenous foods are neces- 
 sary to increase proteids in the milk. It may happen 
 that the mother's milk in cases of debility shows an 
 excess of proteids with a deficiency of other constitu- 
 ents, the debilitated infant exhibiting evidences of in- 
 digestion, in constipation or in diarrhoea and vomit- 
 ing. 
 
 Excessive proteids may appear, also, in the milk of 
 the overfed mother of sedentary habits for whom ex- 
 ercise in the open air with reduction of diet is re- 
 quired. Idleness and discontent may be replaced by 
 congenial occupation, to the improvement of the milk 
 in this respect. The relief of constipation or the alle- 
 viation of any bodily discomfort may alone be suffi- 
 cient. 
 
 Violent agitation of the nervous system of the 
 mother may change the quality of the milk almost in- 
 stantly. Quite frequently, under these circumstances, 
 it resembles colostrum in its changed proteids, low 
 fat and colostrum corpuscles. Instances are known 
 where convulsions and even death to the nursling 
 have followed. 
 
 The secretion of the colostrum milk sometimes fol- 
 lows undue fatigue, excitement, anger, grief, also 
 menstruation and conception. Disturbances of diges- 
 tion in the infant are frequently the first intimation of
 
 CHANGING QVAL1TY OF FOOD 69 
 
 pregnancy in the mother. In the event of the above 
 disturbances, the child should be removed from the 
 brea'st and artificially fed until the milk approaches the 
 normal as shown by analysis. Meanwhile, the breasts 
 should be emptied regularly by the breast pump, 
 
 SUCTION BREAST PUMP. 
 
 Both quantity and quality of the milk are influenced 
 by the frequency of nursing. Poor milk usually re- 
 sults from irregular intervals in nursing. The more 
 frequently the breasts are emptied, the higher will be 
 the percentage of solids, especially the proteids. The 
 infant, restless from indigestion induced by excess of 
 proteids, often is unfortunately given the nipple at 
 short intervals to quiet him. The result is increased 
 indigestibility of the milk from greater excess of pro- 
 teids. What is needed is water for his thirst, rest for 
 his stomach and rest for the mammary glands. 
 
 Eftect 
 Frequency 
 of Nursing
 
 70 CARE OF CHILDREN 
 
 In conclusion, a table may best express a summary 
 of the means at our command for regulating the com- 
 position of mother's milk. 
 
 The percentages of sugar and salts vary but little. 
 
 The Percentage of Proteid may be Increased by 
 
 Increased frequency of nursing. 
 
 Increased liberality of proteid food. 
 
 Insufficient exercise. 
 The Percentage of Proteid may be Diminished by 
 
 Diminished frequency in suckling. 
 
 Diminished proteid food. 
 
 Increased exercise. 
 The Percentage of Fat is Increased by 
 
 Increased proteid diet. 
 The Percentage of Fat is Diminished by 
 
 Deficiency of proteid food. 
 
 Excess of fatty foods. 
 
 Fasting. 
 The Percentage of Water is Increased by 
 
 Increased fluid diet. 
 The Percentage of Water is Diminished by 
 
 Saline cathartics. 
 
 Diminished fluid diet. 
 
 Care of The nursing mother must keep herself in the best 
 
 the Mother 
 
 possible physical condition if she would have a healthy, 
 contented baby. She should take daily exercise in the 
 open air, simple food, and plenty of sleep. She should 
 keep free from worry, avoid too much excitement, un- 
 due fatigue and late hours. Constipation should be 
 remedied.
 
 NATURAL FOOD 71 
 
 VOMITING 
 
 Vomiting should never be regarded as trivial. It 
 should be to the baby feeder as the red light is to the 
 engineer. A careful consideration of all the condi- 
 tions may determine the cause, which should always 
 be sought, and when found removed. With rare ex- 
 ception, this cause will be found in the non-observ- 
 ance of the rules of hygiene outlined in these lessons. 
 Although almost invariably the vomiting of infancy 
 is due to dietetic errors, it occasionally ushers in some 
 of the graver diseases, such as scarlet fever, measles, 
 meningitis, cholera infantum, etc. 
 
 Whatever be the cause, no mistake will be made if Diminish 
 
 i r i > i t * i i i i the 
 
 the food is diminished in quantity or withheld entirely 
 for a time. 
 
 The regurgitation of a small quantity of milk 
 directly after a feeding is not always an indication 
 of serious trouble, but may result from overfeed- 
 ing and careless handling. 
 
 WEANING AND SUBSTITUTE FEEDING 
 
 The question of substitute feeding is of secondary 
 importance only to that of lactation. Conditions may 
 develop at any time which render breast feeding im- 
 practicable. Progressive changes occur in the con- 
 stituents of breast milk which render it, after a time, 
 insufficient to furnish the material demanded by the 
 rapid growth of the infant. Moreover, the presence 
 of several teeth, the changes in the salivary secretion,
 
 CARE OF CHILDREN 
 
 Period of 
 Lactation 
 
 Do Not 
 
 Wean for 
 
 Slight 
 
 Cause 
 
 Early 
 Weaning 
 
 as well as in those of the stomach and pancreas, indi- 
 cates preparation for digestion of a different class of 
 foods. 
 
 The changes in breast milk show considerable vari- 
 ation as to the time of their occurrence in different 
 women. Thus, one mother may have exhausted her 
 power to produce good milk by the end of the seventh 
 month ; while another woman may continue to furnish 
 good milk until the fifteenth month. 
 
 The growing tendency to recommend weaning upon 
 the slightest pretext suggests the need of more em- 
 phasis upon the injunction not to substitute artificial 
 for breast feeding until it is clearly proven that the 
 latter can not be made to agree. However, the infant 
 should not be deprived of his right to a fair start in 
 life by being confined to the breast which fails to fur- 
 nish all the requisites for normal nutrition. 
 
 Aside from the normal time of weaning, which 
 should rarely be deferred beyond the twelfth month, 
 occasions may arise during the first year when the 
 decision must be made as to whether the child can 
 thrive on the milk of his nurse. Transient disturb- 
 ances due to the milk should not be considered suffi- 
 cient cause for rejecting the breast, since many tem- 
 porary disagreements may be corrected by attention 
 to the hygiene of the mother or child. 
 
 The indications for early weaning, so far as the 
 infant is concerned, are evidences of deficiency in 
 normal development, which is frequently best shown
 
 WEANING 73 
 
 by a failure to gain in weight. However, weight gain 
 is not always evidence of normal nutrition, as many 
 rachitic babies make fat rapidly. 
 
 The process of weaning should be gradual, the in- 
 fant having been accustomed to supplemental feeding 
 commencing with one a day and increasing the num- 
 ber through a period of several weeks. 
 
 The food selected for the supplemental feeding First 
 should at first be weaker than that for an artificially- Food 
 
 BREAST PUMP WITH BULB. 
 
 fed infant of the same age and development. This 
 is particularly important in the proteids, which in 
 cows' milk are much more difficult to digest. As the 
 skimmed milk contains most of the proteids, about 
 one-half of this constituent may be replaced with 1 
 water in the food formula for an infant of the same 
 age. If the new diet is tolerated, the skimmed milk 
 may be increased cautiously from day to day until the 
 regular formula is used. 
 
 The season or time of vear must be considered in Time of 
 
 .. , ,' , , the Year 
 
 the weaning, as radical food changes should not be
 
 74 
 
 CARE OF CHILDREN 
 
 Menstruation 
 
 made at the commencement of or during the heated 
 term, at which time infants are especially susceptible 
 to digestive disorders. The cutting of an unusually 
 troublesome tooth might well delay the change in 
 food. 
 
 A child should be immediately 
 removed from the breast upon the 
 appearance of acute infectious dis- 
 ease in the mother or upon well- 
 grounded suspicion of the exist- 
 ence of syphilis or tuberculosis. A 
 suitable wet nurse should be se- 
 cured if possible, in case the infant 
 is free from syphilitic infection. 
 
 The development of abscess ren- 
 ders the affected breast unfit for 
 nursing 
 tinues. 
 frequently 
 
 early appearance may not require weaning, but its 
 regular return should suggest its advisability. It is 
 usually best to give substitute feedings during the 
 first day of a period. 
 
 The occurrence of conception is an indication for 
 the immediate removal of the child from the breast, 
 as this condition renders the milk insufficient, if not 
 positively injurious. 
 
 When it becomes evident that substitute feeding is 
 necessary, the question what shall be substituted is of 
 
 Artiflcial Nipple for 
 
 Use with Sore 
 
 Breasts 
 
 Menstruation 
 
 while suppuration con- 
 
 disturbs lactation. Its
 
 SUBSTITUTE FEEDING 75 
 
 the greatest importance. Errors in the management 
 of substitute feeding are probably responsible to a 
 greater extent than any other cause for the high infant 
 mortality. 
 
 The best substitute is the wet nurse. The draw- ' The wet 
 
 , . . . Nurse 
 
 backs to wet-nursing are many and extremely trying, 
 and it is probably on account of these that this substi- 
 tution is not more frequently resorted to in this coun- 
 try. The wet nurse should be chosen with reference 
 to her temperament, the quality and quantity of her 
 milk and her freedom from syphilis or tuberculosis. 
 She should be examined by the family physician and 
 accepted only upon his recommendation. 
 
 Should the first wet nurse's milk fail to agree, it 
 need be no cause for discouragement, as in some cases 
 repeated trials are necessary. In case a wet nurse is 
 not available it will become necessary to adopt arti- 
 ficial feeding.
 
 ARTIFICIAL FEEDING 
 
 More has been written and said concerning artificial 
 feeding during the past ten years than all other pedia- 
 tric subjects combined. 
 
 Having studied natural feeding, we should have a 
 fairly practical knowledge of the quantity and quality 
 of food required at different ages, and also the time 
 and method of feeding. That we should keep close to 
 nature, both in the composition and physical proper- 
 ties of the food, seems hardly necessary to state. Yet 
 we see infants fed (?) on compounds differing so 
 widely from those which their organs are prepared to 
 digest that it is surprising so many survive. 
 Digestion The stomach of the infant at birth was found to be 
 little more than a receptacle for food in which the 
 action of rennet coagulating the milk, prepares it for 
 the first step in the digestive process. 
 
 As the infant grows the capacity of the stomach in- 
 creases rapidly, its walls thicken, the glands develop 
 and pepsin and hydrochloric acid secretions gradually 
 become more abundant. It is not, however, until after 
 the sixth month that the salivary and pancreatic secre- 
 tions develop to any great extent the power of con- 
 verting the starch into sugar. 
 
 This conversion is necessary before cereals may en- 
 ter largely into the food, as nature has made little or 
 no other provision for the digestion of starch. 
 
 During the latter half of the first year the stomach 
 empties itself of a digested meal in two or three hours, 
 
 76
 
 COVERED MILK PAIL IN USE AT CONNECTICUT 
 AGRICULTURAL COLLEGE 
 
 The first jets from each quarter of the udder are drawn into a cup 
 and discarded
 
 z 8 
 
 <J(E 
 01 o 
 
 ?. "o 
 
 I 
 o & 
 
 i*
 
 ARTIFICIAL FEEDING 
 
 77 
 
 the time depending upon the quality of the food taken, 
 cow's milk requiring the longer time. 
 
 That a very large percentage of the food is ab- 
 sorbed in the normal infant normally fed, is shown by 
 analysis of the faeces. As a result of observations 
 upon infants fed wholly upon milk, it is stated that 
 the faeces consist of 84 to 86 per cent water ; that 
 digestion and absorption of proteids in the alimen- 
 tary canal are so efficient that but little is lost; that 
 the whitish flakes and clots, nearly always seen, are 
 composed largely of fat, fatty and lactic acids in com- 
 bination with lime. 
 
 Milk acids are always found and to their presence 
 are attributed the slightly acid smell and reaction. 
 Fermentation of milk sugar leads to the development 
 of carbon-dioxide and hydrogen, which are the prin- 
 cipal gases in the intestinal tract of a healthy infant 
 fed purely on milk, foul-smelling gases being absent. 
 
 Though the amount of faeces varies much in in- 
 fants, yet three per cent of the milk taken is the aver- 
 age proportion. The fecal discharges after the first 
 few days are an orange yellow, frequently turning to 
 green on exposure to air, are of the consistency of 
 batter and homogeneous throughout. . They average 
 from three to five movements daily. These character- 
 istics vary somewhat with the quality of food taken 
 and the completeness of the digestive process. 
 
 The urine increases from about six ounces at the 
 end of the first week to eight or sixteen ounces at six 
 
 Completeness 
 of Digestion 
 
 Fecal 
 Discharges
 
 CARE OF CHILDREN 
 
 Essentials 
 
 in Substitute 
 
 Feeding 
 
 Composition 
 
 Anti-Scorbutic 
 
 Quantity 
 
 months. There is considerable variation, however, de- 
 pendent upon the secretions from the skin and bowels 
 and the amount of fluids taken. The marked tend- 
 ency to urination is variable, occurring sometimes 
 every hour during the day and twice or thrice at 
 night, while at othei times several hours may elapse 
 without urination. The urine is usually light in color, 
 of low specific gravity, 1.004 to i.oio, and in health 
 rarely stains the diaper. 
 
 A few "essentials" from Cheadle may be of value 
 in assisting the student to a practical application of 
 some of the principles already indicated. 
 
 First The food must contain tlic different ele- 
 ments in the same proportions as found in human milk, 
 viz. : proteids, I to 2 per cent ; fats, 3 to 4 per cent ; 
 milk sugar, 6 to 7 per cent ; salts, y 8 ^ per cent ; water, 
 88 per cent. 
 
 Second It must possess the anti-scorbutic prop- 
 erty. Infants at the breast very rarely suffer from 
 scurvy, that disease being found among those fed 
 upon condensed or sterilized milk, or upon dried or 
 evaporated preparations. Prompt recovery usually 
 occurs with the food unchanged, except the discon- 
 tinuance of sterilization. Fresh milk possesses this 
 anti-scorbutic element, but not in large proportion, 
 for milk in extreme dilution will not prevent the de- 
 velopment of scurvy. 
 
 Third The total quantity in twenty- four hours 
 must represent the equivalent in nutritive value of
 
 ARTIFICIAL FEEDING 79 
 
 from one to three pints of human inilk, according to 
 age. 
 
 No fixed arbitrary rule can be given for all chil- 
 dren. Careful observation of the infant as to whether 
 he rejects some of his food soon after taking it or 
 seems hungry half an hour after feeding, may prove 
 a guide. The best indication that he is receiving his 
 full equivalent is a steady weekly gain of two or three 
 ounces or more in the early months. 
 
 Fourth // must not be purely vegetable, but 
 must contain a large proportion of animal matter. 
 
 Most vegetable substances are deficient in proteids 
 and yield but a small quantity of fat. Moreover, it is 
 known that the infant does not assimilate them as 
 easily and fully as those derived from animal sources, 
 even though these ingredients be supplied in the 
 proper percentages. 
 
 Fifth It must be in a form suited to infantile Fluid 
 digestion. 
 
 The digestive organs, it will be remembered, have 
 only recently assumed their function and are de- 
 signed to deal solely with the bland, dilute and easily- 
 dissolved nutriment of mother's milk. In the natural 
 method of feeding, the infant gets his nourishment in 
 the same form at every meal ; so in artificial feeding 
 variety is not desirable. 
 
 As the walls of the stomach are lacking in muscular 
 power and the glands produce but little secretion, it 
 is evident that it is not right to ask this organ to deal
 
 8o CARE OF CHILDREN 
 
 with large masses - of solid or semi-solid matter. Sol- 
 ids can be digested only in a state of minute subdivi- 
 sion. 
 
 sterile Sixth // must be as nearly sterile as possible. 
 Infants are extremely susceptible to stomach and in- 
 testinal disorders, having little resistance to bacteria 
 "* and their poisons. The products of fermentation are 
 highly irritating and the sensitive, unstable nervous 
 system of the infant may be profoundly affected there- 
 by. The gastric secretions of the infant do not con- 
 tain the protecting hydrochloric acid of the adult. 
 
 iiTik Cow's milk, on account of its cheapness and the 
 abundant supply, is the most available substitute for 
 mother's milk. The proneness to stomach disorders 
 and the great mortality among the bottle-fed babies 
 has led to a systematic study of cow's milk. As a re- 
 sult of this study, some of the reasons why cow's milk 
 does not meet all the requirements of the infant may 
 be shown. The results of recent analyses give the con- 
 stituents of cow's and mother's milk as follows: 
 
 Composition of Milk 
 
 Average Composition. Cow's. Mother's. 
 
 Per Cent. Per Cent. 
 
 Specific gravity 1.032 1.030 
 
 Total solids 14-13 13-12 
 
 Proteids 4.00 1.50 
 
 Fat 4.00 4.00 
 
 Sugar 4.50 6.50 
 
 Salts 0.70..: 0.15 
 
 Reaction Acid* Alkaline 
 
 Bacteria Swarming with* .... None 
 
 This refers to cow's milk as it reaches the consumer.
 
 ARTIFICIAL FEEDING 
 
 81 
 
 It will be seen at a glance that the milks differ but 
 little in specific gravity, in the quantity of their total 
 solids and water, and in their percentage of fat ; more 
 widely in their salts, sugar and proteids; most widely 
 in regard to chemical reaction and presence of bac- 
 teria. 
 
 The sugar in cow's milk is identical with that in 
 breast milk. The fats are nearly the same, although 
 those in breast milk are in more finely divided par- 
 ticles and more easily digested. It is in the proteids 
 that the greatest difference comes, the percentage be- 
 ing much higher in cow's milk and the composition 
 different. The proteids of both cow's and mother's 
 milk are made up chiefly of casein and albumen (lac 
 albumen), but the relative porportion of the casein to 
 the albumen in cow's milk is about 6 to I, and in breast 
 milk is about i to i. Even the casein in the two milks 
 is not of identical composition; that in cow's milk 
 coagulates in much denser and less digestible clots. 
 The nitrogenous substances called "extractives" differ 
 in the two milks and the mineral parts the salts are 
 not the same. Thus it is apparent that cow's milk 
 can not be so modified as to be identical with mother's 
 milk. The best we can do is to approximate nature's 
 supply as nearly as possible. 
 
 Most of the disturbances of infants' digestion are 
 traceable directly to proteids ; their excess in cow's 
 milk being the principal factor in its disagreement. 
 It is usual to reduce the percentage of proteids by the 
 addition of water. 
 
 Differences 
 from Mother's 
 Milk 
 
 Proteids 
 Cause of 
 Trouble
 
 82 
 
 CARE OF CHILDREN 
 
 Modified 
 
 Milk 
 
 laboratories 
 
 Bacteria 
 
 the Cause 
 
 of Disorders 
 
 Safe Milk 
 
 In this dilution, however, the nutritive value of the 
 milk suffers from a diminution of fats and sugars. 
 Consequently it is necessary that the percentage of 
 sugar and fats be maintained by the addition of sugar 
 of milk and cream. 
 
 Laboratories for this modification, like those of the 
 Walker-Gordon Co.,* have been established in the 
 leading American cities, to which orders are sent for 
 definite percentages of modified milk, as drugs are 
 ordered by prescription from a pharmacy. The physi- 
 cian may, at will, control the amount of different in- 
 gredients, varying their percentages to meet the vary- 
 ing requirements of the little patient. 
 
 That many disorders of infancy are due to the 
 presence of bacteria in cow's milk is no longer a mat- 
 ter of doubt. In addition to infection from the pos- 
 sible presence of such germs as those of tuberculosis, 
 typhoid fever, scarlet fever, diphtheria, etc., it should 
 be emphasized that the proneness of cow's milk to 
 decomposition with its effects upon the nursling is 
 one of the greatest dangers of milk feeding. Hence, 
 the hygienic dairy management becomes a question of 
 the highest importance. 
 
 It has been proved that milk production may be so 
 guarded as to furnish a product comparatively free 
 from bacteria. As an example of what scrupulous 
 
 * The Walker-Gordon Co. have laboratories or stations in the follow- 
 ing cities: New York, Boston, Chicago, Philadelphia, Washington, 
 Baltimore, Buffalo, Cincinnati. Cleveland, Detroit. Grand Rapids. 
 Milwaukee, Pittsburg, St. Louis, Atlantic City, Princeton, Newark, 
 Elizabeth, Montreal, Can., Ottawa, Can., London, Eng. .
 
 ARTIFICIAL FEEDING 83 
 
 care and cold can accomplish in producing bacteria- 
 free milk, may be mentioned the exhibits of a number 
 of American dairies at the Paris exposition in 1904. 
 Milk and cream were shown that remained sweet for 
 several days after the journey of ten days or more. 
 The officials found it hard to believe that no preserva- 
 
 a W U O ft 
 
 MICROSCOPIC APPEARANCE OF MILK. 
 
 a. Pure milk. 6. After standing in a dirty dish for some hours in a 
 warm room, showing many varieties of bacteria. 
 
 tives had been added or treatment given until con- 
 vinced by analysis and by proof. 
 
 The same care in the selection of the cow is rec- selection 
 ommended as in the selection of the wet nurse ; the of Cows" 
 same details in her hygiene as well as in the antiseptic 
 care of the milk will insure milk that is practically 
 sterile. 
 
 In the choice of the family cow three requisites at 
 least should be kept in view. First: The quality of 
 the milk. Second: The constitution of the animal,
 
 CARE OF CHILDREN 
 
 Jerseys 
 
 Holsteins 
 
 Durhams 
 
 her hardihood and freedom from disorders and her 
 adaptability to variations in climate and food. Third: 
 Her temperament and freedom from disturbances due 
 to accidental causes. 
 
 Of many types distributed throughout the country 
 we will discuss but three, viz., the Jersey, the Hoi- 
 stein and the Durham. 
 
 The Jersey gives a fair quantity of milk, exceed- 
 ingly rich in cream. In-breeding, however, has made 
 
 I 2. 3 48 67831011121314 15161718192021 22 
 
 6% 
 
 \/ 
 
 V 
 
 VARIATION IN PERCENTAGE OF CREAM 
 IN ONE COW'S MILK. 
 
 her delicate and quite susceptible to diseases, as tuber- 
 culosis, etc., and though quite gentle she is nervous 
 and sensitive. The 'fats of Jersey milk differ some- 
 what from those in' other milks and the globules of 
 fat are larger, thus making it less digestible. 
 
 The Holstein is docile, hardy and the greatest of 
 all milkers, but the milk is low in the percentage of 
 cream and proteids. 
 
 The third type, the Durham, undoubtedly is the 
 best, as she is a good feeder, of placid temperament, 
 and yields a large quantity of very good milk. 
 
 In the best of cows, however, the milk varies from 
 time to time in quantity and quality under the chang-
 
 
 \ 
 
 V * 
 
 
 FAT GLOBULES IN HUMAN MILK 
 Storrs Agricultural Experiment Station, Bulletin No. 31
 
 -'o" ; *^-*~-4 
 
 
 FAT GLOBULES IN HOLSTEIN MILK
 
 FAT GLOBULES IN JERSEY MILK

 
 ARTIFICIAL FEEDING 85 
 
 ing influences of food, care and surroundings, so that 
 the popular idea of the great value of a "one cow's 
 milk" supply for the baby is erroneous. The mixed 
 product of a herd secures a greater uniformity in the 
 quality and the percentage of constituents. 
 
 The selection of the dairyman should depend upon 
 his known methods of handling his herd and its prod- 
 
 THE COVERED MILK PAIL. 
 
 ucts. Does he select his cows upon the principles 
 above enumerated? Is his herd regularly inspected 
 by a competent veterinarian for evidences of tuber- 
 culosis or other disease? Are the animals properly 
 fed, watered and pastured? Are they comfortably 
 housed in stables that may be cleaned daily and regu- 
 larly whitewashed? Are the milkers kind, intelligent, 
 cleanly and conscientious? Is the cow cleaned and 
 her udder washed before each milking? Is the first 
 teat full of milk discarded and the remainder received 
 
 The Baby's 
 Milkman
 
 86 
 
 CARE OF CHILDREN 
 
 Importance 
 
 of 
 
 Eefrigeration 
 
 Certified Milk 
 
 in a sterilized pail through a cover of cheesecloth ? Is 
 the milk immediately strained, bottled and placed in a 
 cooler which rapidly reduces its temperature to 40 
 F? 
 
 Rapid cooling and refrigeration are fully as impor- 
 tant as cleanliness in the production of safe milk, for 
 
 a 
 
 DIAGRAM SHOWING THE RATE OF INCREASE OF 
 BACTERIA IN MILK. 
 
 o. Single Bacteria. t>. Increase in 24 hours at 50 F. c. Increase in 
 24 hours at 70 F. 
 
 the few bacteria which are present in even the most 
 carefully-cared-for milk multiply with enormous ra- 
 pidity at 70 F., while they increase only about five- 
 fold in 24 hours in milk kept at 50 F. 
 
 The above enumeration includes most of the prin- 
 ciples, the observation of which is absolutely neces- 
 sary in the production of milk suitable for baby feed- 
 ing. The source of supply should be investigated by
 
 COVERED MILK PAILS, SHOWING STRAINER IN PLACE 
 
 Sixty-three per cent of the dirt that woujd fall in an open pail kept out 
 
 by the cover
 
 COVERED MILK PAILS, SHOWING COVERS REMOVED 
 Storrs Agricultural Experiment Station, Storrs, Connecticut
 
 ARTIFICIAL FEEDING 
 
 personal visit if possible. Some dairies in the larger 
 cities furnish milk especially for babies, called "certi- 
 fied milk," at advanced price 12 to 14 cents a quart. 
 It will be found economy to pay the advanced price 
 necessary for the extra care, but it may be well to 
 make sure that the extra care is given. 
 
 The cold sealed bottle when received at home must 
 be placed at once in a clean refrigerator (free from 
 taint or odor of other food or vegetables), and kept 
 stoppered. The refrigerator should be kept at least as 
 low as 50 F. This point should be tested with a 
 thermometer. 
 
 Milk received in good 
 condition is not infre- 
 quently rendered unfit 
 for infants' food by 
 careless handling in the 
 home. The bacteria 
 which by their growth 
 render the milk unsafe 
 are present everywhere 
 in the air with dust, 
 in every particle of dirt, 
 
 in water, on the hands and clothes, on all utensils and 
 vessels. (See Household Bacteriology.} No utensil, 
 spoon or receptacle should be used which has not been 
 sterilized. Milk once poured out should never be re- 
 turned to the bottle, nor should remnants ever be used. 
 Flies (common carriers of infections) must be reli- 
 giously excluded. 
 
 THE FREEMAN PASTEURIZER. 
 
 Home 
 Care of 
 Milk
 
 CARE OF CHILDREN 
 
 Treatment 
 of Unsafe 
 
 Milk 
 
 Pasteurizing 
 
 Sterilizing 
 
 Where doubt exists as to the safety of the milk, or 
 during hot weather, it may be freed from germs by 
 pasteurization or sterilization. The first is accom- 
 plished by subjecting the milk for 40 minutes to a 
 temperature of 150 F. A pasteurizer is on the 
 market in which the bottles of milk are placed and 
 sufficient boiling water added to bring the temperature 
 of the whole to 150 F.* In the absence of a spe- 
 cial pasteurizing apparatus, a small jar or cup about 
 the height of a nursing bottle is filled with boiling 
 water. Into this the bottle containing one feeding of 
 milk is immersed, the projecting neck stoppered with 
 sterilized unabsorbent cotton. The whole is then cov- 
 ered with a cozy or another jar to retard radiation 
 and allowed to stand 40 minutes. The temperature 
 should be tested in an extra bottle with a thermometer 
 until the correct amount of boiling water to be added 
 is determined. 
 
 If preferred, the entire day's supply may be pas- 
 teurized at once, either in bulk or, better, in a number 
 of separate feeding bottles, which should then be 
 cooled rapidly and kept on ice until used. It is im- 
 portant to cool the milk as soon as possible, for the 
 spores not killed by pasteurizing will develop if the 
 milk is kept warm for some time. The quickest way 
 to do this is to place the bottles in running water. 
 
 Sterilization, i. e., the destruction of both bacteria 
 and spores, is accomplished by heating the milk to a 
 
 * The Freeman Pasteurizer. Price. $3.50.
 
 ARTIFICIAL FEEDING 89 
 
 temperature of 212 F. (boiling temperature) for 
 about an hour. This may be done in an ordinary 
 double boiler or farina kettle. Thus treated the milk 
 will keep unchanged for 24 hours or so. If necessary 
 to protect it for a longer period, as for traveling, ship- 
 ping, etc., the process must be twice repeated after 
 intervals of 24 hours each, when, if properly sealed, it 
 will remain bacteria free indefinitely. 
 
 THE ARNOLD STEAM STERILIZING AND PASTEURIZING 
 APPARATUS. Price, $3.00 to 85.00. 
 
 It must be borne in mind that no amount of pasteur- Milk 
 
 .... 1 i j -11 i T Must Be 
 
 ization or sterilization can make bad milk good. It Fresh 
 merely destroys the bacteria, which by their growth 
 render the milk unfit for infant food. The chemical 
 changes in the milk which, through age, has begun to 
 deteriorate, are beyond retrieve. 
 
 Milk should be at first hand, like Caesar's wife, 
 "above suspicion," in which case pasteurization is un- 
 necessary and sterilization is unwise, as the high tem- 
 perature changes it somewhat and renders it more
 
 po CARE OF CHILDREN 
 
 difficult of digestion. A child fed continuously on 
 cooked or sterilized milk is liable to develop nutri- 
 tional disorders, as scurvy, etc. 
 
 The practice of keeping the baby's food warm for 
 emergencies is entirely wrong, as it favors the devel- 
 opment of any bacteria present and spores which are 
 not destroyed by pasteurization. 
 
 supply Because of the limited field of operation of the 
 important milk laboratory home modification is of great impor- 
 tance in artificial feeding. In this connection, tin- 
 protection of the supply ?i'/7/ erer continue to be the 
 most important consideration. 
 
 MODIFIED MILK 
 
 Apparatus To modify milk satisfactorily in the home the 
 Supplies mother or nurse must be equipped with all necessary 
 utensils. These include a good ice box, two syphons 
 (made by heating and bending glass tubing), a ster- 
 ilizer or pasteurizer thermometer registering to 212 
 F., a dozen graduated feeding tubes (large mouth 
 without shoulder with small lip), bottle brifshes. ab- 
 sorbent cotton, straining gauze, non-absorbent cotton 
 for stoppers, mixing pitcher, 8-ounce graduate, tall 
 cup for warming bottle, three 'to six black rubber 
 nipples (to fit mouth of tubes, reversible for clean- 
 ing), bicarbonate of soda and boric acid. 
 
 Lime water should be kept in well-corked bottles, 
 as it is soon changed by the carbon dioxide in the air 
 to carbonate of lime, which is deposited on the sides
 
 MODIFIED MILK 
 
 of the bottle. Milk sugar solution should be prepared 
 fresh for each day's supply. 
 
 The supply of food may be prepared once or twice 
 in the twenty-four hours, depending upon the time of 
 milk delivery and number of tubes to be used. The 
 milk should always be kept on ice before and after 
 preparation. 
 
 All bottles and utensils should 
 be washed with hot soapsuds, 
 then rinsed and boiled or steril- 
 ized. Nipples must be scrubbed 
 inside and out with soap and 
 water, rinsed and kept in a solu- 
 tion of soda or boric acid until 
 needed again. Milk tubes when 
 filled should be stoppered with 
 non- absorbent cotton so that in 
 cooling the air may pass 
 through. After warming to 
 about 100 F. (38 C.) by 
 standing the bottle in a cup of 
 warm water the cotton is re- 
 placed by the nipple. 
 
 After nursing, any food remaining in the bottle 
 must be thrown away. No flies should ever touch 
 food, utensils or baby. 
 
 Of course, the nurse will never touch the nipple 
 with her lips. The temperature of the milk may be 
 tested by allowing a few drops to fall upon the back of 
 the hand. Eternal vigilance is the price of sterility. 
 
 AN EIGHT OUNCE 
 GRADUATE. 
 
 Time of 
 Preparation 
 
 Warming
 
 92 CARE OF CHILDREN 
 
 Feeding The bottle should be held inverted in the hand dur- 
 ing the feeding so that the babe will not suck air. 
 If the milk flow is too free the nipple may be with- 
 drawn from time to time so that about twenty minutes 
 is consumed in the feeding, during which the babe 
 
 APPARATUS AND MATERIALS FOR MODIFYING MILK. 
 Walker -Gordon Co. 
 
 would better be on the arm or lap of the nurse. If the 
 milk does not drop freely enough more holes should be 
 made in the nipple by means of a hot needle. 
 Follow The rules of feeding as to regularity, number and 
 length of intervals should be about the same as those 
 given for infants at the breast. .Water between feed- 
 ings is generally required, and to a ravenous infant 
 should be freely given. The water should be boiled 
 and cooled and may be given from either bottle or 
 spoon.
 
 MODIFIED MILK 93 
 
 As a rule, artificial feeding in the normal vigorous Composition 
 babies should be begun with formulae representing 
 low percentages. Especially is this true of the pro- 
 
 FEEDING THK BABY, 
 Showing Proper Position of Infant. 
 
 teids. Taking average mother's milk as a standard, 
 the percentage of sugar may be about the same, the 
 fats about half, and the proteids about one-third, 
 for the first weeks, remembering that temporary error
 
 Firt 
 
 94 
 
 CARE OF CHILDREN 
 
 on the side of underfeeding is easier of correction 
 than the more common mistake of overfeeding. 
 
 The proteid in cow's milk is the most frequent 
 cause of indigestion, and this absolutely essential in- 
 gredient requires most careful watching. Since its 
 variation by ever so little is sufficient, at times, to 
 determine results, it would appear to. be the point 
 around which the problem of milk feeding revolves. 
 
 increase 
 
 Strength 
 
 slowly 
 
 HYGEIA PASTEURIZER AND STERILIZER. 
 
 Hence the importance of the percentage method, both 
 on account of its advantages for comparisons and in 
 its ready adaptability to the necessity for slight 
 changes. 
 
 As toleration of the new diet is established a grad- 
 
 . 
 
 ual increase may be made in the low constituents 
 week by week until the ratio of ingredients approaches 
 the standard of breast milk. The standard formulae 
 given later should be used only as a suggestive guide 
 and not as an imperative rule, since the first test of 
 any food formula is its effect upon the baby.
 
 MODIFIED MILK 
 
 95 
 
 In considering increase in the amount of food, we 
 tnust be governed by age, size for age, stomach ca- 
 pacity for age and the infant's hunger, but largely by 
 the daily weight gain which should be manifest from 
 week to week. 
 
 The increase in the amount of 
 food, like that of the percentage 
 of its constituents should never 
 be made suddenly. An ounce 
 added to the total day's food in 
 early infancy means an increase 
 of from 6 to 3 per cent. This one 
 ounce increase should be distrib- 
 uted among the different tubes, 
 i. e., if there are ten tubes, about 
 one-tenth of an ounce should be 
 added to each. If tolerated for 
 several days another advance 
 may be made in quantity. Four 
 consecutive weeks should be the 
 outside limit for an increase of an ounce at a feed- 
 ing, as the tendency will be to far exceed the infant's 
 stomach capacity by flooding him with a too diluted 
 food. (See "Capacity of the Stomach," page 46.) 
 Both the amount at a feeding and the strength should 
 not be increased at the same time. 
 
 The acid reaction of cow's milk renders the addi- 
 tion of an alkali necessary. For this purpose bicar- 
 bonate of sodium (baking soda) or lime water may 
 
 increase 
 Amount 
 Gradually 
 
 Cell 
 
 THE HYGEIA NURS- 
 ING BOTTLE. 
 
 Neutralizing 1 
 Acidity
 
 CARE OF CHILDREN 
 
 be used (preferably the latter, of which 5 to 10 per 
 cent may be necessary). The lime water also has 
 
 the important property of 
 making the curds more floc- 
 culent and therefore more 
 easily digested. Of the so- 
 dium bicarbonate, one or two 
 grains to the ounce will be 
 sufficient. A solution of one 
 drachm of sodium bicarbon- 
 ate in a quart of water has 
 the same alkaline strength as 
 lime water. 
 
 If the food is to be steril- 
 ized, sodium bicarbonate 
 should be used or the lime 
 water should be added to the 
 tube afterwards. Heating 
 with lime water brings about certain undesirable 
 changes in the milk. 
 
 The following formulae fairly express the com- 
 position, amount and frequency of feeding, with the 
 length of intervals, for normal, healthy infants of 
 average weight and development: 
 
 FOOD WARMER AND 
 ALCOHOL LAMP.
 
 MODIFIED MILK 
 
 97 
 
 Formula 1. 
 
 Proteids; 22% Fats; 1.00% Sugar; 6.50% 
 Cream (16%) i ounce 
 
 First 3 days Milk sugar. | " 
 
 or Lime water | " 
 
 Premature. Boiled water 7 " 
 
 Salt small pinch 
 
 Total 8 ounces 
 
 Feedings, 10 to 12; Quantity of each, i to ^ ounce; Inter- 
 vals, 2 hrs. 
 
 Formula 2. 
 
 Proteids; 0.47% Fats; 1.00% Sugar; 675% 
 
 Cream (16%) 1 ounce 
 
 Skimmed milk 1 " 
 
 1st week. Milk sugar 
 
 Lame water 
 
 Boiled water 13 " 
 
 Salt a pinch 
 
 Total 16 ounces 
 
 Feedings, 10; Quantity of each, \ to 2 ounces; Intervals, 
 2 hrs. 
 
 Formula 3. 
 
 Proteids; 0.58% Fats; 1.50% Sugar; 6 50% 
 
 Cream (16%) \\ ounces 
 
 Skimmed milk If " 
 
 2nd week Milk sugar ^ " 
 
 Lime water 1} " 
 
 Boiled water 20 " 
 
 Salt 2 pinches 
 
 Total 24$ ounces 
 
 Feedings, 10; Quantity of each, 1 to 2 ounces; Intervals, 
 2 hrs.
 
 CARE OF CHILDREN 
 
 Formula 4. 
 
 3rd week. 
 
 Feedings, 10; 
 9. hrs. 
 
 Proteids; 0.70% Fats; 2.00% Sugar; 6.50% 
 
 Cream (16%) 
 
 Skimmed milk 
 
 Milk sugar 
 
 Lime water 
 
 Boiled water 
 
 Salt.. 
 
 Total 
 
 4 ounces 
 2 " 
 
 1* " 
 2 " 
 24 " 
 2 pinches 
 
 32 ounces 
 
 Quantity of each, 2 to 3 ounces; Intervals, 
 
 Formula 5. 
 
 4th &5th 
 weeks. 
 
 Feedings, 10; 
 2 hrs. 
 
 Proteids; 0.92% Fats; 3.00% Sugar; 6.00% 
 
 Cream (16%) 
 Skimmed milk 
 Milk sugar. . . . 
 Lime water . . . 
 Boiled water . . 
 Salt. . 
 
 6 ounces 
 2 " 
 
 1* " 
 2 " 
 22 " 
 2 pinches 
 
 32 ounces 
 
 Total 
 Quantity of each, 2 to 3 ounces; Intervals, 
 
 Formula 6. 
 
 6th, 7th, 8th 
 weeks. 
 
 Proteids; 1.15% Fats; 3.00% Sugar; 6.00% 
 
 Cream (16%) 
 Skimmed milk 
 Milk sugar. . . . 
 Lime water . . . 
 Boiled water . . 
 Salt . . 
 
 Total 
 
 6 ounces 
 3 " 
 
 1* " 
 2 " 
 21 " 
 2 pinches 
 
 32 ounces 
 
 Feedings, 9; Quantity of each, 3 to 3* ounces; Intervals, 
 2i hrs.
 
 MODIFIED MILK 
 Formula 7. 
 
 99 
 
 Proteids; 1.40% Fats; 350% Sugar; 6.25% 
 
 Cream (16%) 7 ounces 
 
 Skimmed milk 4 " 
 
 5rrf month Milk su " ar H " 
 
 3rd montn. Ume water 2 , 4 
 
 Boiled water 19 
 
 Salt 2 pinches 
 
 Total 32 ounces 
 
 Feedings, 8: Quantit} r of each, 3 to 4 ounces; Intervals, 
 3hrs. 
 
 Formula 8. 
 
 Proteids; 1.50% Fats; 3.50% Sugar; 6.75% 
 
 Cream (16%) 1\ ounces 
 
 Skimmed milk 5J " 
 
 4th & 5th Milk sugar 2 " 
 
 months Lime water 2J " 
 
 Boiled water 21 " 
 
 Salt 2 pinches 
 
 Total 36J ounces 
 Feedings, 7; Quantity of each, 4 to 5; Intervals, 3 hra. 
 
 Formula 9. 
 
 Proteids; 1.90% Fats; 4.00% Sugar; 7.00% 
 
 Cream (16%) 10 ounces 
 
 Skimmed milk 10 " 
 
 6th, 7th, 8th Milk sugar 2 " 
 
 months. Lime water 2 " 
 
 Boiled water 18 " 
 
 Salt 2 pinches 
 
 Total 40 ounces 
 
 Feedings, 6; Quantity of each, 6 to 7 ounces; Intervals, 
 3 hrs.
 
 ioo CARE OF CHILDREN 
 
 Formula 10. 
 
 Proteids; 2.40% Fats; 4.00% Sugar; 6.00% 
 
 Cream (16%) 10 ounces 
 
 Skimmed milk 15 " 
 
 9th & 10th Milk sugar 1$ " 
 
 months. Lime water 2\ " 
 
 Boiled water '.. 12$ " 
 
 Salt 1 pinch 
 
 Total 40 ounces * 
 
 Feedings, 5; Quantity of each, 7 to 8 ounces; Intervals, 
 3J hrs. 
 
 Formula 11. 
 
 Proteids; 2.90% Fats; 4.00% Sugar; 6.00% 
 
 Cream (16%) 12 ounces. 
 
 Skimmed milk 24 " 
 
 i* " 
 
 Boiled water 9 " 
 
 Salt 1 pinch 
 
 Total 48 ounces 
 
 Feedings, 5; Quantity of each, 7 to 9 ounces; Intervals, 
 3} hrs. 
 
 Formula 12. 
 
 Proteids; 3.40% Fats; 4.00% Sugar; 5.50% 
 
 Cream (16%) 12 ounces 
 
 Skimmed milk . . 30 " 
 
 12th month. Milk sugar f ' ' 
 
 L,ime water 3 ' ' 
 
 Boiled water 3 " 
 
 Total 48 ounces 
 
 Feedings, 5; Quantity of each, 8 to 10 ounces; Intervals, 
 4 hrs.
 
 MODIFIED MILK 
 Formula 13 
 
 101 
 
 Proteids; 4.00% Pats; 4.00% Sugar; 5.50% 
 
 Whole milk 48 ounces 
 
 13th month. Milk sugar J ounce 
 
 Bicarbonate of soda 30 grains 
 
 Total 48 ounces 
 
 Feedings, 5; Quantity, 8 to 10 ounces; Intervals, 4 hrs. 
 
 These formulae are intended only as a suggestive 
 guide in the feeding of normal infants according to 
 ages specified. Delicate babies, or those of impaired 
 digestion, should be given the formula for younger 
 infants. 
 
 These mixtures may be prepared from 16 per cent 
 cream, skimmed milk, milk sugar, salt, lime water 
 and boiled water. 
 
 Six ounces of 16 per cent cream may be obtained 
 from a quart bottle of good milk which has stood un- 
 disturbed for six hours by siphoning away the lower 
 four-fifths. This 16 per cent cream may also be 
 obtained from a reliable dairyman. 
 
 Milk sugar may be bought from the druggist by 
 the pound, or more cheaply at wholesale in five-pound 
 packages. 
 
 Accurate scales not being available in most house- 
 holds, the milk sugar must be measured. As different 
 brands vary a little in weight for bulk, it is always 
 advisable to have the druggist weigh accurately por- 
 tions of one, one and one-half, and two ounces, which 
 may be kept as standards. One of the most convenient 
 
 Formulae 
 for Normal 
 Infants Only 
 
 Sixteen 
 Per Cent 
 Cream 
 
 Measuring: 
 Milk Sugar
 
 102 CARE OF CHILDREN 
 
 and accurate ways of measuring the amount for a 
 formula is to put the required weighed portion into 
 the graduate, tap a few times, and mark the level by 
 scratching the glass with a file. This mark will show 
 the amount to be used each time the formula is made 
 up. 
 
 Tablespoons vary so greatly in size that it is not safe 
 to use them for measuring the sugar. Two and one- 
 half large size tablespoons leveled with a knife will 
 measure about an ounce; but if an ordinary kitchen 
 tablespoon is used, it may take three and one-half 
 leveled to give an ounce. As the milk sugar is the 
 largest constituent of the baby's food, it is necessary 
 that it be measured accurately. 
 
 Milk sugar is used because it is more easily digested 
 than cane sugar, and is not so liable to fermentation. 
 Although only about one-half as sweet to the taste, 
 it has about the same nutritive value as cane sugar. 
 In the later months of the first year cane sugar may 
 be substituted for milk sugar, if economy demands it, 
 a smaller amount being used. 
 
 Salt is added to promote digestion and to make up 
 the deficiency occasioned by dilution. 
 Milk Milk containing 4 per cent of fat should be used 
 
 Should be , . 
 
 m the formulae given. A good milk will have this 
 amount, but the legal standard in many localities is 
 3 per cent or less, so that it is best to have the milk 
 supply analyzed occasionally. The board of health 
 or the milk commission in many cities will make an-
 
 MODIFIED MILK 
 
 103 
 
 alyses free, and in the country the dairies will per- 
 form the same service for a small charge. If there is 
 4 per cent of fats present, it is safe to conclude that 
 the proteids are up to standard. 
 
 For making up a formula the following directions 
 may not be amiss : As soon as the baby's special 
 bottle of milk is delivered to the house, .it should 
 be taken in and placed in the coldest part of the re- 
 frigerator. If it is delivered very early in the morn- 
 ing (during hot weather), a small ice box should be 
 provided in which the milkman may place the bottle. 
 
 In the country, if the milk is received while warm, 
 it should be strained through absorbent cotton or 
 cheesecloth into a clean quart milk bottle or preserve 
 jar, stoppered, and placed in cold running water for 
 about half an hour, and then put on ice for six hours, 
 or until the cream has risen. 
 
 It will be found convenient to keep the vessels, lime 
 water, milk sugar, etc., together on a tray. The one 
 to do the mixing should wash her hands carefully and 
 put on a clean apron. The mixing should be done in 
 a clean place. A copy of the formula to be made 
 up should be at hand. 
 
 To siphon off the milk, a glass tube should be used, 
 as shown in the illustration.* To start the siphon, fill 
 it full of boiling wa*er by pouring water in, place the 
 thumb over the end of the long arm and invert the 
 siphon, lowering the short arm gently to the bottom of 
 the bottle of milk. Remove the thumb and the milk will 
 
 Directions 
 for Mixing 
 
 Siphoning 
 Off the 
 Skimmed 
 Milk 
 
 * A milk syphon may be obtained through the school for 25 cents.
 
 i(M CARE OF CHILDREN 
 
 follow the water out of the tube. It is best caught 
 in another bottle or a 32-ounce graduate. A mark on 
 the receiving bottle showing when 26 ounces have been 
 drawn will leave the 6 ounces of 16 per cent cream 
 in the first bottle, provided the bottles are full quarts 
 of 32 ounces. If the milk is very rich in cream, less 
 than 26 ounces of skimmed milk should be removed. 
 Making Suppose Formula 4 is to be made up the 6 oz. of 
 Formula 16 per cent cream is first mixed to a uniform consist- 
 ency by rotating the bottle gently ; exactly 4 oz. is 
 measured in the graduate and poured into the mixing 
 pitcher. Two ounces of the skimmed milk is then 
 very carefully measured in the graduate and poured 
 into the pitcher. Two ounces of- lime water is now 
 measured and added to the pitcher; the i l / 2 oz. of 
 milk sugar is measured in the 8 oz. graduate as de- 
 scribed, and the two pinches of salt added. Boiled water 
 is added up to the 8 oz. mark. The mixture is stirred 
 with a clean spoon kept for the purpose until the 
 sugar is dissolved and added to the pitcher. Sixteen 
 ounces of water (making 24 oz. in all) is measured 
 and added to the pitcher and the whole is stirred with 
 the spoon until thoroughly mixed. 
 
 If wide-mouthed tubes are used, they may be filled 
 by pouring directly from the pitcher up to the 2 oz., 
 2 l / 2 oz. or 3 oz. marks on the tubes, according to the 
 amount to be given at a feeding. If small-mouthed 
 tubes are used, a glass funnel will be necessary. The 
 tubes are stoppered at once with sterilized, non-absor-
 
 MODIFIED MILK 
 
 105 
 
 bent cotton, which is kept in some receptacle away 
 from the dust. After stoppering the tubes are placed 
 in a rack and put in the coldest part of the refrigera- 
 tor. The whole operation should be accomplished as 
 
 SIPHONING SKIMMED MILK FROM THE CREAM. 
 
 If there is a difference in level of about 4}4 inches between the two milk 
 
 bottles, the siphon will stop running with approximately 6 
 
 oz. of cream left in the upper bottle, and 26 oz. of 
 
 skimmed milk in the receiving bottle. 
 
 quickly as possible, so that the milk will not have 
 time to become warm. It should be borne in mind 
 that there is always dust laden with bacteria in the air 
 of the cleanest room. The bacteria we are endeavor- 
 ing to exclude. 
 
 All the utensils used should now be rinsed first in 
 cold water, then washed in hot soap and water, put 
 
 Keep the 
 
 Milk 
 
 Cool 
 
 Washing 
 Vessels
 
 io6 
 
 CARE OF CHILDREN 
 
 Change 
 
 From One 
 
 Formula 
 
 V> the Next 
 
 into a pan of boiling water for 10 or 15 minut:s, and 
 then inverted. They should not be wiped with a 
 towel, and if washed perfectly clean with plenty of 
 soap will drain clear. The tray should be washed, 
 and after the utensils are drained, they should be 
 placed on the tray and covered with a cloth to keep 
 out dust. The milk sugar should be kept stoppered. 
 
 It is apparent that an ignorant, untrained servant 
 cannot be trusted to carry out all these precautions, 
 and that the mixing should be done by the mother or 
 trained nurse. 
 
 The importance of increasing the strength as well 
 as the quantity of the food gradually should again be 
 emphasized. In changing from one formula to the 
 next stronger, the simplest method of making the 
 transition a gradual one is to add water to the new 
 formula in such proportion as to reduce the percent- 
 age of proteid to nearly that of the preceding formula. 
 The following may serve as a suggestive guide: 
 
 In changing from Formula 2 to Formula 3, add to the full 
 quantity of formula 3, the first day 5 oz. of water, second day 
 4 oz., third day 2 oz., fourth day I oz. 
 
 Changing from Formula 3 to Formula 4, add 6 oz. of water 
 the first day, 4 oz. the second day, 2 oz. the third day. 
 
 Changing from Formula 4 to Formula 5, add 5 oz. of water 
 the first day, 4 oz. the second, 3 oz. the third, 2 oz. the fourth, 
 and I oz. the fifth. 
 
 Changing from Formula 5 to Formula 6, add 8 oz. the first 
 day, and I oz. less during succeeding days.
 
 MODIFIED MILK 107 
 
 Changing from Formula 6 to Formula /, add 7 oz. of water 
 the first day, and I oz. less every two days. 
 
 Changing from Formula 7 to Formula 8, add 2 l / 2 oz. of 
 water the first day, 2 oz. the second day, I oz. the third and 
 fourth days. 
 
 Changing from Formula 8 to Formula 9, add 10 oz. of 
 water the first day, and I oz. less during succeeding days. 
 
 Changing from Formula 9 to Formula 10, add 10 oz. of 
 water the first day and i oz. less during succeeding days. 
 
 Changing from Formula 10 to Formula n, add 9 oz. of 
 water the first day and i oz. less during succeeding days. 
 
 Changing from Formula n to Formula 12, add 5 oz. of 
 water the first day and i oz. less during succeeding days 
 
 Changing from Formula 12 to Formula 13, add 8 oz. of 
 water the first day and i oz. less during each succeeding day. 
 
 In case the new formula does not seem to agree, the 
 number of ounces of water added should be reduced Notes 
 more slowly. Carefully written notes should be kept 
 of all changes. 
 
 Cream containing 16 per cent of fat also contains 
 a certain percentage of proteids and milk sugar. 
 Roach gives the following composition : 
 
 Composition of 16 Per Cent Cream 
 
 Per Cent 
 
 Water 76.7 
 
 Proteids 3.2 
 
 Fats 16.0 
 
 Milk Sugar 4.05 
 
 Composition of Skimmed Milk 
 
 Per Cent 
 
 Water 92 7 
 
 Proteids 3.6 
 
 Fats trace 
 
 Milk Sugar 4.6
 
 io8 
 
 CARE OF CHILDREN 
 
 Use of 
 Whey 
 
 Egg 
 
 Albumen 
 
 Where proteids are not tolerated whey (see recipe) 
 may be substituted for the skimmed milk and for the 
 whole or part of the boiled water. 
 
 The whey contains the lac albumen (but no casein), 
 the sugar and the salts of the milk. The Walker- 
 Gordon Co. gives the following analysis for the whey 
 which they furnish. It is made from skimmed milk 
 and contains practically no fat. 
 
 Composition of Whey 
 
 Per Cent. 
 
 Water 93.6 
 
 Proteids I .o 
 
 Milk Sugar 47 
 
 Mineral Matter 0.7 
 
 If the intolerance for milk proteids persists, the pro- 
 teid of egg white (see recipe) may be substituted. 
 The white of one egg has the proteid value of eight 
 ounces of skimmed milk. 
 
 Composition of White of Egg 
 
 Per Cent. 
 
 Water 85.7 
 
 Proteids 12.6 
 
 Fats 0.25 
 
 Mineral Matter 0.59
 
 FOODS OTHER THAN MILK 109 
 
 FOODS OTHER THAN MILK 
 
 Other foods than milk may be utilized, to a limited 
 extent, in the dietary of the infant. Of these there 
 are three general classes. 
 
 First : Farinaceous substances ; such as barley, oat- starch 
 meal, arrowroot, farina, rice, wheat and bread, pref- 
 erably in the form of water gruels, and jellies. 
 
 Second: Albuminoids or proteids, of which class 
 beef juice and egg white are the best representatives. 
 
 Third: Fruit juices, as orange, prune and unfer- Fruit 
 
 . , Juices 
 
 mented grape. 
 
 The first class have, before the sixth month of in- 
 fancy, but a limited food value, because of the indi- 
 gestibility of their starchy contents. A partial con- 
 version into sugar may be secured, however, by thor- 
 ough and prolonged cooking, as in the preparation of 
 gruels and jellies. A still further conversion may 
 be secured by the addition of diatase, as malt and 
 malt extracts, a few minutes before feeding. This 
 changes a certain amount of the starch into dextrin. 
 
 Cereal gruels, in some cases, promote digestion of oiueis 
 cow's milk by mechanically preventing the formation 
 of dense curds in the stomach. They may be used to 
 replace all or a part of the water of a formula. 
 
 When the proteid of cow's milk is not well borne 
 that most essential constituent may be supplied from 
 raw beef juice or egg white. (See recipes.) 
 
 Orange juice, prune juice and unfermented grape 
 juice are very valuable food adjuncts in cases of nutri-
 
 1 10 
 
 .CARE OF CHILDREN 
 
 Patent 
 Baby 
 Foods 
 
 tional depravity. These are especially needed where 
 the infant has been subject to the prolonged use of 
 cooked and pasteurized foods. 
 
 Many of the so-called baby foods contain little more 
 than starch, and on that account can not be too 
 severely condemned for young children ; but the prac- 
 tice, somewhat in vogue, of denouncing all patent 
 foods on that account is thoughtless and unjust. There 
 
 Percentage Composition of Infant Foods 
 
 Food 
 
 Moisture 
 
 Proteids 
 
 Fat 
 
 Carbo- 
 hydrates 
 
 Mineral 
 Matter 
 
 Remark! 
 
 Horlick's 
 
 
 
 
 
 
 A mixture of desic- 
 cated milk (50$) and 
 
 Malted 
 
 3.9 
 
 138 
 
 3.0 
 
 76.8 
 
 2.7 
 
 malted wheat and bar- 
 
 Milk 
 
 
 
 
 
 
 ley. ' No unaltered 
 
 
 
 
 
 
 
 starch. 
 
 
 
 
 
 
 
 A completely malt- 
 
 Mellin's 
 Food* 
 
 5.7 
 
 10.7 
 
 0.1 
 
 79.1 
 
 4.4 
 
 ed food. Allthecarbo- 
 hydrates in soluble 
 
 
 
 
 
 
 
 form. 
 
 
 
 
 
 
 
 A mixture of desic- 
 
 Nestle's 
 
 3.6 
 
 14.0 
 
 5.2 
 
 75.1 
 
 1.9 
 
 cated milk, partially 
 malted wheat flour 
 
 
 
 
 
 
 
 and cane sugar (%!%). 
 Starch 15*. 
 
 
 
 
 
 
 
 A mixture of par- 
 
 Eskay's 
 Food* 
 
 1.7 
 
 6.7 
 
 3.5 
 
 87.1 
 
 1.0 
 
 tially malted wheat, 
 egg albumin and milk 
 sugar (54). Starch 
 
 
 
 
 
 
 
 29& especially treated. 
 
 
 
 
 
 
 
 Unsweetened whole 
 
 
 
 
 
 
 
 cow's milk. 1 part di- 
 
 Condensed 
 Milk 
 
 62.0 
 
 9.1 
 
 10.7 
 
 15.5 . 
 
 4.3 
 
 luted with 2 parts wa- 
 ter gives ordinary 
 milk. Sweetened con- 
 
 
 
 
 
 
 
 densed milk contains 
 
 
 
 
 
 
 
 about 37^ cane sugar. 
 
 Dried 
 
 
 
 
 
 
 
 Human 
 
 
 
 12.2 
 
 26.4 
 
 52.4 
 
 2.1 
 
 Analysis by 
 Hutchison 
 
 Milk 
 
 
 
 
 
 
 
 Latest analyses, given by the manufacturer!.
 
 MEDICAL SUPERVISION 
 
 in 
 
 is much to recommend in some of these preparations, 
 since intelligent modification by supplying a deficiency, 
 may convert it into a most valuable adjunct in sub- 
 stitute feeding. Food which would not meet the re- 
 quirements of nutrition for a long-continued period, 
 because deficient in some essential constituent, may 
 be used temporarily, as in weaning, traveling or tem- 
 porary removal from the breast. 
 
 Among the objections to many of the patent foods 
 may be mentioned : small amount of fats ; insolu- 
 bility of their proteids when present ; excess of sugar, 
 especially cane sugar; the high percentage of uncon- 
 verted starch and the fact that all have been cooked. 
 
 The writer believes that the artificially fed infant 
 should always be under the supervision of a competent 
 physician. Some one has said that it is twice as dan- 
 gerous to be a baby as it is to have smallpox. The 
 mortality in untreated typhoid is less than half that 
 of artificially fed babies, yet no one questions the 
 necessity for a physician in typhoid. Few regard the 
 physician as out of place at the birth of the infant, 
 yet the mortality during birth is slight compared with 
 that of bottle feeding. The most active function of a 
 physician's life is remedying errors, in attempting to 
 patch up the evil results of mistakes. His highest 
 function is to ward off the error and to prevent the 
 mistakes. 
 
 The infant at the breast is in normal relation with 
 his most imperative need and is seldom under the 
 physician's care. He who substitutes artificial for 
 
 Medical 
 Supervision 
 in Artificial 
 Feeding 
 
 Bottle Fed 
 Babies not 
 in Normal 
 Condition
 
 112 
 
 CARE OF CHILDREN 
 
 No Perfect 
 
 Substitute 
 
 Food 
 
 Province 
 of the 
 Mother 
 
 natural feeding unnecessarily may be likened to the 
 captain who, in a safe roadstead, slips his cable in 
 the face of a gale and trusts his vessel to unknown 
 waters without pilot, chart or compass. 
 
 No method yet devised can take the place of breast 
 feeding. No substance nor combination has been dis- 
 covered that meets all the requirements of the infant 
 as does breast milk. 
 
 The vast amount of study and research of the best 
 minds have evolved as yet towards the solution of this 
 question only a few scientific principles. The appli- 
 cation of these to individual cases calls for the best 
 work of the trained physician. 
 
 As before said, the most available artificial food for 
 babies, cow's milk, can not be made to resemble that 
 of the mother, and in many instances man's highest 
 skill can not adapt it to the requirements of the infant, 
 though he modify it ever so wisely. How difficult, 
 then, the task of writing formulae for the modifica- 
 tion of an indefinite substance (milk) for the feeding 
 of unknown infants, whose unknown requirements 
 are the result of unknown conditions. 
 
 The supervision of the physician does not lessen the 
 care required of the mother or nurse, nor make it less 
 necessary that she should understand the situation. 
 However wise the advice may be, trouble is almost 
 sure to follow unless the rules and precautions given 
 are followed to the letter.
 
 FOOD DISORDERS 113 
 
 FOOD DISORDERS 
 
 Overfeeding is responsible for many of the diges- Overfeeding 
 tive disturbances of infancy. Among the causes of 
 overfeeding may be mentioned irregularity as to time ; 
 thirst ; perverted taste ; improperly balanced or too 
 concentrated a food; too rapid feeding, and general 
 ignorance or carelessness on the part of the nurse. 
 The usual result of occasional overfeeding is acute 
 indigestion, with or without vomiting, belching, colic, 
 diarrhoea, curds in stool, restlessness, broken sleep, 
 fever or loss of weight. 
 
 Habitual overfeeding may cause dilatation of the 
 stomach with loss of digestive power and all the symp- 
 toms of chronic dyspepsia, such as flatulence, colic, 
 constipation or diarrhoea, loss of weight or general 
 mal-nutrition. 
 
 Occasional colic or loose stools or even vomiting colic 
 may call for nothing more than a temporary diminu- 
 tion of food and a dose of castor oil. In mild cases, 
 the food may be diluted with about a fourth the vol- 
 ume of water, either in the nursing bottle before feed- 
 ing or when the day's supply is made up. The quan- 
 tity given may also be reduced somewhat. In return- 
 ing to the original formulae the change should always 
 be made gradually. 
 
 Persistent colic may be an indication of excessive 
 proteids, the percentage of which should be reduced 
 to the relief of both colic and diarrhoea, with the dis- 
 appearance of curds from the stools. 
 
 Vomiting, or "spitting up," with or without diar-
 
 114 
 
 CARE OF CHILDREN 
 
 Hot 
 
 Weather 
 Diet 
 
 rhoea, may be caused by an excess of fat and yield 
 promptly to a reduction of this constituent. If food 
 is not digested fermentation occurs in the bowels, with 
 the formation of poisons, which cause restlessness and 
 fever. This "auto-intoxication" is of frequent occur- 
 rence in infancy, but is usually relieved by the cor- 
 rection of the dietetic errors. 
 
 A common mistake is the neglect to modify the 
 food with due regard to the season. Hot weather re- 
 quires diminution in the fats and proteids (from one- 
 eighth to one-half), so that what constituted a well- 
 balanced food for the winter months is not suitable 
 for the heated term. In hot weather infants need 
 more water and frequently cry from thirst rather than 
 hunger. 
 
 The long-continued use of food deficient i n fat 
 is often productive of rickets. Scurvy may be de- 
 veloped by the habitual use of cooked food, while 
 mal-nutrition is the result of chronic indigestion. 
 
 The prevention and correction of these disorders 
 lies in proper feeding (See "Essentials.") Their 
 symptoms will be discussed in the section on Chil- 
 dren's Ailments. 
 
 The practice of experimenting on the baby with all 
 kinds of food patent and otherwise is a most per- 
 nicious one. Nature takes some time to rectify diges- 
 tive disturbances, and a slight improvement at each 
 feeding is all that can be expected. If the simple 
 changes suggested do not give relief after a day or 
 two, the physician should be consulted.
 
 FOOD AFTER THE FIRST YEAR 
 
 Bottle feeding is rarely necessary after the twelfth 
 month. The child may be gradually taught to drink 
 from a spoon or cup. Where the baby is delicate the 
 bottle may be used until the fifteenth month. 
 
 The eruption of teeth, the increase in the salivary, 
 gastric and pancreatic secretions give not only greater 
 power of starch and proteid digestion, but also the 
 ability to masticate some solid food. 
 
 Semi-solids must be introduced gradually into the 
 dietary, milk remaining the principal food. Cream 
 is required particularly where there is a tendency to 
 constipation. Until the eighteenth month little 
 change should be made except the addition of gruels, 
 meat broths and cracker or stale bread soaked in milk. 
 Five feedings in the 24 hours during the second year 
 are sufficient for a healthy child. 
 
 The following dietary is intended only as a sugges- 
 tive guide. Variety at this age is not necessary, but a 
 choice is designated by the letters a, b, c. 
 
 Dietary from 12 to 18 Months 
 FIRST MEAL. 6 TO 7 A. M. 
 
 a Glass of warm milk containing a little stale bread or 
 rolled cracker. 
 
 b A porridge of well cooked (at least two hours) cereal 
 with milk. 
 
 c A little soft egg (poached or boiled) with stale bread 
 crumbs and a glass of milk. 
 
 115 
 
 Taking 
 Away the 
 Bottle 
 
 Semi- 
 Solids
 
 ii6 CARE OF CHILDREN 
 
 I 
 
 SECOND MEAL. 10 A. M. 
 Glass of warm milk. 
 THIRD MEAL, i TO 2 P. M. 
 
 a Stale bread .soaked in gravy from the roast or steak. 
 
 Milk. 
 
 b Soft egg, a little zwieback, glass of milk. 
 c Toast soaked with beef juice (see recipe), glass of 
 
 milk. 
 
 FotTRTH MEAL. 5 TO 6 P. M. 
 
 Glass of milk or milk with cereal jelly. (See recipe). 
 FIFTH MEAL. (If necessary late in the evening or night.) 
 
 Glass of warm milk. 
 
 Dietary from the 18tb to 24th Month. 
 
 FIRST MEAL. 7 A. M. 
 
 a Warm milk with stale bread or buttered cracker. 
 b Cereal porridge with milk and cream. 
 c Glass of milk, soft boiled egg with bread and butter. 
 SECOND MEAL. 10 A. M. 
 a Bread and milk. 
 
 b Milk from oyster stew and cracker. 
 c Milk toast. 
 THIRD MEAL. 2 P. M. 
 
 a Mashed potatoes with dish gravy and a glass of milk 
 b Mutton, beet or chicken broth thickened with rice or 
 
 barley, bread or cracker and milk. 
 
 c Beef juice on toast, rice or tapioca pudding. With 
 this meal may be given a little well baked apple 
 pulp or stewed prune pulp and juice. 
 FOURTH MEAL. 5 TO 6 P. M. 
 
 Bread and milk, or bread with butter and milk. 
 Milk may be given during the night if the baby seems 
 hungry.
 
 FOOD AFTER THE FIRST YEAR 117 
 
 Dietary for Third Year 
 
 FIRST MEAL. 7 TO 8 A. M. 
 
 a Cereal with plenty of milk and cream. 
 
 b Soft boiled or poached egg with toast and milk. 
 
 c Meat jelly with bread or cracker and milk. 
 
 SECOND MEAL, u A. M. 
 
 Bread and milk, meat, or clam broth with cracker. 
 
 THIRD MEAL. 2 P. M. 
 
 a Broiled scraped beef with buttered baked potato. 
 
 Milk. 
 b White meat of fish or" fowl, mashed potato with bread 
 
 and butter. 
 c A little finely cut steak or roast, creamed potato or 
 
 boiled rice and milk. 
 Light pudding, junket, stewed fruit or a little ice cream 
 
 may be added to the above. 
 
 FOURTH MEAL. 6 TO 7 P. M. 
 
 a Bread and butter, glass of milk. 
 
 b Cornmeal mush and milk. 
 
 c Baked apple, graham crackers and milk. 
 
 During this year the child should occasionally have Frui t 
 a little orange juice, scraped raw apple, grape pulp 
 free from seeds, ripe banana grated fine, ripe peach 
 or pear. 
 
 After the third year the child is presumably sitting At the 
 at the family table and will, if not well managed, in- Table 7 
 sist upon having things not good for him. Many sys- 
 tems are hopelessly impaired for want of parental tact 
 and firmness at this time. If the child is once taught 
 that he may not choose for himself, he will gladly
 
 CARE OF CHILDREN 
 
 Foods 
 
 Not 
 
 Advisable 
 
 .Stimulants 
 
 accept the food suitable to his age and condition. In 
 planning the meals for a family containing several 
 young children consideration should certainly be given 
 to their requirements. 
 
 The following articles are best avoided during early 
 childhood : 
 
 Condiments or highly sea- Cake. 
 
 soned food. Hot breads. 
 
 Pork. Cucumbers. 
 
 Fried meats. Corn. 
 
 All fried foods. Doughnuts. 
 
 Griddle cakes. Doughey puddings. 
 
 Cabbage. Rich puddings. 
 
 Tomatoes. Over or under ripe fruits. 
 
 Pastry. Raw celery. 
 
 Dumplings. Turnips. 
 
 It goes without saying that children should never 
 be allowed tea, coffee, beer or other stimulants. 
 
 Nuts and confections should never be allowed on an 
 empty stomach. 
 
 General Rules 
 
 i Regularity as to meals is of prime importance. 
 2 Thorough mastication is absolutely essential to 
 
 perfect digestion. 
 
 3 Rapid eating invariably induces dyspepsia. 
 4 Fluids are essential to good digestion, but the 
 
 food should never be "washed down." 
 5 A judicious balance must always be maintained 
 
 between the five food constituents, viz. : pro- 
 
 teids, fats, sugar, salts and water.
 
 FOOD EECIPES 
 Beef Juice 
 
 Salt and slightly broil small pieces of thick, lean, 
 round steak and while hot express the juice with a 
 meat press or a lemon squeezer. The juice may be 
 given cold or with the addition of a little warm water. 
 Hot water coagulates the albumin. Made in this way 
 the juice contains from 5 to 6 per cent of coagulatable 
 proteids and from 2 to 3 per cent of "extractives" 
 nitrogenous substances without nutritive value, but 
 stimulating to the digestive organs. 
 
 Beef Tea 
 
 To i pound of lean chopped or minced beef add I 
 pint of cold water. Stir and let stand for 2 hours; 
 then let simmer for 20 minutes. Do not boil. Strain 
 and when cool remove all fat. When ready to use 
 warm and season. Best prepared in double boiler. 
 
 Mutton Broth 
 
 Over i pound of lean meat, cut in small pieces, 
 pour i quart of cold water, let stand in cold place for 
 3 hours, then cook slowly down to i pint. Cool, skim 
 off fat, and strain. 
 
 Veal, chicken or beef broths may be made in the 
 same way. 
 
 Meat Pulp 
 
 By scraping with a dull knife separate the meat 
 pulp from the fiber. Season pulp, make in small cake 
 and slightly broil, or may be salted and eaten raw. 
 
 119
 
 120 CARE OF CHILDREN 
 
 Whey 
 
 Heat i quart of fresh milk luke warm; into this 
 gently stir 2 teaspoonfuls of Fairchild's essence of 
 pepsin ; let stand about twenty minutes or until firmly 
 coagulated, then with a fork break up the clot and 
 strain through fine muslin without pressure. Bring 
 the whey thus obtained to a boil to kill the ferment, 
 then cool and keep on ice. 
 
 Albumin Water 
 
 Put the white of one egg in a saucer and cut (do 
 not beat) until fine with knife and fork. Add i cup 
 cold boiled water and strain through cheesecloth. 
 Keep on ice until ready to use. If desired a tiny 
 pinch of salt may be added. 
 
 Lime Water 
 
 Drop a piece of unslaked lime as large as a walnut 
 into a vessel containing 2 quarts of pure filtered 
 water, stir thoroughly and allow to settle. Pour off 
 the clear solution into bottles, which should be kept 
 corked. 
 
 Oat Jelly 
 
 Soak half a cup of coarse oatmeal in a quart of cold 
 water for 10 hours. Boil down so as to make a pint 
 and while hot strain through fine cheesecloth. A 
 jelly is formed when cold. It should be kept on ice 
 until needed. 
 
 Wheat and rice jelly can be prepared in the same 
 way.
 
 FOOD RECIPES 121 
 
 Barley Water 
 
 Put i tablespoonful of washed pearl barley in a 
 saucepan with a quart of water; boil slowly down to 
 i pint ; strain. 
 
 Barley Jelly 
 
 Boil slowly down to a pint, i quart of water and 3 
 tablespoonfuls of pearl barley; strain and let stand 
 until jellied. 
 
 Peptonized Milk 
 
 In 4 ounces of boiled cold water, dissolve a tablet 
 containing 15 grains of bicarbonate of soda and 5 
 grains of pancreatine, to which add 12 ounces of milk. 
 Set vessel containing this mixture in a pan of water 
 at a temperature of H5F for from 8 to 10 minutes. 
 Cool quickly by placing in running water and keep on 
 ice until used. Use double boiler for making. To 
 completely peptonize the milk heat for two hours. 
 It then has a bitter taste. 
 
 Dropped Egg 
 
 Drop a fresh egg into enough boiling milk to cover ; 
 remove from milk as soon as the white is set; salt 
 and serve hot with cracker or bread crumbs. 
 
 Dried Bread 
 
 Cut bread at least 24 hours old in thick slices; put 
 in slow oven and bake until thoroughly dried. (20 to 
 30 min.)
 
 122 CARE OF CHILDREN 
 
 Kumyss (Holt) 
 
 i quart of fresh milk, half an ounce of sugar, 2 
 ounces of water, a piece of yeast cake at least half 
 an inch square ; put into wired bottles, keep at a tem- 
 perature between 60 and 70 F. for I week, shaking 
 5 or 6 times a day ; put on ice.
 
 CARE OF CHILDREN 
 
 PART II 
 
 Read Carefully. Place your name and address on the 
 first sheet of the test. Use a light grade of paper and write 
 on one side of the sheet only. I/eave space between the 
 answers for the notes of the instructor. Use your own 
 words and answer fully. Read the lesson paper a number 
 of times before attempting- to answer the questions. 
 
 1. What is the best food for the baby and why? 
 
 2. What is the effect upon the child of too much 
 
 fat in the milk? Too little? 
 
 3. What are the indications for early weaning? 
 
 4. Why should the baby not nurse the breast of a 
 
 sleeping mother ? 
 
 5. Give and explain four rules for nursing. 
 
 6. Give in detail the difference between mother's 
 
 and cow's milk. 
 
 7. What may be done to increase the percentage 
 
 of fat in breast milk? The percentage of 
 proteid ? 
 
 8. Give some of the causes of impairment of 
 
 mother's milk. 
 
 9. How should the baby be weaned? 
 
 10. When the proteids of cow's milk are not toler- 
 
 ated, what may be substituted for them? 
 
 11. Why give a baby water? When? How? 
 
 How much?
 
 CARE OF CHILDREN 
 
 12. State general objections to the patent baby- 
 
 foods. 
 
 13. What is safe milk? How should the baby's 
 
 milk be cared for in the home? 
 
 14. What governs the quantity given at a feed- 
 
 ing? The strength of the food? 
 
 15. Give the causes and effects of over feeding. 
 
 1 6. What are the principal dangers in feeding a 
 
 baby cow's milk? 
 
 17. What is meant by a balanced food? 
 
 1 8. Why are special precautions necessary to keep 
 
 the baby's food as nearly sterile as possible? 
 
 19. What can you say in regard to feeding during 
 
 the second- year ? 
 
 20. How would you alter the food of a young baby 
 
 in very hot weather? 
 
 21. What may the mother or nurse safely do if 
 
 the baby has indigestion? 
 
 22. Mention new facts you have learned from this 
 
 lesson. 
 
 23. What questions have you to ask? 
 
 Note. After completing the test, sign your full name.
 
 CARE OF CHILDREN 
 
 PART III
 
 
 JAN. FEB. MAR. APL. MAY JUN. JUL. AU6. SEP. OCT. NOV DM 
 
 CHIlDRfN UNDER I Yr. 
 1-2 Yr. 
 2-5 Yr. 
 5-15 Yr. 
 OVER 15 Yrs. 
 
 CHART SHOWING MORTALITY IN LARGE CITIES BY MONTHS 
 
 AND AGES 
 From Circular of Illinois State Board of Health on Infant Feeding
 
 CARE OF CHILDREN 
 
 PART 1)1 
 
 The Sick Child 
 
 SYMPTOMS OF DISEASE 
 
 The sick child should, of course, always be under 
 the physician's care, but the mother can aid greatly 
 by giving him an intelligent account of symptoms. The 
 mother knows (or should know) her child much more 
 thoroughly than can any outsider and it is on her 
 carrying out of directions faithfully and intelligently 
 that the recovery of the sick child must depend. 
 
 In order to recognize the symptoms of disease it is symptoms 
 
 ... in Health 
 
 necessary to become thoroughly familiar with the nor- 
 mal, healthy infant. This is accomplished only by 
 careful, conscious observation. Attitude, both sleep- 
 ing and waking; facial expression, movements of ex- 
 tremities, trunk, head and eyes; sounds, both articu- 
 late and inarticulate ; respiration, frequency and regu- 
 larity; color of the skin and condition as to tempera- 
 ture and moisture, are all significant of sickness or 
 health. 
 
 Restlessness or apathy, if but slight, may be esti- 
 mated only by comparison with the baby's normal con- 
 dition. 
 
 A few of the most easily recognized indications of 
 acute disorder may be mentioned, such as sudden loss 
 of appetite, excessive thirst, unusual drowsiness, lan- 
 guor or fretfulness, all of which may indicate intoxi- 
 cation. 
 
 123
 
 124 CARE OF CHILDREN 
 
 The screaming infant may give some hint as to 
 the location of his pain by chewing his fingers when 
 the mouth or throat is inflamed ; by carrying his hand 
 to his head or pulling at his hair when the ear or 
 mastoid region is the seat of trouble ; by writhing mo- 
 tions of the body with drawing up of the knees which 
 indicates abdominal pain, whether of the stomach or 
 bowels or bladder. 
 
 Breathing The rapid breathing may indicate pulmonary dis- 
 order; the terminal expiratory moan, pneumonia; or 
 the restricted, expiratory grunt may mean an abdomi- 
 nal pain or pleurisy, the short suppressed cough end- 
 ing in a cry may indicate pneumonia, or pleurisy. 
 
 Headache is often indicated by puckering of the 
 eyebrows and intolerance of strong light, while throw- 
 ing the head back with rigidty of the neck or continu- 
 ous head rocking are common symptoms of meningitis 
 or brain fever. Twitching of the face or of the ex- 
 tremities may be the precursor of convulsions. 
 Fever The flushed face of fever is too obvious to be over- 
 looked and the whiteness about the lips and nose is 
 always indicative of nausea or irritation of the intesti- 
 nal tract, whether from indigestion or worms, and 
 usually precedes vomiting. 
 
 Crying when handled usually indicates some local 
 tenderness in trunk or limbs and may be due to in- 
 juries, such as dislocations, fractures or contusions; 
 or to the tenderness of rickets, scurvy, syphilis, rheu- 
 matism or inflammation of some joint. Copious sweat-
 
 THE CRY 
 
 125 
 
 ing during sleep, especially about the head, is always 
 suggestive of rachitic malnutrition. Disinclination or 
 inability to move a limb should never be overlooked 
 as it may mean a grave disorder, either in the affected 
 limb or in the central nervous system. Refusal to 
 nurse may be due to trouble in the mouth, throat or 
 nose which parts should be frequently examined. 
 
 THE CEY 
 
 There is no such thing as a meaningless cry. It is 
 only a question of interpretation. The cry is the in- 
 fant's only means of making his wants known. 
 
 Most welcome is the baby's first cry induced by the 
 discomfort of his new surroundings and its vigor and 
 volume may indicate vital capacity. A little lusty cry- 
 ing in the first days is good for the baby as thereby 
 deep inspiration is induced which more fully inflates 
 the lungs and establishes more completely the new 
 function of respiration. Some babies never entirely 
 overcome the adhesions of the bronchial tubes and air 
 cells, a part of the lung remaining unused. 
 
 The cry should be clear and distinct and any devi- 
 ation from its normal tone is an indication of disorder. 
 Whatever the cause of crying it is usually tearless be- 
 fore the third month. 
 
 Hunger is usually expressed by crying, but it is a 
 great mistake to conclude that because the child was 
 quieted by the nipple he was therefore hungry. He 
 may have been thirsty, or the warm milk may have 
 
 No 
 
 Meaningless 
 
 Crying 
 
 Hungry 
 Cry
 
 CARE OF CHILDREN 
 
 Persistent 
 Crying 
 
 Whining 
 
 temporarily relieved the pain due to indigestion. In 
 either case the food will harm him. Water was what 
 he needed. 
 
 Most often a baby cries because he is uncomforable 
 the diaper may need to be changed ; the clothes may 
 need straightening out, he may need a change of posi- 
 tion, or he may be cold. There is such a thing, too, 
 as the crying habit, which over-anxious mothers help 
 to establish by holding the baby, rocking, singing, 
 walking, coddling or nursing at the first intimation of 
 restlessness, however transient if left alone. 
 
 A persistent cry, if not due to hunger or thirst, is 
 indicative of pain, as from pin prick, itching from 
 bites, eruption, eczema. Earache causes intense pain. 
 Paroxysmal crying may mean colic or bowel cramps, 
 and ceases when the gas moves. Usually with this 
 pain the feet are drawn up and the belly is distended. 
 Pleurisy or tenderness of rickets causes baby to cry 
 when lifted by the arms or chest. Tenderness about 
 legs would suggest rheumatism or scurvy. 
 
 Peevish whining indicates poor health and general 
 discomfort. Brain inflammation is often indicated by 
 a shrill piercing shriek uttered at long intervals. 
 Short suppressed cry occurs in lung inflammation, es- 
 pecially following coughing. Sudden screaming at 
 night suggests night terrors or bad dreams. Hoarse 
 croupy voice points to the larynx, and a nasal tone 
 to stoppage of nose and upper throat. Mouth dis- 
 orders cause fretfulness and crying when anything is
 
 COLIC 
 
 127 
 
 put into the mouth, while cry after swallowing sug- 
 gests sore throat. 
 
 The baby may cry when passing urine due to tight 
 foreskin or the passage of brown uric acid sand, which 
 may be found staining the diaper. If the child frowns 
 while crying or fretting and avoids the strong light, 
 headache is probably the cause. 
 
 COLIC 
 
 Colic is usually due to the pressure of gas in the 
 bowels, one of the results of indigestion. Sudden and 
 violent crying, distended abdomen, alternate drawing 
 up and straightening of the legs, which ceases with 
 the expulsion of gas by mouth or anus, usually indi- 
 cate colic. This colic is often due to too frequent or 
 too copious feeding, hence the great mistake in quiet- 
 ing the cries of the colicky baby by more feeding. 
 Some babies are especially prone to colic and must be 
 fed with extreme care. 
 
 Again babies are colicky while showing no other 
 evidence of dietetic error. In these cases the attacks 
 may be due to chilling of the surface of extremities. 
 Great care, therefore, is necessary in maintaining 
 proper warmth by suitable clothing, especially of the 
 hands and feet. (See baby bag, page 22.) 
 
 Another form of colic is caused, as before men- 
 tioned, by sharp uric acid crystals in the kidneys and 
 urinary tubes. 
 
 Simply changing the position, as holding the baby 
 over the shoulder, is often effective in expelling the 
 
 Causes 
 
 Uric Acid 
 Colio
 
 128 CARE OF CHILDREN 
 
 Treatment gas. Gentle massage of the abdomen is helpful. Hot 
 carminative teas, as peppermint, anise, camomile and 
 catnip, with a grain or two of bicarbonate of sodium, 
 may relieve the pain, or in case of exhaustion as in- 
 dicated by cold or blueness, 2 or 3 drops of brandy 
 in a little water sweetened with milk sugar may be 
 added. Dry heat applied to the extremities and abdo- 
 men by means of hot flannel or water bag with gentle 
 
 RUBBER CATHATER. 
 
 massage of the abdomen will assist. A warm high 
 enema or a rubber tube (see Medicine Chest) intro- 
 duced and left in the bowel for a few seconds may 
 promote the expulsion of the gas. Where colic is per- 
 sistent or of frequent occurrence the physician should 
 be consulted with regard to a change in the diet. 
 
 CONSTIPATION 
 
 Constipation is so common during infancy that some 
 physicians have regarded it as normal to that period 
 of life. While not agreeing with that opinion, it is 
 apparent that certain anatomical and physiological
 
 CONSTIPATION 129 
 
 peculiarities of the infant's intestinal tract predispose 
 to constipation. 
 
 Occasonally it may be relieved by the giving of water 
 water between feedings. As one of the functions of cream 
 fat in the food is to promote bowel movements much 
 good may result from the administration of a little 
 cream, properly diluted, after nursing, or by the in- 
 crease of this element in the baby's bottle, if he is 
 artificially fed. For the same purpose a few drops 
 of olive or cod liver oil, which babies take readily, 
 may be given after each meal. Care must be taken 
 not to develop fatty diarrhea or stomach intolerance 
 with up spitting or vomiting as a result of fat indi- 
 gestion. 
 
 For older infants and children molasses taffy given Massage 
 after food has a laxative effect and much benefit may 
 be derived from fresh fruits and fruit juices given 
 regularly when tolerated. 
 
 At all ages daily gentle massage of the abdomen 
 to stimulate the peristoltic action of the intestine 
 should never be neglected with children having a tend- 
 ency to constipation. To be most effective the abdo- 
 men should be stroked and kneaded gently and firmly, 
 following the course of the large intestine, namely, up- 
 wards on the right side, across above the navel and 
 downwards on the left side towards the groin. 
 
 Where the food is concentrated and quickly ab- Coarse 
 
 -Tp ft J 
 
 sorbed, constipation calls for coarser and more bulky 
 food so that older children should be given coarsely
 
 130 CARE OF CHILDREN 
 
 ground cereals, as cracked wheat, corn bread, graham 
 bread, also fruits, as grapes with the seeds, figs and 
 stewed prunes. 
 
 The frequent use of drugs for constipation should 
 be discouraged and should rarely be resorted to ex- 
 
 HARD RUBBER INFANT SYRINGE 
 
 cept by the advice of the family physician. In obsti- 
 nate cases the bowels may be relieved by an occasional 
 enema of soapy water or sweet oil. 
 
 Regularity Regularity is most important. As stated on page 
 40 this may be taught to infants at an early age with, 
 perhaps, the assistance of a "suggester" in the form 
 of a piece of soap whittled to a point. With older 
 children a fixed time (preferably after the breakfast) 
 for daily defecation should be established. Thus, and 
 by attention to the diet, any tendency to constipation 
 may be overcome and many grave disorders of later 
 life obviated. 
 
 SUMMER DIARRHEAS 
 
 Summer diarrheas are most prevalent and fatal 
 during the periods of infancy and early childhood, 
 the greatest susceptibility to this disease being found 
 between the ages of six and eighteen months, which 
 time the death-rate is many times that at any other
 
 DIARRHEAS 131 
 
 age, hence mother's well-known dread of the baby's 
 second summer. 
 
 In children of all ages a transient form may occur 
 at any season, with decided predilection, however,, for 
 the heated term. In midwinter occasional attacks of 
 severe, although usually transcient, diarrhea without 
 fatal tendency are seen, but it is in the summer months 
 that intestinal disorders, with diarrhea as a common 
 symptom, are most fatal. The high rate of mortality 
 among infants and children during the summer months, 
 resulting from disorders of which diarrhea is an ac- 
 companiment, exceeds that of all other diseases dur- 
 
 BULB INFANT SYRINGE 
 
 ing the same period. Nearly 90 per cent of the deaths 
 from this cause are among artificially fed babies. 
 
 The immediate cause of summer diarrhea is thought 
 to be the presence of great numbers of certain bacte- 
 ria found in unclean and improperly cared for milk. 
 
 The onset is sometimes sudden, being ushered in by 
 a convulsion, vomiting and diarrhea. There is usually 
 high temperature, thirst and nausea which makes the 
 infant snatch at food but push it quickly aside as soon 
 as a few mouthfuls have been swallowed. Restlessness 
 
 Mortality 
 
 Onset of 
 Diarrhea
 
 132 CARE OF CHILDREN 
 
 is nearly always present. The stools may change sud- 
 denly or may be two or three days in changing from 
 the normal in frequency and character. There may be 
 a great deal of colicky pain. 
 
 vomiting The infant while apparently in perfect health may 
 develop vomiting, the matter ejected being at first the 
 contents of the stomach but little changed highly acid 
 or in dense curds ; this is soon followed, however, by 
 a watery, slimy and rarely by a biled-stained fluid, less 
 acid or even alkaline in reaction. Diarrhea frequently 
 accompanies and invariably follows the onset of the 
 disturbance. The first stools may be nearly normal 
 but they quickly change, showing evidence of fermen- 
 tation and later on putrefaction. Finally they become 
 watery and may be of a brownish or greenish color. 
 The odor of the stool varies from the normal sour 
 to intensely putrid and later to a sickening musty 
 smell. 
 
 Drain of The infant, apparently well nourished and playful, 
 quickly shows signs of systemic disturbance in fretful, 
 peevish irritability and restlessness, with head rocking, 
 anxious facial expression, persistent whining cry, 
 fever, dry mouth and softened flabby tissues. The 
 depressed fontanel, sunken, lusterless eyes, sharply de- 
 fined temples, drawn features with the intense thirst 
 all give evidence of the great drain of fluids. The 
 abdomen, at first distended with gas, may soon be- 
 come flabby and depressed and the extremities cold, 
 although the rectal temperature may be from 103 to
 
 DIARRHEAS 
 
 133 
 
 106 F. Convulsions may usher in the attack, follow 
 the initial vomiting by a few hours, appear only at the 
 final stage or occasionally they may not develop. 
 Within twenty-four hours from the onset, and fre- 
 quently earlier, the stage of collapse is reached, with 
 pallor and coldness of the surface, though the internal 
 temperature may be high. The restlessness soon sub- 
 sides into stupor with shallow breathing, collapsed 
 veins, failure of pulse, half closed filmy eyes and death 
 occurs in convulsions or from exhaustion. 
 
 This picture presents symptoms of acute poisoning 
 from the stomach or intestinal tract occurring in a 
 state of apparent health and terminating fatally in from 
 twenty-four to forty-eight hours. 
 
 Though the well-nourished infant is not exempt 
 from this form of acute poisoning it occurs with much 
 greater frequency among those who show evidence of 
 malnutrition. 
 
 Acute summer diarrhea is frequently but improperly 
 called cholera infantum. Fortunately the true cholera 
 infantum (caused by a specific germ) with its almost 
 invariably fatal termination is by no means common. 
 
 The commonest form of summer diarrhea is the re- 
 sult of acute indigestion usually caused by improper 
 or impure food or overfeeding. Not infrequently 
 these attacks of vomiting and diarrhea are relieved by 
 the giving of one or more doses of castor oil and the 
 withdrawal of food for twenty-four hours. In such 
 cases the diet should be resumed very gradually, be- 
 
 Acute 
 Poisoning 
 
 Cholera 
 
 Infantum 
 
 Mild 
 Cases
 
 134 CARE OF CHILDREN 
 
 ginning with small quantities of white of egg water, 
 barley water, strained broth or weak malted milk. 
 After A prolonged attack of summer complaint rarely 
 leaves the child free from evidence of retarded devel- 
 opment, which in many instances is never fully com- 
 pensated. Perhaps the most important effect of severe 
 summer complaint upon the survivors is the feeble 
 resistance to infection from lowered vitality, so that 
 the danger from contagious diseases is greatly in- 
 creased. 
 
 It is needless to say that the mother's immediate 
 duty is to summon her physician upon the appearance 
 of the first symptom of summer diarrheas. 
 
 ABNORMAL PASSAGES 
 
 The normal passages of the infant have been de- 
 scribed on page 77, and various abnormal stools have 
 been mentioned in connection with other disorders, 
 but it may be well to summarize here. Like vomiting, 
 any divergence from the normal in the appearance of 
 the stool is a sign of warning. They should be kept 
 for the inspection of the physician. 
 
 Stools may be abnormal in frequency, consistency, 
 color and odor. During the suckling period the baby's 
 stools may vary in frequency from one to six daily 
 without apparent departure from health, the average 
 probably being three movements in the twenty-four 
 hours. 
 
 Variations in the quantity and quaiity of food in-
 
 ABNORMAL PASSAGES 135 
 
 gested may cause variations in the quantity and fre- 
 quency of the discharges which, if normal in color and 
 consistency, need occasion no anxiety. 
 
 Breast or exclusive milk feeding gives a light color color 
 to the evacuations, varying from a canary to a cream. 
 As before stated, the normal consistency of the suck- 
 
 JOINTLESS BULB SYRINGE. 
 
 ling's stool is about that of thin batter and is smooth 
 and homogeneous throughout. But little gas is pres- 
 ent and the normal odor when freshly voided is 
 slightly sour and not especially offensive. 
 
 If cereals, starch, sugar or proprietary foods enter 
 largely into the dietary the stools will be darker, rang- 
 ing from orange to brown with a greater tendency to 
 gas formation and a disagreeable odor. 
 
 Stools are abnormal when they have a putrid odor Odor 
 suggestive of decomposition ; when they are bubbly 
 or yeasty, suggestive of fermentation; when they are 
 watery or contain blood or mucus; when they are
 
 136 CARE OF CHILDREN 
 
 heterogeneous in character; when they are acrid and 
 irritate the anus and skin of the buttocks; when they 
 are green or variegated in color or gray and tough or 
 putty like; when they are hard and lumpy like mar- 
 bles coated with slime or when they are dry and 
 crumbly, either dark brown, pale gray or white. 
 MUCUS Mucus is normally present in the discharges, but it 
 is only when irritation of some part of the mucous 
 membrane of the digestive tract has caused an extra 
 abundant flow that it becomes visible. Curds in the 
 passages indicate incomplete digestion, the causes of 
 which are many and sometimes hard to determine. 
 The quantity of food may be too great, or it may be 
 too strong, it may be taken too rapidly, too often, too 
 cold, there may have been chilling of the baby or too 
 much excitement, and so on. 
 
 Although some of these conditions may be remedied 
 by the judicious use of castor oil and slight changes in 
 diet, or manner of feeding, they all suggest the advice 
 of the physician, before the underlying causes lead to 
 disorders which may become obstinate. 
 
 RICKETS MALNUTRITION AND SCURVY 
 
 Rickets (rachitis), Malnutrition (marasmus) and 
 Scurvy (scorbutus) are essentially nutritional disor- 
 ders, and as such depend both for their treatment and 
 cure largely upon proper feeding. 
 
 The rickety child shows a constitutional perversion 
 of development which, if not arrested, may lead to ac-
 
 RICKETS 
 
 137 
 
 tual deformities. There is lessened resistance to dis- 
 orders of an infectious nature, hence a marked tend- 
 ency to catarrhal conditions of all the mucous tracts. 
 Early deaths from acute diseases are frequently due 
 to the feeble resistance of the rickety constitution. 
 Rickets is oftenest seen in children between the ages 
 of six months and four years, though some of its 
 effects are visible throughout life. 
 
 Three groups of symptoms and signs stand out pre- 
 eminently as rachitic. 
 
 First. The nervous system shows instability ; there 
 is fretfulness, irritability and intellectual precocity. 
 Tendency to spasmodic seizures is sometimes marked. 
 A form of general spasm, known as "tetany" being 
 peculiar to the rachitic infant. So, also, the crowing 
 spasms so frequently mistaken for croup are essen- 
 tially rachitic. The bright, fidgety child who runs on 
 his toes and the head-sweating, restless, cover kicking, 
 sleep moaning infant suggest the same rachitic disturb- 
 ance of nerve function. 
 
 Second. The muscular system shows tardy devel- 
 opment in strength and remains flabby, so that the in- 
 fant is late in learning to stand or walk and does not 
 sit erect. Curvatures of the spine frequently show the 
 inefficiency of the muscles to support the trunk. The 
 child, meanwhile, may appear to the uninformed as 
 well nourished; in fact, may be fat or overfat with 
 pin-cushiony pads on the top of his feet and the back 
 of his hands. His inability to stand is frequently at- 
 tributed to his great weight. 
 
 Nervous 
 Symptoms 
 
 Muscular 
 Development
 
 i 3 8 CARE OF CHILDREN 
 
 Bony Third. This group consists of signs induced by the 
 indications p ectu j ar retardation of bone growth, such as late clos- 
 ure of the fontanel, square shaped skull, with lateral 
 ridges and bulging forehead, very late and irregular 
 dentition, enlargements at the ends of the long bones 
 showing prominently above the wrist joint and at the 
 ends of the ribs where they join the cartileges of the 
 breast bone. These nodules extend from the upper 
 part of the chest in two receding lines downward and 
 outward like an inverted V and from their resemblance 
 to beads are known as the rachitic rosary. The bones 
 of the rachitic are slow in hardening, hence their 
 ready bending under weight, or pressure resulting in 
 bow legs or knock knees. The chest, too, in later life 
 shows permanent deformities and the "pigeon breast" 
 is a lasting witness to a rachitic infancy. Babies fed 
 on good breast milk very rarely show rickets. 
 
 Successful treatment depends upon the recognition 
 of the earliest rachitic symptoms in their incipiency, 
 namely, those of the first group. The physician should 
 be consulted early, as too often this condition is neg- 
 lected until the third group or bony changes are well 
 under way. 
 
 Rachitic infants often show large abdomen with 
 narrow chest and a marked flaring of the lower border 
 of the ribs. They are especially prone to digestive 
 and respiratory disorders and frequently show signs 
 of tenderness about the chest and trunk when lifted.
 
 MALNUTRITION 
 
 139 
 
 Since a paucity of fat in the food is largely responsi- 
 ble for this disorder that constituent should be freely, 
 though judiciously, supplied, while the inert starchy 
 constituents and the excessive fattening and gas form- 
 ing sugars should be reduced. Meanwhile the physi- 
 cian may endeavor to secure a better supply of earthy 
 salts for the deficient bone forming constituents. 
 
 Marasmus is a special term applied to that general 
 form of malnutrition which seems to be seated upon 
 an inherited or inherent vice of nutrition. It goes 
 without saying that if the feeding of a normal baby 
 requires judgment that of the marantic infant will ex- 
 ercise the highest skill of the ablest physician. "Weakly 
 from birth" is the common expression applied to these 
 babies whose death could be ascribed to no definite 
 disease. Of course, malnutrition may result from mal- 
 hygiene in what would otherwise prove to be a nor- 
 mal infant, and rachitis, one of the results, not only 
 of improper feeding but also of bad environment as 
 to pure air, sunlight and warmth, plays no small part 
 in the production of marasmus. 
 
 No one may prescribe the exact line of feeding or 
 treatment for an unseen case of malnutrition. Since 
 no two marantic children present the same specific 
 disturbances. There is usually the extreme emacia- 
 tion which gives the infant the appearance of senility. 
 The rheumy lack luster eye, the weazened face, feeble 
 wail and voracious hunger, presents a vivid picture of 
 starvation, while the large abdomen and frequent foul 
 
 Malnutrition 
 
 Feeding
 
 140 CARE OF CHILDREN 
 
 smelling stools with or without vomiting emphasizes 
 the need of most careful feeding. How to do this is 
 the special problem for the doctor in each individual 
 case. That any intercurrent infection should speedily 
 terminate the existence of the marantic infant is not 
 surprising. 
 
 Scurvy Scorbutus is a disease occurring only in infants fed 
 continuously on cooked food and is never seen in the 
 baby fed exclusively at the breast. The modern tend- 
 ency or fad for artificial baby foods and sterilized milk 
 is largely responsible for the increasing frequency of 
 this disorder in recent years. 
 
 Scorbutus is so eminently a food disorder that no 
 treatment is necessary other than the proper change 
 in diet. The earliest symptom is crying when the in- 
 fant is handled as in bathing, changing, dressing, etc., 
 and the nurse may discover that it is the legs, espe- 
 cially the thighs, that are tender to the touch. Some- 
 times a swelling is observed about the inner or back 
 part of the thigh, above the knee, with a red or blue 
 discoloration as from a bruise. Frequently the swell- 
 ing is marked and the limb so tender that rheumatism 
 is suspected. Black and blue spots are occasionally 
 seen on different parts of the body or limbs, the re- 
 sult of ordinary handling. The absence of fever (the 
 temperature is usually subnormal) excludes rheuma- 
 tism and ordinary inflammations. Later the skin shows 
 purple spots due to "blood settling," and sometimes 
 bright red spots, the size of a pin head, under the 
 skin as though a little artery had leaked.
 
 COLDS 
 
 141 
 
 The baby takes nourishment poorly and may have 
 indigestion with diarrhea. The inside of the mouth 
 is dark red, the swollen, spongy gums bleed readily 
 upon pressure. Occasionally blood is vomited which 
 had previously been swallowed from the mouth. Later 
 still, hemorrhages may occur from any mucous tract 
 and the stools show blood in clots like liver or changed 
 to the appearance of coffee grounds. Without relief 
 death soon follows. 
 
 For treatment cooked food must be replaced by 
 something raw. A teaspoonful of orange juice, di- 
 luted, may be given 5 or 6 times a day. Raw milk 
 properly modified, raw beef juice ; the white of egg 
 will, if not too late in its administration, bring about 
 a remarkable change. 
 
 COLDS 
 
 Ordinary colds are the infections from the ever 
 present micro-organisms which cause catarrhal in- 
 flammation of some mucous tract when normal resist- 
 ance is lessened. Lessened resistance may be due to 
 lowered temperature from exposure, from over fa- 
 tigue, excitement, loss of sleep, mal-nutrition or indi- 
 gestion. Also from over-feeding, occasional or ha- 
 bitual. Impure air, also, lowers vitality and invites 
 infection. 
 
 Acute catarrh (acute cold) may affect the mucous 
 membrane of the nose (Rhinitis) ; mouth (Stomati- 
 
 Treatment 
 
 No Germs 
 No Colds
 
 142 CARE OF CHILDREN 
 
 tis) ; the middle ear (Otitis) ; the eyes (Conjuncti- 
 vitis) ; the pharynx (Pharyngitis) ; tonsils (Tonsilli- 
 tis) ; larynx (Laryngitis) ; bronchial tubes (Bron- 
 chitis) ; stomach (Gastritis) ; bowels (Enteritis) ; 
 large bowel (Colititis or Dysentery) ; bladder (Cys- 
 titis) ; or the genitals (Urethritis, Vaginitis or Vul- 
 vitis). 
 
 Common Catarrh rarely is confined to a single area but shows 
 a tendency to extend along the continuous mucous lin- 
 ing to adjacent tracts. Repeated acute attacks tend 
 to become chronic under neglect and low vitality. The 
 secretions or discharges from any catarrhal tract will 
 positively infect another which is susceptible, hence 
 their prevalence and the term "common cold." No 
 cold is trivial. All colds, with discharges, are con- 
 tagious. 
 
 SORE THEOAT 
 
 Frequent Sore throat is always due to infection, and though 
 
 Symptom 
 
 it may prove trivial it should never be so regarded, 
 as it is frequently the forerunner of a most grave dis- 
 ease. No physician ever fails to examine the throat 
 of a sick child, and the mother should always do so. 
 The tonsils are very commonly the seat of disease 
 from which infection readily gains access to the blood 
 and system. Recurrent attacks of acute tonsillitis re- 
 sult in permanent enlargement of these structures with 
 increased tendency to acute attacks, and absorption of 
 poison which causes enlargement of the neck glands.
 
 SORE THROAT 
 
 143 
 
 The throat may become nearly closed, breathing in- 
 terfered with, voice is changed and relief is found only 
 in removal of the tonsil by the surgeon. 
 
 The space above the tonsils, behind the soft palate 
 and at the top of the pharynx, is most important. It 
 may well be called the anarchist's den, for here hidden 
 
 DIAGRAM OF THE MOUTH. 
 The "Anarchist's Den" is above the "Pharyngeal Isthmus" 
 
 from sight more dangerous infections are cultivated 
 than in any other part of the body. It is called the 
 "post nasal space." Into it open from in front the 
 passages from the nose ; from the sides, the tubes from
 
 144 
 
 CARE OF CHILDREN 
 
 Adenoids 
 
 Care of 
 the Nose 
 
 the middle ears; and from below, the upper end of 
 the pharynx. It is warm, moist, dark and ventilated, 
 an ideal place for the growth of micro-organisms 
 which find in the catarrhal secretions of its mucous 
 lining their ideal food. All nasal catarrhs extend to 
 this space, and the hawking and spitting is due to ac- 
 cumulations here. 
 
 Repeated attacks of catarrh (cold . in the head) 
 cause soft warty growths, called Adenoids, or "the 
 
 AN OIL ATOMIZER 
 
 third tonsil," which sometimes fill this space, blocking 
 the ear tubes, causing ear disease and deafness, shut- 
 ting off the air and forcing the child to breathe 
 through the mouth with snoring in sleep. These 
 adenoids give to the voice a nasal tone, change the 
 shape of the face, raise the roof of the mouth which 
 gives the child a stupid expression and ultimately af- 
 fects both mind and body. The only cure when well 
 advanced is in removal by the surgeon. 
 
 The early habitual care of the nose, naso-pharynx 
 and throat by sprays and washes will do much to pre-
 
 CROUP 
 
 145 
 
 vent the numerous ills due to the neglect of this im- 
 portant area. 
 
 With a child subject to colds, the oil atomizer should 
 be used daily, night and morning. Alboline with some 
 
 GIVING A NASAL DOUGH. 
 
 medication such as menthol will be prescribed by a 
 physician. The formula may need to be weakened at 
 first by adding plain alboline until the child becomes 
 accustomed to the treatment 
 
 Oil 
 Atomizer 
 
 CBOTTP 
 
 There are two forms of croup, spasmodic and diph- 
 theritic. The first form occurs usually at night. The 
 child may or may not have shown signs of illness be- 
 fore going to sleep. Frequently he has been troubled 
 
 Kindt 
 of Croup
 
 146 CARE OF CHILDREN 
 
 with a cold and some hoarseness during the day. Sud- 
 denly he is awakened with a barking, metallic (croupy) 
 cough and may sit up struggling for breath. He may 
 have noisy inspirations with all the symptoms of im- 
 pending suffocation. The doctor is hurriedly sum- 
 moned, but ere his arrival the paroxysm has passed and 
 the child is sleeping with little evidence of disturb- 
 ance, or the attack may recur three or four times in 
 the night. Usually the second night sees a return, 
 although he has spent the day comfortably. A return 
 on the third night is not uncommon but with lessened 
 severity. Children rarely die in these attacks, as the 
 suffocation relieves the spasm of the larynx, allowing 
 the air to enter freely again. Some children are 
 "croupy" while others are exempt. Cold and damp- 
 . ness are the usual exciting causes. The attacks are 
 commonest from 2 to 3 years and are rarely seen after 
 the sixth year. 
 Emetic For croupy children an emetic (see Medicine Chest) 
 
 for Croup 
 
 should be kept in the house and a dose administered 
 before sending for the doctor. 
 
 Diphtheritic croup is laryngeal diphtheria, one of 
 the diseases most to be dreaded. It may complicate 
 a previously existing diphtheria of the throat or nose 
 or the disease may make its first appearance in the 
 larynx. The symptoms are continuous and increasing 
 air hunger with great restlessness and weakness. A 
 physician should always have the case in charge with 
 the assistance of a trained and experienced nurse.
 
 TEMPERATURE 147 
 
 TEMPERATURE 
 
 Elevation of temperature in infants and children cause 
 may be due to slight causes but should never be dis- slight 
 regarded. Fever is an indication for rest and careful 
 watching, and in an acute attack food should be re- 
 duced or entirely withheld. 
 
 TAKING TEMPEEATUKE BY RECTUM. 
 
 Fever due to indigestion from over or improper 
 feeding is not uncommon, while on the other hand in- 
 sufficient food may cause elevation of temperature 
 known as "inanition fever." When due to indiges- 
 tion, fever may be relieved by removing the offending 
 material by means of a brisk cathartic (castor oil), or 
 copious enema, or both. Inanition fever calls for 
 nourishment. 
 
 A daily rise in temperature of from 2 to 4 degrees 
 long continued, especially in the evening, is suggestive 
 of tuberculosis. 
 
 A continued fever or a daily rise in temperature de- 
 mands medical advice. Feverish conditions may be 
 greatly allayed by tepid sponging or the cool bath.
 
 NERVOUS DISORDERS 
 
 Exciting 
 Causes 
 
 Symptoms of 
 
 Nervousness 
 
 An excitable condition called nervousness is usually 
 due to unbalanced nutrition or insufficient rest. In- 
 heritance may exert an influence as a remote or pre- 
 disposing cause and the "nervous temperament" has 
 long been recognized. 
 
 Among the exciting causes may be mentioned fa- 
 tigue, indigestion, foreign bodies in the digestive tract, 
 as worms ; local irritations which by reflex action dis- 
 turb nerve equilibrium, as disorders of the genitals, 
 irritable bladder, constipation, seat worms ; inflamma- 
 tion of the middle ear ; growths in the naso-pharynx ; 
 eye strain ; skin eruption as eczema, etc. Also im- 
 proper clothing which occasions unequal temperature 
 or discomfort. 
 
 Some of the manifestations are seen in disturbed 
 sleep, grinding of teeth, bad dreams, night terrors, 
 muscular twitchings, chorea (Saint Vitus's dance), 
 convulsions or epilepsy. 
 
 Some of the minor symptoms appear as fidgeting, 
 squirming, grimacing, blinking, chewing, nail biting, 
 head scratching, picking at the nose, bed wetting and 
 ready crying, which to the experienced eye proclaim 
 some nerve irritation. 
 
 Children should rarely be punished but rather fed 
 for the correction of these involuntary manifestations 
 of nervousness. The wise parent will always consult 
 the physician in these cases. 
 
 148
 
 NERVOUS DISORDERS 149 
 
 CONVULSIONS, SPASMS, FITS, CHAMPS 
 
 In the category of infantile disorders nothing is 
 more dreaded and no childhood ailment demands great- 
 er presence of mind on the part of the mother. It has 
 frequently been stated that children rarely die of 
 spasms, that is, the convulsion of itself rarely kills. 
 Spasms do not constitute the disease, but are only 
 symptoms of some disorder which disturbs the 
 equilibrium of the nervous system. 
 
 We have seen that reflex action was highly devel- cause of 
 oped at birth and that inhibition (control) was a func- 
 tion of later development. The younger the infant 
 the greater the likelihood of muscular contractions 
 being excited beyond control of the feeble inhibition. 
 Therefore anything which powerfully excites mus- 
 cular contraction may induce convulsions in infants 
 and young children. 
 
 Hyper-excitability and feeble inhibition are also to 
 a certain extent hereditary. The so-called nervous 
 constitution finds its best expression in this want of 
 balance between excitability and inhibition. Nutri- 
 tion also plays an important part in determining the 
 balance between these two functions of the nervous 
 system (see Rickets). What might be a very trifling 
 disturbance in the adult may induce convulsions in 
 the infant. Again spasms may be one of the symp- 
 toms of a very grave disease. It is the cause of the 
 fits, then, that is of paramount importance.
 
 ISO CARE OF CHILDREN 
 
 From the above may be seen some of the reasons 
 why spasms are frequently among the terminal symp- 
 toms of a fatal disease, so that death, not of but in 
 convulsions, is not infrequent in young infants. 
 
 Among the various causes are the onset of some 
 severe illness as scarlet fever, pneumonia, brain dis- 
 ease, etc., or convulsions may be induced by indiges- 
 tion, constipation, intestinal worms, high fever, very 
 hot weather, severe pain or fright. The ordinary chill 
 in the adult may be expressed by a spasm in the infant. 
 Symptoms The symptoms of a spasm may be so slight as almost 
 to escape notice, such as transient eye squint, turning 
 in of the thumbs or great toe, slight muscular twitch- 
 ings of the face or jerking of the trunk muscles. 
 These evidences of so-called "internal spasms" may 
 pass away or may prove the beginning of violent con- 
 vulsions, hence should not be disregarded. 
 
 General convulsions involve nearly all the muscles 
 of the head, trunk and limbs. Usually there is a pe- 
 culiar choking sound in the throat; the twitching fea- 
 tures become set ; the eyes fixed and staring, crossed or 
 rolled upwards, showing only the whites, the body be- 
 comes rigid with the back arched, the hands clenched 
 and arms flexed, the jaws firmly closed and if teeth 
 be present the tongue is usually bitten. The face be- 
 comes blue from suspended respiration. 
 
 This rigidity usually lasts but a few seconds and the 
 child begins to jerk violently with rhythmic motions 
 in arms, legs and trunk. An unnatural audible sound
 
 CONVULSIONS 151 
 
 sometimes occurs with the breathing and the free flow 
 of saliva may be churned into a froth which clings to 
 the lip. The jerking then becomes less marked and 
 finally ceases and the child soon recovers consciousness 
 and cries or falls asleep from exhaustion. This cycle 
 is usually completed in from one to three minutes, 
 though to the watching parents it may seem many 
 times that. 
 
 The attacks may recur at intervals for many hours 
 if the cause is not removed and death has been known 
 to occur apparently from exhaustion. 
 
 Since in infancy one of the commonest causes of Treatment 
 convulsions is indigestion or the presence of some irri- 
 tant in the digestive tract the first thing to be done is 
 to clean out the stomach and bowels. A prompt 
 emetic should be given at once, followed by a dose of 
 castor oil. A copious enema of warm salt solution 
 (teaspoonful of salt to a pint of warm water) should 
 also be given. 
 
 For the relief of the immediate spasm the child 
 should be quickly immersed in a hot bath (temperature 
 110 F. or test with the whole arm) containing a tea- 
 spoonful of strong mustard to the gallon, with ice cold 
 cloths to the head. A simpler method of applying 
 moist heat is to wrap the baby in a small blanket or 
 turkish towel wrung out of hot water. 
 
 A physician should be at once summoned, but if he 
 is not in reach ani the convulsions recur an enema of 
 five grain tablet of sodium bromide dissolved in an
 
 After 
 
 Effects 
 
 152 CARE OF CHILDREN 
 
 ounce of tepid water may be administered and retained 
 by pressure upon the anus, or half this dose may be 
 given by mouth to a child of 18 months, every two 
 hours if necessary. 
 
 A NIGHT LIGHT. 
 
 Although as stated, death is rarely due to a convul- 
 sive seizure, it is none the less to be dreaded, and all 
 means should be employed to ward off its recurrence, 
 for the reason that severe spasms, from whatever 
 cause, may result in permanent injury to the delicate 
 tissues of the brain, among the results of which may 
 be paralysis, with mental impairment.
 
 CONTAGIOUS DISEASES 
 
 Contagious diseases are those due to germs carried source of 
 
 Infection 
 
 to the individual from some other person suffering 
 from that disease. These germs may come through 
 direct contact or may be brought by air, water, food, 
 clothing, books, papers, letters, etc., so that the source 
 from which the child is exposed is often difficult to 
 trace. 
 
 Of the contagious diseases we will consider only 
 those most commonly found in infancy and childhood, 
 viz., measles, scarlet fever, chicken-pox, diphtheria 
 and whooping cough. They have a common resem- 
 blance in that they have a stage of incubation (the 
 interval from exposure to the first symptoms), all are 
 self limiting diseases (run out their course), all are 
 accompanied by more or less fever, one attack usually 
 immunes from a second (except in diphtheria), each 
 has the characteristic skin eruptions (except diph- 
 theria and whooping cough), and each has its stage of 
 invasion (the interval between the first symptom? and 
 the appearance of the characteristic symptom). 
 
 MEASLES 
 
 Measles, German measles, scarlet fever and chicken- Eruptive 
 pox are called the "eruptive fevers." 
 
 Measles is the most frequent and most contagious, 
 attacking all ages and is most prevalent in the winter 
 season. It is contagious during stages of incubation, 
 probably from the breath of the patient, and is rarely 
 carried by a third person. Though lightly regarded 
 
 153
 
 154 CARE OF CHILDREN 
 
 by most people, measles is a very serious disease, espe- 
 cially in delicate children, where it may prove fatal 
 from the broncho-pneumonia or tuberculosis which 
 frequently follows it. 
 Symptoms The attack begins with the symptoms of a bad cold ; 
 
 of Measles 
 
 eyes red, nose wet, fever, hoarseness, sneezing and 
 cough, with slight sore throat, coated tongue and fe- 
 verish breath. About the fourth day the rash appears, 
 first on the face, gradually spreading downward over 
 the trunk and limbs, which it usually covers in twenty- 
 four hours. This consists of dusky red, slightly ele- 
 vated, flattened papules, from wheat grain to split pea 
 in size. On the face and trunk, especially, they run 
 together, giving a blotchy look to the dark red with 
 little spaces of normal skin between. The rash period 
 is less than a week and fades away gradually. 
 
 The eyes may be very troublesome and permanent im- 
 pairment often follows. The cough may increase with 
 symptoms of pneumonia. The fever, in uncompli- 
 cated cases, subsides with the rash, which is followed 
 by a falling off of fine branny scales continuing dur- 
 ing the week of convalescence. Treatment: Call a 
 doctor, avoid bright light and put child to bed in a 
 warm room. 
 
 GERMAN MEASLES (ROETHELN) 
 
 A milder disease than measles, for which it is fre- 
 quently mistaken. It generally comes in epidemic 
 form in the winter season. The rash appears on the 
 second day, first on the face in pale rose spots slightly
 
 SCARLET VEVER 155 
 
 elevated, size of pin head, which usually reaiain sepa- 
 rate. When they do run together they do not form 
 blotches like measles but rather a continuous redness 
 like scarlet fever, for which it is sometimes mistaken. 
 The rash spreads downward rapidly over the body, 
 at the same time beginning to fade from the face so 
 that in three days it has disappeared. The fever is 
 slight, with a little sore throat and wet eyes and nose. 
 Usually small scales from the outer skin fall off a few 
 days after the rash. 
 
 Treatment: Protect from broncho-pneumonia by 
 keeping in bed on light diet. 
 
 SCARLET FEVER (SCARLETINA) 
 
 Scarlet fever is very common at all ages above six 
 months. Occurs most frequently in Autumn (after 
 schools open) and is very contagious. The germs 
 may be carried in clothing and may live for a year 
 stowed away in clothes and bedding. 
 
 The disease may be so mild as to be overlooked or viruienc* 
 so severe as to destroy life in 24 hours. The mildest 
 case may furnish germs for one of the severest type, 
 hence the importance of recognizing and isolating 
 every case. It usually comes on suddenly with vomit- 
 ing. High fever appears on the first day and rash on 
 the second. Eruption first appears on the neck and 
 spreads rapidly over the body and limbs but usually 
 spares the face. The color is uniformly scarlet in typ- 
 ical cases with pin points of intense red showing 
 through. The throat is red and sore from the begin-
 
 156 CARE OF CHILDREN 
 
 ning of invasion and may develop a whitish membrane 
 like diphtheria. The tongue, at first white coated 
 with red points showing through, cleans off so that by 
 the third or fourth day it has the glistening red rasp- 
 berry appearance, called "strawberry tongue." 
 Duration The fever lasts a week or ten days, the rash from 
 five to eight days. A mild attack may suddenly de- 
 velop alarming symptoms and may be followed by 
 ear disease, enlarged glands of the neck, rheumatism, 
 heart disease or Bright's disease. The latter after 2 
 or 3 weeks. Treatment: Isolate the child and send 
 for the doctor. 
 
 CHICKEN POX (VARICELLA) 
 
 Chicken pox is very common. Limited to no age, 
 and may be carried by a third person. Onset mild. 
 F/equently the first symptom is the eruption of small 
 rose colored spots on neck and trunk, which change in 
 a few hours to little blisters about the size of a split 
 pea or larger, filled with water. These stand out 
 prominently, having a narrow red ring around their 
 base. There may be a thousand or only ten at one 
 time on the entire body. The blisters dry down and 
 scab, and another crop appears so that spots, blisters 
 and scabs may all be present at once. 
 
 About a week terminates the eruption and the child 
 gets well. Scabs should not be picked off, as pock 
 marks will result. Large blisters on the face should 
 be pricked and treated by the physician to prevent 
 pitting.
 
 DIPHTHERIA 157 
 
 DIPHTHERIA 
 
 Before the use of antitoxin this was an extremely 
 fatal and is even now a dread disease. No age is ex- 
 empt, though it is rarely seen in very young infants. 
 It is most prevalent in damp weather when sore 
 throats are common and may develop in any sore 
 throat or catarrhal nose or larynx. In the latter sit- 
 uation it is known as "diphtheritic croup," a most dan- 
 gerous form, for, added to the blood infection we have 
 the danger of suffocation from laryngeal obstruction. 
 In this complication it is often necessary to introduce 
 a tube that the child may get air. 
 
 The germs of diphtheria may be carried long dis- 
 tances and maintain their infective properties for 
 months. Hence the utmost care must be observed to 
 isolate the child and destroy all secretions from throat 
 and nose. One attack does not prevent, but rather 
 favors, subsequent infection. 
 
 The stage of invasion is marked by feverishness, loss symptonu 
 of appetite, debility and sore throat. The reddened 
 throat may show one or more whitish patches on one 
 or both tonsils. Next day both tonsils and soft palate 
 may be covered with a thick, greyish white membrane 
 which may invade the naso-pharynx and cause dis- 
 charge from the nose. The breath is fetid and the 
 glands under the angle of the jaws may swell enor- 
 mously. No disease of brief duration causes such 
 muscular weakness as diphtheria, and some cases of 
 death from heart failure occur after the child is over 
 the disease itself.
 
 158 CARE OF CHILDREN 
 
 Treatment: Prompt and strict isolation and most 
 rigid observance of the physician's orders. The acute 
 stage of this disease rarely lasts more than a week. 
 
 WHOOPING COTJGH 
 
 Most commonly seen in young children and infants. 
 It is highly contagious and is seen at all seasons of the 
 year. It usually comes through direct exposure. The 
 mistaken idea that w r hooping cough is not a dangerous 
 disease has cost many lives. 
 
 The onset is gradual, the stage of invasion lasting 
 from one to three weeks as a mild bronchitis before 
 the characteristic whoop is heard. Some children do 
 not whoop, which is merely the effect of forcible in- 
 spiration after a prolonged paroxysm of coughing. 
 In that case the nature of the affection must be deter- 
 mined by the paroxysmal character of the cough, 
 which recurs after intervals of one to three hours, and 
 usually ends in gagging and spitting up sticky phlegm 
 from the throat, or vomiting the contents of the stom- 
 ach without nausea. 
 
 Between paroxysms the child may appear in usual 
 health and spirits. The cough is worse at night. 
 Much food is lost in vomiting and nutrition suffers. 
 The younger the child the more dangerous the disease. 
 Duration Whooping cough covers about two months. A 
 longer continuance is usually due to the bronchitis 
 which complicates it. The complication may be se- 
 vere and sometimes fatal in infants. Lowered nutri- 
 tion is quite serious, and feeding should follow rather
 
 FOREIGN BODIES 159 
 
 than precede the paroxysm to secure retention of the 
 food which must be liquid for prompt absorption. 
 
 Treatment: Bronchorpneumonia and tuberculosis 
 are important sequelae. The best of medical super- 
 vision is due in each case but probably nothing is more 
 important than abundance of fresh air. 
 
 FOREIGN BODIES 
 
 The swallowing of foreign bodies that are not poi- Buikr 
 sonous need cause no alarm or special anxiety, as the 
 bowel will usually discharge the body in a few days. 
 Its passage may be facilitated and the stomach and 
 bowels protected from injury by copious feeding with 
 mush and milk or bread stuffs. As sometimes the ob- 
 ject lodges in the narrowing portion of the oesophagus 
 near its upper end, from which it may be recovered by 
 means of curved forceps, the physician should be con- 
 sulted, or an X ray examination had to determine its 
 location. If the child be choked by a foreign body in 
 the throat, suspension head downward with slapping 
 on the back may cause its ejection. 
 
 In the Ear. A foreign body in the ear which can use of 
 not be dislodged by syringing the ear with warm water 8 J rrin s e 
 should be sent to the physician. The body itself is 
 harmless if no clumsy attempts at extraction be made. 
 
 An insect in the ear should be drowned in sweet oil 
 and later washed out with a syringe. 
 
 In the Nose. A body in the nose that can not be 
 dislodged by blowing the nose or by sneezing should 
 be sent at once to the specialist, as unskilled attempts 
 at removal are usually mischievous.
 
 160 CARE OF CHILDREN 
 
 EARACHE 
 
 Earache may be the first intimation of an inflamma- 
 tion of the middle ear. The screaming infant may 
 sometimes pull "his hair or put his hand to the affected 
 side of the head. Gentle pressure with the thumb in 
 front of or behind the ear may cause flinching from 
 tenderness. After pus has formed its pressure will 
 usually rupture the drum membrane and allow a dis- 
 charge through the external passage. Inflammation of 
 the middle ear is usually due to infection from the 
 throat or naso-pharynx through the tube (eustachian) 
 which connects the two cavities. Acute congestion of 
 
 RUBBER EAR SYRINGE. 
 
 the ear with intense pain is sometimes the result of ex- 
 posure to cold or drafts and may be relieved by hot 
 applications as salt or water bag. The infected ear 
 may be gently filled with hot water or warm sweet 
 oil, care being taken not to burn. 
 
 Danger of So great harm results from neglected ear trouble 
 
 Meningitis fa a t fa j^ est mec ij ca i advice should be obtained upon 
 
 the appearance of the first symptoms. Aside from 
 
 pain and danger of impaired hearing from formation 
 
 of pus in the middle ear it should be remembered that
 
 EARACHE 161 
 
 this cavity is in close relation to that containing the 
 brain, and frequent death in infants and children from 
 brain fever (meningitis) is the direct result of infec- 
 tion by this route. 
 
 The relation of meningitis in children to the neglect- 
 ed nose, throat and ear, is a very intimate one. 
 
 The following table shows briefly a few of the typical Table of 
 points of resemblance and difference between these 
 six most common contagious diseases. It frequently 
 occurs that the disease so differs from the accepted 
 type, that its recognition is extremely difficult, requir- 
 ing a careful consideration of symptoms and condi- 
 tions, the enumeration of which is impracticable. la 
 all cases the early summoning of the family physician 
 is urged.
 
 
 
 Important After 
 Eifects 
 
 Broncho - Pneu- 
 monia, Tuberculo- 
 sis, Diarrhoea Di- 
 seases, Eye Disease 
 Ear Disease. 
 
 Rarely any. 
 
 Ear Disease, 
 Heart Disease, 
 Gland Disease, 
 Anarmia, Bright's 
 Disease. 
 
 Nothing but 
 pock marks. 
 
 Ear, Nose, or 
 Throat Diseases. 
 Kidney Disease. 
 Paralysis of Soft 
 Palate and Sudden 
 Death. 
 
 Bronc h i t is , 
 Broncho- Pneumo- 
 nia, Pulmonary, 
 Phthisis. 
 
 1 
 
 
 
 n 
 
 
 
 
 O O 01 
 
 
 
 
 
 
 
 O*n O 
 
 o M 
 
 * 
 
 | 
 
 
 01 
 
 CJ 01 
 
 .2 " -3 
 
 3 * 
 
 o ** 
 
 O M 
 
 3 | 
 
 o 3 
 
 * ff> 
 
 o "I 
 
 2 sj s 
 
 c- ^ 
 
 ec "3 
 
 *" o 
 
 
 
 1 
 
 p o> >> 
 
 
 
 p 
 
 
 
 
 s 
 
 
 
 3 
 
 2 
 
 
 
 
 
 13-0 
 
 O.A 
 
 2^*0 *-* &c 
 
 . 
 
 ^ ^, , M 
 
 .j 
 
 
 2 a * 
 
 a s 
 
 o c a 
 
 0? 
 
 ^ QJ'rH 2^ 
 
 03 
 
 1 
 
 
 a a 
 
 * tca^"5 
 
 t> 
 
 
 ,2 2" c 
 
 
 
 tn 
 
 '3 g 
 
 js of o 
 
 ^.JS 
 
 5 .2 J 
 
 ^ 
 
 M'5 ^"^ 
 
 H 
 
 31 
 
 P'S 
 
 ' _, 
 
 IM*"^ 
 
 5 1?1 
 
 3 
 
 i o'^'g'l 
 
 a 
 
 OH g 1 
 
 :*j 
 
 O 
 
 
 ^H 
 
 " H S o a 
 
 4t 
 
 7 a 
 
 Q3 (p fe 
 
 "rt -H 
 
 J ^*PH ^ 
 
 N 
 
 o Si's 
 
 H 
 
 S > 
 
 'S fe 
 
 h -4J 
 
 ^ "2 *M tic d 
 
 b 
 
 to &L 
 
 a . 
 
 *> 
 
 5 , ^3 . 
 
 3-5 
 
 -2* tf .23 
 
 O 
 
 in aS^f 
 
 o-a 
 
 5 
 
 ^3 ^ ^? ^ 
 
 03 ^ a" 
 
 -fl O ^ "Q ^ -^ 
 
 ^ri 
 
 ^2 * 3 H cfl 
 
 ^ ~p 
 
 
 So 2 
 
 15 
 
 5 o--'^ 5 " 
 
 
 .tj 2-a"a 
 
 o 
 
 
 <o o d 
 
 ^-fci 
 
 * ja -- 1 
 
 
 14 O O fl? 
 
 o 
 
 i. 
 
 lift 
 
 50 -gi 
 
 Is si 
 
 PI! 
 
 Hi! 
 
 sa-o- 3 
 
 |||l 
 
 111! 
 
 o"8.a a o 
 fta'S S tc 
 S 2 
 
 g 01 03 
 
 Dusky red 
 slightly eleval 
 ginning on fa< 
 spreading ovei 
 
 Bright pinl 
 orpapulesbeg 
 on face and e 
 ingrapidlyove 
 
 Continuous 
 red rash, ext< 
 from neck 
 wards over 
 and limbs. 
 
 l|aa 
 
 UI4-I rt M< 
 
 03 H to 
 080 
 
 O*H -4- 
 
 Greyish 
 membrane on 
 or hidden behi 
 palate or i 
 JLarynx. 
 
 Recurren 
 longed paroxy 
 cough (with 01 
 out whoop) f 
 ating in gagg 
 vomltiner. 
 
 O e8'^3 6,tn 
 
 
 
 a >> 
 
 w (-> 
 
 Is 
 
 g -8 
 
 ^S.2 B a 
 
 -4-3 CO 
 
 2 * 
 
 a -S 
 
 01 03 
 
 
 
 Qg 
 
 T3 
 
 
 ^ 
 
 
 -w " 
 
 eS | 
 
 
 
 S In ft" 
 
 i-l 01 
 
 - 1 w 
 
 *" m 
 
 
 H 01 
 
 <=> 01 
 
 * o) 
 
 pisgfl 
 
 S s? 
 
 -2-3 
 
 S | 
 
 O "> 
 
 O ^ 
 
 T? >> 
 
 s| 
 
 H ^ 
 
 -i 
 
 ** 
 
 
 1-1 
 
 N 
 
 
 
 
 
 o> ^-> 
 
 M 
 
 
 
 03 
 
 
 
 : - es 
 
 ^ 
 
 
 
 1 X--. 
 
 
 
 ^^ 
 
 
 CM (B 
 
 1 
 
 tc B W 
 
 1 
 
 M 
 
 Q 
 
 _rt 
 || 
 
 German 
 Measles 
 (Rotheln 
 
 -tf 03 
 OS o 
 
 Chicken 
 (Varicell 
 
 H 
 1 
 
 S 
 
 1 fe 
 
 162
 
 THE MEDICINE CHEST 163 
 
 THE MEDICINE CHEST 
 
 A little learning is a dangerous thing, so too is a Hygiene 
 razor in the hands of a child. Much more harm may Medicine 
 follow the unskilled use of drugs than from their neg- 
 lect. Pernicious as is constant "doping" for the adult, 
 it is much more so for the child. A complicated medi- 
 cine chest may become a source of endless mischief in 
 the household. "If it does no good it can not do any 
 harm" may be said of nothing possessed of any po- 
 tency for either good or evil. The following is a brief 
 list of remedial agents for the nursery : 
 Alcohol. 
 
 Alboline (or Lavoline) for daily use in the atomization of 
 nose and throat. In nasal catarrh a physician will 
 give a prescription for a medicated aboline. 
 Boric Acid. A solution of a tablespoonful to a pint of boil- 
 ing water, cooled and strained through gauze into a 
 sterilized bottle, may be used as a gargle or wherever 
 a mild antiseptic wash is needed cuts, bruises, etc. 
 Bicarbonate of Sodium. 
 Brandy. 
 
 Bromide of Sodium In five grain tablets, for convulsions. 
 Castor oil the most effective and least harmful cathartic. 
 Usual dose, 2 to 6 months, I teaspoonful of castor 
 oil and sweet oil mixed; under 2 months, half the 
 amount of the mixture; up to I year, about i tea- 
 spoonful of castor oil; I to 4 years, 1^/2 to 2 teaspoon- 
 fuls or more, according to susceptibility. To a child 
 old enough to find the taste objectionable the castor 
 oil may be given in a little warm milk or coffee and 
 milk, followed by more milk, lemonade or peppermint 
 candy.
 
 164 CARE OF CHILDREN 
 
 Ipecac, Syrup of. As an emetic give a year old baby l /z tea- 
 spoonful, followed by drink of warm water. Repeat 
 dose every 15 minutes until vomiting. 
 
 Lime Water. 
 
 Mustard. 
 
 Peppermint, Essence of. 
 
 Sweet oil. 
 
 Vaseline. 
 
 Absorbent Cotton, antiseptic. 
 
 Adhesive Plaster. 
 
 Alboline Atomizer (Constructed to spray oils). 
 
 Ear and Nose Syringe. (Soft rubber.) 
 
 Fountain Springe. 
 
 Flexible rubber Catheter, number 10 (for rectal tube). 
 
 Gauze, antiseptic. 
 
 Hot water bottle.
 
 HYGIENE OF THE CHILD AND YOUTH 
 
 Getting the baby out of arms should not diminish 
 the mother's care, but the same protection as given 
 in the nursery should extend throughout childhood, 
 with such modifications as the changing anatomy and 
 physiology demand. In fact, the child of two or three 
 years should receive more of her time and thought 
 than the younger babe, for it is now that his training 
 in personal hygiene should begin and habits of per- 
 sonal cleanliness be established. After infancy, the 
 danger from death may be lessened but not of per- 
 verted 'development. 
 
 The fact that a child is able to dress himself does 
 not relieve the mother of the responsibility of seeing 
 that he is properly clothed, and even though he is old 
 enough to sit at the family table, especial attention 
 must still be given to his diet and manner of eating. 
 Thorough mastication is a most important feature of 
 the child's early training and he should not be allowed 
 to "wash down" his food. He should eat some foods 
 requiring vigorous mastication, such as toast and hard 
 cracker, to help in developing strong teeth. 
 
 Too frequently the temporary teeth are neglected 
 both as to personal and dental care under the mistaken 
 impression that their early loss renders. them of little 
 importance. Even were this true (which it is not) 
 the health and comfort of the child would suggest 
 that they be kept clean and in perfect condition as long 
 
 166 
 
 More Care 
 Not Less 
 
 Care of 
 the Teeth
 
 i66 
 
 CARE OF CHILDREN 
 
 Care of 
 the Throat 
 
 Deep 
 Breathing 
 
 as they remain. To accomplish this end the teeth 
 should be thoroughly brushed and the mouth cleansed 
 with a pleasant antiseptic, such as dilute listerine, boro- 
 lyptol or glyco-thymoline, night and morning (especi- 
 ally at night) and the slightest decay of the teeth 
 should be referred to the dentist. 
 
 After a child is taught to properly cleanse his mouth 
 it is but a short step to teach him to gargle and this 
 mastered a little tact and patience on the part of the 
 mother or nurse will soon initiate him into the use of 
 the atomizer and nasal douche, accomplishments which 
 may prove of inestimable value at some critical time. 
 
 Every night and morning (oftener if necessary) the 
 nasal passages should be freed from excessive secre- 
 tion, not only so that the child can breathe through 
 his nose but to get rid of material which harbors in- 
 fections. The child should early be taught the use 
 of the handkerchief and required to carry his own 
 and impressed with the danger of contact with those 
 soiled by others. 
 
 Any tendency to mouth breathing should be immedi- 
 ately corrected and if necessary the advice of a physi- 
 cian sought. 
 
 Deep breathing should be early taught and insisted 
 upon until it becomes a firmly established habit. This 
 cannot be accomplished with unsuitable clothing or 
 without correct postures in standing, sitting and walk- 
 ing. Frequent exercise jn the open air, such as taking 
 a deep inspiration while five, ten or even fifteen sec-
 
 HYGIENE OF THE CHILD 167 
 
 onds are being counted, may be made a game of com- 
 petition. 
 
 The need of plenty of sleep throughout the entire sleep 
 developing period can not be unduly emphasized and 
 to this end quiet, well ventilated chambers and indi- 
 vidual beds are necessary. 
 
 Young children should retire soon after the light 
 supper. Studying, playing or reading by artificial 
 light may interfere with the rest and recuperation 
 required after the fatigue of the day. 
 
 The frequency, duration and temperature of the Bathing 
 bath should depend upon the reactionary effects upon 
 the child. A cold tonic shower bath is best given in 
 the morning and should not last more than half a 
 minute. The child should stand in warm water which 
 covers his feet and be gently sprayed with warm water 
 before turning on the cold shower. If a shower bath 
 is not available, a quick sponge with tepid to cold 
 water with a brisk toweling may be given. The 
 advisability of the cold baths should be decided by the 
 family physician, as all children should not take them. 
 The warm bath may be given before retiring if suffi- 
 cient time be allowed for the digestion of the supper. 
 General bathing should never immediately follow a 
 meal. 
 
 EDUCATION 
 
 Childhood is recognized as the piaytime of life and 
 most of the plays of children are educational in their 
 tendency. That physical development and training
 
 i68 
 
 CARE OF CHILDREN 
 
 Games 
 for Girls 
 
 Development 
 of the Brain 
 
 should take precedence of the mental is self-evident to 
 all who witness the sad spectacle of an over-trained 
 mind in a feeble body. 
 
 In childhood, at least, girls should share the outdoor 
 sports of their brothers. There is no reason why the 
 pleasurable and useful exercise of running, jumping, 
 swimming, rowing, skating, riding, cycling and most 
 games should be confined to boys. The cry of ."tom- 
 boy" has deprived many a girl of the physical founda- 
 tion for the duties and responsibilities of mature 
 womanhood. 
 
 Rousseau says, and truly, the weaker the body is, 
 the more it commands; the stronger it is, the more it 
 obeys. 
 
 "A well-trained nervous system is the greatest friend 
 that the mind can have." Halle ck. 
 
 The country affords special advantages for the nor- 
 mal development of the child, for here it is that he 
 comes close to nature which furnishes innumerable 
 object lessons and problems which his inherent curi- 
 osity impels him to solve. Thus he is led to develop 
 himself through a symmetrical training of muscles 
 and brain. For the city child, these conditions should 
 be approximated as nearly as possible. 
 
 The brain, relatively large, even at birth, is suscepti- 
 ble of very rapid development. If, however, this be 
 allowed to exceed that of the muscles, irreparable dam- 
 age may result and mediocrity take the place of early 
 precocity through early exhaustion of the brain cells 
 from over stimulation. It must never be forgotten
 
 HYGIENE OF THE YOUTH 
 
 169 
 
 that young nerve cells tire quickly, not yet having the 
 stored energy of maturity. 
 
 The younger the child the more should the early 
 educational efforts be restricted to the larger groups 
 of muscles, leg, arm and body exercise rather than 
 those of the fingers and smaller groups of muscles 
 which require concentrated efforts at finer co-ordina- 
 tion. The use of the needle, pencil, brush and scissors 
 may well be deferred and replaced by romping games, 
 efforts at house building with large blocks or shovel 
 and sand pile. 
 
 The proverbial laziness of the boy of eight years is 
 based upon a physiological fact which is too frequently 
 overlooked. His heart at this time has not kept up 
 with the rapid growth in body length and is barely able 
 to maintain the circulation of the blood for ordinary 
 mental and muscular exertion. He is least fitted at 
 this time for the extra demands made upon him for 
 running errands and doing all sorts of chores which 
 he usually does clumsily and tardily because of ex- 
 cessive fatigue. Many boys and girls are stunted for 
 life or succumb to infectious disease from excessive 
 burdens imposed during this period of weak heart, 
 namely, from the eighth to the twelfth year. 
 
 It has been shown often that the purpose of our so- 
 called educational systems has been defeated by ig- 
 norance of the child's capacity for concentrative atten- 
 tion to a given subject. Fifteen minutes is about the 
 limit for a child between five and seven years of age 
 
 Period of 
 Weak Heart 
 
 Limit of 
 Attention
 
 170 
 
 CARE OF CHILDREN 
 
 Eye and Ear 
 Strain 
 
 and the grammar school pupils rarely show a ca- 
 pacity for more than thirty minutes of uninterrupted 
 study. This power may be even further reduced by 
 debilitating conditions, such as improper food, im- 
 paired digestion, physical fatigue, insufficient sleep or 
 vitiated air of the school room. 
 
 6 7 a 9 lO'ii 12 13 14 15 16 YEA3> 
 
 o- 
 
 
 JSOY.S 
 
 JU.S 
 
 \ 
 
 \ 
 
 Krohn's Diagram Representing Relative Time of Fatigue 
 at Different Ages. 
 
 Early exhaustion of nerve force is frequently in- 
 creased by eye strain from defective vision and pupils 
 often appear dull at school because they can not see 
 distinctly maps, charts or blackboard exercises. In 
 the same category as a cause of apparent mental dull- 
 ness is defective hearing, the words of the teacher 
 failing to make a definite impression upon the child's 
 sensorium, with resultant confusion of ideas. In this 
 respect a grave responsibility rests upon parents and 
 teachers. The oculist and aurist should be frequently
 
 PUBESCENCE 171 
 
 consulted and any defects in these "avenues to the 
 mind" corrected. 
 
 The subject of school -room hygiene is too broad to school 
 receive more than passing .mention here. The parent 
 should visit the schools and satisfy himself as to the 
 heating and ventilation of the rooms in which his chil- 
 dren spend so many hours. The seating with refer- 
 ence to light and vision, adaptation of seat and desk 
 to the size of the child so that undue fatigue or actual 
 deformity may be obviated, should also be given con- 
 sideration. Is there a judicious alternation between 
 mental concentration and free-limbed exercise suitable 
 to the child's age? 
 
 PUBESCENCE 
 
 Pubescence is a period of the greatest importance in 
 the development of the child, not only physically but 
 mentally and morally. 
 
 The rounding out of the girl's physique with broad- Changes 
 ening of the hips and rapid growth of the breasts sug- <Hri 
 gests the approach of menstral function. This should 
 never be allowed to take the little maiden by surprise, 
 but the mother should have prepared her daughter's 
 mind for this sign of womanhood. Unfortunate is the 
 girl whose mother has not had the tact and courage to 
 instruct her beforehand concerning the true meaning 
 of conception, gestation and motherhood. Many lives 
 have been lost or ruined because the mother has failed 
 in her duty in this respect. 
 
 Probably the best argument for the early study of
 
 172 CARE OF CHILDREN 
 
 biology, including botany, is the natural introduction 
 thus afforded to the great mysteries of ovulation, fruc- 
 tification, conception, gestation and parturition and the 
 true physical relation of the sexes in the great plan of 
 life. There is nothing to shock the modesty of the 
 normal girl if these subjects are properly approached 
 along the lines of comparative biology. 
 Oar The pubescent girl's periodical indisposition should 
 be recognized and guarded from undue burdens and 
 responsibilities, as the foundation for future suffering 
 and disease is often laid at this time. The woman is 
 fortunate whose pubescent life escaped the crippling 
 effect of tight or high-heeled shoes, whose anatomy 
 has not been distorted and generative organs disar- 
 ranged by the corset, and whose moral and social edu- 
 cation has followed natural family and domestic lines 
 rather than the artificialities of the so-called modern 
 society. 
 
 Wholesome companions and literature, out-of-door 
 exercises and amusements with reasonable domestic 
 responsibilities should alternate with judicious selec- 
 tion of musical, physical and literary curriculum in 
 well-selected schools. 
 
 The judicious parent will endeavor to teach the pu- 
 bescent boy manliness rather than mannishness, and 
 to inculcate early reverence and respect for pure 
 womanhood. He should have the companionship of 
 pure-minded girls. 
 Boy The boy ought to be taught by a senior whom he re-
 
 PUBESCENCE 
 
 veres (preferably his father) the true meaning of sex 
 differentiation and sexual passion. It should be clearly 
 shown him that venereal disease with its far-reaching 
 baneful effects lurks ever as the penalty for licentious- 
 ness. He should be given to understand that an oc- 
 casional seminal emission while sleeping is no more 
 sinful than a transient hemorrhage from overcharged 
 blood vessels or vomiting for an overloaded stomach. 
 Above all, he should be taught to respect his own 
 body. 
 
 Here again competitive athletic sports, good litera- 
 ture, the study of natural sciences with abundance of 
 out-door life will lead the boy away from tendencies 
 toward immorality and dissipation. 
 
 Close confinement to books and literature too fre- 
 quently causes physical and mental collapse during 
 pubescence, for which the prizes for scholarship are 
 not infrequently responsible. Plenty of fresh air both 
 day and night and the daily cold bath are items of tre- 
 mendous value in the hygiene of pubescence. Empha- 
 sis and encouragement to physical development should 
 be given by the parent at this time (and at all times). 
 Better take the boy or girl out of school for a term or 
 two, if necessary, than to harm his body for life. Book 
 learning can easily be made up, but perverted physical 
 development often can never be rectified. 
 
 Physical 
 
 Development 
 
 Host 
 
 Important
 
 174- CARE OF CHILDREN 
 
 BIBLIOGRAPHY 
 \ 
 
 Care of the Baby ($1.50, postage .18). J. P. Crozer Griffith, 
 
 M. D. 
 Care of a Child in Health ($1.25, postage .12). N. Oppenheim, 
 
 M. D. 
 Care and Feeding of Children ($.75, postage .08). L. E. Holt, 
 
 M. D. 
 
 Century Book for Mothers ($2.00, postage .18). Yale and Pol- 
 lock. 
 Development of the Child ($1.25, postage .12). N. Oppenheim, 
 
 M. D. 
 
 Hygiene of the Nursery ($1.00, postage .08). Louis Starr. 
 Theory and Practice of Infant Feeding ($2.25, postage .20). 
 
 Henry Dwight Chapin, M. D. 
 Food and Principles of Dietetics ($3.00, postage .26). Robt. 
 
 Hutchison, M. D. Chapters 24, 25, 26. 
 School Hygiene (For teachers) ($1.00, postage .10). Edward 
 
 R. Shaw. 
 
 Medical Books 
 
 Diseases of Children ($3.50). A. C. Cotton, M. D. 
 Pediatrics Hygiene and Medical Treatment of Children 
 
 ($6.00). T. M. Rotch, M. D. 
 Diseases of Infancy and Childhood ($6.00). L. E. Holt, M. D.
 
 TEST QUESTIONS 
 
 The following questions constitute the "written reci- 
 tation" which the regular members of the A. S. H. E. 
 answer in writing and send in for the correction and 
 comment of the instructor. They are intended to 
 emphasize and fix in the memory the most important 
 points in the lesson.
 
 CARE OF CHILDREN 
 
 PART III 
 
 Read Carefully. Place your name and address on the first 
 sheet of the test. Use a light grade of paper and write on 
 one side of the sheet only. Leave space between the answers 
 for the notes of the instructor. Answer every question fully. 
 Read the lesson paper a number of times before attempting 
 to answer the questions. 
 
 1. Does crying benefit the baby? If so, how? 
 
 2. Describe different cries and give their interpre- 
 
 tation. 
 
 3. What do you understand by nervousness irr a 
 
 child? 
 
 4. Name some causes for nervousness and the 
 
 symptoms. 
 
 5. (a) What does fever indicate in an infant? 
 (b) What may be done for its relief? 
 
 6. (a) What is an ordinary cold? 
 (b) Why is no cold trivial? 
 
 7. Give the cause of sore throat. 
 
 8. (a) What is the "anarchist's den"? 
 (b) How may it be cared for? 
 
 9. What contagious diseases are the most danger- 
 
 ous and why? 
 
 10. Mention the possible after effects of measles. 
 
 of scarlet fever. 
 
 11. What causes convulsions? Why are they to 
 
 be dreaded? 
 
 12. What should be done for their immediate re- 
 
 lief? What for their prevention?
 
 CARE OF CHILDREN 
 
 13. Mention two important items in the care of 
 whooping cough? 
 
 14. Why should a physician be called immediately 
 in a case of suspected contagious disease? 
 
 15. How may scurvy be prevented? 
 
 16. What is rachitis? How may it be prevented? 
 
 17. What are the dangers of a discharging ear? 
 
 1 8. How would you guard the baby against sum- 
 mer complaint? 
 
 19. What can you say as to treatment for consti- 
 pation ? 
 
 20. What is the aim of education? 
 
 21. What to you are the most important points in 
 the hygiene of the school child ? 
 
 22. Pubescence, what does it mean in the life of 
 the boy and girl ? 
 
 23. What questions have you to ask? 
 
 Note After completing the test, sign your full name
 
 SODIUM CITRATE IN INFANT FEEDING * 
 
 BY A. C. COTTON, M. D. 
 
 The infant deprived of the breast must, in relation 
 to his feeding, be regarded as a pathologic problem. 
 That this statement is axiomatic is shown by the fact 
 that more earnest work has been bestowed on infant 
 feeding during the past twenty years than on all other 
 pediatric subjects combined. That the problem is 
 still unsolved the high relative mortality and later 
 morbidity (illness) of artificially fed infants bear 
 constant witness. 
 
 The six essentials of Cheadle, enunciated by that 
 observer some time in the '8o's, bear witness that the 
 essential requirements of an artificial food for babies 
 were broadly understood twenty years ago. Quoting 
 from memory, they are briefly as follows: i. Steril- 
 ity. 2. Antiscorbutic property. 3. Quantity. 4. 
 Some Animal constituents. 5. Form suitable. 6. 
 Constituency. Much has been learned since Cheadle 
 by amassing clinical results and observations. Mean- 
 while the deductions from a priori reasoning have 
 proven unsatisfactory for the simple reason that so 
 little was known of the physiology of infant digestion. 
 Latterly the premises from which we reasoned have 
 been proven, almost without exception, to be incor- 
 rect. 
 
 * Read in the Section on Diseases of Children of the American Medical 
 Association, at the Fifty-seventh Annual Session, June, 1906. Reprinted 
 from the Journal of the American Medical Association of October 6, 1906. 
 
 179
 
 i8o CARE OF CHILDREN 
 
 Thus the great American experiment known as 
 the exact percentage method of feeding required 
 that the baby's diet should consist wholly of cow 
 products and water, so modified in its five gross 
 constituents as to coincide quantitatively with simi- 
 larly named constituents of average breast milk. 
 One other ingredient only was allowable in this 
 feeding mixture, viz., some alkalin solution, as lime 
 water, sodium bicarbonate, or magnesia. This dogma, 
 which in connection with laboratories established 
 throughout the country had almost become a cult 
 in infant feeding, was practically based on seven 
 assumptions, which have recently been proven 
 erroneous, to wit: 
 
 1. The qualitative similarity in breast and cow's 
 milk of the lactose, fats, albuminoids, proteids and 
 their chemical combination with the milk salts. 
 
 2. The claimed alkalinity of breast milk in contra- 
 distinction to the acidity of cow's milk. 
 
 3. The possibility of a synthetical substitute for 
 breast milk from cow products alone. 
 
 4. The claim that cereals were not allowable 
 because indigestible in the infant's secretions and 
 that they induced dyspepsia and intoxication by 
 acting as decomposing foreign matter. 
 
 5. That cereal gruels were no more efficient in the 
 prevention of dense milk coagula than dilution with 
 plain water. 
 
 6. That HC1 played no part in the digestive process 
 until later infancy.
 
 SODIUM CITRA TE IN INFANT FEEDING 181 
 
 7 . That the important proteid content of the baby 's 
 food could be made up from the non-coagulable whey 
 albumin of cow's milk. 
 
 The elucidation of facts in refutation of these prem- 
 ises is due to the earnest work of a number of men, 
 prominent among whom as members of this associa- 
 tion may be mentioned Chapin on cereal gruels and 
 gastric development, Kerley on milk reaction and 
 alkalinization, Shaw on HC1 secretion in infants, 
 Stern on milk fats, Southworth on the art versus the 
 science of infant feeding, Morse on acidified milk and 
 buttermilk feeding, and the recent unsurpassed work 
 in chemistry of milk by Van Slyke and Hart at 
 Geneva. Most of these contributions have enriched 
 our literature and become familiar to all. The 
 subject is still a broad one. I disclaim any intention 
 of attempting in this limited paper to deal with it in 
 toto, and indulge in these preliminary observations 
 merely to emphasize the fact that no royal road to 
 successful feeding by exact mathematical formulas 
 has yet been found. Nor do I wish to convey the 
 impression that I would belittle the value of attempts 
 at accuracy in determining the component parts of 
 the infant's dietary. 
 
 Great credit is due and will ever be associated with 
 the name of Dr. Rotch as the founder of a system 
 which has not only served as a hypothesis for tenta- 
 tive feeding, but has stimulated to greater accuracy 
 and more careful clinical observation and recording 
 of results than was possible by any other method.
 
 1 82 CARE OF CHILDREN 
 
 As an enthusiastic advocate of the so-called American 
 method, I am on record frequently both at home 
 and abroad. I may be pardoned if I suggest that the 
 tendency in general is too much along the line of the 
 refinement of mathematical formulas to the neglect 
 of the obvious importance of gastric development 
 along normal physiologic lines. 
 
 The spectacle of a marantic infant with persistent 
 curds in the stools, though cow proteids have been 
 reduced to the extreme limit of attenuation by dilu- 
 tion with water, is a familiar one. So, also, too 
 commonly in evidence is the child, fed long but not 
 nourished, on whey proteids and cream, whose gastric 
 vigor has not progressed beyond that of early infancy. 
 
 Important as the role of carbohydrates and fats in 
 infant development may be, and difficult as the pro- 
 blem of properly dealing with fats is, it is to the 
 management of the proteids that I beg to call your 
 attention in the few minutes allowed. Their impor- 
 tance in the nutrition of the child needs no emphasis, 
 as it is universally accepted both theroetically and 
 clinically. 
 
 The intolerance of the infant's digestive organs to 
 cow proteids, so widely different from those for which 
 they were intended, is also well known. Of the many 
 methods in vogue for the establishment of toleration of 
 these refractory curds the one most common, unfor- 
 tunately, is their quantitative reduction by dilution 
 far below percentages absolutely necessary for the
 
 SODIUM CITRA TE IN INFANT FEEDING 183 
 
 development and growth of the child. In fact, the 
 common advice to infant feeders on percentages of 
 milk in recognition of its refractoriness, is either to 
 restrict the proteid percentage far below that which is 
 known to obtain in average breast milk (as though 
 Nature would commit the absurdity of elaborating 
 the necessary amount of proteid from even a less 
 quantity when presented in the more obstinate form 
 of cow casein), or to substitute the non-coagulable 
 proteids of whey. 
 
 In either case Nature is cheated of her absolute 
 demands. The pathetic malnutritional results of 
 low proteid feeding, both immediate and remote, are 
 too familiar to us all to need further elaboration. 
 Aside from this slow starvation and stunted growth 
 with its diminished resistance to intercurrent disease 
 from insufficiency of nitrogenous food, abundance of 
 proteids is demanded in a coagulable form for the nor- 
 mal development of the gastric function, as ably 
 shown by Chapin and corroborated by a host of clini- 
 cal observers. This the infant gets at the mother's 
 breast in proteids which clot on admixture with the 
 gastric contents in soft, flocculent, semi-solid coagula 
 which readily pass the pylorus in a form suitable to 
 intestinal digestion and absorption. 
 
 The important question, then, in feeding cow's 
 milk is not how to reduce the proteids and sustain 
 life, but how to increase the proteids and maintain 
 unimpaired digestion. Buttermilk has been tried:
 
 1 84 CARE OP CHILDREN 
 
 acidulated milk has been tried; admixture with 
 gruels has been tried ; koumiss, matzoon, and kephir 
 milk have been tried; the addition of various alka- 
 lies is much in vogue; all with varying degrees of 
 success, and each measure has its ardent advocates. 
 That the question is not yet settled this diversity of 
 opinion amply indicates. It is still an open field, and 
 the cry that no chemical tampering with the milk 
 should be encouraged need deter no one, since it is 
 proven beyond dispute that cow's milk, however 
 modified, is not a natural food for the human infant. 
 The more orthodox observers of the original labora- 
 tory percentage modification have from the first 
 chemically tampered with the milk in the addition of 
 lime water, sodium bicarbonate, etc., in the mistaken 
 notion of humanizing the mixture by rendering it 
 alkalin. That we reached further than we intended 
 in our administration of alkalies and secured tolera- 
 tion of the curds through neutralization of the normal 
 gastric acids does not lessen the evils of inhibition 
 of those digestive processes which can occur only in an 
 acid medium. 
 
 Since deductive methods from a priori reasoning 
 have thus far failed of a satisfactory solution of this 
 problem, let us welcome inductive methods conducted 
 along rational lines, since massed clinical evidence 
 must ever be the tribunal before which all method 
 must come to trial. Whether secundus artem or 
 secundus scientiam, it is the greatest number of babies
 
 SODIUM CITRA TE IN INFANT FEEDING 185 
 
 who live and thrive and resist disease that demon- 
 strates the merits of their hygiene. 
 
 It is with the firm conviction that sodium citrate, 
 through its inhibition (prevention) of dense coagula- 
 tion of cow's milk in the presence of an acid and 
 rennin, may prove valuable in the solution of the 
 proteid problem that I present a brief re"sum<S of my 
 experience with this agent. 
 
 More than two years ago in a personal letter from 
 one of my assistants, Dr. J. W. Vanderslice, who was 
 studying abroad, my attention was called to this 
 use of sodium citrate. The reports from Dr. F. J. 
 Poynton's clinic at Great Ormond Street, London, 
 from which the writer as an eye witness drew his con- 
 clusions, seemed sufficient to justify a careful con- 
 sideration of this new method of overcoming some 
 of the obstacles in the adaptation of cow's porteids 
 to infant digestion. 
 
 Rather cautiously, I began prescribing the citrate 
 in cases in which varying milk mixtures had been 
 used with poor success. Later, as I found that 
 infants would tolerate a larger proportion of the milk 
 in the feeding mixture when citrated, than by any 
 other modification known to me, I used it more boldly, 
 so that during the past two years I find a record of its 
 employment for a longer or shorter period in more 
 than 50 cases in both hospital and private practice. 
 I have here, by the courtesy of Dr. J. D. Merrill, a 
 report of 8 cases in which she has carefully observed
 
 1 86 CARE OF CHILDREN 
 
 its effects for a considerable time, also, by the courtesy 
 of Dr. Vanderslice, a history of 29 cases reported by 
 him at different times to the Chicago Pediatric Society. 
 In addition to this I have read carefully Dr. Shaw's 
 report of 22 cases, making a total of 1 1 2 cases embrac- 
 ing nearly all conditions from simple dyspepsia to 
 marasmus and ranging in age from the new born to 
 adults who have suffered from milk dyspepsia. 
 
 Sodium citrate being very soluble in water, the 
 method of employment is simple, as follows: An 
 aqueous solution is ordered containing from i to 5 gr. 
 to the dram. A quantity of this solution is furnished 
 the mother or nurse with instructions to add to the 
 baby's bottle immediately before feeding enough of the 
 solution to represent i, 2, or even 3 gr. of the citrate 
 to each ounce of milk in the feeding mixture, accord- 
 ing to the prescriber's idea of the requirements. The 
 feeding mixture may consist of varying dilutions of 
 milk with water or gruel, with the addition of cane or 
 milk sugar, with or without cream. No alkalies are 
 added, the sodium citrate used being a neutral salt. A 
 most noticeable feature in this method of feeding is the 
 large proportion of milk in the feeding mixture that 
 the infant will tolerate without evidence of gastric 
 disturbance or the appearance of any considerable 
 amount of undigested casein in the stools. In fact, 
 the stools of babies fed on citrated milk have come 
 to be regarded by Drs. Merrill, Vanderslice, and 
 myself as positively characteristic, being firm enough
 
 SODIUM CITRA TE IN INFANT FEEDING 187 
 
 to show form on the diaper, free from fecal odor, and 
 homogeneous in color and consistency. The slight 
 tendency to constipation mentioned by Dr. Vander- 
 slice I have observed in a number of cases. This I 
 attributed to the low percentage of fat in the food 
 consisting of equal parts of milk and water or even 
 one part of milk to two of water. In but few instances 
 have I observed this constipation where the fat 
 content of the mixture equaled 3 per cent. 
 
 One indication for the increase of the sodium 
 citrate, even in some cases to as high as 3 gr. to the 
 ounce of milk, is vomiting of curds. Another indica- 
 tion is the appearance of curds in the stools, care 
 being taken to exclude indigestion from excess or 
 intolerance of fats. Of the stools, J. H. Salisbury, 
 professor of chemistry, to whom they were submitted, 
 reports as follows: 
 
 Three samples of the feces of infants fed with milk modi- 
 fied by the addition of citrate of sodium were examined. 
 The feces were yelloV, of a moderately firm consistence and 
 remarkably homogeneous. On microscopic examination a 
 few round masses, probably calcium soaps, could be seen 
 scattered through the otherwise very fine debris. In two 
 specimens short crystals of soap could be detected. No 
 free fat was found. On treatment with acetic acid more 
 or less acid crystals could be observed and in one specimen 
 this was especially marked. Chemical examination of one 
 specimen for proteids was negative. 
 
 The duration of the administration of the sodium 
 citrate, as well as the quantity employed, varies con- 
 siderably in different cases, the purpose being to
 
 188 CARE OF CHILDREN 
 
 bring the baby's feeding up toward whole milk as 
 rapidly as possible. As toleration is established the 
 amount of citrate is reduced to one, to one half and to 
 one fourth of a grain per ounce of milk until it can be 
 discontinued. It happens not infrequently that the 
 citrate is profitably resumed on the recurrence of 
 signs of indigestion. In but 6 cases have I felt 
 obliged to discontinue the citrated milk and adopt 
 other methods of feeding. Some of these were among 
 my early cases which, if occurring later, would pos- 
 sibly have received a more persistent treatment with 
 citrated milk. 
 
 In consideration of this subject three questions 
 naturally arise: i. Is the employment of sodium 
 citrate any better than other methods of rendering 
 cow proteids tolerable and digestible ? 2 . Is its 
 employment harmful? 3. In what manner does 
 it act? 
 
 In answer to the first I would say that this method 
 seems to allow a more rapid increase in the propor- 
 tion of milk ingested than any other known to me. 
 Moreover, the frequency of relief from milk indi- 
 gestion on the addition of the citrate and the favor- 
 able reports from all whom I have known to give 
 it a thorough trial are not without significance. 
 In regard to its harmfulness, no case of citrated 
 milk feeding has been brought to my attention in 
 which there appeared to be cause for regret because 
 of the employment of this method.
 
 SODIUM CITRA TE IN INFANT FEEDING 189 
 
 Concerning its manner of action in a chemical 
 sense, there appears to be some difference of opinion. 
 Professor Salisbury, above quoted, to whom the 
 question was submitted, states as follows: 
 
 Citrate of calcium is insoluble in water, but dissolves readily 
 in solutions of the alkali citrates. It is to be presumed, 
 therefore, that when a solution of sodium citrate is added 
 to milk, which contains calcium in combination with casein, 
 a reaction would occur producing a sodium combination 
 of casein and an insoluble calcium citrate. The latter 
 would dissolve on the addition of an excess of sodium citrate. 
 It is to be presumed, therefore, that the milk treated with 
 citrate of sodium contains a sodium compound of casein 
 and calcium citrate held in solution by the presence of sodium 
 citrate. Such milk would not yield a curd containing an 
 excess of calcium, but the calcium would be found in the whey 
 as well as in the curd. The experiments of Dr. R. Aibinder 
 do not contradict the theory of Poynton that sodium citrate 
 acts by separating the calcium from the casein, thus render- 
 ing it less easily coagulable. Sodium citrate would react 
 with hydrochloric acid solution to form sodium chlorid and 
 citric acid. The decomposition would not be complete but 
 so nearly so that a large quantity of sodium citrate would 
 neutralize nearly all the free hydrochloric acid of the gastric 
 juice. Too large an amount of sodium citrate in the milk 
 might, therefore, interfere with the digestion of proteids 
 in the stomach. Such digestion might occur in the intestine 
 from the action of the pancreatic juice. 
 
 The physical behavior of citrated milk in vitro, 
 outside the body, is obvious and may be demonstrated 
 in a simple manner suggested by Wright and Poyn- 
 ton, who first exploited this method of feeding. Into 
 each of two test tubes containing equal quantities of
 
 igo CARE OF CHILDREN 
 
 milk (to one of which sodium citrate has been added) 
 drop a given quantity of liquid rennet and dilute 
 hydrochloric acid. In both milks coagulation occurs, 
 with this difference, that the citrated milk clots less 
 promptly and the resultant curd is softer, less dense, 
 more nearly resembling the curd of breast milk. 
 
 My assistant, Dr. F. W. Allin, as the result of more 
 than a hundred careful comparisons, has obtained 
 the following results: 
 
 Materials Used. Ordinary dairy milk was used 
 in these experiments. Wyeth's liquid rennet was 
 used for curdling agent, which was always added 
 last. A i per cent hydrochloric acid solution and 
 4 per cent sodium citrate solution were used. Two 
 drops of HC1 in 5 c.c. milk equals .025 per cent. 
 Five drops of sodium citrate solution equals .25 per 
 cent. One grain of sodium citrate to the ounce of 
 milk would be .20 per cent. The gruels were stand- 
 ardized to one ounce of flour or oatmeal to the quart 
 of water and cooked three hours in a double boiler. 
 
 Conditions. The experiments were all performed 
 at 40 C. in glass test tubes. The milk was used as 
 whole milk or diluted with water, flour gruel, or oat- 
 meal gruel. The dilutions made were two thirds, 
 one half, one third, one fourth, one eighth milk. 
 
 ******* 
 
 CONCLUSIONS 
 
 i. Sodium citrate in 25 per cent, or more, retards, 
 and very high percentages will inhibit coagulation.
 
 SODIUM CITRA TE IN INFANT FEEDING igi 
 
 2. The presence of HC1 hastens coagulation. 
 
 3. Diluting milk generally retards coagulation. 
 
 4. Gruels appear to have little or no effect in 
 retarding coagulation more than water when the 
 the citrate is used. 
 
 5. The coagula of citrated milk are softer, smooth- 
 er, and more jelly-like or more flocculent than those 
 of milk not thus treated. 
 
 The simplicity of this method commends itself, 
 especially in dispensary and out-patient practice, 
 where the mother's demand for "medicine" for the 
 baby's dyspepsia may be met by the standard solu- 
 tion of sodium citrate to be administered in teaspoon- 
 ful dose in each bottle of the feeding mixture. In 
 private practice it furnishes another rational method 
 of infant feeding. 
 
 1485 Jackson Boulevard, Chicago. 
 
 Editor's Note. This article, intended for physicians, is 
 included here only to inform mothers and nurses of the 
 latest and seemingly, a very important development in the 
 artificial feeding of infants. It is obvious that this new 
 method should be tried only under the direction of the at- 
 tending physician. 
 
 Sodium citrate is made by neutralizing citric acid with 
 soda Citric acid is the acid found in lemons, oranges, and 
 some other fruits. As stated, sodium citrate unites with 
 some of the lime (calcium) compounds which make the clots 
 of cow's milk more dense than those of mother's milk.
 
 THE SOOTHER* 
 
 BY A. C. COTTON, M.D. 
 
 In these days, the inalienable right of a child to 
 protection, especially during the helpless period of 
 infancy, no thoughtful physician questions. Even 
 the lay mind seems to have grasped the idea that 
 the infant should be guarded against all influences 
 detrimental to his normal growth and development. 
 
 It is well recognized that one of the commonest 
 causes of infant mortality and morbidity is to he 
 found in disturbances of the digestive tract. That 
 these disturbances are commonly due to infections 
 is generally admitted. Much is yet to be learned 
 in regard to the exact nature of these infections, but 
 all observers seem to agree upon two principal 
 sources of infection, viz., exogenous and endogenous. 
 In the majority of cases of gastro-intestinal disturb- 
 ance it is not easy to differentiate between these two 
 sources. The term "Autointoxication" is frequent- 
 ly heard as an explanation of gastro-enteric infec- 
 tion in many instances in which the source of the 
 infective material is in doubt. Enough is known 
 however, both from clinical observation and bac- 
 terial demonstration, that food infection, especially 
 among nurslings, is the most frequent cause of their 
 disorders; hence the recent revival of interest in the 
 
 *Reprinted from the Medical Brief, September, 1904. 
 192
 
 THE SOOTHER 193 
 
 milk supply and methods of handling the same, also in 
 the means of protection from germs which might prove 
 detrimental to the quality of the milk or injurious 
 to the digestive apparatus of the infant. Pasteur- 
 ization, and even sterilization, though undoubted- 
 ly depreciating the food value of the milk as well as 
 its digestibility, are advocated by many who would 
 minimize the danger from the introduction of path- 
 ogenic micro-organisms with the food. For the 
 same reason, the improved hygiene, including the 
 care of the nursing bottle, the sterilization of the nip- 
 ple, the antiseptic care of the baby's mouth, and 
 everything pertaining to the act or process of feed- 
 ing, is widely practiced. 
 
 The unanimity of the profession in regard to these 
 details leads the writer to call attention to a glaring 
 inconsistency in infant hygiene, which is so wide- 
 spread as to come under the daily observation of 
 every baby feeder. The long-tube nursing bottle 
 is practically obsolete; indeed, some municipalities 
 have enacted laws against the sale or use, for the 
 evident reason which has been amply demonstrated 
 that the apparatus can not be kept germ-free. 
 Great cedit is due to Doctor Ernest Mende, of Buffalo, 
 for his vigorous and successful crusade against this 
 death-dealing tube. As though the nursling had not 
 enough to contend with in securing his right to 
 protection in our unhygienic homes, it would seem
 
 194 CARE OF CHILDREN 
 
 that saturnine ingenuity were invoked to devise 
 methods to introduce pathogenic micro-organisms 
 into his very vulnerable digestive tract. 
 
 Such an ingenious device I now refer to, as the 
 "soother" conspicuously displayed for sale at all 
 shops. So popular with the laity is this devilish 
 invention that mothers and grandmothers wantonly 
 teach the baby its use, and have been known to 
 express regret when the infant did not take to it 
 kindly, because it appeared to be such a comforting 
 habit when once established. 
 
 Upon examination of the construction of this so- 
 called "soother" and its method of employment, it 
 is evident that no apparatus could be constructed 
 to furnish a better medium for the collection and 
 cultivation of a great variety of organisms, many 
 of which are undoubtedly pathogenic to the nursling. 
 Warmth and moisture are supplied by the baby's 
 mouth and secretions. Germs, everywhere present, 
 are planted upon this culture bed from frequent 
 contact with hands and garments and furniture, 
 floor, ground, and not infrequently, from the mouth 
 of the mother or nurse. The contrivance itself, 
 with its adhesive, retaining surfaces, its constrictions 
 and ridges, its bone shield and stem with their crev- 
 ices, depressions, and openings, its ornamental ring 
 with fancy ribbon or filthy string by which it is 
 attached to the person of the victim, all perform 
 their part in the cultivation and colonization of
 
 THE SOOTHER 195 
 
 possibly death-dealing microbes. If any one is 
 inclined to question the truthfulness of these state- 
 ments, let him possess himself of the next " soother " 
 that he meets in active operation, and examine 
 smears from the accumulations in its grooves. His 
 microscope and cultures will convince him of the 
 truth of my statement. 
 
 Pernicious as it may be, this daily and hourly 
 ingestion of infective organisms is not the limit of 
 possible injury to the infant through means of the 
 "soother." The subject of adenoid facies, so-called 
 in its relation to the existence of troublesome aden- 
 oids, has not escaped the attention of any student 
 of child development. Peculiar conformation of oral 
 and facial structures is commonly perhaps too com- 
 monly attributed to the presence of the adenoids. 
 That the adenoid face frequently appears as a 
 familiar type is well known, and the etiological 
 relationship of the malformation to the naso-pharyn- 
 geal growths is a question not yet settled. That 
 the adenoid face is found with the adenoids, is not 
 proof that the former is due to the latter. That 
 adenoids may cause mouth-breathing is evident. 
 That mouth-breathing causes well-known deform- 
 ities such as a narrowing of the palate, constriction 
 of the inferior nasal meati, with deflection of the 
 nasal septum, is not so apparent. That mere in- 
 spiration and expiration through the mouth will 
 cause, or even greatly influence the oro-nasal con-
 
 196 CARE OF CHILDREN 
 
 formation, the writer does not believe, though he 
 accepts the deformity or any other condition which 
 interferes with free nasal respiration as prolific in the 
 causation of naso-pharyngeal catarrhs, with hyper- 
 trophy of adenoid tissue. The direct current in- 
 spired in the mouth-breather incites tonsilar hy- 
 peremia and hypertrophy, so that the familiar type 
 of this deformity may prove the starting point to 
 the lesions of the mucosa above mentioned. 
 
 In the absence of heredity it may be questioned 
 whether intrauterine conditions or pressure at the 
 time of delivery, with or without forceps, may not 
 influence the peculiar conformation known as "con- 
 genital adenoid facies." Be that as it may, the 
 fact is well known that an infant apparently normal 
 at birth may gradually develop this oro-naso-facial 
 deformity between the sixth month and the third 
 year of its life. The not uncommon dental deform- 
 ity produced by thumb sucking has been thoroughly 
 exploited. Little, however, so far as the writer 
 knows, has been said in regard to the effect of the 
 continuous use of the "soother" in this connection. 
 When we recall the plastic condition of the structures 
 that make up the oral and nasal cavities, giving form 
 to the infant face, and remember that ossification 
 is incomplete at birth, proceeding only from numer- 
 ous ossific centers with intervening areas of plastic 
 tissue, it is not difficult to perceive that persistent,
 
 THE SOOTHER 197 
 
 or continuously remittent pressure applied in the 
 same direction will influence the shape of the struc- 
 ture as ossification proceeds. The modern opera- 
 tions for congenital bony defects, as fissure of the 
 palate, shows how plastic are these palatal and al- 
 veolar structures in early infancy. The normal 
 oral cavity in infancy is extremely shallow. The 
 alveolar ridges are low, and do not approximate 
 when the mouth is closed, in which position the 
 tongue fills the entire fossa, pressing lightly against 
 the flat, low-vaulted palate. 
 
 The mother's nipple, conical in shape, with proxi- 
 mal base, very compressible, is seized in the act of 
 nursing by the infant's lips, which are exceedingly 
 prehensible in their function, the anterior alveolar 
 ridges being employed to assist the suction in strip- 
 ping the nipple from base to apex. The milk; which 
 flows freely from the sympathetic breast in response 
 to the nervous mechanism of the mother, is thus 
 easily secured with but little effort on the part of 
 the child, in the line of vacuum formation. To be 
 sure, where the flow is meagre or refractory, the 
 vacuum-forming apparatus with its sucking pads 
 is complete, and may be employed with great energy. 
 In all of this, however, the roof of the mouth is dis- 
 turbed by little or no pressure, and the child, grati- 
 fied with the steady flow of delicious aliment, finds 
 but little need for suction sufficient to cause great 
 lateral pressure on the alveolar ridges. Moreover
 
 1 98 CARE OF CHILDREN 
 
 the act of nursing occupies but a short time, and is 
 followed by hours of rest. 
 
 The "soother" resembles the maternal nipple 
 in no respect. Almost without exception it is pear- 
 shaped, the narrow neck emerging from a disc of 
 bone, which, resting against the outside of the flat- 
 tened lips, prevents the apparatus from being swal- 
 lowed. This pressure does away witli the prehensile 
 function of the lips. The large foreign body, en- 
 gaged between the tongue and the yielding, plastic 
 roof of the mouth, is mumbled continuously, while 
 frantic efforts at suction to derive milk from this 
 barren apparatus develop the mechanism for vacuum 
 formation to the highest degree. What follows? 
 The powerful buccal muscles with their sucking 
 pads are continuously forced against the lateral 
 alveolar ridges. The upward pressure of this pear- 
 shaped body increases the concavity of the yielding 
 palatal arch, thus favoring the approximation of 
 the superior lateral alveolar ridges. The inferior 
 nasal meati, whose floor is thus uplifted, are dimin- 
 ished in height. The septum nari, buckling under 
 pressure, still further limits the respiratory area of 
 the nose. Moreover, the use of the "soother" be- 
 comes practically continuous as the habit develops, 
 so that the mumbling and sucking continues even 
 during the broken slumber. Indeed, it is usually 
 interrupted only long enough for the infant to 
 receive food, and the infernal contrivance to receive
 
 THE SOOTHER 199 
 
 fresh smears of bacteria from the never-failing 
 environmental supply. It is doubtful if this pro- 
 lific agent of infection and deformity will ever be 
 entirely abolished without legislation prohibiting 
 its manufacture and sale. 
 1485 Jackson Boul , Chicago
 
 SUPPLEMENTAL PROGRAM ARRANGED FOR 
 CLASSES ON 
 
 CARE OF CHILDREN 
 
 MEETING I 
 
 (Study pages 1-31) 
 Before Baby Comes. 
 
 Care of the Child in Health, Oppenheim, pages 1-46. 
 
 ($1.25, postage 120.) 
 Century Book for Mothers, Yale and Pollock, pages 1-24. 
 
 ($2.00, postage iSc.) 
 Care of the Baby, Griffith, pages 17-34. ($1.50, postage 
 
 i8c.) 
 The New Born Baby and His Care. 
 
 Care of the Baby, pages 34-46; Century Book for Mother?., 
 
 pages 25-29. 
 Clothing. 
 
 Century Book for Mothers, pages 44-58. 
 Care of the Baby, pages 86-115. 
 Exhibit. 
 
 (1) Make pattern, cut and finish a " baby bag," as shown 
 on page 23. Contrast this with a typical pinning 
 blanket. 
 
 (2) Show simple and tasteful baby's dresses and over 
 elaborate dresses. 
 
 (3) Trace the outline of a child's bare foot. 
 
 (4) Show good and bad shoes. 
 
 MEETING II 
 
 (Study pages 32-53) 
 The Nursery, Sleep, Bathing. 
 
 Care of the Baby, pages 213-224, 68-85. 
 Century Book for Mothers, pages 18-24.
 
 262 CARE OF CHILDREN 
 
 See article on The Soother in the Supplement. 
 Development and Growth 
 
 Century Book for Mothers, pages 59-76. 
 
 Care of the Baby, pages 46-67. 
 
 If possible, show a weight chart for some baby. 
 
 (Select answers to the Test Questions on Part I and send 
 
 them to the School. Report on supplemental reading, 
 
 etc. for the first two meetings.) 
 
 MEETING III 
 
 (Study pages 55-75) 
 Natural Food. 
 
 Food and Dietetics, Hutchison, pages 414-427. ($3.00, 
 postage s6c.) 
 
 Care of the Baby, Griffith, pages 116-132. 
 
 If not familiar with food principles and their use in the 
 body, read Food and Dietetics, Norton (Volume VI, 
 Library of Home Economics) , or send to the Department 
 of Agriculture, Washington, D. C., for some of the free 
 bulletins called Farmers' Bulletins: No. 142, Principles 
 of Nutrition and Nutritive Value of Food; No. 42, 
 Facts about Milk; No. 74, Milk as Food; No. 93, Sugar 
 as Food; No. 108, Eggs and their Use as Food, etc. 
 
 MEETING IV 
 
 (Study pages 75-122) 
 Artificial Feeding 
 
 Care and Feeding of Infants, Holt. (750. postage 6c.) 
 
 Food and Dietetics, Hutchison, pages 428-453. ($3.00. 
 postage 26c.) 
 
 See article in the Supplement on Citrate of Soda in Infant 
 Feeding. 
 
 See Farmer's Bulletin, No. 210, The Covered Milk Pail; 
 No. 227, Clean Milk. 
 
 Have a report on the local milk supply as to sanitary condi- 
 tion of dairies, age of milk when delivered, enforcement 
 of local regulations.
 
 PROGRAM 203 
 
 Visit a model dairy. 
 
 Send for the booklets of the manufacturers of the various 
 
 " infant foods." Weigh the evidence. 
 Food for the Second -year and Older Children. 
 
 See Food and Dietetics, Norton (Vol. VI of the Library) 
 
 pages 174-178. 
 
 How to Feed Children, Hogan. ($1.00, postage ice.) 
 (Send in answers to the Test Questions on Part II and give 
 
 a report of Meetings III and IV.) 
 
 MEETING V 
 
 (Study pages 123-164.) 
 Food Disorders. 
 
 Care and Feeding of Infants, Part III. 
 
 Century Book for Mothers, pages 124-135; 258-265. 
 Minor Troubles. 
 
 Send 2 cent stamp to the State Board of Health, Spring- 
 field, 111., for their bulletin on "Infant Feeding." 
 
 See article on "Soothing Syrups" in Collier's Weekly, 
 April 28, 1906. 
 
 Century Book for Mothers, pages 193-218; 233242. 
 Children's Diseases. 
 
 Care of the Baby, pages 314-336. 
 
 Send to the State Board of Health, Lansing, Michigan, for 
 their bulletin on Diphtheria, Scarlet Fever, Whooping 
 Cough, Measles, Meningitis, and Teachers' Bulletin No. 
 87, " The Milk Problem." 
 
 Also send to the Secretary of your own State Board of 
 Health (to the capital city) for any bulletins on conta- 
 gious diseases. 
 
 MEETING VI 
 
 (Study pages 165-173.) 
 Hygiene of the Child and Youth. 
 
 Report on the ventilation, heating, lighting, and sanitary 
 
 care of local schools. 
 What attention is given to physical education.
 
 204 CARE OF CHILDREN 
 
 Read extracts from "The Medical Inspection of Schools," 
 Lewis S. Somers, M. D. Prize essay, free from the publish- 
 ers, The Maltine Company, Brooklyn, N. Y. (6c. of the 
 School.) 
 
 (Send answers to the Text Questions on Part III and give 
 a report of Meetings V and VI.)
 
 INDEX 
 
 Abnormal passages, 134 
 Adenoids, 144 
 Albumin water, i 20 
 Anarchistic den, 143 
 Artificial feeding, 76-114 
 Attention, limit of, 169 
 Baby bag, 22 
 
 bottle fed, u i 
 
 care of, 15 
 
 care of before birth, i 
 
 clothes, 20 
 
 needs of, 1 7 
 
 new born, 6 
 Bacteria in milk, 82 
 Bands, 30 
 Bare legs, 31 
 Bath, bran, 38 
 
 first, 17 
 
 salt, 38 
 Baths, duration of, 39 
 
 frequency of, 39 
 
 temperature of, 38 
 Bathing, 38, 167 
 Beef tea, 119 
 Bibliography, 174 
 Bones, condition of, 1 1 
 Bottle fed baby, 92, in 
 Brain, development of, 168 
 Breasts, care of mother's, 4 
 Breathing, 12, 124 
 
 deep, i 66 
 
 Capacity of stomach, 46 
 Care in dressing baby, 27 
 
 of baby before birth, i 
 
 of mother, i, 70 
 
 of new baby, 15 
 
 of nose, 144, 1 66 
 
 of scalp, 1 9 
 
 of teeth, 165 
 
 Care of throat, 166 
 
 Catarrh, 141 
 
 Certified milk, 86 
 
 Chart, weight, 43 
 
 Chest, development of. 13. 45 
 
 Children at table, 1 1 7 
 
 requirements of, 55 
 Chicken pox, 156 
 Cholera in fan turn, 133 
 Cleansing, first, 15 
 Clothes, material of, 25 
 
 night, 24 
 
 short, 27 
 
 texture of, 20 
 
 under, 24 
 
 weight of, 20 
 
 winter, 25 
 
 Clothing for older children, 30 
 Colds, 141 
 Colic, 113, 127 
 
 treatment of, 128 
 
 uric acid, 127 
 Colostrum milk, 68 
 Composition of milk, 62, 80, 
 
 107 
 
 Constipation, 40, 128 
 Contagious diseases, 153 
 Constrictions, dangers from, 
 
 3 
 Convulsions, 133 
 
 cause of, 149 
 
 effects of, 152 
 
 symptoms of, 150 
 
 treatment for, 151 
 Cord, care of, 16 
 Cow's milk, So 
 Cows, care of, 83 
 
 selection of, 83 
 Croup, kinds of, 145 
 
 205
 
 206 
 
 CARE OF CHILDREN 
 
 Croup treatment for, 146 
 Cry, the, 125 
 Crying, 37 
 
 persistent, 126 
 Daily outing, 37 
 Diaper, material of, 26 
 Diarrhea, summer, 130 
 Dietaries lor children, 116 
 Digestion, completeness of, 77 
 
 gastric, 76 
 Digestive organs, 13 
 
 secretions, development of, 
 
 46 
 Diphtheria, cause of, 157 
 
 symptoms of, 157 
 Diseases, contagious, 153 
 
 nervous, 148 
 
 symptoms of, 123 
 
 table of contagious, 162 
 Drawers, 28 
 Dress of mother, i 
 Dressing, care in, 27 
 Drugs, use of, 130 
 Earache, 160 
 Ear strain, 170 
 Education, 167 
 Emotion, expression of, 52 
 Exercise, 37 
 Eye strain, 1 70 
 Eyes, care of, n, 16 
 Fats, 63 
 Feeding, 92 
 
 artificial, 76-114, 179 
 
 irregular, 59 
 
 substitute, 71 
 Fever, 124 
 
 scarlet, 155 
 Fevers, eruptive, 153 
 Fluids, drain of, 132 
 Fontanelles, 10 
 Food, artificial, 74 
 
 coarse, 129 
 
 disorders, 113 
 
 first substitute, 73 
 
 for mother, 3 
 
 Food for older children, 115 
 
 natural, 56 
 
 other than milk, 109 
 
 patent, no 
 
 recipes, 119 
 
 semi-solid, 115 
 
 test of, 64 
 
 unadvisable, 118 
 Foreign bodies, 159 
 Formula, making up a, 104 
 Formulas, changing, 106 
 Fruit juices, 109 
 Furnishing of nursery, 33 
 Games for girls, 168 
 Genitals, care of, 39 
 Growth, relative, 45 
 Gruels, 109 
 Head, development of, 45 , 
 
 shape of, 9 
 
 Health, symptoms in, 123 
 Hearing, development of, 51 
 Height, table of. 42 
 Hot weather diet, 114 
 Infant feeding, sodium citrate 
 in, 179 
 
 hgyiene, importance of, 6 
 Kicking, 37 
 Kumyss, 122 
 Lactation, period of, 72 
 Length, gain in, 44 
 Lime water, 120 
 Lungs, 12 
 Malnutrition, cause of, 139 
 
 treatment for, 139 
 Marasmus, 139 
 Massage, 129 
 Maternity gown, 2 
 Materials for children's clothes 
 
 3i 
 Measles, 153 
 
 German, 154 
 Medicine chest, 163 
 Meningitis, 160 
 Mental attitude of mothet, 5, 
 
 66
 
 INDEX 
 
 207 
 
 Milk, 62, 80 
 
 analysis of, 102 
 
 certified, 86 
 
 changing fats in, 66 
 
 changing proteids in, 67 
 
 colostrum, 68 
 
 composition of, 80 
 
 cow's, 80 
 
 fresh, 89 
 
 home care of, 87 
 
 modified, 82, 90 
 
 mother's, 62 
 
 neutralizing acidity of, 95 
 
 Pasteurizing, 88 
 
 safe, 82 
 
 sterilizing, 88 
 
 unsafe, 88 
 .Moccasin shoe, 28 
 Modified milk, formulae for, 
 
 97 
 
 mixing, 103 
 Morning sickness, 3 
 Mortality in summer, 131 
 Mother, care of, i, 70 
 
 dress of, i 
 
 food for, 3 
 
 mental conditions of, 5 
 
 milk, composition of, 62 
 Motor development, 50 
 Mutton broth, 119 
 Natural food, 56 
 Nervous disorders, 148 
 
 system, 14 
 Night garment, 24 
 Xose, care of, 144 
 Xurse, wet, 75 
 Nursery, 32 
 
 furnishing of, 33 
 
 location of, 33 
 
 temperature of, 33 
 Nursing, control of, 57 
 
 co-operation in, 60 
 
 early, 56 
 
 effect of frequent, 69 
 
 first, 17 
 
 Nursing, frequency of, 58 
 
 position in, 59 
 Nutrition, of the child, 55 
 Oil atomizer, 145 
 Outing, daily, 37 
 Overfeeding, 61, 113 
 Passages, abnormal, 134 
 
 normal, 77 
 
 Pasteurizing milk, 88 
 Patent baby foods, no 
 Peptonized milk, 121 
 Protection of baby, 32 
 Proteids, 63 
 
 cause indigestion, 81 
 Proportions at birth, 9 
 Pubescence, 171 
 Quality of milk, variation in, 
 
 64 
 Quantity of milk, variation in, 
 
 65 
 
 Recipes, 119 
 
 Refrigeration, of milk, 86 
 Regularity, 40, 130 
 Requirements of child, $c 
 Respiration, 12 
 Rickets, symptoms of, 137 
 Rules for eating, 118 
 Scalp, care of, 19 
 Scarlet fever, 155 
 School hygiene, 171 
 Scorbutus, cause of, 140 
 
 treatment for, 141 
 Scurvy, 136 
 
 Senses, development of, 50 
 Shock, danger of, 18 
 Shoes, kinds of, 28 
 Short clothes, 27 
 Siphoning off milk, 103 
 Sitting, 52 
 Skin at birth, 6 
 
 care of, 14 
 Sleep, 34, 167 
 Soap, quality of, 19 
 Soidum citrate in infant feed- 
 ing, 179
 
 208 
 
 CARE OF CHILDREN 
 
 Soother, the, 35, 192 
 Sore throat, 142 
 Spasms, cause of, 149 
 Special senses at birth, 15 
 Spine, condition at birth, n 
 Standing, 52 
 Starch as food, 109 
 Sterilizing milk, 88 
 Stimulants, 118 
 Stomach, capacity of, 46 
 Stools, color of, 135 
 Substitute feeding, essentials 
 
 in, 78 
 Sucking cushions, 1 1 
 
 thumb, 36 
 Sugar, 63, 101 
 Summer complaint, 130 
 
 after effects, 134 
 Surroundings and care, 32 
 Symptoms in health, 123 
 Syringe, use of, 159 
 Taste, development of, 50 
 Teeth, care of, 39, 165 
 
 examination of, 5 
 
 milk, 47 
 
 order of eruption, 47 
 
 permanent, 48 
 Teething, 47 
 
 retarded, 50 
 Temperature, 20, 147 
 
 of baths, 38 
 
 Temperature of nursery, 
 
 33 
 
 variations in, 147 
 Thirst, 6 1 
 
 Throat, care of, 166 
 Thumb sucking, 36 
 Under clothes, 24 
 Unsafe milk, 88 
 Uric acid, 62 
 Urine, examination of, 4 
 Viscous circle, 36 
 Vision, development of, 51 
 Vomiting, 113, 132 
 
 cause of, 71 
 Walking, 52 
 
 Water bath, first general, 18 
 Water, importance of, 62 
 Weak heart, period of, i6<> 
 Weaning, 71 
 
 early, 72 
 
 time of year, 73 
 Weight at birth, 9 
 
 chart, 43 
 
 loss of, 57 
 
 rate of increase in, 43 
 
 table of, 42 
 Wet nun c e 75 
 Whey, 1 20 
 Whining, 126 
 Whooping cough, 158 
 Winter clothes, 25
 
 This book is DUE on the last date stamped below 
 
 JUL 31 1929 
 
 WOV 2 9 1938 
 
 ** 11 134$ 
 'JUL 9- 1958 
 
 JUN 1 
 
 1473 
 
 UB 
 
 Form L-9-107n-5,'28 
 
 1980
 
 3 1158 00555 2343 
 
 ^ 
 
 
 A 000356150 3 
 
 SCHOOL 
 
 CALIFORNIA