CARE OF THE BABY[6]
“Everything in after life depends upon uninterrupted healthy growth
during infancy.”
—DOCTOR F. TRUBY KING.
“There is no young creature in the world so ignorantly and cruelly
nurtured as the average infant.”
—_Ibid._
“Since what is needed most is intelligent care, all proper means
should be employed to educate mothers and those caring for infants,
in proper methods of doing this.”
—DOCTOR L. EMMETT HOLT.
The baby is a unity of body, mind, and soul, and these cannot be
separated in his actual life. During every minute of his care, in
every detail, his whole nature is being influenced and his character
shaped. It is only for convenience of discussion that the physical
régime is separated from the rest of his care.
The régime here outlined is for normal, well babies, for their first
year or two. Delicate, feeble, or sickly infants must receive special
care, under the physician’s directions, in their feeding, bathing,
clothing, and outdoor living.
There are only a few fundamental principles, but these are to be
practiced with conscientious thoroughness by every one who has
anything to do with the child. It is the little details in the
routine of his daily life that produce vigor or weakness. Errors in
his care now easily cost his life; or apparently they may not harm
him now but will be paid for in suffering, deformities, or weakness
in childhood or adulthood. The woman who has this responsibility
needs special preparation in self-sacrifice, self-control,
gentleness, regularity, thoroughness, and accuracy in little details.
She should be in good health, free from any contagious disease.
Fundamental Principles.
1. Regularity, particularly in feeding, sleep, stools
2. Cleanliness of baby, food, clothing, utensils, toys, nursery
3. Fresh air and sunshine, Nature’s great disinfectants and
vitalizers
4. Gradual, moderate changes in temperatures, clothing, food, régime
5. Quiet, because the brain and nervous system are yet incomplete
in their development, and are very sensitive; the maximum of sleep,
with little stimulation while awake. The brain grows as much during
the first year as during all the rest of life.
6. Gentleness in handling, to prevent any curvature or misshaping
of the soft bones, or shocks to the nerves
7. Moderate warmth, which avoids either chilling or coddling
8. Freedom of movement, for only thus can body and mind normally
develop
9. Training in self-control, which can begin the first day and
needs daily attention
10. Mothering, cuddling, fondling, regularly every day, _before_
feeding, at bath or dressing times, an hour previous to bedtime
11. Holding and Lifting. The whole length of the spine and the
weight of the head must be well supported until the baby is strong
enough, at six or seven months of age, to support these himself. In
lifting a young baby, the left hand and arm are slipped under the
head, neck, and upper back, the right hand under the lower back. He
may be carried in one arm by supporting the head in the crook of
the elbow and supporting the entire length of the back with the
forearm, wrist, and hand. If held in an upright position at this
early age, the wobbly head should always be supported. _Never_ lift
a baby or little child by his arms.
=Daily Régime.= The following schedule is in general typical for
the first year. It will vary somewhat with the age of the baby, the
climate and season. In varying from this schedule, note that the
following factors are important and to be observed strictly:
1. Regularity in feeding
2. Interval of one hour after a feeding before bath
3. Interval of one hour between feeding and fruit juice
4. Interval of twenty to thirty minutes between feeding or water
and urinating; this interval should be observed for the individual
child, that the habit of control (and the saving of wet diapers)
may be established as early as possible
5. Regular time for stools; by beginning the week after birth this
can be early established, and much unnecessary work saved
6. Regular time for the bath, scheduled for mid-morning or for
evening, according to which time is found to agree best with the
baby
7. Regular times for play, kicking, cuddling
8. Regular time for weighing, that conditions may be the same
9. Note that in cool weather the baby should not be put outdoors
until one hour after the bath; and that an oil rub may be given
instead of the cool sponge at night
A daily schedule card is of assistance in maintaining regularity,
noting new developments or unusual conditions. It is advisable to
record it at least once a week, on the day for the weekly weighing.
Typical Schedule
CONDITIONS. SEASON: _June_ AGE OF BABY: _Four Months_
A.M.
5:30 Wakened; changed. (Some babies will sleep until
6:00, others will waken early, and should be changed
but not fed; may be given water if they cry, and left
to play in bed.)
6:00-6:15 Feeding
6:30 Urinated (cuspidor)
6:45-8:00 Slept
8:00 2 teaspoons water; stool (cuspidor) normal
8:00-8:30 Kicking in bassinet (or on nursery table); crying
10 minutes
8:30 Weighing, exercise, rub
8:40 Urinated (cuspidor)
8:40 Bath (temperature 98° F.); cool sponge (84° F.);
dressed; crying 10 minutes
9:00-9:15 Feeding
9:30 Put outdoors; asleep
11:55 Wakened; changed
12:00-12:15 Feeding
P.M.
12:40 Urinated (cuspidor)
12:45 Put outdoors
1:00-2:00 Slept
2:00 Changed; 2 tablespoons prune juice
2:00-3:00 Kicking on nursery table (or in pen) in open air
3:00-3:15 Feeding
3:30 Urinated (cuspidor)
3:30-4:30 Put outdoors; slept; crying 10 minutes
4:30-5:30 Cuddled
5:00 2 teaspoons water
5:30 Urinated; stool (cuspidor) normal
5:45 Rub; sponge bath (90° F.); dressed for night
6:00-6:15 Feeding
6:30 In bassinet, asleep (Change if wet)
10:00 Changed
10:00 Feeding
Totals. Sleep: 17 hrs. Water: 3 T. Stools: 2. Crying: 30
minutes.
=Clothing.= The designs previously suggested for the baby clothes
(page 83) are adapted to ease in dressing, laundering, making, and
to freedom of movement. With these, the baby need be turned only
once in dressing, or not at all, if the dress is fastened in front.
Use only flat, protected safety pins, no common, straight, or ridged
pins. With tapes and snappers, pins may be eliminated.
It is much easier and more comfortable to dress and change a baby on
the nursery table than on a low bed or the lap.
The clothes should be put on and off over the feet, not over the head.
The clothing should be changed completely at the morning bath and at
night. The day outfit is the same as the night during the first three
months. Later the day slip is worn, as the baby is awake longer.
The nightgown may be of Viyella flannel, the petticoat then being
unnecessary, except with the temperature below 40°-50° F.
Overdressing, like overfeeding, is a common and serious mistake. If
the baby’s skin is moist to the touch, he is overwarmly dressed and
thereby made highly susceptible to “colds” and pneumonia. If his
feet are cold, skin “goose-fleshed”, and lips blue, he needs more
clothing. With a room temperature of 68°-70° F., duly humidified,
a baby four months or over usually needs only a diaper, cotton or
quarter-wool double-breasted shirt, flannel petticoat and cotton
slip. The binder is needed only until the navel heals,—about three
weeks. It should be loosely applied, fastened by tapes rather than
by pins or sewing. If applied tightly or worn longer it hinders
the development of the trunk muscles, interferes with digestion
and breathing, and, contrary to superstition, will not prevent but
may cause rupture. For babies under four months or with a room
temperature below 68° F. a wrapper, sweater, or sack should be added.
The cotton petticoat is only for ornamental purposes with fine slips.
On warm summer days (over 72° F.) he may dispense with the petticoat.
In very hot weather, also, substitute a cotton, half-sleeve vest
for the long-sleeved shirt, or after three months dispense with all
but the diaper while awake, adding a cotton slip during naps, and a
cotton shirt at night.
For outdoors, he should not be bundled until the minute before he
departs. A thin cap of cotton, linen, or silk may be worn in warm
weather (or none at all after three months) and a double one for
winter, not thick enough to cause perspiration. For the first twelve
months a kimono-sleeved coat, with drawstrings at shoulder and wrist,
will provide protection, with the blankets, for cold weather. The
nightgown pattern may be used to make a sleeping bag of eiderdown,
broadcloth, or flannel. This allows much more freedom than the usual
type of sleeping bag, and is better ventilated. The hood should be
of lighter fabric, knitted or of flannel, broadcloth, cashmere;
eiderdown or angora is overheating.
Stockings and booties ordinarily are not needed during the first
year except when the baby is kicking and creeping about with a
temperature below 68° F., or for appearance when he is taken out in
arms. See that the feet are warm, but not hot or moist. Stockings
are always coming off or getting wet from the diaper; they keep the
feet perspiring, making them tender and increasing the possibility
of colds. When worn, they should be of cotton, or in very cold
weather, one quarter or one half wool; all wool are overheating and
shrink badly. When the baby begins standing or creeping, the leather
Indian moccasins may be used. Other baby shoes on the market have
many faults,—tightness across toes and instep, seams turned inside,
non-porous patent leather; slippery, stiff, or rough soles; they
produce only discomfort at the time and are productive of callouses,
corns, bunions, and misshaped feet. At twelve or fifteen months a
heavier-soled Indian moccasin may be worn or sandals with flexible,
corrugated soles, roomy at the toes, shaped like the foot, right and
left, soft, porous (not patent) leather, perfectly smooth inside,
using gaiters or leggings with these for out-of-doors in damp or cold
weather.
=Diapering.= Reduce the number of wet and soiled diapers by training.
Begin training at one week of age.
Hold a small (warmed) cuspidor firmly in the lap.
Hold the baby above this, the legs extended in the hands, back
resting against the mother’s chest.
Do this at regular time for stool, early morning or late afternoon.
The use of a suppository for a few days will assist; use a little
roll of soft, clean paper dipped in liquid vaseline.
Note on daily record the interval between feeding or drinking, and
urinating (20 to 30 minutes).
Hold the baby for urinating at these regular times when awake and
before beginning the bath.
In a few months he will learn to control the bladder as well as the
bowels for these times, when awake.
At eight or ten months the baby may be supported on the toilet
seat, by using the baby’s detachable toilet chair now manufactured.
A nursery chair for this purpose is not advised. They are usually
wrongly proportioned and constructed; and the child is usually
left alone to sit for half an hour or more, thereby inducing local
irritation, deferred action, prolapsis of the rectum through
straining, or bad habits. The mother or nurse should always stay with
the child, and the least possible time should be permitted.
Change the diaper as soon as the baby wakes or immediately, if it
becomes wet while he is awake. (The urine is salty, sometimes acid,
and always irritating.)
Before removing diaper, have at hand everything needed, viz.:
Clean, dry, warm, folded diaper
Diaper preferably folded oblong and fastened at the sides
Diaper handbasin with warm water
Special wash cloth and towel kept only for diapering
Powder, zinc ointment
Diaper bucket
Lay the baby on the nursery table, on a Turkish towel.
If pins are used, put into blanket at right hand, removed from baby’s
reach.
Remove the diaper and drop it into bucket.
Wash baby clean and pat dry, especially in creases.
Use powder very sparingly or not at all.
Use albolene or zinc ointment for chafed places.
Put on dry diaper.
Leave baby in safe position while putting away utensils.
Never use a diaper a second time without washing; the acid and salty
urine deposit will cause chafing.
Avoid pulling tight about the waist; the pelvic bones are now
only cartilage, easily misshaped; if pelvis is narrowed in girls,
childbirth will be made more difficult for them.
Avoid tightness in front, especially for boys, as this will produce
irritation.
Avoid much thickness between the legs; it will cause bow legs.
Never use rubber or other waterproof diapers; they are overheating
and may cause bad habits.
A small pad of cotton batting folded into sterilized cheesecloth, or
a double fold of Turkish toweling or stockinet placed in the diaper
will absorb moisture and avoid the extra thickness of a heavy diaper;
this pad may be burned if soiled.
A quilted or stockinet pad placed between the diaper and petticoat
will prevent drenching of clothes while asleep.
If diaper is fastened to shirt, make sure of ample length; avoid any
pull on shirt or diaper.
Throw water from basin into toilet or slop bucket, not into lavatory.
Wash out cloth, disposing of water in same way; or put cloth into
diaper bucket.
If diaper is soiled, flush off in toilet before putting to soak.
_Wash hands_ thoroughly in the special basin, with soap and water,
after changing diaper.
If marked congestion of genitals, or a discharge appears, take
special care to disinfect hands and burn cloths and diapers. Report
the condition at once to the physician; these symptoms may indicate a
serious disease.
Never let a child use a public toilet without placing paper or cloth
over the seat; children’s detachable seats may be purchased that can
be carried in traveling.
=Laundering.= Baby clothes should be washed with a mild white soap,
such as Ivory, and thoroughly rinsed. Diapers require special care.
They should be thoroughly boiled and rinsed. Laundry soap, soda, or
bluing should not be used, but Ivory soap, with borax or ammonia if
necessary. Dry in sun if possible. Ironing is not necessary.
Boiling, outdoor sunshine, and pressing with a hot iron, are all
sterilizing processes.
Starch is never to be used in baby clothes, which should always be
soft and non-irritating.
For woolens, use warm water; add soap in solution, not rubbing on
clothes; add one teaspoonful of borax or ammonia per gallon of water,
if very soiled. Squeeze, or wash with vacuum washer; do not rub,
but use hand brush on very soiled places. Squeeze or press without
twisting. Rinse through two waters, same temperature as the first.
A teaspoonful of glycerine per gallon of water, added to the last
rinsing water, preserves softness.
Dry at once by moderate heat; avoid freezing or extreme heat. Stretch
into shape, and lay on frames or towels to dry, turning once or
twice. If pressing is desired, use a moderately hot iron. Cheesecloth
between iron and fabric preserves softness.
Bathing.
One bath every day
Sponge bath until cord heals; later, tub bath
Not within an hour after feeding
Not when greatly fatigued
Tub bath preferably in morning, before second feeding; otherwise,
before third or evening feeding
In warm weather an additional sponge bath at night (same as lower
temperature of morning) is advisable.
In hot weather give two or three sponge baths 70° to 90° F.,
according to age, in addition.
In cold weather, an oil rub at night may be given instead of
sponge[7] bath.
_Temperature for bath_ is always to be regulated by bath thermometer.
Changes to be gradual, by 1° F., from day to day.
Until sixth or eighth month, tub bath 98° to 100° F., followed by
cool. Then reduce 1° a fortnight, to 90° F.
After second week, a dash of cool water (90° F.) applied by hand to
back (begin at lower end), chest and buttocks. At two months lower by
2° F. and apply with wash cloth; lower 2° F. each month to 80° F.,
so long as baby reacts well—skin rosy and warm, not blue lips, goose
flesh, cold feet.
Cool water may be added slowly while baby is in tub, but not hot
water.
_Giving the Bath._ Before beginning to undress the baby, have
everything ready, and just before undressing the baby, wash the hands
thoroughly.
Costume: wash dress, sleeves to elbow, bib apron, bath apron.
Room: no drafts; temperature about 70° F. (65°-72°).
Equipment: Clean tub or basin filled with bath water; enamel, tin,
or rubber tub may be used; after six months, large tub may be used.
Heavy bath towel may be placed in bottom of tub.
Prepare tray with toilet articles and rolled gauze.[8]
Bath thermometer; supply of hot and cold water.
Fresh wash cloths for face and body, kept only for baby.
Soft face towel; two large bath towels spread on nursery table.
Laid out in order for dressing; dry, warm clothes, petticoat placed
inside of dress; wrapper or shawl.
Allow fifteen to twenty minutes for undressing, exercises, bathing,
dressing.
Allow five to ten minutes for rubbing and exercise.
Allow two to ten minutes for clearing away after bath.
Undress the baby on the nursery table; have a large, warm, Turkish
towel under him; leave the diaper on, unpinned, until put into tub.
_Rubbing._ ½ minute to 2 minutes. Use only the hand until 9-12 months.
Hands warmed; anoint with cold cream or cocoa butter, if rough.
Give 2 to 6 long strokes, each arm and leg, beginning at extremity
and rubbing towards heart;
4 to 6 long stokes down back;
4 to 6 long stokes across chest;
4 to 6 long strokes on abdomen, gently, beginning at lower right, and
ending at lower left;
2 to 4 strokes on ribs, from back to front.
_Exercises._ 3 to 10 minutes. (Begin at one month, see page 112.)
Fill tub to depth covering abdomen of baby; note temperature with
thermometer.
Wrap the towel around the baby and put on cuspidor to urinate. Keep
towel around the baby until ready for the tub. Ears, eyes, and head
are washed before going in the tub; also the buttocks, if soiled,
using the diaper basin and cloth, not the bath water.
_Ears._ Use sterilized cheesecloth or old soft muslin squares, little
or no soap.
Use warm water from tub.
Wash carefully in all creases and behind the ears; let no dirt remain.
Apply albolene or liquid vaseline for scurf.
Never use a pointed instrument; “never put anything smaller than your
elbow in the ear.”
Put soiled gauze in tissue paper receptacle.
_Nose._ Clean each nostril with a fresh cheesecloth square rolled to
a point.
Dip the gauze in the liquid vaseline or albolene, and then push gauze
gently into the nostril and twist around, until nostril is clean.
Never dip the gauze a second time into the oil; put used gauze into
tissue paper receptacle.
If the nose accumulates dirt or mucus during the day, repeat.
_Eyes._ Use a fresh square of sterilized cheesecloth for each eye.
Wet the gauze in the weak boric solution (2 per cent.), and squeeze a
drop into the corner of the eye.
Wash eyelids gently, toward outer corner, and carefully remove dirt
or secretion.
Never put gauze in solution a second time; put gauze into tissue
paper receptacle.
If eyelids are sticky or with slight secretion, anoint with vaseline,
avoiding eyes.
Repeat boric wash at night, or at hourly intervals, if eyelids are
inflamed.
Report severe redness or discharge to physician immediately.
_Head._ Use face cloth, soap, water from tub.
Soap wet cloth and rub over head, avoiding pressure over fontanel or
getting soapy water in eyes.
If head has scurf, anoint at night with vaseline, olive oil, or fresh
lard, and put on a thin muslin cap.
Never use a comb or harsh rubbing.
_Body Bath._ Note temperature of water and modify with supply at
hand to exact degree. Place the baby in the tub, supporting the head
and upper back with left hand. Baby may be lowered in the towel, if
afraid.
If giving only sponge bath, hold head face upward over basin to
rinse, and wash and dry each part of body separately.
Rinse the head several times very thoroughly with cloth.
Wash the body gently; use a little soap two or three times a week.
Wash under arms, in creases of neck, thighs, fingers, and toes; turn
baby over and wash the back.
After six months, baby may splash or attempt swimming for one to four
minutes.
Lift baby on to bath apron and give cool sponge very quickly.
Lay baby on table and wrap in dry Turkish towel.
Wipe face and ears with soft face towel; pat body dry with towel. Dry
the head thoroughly.
Do not rub with towel before ten months.
Dry carefully under arms, in creases of neck, thighs, knees, fingers,
and toes.
Remove wet towel.
In warm weather, after two months, allow an air bath one to three
minutes, patting or gently rubbing skin with the hand.
Avoid the use of powder, except in hot weather, in creases, for fat
babies; powder clogs the pores.
Put zinc ointment or albolene on chafed places.
If there is any bulging of the umbilicus, put two strips of surgeon’s
plaster across, to hold in place and prevent rupture.
During first four to six weeks, gently draw back foreskin in boys and
cleanse with boric acid; wash genitals of girls with boric solution;
apply vaseline. Later, general bathing is usually sufficient, and
special attention is not desirable.
Dress with dry, warm clothes; brush hair; put on wrapper or shawl.
_Cleaning Room._ Empty tub, scrub, dry thoroughly, put away.
Put toilet articles carefully away from dust.
Remove soiled clothes.
Wrap soiled gauze in paper receiver and burn.
Leave room in order; lower temperature to 68°-70° F.
_Avoid._ Washing the mouth; the saliva keeps it naturally clean; the
delicate membrane is easily injured.
Getting soapy water in eyes.
Removing wax from ears with instruments; soft wax is needed; hard wax
may be softened with a few drops of olive oil or liquid vaseline.
Special washing of genitals after six weeks unless hard secretion
develops, which should be softened and removed with olive oil or
liquid vaseline. The usual daily bath and washing when diapering will
cleanse sufficiently; further attention may lead to irritation or
to bad habits. Unusual redness or secretion or adhesions should be
immediately reported to the physician. Circumcision may be needed.
Never let the child touch these parts.
Opening of doors, or other sources of draft, during bath.
Bathroom too warm—above 72° F.
Sudden change to cool temperature after bath; or taking outdoors in
less than an hour after bath, in cold weather.
Public bathtub, as in hotel; infection is possible.
At any time putting the fingers into the baby’s mouth unless
necessary, and then only after thorough washing.
=Care of Nursery.= Watch the temperature, humidity, and ventilation;
keep the room well sunned.
Air the room and bedding thoroughly with a strong air current from
ten to thirty minutes twice a day, while baby is out of the room.
Keep clothing, towels, bedding, and furniture orderly and clean.
Drying of clothing and bedding, or cooking, should not be done here.
When baby is creeping or walking, take special care that pins,
needles, scissors, matches, and other small objects are not on floor
or in reach.
Clean daily while baby is out of room; dust is the baby’s worst enemy.
Dust-raisers, such as corn or whisk brooms, feather or dry cloth
dusters, are not to be used.
Carved woodwork or furniture, bric-a-brac or other dust catchers are
out of place in the nursery.
Use a vacuum cleaner, dustless mop, oiled or damp dusting cloths; for
toys, use a clean damp cloth.
Wipe floor, window-sills, furniture and toys, and vacuum-clean rugs.
=Weekly Cleaning.= Vacuum-clean rugs, floor, moldings, ledges, and
walls.
Hang rugs out of doors from one to three hours.
Wash or wax floor; wash window-sills, doors, picture frames.
Hang fresh window curtains, screen curtains, crib draperies.
Wash bassinet canopy; brush bassinet thoroughly outdoors.
Clean carriage frame with vacuum, brush, and damp cloth.
=Feeding.= The kinds of food, quantity, intervals, and times of
feeding are important.
The only natural and adequate food is mother’s milk. No thoroughly
satisfying substitute has ever been found, or is likely to be.
Mother’s milk has the following advantages:
1. It is germicidal—it contains no harmful bacteria, and it has
elements which destroy disease germs in the baby. The babies that are
nursed have a special protection against such diseases as influenza,
whooping-cough, measles, scarlet fever, diphtheria.
2. It is always clean, and therefore greatly reduces the possibility
of diarrhea. Only one breast-fed baby dies to ten bottle-fed babies.
3. It does not sour.
4. It requires no time for preparation or care of bottles.
5. It is always ready.
6. It is balanced in proteins, fats, carbohydrates, for the baby’s
needs, and the proportion of these elements changes with his
development.
7. It is in fine, soft curds, adapted to the baby’s stomach and
digestion.
8. It contains vitamines, the living, organic principles essential to
growth, and found only in fresh or slightly cooked foods.
9. It has growth-producing properties found in no substitute. In a
study made not long since of 100,000 French soldiers, it was found
that the group of those who in their infancy had been nursed for
six months averaged heavier and taller than those nursed only three
months; the group nursed nine months likewise exceeded in height and
stature those nursed only six months. Similar phenomena have been
noted by many observers.
10. It produces better teeth, less subject to decay, both first and
second set.
11. Nursing her baby promotes the return of pelvic organs to their
normal condition, and thus promotes the mother’s comfort, shapeliness
and health.
12. It fosters her love for her baby, and the baby’s love for her.
Patent baby foods are usually either some form of dried or condensed
milk, or a dextrinized cereal. The constituents having been subjected
to a high temperature, the vitamines have been destroyed; there are
frequent cases of scurvy among babies so fed. These preparations
usually contain a high percentage of starch or sugar, with an
insufficiency of proteins, fats, and minerals; this produces plump
babies that look flourishing in pictures, but that are lacking in
solid muscles, bone and nerve tissue, and are subject to rickets,
With little resistance for pneumonia or other germ diseases. Patent
baby foods, condensed or powdered milk, are the last makeshift.
If artificial feeding becomes necessary, clean cow’s milk is the
best substitute. Cow’s milk is made for the calf, whose stomach and
digestion are much coarser, and development much more rapid, than the
baby’s. As produced, it contains too high a percentage of protein
and lime, too low a percentage of sugar and phosphorus, and the curd
is too large and coarse for the baby’s digestion. It is difficult to
produce perfectly clean, and to keep perfectly sweet until feeding.
It must be modified carefully, according to the age and condition of
the baby.
The formula is a technical matter for the medical or dietetic
specialist to work out and prescribe in each individual case, and
to change as the individual baby requires; it is no more a subject
for experiment by a novice than is a case of fever. The formula
prescribed must be prepared with scrupulous cleanliness and exactness.
As about ninety mothers in every hundred are fitted and able, with
wise prenatal and postnatal hygiene, to nurse their babies, the
subject of artificial feeding merits relatively less attention.
Ability to nurse is affected by conditions long before motherhood
begins. An active, out-of-door life, with freedom from nervous strain
or worry, and with clothing that does not compress or overheat the
breasts, is important from childhood. Alcoholism in the mother’s
father, or Cæsarean birth of the child, usually inhibit nursing.
The ability is increased by a moderate, nutritious diet,[9] including
cereals, milk, water (not exceeding an additional quart of liquid
daily beyond the mother’s normal need); by quiet mind, outdoor
living, moderate exercise; by regularity in nursing, and the complete
emptying of a breast at a nursing. It is decreased by a contrary
régime, by fatigue, nervousness, or by interrupting or discontinuing
the effort to nurse.
Fats are increased by more nutritious diet; proteins, by diet and
decreasing the intervals between nursings. Fat in the diet does not
affect the proportion in the milk. Indoor life, with overfeeding
and insufficient exercise, will unduly increase the proportion of
protein and cause colic. A too hearty diet, especially if high in
sugars and starches, will unduly increase the fat. Irregular nursing,
nervousness, not completely emptying the breast, decreasing the
liquids in the diet, will decrease the supply.
Every drop of the mother’s milk is of great value to the baby. If
the quantity or quality is not sufficient, nursings should not be
stopped, but one or more supplemented with modified milk, prescribed
by the physician or dietitian, to furnish the balance. Contagious
disease, except tuberculosis, is not necessarily a contraindication
to nursing. Unless the milk disagrees with the baby, nursing need
not be suspended during menstruation; otherwise, modified milk may
be used temporarily, and the milk regularly withdrawn. Weaning
should be done slowly, substituting one feeding for a nursing, and
discontinuing other nursings at intervals of two or three days. In
this way the baby is gradually accustomed to other food, and the
mother’s milk gradually disappears. Reducing the diet and omitting
liquids for a few days will stop the flow of milk.
While the mother is in bed no more food is needed than under ordinary
circumstances, as the food requirement is low during rest and the
quantity needed by the baby is very small (page 118). An excess of
food is likely to produce indigestion and constipation, and actually
interfere with nursing. Foods easily digested, laxative, rich in
minerals (especially lime and iron) should be selected through the
nursing period. The diet list as for children six to eight years
of age is a desirable one to follow.[10] No patent nostrums should
ever be experimented with; they are worthless when not harmful.
Beer and all forms of alcohol are particularly to be avoided;
they do not increase the amount of fluid more than would an equal
quantity of water or milk; any increase they produce is of fluid,
not of nutriment; the alcohol enters the baby’s system unchanged,
and may injure his sensitive nerve cells. Doctor D. D. Bezzola, of
Switzerland, who has made extensive studies of the effects of alcohol
upon infancy, concludes: “The time may come when we shall see that
every drop of alcohol taken by the parent means a drop of stupidity
for the child.”[11] Malt liquors are apt to disturb the mother’s
digestion and cause her to put on superfluous fat.
Constipation in the mother will produce constipation in the baby,
and laxatives or drugs taken by the mother are likely to affect the
baby. Anger, worry, excitement produce poisons that render the milk
indigestible, even poisonous; if these are indulged in, the baby
should be given only plain or barley water, and the milk withdrawn
and thrown away for one or two nursings.
Before a nursing the mother should wash her hands thoroughly with
soap and hot water, and then wash the nipples with a saturated boric
solution. The feeding should be done in a quiet room where there is
no noise or conversation to disturb the baby, and the mother should
be composed and relaxed. After the feeding, give the baby a swallow
of water to rinse out the mouth. Wash the nipple again with the
boric solution and dry thoroughly with a clean towel. A triple fold
of clean, sterilized gauze, or surgeon’s lint, should be pinned to
the undervest, covering each nipple, thus protecting both the nipple
and the clothing; this should be changed every day. Cleanliness will
prevent thrush in the baby’s mouth, and local soreness and discomfort
for the mother.
The quantity normal at a feeding will depend upon the baby’s age, and
consequently the size of his stomach and the amount needed for his
growth and maintenance. (See page 118.) The quantity taken at one
feeding may be ascertained by weighing the baby just before and just
after a feeding.
Until recently, two-hour intervals for feeding were prescribed for
babies at one or two months, with two night feedings. Extensive
studies in France and Germany (where the raising of babies for
replenishing the army has made infant hygiene a subject of State
investigation) have proven that babies usually thrive better on
longer intervals, allowing time for the stomach to rest. Some
continental specialists advise four-hour intervals from the
beginning, and with some babies this is quite satisfactory. The Table
on page 118 presents the more usual schedule now recommended. It
provides for a three-hour schedule at the start, changing to four
hours at five months, with no feeding after 10 P.M. The 10 P.M.
feeding can usually be dropped with advantage at about nine months.
To drop a feeding, substitute water for a few nights if the baby
wakes or cries.
Regularity is of the greatest importance in the feeding. Clock
schedule should be observed from the first day and maintained
thereafter. The digestive system is much like a machine, pouring out
its digestive fluids at regular habitual intervals, and doing good
work so long as this regularity is respected and observed in the
feeding. Feeding the baby whenever he cries produces indigestion,
colic, irritability, self-indulgence.
Ten to fifteen minutes is the usual duration of a feeding. The first
milk is thinner, the latter part of the nursing richer. Generally
one breast is taken at a feeding, the other breast at the succeeding
feeding; if the quantity in one is insufficient, both may be used
at one feeding. Neither the mother nor the baby should go to sleep
during the nursing. If the baby dawdles, the food may be taken away
until the next time. He should stop a minute at the end of each five
minutes, to rest and breathe. If he regurgitates or vomits up after
nursing, he is being fed too much, or the intervals are too short.
When the baby has finished, he should be handled very gently for
the succeeding hour. His condition is not unlike that of an uncorked
bottle. He should lie or sit quietly without jolting or rocking, much
less tumbling or other vigorous manipulations. Lay, him on his right
side if he is inclined to eructation; on the left side in diarrhea or
intestinal trouble, to open the rectal valves and allow gas to escape.
Between feedings, the baby should be given pure water, 65° to 70° F.,
at regular intervals, several times a day; or during the night if he
cries. It can be given the first month from a sterilized medicine
dropper, then from a spoon; the use of a cup may begin at five or six
months.
If the water is not perfectly pure, it should be boiled twenty
minutes; to remove sediment, strain through several thicknesses of
sterilized cheesecloth.
Strained orange juice or prune juice, without sugar, at first diluted
one half with water, may be given daily at six months, or earlier if
the baby is constipated. Begin with one teaspoonful and gradually
increase to four tablespoonfuls at six months. It should be given an
hour before feeding time.
At six months a scraped, clean chicken or chop bone (after being
cooked) may be given once or twice a day, a quarter hour before
feeding, to exercise the jaws (being very careful that it is not
dropped on the floor). At ten months this may be replaced once a day
by a hard crust to be sucked after feeding, watching that the baby
does not break off any pieces, or removing these from his mouth.
No other food should ordinarily be given until nine months, when
weaning may usually begin by substituting for one nursing a feeding
of milk and strained cereal, given with a spoon or from a cup. The
formula should be prescribed by the physician or dietitian. Whether
a baby should be completely weaned at nine months or at twelve will
depend upon the condition of the baby, quality of the mother’s milk,
and the season. The baby and the milk should be examined, and the
physician’s or dietitian’s advice followed. Starch is not normally
digested under nine months; solid food or lumps may cause convulsions.
=Stools.= There should be at least one normal movement every day;
some babies have two or three.
Begin the second week to establish regularity.
A movement is most likely to follow a feeding in early morning and
the afternoon.
Normal stools are yellow, soft, and smooth.
If gray or brown, with mucus, blood, or undigested food, report to
the physician.
If green or with foul odor, report immediately and substitute barley
water for feedings. Spinach will cause green stools, or they may turn
green an hour after removal; this is normal.
Keep the bowels in good condition by giving plenty of water, fruit
juice, and abdominal exercises; avoid enemas, suppositories, and
laxative drugs, all of which are detrimental.
=Sleep.= During his first year this should be the baby’s chief
occupation. Any period of rapid growth involves much work on the
part of all internal organs, and a low power of resistance. In this
twelve months, the weight trebles, and the length increases about one
half; the brain increases its weight nearly three times, and has by
far more work in learning new adjustments than in any similar period
later in life.
The amount of sleep required at different stages is shown in the
table on page 118.
The baby should always have his own bed, and if possible, his own
room. He should preferably sleep outdoors except (1) in rain or
falling snow, (2) damp, fogging weather, (3) with snow melting, (4)
dusty, windy weather, (5) temperature below 40° F. or above 90°.
The night air is as healthful as that of the day with these same
provisions. A sleeping porch is an investment that will pay high
dividends all through his life.
In dry, still weather, 68° to 95° F., the baby may be taken outdoors
two or three days after his arrival; otherwise he must gradually be
accustomed to the cooler outer air by being taken into a room with
windows open on one side (wrapping him up judiciously), reducing the
temperature every few days, until at one month he is breathing a
temperature of 65° F., at two months of 55° F., and at three months,
he can breathe it nearly at freezing (32° F.). Abrupt changes should
be carefully avoided. Pure cold air is invigorating; stale air is
poisonous; air too dry injures the mucous membrane of the nose and
throat; air too moist is oppressive; all of these develop colds and
pneumonia.
When the baby is indoors, there should be a constant, quiet current
of fresh air, except during dressing and bathing. The air should be
regulated, not by guess, but by a reliable thermometer (tested at the
baby’s head), and the equally important hygrometer for humidity, when
there is not a constant intake of fresh, outside air.
The room temperature should not exceed 70° F. the first three months,
and 68° F. later, when the baby is dressed. It may advantageously
thereafter be 65°-68° ordinarily. When the baby is sleeping, or
playing with wraps on, it is of vital value to have it lower,
graduating it from 40° to 60° according to circumstances. Cold air
is vitalizing; warm air is devitalizing. An open fireplace, with one
window lowered from the top, or a six-inch window board for very cold
or windy weather, will provide reasonable ventilation.
A baby has more room and sleeps more comfortably in his basket or
crib than in a carriage. When awake, he needs more space to roll,
kick, creep, walk. In the open country, he is much better off on
the veranda or in the nursery with windows open, lying in his basket
or pen, than rolled up in a carriage. Babies unfortunately housed
in city apartments or crowded tenements must sometimes be confined
in a carriage for the sake of getting to the open air. In a sunny,
open-aired room or by an open window is better for a baby than down
in a dusty street. The air at higher levels has less dust and fewer
germs. The roof of an apartment house, if there is protection from
chimney gas, hot sun, and high winds, is preferable to the street.
He should never be put on the ground without the protection of a
waterproof and blanket or rug to prevent chilling.
=Making and Care of Bed.= Lay in the mattress—preferably a washable
folded quilt, laid smooth, or a floss, hair, or straw-filled mattress.
Cover mattress with papricloth nursery blanket or light-weight rubber
sheeting, laid smooth.
Over this, lay the large quilted pad or felting.
Lay on the lower sheet, tucking it under the mattress.
Lay a small quilted pad under the baby’s hips, or use a large size
pad for older, tossing babies.
Lay a flat quilted or hair pad (which may be covered with a cotton or
linen slip) or a folded diaper or soft folded towel for the head and
face; a pillow is inadvisable.
Put on the top sheet and the coverlet, folding the sheet back six
inches over the top of the coverlet for protection, and tucking in at
sides (not tight) and at foot.
For cold weather, especially outdoors, put in first a woolen blanket.
Lay several newspapers between this and the mattress, and when the
baby is in, fasten this over the coverlet like a sleeping bag; for
cold weather a knit or woolen sleeping bag is desirable.
When the baby is out of his bed, it should be taken apart, both
morning and afternoon, shaken, thoroughly aired, and sunned.
In cold weather, the bed should be warmed before putting the baby in,
and flannelette may well be used instead of muslin sheets.
Change sheets and pads whenever they are wet.
The crib bed is cared for in the same way. Padded side protectors
should not be used, as they prevent good ventilation. The
light-weight, washable side curtains may be used, but these on only
one side and end; they should be removed and washed every week. The
screen will furnish ample protection from drafts.
The bed should always be placed where it has a quiet current of fresh
air but not a draft, strong wind, or hot sun. The basket should rest
firmly on its stand, or a large table, or dry surface, never on the
floor. Protection should be provided against flies, mosquitoes, cats,
dogs, falling objects; and after eight months, against the baby’s
climbing and falling out.
“Putting the baby to sleep” should consist in laying the baby in his
stationary bed,—warm, dry, comfortable, protected,—to go to sleep
by himself. Rocking disturbs the circulation in the brain, produces
only light sleep, and is bad for the nervous system. Babies often
cry at first, when laid in bed, merely to be taken up, rocked, or
played with. To humor them in this way is to cultivate in them
self-indulgence, irritable temper, and tyranny. If let alone they may
cry themselves to sleep for a few nights, but this will do them no
physical harm; they will have learned their lesson, and the family
will be spared further trouble.
The baby should not always be laid on his back, but may be laid on
one side, or on his stomach, turning his head to one side and putting
a flat pad under his chest. The latter position is not only a restful
change, but also promotes digestion and encourages development of
the muscles at the base of the head and in the upper back.
Disturbed sleep may be caused by bad air, overclothing, rough
clothing, cold feet, indigestion, thirst, need of circumcision, a
habit of rocking. It is not necessary to keep the house in silence
while the baby is sleeping. Sudden and boisterous noise should be
avoided, but the baby outdoors or in his own room learns to sleep
undisturbed by ordinary conversation, music, household activities.
The baby should be gently wakened, if asleep at feeding or bath
time. After a few weeks, his system will be so trained that he will
naturally waken at these times.
The regular waking of the baby should be anticipated, and the mother
or nurse should be there at the time to take him up, change the
diaper, and make him comfortable before he begins to cry. Waking time
should be a smiling time.
=Play and Exercise.= The first play is simple, muscular play of limbs.
After the first month, arrange clothing and covers so there is great
freedom for kicking, twisting, rolling, stretching, pulling.
After two months, baby will not sleep so much and will be more active
with hands, arms, legs.
He should have a pen or yard, raised six inches above the floor;
or a board may be made to fit over mattress of crib. Pen or board
should have woolen blanket and quilted pad over it; let baby kick and
roll freely. The floor is bad because of drafts and dust. A large
dry-goods box, raised, is better than the floor.
Do not prop a baby up in a sitting position until he is strong enough
to hold himself up five minutes without support; then allow sitting
position for only ten minutes at a time, not on the table or bed with
the feet extended in front, but in a carriage or chair, legs bent at
knee.
After two months place objects for him to grasp toward, upward, and
forward.
As soon as the baby learns to smile, this becomes a little game.
At six or eight months, he begins to play with vocal sounds, at
peek-a-boo and pat-a-cake. Boisterous play, tossing, tumbling,
tickling, are too severe for the delicate nerves; his laughing at
this is a symptom rather of nervousness than of joy. The baby is not
a plaything for his elders. The hour before bedtime is a good time
for quiet mothering.
Motor development during the first year normally approximates the
following plan.
Eyes begin to focus at about six weeks; coördination not well
developed until three months or later; real tears, from the lachrymal
glands, begin at about three months; knows mother or nurse by sight
at about three months. Voluntary smiling begins at about five weeks,
laughing at five or six months. Ability to sit alone develops at from
six to eight months, to stand alone at twelve to fourteen, and to
walk alone at fourteen to eighteen months.
=Exercises.= Special exercise may begin at three or four weeks
of age. Begin with one exercise, and three-minute periods. Each
fortnight time may be increased two minutes up to twenty-minute
limit. Add new exercises gradually, at two-week intervals.
All exercises should be given slowly, rhythmically, two hours after a
feeding, when baby is in happy mood; before bathing in mid-morning,
or in mid-afternoon, is a good time. Do not permit fatigue or test
endurance.
Always do the exercises in the same order, thus cultivating motor
memory.
Lay the child on the padded nursery table; have clothing loose,
or preferably without clothing; diaper unfastened; no drafts;
temperature at 70° to 72° F.
_Arm movements._ For development of chest, upper back, upper arms.
1. Take hold of each hand; extend arms straight on table, at right
angles to body, saying “down”, 4 times; bring hands together in front
of body as in clapping, saying “up”, 4 times. (Figures 1, 2.)
2. At “down”, bring arms down to sides, parallel with body; at “up”
stretch arms upward to table above the head (if baby objects, each
arm may be done separately) 4 times. Keep his elbows straight in both
exercises. (Figure 4.)
_Leg movements._ For trunk and leg muscles; overcoming constipation.
1. Grasp foot, bend knee to body; do alternately with right and left,
each 4 times; then both together 4 times. (Figure 3.)
2. Grasp leg, keep knee straight, bring leg to right angles with
body; take each leg alternately, 4 times; then together, 4 times.
Avoid sidewise movement. (Figures 5, 6.)
When the child is able to lift his head, he may be allowed to pull
himself up as far as he can, holding the nurse’s hands. Grasp his
hands firmly so he will not suddenly lose his hold and fall back;
do not pull him, but let him develop strength to pull himself to a
sitting position. (Figures 7, 8.)
At first let him immediately lower himself to lying position,
gradually sitting up one minute, and slowly increasing by one minute.
Many babies at about eleven months go on all fours, bear-fashion. At
this stage the wheelbarrow exercise can begin, grasping the baby’s
feet and lifting them up while he supports himself on his hands and
arms. This is strengthening for arms, chest, back, and trunk. At this
age the substituting of rompers for dresses permits more freedom of
action and minimizes accidents from tumbling.
=Crying.= Every baby does some crying, and every cry has some
meaning. The wise mother will find the cause and will, if necessary,
remove it. She will never use pacifiers, sugar, soothing syrups, loud
noise, trotting, bouncing, tossing, irregular feeding, all of which
are injurious to the baby’s sensitive nerves.
=Causes of Crying= =Nature of Cry; Treatment=
Painless, spontaneous exercise Vigorous, red-faced. Usually
at feeding, bathing,
dressing; 3-20 minutes.
Necessary
Physical discomfort. Fretful or sharp; continued
Clothing wet; pins in clothes Remove cause
Clothing wrinkled, tight, oppressive Practice better hygiene
Clothing rough, hot Rub the back, with downward
Bed rough, covers tight strokes
Tired of one position
Air oppressive, stale, too
warm, dry
Cold feet, thirst, overfeeding
Sleepiness, overtired, hunger
Teething, constipation
Colic, gas, indigestion Sharp, intermittent;
feet drawn up
Illness Moan, wail, feeble,
intermittent
Psychological: Lusty, continued
Desire for attention, especially Stops when desire is granted
at night Will soon stop if ignored
Desire for things forbidden
A pernicious habit of self-indulgence and tyranny is cultivated if
the baby learns that he can get his desires by crying. If indulged,
even at a few weeks of age, he develops temper, self-indulgence, and
disrespect for authority. If no attention is paid to such crying,
or desires cried for are denied, he soon learns self-control,
self-reliance, respect for law and authority.
[Illustration:
Fig. 1 Fig. 2
Fig. 3 Fig. 4
Fig. 5 Fig. 6
Fig. 7 Fig. 8
Exercises for the Baby.]
=Infant Mortality.=[12] Chief causes presented in the order of their
frequency.
=Immediate Causes as Given in= =Underlying Causes=
=Mortality Statistics=
Ignorance; poor hygiene
Low Vitality
Bottle feeding
1. Diarrhea and indigestion Unclean milk and preparation
Solid food too early
Irregular feeding
Ignorance; poor hygiene
Congenital debility
Indoor living
Overheated, overdry rooms
Tobacco smoke in rooms
2. Pneumonia, croup, colds Overclothing; overfeeding
Playing on floor
Sitting on unprotected ground
Adenoids, enlarged tonsils
Ignorance; inadequate prenatal
hygiene
Weak heredity
Poor health of parents
Use of alcohol by parents
3. Congenital debility Syphilis
(weakness at birth) Self-indulgence of parents
Lack of continence during pregnancy
Poor nutrition of mother
Overwork of mother
Too short interval between
births (less than two years)
Ignorance; poor hygiene
Lack of resistance
4. Contagious diseases: Indoor living
whooping cough, Infections in crowds, streetcars,
diphtheria, measles stores, dusty streets
Infection of colds from family or
visitors; kissing
Adenoids, enlarged tonsils
=Defects Easily Acquired= =Causes=
=in Infancy=[13]
Spinal curvature Careless lifting, holding, or
laying down
Sitting up too early or too long
Bow legs Diapers too thick
Standing too early
Inadequate feeding
Narrow pelvis Diapers too tight
Binders too tight
Misshapen ribs and chest Clothes too tight
Rickets
Rupture Binder too tight
Binder worn too long
Rough handling
Internal displacements Careless lifting or holding
Jogging, tossing
Too long sitting
Enlargement of stomach Overfeeding
Tender or deformed feet Feet kept too warm, perspiring
Shoes tight, rough, non-porous
Shoes worn too early
Use of “baby walker”
Walking too early
Nervousness Irregularity
Indoor living
Wrong feeding
Lack of training in self-control
Nervousness of attendant
Disturbance of sleep
Need of circumcision
Excitement; tickling, tossing,
rocking
Frequent among preventable illnesses of infancy are colds,
constipation, colic, rickets, scurvy, marasmus.
=Bad Habits to be Guarded= =Remedies=
=Against=
Putting fingers in mouth Give suitable toys
Thumb sucking (produces ugly Put aloes or golden seal on fingers
mouth, self-indulgence; may Put on sleeveless sack dress
cause infections, adenoids) Put on aluminum mitts
Screaming, tantrums Leave alone
Deny object desired
Masturbation Medical examination
Circumcision
Local cleanliness
Toys; occupation
To state the underlying causes of infant mortality and defects is
at the same time to emphasize their preventability and to indicate
the method of prevention. The pathos is less in the high rate of
death and illness than in their needlessness,—if only young women
and young men were provided with even a meager preparation for this
responsibility! The following are representative judgments expressed
repeatedly by physicians everywhere.
“The problem of infant mortality is not one of sanitation alone or
housing or indeed of poverty as such, but is mainly a question of
motherhood.”
—Doctor G. Newman (English).
“The parents in their homes are largely responsible for the high
infant mortality.”
—Doctor Ira S. Wile (American).
It is advisable to have the baby examined by the physician once
a week during the first three months and at least once a month
thereafter during the first year. If the daily régime is followed
carefully, with judgment, the baby will probably gain normally in
weight, be rosy and happy, free from any illness. The first year is
the critical year, the time for every precaution both to prevent
defects and promote vigor.
TABLE OF FEEDING, SLEEP, AND WEIGHT[14]
————————————————————————————————————————————————————————————————————————
———————+————————————————+—————+——————+——————+——————+—————————————+——————
AVERAGE| | NO. |OUNCES|TOTAL |INTER-| |
WEIGHT | AGE OF BABY | OF | AT |Ounces|VALS | HOURS | SLEEP
OF BABY| |FEED-|EACH |IN 24 |IN | |
IN | |INGS |FEED- |HOURS |HOURS | |
POUNDS| | |ING | | | |
———————+————————————————+—————+——————+——————+——————+—————————————+——————
7½ |Birth and 2d day| 4 | 1 | 4 | 6 | |22
7 | 3d day | 6 | 1 | 6 | 3 |6, 9, A.M., | hours
| 4th ” | 6 | 1½ | 9 | 3 |12 noon; 3, | ”
| 5th ” | 6 | 2 | 12 | 3 |6, 10 P.M. | ”
7¼ | 7th ” | 6 | 2½ | 15 | 3 | ” | ”
7½ | 10th ” | 6 | 3 | 18 | 3 | ” | ”
|Begin 3d week | 6 | 3½ | 21 | 3 | ” | ”
| ” 4th ” | 6 | 4 | 24 | 3 | ” |21 ”
8¾ | ” 2d month | 6 | 4¼ | 25½ | 3 | ” |20 ”
10½ | ” 3d ” | 6 | 4½ | 27 | 3 | ” |19 ”
14¼ | ” 4th ” | 6 | 5 | 30 | 3 | ” |18 ”
13¾ | ” 5th ” | 5 | 6½ | 32½ | 4 |6, 10, A.M.; |16 ”
15 | ” 6th ” | 5 | 7 | 35 | 4 |2, 6, 10 P.M.| ”
16 | ” 7th ” | 5 | 7½ | 37½ | 4 | ” | ”
16¾ | ” 8th ” | 5 | 8 | 40 | 4 | ” |15 ”
17½ | ” 9th ” | 5 | 8¼ | 41¼ | 4 | ” | ”
18 |End 9th ” | 5 | 8½ | 42½ | 4 | ” | ”
21 | ” 12th ” | 5 | | | 4 | ” | ”
———————+————————————————+—————+——————+——————+——————+—————————————+——————
————————————————————————————————————————————————————————————————————————
FOOTNOTES:
[6] See Preface, page xiii.
[7] A “sponge bath” is given with a wash cloth; _sponges_ are _never_
to be used, because unsanitary.
[8] See page 79.
[9] See Chapter IX.
[10] See pages 164, 5.
[11] “The Body in Health” (O’Shea and Kellogg).
[12] For statistics, see Appendix.
[13] For statistics on infant mortality, see Appendix.
[14] From “Feeding and Care of Baby.”—F. TRUBY KING, M. B.