Produced by Audrey Longhurst, Hillie Plantinga and the
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Transcriber's notes:
Seven typographical errors have been corrected:
Page 8, "15" changed to "18" (See Fig. 18)
Page 208, "5" changed to "7" (See Fig. 7)
Page 281, "does" changed to "dose" (Give a big dose of castor oil)
Page 306, "he" changed to "be" (which should be covered with a single
thickness)
Page 348, "iself" changed to "itself" (than by the bite itself)
Page 362, "dioxid" changed to "dioxide" (harmless substances as water
and carbon dioxide)
Page 435, "ecezmatous" changed to "eczematous" (to keep the eczematous
skin area moist)
[Illustration]
THE MOTHER
AND HER CHILD
BY
WILLIAM S. SADLER, M. D.
PROFESSOR OF THERAPEUTICS, THE POST-GRADUATE MEDICAL
SCHOOL OF CHICAGO; DIRECTOR OF THE CHICAGO INSTITUTE
OF PHYSIOLOGIC THERAPEUTICS; FELLOW OF THE
AMERICAN MEDICAL ASSOCIATION; MEMBER OF
THE CHICAGO MEDICAL SOCIETY; THE ILLINOIS
STATE MEDICAL SOCIETY; THE
AMERICAN ASSOCIATION FOR THE ADVANCEMENT
OF SCIENCE, ETC.
AND
LENA K. SADLER, M. D.
ASSOCIATE DIRECTOR OF THE CHICAGO INSTITUTE OF PHYSIOLOGIC
THERAPEUTICS; FELLOW OF THE AMERICAN MEDICAL
ASSOCIATION; MEMBER OF THE CHICAGO MEDICAL
SOCIETY; THE MEDICAL WOMEN'S CLUB OF CHICAGO;
NATIONAL CONGRESS OF MOTHERS AND
PARENT-TEACHER ASSOCIATION; THE
CHICAGO WOMAN'S CLUB, ETC.
_ILLUSTRATED_
[Illustration]
TORONTO
McCLELLAND, GOODCHILD & STEWART
CHICAGO: A. C. McCLURG & CO.
1916
Copyright
A. C. McClurg & Co.
1916
* * * * *
Published August, 1916
* * * * *
_Copyrighted in Great Britain_
W. F. HALL PRINTING COMPANY, CHICAGO
TO
"BILLY"
WHO, BECAUSE OF HIS UNCONSCIOUS CONTRIBUTIONS TO ITS
PRACTICAL FEATURES, SHOULD BE REGARDED AS A
CO-AUTHOR, THIS VOLUME IS AFFECTIONATELY
DEDICATED BY HIS PARENTS
THE AUTHORS
PREFACE
For many years the call for a book on the mother and her child has
come to us from patients, from the public, and now from our
publishers--and this volume represents our efforts to supply this
demand.
The larger part of the work was originally written by Dr. Lena K.
Sadler, with certain chapters by Dr. William S. Sadler, but in the
revision and re-arrangement of the manuscript so much work was done by
each on the contributions of the other, that it was deemed best to
bring the book out under joint authorship.
The book is divided into three principal parts: Part I, dealing with
the experience of pregnancy from the beginning of expectancy to the
convalescence of labor: Part II, dealing with the infant from its
first day of life up to the weaning time; Part III, taking up the
problems of the nursery from the weaning to the important period of
adolescence.
The advice given in this work is that which we have tried out by
experience--both as parents and physicians--and we pass it on to
mothers, fathers, and nurses with the belief that it will be of help
in their efforts at practical and scientific "child culture." We
believe, also, that the expectant mother will be aided and encouraged
in bearing the burdens which are common to motherhood by the advice
and instruction offered.
While we have drawn from our own professional and personal experience
in the preparation of this book, we have also drawn freely from the
present-day literature dealing with the subjects treated, and desire
to acknowledge our indebtedness to the various writers and
authorities.
We now jointly send forth the volume on its mission, as a contribution
toward lightening the task and inspiring the efforts of those mothers,
nurses, and others who honor us by a perusal of its pages.
WILLIAM S. SADLER.
LENA K. SADLER.
_Chicago_, 1916.
CONTENTS
* * * * *
PART I
THE MOTHER
CHAPTER PAGE
I The Expectant Mother 1
II Story of the Unborn Child 7
III Birthmarks and Prenatal Influence 14
IV The Hygiene of Pregnancy 21
V Complications of Pregnancy 35
VI Toxemia and Its Symptoms 47
VII Preparations for the Natal Day 53
VIII The Day of Labor 63
IX Twilight Sleep and Painless Labor 71
X Sunrise Slumber and Nitrous Oxid 84
XI The Convalescing Mother 93
PART II
THE BABY
XII Baby's Early Days 103
XIII The Nursery 114
XIV Why Babies Cry 123
XV The Nursing Mother and Her Babe 133
XVI The Bottle-Fed Baby 147
XVII Milk Sanitation 156
XVIII Home Modification of Milk 165
XIX The Feeding Problem 177
XX Baby's Bath and Toilet 190
XXI Baby's Clothing 202
XXII Fresh Air, Outings, and Sleep 213
XXIII Baby Hygiene 222
XXIV Growth and Development 232
PART III
THE CHILD
XXV The Sick Child 251
XXVI Baby's Sick Room 266
XXVII Digestive Disorders 274
XXVIII Contagious Diseases 285
XXIX Respiratory Diseases 300
XXX The Nervous Child 308
XXXI Nervous Diseases 323
XXXII Skin Troubles 333
XXXIII Deformities and Chronic Disorders 341
XXXIV Accidents and Emergencies 348
XXXV Diet and Nutrition 360
XXXVI Caretakers and Governesses 370
XXXVII The Power of Positive Suggestions 380
XXXVIII Play and Recreation 390
XXXIX The Puny Child 400
XL Teaching Truth 405
Appendix 427
Index 449
ILLUSTRATIONS
The mother and her child _Frontispiece_
FIGURE PAGE
1 Steps in early development 10
2 The "expectant" costume 23
3 The photophore 43
4 Taking the blood pressure 48
5 Breast binder 59
6 How to hold the baby 110
7 Making the sleeping blanket 117
8 In the sleeping blanket 118
9 Homemade ice box 149
10 Heating the bottle 151
11 A sanitary dairy 158
12 Articles needed for baby's feeding 167
13 Supporting the baby for the bath 194
14 Developmental changes 240
15 The cooling enema 290
16 X ray showing tuberculosis of the lung 346
17 Father and Mother Corn and Morning Glory 406
PART I
THE MOTHER
THE MOTHER AND HER CHILD
* * * * *
PART I
THE MOTHER
* * * * *
CHAPTER I
THE EXPECTANT MOTHER
There can be no grander, more noble, or higher calling for a healthy,
sound-minded woman than to become the mother of children. She may be
the colaborer of the business man, the overworked housewife of the
tiller of the soil, the colleague of the professional man, or the wife
of the leisure man of wealth; nevertheless, in every normal woman in
every station of life there lurks the conscious or sub-conscious
maternal instinct. Sooner or later the mother-soul yearns and cries
out for the touch of baby fingers, and for that maternal joy that
comes to a woman when she clasps to her breast the precious form of
her own babe.
MOTHERHOOD THE HIGHEST CALLING
Motherhood is by far woman's highest and noblest profession. Science,
art, and careers dwindle into insignificance when we attempt to
compare them with motherhood. And to attain this high profession, to
reach this manifest "goal of destiny," women are seeking everywhere to
obtain the best information, and the highest instruction regarding
"mothercraft," "babyhood," and "child culture."
In an Indiana town not long ago, at the close of a lecture, a small,
intellectual-appearing mother came forward, and, tenderly placing her
tiny and emaciated infant in my arms, said: "O Doctor! can you help me
feed my helpless babe? I'm sure it is going to die. Nothing seems to
help it. My father is the banker in this town. I graduated from high
school and he sent me to Ann Arbor, and there I toiled untiringly for
four years and obtained my degree of B. A. I have gone as far as I
could--spent thousands of dollars of my unselfish father's money--but
I find myself totally ignorant of my own child's necessities. I cannot
even provide her food. O Doctor! can't something be done for young
women to preparé them for motherhood?"
MOTHERCRAFT PREPARATION
The time will come when our high and normal schools will provide
adequate courses for the preparation of the young woman for her
highest profession, motherhood. This young mother, who had reached the
goal of Bachelor of Arts, found to her sorrow that she was entirely
deficient in her education and training regarding the duties and
responsibilities of a mother. In every school of the higher branches
of education that train young women in their late teens there should
be a chair of mothercraft, providing practical lectures on baby
hygiene, dress, bathing, and the general care of infants, and giving
instruction in the rudiments of simple bottle-feeding, together with
the caloric values of milk, gruels, and other ingredients which enter
into the preparation of a baby's food.
Young women would most enthusiastically enroll for such classes, and
as years passed and marriage came and children to the home, imagine
the gratitude that would flood the souls of the young mothers who were
fortunate enough to have attended schools where the chairs of
motherhood prepared them for these new duties and responsibilities.
EARLY MEDICAL SUPERVISION
Just as soon as it is known that a baby is coming into the home, the
expectant mother should engage the best doctor she can afford. She
should make frequent calls at his office and intelligently carry out
the instruction concerning water drinking, exercise, diet, etc.
Twenty-four hour specimens of urine should be frequently saved and
taken to the physician for examination. In these days the
blood-pressure is closely observed, together with approaching
headaches and other evidences of possible kidney complications. The
early recognition of these dangers is accompanied by the immediate
employment of appropriate sweating procedures and other measures
designed to promote the elimination of body poisons. Thus science is
able effectively to stay the progress of the high blood-pressure of
former days, and which was so often followed by eclampsia--uremic
poisoning.
In these days of careful urine analysis, expertly administered
anaesthetics, and up-to-date hospital confinements, the average
intelligent woman may enter into pregnancy quite free from the oldtime
fears, whose only rewards were grief and cankering care. All fear of
childbirth and all dread of maternal duties and sacrifices do not in
the least lessen the necessary unpleasantness associated with normal
labor. It lies in the choice of every expectant mother to journey
through the months of pregnancy with dissatisfaction and resentment or
with joy and serenity. "The child will be born and laid in your arms
to be fed, cared for, and reared, whether you weep or smile through
the months of waiting."
THE RESENTFUL MOTHER
A little woman came into our office the day of this writing, saying:
"Doctor, I'm just as mad as I can be; I don't want to be pregnant, I
just hate the idea." As I smiled upon this girl-wife of nineteen, I
drew from my desk a sheet of paper and slowly wrote down these words
for the head of a column: "Got a mad on," and for the head of another,
"Got a glad on;" and then we quickly set to work carefully to tabulate
all the results that having a "mad on" would bring. We found to her
dismay that its harvest would be sadness of the heart, husband
unhappy, work unbearable, while all church duties as well as social
functions would be sadly marred. Then, just as carefully, we
tabulated the benefits that would follow having a "glad on." Her face
broke into a smile; she laughed, and as she left the office she
assured me that she would accept Nature's decree, make the best of her
lot, and thus wisely align herself with the normal life demands of old
Mother Nature. This view of her experience, she came to see, would
bring the greatest amount of happiness to both herself and husband.
She left me, declaring that she was just "wild for a baby;" and there
is still echoing in my ears her parting words: "I'm leaving you, Oh,
such a happy girl! and I'm going home to Harold a happy and contented
expectant mother."
There often enters on the exit of a discontented and resentful
expectant mother, a woman, very much alone in the world--perhaps a
bachelor maid or a barren wife, who, as she sits in the office,
bitterly weeps and wails over her state of loneliness or sterility;
and so we are led to realize that discontentment is the lot of many
women; and we are sometimes led to regret that ours is not the power
to take from her that hath and give to her that hath not.
EARLY SIGNS OF PREGNANCY
Among the first questions an expectant mother asks is: "What are early
signs of pregnancy?" The answer briefly is:
1. Cessation of menstruation.
2. Changes in the breast.
3. Morning sickness.
4. Disturbances in urination.
Menstruation may be interrupted by other causes than pregnancy, but
the missing of the second or third periods usually indicates
pregnancy. Accompanying the cessation of menstruation, changes in the
breast occur. Sensation in the breasts akin to those which usually
accompany menstruation are manifested at this time in connection with
the unusual sensations of stinging, prickling, etc. Fully one-half of
our patients do not suffer with "morning sickness;" however, it is the
general consensus of opinion that "morning sickness" is one of the
early signs of pregnancy, and these attacks consist of all
gradations--from slight dizziness to the most severe vomiting. It is
an unpleasant experience, but in passing through it we may be glad in
the thought that "it too, will pass."
Because of the pressure exerted by the growing uterus upon the
bladder, disturbances in urination often appear, but as the uterus
continues to grow and lifts itself up and away from the bladder these
symptoms disappear.
Chief of the later signs of pregnancy are "quickening" or fetal
movements. The movements are very much like the "fluttering of a young
birdling." They usually are felt by the expectant mother between the
seventeenth and eighteenth weeks. This sign, together with the noting
of the fetal heartbeat at the seventh month, constitute the positive
signs of pregnancy.
PROBABLE DATE OF DELIVERY
And now our expectant mother desires to know when to expect the little
stranger. From countless observations of childbirth under all
conditions and in many countries, the pregnant period is found to
cover about thirty-nine weeks, or two hundred and seventy-three days.
There are a number of ways or methods of computing this time. Many
physicians count back three months and add seven days to the first day
of the last menstruation. For instance, if the last menstruation were
December 2 to 6, then, to find the probable day of delivery, we count
back three months to September 2, and then add seven days. This gives
us September 9, as the probable date of delivery. The real date of
delivery may come any time within the week of which this calculated
date is the center.
As a rule, ten days to two weeks preceding the day of delivery, the
uterus "settles" down into the pelvis, the waist line becomes more
comfortable, and the breathing is much easier.
On the accompanying page, may be found a table for computing the
probable day of labor, prepared in accordance with the plan just
described.
TABLE FOR CALCULATING THE DATE OF CONFINEMENT
=========+=================================================+=======
Jan. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |
Oct. | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 |
---------+-------------------------------------------------+-------
Jan. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
Oct. | 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 | Nov.
=========+=================================================+=======
Feb. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |
Nov. | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 |
---------+-------------------------------------------------+-------
Feb. | 17 18 19 20 21 22 23 24 25 26 27 28 |
Nov. | 24 25 26 27 28 29 30 1 2 3 4 5 | Dec.
=========+=================================================+=======
Mar. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |
Dec. | 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 |
---------+-------------------------------------------------+-------
Mar. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
Dec. | 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 | Jan.
=========+=================================================+=======
April. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |
Jan. | 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 |
---------+-------------------------------------------------+-------
April. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 |
Jan. | 22 23 24 25 26 27 28 29 30 31 1 2 3 4 | Feb.
=========+=================================================+=======
May. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |
Feb. | 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 |
---------+-------------------------------------------------+-------
May. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
Feb. | 21 22 23 24 25 26 27 28 1 2 3 4 5 6 7 | Mar.
=========+=================================================+=======
June. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |
Mar. | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 |
---------+-------------------------------------------------+-------
June. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 |
Mar. | 24 25 26 27 28 29 30 31 1 2 3 4 5 6 | Apr.
=========+=================================================+=======
July. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |
Apr. | 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 |
---------+-------------------------------------------------+-------
July. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
Apr. | 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 | May.
=========+=================================================+=======
Aug. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |
May. | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 |
---------+-------------------------------------------------+-------
Aug. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
May. | 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 | June.
=========+=================================================+=======
Sept. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |
June. | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 |
---------+-------------------------------------------------+-------
Sept. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 |
June. | 24 25 26 27 28 29 30 1 2 3 4 5 6 7 | July.
=========+=================================================+=======
Oct. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |
July. | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 |
---------+-------------------------------------------------+-------
Oct. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
July. | 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 | Aug.
=========+=================================================+=======
Nov. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |
Aug. | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 |
---------+-------------------------------------------------+-------
Nov. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 |
Aug. | 24 25 26 27 28 29 30 31 1 2 3 4 5 6 | Sept.
=========+=================================================+=======
Dec. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |
Sept. | 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 |
---------+-------------------------------------------------+-------
Dec. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
Sept. | 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 | Oct.
=========+=================================================+=======
Supposing the upper figure in each pair of horizontal lines to
represent the first day of the last menstrual period, the figure
beneath it, with the month designated in the margin, will show the
probable date of confinement.
CHAPTER II
STORY OF THE UNBORN CHILD
To every physician in every community, sooner or later in his
experience there come thoughtless women making requests that we even
hesitate to write about. Their excuses for the crime which they seek
to have the physician join them in committing, range all the way from
"I don't want to go to the trouble," to "Doctor, I've got seven
children now, and I can't even educate and dress them properly;" or,
maybe, "I nearly lost my life with the last one."
EMBRYOLOGICAL IGNORANCE
One little woman came to us the other day from the suburbs, and
honestly, frankly, related this story:
"We've been married just six months, I have continued my stenographic
work to add the sixty-five dollars to our monthly income. Doctor, we
must meet our monthly payments on the home, I must continue to work,
or we shall utterly fail. I am perfectly willing a baby shall come to
us two years from now, but, doctor, I just can't allow this one to go
on, you must help me just this once. Why doctor, there can't be much
form or life there, it's only three months now, or will be next week,
and you know it's nothing but a mass of jelly."
She had talked with a "confidential friend" in her neighborhood, had
been told that she "could do it herself," but fearing trouble or
infection, had come to the conclusion she had better go to a "clean,
reputable physician," to have the abortion performed.
This is not the place to narrate the experiences of the unfortunate
victims of habitual criminal abortion, but we would like to impress
upon the reader some realization of the untimely deaths, the awful
suffering, and the life-long remorse and sorrow of the poor, misguided
women who listen to the criminal advice of neighborhood "busybodies."
The infections, the invalidism, the sterility that so often follow in
the wake of these practices, are well known to all medical people.
THE STREAM OF LIFE
And so after the patient's last statement, "It's nothing but a mass of
jelly," we began the simple but wonderfully beautiful story of the
development of the "child enmothered." Just as all vegetables, fruits,
nuts, flowers, and grains come from seeds sown into fertile soil, and
just as these seeds receive nourishment from the soil, rain, and
sunshine, so all our world of brothers and sisters, of fathers and
mothers, came from tiny human seeds, and in their turn received
nourishment from the peculiarly adapted stream of life, which flows in
the maternal veins for the nourishment and upbuilding of the unborn
embryo.
Every little girl and boy baby that comes into the world, has stored
within its body, in a wonderfully organized capsule, a part of the
ancestral stream of life that unceasingly has flowed down through the
centuries from father to son and from mother to daughter. This "germ
plasm" is a divine gift to be held in trust and carefully guarded from
the odium of taint, to be handed down to the sons and daughters of the
next generation. Any young man who grasps the thought that he
possesses a portion of the stream of life, that he holds it in sacred
trust for posterity, cannot fail to be impressed with a sense of
solemn responsibility so to order his life as to be able to transmit
this biologic trust to succeeding generations free from taint and
disease.
THE PROCESS OF FERTILIZATION
Just as within the body of "Mother Morning Glory" (See Fig. 15) may be
found the ovary or seed bed, so there are two wonderfully organized
bodies about the size of large almonds found in the lower part of the
female abdomen on either side of the uterus, and connected to it by
two sensitive tubes. There ripens in one of these bodies each month a
human baby-seed, which finds its way to the uterus through the little
fallopian tube and is apparently lost in the debris of cells and mucus
which, with the accompanying hemorrhage go to make up the menstrual
flow. This continues from puberty to menopause, each gland
alternatingly ripening its ovum, only to lose it in the periodical
phenomenon of menstruation, which is seldom interrupted save by that
still more wonderful phenomenon of conception.
At the time of conception, countless numbers of male germ-cells
(sperms) are lost--only one out of the multitude of these perfectly
formed sperms made up of the mosaics of hereditary depressors,
determiners, and suppressors that so subtly dictate and determine the
characteristics and qualifications of the on-coming individual--I
repeat, only one of these wonderful sperms finds the waiting ovum
(Fig. 1). In this search for the ovum, the sperm propels itself
forward by means of its tail--for the male sperm in general appearance
very much resembles the little pollywog of the rain barrel (Fig. 1).
The fateful meeting of the sperm and the ovum takes place usually in
the upper end of one of the fallopian tubes. It is a wonderful
occasion. The wide-awake, vibrating lifelike sperm plunges head first
and bodily into the ovum. The tail, which has propelled this bundle of
life through the many wanderings of its long and perilous journey, now
no longer needed, drops off and is lost and forgotten. This union of
the male and female sex cells is called "fertilization." There
immediately follows the most complete blending of the two germ
cells--one from the father and one from the mother--each with its
peculiar individual, family, racial, and national characteristics.
Here the combined determiners determine the color of the eyes, the
characteristics of the hair, the texture of the skin, its color, the
size of the body, the stability of the nervous system, the size of the
brain, etc., while the suppressors do a similar work in the
modification of this or that family or racial characteristic.
THE FIRST WEEKS OF LIFE
The fertilized ovum remains in the tube for about one week, when it
slowly makes its way down into the uterus, all the while rapidly
undergoing segmentation or division. It does not grow much in size
during this first week, but divides and subdivides first, into two
parts, then four, then eight, then sixteen and so on, until we have a
peculiar little body made up of many equally divided parts, and known
as the "Mulberry Mass" (Fig. 1). The blending of the sperm and ovum
has been perfect, the division of the original body multitudinous.
[Illustration:
Sperm and Ovum Cell Division
Fetus at Six Weeks Fetus at Three Months
Fig. 1. Steps in Early Development]
While this division of the united sex cells is progressing, a
wonderful change is also taking place in the inside lining of the
uterus. Instead of the usual thin lining, it has greatly thickened and
has become highly sensitized, and as the ovum enters the uterus from
the fallopian tube, this sensitized lining catches it and holds it in
its folds--actually covers it with itself--holding the precious mass
much as the cocoon, you have so often seen fastened to the side of a
plant or leaf, holds its treasure of life.
Just as soon as the new uterine home is found the baby heart begins to
make its appearance, as also do many other rudimentary parts. By the
end of the third week, our round mass has flattened and curved and
elongated, and the nervous system and brain begin to develop, while
the primitive ears begin to appear. At this time, the alimentary canal
presents itself as one straight tube which is a trifle larger at the
head end. And it is interesting to note that at this early date, even
the arms and legs are beginning to bud and push out from the body.
LATER EMBRYONIC DEVELOPMENT
In the fourth and fifth weeks, the lungs and the pancreas may be
found, the heart develops, the nervous system has taken on more
definite form, and several of the larger blood-vessels are appearing.
By the eighth week, by the most wonderful and complicated processes of
overlapping, pushing out, indentation, enfolding, budding, pressing,
and curving, the majority of the important structures are formed--the
eyes, ears, nose, hands, feet, abdominal organs, and numerous glands.
Thus, at the end of two months, almost every structure and organ
necessary to life is present in a rudimentary state.
AT THE END OF THREE MONTHS
By the close of the third month, witness the work of creation! From
the blending of the two germ cells there has come forth a beautifully
formed body (Fig. 1). True, it is but three and one half inches in
length, but it is nevertheless a perfect body. About this time, the
sex may be determined. The eyes, nose, ears, chin, arms and legs and
even the fingers and toes may all be clearly distinguished.
A "jelly mass" at three months? No, by no means! No! Life and form and
features are all there. It really has a face, whose features may
easily be delineated.
In all my experience, I have yet to find the woman who wished to
continue in her wicked and criminal intent after she had listened to
this story of the creative development of the first three months of
her "child enmothered."
During the next four months, which take us to the close of the
seventh, rapid growth and farther development take place to the
extent, that, should birth occur at that time, life may continue under
proper conditions.
LAST WEEKS OF PREGNANCY
Everything is now nearing completion--only awaiting further growth,
development, and strength--except some of the bone development, which
takes place during the remaining two months. Growth is rapid, strength
is doubled, and as the two hundred and seventy-three days draw to a
close, everything has been completed. It has all taken place according
to the laws of creation in an infinite way and with clock-like
precision.
With the developmental growth of the product of conception, the uterus
or room that had been particularly prepared for the "big reception" of
the second week, has also grown to great dimensions. It fills almost
the entire abdomen and as a result of the pressure against the
diaphragm the breathing is somewhat embarrassed.
The door of this "room" has been closed by a special mechanism,
while, in the fullness of time, Mother Nature begins the delicate work
of opening the door, through whose portals passes out into the world
the completed babe.
The authors feel that this discussion of, and protest against,
abortions, _should be_ accompanied by an appropriate consideration of
the control of pregnancy. We are never going to eliminate the abortion
curse of present-day civilization by merely preaching against
it--warnings and denouncements alone will not suffice to remove the
stain. Notwithstanding our feelings and convictions in this respect,
we are also well aware of the fact that public sentiment is not now
sufficiently ripe to welcome such a full and frank discussion of the
subject of the prevention of conception as the authors would feel
called upon to present; we are equally cognizant of the fact that
existing postal regulations and other Federal laws are of such a
character (at least capable of such interpretation) as possibly to
render even the scientific and dignified consideration of such
subjects entirely out of question.
CHAPTER III
BIRTHMARKS AND PRENATAL INFLUENCE
In the preceding chapter we learned that when the two germ cells came
together, there occurred a complete blending of two separate and
distinct hereditary lines, reaching from the present away back into
the dim and distant past. By the union of these two ancestral strains
a new personality is formed, a new individual is created, with its own
peculiar characteristics.
HEREDITARY TRAITS
Probably none of the laboriously acquired accomplishments of the
present generation can be directly--and as such--handed down to our
children. What we are to be and what we will do in this world was
largely determined by the laws of heredity by the time we were well
started on our development experience _en-utero_ during the third or
fourth week of our prenatal existence, as outlined in a former
chapter.
It is now generally accepted in scientific circles that acquired
characteristics are not transmissible. Someone has aptly stated this
truth by saying that "wooden heads are inherited, but wooden legs are
not." This does not by any means imply that we do not have power and
ability to fashion our careers and carve out our own destiny, within
the possible bounds of our hereditary endowment and environmental
surroundings. Heredity does determine our "capital stock," but our own
efforts and acts determine the interest and increase which we may
derive from our natural endowment. From the moment conception takes
place--the very instant when the two sex cells meet and blend--then
and there "the gates of heredity are forever closed." From that time
on we are dealing with the problems of nutrition, development,
education, and environment; therefore, so-called prenatal influence
can have nothing whatever to do with heredity.
A father may have acquired great talent as a physician or a surgeon,
in fact he may hold the chair of surgery in a medical college, but
each of his children come into the world without the slightest
knowledge of the subject, and, as far as direct and immediate heredity
is concerned, will have to work just about as hard to master the
subject as will the same average class of children whose parents were
not surgeons. This must not be taken to mean that certain abilities
and tendencies are not inheritable--for they are; but they are
inherited _through_ the parents--and not _from_ them--directly. These
transmitted characteristics are largely "stock" traits, and usually
have long been present in the "ancestral strain."
MATERNAL IMPRESSIONS
A mother may sing and pray all through the nine months of expectancy,
or she may weep and scold, or even curse. In neither case can she
influence the spiritual or moral tendencies of her child and cause it,
through supposed prenatal influence, to be born with criminal
tendencies or to grow up a pious lad or become a devout minister.
These tendencies and characteristics are all largely determined by the
"depressors," "suppressors," and "determiners" which were present in
the two microscopic and mosaic germ cells which united to start the
embryo at the time of conception.
The child is destined to be born, endowed, and equipped with the
mental, nervous, and physical powers which his line has fallen heir to
all through the past ages. Down through the ages education, religion,
environment, and other special influences have no doubt played a small
part in influencing and determining hereditary characteristics; just
as environment in the ages past changed the foot of the evolving horse
from a flat, "cushiony" foot with many toes (much needed in the soft
bog of his earlier existence) into the "hoof foot" of later days, when
harder soil and necessity for greater fleetness, assisted by some sort
of "selection" and "survival," conspired to give us the foot of our
modern horse, and this story is all plainly and serially told in the
fossil and other remains found in our own hemisphere. It would appear
that many, many generations of education and environment are required
to influence markedly the established and settled train of heredity
regarding any particular element or characteristic in any particular
line or lines of hereditary tendencies.
EUGENIC SUPERSTITION
There is probably more misinformation in the minds of the people on
the subject of "maternal impressions" and "birthmarks" than any other
scientific or medical subject. The popular belief that, if a pregnant
woman should see an ugly sight or pass through some terrifying
experience, in some mysterious way her unborn child would be "marked,"
deformed, or in some way show some blemish at birth, is a time-honored
and ancient belief.
Such unscientific and unwarranted teaching has been handed down
from mother to daughter through the ages, while the poor, misguided
souls of expectant women have suffered untold remorse, heaped blame
upon themselves, lived lives literally cursed with fear and
dread--veritable slaves to superstition and bondage--all because of
the simple fact that a certain percentage of all children born in this
world have sustained some sort of an injury or "embryological
accident" during the first days of fetal existence. For instance, take
the common birthmark of a patch of reddened skin on the face, brow, or
neck. As soon as the baby is born, the worried mother asks in anxious
tones: "Doctor, is it all right, is it perfect, has it got any
birthmarks?" On being told that the baby has a round, red patch on its
left brow, the ever-ready statement of the mother comes forth: "Yes, I
knew I'd mark it, I was picking berries one day about three months
ago, and I ate and ate, until I suddenly remembered I might mark my
baby, and before I knew what I was doing, I touched my brow and I just
knew I had marked my baby." Do you know, reader, that that birthmark
was present fully four months before she passed through that
experience in the berry patch? And yet so worried and apprehensive
has been the pregnant mother, that, although she can never
successfully predict the "birthmarks" and blemishes of her child,
nevertheless when these defects are disclosed at birth she is
unfailingly able immediately to recall some extraordinary experience
which she has carefully stored away in her memory and which, to her
mind, most fully explains and accounts for the defect.
Is it much wonder that in the very early days of embryonic existence,
during the hours of delicate cell division, indentation, outpushing,
elongation, and sliding of young cells--is it much wonder, I
repeat--that there occur a few malformations, blemishes, or other
accidents which persist as "birthmarks?"
CAUSES OF BIRTHMARKS
There are many factors which may enter into the production of
birth-blemishes, deformities, monstrosities, etc. These influences are
all governed by certain definite laws of cause and effect. A
pre-existent systemic disease in the father, or a coexistent disorder
in the mother, may be a leading factor. A mechanical injury, such as a
sudden fall, a blow, or a kick, or certain kinds of prolonged
pressure, not to mention restrictions and contractions of the maternal
bony structures, may all possibly contribute something to these
prenatal miscarriages of growth and development. Maternal or prenatal
embryonic infections could bring about many sorts of birthmarks and
malformations. These defects might also be caused by certain types of
severe inflammatory disorders in the uterus during the early days of
pregnancy.
The same factors that produce the accidents of embryology resulting in
malformations or monstrosities in the human family, are also operative
in the case of our lesser brethren of the animal kingdom, for
monstrosities and birth-defects are very common among the lower
animals, notwithstanding the fact that the animal mother probably does
not "believe in birthmarks."
"It is a striking fact that during the nineteenth century, the
teratologists, those who have scientifically investigated the causes
of monstrosities and fetal morbid states, have almost without
exception, rejected the theory of maternal impressions." Scientists
and physicians are coming to recognize the fact that fears and frights
do not in any way act as causes in the production of monstrosities and
deformities. Let us seek forever to liberate all womankind from the
common and harassing fear and the definite dread and worry that,
because they failed to control themselves at the instant of some
terrifying sight or experience, they were directly responsible for the
misfortune of their abnormal offspring.
It should be remembered that there exists no direct connection
whatsoever between the nervous system of the unborn child and the
nervous system of the mother. The only physiological or embryological
relationship is of a nutritional order, and even that is indirect and
remote.
ROLE OF THE PLACENTA
By the end of the third month, the "cocoon" attachment described in
chapter two has disappeared; the fetus is slowly pushed away from the
uterus which has so snugly held it for more than eleven weeks; while
upon the exact site of its previous attachment the thickened uterine
membrane undergoes a very interesting and important change--definite
blood vessels begin to form--which begin indirectly to form contact
with the maternal vessels, and thus it is that the placenta, or "after
birth" is formed; and then, by means of the umbilical cord,
nourishment from the mother's blood-stream is carried to the growing
and rapidly developing child. In exchange for the nourishing stream of
life-giving fluid by which growth and development take place, the
embryo gives off its poisonous excretions which are carried back to
the placenta, from which they are absorbed into the veinous
circulation of the mother; so, while the mother does, through the
process of nutrition, influence growth and development in the embryo,
she is wholly unable to produce specific changes and such definite
developmental errors as birthmarks and other deformities.
Just as truly as it would be impossible so to frighten a setting hen
as to "mark" or otherwise influence the form or character of the
chicks which would ultimately come forth from the eggs in her nest,
it is just as truly impossible to frighten the pregnant mother and
thereby influence the final developmental product of the human egg
which is so securely tucked away in its uterine nest; for, when
conception has occurred, the human embryo is just as truly an
egg--fashioned and formed--as is the larger and shell-contained embryo
of the chick which lies in the nest of the setting hen.
And so we are compelled to recognize the fact that there is little
more danger to the unborn child when the mother is frightened than
when the father is scared. The one contributes as much as the other to
the general character of the child, while neither is to blame for
development errors and defects.
SUGGESTION AND HEREDITY
Certain fears are suggested to children. For twenty years I lived
under the delusion that I was terribly afraid of snakes--more so than
any other human being; for I was told when a mere child that I had
been "marked with the fear of snakes," that just two months before I
saw the peep of day, my esteemed mother had been terrified by a snake.
Everywhere I went, I announced to sympathizing and ofttimes
mischievous friends, that "I was marked with the fear of snakes and
must never be frightened with them." It is needless to add in passing,
that I was teased and frightened all through my girlhood days. I was a
veritable slave to the bondage of snake-fear. Everywhere I went I
looked for my dreaded foe, expecting to sit on one, step on one, or to
have one drop into my lap from the roof.
The day of deliverance came after marriage, when in a supreme effort
to deliver me from the shackles of fear, the goodman of the house
tenderly, but firmly, maneuvered a morning walk so that it halted in
front of a large plate-glass window of the Snake Drug Store in San
Francisco. Just back of this plate glass, and within eighteen inches
of my very nose, were fifty-seven varieties of the reptiles, big and
small, streaked and checkered, quiet and active. After much
remonstrance and waiting, I came-to--gazed at the markings, beautiful
in their exactness--while slowly the change of mind took place. Faith
took the place of fear, calmness subdued panic, and I was wondrously
delivered from the veritable bondage of a score of years. And so it is
that the mother suffers and then the child suffers, ofttimes a living
death, because of the superstition "I'm marked," while there is ever
present the fear or dread that "something is going to happen, because
I'm different from all other individuals--because 'I'm marked!'"
CHAPTER IV
THE HYGIENE OF PREGNANCY
As soon as a woman discovers that she is pregnant, she should sit down
and quietly think out the plan for the nine months of expectancy.
The cessation of the menses may come as a surprise to her, and for a
while she is more or less confused; she must go over the whole
situation and adjust future plans to fit in with this new and all
important fact. From a large experience with maternity cases, I have
reached the conclusion that the larger percentage of pregnancies do
come as a surprise, and in many instances a complete change of program
must be painstakingly thought out. This is especially true of the
business woman, the professional woman, the busy club woman, or the
active society woman.
EARLY PLANNING
Let me say to the woman who is pregnant for the first time, the
experiences of the pregnant state should cause you no fear, worry, or
anxiety. Giving birth to a baby is a perfectly natural, normal
procedure, and if you are in reasonable health--if your physician
tells you you are a fairly normal woman--then you can dismiss further
thought of danger and go on your way rejoicing. For thousands of years
maternity has been women's exclusive profession and no doubt will
continue to be many ages hence.
By far the most important and the first thing to do is carefully to
select the best physician your means will allow, and place yourself
under his or her care. Your doctor will help you to plan wisely and
intelligently during the waiting time, for physicians have learned
from experience that the better care the pregnant woman receives, the
easier will be her labor, and the more speedy and uneventful the
recovery.
And now, we proceed to take up one by one the particular phases of the
hygiene of pregnancy which touch the comfort, convenience, and health
of both the mother and her unborn child.
THE CLOTHING
At all times and under all circumstances the pregnant woman's clothing
should be comfortable, suitable for the occasion, artistic, and
practical. And to be thus beautifully clothed is to be as
inconspicuous as is possible. Of all times, occasions, and conditions,
that of pregnancy demands modesty in color, simplicity in style,
together with long straight lines (Fig. 2). For the "going out" dress,
select soft shades of brown, blue, wine, or dark green. Let the house
dresses be simple, easy to launder, without constricting waist bands,
of the one-piece type, in every way suitable for the work at hand.
Under this outer dress, a princess petticoat should cover a specially
designed maternity corset (if any corset at all be worn), to which is
attached side hose-supporters. A support for the breasts may be worn
if desired, it should be loose enough to allow perfect freedom in
breathing.
The union suit may be of linen, silk, or cotton, with the weight
suitable for the season. Stockings and shoes should be of a
comfortable type, straight last, low or medium heel and at least as
wide as the foot. There are two or three shoes on the market that are
particularly good, whose arches are flexible, heels comfortable,
straight last, and whose soles look very much like the lines of the
foot unclothed. This style is particularly good during the maternity
days. Painful feet are a great strain upon the general nervous system.
Who of us has not seen women with strained, tense faces hobbling about
in high-heeled, narrow-toed shoes? And if we followed them we would
not only see tenseness and strain in the features of the face, but
could hear outbursts of temper on the least provocation. Aching feet
produce general irritability. If ease of body and calmness of spirit
is desired, wear shoes that are comfortable, and the surprising part
of it is that many of them are very good looking.
[Illustration: Fig. 2. The "Expectant" Costume
The long lines, so admirable for maternity wear are portrayed in this
handsome afternoon costume. Tunic waist is made with shoulder yoke
from which fullness hangs in fine plaiting with panel at back, front
and under arms. The set in vest is of black-striped gold cloth trimmed
with gold thread crochet buttons and with tiny waistcoat of black
moire. Sleeves are of Georgette crepe. Loose adjustable girdle of
black moire ribbon. Full skirt is attached on elastic to china silk
underbodice. Material Crepe de chine or any other soft, clinging
fabric.]
Toward the end of pregnancy ofttimes the feet swell, in which instance
larger shoes should be worn in connection with the bandaging of the
ankles and legs.
During the latter days of expectancy an abdominal supporter may be
worn advantageously. Much of the backache and heaviness in the pelvis
is entirely relieved by the supporting of the pendulous abdomen with a
well-fitted binder. An ordinary piece of linen crash may be fitted
properly by the taking in of darts at the lower front edge; or elastic
linen, or silk binder may be secured; in fact, any binder that
properly supports the abdomen will answer the purpose.
It should be within the means of every pregnant woman to have a neat,
artistic out-door costume, for social, club and church occasions (Fig.
2). For no reason but illness should an expectant mother shut herself
up in doors.
True men and true women hold the very highest esteem for the maternal
state, and the opinion of all others matters not; so joyfully go forth
to the club, social event, concert, or church; and to do this, you
must have a well-designed, artistic dress. The material does not
matter much, but the shade and style are important.
DIET
There are certain laws which govern the diet at all times; for
instance, the man who digs ditches requires more of a certain element
of food and more food in general, than does the man who digs thoughts
out of his brain. The growing child requires somewhat different
elements of food than does an adult. In other words, "The diet should
suit the times, occasions, occupations, etc."
In the case of the expectant mother it should be remembered that the
child gains nine-tenths of its weight after the fifth month of
pregnancy, and it is, therefore, not necessary that a woman shall
begin "eating for two" until after the fifth month. And since it is
also true that the baby doubles its weight during the last eight weeks
of pregnancy, it follows that then is the time when special attention
must be given to the quantity as well as the quality of "mothers'
food."
During the first five months, if the urine and blood-pressure are
normal, the "lady in waiting" should follow her usual dietetic tastes
and fancies so long as they do not distress or cause indigestion.
Because of the additional work of the elimination of the fetal wastes,
much water, seven or eight glasses a day, should be taken; while one
of the meals--should there be three--may well consist largely of
fruit. All of the vegetables may be enjoyed; salads with simple
dressings and fruits may be eaten liberally. Of the breads, bran,
whole wheat, or graham are far better for the bowels than the finer
grain breads, or the hot breads.
Something fresh--raw--should be taken every day, such as lettuce,
radishes, cabbage salad, and fresh fruits.
If the prospective mother is accustomed to the liberal use of meat,
providing the blood-pressure and urine are normal, she may be able to
indulge in meat once a day. Many physicians believe that the maternal
woman should eat meat rather sparingly--from once a day to once or
twice or three times a week.
Of the desserts, gelatine, junket, ice cream, sponge cake, and fruit
are far better than the rich pastries, which never fail even in health
to encourage indigestion and heart burn. The fruitades are all good.
Candies and other sweets may be eaten in moderation. Alcohol should be
avoided. Tea and coffee should be restricted, and in many cases
abandoned. For many, two meals and a lunch of fruit or broth are
better than three full meals. There is a continual and increased
accumulation of waste matter which must be thrown off by the lungs,
kidneys bowels, and skin; so that clogging of one channel of
elimination makes more work for one or more of the other eliminative
organs.
Sometimes the craving for food is excessive, and the desire to nibble
between meals is quite troublesome. These unusual feelings should be
controlled or ignored. A glass of orangeade will sometimes satisfy
this unnatural craving. Save your appetite for meal time--for a good
appetite means good digestion--all things equal. The woman who
habitually eats between meals is the sluggish, constipated individual
who needs to acquire self-control and learn self-mastery.
WATER DRINKING
Water is the circulating medium of the body, from which the digestive
secretions are formed, and by which the food is assimilated and
distributed to individual cells. And, finally, water is the agent for
dissolving and removing waste products from the body through the
various eliminating organs. We literally live, think, and have our
being, as it were, under water. The tiny cell creatures of our bodies,
from the humble bile workers of the liver to the exalted thinking
cells of the brain, all carry on their work submerged. Accordingly,
the amount of water we drink each day, determines whether the liquids
circulating through our tissues shall be pure, fresh, and life-giving,
or stagnant, stale, and death-dealing.
Thirst is the expression of the nervous system, constituting a call
for water, the same as hunger represents a call for food. Pure water,
free from all foreign substances, is the best liquid with which to
quench this thirst.
It is just as important to supply abundance of water for the proper
bathing and cleansing of the internal parts of the body, as it is to
wash and bathe the external skin frequently. The living tissues are
just as literally soiled and dirtied by their life action and their
poisonous excretions, as is the skin soiled by its excretions of sweat
and poisonous solids. Thus the regular drinking of water is absolutely
necessary to enable the body to enjoy its internal bath, and this
internal cleansing is just as grateful and refreshing to the cells and
tissues, as is the external bath to the nerves which exist in the
skin.
The total amount of water necessary varies according to the nature of
one's work, the amount of sweating from the skin, the moisture of the
atmosphere, the amount of water in the food, etc. We believe the
average person requires about eight glasses of liquid a day; that is,
about two quarts. By the word "glass" we refer to the ordinary glass
or goblet, two of which equal one pint. This amount of water should
be increased, if anything, throughout pregnancy; while, during the
later months, the amount of water taken each day should be at least
doubled.
In the condemnation of so-called artificial beverages, an exception
should be made of the fruit juices. The fresh, unfermented juices of
various fruits come very near being pure, distilled water, as they
consist of only a little fruit sugar and acid, together with small
amounts of flavoring and coloring substances, dissolved in pure water.
None of these substances contained in pure fruit juice needs to be
digested.
Lemonade not too sweet, and taken in moderate quantities, is certainly
a beverage free from objection when used by the average pregnant
woman. Unripe or overripe fruits frequently cause bowel disturbances;
as also do the millions of germs which lurk upon the outside of
fruits, and which find their way into the stomach and bowels when
these fruits are eaten raw without washing or paring. Otherwise, the
juices of fruits and melons are wholesome food beverages when consumed
in moderation.
EXERCISE
It should be the regular practice of every expectant mother to spend a
portion of each day in agreeable, suitable exercise or physical work
of some description. This exercise will be far more beneficial if it
can be taken in the open air. The weather and the strength of the
patient must be taken into consideration and the necessary
modifications of the daily exercise should be made.
An expectant mother living in the city and enjoying the average health
and strength, should engage in such agreeable exercise as the raising
of flowers, the training of vines, with brisk walks in the fresh air.
As much time as possible should be spent in the parks.
The rural "mother in waiting," may do light gardening, raising of
chickens, or pigeons, training of vines, or other outdoor work she may
enjoy.
No matter what kind of weather prevails, a daily brisk walk should be
taken, out of doors, on the porch or in a room with open windows. A
daily sweat, as well as the daily prayer, is good for the well-being
of the expectant mother. All forms of light housework are commendable.
Keep out of crowds. Spend more time in the parks than in the
department stores. An occasional evening at the concert or theater is
diversion and harmless provided the ventilation is good. Such
exercises as horseback riding, bicycling, dancing, driving over rough
roads, lifting and straining of any kind, and all other forms of
fatiguing exercise should be avoided.
REST
Rest and relaxation are quite necessary for men and women even in the
best of health. A kind providence has arranged that we spend a large
portion of our time resting, and sleeping. In addition to unbroken
rest at night it is well for the prospective mother quietly to
withdraw from the family circle, when the first signs of fatigue begin
to appear, and indulge in a little rest, before she gets into a state
of nervousness--where nerves twitch and she becomes irritable.
A mother who has borne six children, who has had little domestic
help, and who yet retains her youthful appearance and energy,
thinks her present condition due to the fact that while carrying
and nursing her babies she never permitted herself to reach that
stage of exhaustion where her nerves twitched, her voice
shrilled, and she became irritable. She made it a practice to
drop her work when these symptoms began to appear, and to seek
the sanctuary of a quiet room apart from her family, if only for
ten or fifteen minutes. And, most important, from the very start
she trained her household to respect her right thus to draw
apart.
I have told many women whose household duties press hard: "Your
husband would rather see a cold lunch on the table, or 'go out' for
dinner, while his wife rested, smiling and happy, than to have a most
sumptuous meal spread before him and the wife tired, and fretful."
Every woman should make it the rule of her life to stop just this side
of the outburst of words, and lie down long enough, breathing deeply,
to calm the spirit.
FRESH AIR
"With all persons plenty of fresh air, night and day, is indispensable
to health, and to none more than the pregnant woman. She should sleep
with the windows open, or out of doors, at all seasons of the year; of
course, making due allowance for the severity of the winters in the
North. It is not only necessary to provide for the adequate
ventilation of sleeping-rooms, but also for that of the living-rooms
of the house.
Many persons, who are quite particular to open wide the windows of the
bedrooms, forget that the other rooms need it quite as much. All the
rooms of the house which are occupied should be thoroughly ventilated
by throwing doors and windows open every morning; at night when the
family is assembled the air must be changed now and then or it will
become unfit for human lungs."
Men and women are outdoor animals. They were made to live in a garden,
not a house. Remember that each person requires one cubic foot of
fresh air every second. Don't allow the temperature of living-rooms,
during the winter season, to go above sixty-eight degrees. If your
home has no system of ventilation, open wide the windows and doors
several times a day and enjoy the blessings of a thorough-going
flushing with fresh air.
Oxygen is the vital fire of life. Our food, however well digested and
assimilated, is just as useless to the body without oxygen, as coal is
to the furnace without air. It is equally important to keep up the
proper degree of moisture in the air of the living-rooms.
BATHING
Bathing is made necessary by the clothes we wear and by our indoor
life. If the skin were daily exposed to sunshine and fresh air, it
would seldom be necessary to bathe. The neglect of regular bathing
results in overworking the liver and kidneys, and debilitates the
skin. Regular bathing--ofttimes sweating baths--is very essential to
the hygiene of pregnancy.
The neutral bath (97 F.) is excellent to quiet the nerves and induce
sleep. Morning bathing is an exceedingly valuable practice. If
properly taken before breakfast or midway between breakfast and lunch,
it is found to be refreshing and tonic in nature. The feet should be
in warm water, the application of cold should be short and vigorous. A
rough mit dipped in cold water, rubbed over the body until the skin is
pink, is a splendid tonic.
Warm cleansing baths should be taken twice a week at night. There is
no good reason for the use of the vaginal douche during pregnancy.
THE TEETH
Because the mother's system is drained of the lime salts which aid in
building up the bones of the child, along with other metabolic changes
which cause the retention of certain acids which ofttimes affect the
teeth, they should be frequently examined and carefully guarded.
Severe dental work should be avoided, but all cavities should receive
temporary fillings while the teeth are kept free from deposits.
As a preventive to this tendency of the teeth to decay, a simple mouth
wash of one of the following may be used after meals:
1. One teaspoon of milk magnesia.
2. One tablespoon of lime water.
3. One-half teaspoon common baking soda.
Any one to be dissolved in a glass of water.
DIRECTIONS FOR SAVING URINE SPECIMENS
Beginning with the second voiding of urine after rising on the morning
of the day you are to save the specimen, save all that is passed
during the following twenty-four hours, including the first voiding on
the second morning. Measure carefully the total quantity passed in the
twenty-four hours. Shake thoroughly so that all the sediment will be
mixed, and immediately after shaking take out eight ounces or
thereabouts for delivery to the physician the same forenoon. The
following items should be noted, and this memoranda should accompany
the specimen:
1. Patient's name.
2. Address.
3. This specimen was taken from a twenty-four hour voiding of urine,
which began at .... A.M. ...., and ended at .... A.M. ....
4. The total quantity voided during this twenty-four hours was ....
pints.
This specimen should reach the laboratory by ten o'clock the same
morning.
It is of utmost importance the specimen should be taken to your
physician every two weeks, and oftener if conditions indicate it. Take
it yourself at the appointed time.
THE BOWELS
Owing to the increasing pressure exerted upon the intestines, most
expectant mothers experience a tendency to sluggish bowels and
constipation. This unpleasant symptom is usually increased during the
later months.
In the first place, a definite time must be selected for bowel action.
It may ofttimes be necessary, and it is far less harmful, to insert a
glycerine suppository into the rectum, than to get into the enema
habit. The injection of a large quantity of water into the lower bowel
will mechanically empty it; but the effects are atonic and depressing
as regards future action.
Before we take up the advisability of taking laxatives let us consider
what foods will aid in combating constipation. The following list of
foods are laxative in their action and will be found helpful in
overcoming the constipation so often associated with pregnancy:
1. All forms of sugar, especially fruit sugar, honey, syrup, and malt.
All the concentrated fruit juices. Sweet fruits, such as figs,
raisins, prunes, fruit jellies, etc.
2. All sour fruits, and fruit acids: Apples, grapes, gooseberries,
grape fruit, currants, plums, and tomatoes.
3. Fruit juices, especially from sour fruits: Grape juice, lemonade,
fruit soup, etc.
4. All foods high in fat: Butter, cream, eggs, eggnog, ripe olives,
olive oil, nuts--especially pecans, brazil nuts, and pine nuts.
5. Buttermilk and koumiss.
6. All foods rich in cellulose: Wheat flakes, asparagus, cauliflower,
spinach, sweet potatoes, green corn and popcorn, graham flour, oatmeal
foods, whole-wheat preparations, bran bread, apples, blackberries,
cherries, cranberries, melons, oranges, peaches, pineapples, plums,
whortleberries, raw cabbage, celery, greens, lettuce, onions,
parsnips, turnips, lima beans, and peanuts.
White bread should be tabooed, and in its place a well-made bran bread
should be used. Two recipes for bran bread follow, one sweetened and
containing fruit, the other unsweetened:
BRAN BREAD RECIPES
1. Two eggs, beaten separately; three-fourths cup of molasses, plus
one round teaspoon of soda; one cup of sour cream; one cup of sultana
seedless raisins; one cup of wheat flour, plus one heaping teaspoon
baking powder; two cups of bran; stir well and bake one hour.
2. One cup of cooking molasses; one teaspoon of soda; one small
teaspoon of salt, one pint of sour milk or buttermilk, one quart of
bran, one pint of flour. Stir well, and bake for one hour in a very
slow oven. It may be baked in loaf, or in gem pans, as preferred. The
bread should be moist and tender, and may be eaten freely, day after
day, and is quite sure to have a salutary effect if used persistently.
The drinking of one-half glass of cold water on rising in the morning
often aids in keeping the bowels active. Of the laxative drugs which
may be used at such a time, cascara sagrada and senna are among the
least harmful. Two recipes of senna preparation follow, and may be
tried in obstinate cases:
1. _Senna Prunes._ Place an ounce of senna leaves in a jar and pour
over them a quart of boiling water. After allowing them to stand for
two hours strain, and to the clear liquid add a pound of well-washed
prunes. Let them soak over night. In the morning cook until tender in
the same water, sweetening with two tablespoons of brown sugar. Both
the fruit and the sirup are laxative. Begin by eating a half-dozen of
the prunes with sirup at night, and increase or decrease the amount as
may be needed.
2. _Senna with prunes and figs._ This recipe does not call for
cooking. Take a pound of dried figs and a pound of dried prunes, wash
well. Remove the stones from the prunes and if very dry soak for an
hour. Then put both fruits through the meat chopper, adding two ounces
of finely powdered senna leaves. Stir into this mixture two
tablespoons of molasses to bind it together, the result being a thick
paste. Begin by eating at bedtime an amount equal to the size of an
egg, and increase or decrease as may be necessary. Keep the paste
tightly covered in a glass jar in a cool place. If the senna is
distasteful a smaller quantity may be used at first.
CARE OF THE BREASTS
The breasts are usually neglected during the months of pregnancy, and
as a result complications occur after the baby comes which cause no
end of discomfort to the mother. If, during the pregnancy, the breasts
are washed daily with liquid soap and cold water, and rubbed
increasingly until all sensitiveness has disappeared, they may be
toughened to the extent that no pain whatsoever is experienced by the
mother when the babe begins to nurse. During the last month of
pregnancy a solution of tannin upon a piece of cotton may be applied
after the usual vigorous bathing. If the nipples are retracted they
should be massaged until visible results are attained.
THE MENTAL STATE
Keep the mind occupied with normal, useful, and healthy thoughts.
Listen to no tales of woe. Stay away from the neighborhood auntie
dolefuls. Keep yourself happy and free from all worry, care, and
anxiety.
"Put no faith in fables of cravings, markings, signs, or
superstitions. They are all unfounded vagaries of ignorant old women
and will not bear investigation."
Don't take drugs for worry and sleeplessness. Take a bath.
The secret of deliverance from worrying is self-control. Minimize your
difficulties. Cultivate faith and trust.
The conditions which favor sound sleep are: Quiet, mental peace, pure
blood, good digestion, fresh air (the colder the better), physical
weariness (but not fatigue), mental weariness (but not worry).
When tempted to borrow trouble, when harassed by fictitious worries,
remember the old man who had passed through many troubles, most of
which never happened. Train the mind to think positive thoughts.
Replace worry-thought with an opposite thought which will occupy the
mind and enthuse the soul. Drive out fear-thought by exercising
faith-thought. Cultivate the art of living with yourself as you are,
and with the world as it is. Learn the art of living easily. Associate
with children and learn how to forget the vexing trifles of everyday
life.
There is something decidedly wrong with one's nerves when everybody is
constantly "getting on them." They are either highly diseased or
abnormally sensitive. Every woman is a slave to every other that
annoys her.
Fear is capable of so disarranging the circulation as to contribute to
the elevation of blood-pressure--which will be more fully considered
in a later chapter.
CHAPTER V
COMPLICATIONS OF PREGNANCY
It is the purpose of this chapter to take up the various complications
which may appear in the course of an otherwise normal pregnancy, and
offer advice appropriate for their management.
MORNING SICKNESS
About one-half of the expectant mothers that come under our care and
observation, experience varying degrees of nausea or "morning
sickness." This troublesome symptom makes its appearance usually about
the fourth week of pregnancy and lasts from six to eight weeks.
On attempting to rise from the bed, there is an uncomfortably warm
feeling in the stomach followed by a welling up into the throat of a
warmish, brackish tasting liquid which causes the patient to hasten to
rid herself of it; or, as she rides on the train, on the street cars,
in a carriage or automobile, she frequently senses the same unpleasant
and nauseating symptoms during the second and third months of
pregnancy. Normally, this uncomfortable symptom quite disappears by
the end of the third month. A number of remedies have been suggested
for it, but that which seems to help one, gives little or no relief to
another; we therefore mention a variety of remedies which may be
tried.
First and most important of all remedies--is to keep the bowels open.
Sluggishness of the intestinal tract greatly increases the tendency to
dizziness and nausea. During the attack, it is advisable not to
attempt to brush the teeth, gargle, or even drink cold water. While
you are yet lying down, the maid or the goodman of the house should
bring to you a piece of dry, buttered toast, a lettuce sandwich with
a bit of lemon juice, or perhaps a cup of hot milk or hot malted milk.
Coffee helps to raise the blood-pressure, and all articles of diet
that tend to raise the blood-pressure are best avoided during
pregnancy. A cup of cocoa may be tried, but, as a rule, women at this
time do not relish anything sweet. Oftentimes a salted pretzel is just
the thing, or a salted wafer will greatly help. Remain in bed from
one-half to one hour and then rise very slowly. There should be plenty
of fresh air in the room, as remaining in overheated places is quite
likely to produce a feeling of sickness at the stomach.
When the attack comes on during a train ride, open the window and
breathe deeply, this, with the aid of a clove or the tasting of a bit
of lemon, will usually give relief. In extreme instances the patient
should lie down flatly on the back, with the eyelids closed. Go to the
rear of the street car, so that you can get off quickly if necessity
demands; breathe deeply of the air; resort to the use of cloves or
lemons; and thus by many and varied methods will the expectant mother
be enabled to continue her journey or finish her shopping errand. We
would suggest that, as far as possible, walking should be substituted
for riding. I have never heard of a woman being troubled with nausea
while walking in the parks, on shady streets, along the country road,
or on the beach.
Of the medicines prescribed for "morning sickness" and the nausea of
pregnancy, cerium oxalate taken three times a day in doses of five
grains each, is probably one of the best.
The persistent or pernicious vomiting which continues on through
pregnancy will be spoken of later.
HEARTBURN
Acid eructations are spoken of as "heartburn," and are occasioned by
the increased activity of the acid making glands of the stomach. Under
certain conditions this acid content of the stomach is regurgitated
back into the throat and even belched up into the mouth. In this
condition it is well to avoid most acid fruits. Ice cream and other
frozen desserts are beneficial. The lowered temperature of cold foods
depresses the activity of the acid glands, as also does the fats of
the cream, while protein food substances such as white of egg, cheese,
and lean meat, help by combining with the excess of acid present in
the stomach. Buttermilk or the prepared lactic acid milk, if taken
very cold, is often helpful, notwithstanding it is an acid substance,
in connection with the dietetic management of heartburn. If the acid
eructations be troublesome between the meals, the taking of calcined
magnesia (one round teaspoon in a glass of cold water), or, one-half
teaspoon of common baking soda in a glass of water, will afford
immediate and temporary relief. Simply nibbling a little from a block
of magnesia will often give instant relief. These alkalines
effectively neutralize the mischievous acids which cause the so-called
"heartburn."
IRRITABILITY OF THE BLADDER
The flexing or bending forward of the gravid uterus, by making
pressure on the bladder, sets up more or less irritation and
consequent disturbance of the urinary function. The capacity of the
bladder is actually diminished, and this produces frequent urination.
There is usually no pain connected with this annoying symptom--the
chief discomfort is the frequent getting up at night. This
inconvenience may be lessened by drinking less water after six P.M.
These bladder disturbances are most marked in the earlier months, and
gradually disappear as the uterus raises higher up into the abdomen;
although this symptom may reappear in the last two weeks, as the head
descends downward on its outward journey.
Should the urine at any time become highly colored, take a specimen to
your physician at once. Twenty-four hour specimens of urine should be
taken by the patient to her physician every two weeks. Do not send
it--take it.
LEUCORRHEA
While leucorrhea is an unusual complication of pregnancy, it is often
very troublesome and sometimes irritating. Do not take a vaginal
douche unless it has been ordered by your physician, and even then
make sure that the force of the flow of water is very gentle. The bag
of the fountain syringe should be hung only about one foot above the
hips. Soap and water used externally, followed by vaseline or zinc
ointment, will usually relieve the accompanying irritation.
THREATENED ABORTION
In the third chapter attention was called to the formation of the
placenta or "after birth," on the site of the attachment of the cocoon
embryo. At this particular time of the pushing away of the embryo from
the uterine wall, one of the accidents of pregnancy occurs, in which
the embryo becomes completely detached and starts to escape from the
uterus, accompanied by varying degrees of pain and hemorrhage. The
symptoms of this threatened abortion are:
1. Heavy menstrual pains.
2. Backache.
3. Hemorrhage.
The approach of the calendar date of the third month of pregnancy
should be watched for, and all work of a strenuous nature studiously
avoided; while at the first signs of the backache or any unusual
symptom, the expectant mother should immediately go to bed and send
for the physician. One patient who had aborted on four different
occasions was able to pass this danger period by adhering to a rigid
program of prevention during her fifth pregnancy. Two weeks before the
third month arrived she discontinued her teaching and went to bed. She
remained there four weeks, thus running over into the middle of the
following month. Gradually, she resumed her duties of teaching,
carried her precious bundle of life to full term, and is now the proud
and happy mother of a splendid baby girl.
Should abortion seem imminent, from one-eighth to one-fourth of a
grain of morphine sulphate will greatly reduce all uterine
contractions, and this, with the general quieting effect on the whole
system, will usually suffice to prevent an abortion. The patient
should quietly remain in bed from three days to one week.
If the abortion takes place--if a clot accompanied by hemorrhage is
passed--save everything, lie in bed very quietly and send for your
physician at once; and when he does arrive, be content if he does not
make an internal examination at once, for if he should there is more
or less danger of infection. And I repeat--throw nothing away--burn
nothing up, save everything that passes until your physician has
carefully examined it.
SUDDEN ABDOMINAL PAIN
Sudden or severe pains in the abdomen should be reported at once to
your physician, while you should immediately go to bed and quietly
remain there until you receive further instruction from your doctor
when he calls.
In the later stages of pregnancy any appearance of blood should
likewise be noted and reported without delay. These symptoms may not
always be serious, but they are also associated with grave
complications, and should, therefore, be given prompt attention.
MISCARRIAGE
Abortion is a term used to designate the loss of the embryo prior to
or at the third month. Miscarriage applies to the expulsion of the
fetus or emptying of the uterus after the third month. It is possible
for a miscarriage to occur anytime during the interim between the
fourth and ninth months. After the uneventful passing of the third
month, if an accident threatens, we instruct the mother to remain
quietly in bed three to five days at the calendar date comparable with
each menstrual period; and as she approaches the seventh month, we
adjure her to be unusually careful and prudent.
The causes of miscarriages are many: Disease of the embryo, imperfect
fetal development, some constitutional disease of the mother, a faulty
position of the uterus, or it may result from something unusual about
the lining of the uterus such as an endometritis--an inflammation of
the mucus membrane.
Expectant mothers who manifest symptoms of a threatened miscarriage
should studiously avoid such exercises as climbing, riding, skating,
tennis, golf, dancing, rough carriage or automobile riding, and such
taxing labor as sweeping, lifting, washing, running the sewing
machine, window cleaning, the hanging of pictures, draperies, etc.
CRAVINGS
Within reason, a pregnant mother should follow her natural appetite
and satisfy her dietetic longings. Should she desire unusual articles
of food, as far as possible she should have them. The idea has long
prevailed that if the mother does not get what her longing soul
supremely desires, that the on-coming baby is going to cry and cry
until it is given what the mother wanted with all her heart and did
not get. Such an idea is the very quintessence of folly and the
personification of foolishness and superstition.
Many a precious babe has suffered as a victim of this notion of
"craving" and "marking." One mother gave her baby a huge mouthful of
under-ripe banana because "she knew that was just what he wanted,
because, when pregnant, she had craved and craved bananas and for some
reason or another she did not get them." The soft, smooth piece of
banana slipped down the baby's throat--on into the stomach and
intestines--caused intestinal obstruction and finally the end came;
and we registered one more victim to the fallacies of fear and the
superstitious belief in "cravings" and "markings." Occasionally some
cravings are unusual and freakish, for instance, egg shells, leather,
candles, chalk, and other abnormal tastes are developed. Of these we
have only to say, "Rise above them, become mistress of the situation
and change your longings." If such abnormal cravings come to you in
the kitchen, don your bonnet and go at once out of doors and take a
walk. Don't be foolish just because somebody told you foolish stories
about these things.
CONSTIPATION
Bowel hygiene is an important part of the management of pregnancy.
Constipation often proves to be very troublesome. In another chapter
this subject is treated at some length. Here, we pause only long
enough to say that habit has much to do with this difficulty. A
regular time should be set apart each day for attending to this
important matter.
HEMORRHOIDS
Of all the maladies that the human family falls heir to, hemorrhoids
are among the commonest and, we may add, the most neglected. Any woman
who enters pregnancy, suffering from hemorrhoids, is going to have her
full share of suffering and pain before she has finished with her
labors. Taken early, they may be greatly helped, if not entirely
relieved, by the daily use of the medicated suppository (See
Appendix). The bowel movements should never be allowed to become hard,
the dietetic advice of another chapter should be carefully followed
and the oil enema, as described in the appendix, should be used if
necessary. For immediate relief, hot witch-hazel compresses may be
applied; or, in the case of badly protruding piles, the patient should
immerse the body in a warm bath and by the liberal use of vaseline
they can usually be replaced. The physician should be called and he
will advise any further treatment the case may require.
VARICOSE VEINS
Varicose veins or the distension of the surface veins of the legs are
very common among women in general and pregnant women in particular.
The legs should be elevated whenever the patient sits, while in bad
cases they should be bandaged while standing. There are many elastic
surgical stockings on the market today that, if put on before rising
in the morning, will give much relief and comfort all during the day.
Any large medical house or physician's supply house can furnish them
according to your measurements--which should be taken before getting
out of bed in the morning. These measurements are taken according to
instructions and usually are of the instep, ankle, calf of leg, length
of ankle to knee, etc.
CRAMPS
Cramps are sharp, exceedingly painful muscular spasms occurring in the
muscles of the calf of the leg, the toes, etc. The expectant mother
in the later months of pregnancy awkwardly turns in bed, is suddenly
awakened and without a moment's warning, is seized with a most
excruciating pain in her leg or toe. The most effectual treatment for
these cramps is quickly to apply a very cold object to the cramping
muscle. Extremes of either heat or cold usually relieve as well as the
vigorous grasping or kneading of the muscle. A hot foot bath on going
to bed will often prevent an attack. A long walk in the latter months
of pregnancy should invariably be followed by a short hot bath or a
foot bath. Many attacks may be avoided by this procedure.
SWELLINGS
All swellings should be taken seriously by the pregnant mother to this
extent, that she save a twenty-four hour specimen of urine and that
she personally take it to her physician, with a report of her
"swellings." This symptom may or may not indicate kidney
complications. The blood-pressure together with chemical and
microscopical analysis of the urine will determine the cause.
Slight swelling of the feet is often physiological and is due to
pressure of the heavily weighted uterus upon the returning veins of
the legs. The progress of the veinous blood is somewhat impeded, hence
the accumulation of lymph in the tissues of the legs, ankles, and
feet.
Never allow yourself to guess as to the cause of swellings, always
take urine to the physician and allow him definitely to ascertain the
true cause. All tight bands of the waist and knee garters must be
discarded at this time. The same general treatment suggested for
varicose veins holds here.
GOITRE
The enlargement of the thyroid gland--goitre--is physiological during
pregnancy, and is believed to be caused by the throwing into the
maternal blood stream of special protein substances derived from the
fetus. As just stated, this is more or less physiological, will
usually pass away after the babe is born, and, therefore, need give
the mother no particular concern. Tight neck bands should be replaced
by low, comfortable ones. The bowels should move freely every day, and
water drinking be increased as well as sweating of the skin encouraged
by a short, hot bath, followed by the dry blanket pack, while the head
is kept cool by compresses wrung from cold water. In this manner the
elimination of these poisons is increased through both the skin and
the kidneys.
BACKACHE
The backache of the later months of expectancy is very annoying and
often spoils an otherwise restful night's sleep. This is probably also
a pressure symptom, if the physician's analysis of the urine proves
that the kidneys are not at fault. If you have electric lights in the
home, a very useful contrivance can be made which will give you great
relief. The light end of an extension cord, five to seven feet in
length, is soldered into the center of the bottom of a bright, pressed
tin pail about twelve inches in diameter at the top and nine or ten
inches deep. With the bail removed, screw in a sixteen or thirty-two
candle power bulb and attach the extension cord to a nearby wall or
ceiling socket. This arrangement supplies radiant heat and is called a
photophore (See Fig. 3). Apply this twofold remedial agent--light and
heat combined--to the painful back (underneath the bed clothing) and
our restless mother will go to sleep very quickly. This may safely be
used as often and as long as desired.
[Illustration: Fig. 3. The Photophore.]
PERNICIOUS VOMITING
Persistent, prolonged, and very much aggravated cases of morning
sickness are termed pernicious vomiting. The patient emaciates because
of the lack of ability to keep food long enough to receive any
benefits therefrom.
In treating these cases the sufferer should be put to bed in a room
with many open windows, or, if the weather permit, should be out of
doors on a comfortable cot. She should remain in bed one hour before
the meal is served and from one to three hours afterward. The mind
should be diverted from her condition by good reading, friends, or
other amusements. The utmost care and tact should be used in the
preparation of her food, and art should be manifested in the
daintiness of the tray, etc. We found one mother was nauseated even at
the sight of her tray and so we planned a call that should bring us to
her home at the meal hour. The tray came in with the attendant in
unkempt attire, who said, as she placed it carelessly down on a
much-loved book our patient had been reading: "I heard you say you
liked vegetable soup so I brought you a big bowl full." As I gazed at
the tray, I saw a large, thick, gravy bowl running over with the soup.
I usually like vegetable soup, but at the sight of that sloppy looking
bowl--well, I thought I should never care for it again.
After installing a new maid who had a sense of service and daintiness,
and who took real pleasure in the selection of the dishes for the
tray, as well as the quality and quantity of food served in them, our
patient made speedy recovery, went on to full term and became a happy
mother.
There is no doubt that the mind has very much to do with this vexing
complication of pregnancy. One mother immediately stopped vomiting
everything she ate when told by her husband that "the doctor said he
was coming in the morning to take you away from me to the hospital if
you didn't stop vomiting." Everything known should be tried for the
relief of these patients and in extreme cases, when the mother's life
is endangered, pregnancy should be terminated.
INSOMNIA
The neutral full bath, temperature 97 F., maintained for twenty
minutes to one-half hour, should be taken just on going to bed. The
patient must not talk--must rest in the bath--absolutely quiet. The
causes of insomnia should be determined if possible, and proper
measures employed to remove them. They may consist of backache,
cramps, frequent urination, pressure of the uterus on the diaphragm or
pressure against the sides of the abdomen. The bed should be large,
thus giving the patient ample room to roll about.
The following procedures may be tried in an effort to relieve the
sleeplessness:
Rubbing of the spine, alcohol or witch-hazel rubbing of the entire
body, the neutral bath, or the application of the electric
photophore--described a few pages back--may be made to the painful
part. _Do not resort to drugs_, unless you are directed to do so by
your physician.
HEADACHE
Headaches should not be allowed to continue unobserved by the
attending physician. Measure the daily output of urine, which should
be at least three pints or two quarts. In case of daily or frequent
headaches, notify your physician at once and take a twenty-four hour
specimen of urine to him. Headache is an early symptom of retained
poisons and if early reported to the physician quick relief can be
given the patient and often severe kidney complications be avoided by
the proper administration of early sweating procedures. Water drinking
should be increased to two quarts (about ten glasses) a day. Less food
and more water are the usual indications in the headaches of
pregnancy.
HIGH BLOOD-PRESSURE
Blood-pressure is called _high_ when the systolic pressure registers
above 150 to 160 millimeters of mercury. Pressure above 165 should be
taken seriously and the patient should keep in close touch with her
physician. Tri-weekly examinations of the urine should be made, while
eliminating baths should be promptly instituted. The subject of
blood-pressure in relation to pregnancy will be fully dealt with in
the next chapter--in connection with toxemia, eclampsia, etc.
CHAPTER VI
TOXEMIA AND ITS SYMPTOMS
At the close of the preceding chapter on the complications of
pregnancy, brief mention was made of blood-pressure as a possible
source of anxiety. This chapter will be devoted to a further
discussion of the subjects of toxemia, eclampsia, convulsions, and
especially blood-pressure--in connection with other leading symptoms
of these serious complications of pregnancy.
TOXIC SYMPTOMS
In a former chapter we learned that the developing child nearly
doubled its weight in the last two months of pregnancy. As the child
grows, its metabolic waste matter is greatly increased, while all
these poisonous substances must finally be eliminated by the mother.
Now, the mother's waste matter is of itself considerably increased;
and so, if the kidneys, the liver, and the skin are already over-taxed
in their work of normal elimination--if they are already doing their
full quota of work--we can readily see that the additional waste
matter of the unborn child will throw much extra work on the already
overworked eliminative organs, and this results in a condition of
toxemia. Certain symptoms accompany this state of constitutional
poisoning or auto-intoxication--the chief of which are:
1. Headache.
2. Dizziness.
3. Blurring of the vision.
4. Swelling of the feet and hands, or puffiness of the face.
5. Diminished urine.
6. Vomiting.
7. High blood-pressure.
8. Albumin and casts in the urine.
Any one of these symptoms may or may not indicate toxemia; but it
should be reported at once to the attending physician. In the presence
of one or more of these symptoms an expectant mother is always safe,
while awaiting the physician's advice, in carrying out the following
program:
1. Drink more water or lemonade.
2. Take a mild cathartic.
3. Avoid eating much meat and other highly protein foods.
CONVULSIONS OF PREGNANCY
This serious complication of the last weeks of pregnancy demands
immediate attention. They may almost invariably be avoided if the
blood-pressure and the urine are studiously watched during the latter
part of the expectant period.
If you are unable to get your physician at once, the following
treatment should be administered immediately.
1. A hot colonic flushing (See Appendix).
2. A hot bath followed by the hot blanket pack (See Appendix).
3. One drop of croton oil on a bit of sugar may be placed
on the back of the tongue.
4. Chloroform may be administered, provided a competent
nurse or other medical person is present.
The appearance of convulsions which have been preceded by one or more
of the symptoms noted under the head of "toxemia," indicates that the
patient has become so profoundly intoxicated and poisoned by the
accumulating toxins, that the lives of both mother and child are
jeopardized by threatened eclampsia. At such a time, the attending
physician will immediately set about to bring on labor, and thus seek
to empty the uterus at the earliest possible moment.
CARDINAL SYMPTOMS OF TOXICITY
Since toxemia (eclampsia) is one of the complications of pregnancy
most to be dreaded, it is fortunate that it almost invariably exhibits
early danger signals which, if recognized and heeded, would enable the
patient and physician to initiate proper measures to avert danger
and escape the threatened disaster. The presence of this toxic danger
is indicated by the persistent presence of the following three
symptoms:
1. Persistent, dull headache.
2. Presence of casts in the urine.
3. Persistent high blood-pressure, with tendency to increase.
Of course, albumin will probably appear in the urine along with the
casts, but it is the continued appearance of the casts that is of more
importance as a danger signal. Albumin is quite common in the urine of
the expectant mother, but casts--long continued--suggest trouble.
Headache as an indicator of toxemia is of special significance when
coupled with the other two cardinal symptoms of eclampsia--urinary
casts and increasing high blood-pressure. Therefore, the necessity for
frequent urinary tests and blood-pressure examinations during the last
weeks of pregnancy--especially, if the patient has suffered from
headaches and has been running albumin in the urine.
[Illustration: Fig. 4. Taking the Blood Pressure]
HIGH BLOOD-PRESSURE
Blood-pressure is a term used to indicate the actual pressure of the
blood stream against the walls of the blood vessels. The
blood-pressure machine tells us the same story about our circulatory
mechanism, that a steam gauge does about a high-pressure boiler (See
Fig. 4). The normal blood-pressure varies according to the age of the
patient. For instance, the normal pressure of a young person, say up
to twenty years of age, runs from 100 to 120 millimeters of mercury;
and then, as the age advances, the blood-pressure increases in direct
ratio; for every two years additional age the blood-pressure increases
about one point--one millimeter.
The average pregnant woman starts in her pregnancy with a
blood-pressure of say, 125 millimeters, but as pressure symptoms
increase, and as constipation manifests itself, and as the circulating
fluids are further burdened with the toxins which are eliminated from
the child, the blood-pressure normally increases to about 140 mm., and
later, possibly to 150 mm. If the pressure goes no higher, we are not
alarmed, for we have come to recognize a blood-pressure of 140 as
about the normal pressure of the pregnant woman.
There are a number of factors which enter into the raising of the
blood-pressure. For instance, at any time during the pregnancy, if the
eliminative organs of the mother are doing inefficient work, if she
falls a victim to a torpid liver, diseased kidneys, decreased skin
elimination, or sluggish bowels, then, with the added and extra
excretions from the child, there is superimposed upon the mother far
more than the normal amount of eliminative work--and then, because of
improper and incomplete elimination, the blood-pressure is
increasingly raised.
ECLAMPSIA PREVENTED
This whole subject can best be illustrated by relating a story, the
actual experience of Mrs. A. This patient came to the office with a
history of Bright's disease (albumin and casts in the urine), and
chronic appendicitis. While treating her for the kidney condition,
preparatory to an operation for the removal of the troublesome
appendix--in the very midst of this treatment--she became pregnant,
and great indeed was our dismay. We entertained little hope of getting
both the mother and child safely through. Frequent examination of
urine was instituted, the albumin did not increase and the
blood-pressure remained at normal--about 124 mm. She paid weekly or
bi-weekly visits to the office and carefully followed the regime
outlined. She drank abundantly of water and strictly followed the
dietary prescribed. Weeks and months passed uneventful, until we
approached the last six weeks of pregnancy, and then we found to our
surprise one day that the blood-pressure had made a sudden jump up to
175 mm., while the urine revealed the presence of numerous casts and
albumin--in the meantime the albumin had entirely disappeared. There
were also other urinary findings which showed that the liver was not
doing its share in the work of burning up certain poisons.
In her home we began the following program: Every day we had her
placed in a bathtub of hot water, keeping cold cloths upon her brow,
face and neck, and then, by increasing the temperature of the bath, we
produced a very profuse perspiration. She was taken out of this bath
and wrapped in blankets, thus continuing the sweat. All meat, baked
beans, and such foods as macaroni and other articles containing a high
per cent of protein were largely eliminated from her diet. At times
she did not even eat bread. Her chief diet was fruit, vegetables, and
simple salads, and yet the albumin and casts continued to increase in
the urine and the blood-pressure climbed up to 190 mm.
As we approached the last two weeks of pregnancy, this little woman
was taken to the hospital and systematic daily treatment with sweating
procedures was begun. Among other things, she had a daily electric
light bath. After each of these baths she was wrapped in blankets and
the sweating continued for some time. Careful estimations of albumin
were made daily and the blood-pressure findings noted three times a
day. During the last week of pregnancy she lived on oranges and
grapes. Day by day she was watched until the eventful hour arrived.
She went into the delivery room and gave birth to a perfectly normal
child. The albumin and casts quickly cleared up, the blood-pressure
lowered, and today the little woman is a fond mother of a beautiful
baby boy.
It is hard to estimate what might have taken place had not her
elimination been stimulated. The blood-pressure was our guide. Had the
albumin (without casts) appeared in the latter weeks of pregnancy
with a blood-pressure of 140 or 150 mm., we would not have become
excited, for the reason that in every normal pregnancy there is
often present a trace of albumin in the latter weeks; but when
the blood-pressure jumped to 170 or 190, then we knew that
toxemia--eclampsia--convulsions--were imminent. So we have in recent
years, come to look upon the blood-pressure as an exceedingly
important factor--as an infallible indicator of approaching
trouble--as a red signal light at the precipice or the point of
danger; and it not only warns us of the danger, but it tells us about
how near the boilers are to the bursting point. The glassy eye, the
headache, the full bounding pulse and the blurring of vision, are all
symptoms accompanying this high blood-pressure, so that in these
enlightened days no practitioner can count himself worthy the name, or
in any way fit to carry a pregnant woman through the months of
waiting, unless he sees, appreciates, and understands the value of
blood-pressure findings in pregnancy.
CHAPTER VII
PREPARATIONS FOR THE NATAL DAY
Two months before baby is to arrive, the expectant mother should pay
particular attention to the conservation of her strength. The woman
who is compelled to leave her home for the factory, the laundry, the
office, or other place of employment, should stop work during these
last two or three months. The active club woman should pass the
burdens on to others, and the woman of leisure should withdraw from
active social life with its varied obligations. During the final weeks
of pregnancy, the prospective mother needs the same hygienic care
regarding fresh air, exercise, diet, and water drinking, as outlined
in a former chapter.
THE FINAL WEEKS
As the gravid uterus rises higher in the abdomen, increased pressure
is exerted on the stomach, the lungs, and upon the nerve centers of
the back; and it is because of this situation, that the duties and
obligations of the prospective mother should be reduced to a minimum,
that she may feel at liberty to lie down several times during the day
on the porch or in a well-ventilated room, in the midst of the best
possible surroundings. Sexual intercourse should be largely
discontinued during the last months of pregnancy.
I sometimes wish the prospective mothers in our dispensary districts
might have some of the care and the kind treatment which is bestowed
upon an ordinary prospective mother horse, which at least enjoys a
vacation from heavy labor, and whose food is eaten with calm nerves
and in the quietness of a clean stall. While the state of the mother's
mind does not materially influence the child; nevertheless, the state
of the mother's body, the weary over-worked muscles and nerves of
hot, tired women, bending over cook stoves, laundry tubs, or scrubbing
floors, does materially derange the mother's health and digestion,
which in turn, reflexly interferes with the growth and physical
development of her child. Extra strength is required for the day of
labor, and since the baby doubles its weight during the last two
months, the mother is living for two, and should, therefore, avoid
extreme fatigue, over tiring, and irksome labor during these final
weeks of watchful waiting.
SELECTION OF THE HOME
It may or may not be within the province of prospective parents to
rearrange, rebuild, or otherwise change the home. Usually the size of
the pocketbook, the bank account, or the weekly pay envelope decide
such things for us. The home may be in the country or suburbs, with
its wide expanse of lawns, its hedges of shrubbery, and with its
spacious rooms and porches; or it may be a beautifully equipped,
modern apartment on the boulevard of a city, with its sun parlors,
large back porches, conveniently located near some well-kept city
park, or it may be one of those smaller but "snug as a bug in a rug"
apartments, in another part of the city, where usually there is a
sunny back porch; or again some of my readers may themselves be, or
their friends may be, in a darkened basement with broken windows, illy
ventilated rooms, with no porches, no yards, no bright rays to be seen
coming in through windows--and yet into all of these varied homes
there come little babies--sweet, charming little babies, to be cared
for, dressed, fed, and reared. And we must now proceed to the subject
of making the most of what we have--to create out of what we have, as
best we can, that which ought to be.
SANITARY PREMISES
In both the country and city place, yards and alleys should be cleaned
up. Garbage--the great breeding place of flies--should be removed or
burned. The manure pile of the stable or alley should also be properly
covered and cared for. In this way breeding places for flies are
minimized and millions and billions of unhatched eggs are destroyed.
In the large cities, provision is made for the prompt disposal of
garbage, and laws are beginning to be enforced regarding the covering
and the weekly removal of manure, and thus in many of our large cities
flies are diminishing in numbers each year. Fly campaigns and garbage
campaigns are teaching us all to realize the dangers of infection,
contagion, and disease as a result of filth; while through the
schools, the children of even our foreign tongued neighbors take home
the spirit of "cleaning up week." Even in the rural districts we hope
for the dawning of the day when filth, stagnant pools, open manure
piles, and open privies, will be as much feared as scorpions or
smallpox.
ENGAGING THE DOCTOR
As suggested elsewhere, as soon as the expectant mother is aware that
she is pregnant, she should engage her physician. And since these are
days of specialists, he may or may not be the regular family doctor.
The husband and friends may be consulted, but the final choice should
be made by the prospective mother herself. "The faith which casts out
fear, the indefinable sense of security which she feels in her chosen
physician, supports her through the hours of confinement." Twenty-four
hour specimens of urine should be saved and taken to the physician
twice each month and oftener during later months of pregnancy. The
chosen physician's instructions and suggestions should be carried out
and counsel should be sought of him as to the place of confinement.
THE PLACE OF CONFINEMENT
There are a number of factors that enter into the selection of the
place of confinement. In the first place, if the home be roomy,
bathroom convenient, if the required preparation of all necessities
for the day of labor can be effected, and it is further possible to
prepare a suitable delivery-room at home with ample facilities for
emergencies and complications, and you can persuade your physician to
do it--then the best place in the world for the mother to be confined
is within the walls of her own home. But such is the case in but one
home out of hundreds, and I regret that time and space will not allow
me to describe and portray the many untimely deaths that might have
been avoided if this or that supply had only been ready at the moment
of the unexpected complication of delivery. Why should we needlessly
risk the lives of prospective mothers, when, in every up-to-date
hospital delivery-room, all these life-saving facilities are freely
provided? Here in the modern hospital, the mothers from small homes
and apartments, the mothers who live in stuffy basements, as well as
those from the average home in the average neighborhood, can come with
the assurance of receiving the best possible care and attention. Every
woman who can arrange or afford it, should plan to avail herself of
the benefits, comforts, quietness, and calm of a well-equipped
hospital and the surgical cleanliness and safety of its aseptic
delivery-room.
Fortunately, the mother of the basement home may have the same clean,
sterile dressings used upon her as does the mother of the boulevard
mansion. The maternity ward bed at $8.00 to $10.00 a week can be just
as clean as the bed of the $40.00 a week room. The methods and
procedures of the delivery-room can be just as good in the case of the
very poor woman as in the case of the magnate's wife. In no way and
for no reason fear the hospital. It is the cleanest, safest, and by
far the cheapest way. The weekly amount paid includes the board of the
patient, the routine care, and all appliances and supplies of every
sort that will be used. Under no circumstances should a midwife be
engaged. Any reputable physician or any intellectual minister will
advise that. Let your choice be either the hospital or the home; but
always engage a physician, _never_ a midwife.
THE NURSE
After selecting the place of confinement, the question of the nurse
may next be considered. If it is to be the hospital, you need give
little further thought to the nurse, for your physician will arrange
for the nurse at the time you enter the hospital. She will be a part
of the complete service you may enjoy. You will find her on duty as
you, quietly resting in your room, awaken in the sweet satisfaction
that at last it is all over--at last your baby is here.
A competent nurse is a necessity, if the confinement takes place in
the home. She may be a visiting nurse, who, for a small fee, will not
only come on the day of labor, but will make what is known as
"post-partum calls" each day for ten or twelve days. These are short
calls, but are long enough to clean up the mother and wash and dress
the babe. She is not supposed to prepare any meals or care for the
home. Then there is the practical nurse--women who have prepared
themselves along these lines of nursing, whose fees range from $12.00
to $18.00 a week. If your physician recommends one to you, you may
know she is clean and dependable. The trained nurse, who has graduated
from a three years' course of training, is prepared for every
emergency, and will intelligently work with the physician for the
patient's welfare and comfort. Her fees range from $25.00 to $35.00 a
week.
Both the practical and the trained nurses are human beings, and
require rest and sleep the same as all other women do. One nurse,
after having faithfully remained at her post of duty some sixty hours
reminded the husband and sister of the patient that she must now have
five hours of unbroken rest and they replied in a most surprised
manner, "Why we are paying you $30.00 a week, and besides, we
understood you were a _trained_ nurse."
The physician usually makes arrangement with the family for competent
relief for the nurse. She should have at least one to two hours of
each day for an airing, and six hours out of the twenty-four for
sleep.
PREPARATIONS FOR A HOME DELIVERY
The supplies should all be in the home and ready, as the seventh month
of pregnancy draws near. In the first place, select the drawer or
closet shelf where the supplies are to remain, untouched, until your
physician orders them brought out. The supplies requiring special
preparation and sterilization are:
Three pounds of absorbent cotton.
One large package of sterile gauze (25 yards).
Four rolls of cotton batting.
Two yards of stout muslin for abdominal binders.
Two old sheets.
Twelve old towels or diapers.
One yard of strong narrow tape for tying the cord.
Three short obstetrical gowns for the patient.
Two pairs of extra long white stockings.
Four T-binders.
Other articles needed by physician, nurse, and patient are:
Fifty bichloride of mercury tablets (plainly marked "_poison_").
Four ounces of lysol.
Two ounces of powdered boric acid.
One half ounce of 20% argyrol.
One quart of grain alcohol.
One pound jar of surgeon's green soap.
One half pound of castile soap.
One bottle white vaseline.
One drinking tube.
One medicine glass.
One two-quart fountain syringe.
One covered enamel bucket or slop jar.
One good sized douche pan.
Three agateware bowls, holding two quarts each.
Two agateware pitchers, holding two quarts each.
Two stiff hand-brushes.
One nail file.
One pair surgeon's rubber gloves.
One and one-half yards rubber sheeting 36 inches wide.
Two No. 2 rubber catheters.
Two dozen large safety pins.
Small package of tooth picks, to be used as applicators.
Six breast binders (Fig. 5).
Six sheets.
Just before confinement send for one ounce of fluid extract of ergot
and an original pint bottle of Squibb's Chloroform.
THE PREPARATION OF THE SUPPLIES
1. _The sanitary pad_ is used to absorb the lochia after confinement,
and needs to be changed many times during the day and night; fully
five or six dozen will be required. They are usually made from cotton
batting and a generous layer of absorbent cotton. If made entirely
from absorbent cotton they mat down into a rope-like condition. They
are four and one-half to five inches wide and ten inches long. The
sterile cheesecloth is cut large enough to wrap around the cotton
filling and extends at both ends three inches, by which it is
fastened to the abdominal binder. With a dozen or fifteen in each
package these vulva pads are wrapped loosely in pieces of old sheets
and pinned securely and marked plainly on the outside.
2. _Delivery pads._ These pads should be thirty-six inches square and
about five inches thick, three or four inches of which may be the
cotton batting and the remainder absorbent cotton. Three of these are
needed. Each should be folded, wrapped in a piece of cloth and
likewise marked.
3. _Gauze squares._ Five dozen gauze squares about four inches in size
may be cut, wrapped and marked. These are needed for the nipples,
baby's eyes, etc.
[Illustration: Fig. 5. Breast Binder]
4. _Cotton pledgets._ These are cotton balls, made as you would a
light biscuit with the twist of the cotton to hold it in shape. They
should be about the size of the bottom of a teacup. These are thrown
in a couple of pillow slips and wrapped and marked.
5. _The Bobbin._ Cut the bobbin or tape into four nine-inch lengths
and wrap and mark.
6. The _tooth picks_ are left in the original package and do not
require sterilization.
7. _Sterilization._ Before steaming and baking, wrap each bundle in
another wrapping of cloth and pin again securely. Mark each package
plainly in large letters or initials. These packages may be sent to
the hospital for sterilization in the autoclave or they may be
steamed for one hour in the large wash boiler, by placing them loosely
into a hammock-like arrangement made by suspending a firm piece of
muslin from one handle of the boiler to the other. The center of the
hammock should come to within five inches of the bottom of the boiler
which contains three inches of boiling water. The cover of the boiler
is now securely weighed down and the water boils hard for one hour, at
the end of which time they are removed and placed in a warm oven to
dry out. The outer wrapping may be slightly tinged with brown by this
baking. After a thorough drying they are allowed to remain in the same
wrappings into which they were first placed and put away in a clean
drawer awaiting the "Natal Day."
REQUISITES FOR THE HOSPITAL
Each hospital has its own methods and regulations for caring for
obstetrical patients and it is well for the expectant mother to visit
the obstetrical section, the delivery-room and the baby's room, that
she may personally know more about the place where she is to spend
from ten days to two weeks. Here she may ascertain from the
superintendent just what she will need to bring for the baby. Many of
the hospitals furnish all the clothes needed for the baby while in the
hospital; in such instances, the hospital also launders them. Other
hospitals require the baby's clothes to be brought in, in which case
the mother looks after the laundry. The mother always takes her toilet
articles, a warm bed jacket with long sleeves, several night dresses
and a large loose kimono or wrapper to wear to the roof garden or
porch in the wheel chair. Warm bedroom slippers and a scarf for the
head completes the outfit.
BABY'S NECESSITIES
Baby's basket on the day of confinement should contain:
One pound of absorbent cotton.
One pint of liquid albolene.
One half ounce of argyrol (mentioned in the mother's list).
Safety pins of assorted sizes.
A powder box containing powder and puff.
An old soft blanket in which to receive the child after birth.
A soft hair brush.
Three old towels.
Small package of sterile gauze squares.
Scales.
Diapers.
A silk and wool shirt (size No. 2).
An abdominal band to be sewed on with needle and thread.
A pair of silk and wool stockings.
A flannel skirt.
An outing flannel night dress.
A woolen wrapper.
THE CONFINEMENT ROOM
By special preparation, the ordinary bedroom may be fashioned into a
delivery-room. Carpets, hangings and upholstered furniture must be
removed. Clean walls, clean floors, and a scrupulously clean bed must
be maintained throughout the puerperium. Bathroom, and if possible, a
porch should be near by. In the wealthy home, a bedroom, bathroom and
the nursery adjoining is ideal; but I find that real life is always
filled with anything but the ideal.
The dispensary doctor is compelled to depend upon clean newspapers to
cover everything in the room he finds his patient in. The only sterile
things he uses he brings with him, and should he have to spend the
night, the floor is his only bed. A student who was in my service told
me that there was not one article in the entire home, which consisted
of but one room, that could be used for the baby. He wrapped his own
coat about it and laid it carefully in a market basket and placed it
on the floor at the side of the pallet on which the mother lay and by
the aid of a nearby telephone secured clothes from the dispensary for
the babe.
Always select the best room in the house for a home confinement. If
the parlor is the one sunny room, take it; remove all draperies,
carpet, etc., and make it as near surgically clean as possible. While
sunshine is desirable, ample shades must be supplied, as the eyes of
both mother and babe must be protected.
THE BED
A three-quarter bed is more desirable than a double bed. If it is low,
four-inch blocks should be placed under each leg, the casters having
been removed to prevent slipping. The bed should be so placed that it
can be reached from either side by the nurse and physician. The
mattress may be reenforced by the placing of a board under it if there
is a tendency to sag in the middle. Over this mattress is securely
pinned the strip of rubber sheeting or table oilcloth. A clean sheet
covers mattress and rubber cloth and at the spot where the hips are to
lie may be placed the large sterile pad to absorb the escaping fluids.
The floor about the bed is protected by newspapers or oilcloth. Good
lighting should always be provided. Much trouble and possible
infection may be avoided by clean bedding, plenty of clean dressings,
boiled water, rubber gloves, and clean hands.
CHAPTER VIII
THE DAY OF LABOR
As the two hundred and seventy-three days come to a close, our
expectant mother approaches the day of labor with joy and gladness.
The long, long waiting days so full of varied experiences, so full of
the consciousness that she, the waiting mother, is to bring into the
world a being which may have so many possibilities--well, even the
anticipated pangs of approaching labor are welcomed as marking the
close of the long vigil. These days have brought many unpleasant
symptoms, they have been days of tears and smiles, of clouds and
sunshine.
THE TIME OF WAITING
The prospective mother has thought many times, "Will my baby ever
come?" But nature is very faithful, prompt, and resourceful. She
ushers in this harvest time under great stress and strain, for actual
labor is before us--downright, hard labor--just about the hardest work
that womankind ever experiences--and, as a rule, she needs but little
help--good direction as to the proper method of work and the
economical expenditure of energy. In the case of the average mother
this is about all that is needed, and if these suggestions come from a
wise and sympathetic physician--one who understands and appreciates
asepsis--she may count herself as fortunately situated for the
oncoming ordeal.
In the days of our grandmothers it was almost the exception rather
than the rule to escape "child-bed fever," "milk leg," etc.; but in
these enlightened days of asepsis, rubber gloves, and the various
antiseptics, puerperal infection is the exception, while a normal
puerperium is the rule; and this work of prevention lies in the
scrupulous care taken by anyone and everyone concerned in any way with
the events of the day of labor.
On this day of labor, the mother, who has gone through the long
tedious days of waiting, should see to it that nothing unclean--hands,
sponges, forcep, water, cloth--is allowed to touch her. Above all
things do not employ a physician who has earned the reputation of
being a "dirty doctor." Puerperal infection is almost wholly a
preventable disease and every patient has a right to insist upon
protection against it.
In a former chapter will be found a detailed description of the
"delivery bed." Beside this bed, or near by, are to be found the rack
on which are airing the necessary garments for the baby's
reception--the receiving blanket and other requisites for the first
bath--together with numerous other articles essential to safety and
comfort.
There should be an easy chair in the room for the mother to rest in
between her walking excursions during the first stages of labor. The
sterilized pads and necessary articles mentioned in an earlier chapter
are, of course, close at hand.
FIRST SYMPTOMS OF LABOR
Regular, cramp-like pains in the lower portion of the abdomen which
are frequently mistaken for intestinal colic, often beginning in the
lower part of the back, and extending to the front and down the thigh,
are often the first symptoms of the approaching event. With each cramp
or pain the abdomen gets very hard and as the pain passes away the
abdomen again assumes its normal condition. These regular cramp-like
pains are the result of the early dilation of the cervix--the first
opening of the door to the uterine room which has housed our little
citizen through the developmental stages of embryonic life--and as a
result of this stretching and dilating there soon appears that special
blood-tinged mucus flow commonly known as "the show."
THE PRELIMINARY BATH
At this time a very thorough-going colonic flushing should be
administered. The patient takes the "knee-chest" position, or the
"lying-down" position, and there should flow into the lower bowel
three pints of soapy water; this should be retained for a few moments;
and after its expulsion, a short, plain water injection should be
given. Now follows the preliminary general bath.
Just prior to the bath, the pubic hair should be clipped closely, or
better shaved. Then should follow a thorough soap wash, with patient
standing up in the tub, using plenty of soap, applied with a shampoo
brush or rough turkish mit. The rinsing now takes place by either a
shower or pail pour. _Do not sit down in the tub._ This is a rule that
must not be broken, because of the danger of infection in those cases
where the bag of waters may have broken early in the labor.
A weak antiseptic solution, prepared by putting two small antiseptic
tablets into one pint and a half of warm water, is now applied to the
body from the breasts to the knee. Put on a freshly laundered gown,
clean stockings and wrapper. The head should be cleansed and hair
braided in two braids.
THE PROGRESS OF LABOR
If all the mothers who read this volume could bear children with the
comfort Mrs. C. does, I should be happy, indeed.
At four o'clock one morning a very much excited father telephoned me,
"Hurry, quick, Doctor, it's almost here." It was well that we did
hurry, for the first sign the little mother had was the deluge of the
waters--at this point the husband ran to telephone for the doctor--no
more pains for thirty-eight minutes (just as we entered the door) and
the baby was there. But such is not usually the case, nor will it be,
as labor usually progresses along the lines of conscious dilating
pains, occurring at intervals twenty minutes apart at first, later
drawing nearer together until they are three to five minutes apart.
This "first stage of labor" lasts from one to fifteen hours--during
which time the tiny door to the uterine room which was originally
about one-eighth of an inch open--dilates sufficiently to allow the
passage of the head, shoulders and body of the fully developed child.
About this time the bag of waters usually bursts, and, as a rule,
this marks the beginning of the "second stage of labor." The amount of
water passed varies in amount. Should the rupture take place before
the door is fully open, then labor proceeds with difficulty and the
condition is known as "dry labor."
The head after proper rotation now begins the descent; and here the
pains begin to change from the sharp, lancinating, cramp-like pains
which begin in the back and move around to the front, to those of the
"bearing down" variety, while at the same time there begins to appear
the bulging at the perineum, which means that the head is about to be
born. At this time great stress is brought to bear upon the perineum
and often, in spite of anything that can be done to prevent it, the
perineum is more or less lacerated.
As soon as the baby is born the "second stage of labor" has passed and
within thirty to fifty minutes the close of the third stage of labor
is marked by the passage of the placenta or "afterbirth."
FALSE LABOR PAINS
Sometimes, as long as two weeks before the birth of the child, certain
irregular, heavy, cramp-like pains occur in the abdomen and back. For
a half-dozen pains they may show some signs of regularity; but they
usually die down only to start up again at irregular intervals. These
are known as "false pains."
When the pains begin to take on regularity and gradually grow heavier
and it is near the appointed time for the labor, the patient should
prepare to start for the hospital; or, if it is to be a home delivery,
the physician should be called. As noted above, the first subjective
symptom may be the rupture of the bag of waters, and it is imperative
to prepare at once for the labor. It is far better to spend the day at
the hospital, or even two days waiting, rather than to run the risk of
giving birth to the child in a taxicab or street car; or, in the event
of a home labor, to have the child born before the doctor arrives.
WHAT TO DO IN THE ABSENCE OF A DOCTOR
It is often the case that when we need our physician the most, he is
busy with another patient and cannot come, or perhaps an automobile
accident detains the man of the hour. The hospital delivery always
possesses this advantage over the home--physicians are always on hand.
We deem it wise to relate in detail the method of procedure during the
rapid birth of a child; that the husband or nurse may give intelligent
and clean service.
After the patient has been given the enema and has been shaved and the
bath has been administered as previously directed, the helper most
vigorously "scrubs up." There are three distinct phases to the
"scrubbing up": First, the three-minute scrubbing of the hands and
forearms with a clean brush and green soap; to be followed by, second,
the trimming and cleaning of the finger nails, for it is here, under
the nails, that the micro-organism lives and thrives that causes
child-bed fever or septicemia; and, third, the final five-minute
scrubbing of the fingers, hands, and forearms. An ordinary towel is
not used to dry the well-cleansed hands, but they are now dipped in
alcohol and allowed to dry in the air.
And now if the pains are returning every three to five minutes or if
the bag of waters has broken, the patient should go to bed. She will
lie down on her back with the knees drawn up and spread apart. The
patient, having had the cleansing bath, is now washed with the
disinfectant bath (2 antiseptic tablets to 1½ pints of water), from
the breasts to the knees. Another member of the family takes the outer
wrappings off the sterilized delivery pad and the "clean" helper
places the sterile delivery pad under the expectant mother, who is
directed to "bear down" when her pains come. She may be supported
during these pains by pulling on a sheet that has been fastened to the
foot of the bed.
The _clean_, helper then sits by her constantly until the baby is born
but under no circumstances should touch her until after the head
appears. Immediately after the birth of the head, the shoulders
usually follow with the next pain, which ought to occur within two or
three minutes. Occasionally the face turns blue, in such an instance,
the mother is directed to strain vigorously and presses down heavily
on the abdomen with both her hands, this usually hurries matters
materially, and the body of the child follows quickly. The baby should
cry at once. If the child does not show signs of life, quick, brisk
slapping on the back usually brings relief. During the birth of the
head it is imperative that, in the event of liquid passing at the same
time, no water or blood be sucked into the mouth by the baby. Great
care must be exercised in this matter. Should the baby remain blue,
lay it quickly upon its right side near the mother, and after the
pulse of the cord has stopped beating the clean helper ties the cord
twice, two inches from the child and again two inches from this tying
toward the mother, and then the cord is cut between the two tyings
with scissors that have been boiled twenty minutes.
Should there be more difficulty with the breathing of the new born
child, if slapping it on the back brings no relief, its back (with
face well protected) may be dipped first in good warm water, then
cold, again in the warm, again in the cold--this seldom fails. The
child should then be kept very warm, lying on its right side.
CARE OF THE MOTHER
All this time, a member of the family has been firmly grasping the
mother's abdomen, and within an hour the afterbirth passes out through
the birth canal. If the physician has not yet arrived, all dressings,
the pad, the afterbirth, must all be saved for his inspection.
The inside of the thighs and the region about the vagina is now washed
with bichloride solution, the soiled delivery pad removed, a clean
delivery pad is placed under her; an abdominal binder is applied and
two sterile vulva pads are placed between the legs, and hot water
bottles are put to her feet, as usually at this stage there is a
slight tendency toward chilliness. She should now settle down for
rest. Fresh air should be admitted into the room. There may be some
hemorrhage, and if it is excessive, grasp the lower abdomen and begin
to knead it until you distinctly feel a change in the uterus from the
soft mass to a hard ball about the size of a large grape fruit; thus
contraction has been brought about which causes the hemorrhage to
decrease. If the doctor has not yet arrived put the baby to the
breast, and place an ice bag for ten or fifteen minutes on the abdomen
just over the uterus. Should there be lacerations, the doctor will
attend to their repair when he comes. One teaspoonful of the fluid
extract of ergot is usually given at this time, if possible get in
touch with the physician before it is administered.
CARE OF THE BABY
After the mother is comfortable, your attention is directed to the
baby; the condition of the cord is noted; should it be bleeding, do
not disturb the tying, but tie again, more tightly just below the
former tying, and with the long ends of the tape, tie on a sterile
gauze sponge or a piece of clean untouched medicated cotton, thus
efficiently protecting the severed end of the cord. No further
dressing is needed until the doctor arrives.
Grave disorders have arisen from infection through the freshly cut
umbilical cord.
Should the doctor be longer delayed, one drop of twenty per cent
argyrol should be dropped in each of the infant's eyes and separate
pieces of cotton should be used for each eye to wipe the surplus
medicine away.
This application must not be long neglected, for a very large per cent
of all the blindness in this world might have been avoided had this
medicine been placed in each eye soon after birth.
The warmed albolene is now swabbed over the entire body of the infant
(this is done with a piece of cotton), the arm pits, the groins,
behind the ears, between the thighs, the bend of the elbow, etc, must
all receive the albolene swabbing. In a few minutes, this is gently
rubbed off with a piece of gauze or an old soft towel, and the baby
comes forth as clean and as smooth as a lily and as sweet as a rose.
The garments are now placed on the child--first the band, then shirt,
diaper, stockings, flannel skirt, and outing flannel gown--and it is
put to rest after the administration of one teaspoonful of cooled,
boiled water. In six to eight hours it will be put to the breast.
CHAPTER IX
TWILIGHT SLEEP AND PAINLESS LABOR
In recent years much has appeared in both the popular magazines and
the medical press concerning the so-called "twilight sleep" and other
methods of producing "painless childbirth." Many of these popular
articles in the lay press cannot be regarded in any other light than
as being in bad taste and wholly unfortunate in their method and
manner of presenting the subject; nevertheless, these writings have
served to arouse such a general public interest in the subject of
obstetric anesthetics, that we deem it advisable to devote two
chapters to the brief and concise consideration of the subjects of
pain and anesthetics in relation to the day of labor.
THE PAIN OF LABOR
First, let us briefly consider the question of pain in connection with
childbirth. Many women--normal, natural, and healthy women--suffer but
comparatively little in giving birth to an average-sized baby during
an average and uncomplicated labor. Like the Indian squaw, they suffer
a minimum of pain at childbirth--at least this is largely true after
the birth of the first baby; and so there is little need of discussing
any sort of anesthesia for this group of fortunate women; for at most,
all that would ever be employed in the nature of an anesthetic in such
cases, would be a trifle of chloroform to take the edge off the
suffering at the height or conclusion of labor.
But the vast majority of American mothers do not belong to this
fortunate and normal class of women who suffer so little during
childbirth; they rather belong to that large and growing class of
women who have dressed wrong; who have lived unhealthful and sometimes
indolent lives; who are more or less physically and temperamentally
unfitted to pass through the experiences of pregnancy and the trials
of labor.
The average American woman shrinks from the thought and prospect of
suffering pain; she is quite intolerant with the idea of undergoing
even the few brief moments of physical suffering attendant upon
childbirth. She refuses to contemplate the day of labor in any other
light than that which insures her against all possible pain and other
physical suffering.
And it is just this unnatural and abnormal fear of labor-pains--this
unwomanly dread of the slightest degree of physical suffering--that
has indirectly led up to so much discussion regarding the employment
of "twilight sleep" and other forms of obstetric anesthesia.
While the authors recognize the great blessing of anesthesia to the
woman in labor--and almost unfailingly make use of it in some
form--nevertheless, we also recognize that it would be a fine form of
mental discipline and mighty good moral gymnastics, if a great many
self-centered and pampered women would "spunk right up" and face the
ordeal of labor with natural courage and normal fortitude. It would be
"the making of them," it would make new women out of them, it would
start them out on the road to real living. At the same time we do not
mean to advocate that women should suffer unnecessary pain in
childbirth any more than we allow them to suffer in connection with
surgery.
PREPARATION FOR LABOR
While so much is being written about "twilight sleep" and "painless
labor," it might be well to remind the American mother that much can
be done to lessen the sufferings of the day of labor by one's method
of living prior to the confinement.
We believe that child-bearing is a perfectly normal physical function
for a healthy and normal woman--that it is even essential to her
complete physical health, mental happiness, and moral well-being.
Theoretically, child-bearing ought to be but little more painful than
the functionating of numerous other vital organs--stomach, heart,
bladder, bowels, etc.--and, indeed, it is not in the case of certain
savage tribes and other aboriginal people, such as our own North
American Indian.
But we must face the facts. The average American woman does suffer at
childbirth; and she suffers more than we are disposed to allow her, or
more than she, as a general rule, is willing to suffer. So, while we
discuss appropriate methods of lessening the pain of labor and the
pangs of childbirth by the scientific use of anesthetics, let us also
call attention to certain things which may aid in decreasing the
amount of pain which may reasonably be expected to attend child
bearing.
To assist in bringing about this preparation for decreased pain at
childbirth, mothers should teach their daughters how to develop,
strengthen, and preserve their physical, mental, and moral resistance.
The young mother should be taught by both her mother and her physician
how to dress, how to work, and how to eat. Every care should be given
to the hygiene of pregnancy and labor.
The expectant mother should have plenty of fruits and fruit juices,
and if not physically well endowed to give birth to a large babe, she
should have her diet restricted in meat, bread and milk, as well as
the cereals. Overeating during pregnancy should be carefully guarded
against, as emphasized in an earlier chapter. Deformities of the
pelvis, etc., should rule out a consideration of pregnancy.
While artificial painless childbirth by means of "twilight sleep" and
other similar methods all have their place; nevertheless, these
procedures should not lead to the neglect of those natural methods and
preventive practices which aid in preparing the normal expectant
mother for nature's relatively painless labor. When so much anesthesia
has to be used in a normal labor, it cannot but strongly suggest that
both patient and physician have neglected those common but efficient
methods which contribute indirectly to lessening the pangs of child
bearing.
WHAT IS TWILIGHT SLEEP?
"Twilight sleep" is a recent term which has become associated in the
public mind with "painless labor." The reader should understand that
"twilight sleep" is not a new method of obstetric anesthesia. While
this method of inducing "painless labor" has been brought prominently
before the public mind in recent years by much discussion and by
numerous magazine articles--being often presented in such a way as
sometimes to lead the uninstructed layman to infer that a new method
of obstetric anesthesia had just been discovered--it has,
nevertheless, been known and more or less used since 1903. Later known
as the "Freiburg Method," and as the "Dammerschlaf" of Gauss, and
still later popularized as "twilight sleep," this "scopolamin-morphin"
method of obstetric anesthesia, has gained wide attention and acquired
many zealous advocates.
"Twilight sleep" is, therefore, nothing new--it is simply a revival of
the old combination of _scopolamin_ and _morphin_ anesthesia. While
many different methods of administering "twilight sleep" have been
devised, the following general plan will serve to inform the reader
sufficiently regarding the technic of this much-talked-of procedure.
The scopolamin must always be fresh, although different forms of the
drug are used. It tends quickly to decompose--forming a toxic
by-product--and, according to some authorities, this decomposed
scopolamin is responsible for many undesirable results which have
attended some cases of "twilight sleep." Various forms of morphin are
also used, as also is narcophin.
TECHNIC OF "TWILIGHT SLEEP"
The "twilight-sleep" injections are not started until the patient is
in the stage of active labor. The initial injection consists of the
proper dose of scopolamin and morphin (or some of their derivatives),
while the patient's pupils, pulse, and respiration are carefully
noted, as also are the character of the uterine contractions and the
character of the fetal heart action.
Usually within an hour, a second dose of scopolamin is given, while
the application of so-called "memory tests" serves to indicate whether
it is advisable to administer additional injections. Some leading
advocates of this method claim that the majority of the unfavorable
results attendant upon "twilight sleep" are the direct result of
failure to control the dosage of the drug by these "memory tests;" and
they call attention to the large percentage of "painlessness" as proof
of probable overdosing. If the patient's memory is clear and she is
not yet under the influence of the drug, a third dose is soon given.
If, however, the patient is in a state of amnesia (lack of memory),
this third injection is not commonly given until about one hour after
the second injection. The amount of amnesia present is used as a guide
for repeated injections at intervals of one to one and a half hours.
As a rule, the morphin is not repeated.
It must be evident that the success of such a method of anesthesia
must depend entirely upon thoroughgoing personal supervision of the
individual patient by a properly trained and experienced physician;
and it is for just these reasons that "twilight sleep" is destined to
remain largely a hospital procedure for a long time to come.
Experience has shown that those cases of "twilight sleep" that are not
under the influence of scopolamin over five or six hours do vastly
better than those under a longer time. When employed too long before
labor this method seems to favor inertia and thus tends to increase
the number of forceps deliveries.
The number of injections may run from one to a dozen or more, and
patients have come through without accident with fifteen or more
doses, running over a period of twenty-four hours.
THE CLAIMS OF "TWILIGHT SLEEP"
While "twilight sleep" as a method of anesthesia is not altogether
new, many of the claims made for it by recent advocates are more or
less new; and, to enable the reader clearly to comprehend both the
advantages and disadvantages of this method, both the favorable and
unfavorable facts and contentions will be summarized in this
connection. The favorable claims made for "twilight sleep" are:
1. That eighty to ninety per cent of all women who use this method can
be carried through a practically painless labor.
2. That there is practically no danger to the mother (some degree of
danger to the child is admitted by most of its champions) other than
those commonly attendant on the older and better known methods in
general use.
3. That "twilight sleep," being almost exclusively a hospital
procedure, would result in more women going to the hospital for their
confinement--if it were used more; and would, therefore, tend to bring
about more careful supervision and individual care on the part of the
attending obstetrician.
4. That by lessening the dread of labor and the fear of painful
childbirth, there will probably occur an increase in the birth rate of
the so-called "higher classes of society"--the social circles which
now show the lowest birth rates.
5. That it is of special value in the cases of certain neurotic women
and those of low vital resistance; especially those patients suffering
from certain forms of heart, respiratory, kidney, and other organic
diseases.
6. Some authorities maintain that "twilight sleep" is of value even in
threatened eclampsia, although they admit it tends to produce a rise
in blood-pressure.
7. It is supposed to shorten the first stage of labor--by facilitating
the dilation of the cervix--owing to the painless stretching; although
the majority of its special advocates admit that it lengthens the
second stage of labor, during which the patient must be very closely
watched.
8. That even in those cases where the sense of pain is not entirely
destroyed, the patient seems to possess little or no subsequent memory
of any physical suffering or other disagreeable sensations.
9. That the method is of special value in sensitive, high-strung,
nervous women of the "higher classes," who so habitually shun the
rigors of child bearing--especially in the instance of their first
child.
10. That the action of scopolamin is chiefly upon the central nervous
system--the cerebrum--that it diminishes the perception of pain
without apparently decreasing the contractile power of the uterus;
labor may, therefore, proceed with little or no interruption, while
the patient is quite oblivious to the accompanying pains.
11. That the physical and nervous exhaustion is quite entirely
eliminated--especially in the case of the first labor--that patients
who have had this method of anesthesia appear refreshed and quite
themselves even the first day after labor.
12. That there is decidedly less "trauma" (appreciable injury) to the
nervous system and therefore less "shock;" and that all this saving of
nervous strain tends greatly to hasten convalescence.
13. And, finally, that "twilight sleep" does not interfere with the
carrying out of any other therapeutic measures which may be deemed
necessary for a successful termination of the labor.
DANGERS OF TWILIGHT SLEEP
While we are recounting the real and supposed advantages of "twilight
sleep"--especially in certain selected cases--it will be wise to pause
long enough to give the same careful consideration to the known and
reputed dangers and drawbacks which are thought to attend this method
of anesthesia in connection with labor cases.
We desire to state that these expressions, both for and against
"twilight sleep," are not merely representative of our own experience
and attitude; but that they also represent, as far as we are able to
judge at the time of this writing, the consensus of opinion on the
part of the most reliable and experienced observers and practitioners
who have used and studied this method in both this country and Europe.
The dangers and difficulties of "twilight sleep" may be summarized as
follows:
1. That this method tends to weaken the mental resistance of many
women; to lessen their natural courage and to decrease that
commendable fortitude which is such a valuable feature of the
character endowment of the normal woman.
2. That "twilight sleep" is essentially a hospital method and is,
therefore, inaccessible to the vast majority of women belonging to
the middle and lower classes of society, as well as to those women who
live in rural communities.
3. That in fifteen or twenty per cent, the method fails to produce the
desired results--at least, when administered in amounts which are
deemed safe.
4. That this method does decrease the baby's chances of living; that
the second stage of labor is definitely prolonged; that from ten to
fifteen per cent of the babies are sufficiently under the influence of
the anesthesia when born as to be unable to breathe or cry without
artificial stimulus.
5. That it is a method requiring special training and experience; that
it will be many years before the average practitioner will become
proficient in its use; and that the older methods are probably far
safer for the average physician.
6. That the method requires more care in its administration than can
be expected outside of the hospital in order to avoid the dangers of
fetal asphyxiation--which danger has led not a few obstetricians to
abandon it.
7. That a satisfactory technic is almost impossible of development;
that every patient must be individualized; that the chief dangers are
connected with the over dosage of morphin; that the method is not
adaptable to the general practice of the average doctor.
8. That by prolonging the second stage of labor and by sometimes
giving too much morphin, the number of forceps deliveries is greatly
increased, with their attendant and increased dangers to both mother
and child.
9. That the prospects of passing through labor which may be rendered
painless by artificial methods, tends to produce an attitude of
carelessness and indifference towards those natural methods of living
and other hygienic practices which so greatly contribute to naturally
painless confinements.
10. That this method as sometimes practiced greatly increases the
dangers of a general anesthetic, if such should be found necessary
later on during the labor.
11. That "twilight sleep" is contra-indicated (should not be used) in
the following conditions: primary inertia (abnormally delayed and slow
labor); expected short labor--especially in women who have already
borne children; when the fetal head is known to be large and the
mother's pelvis small; placenta praevia (abnormal placental
attachment); accidental hemorrhage; absent or doubtful fetal heart
beat; when labor is already far advanced; and in threatened
convulsions and eclampsia.
CONCLUSIONS REGARDING TWILIGHT SLEEP
Having presented the evidence both for and against "twilight sleep,"
it may be of assistance to the lay reader to have placed before her
the personal conclusions and working opinions of the authors. We,
therefore, undertake to summarize our present attitude and outline our
practice as follows:
1. "Twilight sleep" as a method of obstetric anesthesia in certain
selected cases and in well-equipped hospitals, and in the hands of
careful and experienced practitioners, has demonstrated that it is a
scientific reality--and has probably come to stay--at least until
better and safer methods of affecting a relatively painless
confinement are discovered; although we are compelled to state that it
is not the panacea the lay press has led many of our patients to
believe. (That we believe a much better and safer method has been
devised, the next chapter will fully disclose.)
2. We do not expect this method ever to become general in its use; we
do not look for a chain of special "twilight hospitals" to stretch
across the continent and then to overrun the country. We expect much
of the recent forced enthusiasm to die down, while scopolamin-morphin
anesthesia takes it proper place among other scientific methods of
alleviating the pangs of labor.
3. We know that standard and fresh solutions--as already noted--are
absolutely essential for the success of this method.
4. We are certain that no routine method or technic can be developed.
Each patient must be individualized. The method does not consist in
injecting scopolamin every so often. The patient's mental and physical
condition--as also that of the unborn child--must control the
administration of "twilight sleep."
5. The patient must be in a quiet and partially darkened room. She
must not be disturbed; while the physician, or a competent trained
nurse, must be in constant attendance.
6. While this method of treatment is best carried out in the
well-appointed hospital, there is no real reason why it cannot be
fairly well carried out in a well-regulated private home, provided the
necessary preparations have been made, a trained nurse is present, and
provided, further, that the physician is willing to remain in the home
with the patient the length of time required properly to supervise the
treatment.
7. Even when the treatment is not instituted early in labor, it can,
in certain selected and appropriate cases, be utilized even in the
second stage of labor--thus saving these special cases much
unnecessary pain; in fact, some authorities regard it as a valuable
adjunct in the management of "borderland contractions" as it allows
the patient a full test of labor.
8. In our opinion, this method has little effect on the first stage of
labor if properly administered; but it does undoubtedly prolong and
tend to complicate the second stage; in fact, we are coming to look
upon "twilight sleep" as being more distinctly a first stage
procedure; that it bears the same relation to the first stage of labor
that chloroform bears to the second stage--relieving the pain but not
stopping the progress of labor.
9. That when safe amounts of the drug are used the pain is greatly
lessened in all cases--the subsequent memory of pain is absent in the
majority of the patients--but the labor is not always entirely
painless as is popularly supposed.
10. We do not believe that this method when properly administered
increases the number of forceps deliveries--at least not in the case
of high forceps operations. It undoubtedly does cover up the symptoms
of a threatened rupture of the uterus, and thus increases danger from
that source; nevertheless it may be safely stated that this method
does not in any way greatly interfere with any other measures which
might be found necessary to institute in order to bring about a
successful termination of the labor.
11. The baby's heart beat must be carefully and constantly watched;
sudden slowing means that the treatment must be discontinued and the
child delivered as soon as possible; even then, difficulty may be
experienced in getting the baby's breathing started after it is born.
In the vast majority of cases where the baby does not cry or breathe
at birth, the usual methods employed in such cases serve quickly to
establish normal respiration, and the baby seems to be but little the
worse for the experience.
12. While altogether too much has been claimed for "twilight sleep" at
the same time many false fears have also been suggested, among which
may be mentioned the fear of the mother losing her mind after the
treatment; the undue fear of asphyxiation on the part of the baby; the
fear of post-partum hemorrhage; and the fear that it will lessen the
milk supply. We cannot deny that the child's dangers are often
increased; but in other respects, this method (in properly selected
cases) presents little more to worry us than the older methods of
anesthesia.
13. We are inclined to the belief that this method has but little
influence on the course of convalescence following labor. Certain
nervous and highly excitable women certainly seem to do better, as a
result of experiencing less pain and nervous shock; while other cases
do not turn out so well. It certainly does not retard repair and
recovery during the puerperium.
14. This method seems to have its greatest field of usefulness in
those cases of highly intelligent but excessively neurotic women who
have an abnormal dread of pain and child bearing; or women who have
suffered unusually at the time of a previous confinement--perhaps in
the case of the first baby--or from other complications; women such as
these, and other special cases, are the ones to benefit most from the
employment of "twilight sleep."
15. This method as has already been intimated, is most useful in the
case of the first baby, or in the case of women who have established a
record of tedious and painful labors. It has no place in normal and
short labors; although it may be used to great advantage in certain
cases during the first stage of labor--being carefully and lightly
administered--while chloroform or gas is utilized at the end of the
second stage just as has been our custom for a generation.
16. As noted under the special claims made for this method, it is (as
also is nitrous oxid) the ideal procedure in cases of heart,
respiratory, kidney, and other organic difficulties, the details of
which have already been noted, and their repetition here is not
necessary.
17. It must be remembered that scopolamin and morphin are more or less
uncertain in their action; scopolamin is variable in its results,
often producing such marked nervous excitement in the patient as
greatly to interfere with the carrying out of an aseptic technic;
while morphin has been shunned by obstetricians for a whole
generation, because of its well-known bad effects on the unborn child
as well as its interference with muscular activity on the part of the
mother.
In Germany, it is said, that a great many damage suits against
prominent physicians have resulted because of the alleged ill effects
which have followed the use of "twilight sleep."
18. In presenting these facts and opinions regarding "twilight sleep,"
the reader should bear in mind that we are not only endeavoring to
state our own views and experience, but also to give the reader just
as clear and fair an idea of what other and experienced physicians
think of the method, both favorably and unfavorably; and we will draw
these conclusions to a close by citing the opinion of one or two who
have had considerable experience with the method and who, in summing
up their observations, say:
The disadvantages of the method are entirely with the accoucheur
and not to the mother or child. _It requires his presence at the
bedside from the time the treatment is undertaken until the
completion of labor_, not so much because of any danger, but to
keep the patient evenly under anesthesia on a line midway between
consciousness and unconsciousness, for if she is allowed to go
above that line in several instances she will have several
so-called "isles of memory," and will be able to draw a picture
of her labor in her mind and thus lose the benefit of the
treatment.
These methods of anesthesia are very important and have merit.
They should be used when properly indicated. No one should limit
himself to a routine method. Each case should be individualized
and the form of anesthesia best suited to the case in hand should
be employed. For instance, in dealing with a primipara--one who
is full of fear, who cannot stand pain, who is of an hysterical
nature--morphin-scopolamin anesthesia is best suited in that
particular case, because these drugs have a selective action when
it comes to allay fear and produce amnesia. On the other hand, in
a multipara who has had three or four children, whose soft parts
are relaxed and who has short labors, the anesthetic of choice
would be a few whiffs of chloroform as the head passes over the
perineum. It is ridiculous to try to give such women the
"twilight sleep." Furthermore, take the cases you see for the
first time at the end of the first stage of labor, or during the
second stage; these cases are best treated with the nitrous oxid
and oxygen method. You have to individualize your cases. The
prospective mother now consults the obstetrician early to find
out if her particular case is suitable for the "twilight sleep."
She has been informed that certain examinations--urine, blood
pressure, etc.--are necessary. She knows that these examinations
have to be made at regular intervals. In other words, we get the
patients early and we can give them good prenatal care.
This chapter has been devoted to "twilight sleep;" the following
chapter will consider "nitrous oxid" and other methods of anesthesia
in connection with labor, and should be read along with the foregoing
discussion in order to obtain an intelligent view of the whole subject
of "painless labor."
CHAPTER X
SUNRISE SLUMBER AND NITROUS OXID
Since the public has already been told so much about obstetric
anesthesia, we deem it best to go into the whole subject thoroughly,
so that the expectant mothers who read this book will be able to form
an intelligent opinion regarding the question, and thus be in a
position to give hearty cooperation to the decision of their physician
to employ, or not to employ, any special form of anesthesia or
analgesia in their particular case. In order to give the reader a
complete understanding of "painless labor," it will be necessary to
give attention to that newer and more safe method of obstetric
anesthesia called "sunrise slumber." This method of anesthesia
consists in the employment of nitrous oxid or "laughing gas," and will
be fully considered in this chapter.
OBSTETRIC FEAR
In this connection we desire to reiterate and further emphasize some
statements made in the preceding chapter concerning the unnatural fear
and abnormal dread of childbirth.
We feel that it is very important in connection with this new movement
in obstetrics to reduce the woman's pain and suffering to the lowest
possible minimum, that the trials of labor should not be overdrawn and
the pangs of confinement overestimated. We must not educate the normal
woman to look upon labor as a terrible ordeal--something like a major
surgical operation--which, since it cannot be escaped, must be endured
with the aid of a deep anesthesia.
The facts are that a very small per cent of healthy women suffer any
considerable degree of severe pain--at least not after the first
child. We often observe that judicious mental suggestion on the part
of the physician or nurse in the form of encouraging words and
supporting assurances tends to exert a marked influence in controlling
nervousness and subduing the sufferings of the earlier labor pains.
We must not allow the efforts of medical science to lessen the
sufferings of child-bearing, to rob womankind of their natural and
commendable courage, endurance, and self-reliance.
We do not mean to perpetuate the old superstition that pain and
suffering are the necessary and inevitable accompaniments of
child-bearing--that the pangs of labor are a divine sentence
pronounced upon womankind--and that, therefore, nothing should be done
to lessen the sufferings of confinement. Severe and unnatural pain is
not at all necessary to childbirth, and there exists no reason under
the sun why women should suffer and endure it, any more than they
should suffer the horrors of a very painful surgical operation without
an anesthetic. In this connection, it should be recalled that
analgesic drugs have been introduced into obstetric practice only
during the last fifty years, while such methods of relieving pain have
been used in general surgery for a much longer period. It is now only
sixty-nine years since Simpson first employed anesthetic in
obstetrics, while six years afterwards Queen Victoria gave her seal of
approval to the use of chloroform in labor cases.
Thirty years ago, in speaking of the expectant mothers, Lusk warned
us:
As the nervous organization loses in the power of resistance as
the result of higher civilization and of artificial refinement,
it becomes imperatively necessary for the physician to guard her
from the dangers of excessive and too prolonged suffering.
NITROUS OXID--"LAUGHING GAS"
Nitrous oxid, or "laughing gas," was first used in labor cases in 1880
by a Russian physician. During the last twenty-five years it has been
used off and on by numerous practitioners in connection with
confinement, but not until the last few years has this method of
relieving labor pain come into prominent notice.
While the "laughing gas" method of obstetric anesthesia did not gain
notoriety and publicity from being exploited in magazines and other
lay publications, it did get its initial boost in a very unique and
unusual manner. A gentleman who manufactured and sold a "laughing gas"
and oxygen mixing machine for the use of dentists, insisted that this
method of anesthesia should be used in the case of his daughter, who
was about to be confined. This patient was kept under this nitrous
oxid anesthetic for six hours--came out fine--no accidents or other
undesirable complications affecting either mother or child, and thus
another and safe method of reducing the sufferings of childbirth has
been fully demonstrated and confirmed, although it had previously been
known and used in labor cases to some extent.
Starting from this particular case in 1913, many obstetricians began
experimental work with "gas" in labor cases; and, at the time of this
writing, it has come to occupy a permanent place in the management of
labor, alongside of chloroform, ether, and "twilight sleep."
ANALGESIA VS. ANESTHESIA
The reader should understand the difference between analgesia and
anesthesia. Anesthesia refers to the condition in which the patient is
more or less unconscious--wholly or partially oblivious to what is
going on, and, of course, entirely insensible to all pain. Analgesia
is a term applied to the loss of pain sensation. The patient may not
be wholly or even partially unconscious--merely under the influence of
some agent which dulls, deadens, or otherwise destroys the realization
of pain. This is the condition aimed at by the proper administration
of any form of "twilight sleep," whether by the scopolamin-morphin
method, or by the nitrous oxid ("sunrise slumber") method.
Any method of treatment which can more or less destroy the pain of
labor without in any way interfering with its progress, and which in
no way complicates its course or leaves behind any bad effects on
either mother or child, must certainly be hailed with joy by both the
patient and the physician. While chloroform has served these purposes
fairly well, there have been numerous drawbacks and certain dangers;
and it was the knowledge of these limitations in the use of both
chloroform and ether, that has led to further experimentation and the
development of these newer methods of producing satisfactory
analgesia--freedom from pain--without bringing about such a state of
profound anesthesia as accompanies the administration of the older
methods.
It should be borne in mind that in using "sunrise slumber" (nitrous
oxid) for labor pains, the gas is so administered that the patient is
just kept on the "borderline"--in a typical "twilight" state--and not
in the condition of deep anesthesia which is developed when nitrous
oxid is employed by physicians and dentists as an anesthetic for major
and minor surgical operations.
Analgesia is the first stage of anesthesia--the "twilight zone" of
approaching unconsciousness--in which the sense of pain is greatly
dulled or entirely lost, while even that which is experienced is not
remembered. It seems to the authors that "gas" is the ideal drug for
producing this condition whenever it is necessary, as nitrous oxid is
the most volatile of anaesthetics, acts most quickly, and its effects
pass away most rapidly, while its administration is under the most
perfect control--it may be administered with any desired proportion of
oxygen--and may be discontinued on a moment's notice. It is
practically free from danger even when continued as an analgesic for
several hours. Nitrous oxid never causes any serious disturbance in
the unborn child, as chloroform sometimes does when used too
liberally.
EFFECTS OF NITROUS OXID
It will not be necessary to compare the favorable and unfavorable
claims for nitrous oxid as we did the contentions for and against
"twilight sleep." Whatever service "laughing gas" or "sunrise slumber"
can render the cause of obstetrics we can accept, knowing full well
that, in competent hands, it can do little or no harm; and this we
know from the facts herewith recited and from the further fact that we
have gained a wide experience with this agent in the practice of both
dentistry and surgery. In a general way, the influence of "sunrise
slumber" on mother and child may be summarized as follows:
1. It can accomplish its purpose--can quite satisfactorily relieve the
mother of severe pain--when employed as an analgesic. It is not
necessary to administer the gas to the point of anesthesia except at
the height of suffering at the end of the second stage of labor, when
the head of the child is passing through the birth canal.
2. This method can be stopped at any moment--the patient ran be
brought out from under its influence entirely and almost
instantaneously. It is not like a hypodermic injection of a drug which
may exert a varying and unknown influence upon the patient, and which,
when once given, cannot be recalled.
3. It is a method which may be used in the patient's home just as
safely as in a hospital; the only drawback being the inconvenience of
transporting the gas-containing cylinders back and forth. This is even
now partially overcome by the improved combination gas and oxygen form
of apparatus which has been devised.
4. The administration of nitrous oxid analgesia or anesthesia does not
interfere with or lessen the uterine contractions or expulsive efforts
on the part of the mother--at least not to any appreciable extent.
5. Just as soon as a severe uterine contraction--attended by its
severe pain--begins to subside, the gas inhaler is immediately
removed, and in a few seconds the patient is again conscious. It is
not necessary to keep the patient continuously under the influence of
the drug, as in the case of the scopolamin-morphin method of "twilight
sleep."
6. This method ("sunrise slumber") is certainly far more safe in
ordinary and unskilled hands than the "twilight sleep" procedure. The
patient is more safe with this method in the hands of the average
doctor or trained nurse.
7. It has been our experience that nitrous oxid in the smaller,
interrupted and analgesic doses, actually tends to stimulate the
uterine pains and contractions, while at the same time rendering the
patient quite oblivious to their presence. When properly administered,
the freedom from pain is perfect.
8. Under the influence of "gas," patients often appear to "bear down"
with increased energy. It certainly does not lessen their cooperation
in this respect.
9. We have not observed, nor have we learned of, any cases of inertia
(weak and delayed contractions), post partum hemorrhage, or shock, as
a result of "laughing gas" or "sunrise slumber" analgesia.
10. This method lends itself to perfect control--it may be decreased,
increased, or discontinued, at will; it may be given light now and
heavy at another time; while, at the height of labor, it may be pushed
to the point of complete anesthesia, if desired.
11. We have found "sunrise slumber" (nitrous oxid) analgesia to be the
ideal obstetric anaesthetic, and have adopted it quite to the
exclusion of both chloroform and "twilight sleep." We find that this
form of analgesia has all the advantages of "twilight sleep" without
any of its dangers or disadvantages.
12. A possible objection to the nitrous-oxid method is the cost,
especially in the private home. The average cost in the hospitals
where we are using this method runs about $2.00 for the first hour and
$1.50 for each hour thereafter. This is the cost when using large
tanks of gas, and is, of course, somewhat increased when the smaller
tanks are used in the patient's home.
METHOD OF ADMINISTRATION
Since it was thought best to give the reader some idea of the technic
for the administration of "twilight sleep," it may not be amiss to
explain how "sunrise slumber" is usually employed in labor cases. The
technic is very simple. The administration of the gas is generally
begun about the time the patient begins seriously to complain of the
severity of the second stage pains; although, of course, the gas can
be given during the first stage pains if desired. In the vast majority
of cases, however, we think it is best to encourage the patient to
endure these earlier and lighter pains without resorting to analgesic
procedures.
The form of apparatus used is the same as that employed by dentists
and contains both nitrous oxid and oxygen cylinders. A small nasal
inhaler is best, although the ordinary mouthpiece will do very well.
The gasbag attached to the tank should be kept under low pressure and,
as a pain begins, the patient is told to breathe quietly, keeping the
mouth closed. As a rule this sort of light inhalation serves to
produce the desired analgesic effect. It is not necessary to put the
patient deeply under in order to relieve the pain.
It is our custom to begin "sunrise slumber" as soon as the uterine
contractions become painful. The earlier the gas is started, the more
oxygen should be used. Two or three inhalations will suffice to take
the "edge" off the earlier and lighter pains. When the pains grow
heavier we use less oxygen and permit three or four deep inhalations
just before a bearing-down pain. At the first suggestion of a
contraction, the patient must begin to inhale the gas; while after the
patient has pulled hard on the traction strops--just as the
contraction pain is passing--she is given an inhalation containing a
larger percentage of oxygen.
At the beginning of a pain, pure nitrous oxid is administered, and the
patient is instructed to breathe deeply and rapidly through the nose.
The gasbags should be about half filled. The mixture of gas and oxygen
must be determined by the severity of the pains and individual
behavior of the patient.
Four to six inhalations of the gas are sufficient to produce the
required analgesia in the average case. Following the first few deep
inspirations through the nose, the patient can be instructed to
breathe through the mouth, while the gas is well diluted with oxygen
and continued until the end of the pain. In this way a satisfactory
analgesia is maintained throughout the "pain" with a minimum of "gas."
The proportion of oxygen used will run from nothing up to ten per
cent. This procedure is repeated with the occurrence of each pain.
The use of the "mask" is just as effective as a nasal inhaler, but
wastes more gas and so is more costly.
When the head is passing the perineum the gas should be pushed to the
point of anesthesia, while the patient's color will suggest the amount
of oxygen to be used as well as serve to control the administration of
the nitrous oxid.
CHLOROFORM AND ETHER
For many years chloroform and ether have been used to alleviate the
pains of women in labor. Valuable as these agents are when deep
anesthesia is required for the carrying out of operative procedures,
they have not proved satisfactory as analgesic agents. If administered
in small quantities at the commencement of a strong uterine
contraction, the patient does not usually inhale sufficient to abolish
pain. She is then apt to be irritated and is certain to insist on
being given a larger quantity. If a sufficient amount be administered
to satisfy the woman, the continued repetition gradually inhibits the
power both of the uterus and of the accessory muscles, so that labor
is unnecessarily prolonged, and, possibly, the life of the fetus
endangered. Physicians have, therefore, been accustomed to employ
these drugs very sparingly, restricting their use to the very end of
the second stage, during the painful passage of the head through the
vulva. The results of the administration at this time are also
uncertain. If delivery be rapid the woman may not be able to inhale
sufficient to abolish her consciousness of pain. If it be slow she may
take too much and weaken the muscular powers, thereby prolonging labor
and, often, necessitating forceps delivery. It is not surprising,
therefore, that the medical profession has long been hoping that a
more satisfactory method of relieving the pain of labor would be
found.
CONCLUSIONS
In summing up our conclusions regarding analgesia and anesthesia in
labor cases, the authors would state their present position as
follows:
1. That anesthetics or analgesics are a necessary accompaniment of
confinement in this day and age; that the average labor case demands
some sort of pain-relieving agent at some time during its progress;
but that intelligent efforts should be put forth to limit and
otherwise control their use. While we recognize the necessity for
avoiding needless suffering, at the same time we must also avoid
turning our women into spineless weaklings and timid babies.
2. That we should seek to develop, strengthen, and train our girls for
a normal and natural maternity; that we should study to attain
something of the naturalness and the painlessness of the labors of
Indian tribes; and, even if we partially fail in this effort, we shall
at least leave our women with ennobled characters and strengthened
wills.
3. That the scopolamin-morphin method of inducing "twilight sleep" has
its place--in the hands of experts--and in the hospital; and that in
many cases it probably represents the best method of obstetric
anesthesia which can be employed.
4. That as a general rule and in general practice, the safest and best
method of inducing the "twilight" state of freedom from severe pain,
is by the use of nitrous oxid or "laughing gas"--the "sunrise slumber"
method. It has been our practice to start all general ether
anesthetics with "gas" for a number of years, while we have been doing
an increasing number of both minor and major operations with "gas"
alone.
5. That we still employ general ether or chloroform anesthesia in
Cesarean sections and other major obstetric operations, although
several operators are beginning to use "gas" in even these heavy
cases.
6. That the intelligent and careful use of pituitary extract in
certain cases of labor serves greatly to shorten the second stage;
that it is of great value in certain "slow cases," and serves greatly
to reduce the use of low forceps.
We have treated the subject of obstetric anesthesia in this full
manner, because of the fact that so much has appeared in the public
press on these subjects, and, further, because we desired that our
readers should have placed before them the facts on all sides of the
question just as fully as a work of this scope would permit.
CHAPTER XI
THE CONVALESCING MOTHER
Popularly spoken of as the "lying-in period," and medically known as
the puerperium, this time of convalescence immediately following
childbirth is usually occupied by two important things: the
restoration of the pelvic organs to their normal condition before
pregnancy, and the starting of that wonderfully adaptative mechanism
concerned with the production of the varying and daily changing food
supply of the offspring.
The uterus, now more than fifteen times its normal size and weight,
begins gradually to contract and assume its normal weight of about two
ounces; and it requires anywhere from four to eight weeks to
accomplish this involution. In view of all this it is obvious that
there can be no fixed time to "get up." It may be at the end of two
weeks, or it may not be until the close of four or five weeks, in the
case of the mother who cannot nurse her child; for the nursing of the
breast greatly facilitates the shrinking of the uterus. Extensive
lacerations may hinder the involution as well as other accidents of
childbirth, so it must be left with the physician to decide in each
individual case when the mother may enter into the activities of life
and assume the responsibilities of the care of the baby and the
management of her home.
THE NURSE
During this period of the puerperium a member of the family, a
neighbor, a visiting nurse, a practical nurse, or a trained nurse,
looks after the mother and gives to the babe its first care; whoever
it may be, certain laws of cleanliness must be carried out if
infection is to be guarded against. If there are daily or semi-daily
calls made by the physician, a member of the family may be trained to
care for the mother with proper cleanliness and asepsis; but it is far
better for the mother, if possible, to secure the services of a
trained nurse, or the visiting nurse, in which instance she will call
each day, wash and dress the baby, clean up the mother and care for
the breasts. She is not supposed to clean the room, make the bed or
prepare the food. If a trained nurse can be in charge, the
convalescing time is usually shortened as the responsibilities are
taken from the mother, her mind freed from care and it is her's to
improve, rest, and wait for the restoration of the pelvic organs, when
she may again go forth among her family.
The nurse may have to sleep in the same room; but, if it be possible,
she should occupy an adjoining room, she should have a regular time
each day for an hour's walk in the fresh air, she should be served
regular meals, and be allowed some time out of the twenty-four hours
for unbroken slumber. In return she will intelligently cooperate with
the physician in bringing about the restoration of body and upbuilding
of the mother's nerves.
REST AND EXERCISE
From a monetary standpoint there can be nothing so wasteful or
extravagantly expensive in the home as to allow the mother to drag
about from day to day and week to week with chronic weakness or
invalidism because she did not have proper care during her already too
short puerperium, or because she got up too soon.
Having a baby is a perfectly normal, physiological procedure. It is
also, usually, downright hard work; and, beside the hard laborious
work, there is not only a wearied and severely shocked nervous system
to be restored, but there is also a certain amount of uterine
shrinkage which must take place--and this requires from four to eight
weeks; and so our mother must be allowed weeks or even a month or two
to rest, to enjoy a certain amount of well-directed exercise, to have
an abundance of fresh air, to be wheeled or lifted out of doors if
possible into the sunshine, that she may be the better prepared for
the additional duties and responsibilities the little new comer
entails. Sunshine and fresh air are wonderful health restorers as is
also a well-directed cold water friction bath administered near the
close of the second week of a normal puerperium. During the second
week a few carefully selected exercises such as the following are not
only beneficial, but tend to increase circulation and thus to promote
the secretion of milk and the shrinking of the uterus.
1. Head raising, body straight and stiffened.
2. Arm raising, well extended.
3. Leg stretching, with knees stretched and toe extended.
4. Massage, administered by the nurse.
A splendid tonic circulatory bath may be administered at the close of
the second week (in normal puerperium), known as the "cold mitten
friction," which is administered as follows: The patient is wrapped in
a warm blanket, hot water bottle at feet, and each part of the
body--first one arm then the other; the chest, the legs, one at a
time--is briskly rubbed with a coarse mit dipped in ice water. As one
part is dried it is warmly covered, while the next part is taken, and
so on until the entire body has been treated. The body is now all
aglow, the blood tingling through the veins, and the patient refreshed
by this wide-a-wake bath. Properly given, the cold-mitten friction
bath is one of the most enjoyable treatments known and under ordinary
conditions, if intelligently administered, may be given as early as
the eighth day.
AFTER PAINS
After the birth of the first baby the uterus usually is in a state of
constant contraction, hence there are no "after pains;" but after the
birth of the second or third child, the uterine muscle has lost some
of the tone of earlier days--there is a tendency toward relaxation--so
that when the uterine muscle does make renewed efforts at contraction,
these "after pains" are produced. They usually disappear by the third
day. Nothing should be done for them, indeed they should be welcomed,
for their presence means good involution (contraction) of the uterus.
THE TEMPERATURE
Careful notations of the temperature should be made during the first
week. A temperature chart should be accurately kept and if the
temperature should rise above 100° the physician should be notified at
once. The third day temperature is watched with expectancy, for if an
accidental infection occurred at the time of labor, it is usually
announced by a chill and sudden rise of temperature on the third day.
This may be as good a place as any to mention the commonly met night
sweating. This is due to a marked accentuation of the function of the
skin. It is not at all unusual for a sleeping mother in the early
puerperium to wake up in a sweat with night gown very nearly drenched.
The gown should be changed underneath the bedding, while alcohol is
rubbed over the moistened skin surface.
These sweats will disappear as soon as the mother begins to regain her
strength. A vinegar rub administered on going to bed may often prevent
these sweats.
THE TOILET OF THE VULVA
Immediately after the birth of the baby and the expulsion of the
afterbirth, the thighs and vulva are cleansed as follows: Into a basin
of warm, boiled water are dropped four small antiseptic tablets of
bichlorid of mercury; this gives a proper antiseptic wash. Into this
solution are placed four pieces of sterile cotton Two of these are
used, one at a time, without being returned to the solution to wash
each inside of the thigh, the remaining two to cleanse the vulva.
Without drying the vulva, two sterile pads are applied and pinned to
the binder. These pads are changed every hour during the first day or
two because of the profuse lochial flow.
After each urination and bowel movement, a lysol solution (prepared by
putting one teaspoonful of lysol in a quart of sterile water) is
poured from a clean pitcher over the vulva into the bed pan, and fresh
pads applied. This toilet continues until the close of the second week
or longer, if there is a lochial flow.
These sterile pads not only absorb the lochia but also, among ignorant
or thoughtless mothers, prevent contamination by the patient's hands.
URINATION
The patient should be encouraged to urinate during the first few hours
after labor; catheterization should not take place until every effort
has been made to bring about normal urination; or, until there is a
well marked tumor above the bony arch of the pelvis in the lower part
of the abdomen. It is far less harmful to the patient for her to sit
up on the jar placed on the edge of the bed, than to undergo the risk
of inflammation of the bladder which so often follows catheterization.
THE LOCHIA
The first few days the lochia is very red because of the large amount
of blood which it contains. After the third or fourth day it is paler
and after the tenth it assumes a whitish or yellowish color. During
the three changes it should always smell like fresh blood. Any foul,
putrifying odor should be promptly reported to the physician.
If on getting up at the close of the second week the lochia should
resume its red color, the patient should return to bed and notify her
physician.
THE ABDOMINAL BINDER
After the tenth day, the abdominal binder may be pinned as tightly as
the patient desires, but prior to the tenth day many physicians
believe the exceedingly tight binder causes misplacements of the
enlarged, softened, and boggy uterus. It should be pinned snugly; but
not drawn as tight as possible with the idea of keeping the uterus
from relaxing, for at best, it does not do it; while tight
constriction may produce a serious turning or flexion of the uterus.
The breast binder is applied during the first twenty-four hours to
support the filling breasts, loosely at first, and as they increase in
size, as the glands become engorged, the binder is drawn more tightly.
A sterile piece of gauze is placed over the nipples.
THE BOWELS
On the morning of the second day a cathartic is usually given--say one
ounce of castor oil or one-half bottle of citrate of magnesia. The
bowels should move at least once during each twenty-four hours; if
they are obstinate, a simple laxative may be nightly administered.
Certain constipation biscuits, sterilized dry bran, or agar-agar may
be eaten with the breakfast cereal. Prunes and figs should be used
abundantly. Bran bread should be substituted for white bread. The
enema habit is a bad one and should not be encouraged; however, the
enema is probably less harmful than the laxative-drug habit. Mineral
oil is useful as a mild laxative, and does not produce any bad after
results.
CARE OF THE NIPPLES
Fissures of the nipples should be reported to the physician at once.
There are many good remedies which the physician may suggest; in his
absence, Balsam Peru may be advantageously applied. Boracic acid
solution should be applied before and after each nursing from the very
first day; in this way much nipple trouble may be prevented through
cleanliness and care. The nipples should be kept thoroughly dry
between nursings Nipple shields should be used where fissures persist.
THE DIET
For the first three days a liquid and soft diet is followed such as
hot or cold milk, gruels, soups, thin cereals, eggnog (without
whiskey), eggs, cocoa, dry toast, dipped toast, or cream toast. There
should be three meals with a glass of hot milk at five in the morning
(if awake) and late at night; nothing between meals except plenty of
good cold water. After the third day, if temperature is normal, a
semi-solid diet may be taken, such as baked, mashed, or creamed
potatoes, soups thickened with rice, barley or flour, vegetables
(peas, corn, asparagus, celery, spinach, etc.); eggs, light meats,
stale breads, toast, bland or subacid fruits (sweet apples, prunes,
figs, dates, pears, etc.); macaroni, browned rice (parched before
steaming), etc.; ice cream, custards, and rice puddings for desserts
after the seventh day. Three good meals a day, at eight and one and
six, with a couple of glasses of hot milk or cocoa or an eggnog at
five A.M., to be repeated at 9 or 10 P.M., with plenty of cold water
between the meals, will abundantly supply the necessary milk for the
growing babe. Tea and coffee are not of any special value in
encouraging a flow of milk.
The constant coaxing of the mother with "Do drink this," and "You must
drink this, or you won't have any milk," not only saddens her but
seriously upsets digestion and thus indirectly interferes with normal
lactation.
GETTING UP
Everybody should stay at home and away from the mother and her new
born child until after the seventh day, and then, if our patient is
normal, visitors may call, but should not stay longer than five
minutes. The convalescing mother will improve faster without the
neighborhood gossip, or the tales of woe so often carried by
well-meaning, but woefully ignorant acquaintances.
When the hard ball-like mass can no longer be felt in the lower
abdomen, when the lochia has passed through the three changes already
mentioned, and the flow is whitish or yellowish, scanty and odorless,
the patient may sit up in a chair increasingly each day. Such
conditions are usually found anywhere from the tenth to the fifteenth
day. The patient first sits up a little in a chair--she has already
been exercising some in bed--and this enables her to sit up with ease
for a half-hour the first day, increasing one-half hour each day
during the week following. At the end of three weeks, she may be taken
down stairs providing there is ample help to carry her back up stairs.
After another week (at the close of the fourth), if the lochia is
entirely white or yellow, with no blood, she may begin carefully to go
about the house. There should be no lifting, shoving, pulling,
wringing, sweeping, washing, ironing, or other heavy exercise for at
least another two weeks, better four weeks. Any variance from this
program usually means backache, lassitude, diminished milk supply, and
frequently a general invalidism for weeks or months--sometimes years.
COMPLICATIONS
_Cystitis_, or painful urination, is avoided by tardy "getting up;"
quietly, slowly moving about; abundant water drinking; and the
avoidance of catheterization.
_Hemorrhage._ Notify the physician if it occurs at any time. The
treatment is heavy kneading of the abdomen until the uterus again
becomes like a hard ball. Cold compresses over the lower abdomen may
sometimes help.
_Infection_ is manifested by chilly sensations or a distinct chill
followed by fever, usually on the third day. Take a cathartic; notify
the physician at once and follow his directions.
_Mastitis_, inflammation or caking of the breasts. Very hot
fomentations wrung out of boiling water, alternating with ice-cold
compress, should be applied to the breast for an hour or more, three
or four times a day. Cathartics should be administered, and
eliminative measures instituted such as the hot-blanket pack.
_Pneumonia._ Keeping the arms and chest well protected by a
long-sleeved coat of warm texture, should help in preventing this
serious complication. Pneumonia complicating labor is usually the
result of carelessness and exposure.
PART II
THE BABY
PART II
THE BABY
CHAPTER XII
BABY'S EARLY DAYS
Happy is the mother and fortunate is the home that possesses the
intelligent services of a trained attendant during the early days of
the baby's career. A century or more ago skilled nurses were unheard
of, and both mothers and babies seemed to thrive on the unskilled but
faithful and sympathetic care given by the willing neighbor who
"thought I'd just run over and help out." Who of us cannot remember
the days when mother was "gone to a neighbor's" to give this same
willing but unskilled care at the time of "confinement."
MODERN METHODS
And why are we so concerned today about asepsis, sterilization, etc.,
when a generation ago they were not? We used to live more slowly than
we do now. Then it took the entire day to do the marketing for the
week, now we take a receiver from the hook and a telephone wire
transmits the verbal message. Our days are literally congested with
events that were almost impossibilities a century ago. The ease and
leisure of former days are unknown and unheard of today. The
artificial way in which we live exerts more or less of a strain upon
the present generation; the average woman's nervous system is keyed up
to a high pitch; her general vital resistance is running at a low ebb;
while child-bearing brings a certain added stress and strain that
requires much planning to avoid and overcome.
For many days and ofttimes weeks the mother is unfit--physically
unable--properly to care for her child, and so whether it be the
trained assistant in constant attendance or the visiting nurse in her
daily calls, or the kind, willing, but unskilled neighbor--each helper
must acquaint herself, in varying degrees, with the physical, nervous,
and mental needs of the child, as well as take into account and
anticipate the numerous habits and wants of the new born babe, such as
urination, bowel movement, pulse, respiration, temperature, etc.
THE HEAD
At birth, the head is remarkably large as compared to the rest of the
body, for, surprising as it may seem, the distance from the crown to
the chin is equal to the length of the baby's trunk; and, too, if
birth has been prolonged this large head has also been pressed or
squeezed somewhat out of shape. This state of affairs, however, need
give no cause for either alarm or anxiety, for the head will shape
itself to the beautiful rotundity of the normal baby's head within a
few days.
The general shape of the baby's head, as seen from above is oval. Just
back of the forehead is formed a diamond-shaped soft spot known as the
anterior fontanelle which should measure a little more than one inch
from side to side. On a line just posterior to this soft spot and to
the back of the head, is found another soft spot somewhat smaller than
the one in front. Gradual closure of these openings in the bones
occurs, until at the end of six or eight months, the posterior
fontanelle is entirely closed; while eighteen months are required for
the closure of the anterior fontanelle.
These "soft spots" should not be depressed neither should they bulge.
The head is usually covered with a growth of soft, silky hair which
will soon drop out, to be replaced, however, by a crop of coarser hair
in due season. The scalp should always be perfectly smooth. Any rash
or crusts or accumulation of any kind on the scalp is due to
uncleanliness and neglect, and should be carefully removed by the
thorough application of vaseline followed by a soap wash. The vaseline
should be applied daily until all signs of the accumulation are
entirely removed. The eyes of all babies are generally varying tints
of blue, but usually change to a lighter or darker hue by the seventh
or eighth week. The whitish fur which often is seen on the baby's
tongue is the result of a dry condition of the mouth which disappears
as soon as the saliva becomes more abundant.
CHEST, ABDOMEN, AND LEGS
The baby's chest, as compared to the size of the head and abdomen,
appears at a disadvantage, while the arms are comparatively short and
the legs particularly so, since they measure about the same as the
length of the trunk. They naturally "bow in" at birth so that the
soles of the feet turn decidedly toward each other. All these apparent
deformities, as a rule, right themselves without any help or attention
whatsoever.
PULSE AND RESPIRATION
The pulse may be watched at the anterior fontanelle or soft spot on
top of the head while the child quietly sleeps and should record, at
varying ages, as follows:
At birth 130 to 150
First month 120 to 140
One to six months about 130
Six months to one year about 120
One to two years 110 to 120
Two to four years 90 to 110
The above table is correct for the inactive normal child. Muscular
activity, such as crying and sucking, increases the pulse rate from 10
to 20 beats per minute.
The respiration of the baby often gives us no small amount of real
concern at the first. The baby may be limp and breathless for some few
moments at birth, and this condition calls for quick action on the
part of the nurse and doctor.
The utmost care to avoid the "sucking in" of any liquid or blood
during its birth must be exercised, for this often seriously
interferes with the breathing. Sometimes this condition is not
relieved until a soft rubber catheter is placed in the throat and the
mucus is removed by quick suction. When you are reasonably sure that
there is no more mucus in the throat, then sudden blowing into the
baby's lungs (its lips closely in touch with the lips of the nurse or
physician) often starts respiration. Slapping it on the back also
helps, while the quick dip into first hot then cold water seldom fails
to give relief.
A quiet-sleeping infant breathes as shown below at varying ages. An
increase of six to ten breaths per minute may be allowed for the time
it is awake or otherwise active.
At birth and for the first two or three weeks 30 to 50
During the rest of the first year 25 to 35
One to two years about 28
Two to four years about 25
THE WEIGHT
The normal weight of the average baby is seven to seven and one-half
pounds. Its length may range anywhere from sixteen to twenty-two
inches.
There is an initial loss of weight during the first few days; however,
after the milk has been established the child should make a weekly
gain of four to eight ounces until it is six months old, after which
time the usual gain is from two to four ounces per week.
If the weight has been doubled at six months and the weight at one
year is three times the birth weight, the child is said to have gained
evenly and normally.
THE SKIN
At birth the skin of the baby is red and very soft owing to the
presence of a coating of fine down. A blue-tinged skin may be
occasioned by unnecessary exposure or it may be due to an opening in
the middle partition of the heart which should close at birth. As soon
as the baby is born, it should be placed on its right side while the
cord is being tied, as this position facilitates closure of this
embryonic heart opening. With the provision for a little additional
heat the blue color should disappear, if it is not due to this heart
condition. At the close of the first week the red color of the skin
changes to a yellow tint due to the presence of a small amount of bile
in the blood. This sort of jaundice is very common and is in no wise
evidence of disease. The "down" falls off with the peeling of the
skin which takes place during the second week; by the end of which
time, the skin is smooth and assumes that delightful "baby" character
so much admired.
THE CORD DRESSING
The cut end of the tied umbilical cord is swabbed and squeezed with a
sterile sponge saturated with pure alcohol. It is then wrapped in a
sterile dressing made as follows: Four or five thicknesses of sterile
cheese cloth are cut into a four-inch square with a small hole cut in
the center and one side cut to this center. This is slipped about the
stump of the cord and wrapped around and about in such a manner as
entirely to cover the stump of the cord. The wool binder is then
applied and sewed on, thus avoiding both pressure and the prick of
pins. If it remains dry this dressing is not disturbed until the
seventh or eighth day, when the cord ordinarily drops off. Should it
become moistened the dressing is removed and the second dressing is
applied exactly like the first.
THE EYES
The closed eyes of the newly born child are generally covered with
mucus which should be carefully wiped off with a piece of sterile
cotton dipped in boracic acid solution, in a manner not to disturb the
closed lid. A separate piece of cotton is used for each eye and the
swabbing is done from the nose outward. The physician or nurse drops
into each opened eye two drops of twenty per cent argyrol, the surplus
medicine being carefully wiped off with a separate piece of cotton for
each eye. The baby should now be placed in a darkened corner of the
room, protected from the cold.
The eyes are washed daily by dropping saturated solution of boracic
acid into each eye with a medicine dropper. Separate pieces of gauze
or cotton are used for each eye.
THE FIRST OIL BATH
As soon as the cord and the eyes have received the proper attention
and the mother has been made comfortable, the baby is given its
initial bath of oil. This oil may be lard, olive oil, sweet oil, or
liquid vaseline. The oil should be warmed and the baby should be well
covered with a warm blanket and placed on a table which is covered
with a thick pad or pillow. The temperature of the room should be at
least eighty degrees Fahrenheit. Quickly, thoroughly, and carefully
the entire body is swabbed with the warmed oil--the head, neck, behind
the ears, under the arms, the groin, the folds of the elbow and
knee--no part of the body is left untouched, save the cord with its
dressing. This oil is then all gently rubbed off with an old soft
linen towel.
THE FIRST CLOTHING
After the oil bath, the silk and wool shirt (size No. 2), the diaper
and stockings are quickly put on to avoid the least danger of
chilling. The band having been applied at the time of the dressing of
the cord, our baby is now ready for the flannel skirt. This should
hang from the shoulders by a yoke of material adapted to the season,
cotton yoke without sleeves if a summer baby, and a woolen yoke with
woolen sleeves if a winter baby. The outing-flannel night dress
completes the outfit and should be the only style of dress worn for
the first two weeks. Loosely wrapped in a warm shawl, the baby is
about ready for its first nap, save for a drink of cooled, boiled
water.
This cooled, boiled, unsweetened water should be given in increasing
amounts every two hours until the child is two or three years of age.
It is usually given the child in a nursing bottle. In this way it is
taken comfortably, slowly, can be kept clean and warm, and should the
babe be robbed of its natural food and transferred to the bottle as a
substitute for mother's milk, it will already be acquainted with the
bottle and thus one-half of a hard battle has already been fought and
won.
BABY'S FIRST NAP
The baby's bed should be separate and apart from the mother's. It may
be a well-padded box, a dresser drawer, a clothes basket, or a large
market basket. A folded comfortable slipped in a pillow slip makes a
good mattress. A most ideal bed may be made out of a clothes basket;
the mattress or pad should come up to within two or three inches of
the top, so the baby may breathe good fresh air and not the stale air
that is always found in a deeply made bed. Into this individual bed
the baby is placed as soon as it is dressed; and a good sleep of four
to six hours usually follows.
Frequent observations of the cord dressing should be made as
occasionally hemorrhage does take place, much to the detriment of the
babe. If bleeding is at any time discovered the cord is retied just
below the original tying. By the time baby has finished a six- or
eight-hour nap the mother is wondrously refreshed and is ready to
receive it to her breast.
PUTTING TO THE BREAST
During the first two days the baby draws from the breasts little more
than a sweetened watery fluid known as the colostrum; but its intake
is essential to the child in that it acts as a good laxative which
causes the emptying of the alimentary tract of the dark, tarry
appearing stools known as the meconium. On the third day this form of
stool disappears and there follows a soft, yellow stool two or three
times a day.
The child should be put to the breast regularly every four hours; two
things being thus encouraged: an abundant supply of milk on the third
day and the early shrinking of the uterus. More than once a mother has
missed the blessed privilege of suckling her child because some
thoughtless person told her "why trouble yourself with nursing the
baby every four hours, there's nothing there, wait until the third
day;" and so when the third day came, there was little more than a
mere suggestion of a scanty flow of milk, which steadily grew less and
less.
THE URINE
The urine of the very young child should be clear, free from odor and
should not stain the diaper, nor should it irritate the skin of the
babe. Often urination does not take place for several hours, sometimes
not at all during the first twenty-four hours. If the infant does not
show signs of distress, there is no cause for alarm; the urine should
pass, however, within thirty hours. As a rule there are usually
between ten and twenty wet diapers during each twenty-four hours. The
following table shows about the amounts of urine at different ages:
Birth to two years 8 to 12 ounces
Two to five years 15 to 25 ounces
Five to ten years 25 to 35 ounces
GENITALS OF THE MALE CHILD
The foreskin of the male child is often long, tight, and adherent, and
is often the direct cause of irritability, nervousness, crying, and
too frequent urination. It should be closely examined by both
physician and nurse and when the foreskin does not readily slip back
over the acorn-like head of the organ, circumcision is advised early
in the second week. This simple operation will start the child out on
his career with at least one moral handicap removed and one desirable
possibility established--that of being able to keep himself clean.
POST-OPERATIVE CARE OF CIRCUMCISION
The dressings that are loosely applied at the time of the operation
should remain untouched (especially those next to the skin), unless
otherwise directed by the physician, until the seventh or eighth day
when the babe is placed in a warm soap bath, at which time the
dressings all come off together. Clean sterile gauze is so placed as
entirely to protect the inflamed skin from the diaper at all times
before this bath, and these same dressings should be continued for at
least another week. Sterile vaseline (from a tube) should be applied
twice a day after the original dressings are removed in the bath at
the end of the first week. There should be little or no bleeding
following the operation, neither should the penis swell markedly; if
either complication should occur, the physician should be promptly
notified.
CARE OF THE FEMALE GENITALS
The girl baby is often neglected in respect to the proper care of the
genitals. The lips of the vulva should be separated and thorough but
careful cleaning should be the daily routine. The foreskin or covering
of the clitoris should not be adherent; while the presence of mucus,
pus, or blood in the vulva should be at once reported to the
physician; in his absence, the application of twenty per cent argyrol
should be made daily.
[Illustration: Fig. 6. How to Hold the Baby]
HANDLING THE BABY
Let us thoroughly come to understand the very first day the little
one's life, that it was not sent to us because the family needed
something to play with; it is not a ball to toss up, neither is it a
variety show. It is a tiny individual, and your responsibilities as
parents and caretakers are very great. The child was sent to be fed,
clothed, kept warm, dry, and otherwise cared for by you, until such a
time as it will become able to care for itself. Remember, what we sow,
that shall we also reap. If we sow indulgence we shall reap anger,
selfishness, irritability, "unbecomingness"--the spoiled child. At two
or three days the baby learns that when it opens its mouth and emits a
holler, someone immediately comes. If we do it on the second and third
day, why should we object to run, bow, and indulge on the one
hundredth and second day?
Handle the baby as little as possible. Turn occasionally from side to
side, feed it, change it, keep it warm, and let it alone; crying is
absolutely essential to the development of good strong lungs. A baby
should cry vigorously several times each day. If the baby is to be
handled, support the back carefully (Fig. 6).
THE EARLY BATHS
During the first week the baby is oiled daily over his entire body,
with the exception that the cord dressing remains untouched. The face,
hands, and buttocks are washed in warm water. After the third week the
bathroom is thoroughly warmed and the small tub is filled with water
at temperature of 100 F. The baby having been stripped and wrapped in
a warm turkish towel, is placed on a table protected by a pillow,
while the caretaker stands by and vaselines the creases of the neck,
armpits, folds of the elbows, knees, thighs, wrists, and genitals; and
then, with her own hands, she applies soap suds all over the
body--every portion of which is more quickly and readily reached--than
by the use of a wash cloth. And now, with the bath at 100 F., with a
folded towel on the bottom of the small tub, the soapy child is placed
into the water and after a thorough rinsing is lifted out again to a
warm fresh towel on the table and the careful drying is quickly begun.
After the bath all the folds and creases are given a light dusting
with a good talcum.
During hot weather the bath should be given daily, soap being used
twice a week. On the other days there should be the simple dipping of
the child into the tub. During the cold weather the full bath is given
but twice a week, while on the other days a sponge bath or an oil rub
may be administered.
A weak, delicate child should not be exposed to the daily full bath,
but rather the semi-weekly sponge bath and the daily oil rub should be
administered. We have found the late afternoon hour to be better than
the early morning hour for baby's bath. It requires too much vital
resistance to react to an early morning bath, especially when the
house is cool.
REGARDING SOAP
The use of soap is very much abused with young babies. I recall one
mother who came into the office with her poor little baby which was
constantly crying and fretting because of a greatly inflamed body--all
a result of the too frequent use of soap. I said, "I am afraid you do
not keep your baby clean." "O Doctor!" she replied, "I wash him with
soap every time I change him; I am sure he is clean." And come to find
out, the poor little fellow's tender skin had been subjected to soap
several times a day. We ordered the use of all soap discontinued,
vaseline and talcum powder to be used instead, and the child's skin
got well in a very short time.
CARE OF THE UMBILICUS
Tight bands should not be placed about the babe. If the umbilicus
protrudes, do not endeavor to hold it in by a tight band, but consult
your physician about the use of a bit of folded cotton and adhesive
plaster, and then allow the child the freedom of the knitted bands,
with skirts suspended from yokes. The day of tight bands and pinning
blankets with their additional and traditional windings is over. After
the complete healing of the cord, the need for a snug binder to hold
the dressings in place is over. Should the baby cry violently, the
umbilicus should be protected in the manner described above--the fold
of cotton and the adhesive plaster.
The diaper, stockings, shirt, skirt, and dress with an additional
wrapper for cold days completes the outfit at this age.
BIRTH REGISTRATION
"One of the most important services to render the newborn baby is to
have his birth promptly and properly registered."
In most states the attending physician or midwife is required by law
to report the birth to the proper authority, who will see that the
child's name, the date of his birth, and other particulars are made a
matter of public record. Birth registration may be of the greatest
importance when the child is older, and parents should make sure this
duty is not neglected.
A public health official some time ago epitomized some of the uses of
birth registration as follows:
There is hardly a relation in life from the cradle to the grave
in which such a record may not prove to be of the greatest value.
For example, in the matter of descent; in the relations of wards
and guardians; in the disabilities of minors; in the
administration of estates; the settlement of insurance and
pensions; the requirements of foreign countries in matters of
residence, marriage, and legacies; in marriage in our own
country; in voting and in jury and militia service; in the right
to admission and practice in the professions and many public
offices; in the enforcement of laws relating to education and to
child labor, as well as to various matters in the criminal code;
the irresponsibility of children under ten for crime or
misdemeanor; the determination of the age of consent, etc., etc.
CHAPTER XIII
THE NURSERY
We wish it were possible for every mother who reads this book to have
a special baby's room or nursery. Some of our readers have a separate
nursery-room for the little folks, and so we will devote a portion of
this chapter to the description of what seems to us a model
arrangement for such a room; but, realizing that ninety-five per cent
of our readers can only devote a corner of their own bedroom to the
oncoming citizen, we have also carefully sought to meet their needs
and help them to take what they have and make it just as near like the
ideal nursery as possible.
THE SEPARATE NURSERY
The nursery should be a quiet room with a south or southwesterly
exposure. The bathroom should adjoin or at least be near. A
screened-in porch is very desirable.
Draperies that cannot be washed, and upholstered furniture, do not
belong in the baby's room. A hardwood floor is better than a carpet or
matting; while a few light-weight rugs, easily cleaned, are advisable.
Enameled walls are easily washed and are, therefore, preferable to
wall paper or other dressings.
The windows should be well screened, for by far the greatest dangers
to which the baby is exposed, are flies and mosquitoes--carriers of
filth and disease. Flies, mosquitoes, cockroaches, bed bugs, cats,
dogs, lice, and mice are all disease carriers and must therefore be
kept out of baby's room.
NURSERY EQUIPMENT
At each window should be found dark shades, and if curtains are
desired they should be of an easily washable material, such as mull,
swiss, lawn, voile, or scrim. The hardwood floor may be covered where
necessary with easily handled rugs which should be aired daily. The
other necessary articles of furniture are a crib of enameled iron
whose bedding will be described elsewhere in this chapter, a chest for
baby's clothes and other necessary supplies, a screen or two, a low
table and a low rocker, a small clothes rack on which to air the
clothes at night, a pair of scales, and a medicine chest placed high
on the wall.
If the room will conveniently admit it, a couch will add greatly to
the mother's comfort; and, if possible, it should be of leather
upholstery; otherwise, it should possess a washable cover, for all
articles that promote the accumulation of dust are not to be allowed
in the nursery. In these early weeks and months baby will not benefit
from pictures or other wall decorations, and so let him have clean
walls that are easily washed and quickly dusted.
The necessities for baby's personal care are:
Talcum powder.
Castile soap.
Soft wash cloths.
Soft linen towels.
Bottle of plain vaseline.
Boracic acid, oz. IV (Saturated Solution).
Olive oil.
Sterile cotton balls in covered glass jar.
Safety pins of different sizes.
Hot water bag with flannel cover.
Baby scales.
Drying frames for shirt and stockings.
BABY'S BED
Since the days of Solomon, accidents have occurred where mother and
babe have occupied the same bed. Not only is there the ever-present
danger of smothering the babe, but there are also many other reasons
why a baby should have its own bed. The constant tendency to nurse it
too often and the possibility of the bed clothing shutting off the
fresh air supply, are in and of themselves sufficient reasons for
having a separate bed for baby.
The first bed is usually a basinet--a wicker basket with high
sides--with or without a hood. A suitable washable lining and outside
drape present a neat as well as sanitary appearance. The mattress of
the basinet is usually a folded clean comfort slipped into a pillow
slip; this is to be preferred to a feather pillow, as it is cooler and
in every way better for the babe.
Drapes about the head of the basinet are not only often in the way,
shutting out air, etc., but they also gather dust and are unsanitary.
Screens are movable--they may be used or put away at will--and are,
therefore, very convenient about the nursery.
The basinet may be dispensed with entirely if the sides of the
enameled crib are lined to cut off draughts and the babe is properly
supported by pillows. After the baby is four to six months of age it
is transferred to the crib. The basinet has an advantage over the crib
during those early weeks in that its high sides protect the babe from
draughts, and the comforts and blankets can be more easily tucked
about the little fellow to keep him warm. The sides should not extend
more than four inches above the lying position of the child.
THE CRIB
The enameled iron crib should be provided with a woven-wire mattress,
over which is placed a mattress; hair is best as a filling for the
mattress, wool next, and cotton last. Over the mattress should be
placed a rubber sheet, and over all a folded sheet.
A pillow of hair or down is not to be discarded; for recent
investigation has shown that the pillow favors nasal drainage, while
lying flat encourages the retaining of mucus in the nose and nasal
chambers--the sinuses. The pillow slip should be of linen texture.
During the winter a folded soft blanket over the rubber sheet
increases both softness and warmth. No top sheet is used during the
first months, particularly if the first months are the winter months.
The baby is wrapped loosely in a light weight clean blanket or shawl,
and other blankets--as many as the season demands are tucked about the
child. These blankets should be aired daily, and the one next to the
baby changed, aired, or washed very often.
[Illustration: Fig. 7. Making the Sleeping Blanket]
THE SLEEPING BLANKET
To prevent baby from becoming uncovered the sleeping blanket has been
devised. The blanket is folded and stitched in such a way as
completely to envelop the sleeping babe, and at the same time afford
the utmost freedom (Fig. 7). The babe may turn as often as he desires,
but cannot possibly uncover himself. Bed clothes fasteners are also
used--an elastic tape being securely fastened to the head posts and
then by means of clamps or safety pins attachment is made to the
blankets on either side. The elasticity allows considerable freedom to
the child in turning (See Fig. 8).
NURSERY HEATING AND VENTILATION
The subject of ventilation has been so fully discussed by the authors
in another work that we refer the reader to _The Science of Living, or
the Art of Keeping Well_.
For the first two or three weeks the nursery temperature should be
maintained at seventy degrees Fahrenheit by day and from sixty degrees
to sixty-five degrees by night. In the third week the day temperature
should be sixty-eight degrees Fahrenheit measured by a thermometer
hanging three feet from the floor. After three months the night
temperature may go as low as fifty-five degrees Fahrenheit, and after
the first year it may go as low as forty-five degrees.
The heating of the nursery is usually controlled by the general
heating plant, and no matter what system of heating is maintained,
humidifiers must be used, the necessity for which is doubled when the
system is that of the hot-air furnace.
These shallow pans of water with large wick evaporating surfaces will
evaporate from three to four quarts during the twenty-four hours. The
humidity should be fifty throughout the seasons of artificial heating.
Many colds may be entirely avoided by the use of humidifiers or
evaporators. The open grate is one of the very best means of nursery
heating. Gas and oil heaters should not be depended upon for nursery
heat. Only in an emergency should they be used at all, and the
electric heater is by far the best device for such occasions.
[Illustration: Fig. 8. In the Sleeping Blanket]
BABY'S CORNER IN MOTHER'S ROOM
It is probably a conservative estimate to say that ninety-five per
cent of all the babies occupy a corner of mother's and father's
bedroom for the first two or three years. And believing this estimate
to be correct, it is advisable to give the matter some consideration.
To begin with, a lot of the non-essentials, ruffles and fluffles of
the average bedroom, must go. The good father's chiffonier may have to
be put in the bath room; heavy floor coverings must be discarded, to
be replaced by one or two small, light-weight rugs; wall decorations
and the usual bric-a-brac of dressers, tables, etc., should be
carefully packed away. In fact, there should be nothing in the room
save the parents' bed, dresser (several drawers of which must be
devoted to baby's necessities), table, low rocker, a stool, baby's bed
and a good big generous screen, made out of a large clothes horse
enameled white and filled with washable swiss.
Window draperies must be taken down and packed away, while they are
replaced with simple muslin which can go to the laundry twice a month.
If it be within the means of the family purse, it is well to renovate
the walls just prior to the advent of the little stranger.
And now the baby's bed is placed in the corner most protected from
draughts and the glare of the sunlight. If it can be so arranged that
baby looks away from the light, and not at it, we are guarding it from
defective vision in the future.
CRIB SUBSTITUTES
Many a beautiful artistic creation so much admired in this world is
found to be, on closer inspection, a very ordinary thing which has
received an artistic touch; and so, many convenient, sanitary, and
beautiful cribs are fashioned from market baskets fastened to tops of
small tables whose legs are sawed off a bit; from soap boxes fastened
to a frame, and from clothes baskets. A can of white enamel, a paint
brush and the deft hand of a merry, cheery-hearted expectant mother
can work almost miracles. Remember, please, that all draperies must be
washable and attached with thumb tacks so as to admit of easy and
frequent visits to the laundry.
A medium-sized clothes basket will take care of our baby for four or
five months. The same general plan for the mattress and bedding is
followed as before described.
EXTRA HEAT TO THE CRIB
If necessary--and it usually is, especially during the winter
months--a hot-water bottle may be placed underneath the bedding on top
of the mattress. This insures a steady, mild, uniform warmth and it
not only saves the baby from the danger of being burned, but it also
obviates the temporary overheating of the child which usually occurs
when the bottle is placed inside the bed, next to the baby. If the bed
is properly made--the blankets coming from under the babe up and
over--there is little or no need for extra heat for well babies after
the first month.
LIGHTING BABY'S ROOM
If electric lighting is not an equipment of the home neither gas or
oil lamps should be allowed to burn in the room for long periods. For
emergency night lighting a well-protected wax candle should be used.
However, don't go to sleep and allow a candle to burn unprotected as
did one tired, exhausted mother. The father, suddenly aroused from his
sleep, saw a large flame caused by the overturning of a wax candle
into a box of candles, while the lace drapery of the basinet was
within a few inches of the flame and the baby just beyond. Grabbing a
pillow he smothered the flames and saved baby and all.
FRESH AIR
Plenty of fresh air and lots of sunshine should enter baby's room. The
large screen amply shields from draughts, and when thus protected
there need be no unnecessary concern about cool fresh air, especially
after two or three months, as it is invigorating and prevents
"catching cold." Warm, stuffy air is devitalizing and even during the
early weeks when the fresh air must be warm, an electric fan should be
advantageously placed so that many times each day the warm fresh air
may be put in motion without creating a harmful draught.
Warm stuffy air makes babies liable to catch cold when taken out into
the open.
Throw open the windows several times each day and completely change
the air of baby's room. In the absence of the large screen, a wooden
board five or six inches high is fitted into the opening made by
raising the lower window sash. Then as the upper sash is lowered the
impure air readily escapes while fresh air is admitted.
THE BATH EQUIPMENT
Make early preparations for bathing the baby in the easiest possible
manner; in fact, the young mother should seek to attend to all her
duties--the family, the home, and the baby--in the easiest way. For
the administration of a bath during the early months, a table is
needed, protected by oilcloth on which is placed a roomy bathtub with
a folded turkish towel on the bottom for baby to sit on. In addition
to the tub, have:
An enameled pitcher for extra supply of warm water.
A small cup for boracic acid solution.
Castile soap.
A soft wash cloth.
Several warmed soft towels.
A bath thermometer.
A medicine dropper for washing baby's eyes.
Talcum powder.
Oil or vaseline.
Sterile cotton.
Tooth picks.
A needle and thread for sewing on the band.
All of the clean clothing needed.
See that the bathtub is clean and enamel unbroken, and if it has been
used by another babe, freshen it with a coat of special enamel sold
for that purpose.
BATH TEMPERATURES
During the first eight weeks Temperature 100 F.
From two to six months Temperature 98 F.
From six to twenty-four months Temperature 90--97 F.
A bath at ninety-eight degrees is a neutral bath, and after the baby
is six months and over, the bath may be given at this temperature, and
at the close quickly cooled to ninety degrees.
NURSERY CLEANLINESS
The nursery should furnish the baby's first protection from
contagious diseases. It must be a veritable haven of safety.
Therefore, no house work of any kind should be done in the room,
such as washing or drying the baby's clothes. The floors and the
furniture should be wiped daily with damp cloths. A dry cloth or
feather duster should never be used to scatter dust around the
room.
All bedding and rugs should receive their daily shaking and airing out
of doors, remembering that particles of dust are veritable airships
for the transportation of germs. In every way possible avoid raising a
dust. So much of the lint which commonly comes from blankets may be
avoided with the daily shaking out of doors.
Soiled diapers should not accumulate in a corner or on the radiator;
their removal should be immediate, and if they must await a more
opportune time, soak them in a receptacle filled with cold water. Even
those diapers slightly wetted should never be merely dried and used
again, but should be properly washed and dried. No washing soda should
be used in the cleansing of diapers--just an ordinary white soap, a
good boil, and plenty of rinse water, with drying in the sun if
possible. They require no ironing. Hands that come in contact with
soiled or wet diapers must be thoroughly cleansed before caring for
the baby or preparing his food.
As before mentioned, and it will bear repetition often, all windows
and doors must be well screened, for flies and mosquitoes are dreaded
foes in any community and in babyland in particular. All used bottles
and nipples as well as used cups, pitchers, bits of used cotton,
should be removed at once. The washcloth is a splendid harbinger of
germs. There should be one for the face, and one for the body and
bath, and both should receive tri-weekly boiling. Bath towels should
not be used more than twice, better only once.
The technic of bathing, together with the location, furnishings, and
cleanliness of the baby's sick room, will be taken up in later
chapters.
CHAPTER XIV
WHY BABIES CRY
It is surprising how soon even a young and inexperienced mother will
learn to distinguish between the _pain_ cry and the _plain_ cry of her
baby; for most crying can easily be traced to some physical discomfort
which can be relieved, or to some phase of spoiling and indulgence
which can be stopped.
NORMAL HEALTHY CRYING
The young baby can neither walk, talk nor engage in gymnastics, except
to indulge in those splendid physical exercises connected with a good
hearty cry. To be good and healthy, an aggregate of an hour a day
should be spent in loud and lusty crying. He should be allowed to
kick, throw his arms in the air and get red in the face; for such
gymnastics expand the lungs, increase general circulation and promote
the general well-being of the normal child. As the child grows older
and is able to engage in muscular efforts of various sorts, these
"crying exercises" should naturally decrease in frequency and
severity. When baby cries, see that the abdominal band is properly
applied, that rupture need not be feared.
THE BIRTH CRY
The sound most welcomed by both doctor and nurse is the cry of the
newly born child, for it shows that the inactive lungs have opened up
and the baby has begun to use them, for all the time baby was living
in the uterine room he did not breathe once, the lungs having been in
a constant state of collapse; and not until now, the very moment the
air comes in contact with his skin, do the lungs begin to functionate
as he emits his first lusty holler.
ABNORMAL CRYING
The cry is said to be abnormal when it continues too long or occurs
too often. It may be strong and continuous, quieting down when he is
approached or taken up; or it may be a worrying, fretful cry, a low
moan or a feeble whine. And now as we take up the several cries, their
description, cause, and treatment, we desire to say to the young
mother: Do not yourself begin to fret and worry about deciding just
which class your baby's cry belongs to; for help, knowledge, and
wisdom come to every anxious mother who desires to learn and who is
willing to be taught by observation and experience.
THE HUNGER CRY
The continuous, fretful cry, accompanied by vigorous sucking of the
fists, both of which stop when hunger has been satisfied, is without
question the hunger cry.
If this cry is constant with regular feedings, then the quantity of
the food must be increased, or the quality improved. The tired,
fretful hunger cry must not be neglected; the cause must be removed,
for it points to malnutrition.
THE CRY OF THIRST
One day when lecturing at an Iowa chautauqua, I remained in the
beautiful park for the noonday meal. It was a warm day and the tables
in the well-screened dining tent were filled with mothers who, like
myself, preferred the cool shade of the park to the hot ride through
the city to the home or hotel dinner. At my table a baby was pitifully
crying. The mother had offered the little child seated in a small
uncomfortable go-cart, milk, bread, and a piece of cake--all of which
were ruthlessly pushed aside. My little son, then only four and a
half, said "Mamma, maybe the baby's thirsty," and up he jumped,
hurried to the mother's side with his glass of water, saying, "I
haven't touched it, maybe the baby's thirsty." The mother brushed the
boy aside, saying, "No, I never give the baby water." In spite of the
mother's remonstrance, the baby cried on and on, and finally on
"trying" the water, the child drank fully one-half the glass and the
crying was hushed.
Babies should be given water regularly--many times every day--from
birth, in varying amounts from two teaspoons to one-half cup,
according to the age of the child. The water should be boiled for the
first few months, and longer if there is any suspicion of impurities.
Milk to the nursing infant is like beefsteak and potatoes to the
adult; and many times the milk bottle or the breast is just as
nauseating to the thirsty babe, as meat would be to the very thirsty
adult whose hunger has previously been fully satisfied.
THE FRETFUL CRY
The babe who is wet, soiled, too hot, or is wrapped too tightly, or
who has on a tight, uncomfortable belly band, or whose clothing is
full of wrinkles, has only one way to tell us of his discomfort, and
that is to cry. It is a fretful cry and should command an immediate
investigation as to the possible cause. It takes but a moment to
discover a wet diaper; to run the hand up the back under the clothes;
to sprinkle with talcum if perspiring; to straighten out the wrinkled
clothing; to find the unfastened pin that pricks; or to loosen the
tight band. Acquire the art of learning to perform these simple tasks
easily, and any or all of these services should be rendered without
taking the child from its bed.
Let the child early learn to rest happily and quietly in his own bed.
The pillow or mattress may be turned or perhaps the mattress be raised
nearer the edge of the basinet. One poor youngster instantly stopped
his fretful cry when his mattress was raised four or five inches so he
could get the air, at the same time taking him out of his hot room to
a cooler room with raised windows. Babies like cold air. They cry when
the air is hot, or even warm and close. Every day--rain or shine, wind
or sleet--babies should nap out of doors on the porch, in a
well-sheltered corner. A screen or a blanket protects from the wind,
sleet, or rain; and if the baby's finger tips are warm, you can rest
assured the feet and body are warm. Scores of babies will sleep out on
the porch, on the protected fire escape, or in a room with opened
windows, from one bottle or feeding to another; being aroused at the
end of the three or four hour interval just enough to nurse, when
back they go to their delightful, warm nest in the cool, fresh air to
sleep for another period. Babies should never sleep in a room with
closed windows.
One of the incidents that surprised me most in my early work with
dispensary babies was the utter misconception of the purpose of the
belly band. Invariably it was put on so tightly that I could not slip
a finger between it and the babe. It is not a surgical instrument,
neither is it a truss. These tight belly bands are a source of much
fretting and crying.
THE PAIN CRY
The little pinched look about the face, the drawing up of the legs,
the jerking of the head, arms, or legs, associated with a strong,
sharp, unceasing or intermittent cry, demands immediate attention Our
first work should be to go about quietly, painstakingly, and
systematically to locate the cause of this "cry of pain."
There are often some accompanying symptoms to the cry of pain which
demand skilled medical advice and attention, such as the arching of
the body backward, the drawing of the head strongly to one side, the
inability to use one side of the body, or the presence of fever. There
may be an earache, an abdominal complication, or a sore throat, any
one of which will be detected by the skilled doctor.
Earache frequently occurs in young babies who have been taken out of
doors without proper protection to the ears; or, it may be associated
with a cold in the head, which is not detected until the mischief has
already been done, while the resulting running ear tells the tale of
woeful suffering. Earache must always be thought of as a possible
cause when the cry of pain accompanies a cold in the head, and if
medical aid is secured early, the abscess may be aborted and the
deafness of later years entirely avoided. There is only one home
remedy for earache, and that is the application of external heat,
either by a hot-water bottle or hot-salt bag. Medical advice should be
sought before anything whatsoever is dropped into the baby's ear.
In this connection should be mentioned the wild cry at night which so
often accompanies tuberculosis of the bone. A careful X-Ray
examination will reveal the disease, and proper medical measures
should be instituted at once. Other fretful night crying will be
mentioned further on.
HABIT CRYING
By the frequent repetition of actions, habits are formed. When the
baby is two or three days old, he is so new to us and we have waited
for him so long, and it is such a great big world that he has come
into, that we jump, dance, and scramble to attend to his every need
and adequately to provide for his every want. At this very early,
tender age whenever he opens his mouth to cry or even murmur--some
fond auntie or some overly indulgent caretaker flies to his side as if
she had been shot out of a gun, grabs him up and ootsey tootsey's him
about as she endeavors to entertain and quiet him. The next time and
the next time and the succeeding time he whimpers--like a flash
someone dashes to the side of the basket, and baby soon learns that
when he opens his mouth and yells, somebody comes. In less than a week
the mischief has been done and baby is badly spoiled. No other factor
enters so largely into the sure "spoiled" harvest as picking a new
baby up every time he cries. Often in the early days some indulgent
parent will say, "Oh, don't turn out the light, something might happen
to the dear little thing"--and old Mother Nature sees to it that a
constant repetition of "leaving the light on" brings its sure harvest
of "he just won't go to sleep without the light." And then, "just
once" he had the pacifier--perhaps to prevent his crying disturbing
some sick member of the family--and so we go on and on. If a thing is
bad, it is bad, and a supposedly good excuse will not lessen the evil
when the habit has been thus started and acquired.
The rocking of babies to sleep may be a beautiful portrayal of mother
love, but we all pity the child who has to be rocked to sleep as much
as we do the mother who sits and rocks, wanting, Oh, so much! to do
some work or go for a walk--but she must wait till baby goes to
sleep.
THE TEMPER CRY
And so now we come to the temper cry--that lusty, strong outburst of
the cry of disappointment when he finds that all of a sudden people
have stopped jumping and dancing for his every whim. The baby is not
to blame. We began something we could not keep up, and he--the
innocent recipient of all our indulgences--is in no sense at fault. It
is most cruel to encourage these habits of petty indulgence, which
must cause so much future disappointment and suffering on the part of
the little fellow as he begins to grow up.
Nobody is particularly attracted to the spoiled baby. After the
over-indulgent parent and caretaker have completed their thoughtless
work, they themselves are ashamed of it and not infrequently begin to
criticise the product of their own making--the formation of these
unpleasant bad habits. More than anything else, the spoiled child
needs a new environment, new parents, and a new life.
THE SPOILED BABY
Seek to find out if possible--and it usually is possible--just what he
is crying for. It may be for the pacifier, for the light, or to be
rocked, jolted, carried, taken up and rocked at night, or a host of
other trifles; and if he is immediately hushed on getting his soul's
desire--then we know he is "spoiled."
The unfortunate thing about it all is that the one who has indulged
and spoiled the baby usually does not possess the requisite nerve,
grit, and will power to carry out the necessary program for baby's
cure. And the pity of it all is that overindulgence in babyhood so
often means wrecked nerves and shattered happiness in later life. So,
fond, indulgent parents, do your offspring the very great kindness to
fight it out with them while they are young, even if it takes all
summer, and thus spare them neurasthenia, hysteria, and a host of
other evils in later life.
This sort of "spoiled baby crying" can be stopped only through stern
discipline--simply let the baby "cry it out." The first lesson may
require anywhere from thirty minutes to an hour and thirty minutes.
The second lesson requires a much shorter time, and, in normal babies
with a balanced nervous system, a third or fourth lesson is not
usually required.
THE CRY OF SERIOUS ILLNESS
The cry of the severely sick child is the saddest cry of all. The low
wail or moan strikes terror to the saddened mother-heart. It is often
moaned out when the child is ill with "summer complaint" or other
intestinal disturbances. Instant help must be secured, and, if medical
help is not obtainable, remember, with but one or two exceptions, you
are safe in carefully washing out the bowels, in applying external
heat and giving warmed, boiled water to drink.
Another cry which demands immediate attention, and the faithful
carrying out of the doctor's orders, is the hoarse, "throaty" cry
indicative of croup or bronchitis.
THE COLICKY CRY
Perhaps the greatest cause of the most crying during infancy, next to
that of over-indulgence, is ordinary colic which--
... manifests itself in every degree of disturbance from mere
peevishness and fretfulness to severe and intensely painful
attacks in which restlessness passes into grunting, writhing, and
kicking; the forehead becomes puckered and the face has an
agonized expression; the baby tends to scream violently and draws
his thighs up against his belly, which will usually be found to
be hard and more or less distended.
A colicky baby completely upsets the household and greatly disturbs
the mother, who requires both quiet and rest that she may the better
produce the life-sustaining stream so much needed for the upbuilding
and development of the growing child.
COLIC IN THE BREAST-FED
While colic is so often seen in the bottle-fed babe, it often occurs
in the breast-fed child, and is usually traceable to some error in the
mother's diet or to some other maternal nutritional disturbance. One
mother who was sure she had eaten nothing outside the diet suggestions
she had received, was requested to bring to the office a fresh
voiding of her own urine which was found to be highly acid. The
administration of an alkaline such as simple baking soda or calcined
magnesia to the mother, corrected this acidity, and the colic in the
baby entirely disappeared. I recall the case of one mother who ate her
dinner in the middle of the day, with a light meal in the evening and
thereby stopped the colic in her babe.
Another source of colic in the breast-fed baby is the unclean nipple.
The nipples should be washed with soap and water and rinsed in boracic
acid solution before each nursing. If the mother worries greatly, or
thoughtlessly "gets very angry" just before the nursing hour, there is
a substance known as "epinephrin" secreted by the glands located just
above the kidneys which is thrown into the blood stream and which
raises the blood pressure of the mother and often produces not only
colic in the babe, but many times throws him into severe convulsions.
COLIC IN BOTTLE-FED BABIES
There are many opportunities for colic in the bottle-fed baby; for
instance, dirty bottles, dirty nipples, careless cleansing of utensils
used in the preparation of baby's food, improper mixtures, too much
flour, the wrong kind of sugar, too much cream or too little
water--all these things help to produce wind under pressure in the
intestine, which is commonly known as colic. Underfeeding or
overfeeding, too rapid feeding or too frequent feeding also contribute
their mite in producing colic.
As a rule, the bottle-fed child is fed too often. In the new born, the
interval between feeds should be three hours from the start; after six
months the interval may be lengthened to four hours.
COLIC AND CHILLINESS
Hiccough--a spasm of the diaphragm--often accompanies colic, and, in
the case of infants, is usually due to the swallowing of air or
over-filling the stomach; gentle massage, external heat, and a few
sips of very warm water usually corrects the condition.
The chilling of the skin very often produces a temporary intestinal
congestion with colic as the result. Cold feet, wet diapers, and
loitering at bath are all very likely to produce colic; and when it is
thus caused by chilling, quickly prepare a bath at 100 F., and after
immersing the child for five minutes, wrap up well in warm blankets.
THE TREATMENT OF COLIC
Those of my mother readers who have electric lights in their home,
will find the photophore to be a source of great comfort and
convenience; for this simple contrivance is usually able to banish
colic in a few moments. The photophore is simply radiant heat--heat
plus light (See Fig. 3)--and as this heat is applied to legs and
buttocks of the crying child the diaper is warmed, the abdomen
relaxes, gas is expelled, intestinal contractions relieved, and the
baby is soon fast asleep.
Occasionally with the aid of the photophore, and even without it, the
warm two-ounce enema containing a level teaspoon of baking soda and a
level teaspoon of salt to a pint of water when allowed to flow into
the bowel, will soon bring down both gas and feces to the great relief
of the baby. Warm water to drink is also very helpful. Putting the
feet in very warm water is also quieting to the crying colicky babe.
It is often necessary in cases of repeated and persistent colic, to
give a full dose of castor oil to clear out the bowel tract. Do not
jolt or bounce the baby, do not carry him about, and don't walk the
floor with him.
Heat him up inside and outside, warm his clothing and his bedding, and
thus bring about relief without sowing seeds for future trouble--the
sorrow of a spoiled child.
One very quiet little baby was one day brought to the dispensary whose
mother said: "Doctor, I didn't bring him 'cause he's sick, but 'cause
he looks so pale; he's as quiet as a mouse; he never cries any more
since I got to giving him medicine." On examination of the baby and on
inquiring about the medicine, we found that the baby was dead drunk
all the time. Some "neighbor friend" had told the tired out mother,
"Give him a teaspoon of whiskey at each feeding and that'll fix him
all right." If a few more states go dry maybe it will not be so easy
for the ignorant mother to dope and drug her helpless baby.
And neither is paregoric to be administered wholesale for colic. It
contains an opiate, and should not be given without definite orders
from a physician. And so as a parting word on "Why Babies Cry," we ask
each mother to run over the following summary of the chapter, and thus
seek to find out why her baby cries.
BABY CRIES BECAUSE:
He is hungry.
He is thirsty.
He has been given a dirty bottle.
His mother has failed properly to cleanse the nipples.
His food is not prepared right.
His food is too cold.
His bowels are constipated.
His band is too tight.
His clothes are wrinkled.
His diaper is wet.
He is too hot.
He wants fresh air.
He is too cold.
He is in pain.
He is very sick.
His throat is sore.
His ear aches.
He has been rocked, carried, or bounced.
He has been given a pacifier.
He has had too much excitement.
His mother has eaten the wrong food.
CHAPTER XV
THE NURSING MOTHER AND HER BABE
Happy is the mother, and thrice blessed is the babe when he is able to
enjoy the supreme benefits of maternal nursing. The benefits to the
child are far reaching; he stands a better chance of escaping many
infantile diseases; the whole outlook for health--and even life
itself--is greatly improved in the case of the nursing babe, as
compared with the prospect of the bottle-fed child. Maternal nursing
lays the foundation for sturdy manhood and womanhood.
Out of every one hundred bottle-fed babies, an average of thirty die
during the first year, while of the breast-fed babies, only about
seven out of every one hundred die the first year. At the same time,
nursing the babe delivers the mother from all the work and anxiety
connected with the preparation of the artificial food, the dangers and
risks of unclean milk, and the ever-present fear of disease attendant
upon this unnatural feeding. The mother who nurses her child can look
forward to a year of joy and happiness; whereas, if the babe is
weaned, she is compelled to view this first year with many fears and
forebodings. Mother's milk contains every element necessary for the
growth and development of the child, and contains them in just the
proportions required to adapt it as the ideal food for that particular
child.
A dirty baby, properly fed, will thrive. A baby deprived of fresh
air, but wisely fed, will survive and even develop into a strong
healthy man or woman. But the baby raised according to the latest
and most approved rules of sanitation and hygiene, if improperly
fed, will languish and die.
HYGIENE OF NURSING MOTHERS
_Outings and Exercise._ It is most highly important that the nursing
mother should be able thoroughly to digest her food; otherwise the
flow of milk is likely to contain irritants that will disturb the
baby's digestion, even to the point of making him really sick. In
order to avoid these complications, exercise and outings are
absolutely essential for the mother. A vigorous walk, gardening, light
housework or other light athletics, greatly facilitate digestion and
increase the bodily circulation, as well as promote deep breathing,
all of which are of paramount importance to a good appetite and good
digestion.
_The Bowels._ The bowels should move regularly and normally once or
twice during the twenty-four hours. Unfortunately, this is not usually
the case: and in this connection we would refer our reader to the
chapter on "The Hygiene of Pregnancy," particularly those sections
relative to the care of the bowels, recipes for bran bread, lists of
laxative foods and other suggestions pertaining to the hygiene of the
nursing mother.
_Sleep._ Nothing less than eight hours sleep will suffice for the
nursing mother, and during the day she should take at least one nap
with the baby.
_Care of the Skin._ Salt-rub baths are very beneficial taken once a
week. The daily cold-friction rub described elsewhere, will tone up
the system and increase digestion and improve the general well being.
The soap wash may be taken once a week. The thorough cleansing of the
breasts, and the frequent changing of the undergarments, will help to
keep the baby happy; for oftentimes it is the odor of perspiration as
well as the smell of soiled clothing that spoils the appetite of the
baby, causing it to refuse food.
_Recreation._ Pleasant diversion is very essential for the mother, and
should be indulged in at least once a week. The bedtime hours,
however, should not be interfered with and the recreation should be
selected with a view to amuse, refresh and create a harmless diversion
for the mother's mind. Under no circumstances should the mother settle
down to the thought: "No, I can't go out any more. I can't leave my
baby." You should get away from the baby a short time each day, and
go out among your former friends and acquaintances. Many a wrecked
home--a shattered domestic heaven--dates its beginnings back to the
days when the over-anxious young mother turned her back on her husband
and looked only into the face of her (their) child. Nothing should
come in between the filial friendship of husband and wife, not even
their child. So, dear mother, if you can, go out occasionally, away
from the baby, and enjoy the association of your husband and keep in
touch not only with his interests, but with the outside world. You
will come back refreshed and wonderfully repaid, and the face of the
adored infant will appear more beautiful than ever.
DIET OF THE NURSING MOTHER
The general suggestions on diet which we made to the expectant mother
are also valuable for the nursing mother. The food should be
appetizing, nutritious, and of a laxative nature. Three meals should
be eaten: one at seven A. M., one at one P. M. and one about
six-thirty at night, with the heaviest meal usually at one P. M. As
the mother usually wakens at five o'clock, or possibly earlier, she
should be given a glass of milk, cocoa, or eggnog. If she awakens at
six, nothing should be taken until the breakfast, which should consist
of a good nourishing meal, such as baked potatoes with white sauce,
poached eggs, cereal, milk or cocoa, prunes, figs, or a baked sweet
apple, with bread and butter, etc.
From that hour until one P. M. only water is taken, and several
glasses are urged during this interval. With nothing between meals but
water and a little outdoor exercise, a good appetite is created for
the one P. M. meal which should abundantly supply and satisfy the
hungry mother; and then again, nothing is to be taken between dinner
and supper but water. And after the supper hour, a walk out into the
cool night air should be enjoyed with the husband and on going to bed
about ten P. M., an eggnog or glass of milk may be taken. At the close
of the other meals a cup of oatmeal gruel or milk or any other
nourishing liquid may be enjoyed.
The eating of food or the drinking of nourishing drinks between the
meals not only interferes with digestion and disturbs the mother, but
it also upsets the baby; and it is often the reason why the appetite
of the mother is so deranged at the meal time, her spirits depressed,
and her milk diminished. Plenty of good nourishing food, taken three
times a day with an abundance of water drinking between the meals,
together with a free happy frame of mind occasioned by the recreation
before mentioned, usually produces good milk and plenty of it. A nap
between meals will probably produce more milk than eating between
meals.
OBJECTIONABLE FOODS
All foods that cause indigestion in the mother or babe should be
avoided.
Some mothers continue to eat tomatoes, peaches, sour salads, acid
fruits, and it appears in no way to interfere with baby's comfort; but
they are the exception rather than the rule. Usually tomatoes, acid
salad dressings, and mixed desserts must be avoided. Each mother is a
law unto herself. Certainly none of our readers will selfishly
continue any food she feels will make her baby cry. All acid fruits,
rich desserts, certain coarse vegetables, concoctions of all
descriptions such as rarebit, condiments, highly seasoned sauce, etc.,
should be avoided.
Acid fruitades, such as lemonade, limeade and orangeade, can be taken
by a small per cent of nursing mothers; and, since fruit acids are
neutralized and alkalized in the process of digestion and
assimilation, and since they are the very fruit-drinks we prescribe
for patients suffering with an increased acidity, it would appear that
they were in every way wholesome for the mother--if they in no way
interfere with the baby. Practically, they do as a rule disturb the
baby's digestion and should be avoided by those mothers who have found
this to be the case.
CAKED BREASTS
During the first week of lactation the milk tubes of the breasts very
often become blocked and the breasts become engored with milk, this
condition being known as "caked breasts." At this particular time of
the baby's life, he takes little more than an ounce of milk at a feed;
so, beside the incoming engorgement of milk, an additional burden is
thrown upon the milk tubes of the breasts in that they are not
entirely emptied each nursing time by the young infant. When the
breasts threaten to "cake," immediate steps must be taken to relieve
the condition--to empty the breasts--and this is usually accomplished
in the following manner: with hands well lubricated with sweet oil or
olive oil the nurse begins gentle manipulation of the breasts toward
the nipple in circular strokes, with the result that the milk soon
begins to ooze out. This massage should be continued until relief is
obtained; or the breast pump may be applied. Hard nodules should not
be allowed to form or to remain in the breasts. Hot compresses (wrung
from boiling water by means of a "potato ricer") may be applied to the
caked breast which is protected from the immediate heat by one
thickness of a dry blanket flannel. These hot compresses should be
removed every three minutes until three have been applied, then an ice
water compress is quickly applied, to be followed by more hot ones and
then a cold; and so on, until as many as four sets each have been
administered.
Gentle massage may again be administered and it will be found that
they empty now with greater ease because of the preceding heat. After
the breasts have been emptied, and thoroughly washed with soap suds
and carefully dried, they should be thickly covered with cotton
batting and firmly compressed against the chest wall by a snug-fitted
breast binder, which serves the double purpose of relieving pain by
not allowing the breasts to sag downward, at the same time preventing
an over-abundant secretion of milk by diminishing the blood supply to
the glands of the breast. In case the persistent manipulation of the
breast and the use of the breast pump do not relieve the condition,
and if the repeated effort day after day seems to avail nothing; then,
as a rule, we must look for a breast abscess to follow if the breasts
are not immediately "dried up." In all such cases of engorgement, the
attending physician should be notified at once.
SORE NIPPLES
The nipple must be kept _dry_ between nursings, which should be
limited to twenty minutes. Regularity should be maintained. The
nipples should never be touched or handled by hands that have not been
scrubbed with soap and a nail brush. During the early nursing days
they are wet much of the time and are subject to much stress and
strain in the "pulling effort" of the baby, as a result of which they
become very tender, chapped, cracked, and often bleed. Allowing the
baby to go to sleep with the nipple in his mouth also exposes the
nipple to unnecessary moisture which increases the possibility of
painful cracking. The pain occasioned by nursing at this time is truly
indescribable, and is most often the cause of absolute refusal on the
part of the mother to nurse her babe--with the result that it is put
on the bottle. Again, the fear and dread of being hurt so often tends
to diminish the flow of milk. It is entirely possible so to prepare
the nipple for this exposure, during the last months of pregnancy,
that all this discomfort and pain may be entirely avoided (See
chapter, "The Hygiene of Pregnancy").
Before the mother is put to rest after the birth of the baby the
breasts are prepared as follows: A thorough cleansing with soap and
water is followed by a careful disinfection with alcohol which leaves
the nipple perfectly dry. A soft sterile pad is then applied and held
in place by a breast binder. Before and after each nursing the nipple
and surrounding area is swabbed with boracic acid (saturated solution)
and carefully dried by applying a clean, dry, sterile pad.
Painful cracks and fissures are nearly always due to lack of the care
described above, and are almost wholly preventable. When the first
crack appears and nursing becomes painful, the baby's mouth should not
touch the nipple again until healing has taken place. A thorough
cleansing with boiled water should be made and then the sterile nipple
shield should be applied through which baby will get abundant
satisfaction, while the mother is spared the pain, and the nipple has
an opportunity to get well.
In the case of sore and cracked nipples, thorough cleansing with
boiled water and boracic acid solution follows each nursing seance;
and, after careful drying, balsam peru--equal parts with
glycerine--may be applied with a tiny piece of sterile gauze or
cotton; a sterile cotton pad is then applied to each breast which is
held in place by a breast binder.
The nipple shield, when employed, is boiled after each nursing and
washed in boracic acid solution just before each nursing. The
strictest cleanliness must be observed, and then we hope to bring
relief and comfort to the mother, and effect the saving of nature's
best food for the baby.
CONSTITUENTS OF MOTHER'S MILK
Mother's milk--that wonderfully adaptable, ever-changing food, so
accurately and scientifically suited to the hourly and daily needs of
the growing child--is composed of five different parts, totally unlike
in every particular, and each part exactly suited to the needs which
it supplies. The cream of the milk, as well as the lactose or sugar,
builds up the fatty tissues of the body as well as helps provide the
energy for crying, nursing, kicking, etc. The proteins (the curd of
the milk) are exceedingly important; they are especially devoted to
building up the cells and tissues of the body of the growing child.
The salts form a very small part of the baby's food, but an important
one, for they are needed chiefly for the bones and the blood. The
fats, sugars, proteins, and salts, taken together, form the solids of
mother's milk, and are held in solution in the proportion of thirteen
parts of solids to eighty-seven parts of water; which so holds these
solids in solution that the baby can digest and assimilate these
necessary food elements. The mother's milk increases in strength day
by day and month by month as the baby grows, and is the only perfect
infant food on earth.
THE TIME OF THE FIRST FEEDING
Soon after the birth of the baby the wearied mother seeks rest--she
usually falls into a quiet, restful slumber; the baby likewise goes to
sleep and usually does not awaken for several hours. After six or
eight hours the child is put to the breast and he begins to nurse at
once, without any special help. This first nursing should be
discontinued after four or five minutes, while he is put to the other
breast for the same length of time.
If there is difficulty in sucking, a bit of milk may be made to ooze
out on the clean nipple, while the baby's lips are pressed to it,
after which the nurse gently presses and rubs the breasts toward the
nipple. After the nursing, the nipples should be elongated, if
necessary, by rubbing, shaping, or breast pump.
The baby gets but little nourishment during the first two days, but
that which he does get is essential; for the colostrum--the first
milk--is highly laxative in nature and serves the important purpose of
cleaning out the intestinal tract of that first tarry, fecal residue,
the meconium. This early sucking of the child accomplishes another
purpose besides the obtaining of this important laxative--it also
reflexly increases the contractibility of the muscles of the womb,
which is an exceedingly important service just at this time.
Should the mother or caretaker feel that baby will starve before the
milk comes, or that it is necessary to provide "sweetened water;" let
us assure them that nothing is needed except what nature provides.
Nature makes the babe intensely hungry during these first two days, so
that he will suck well, and if he is fed sweetened water, gruel, or
anything else, he will not suck forcefully; and so nature's plan for
securing extra or increased uterine contractions and the stimulation
of the breast glands will be seriously interfered with.
WATER DRINKING
As soon as the new born babe is washed and dressed he is given two
teaspoons of warmed, boiled water; and this practice is continued
every two hours during the day, until as much as two to four ounces of
unsweetened water is taken by the tiny babe during the twenty-four
hours. Inanition fever--the fever that sometimes follows a failure to
give water to the new born infant--is thus avoided. The bottle from
which the water is given should be scalded out each time, the nipple
boiled, and just before the "water nursing" the nipple should be
swabbed with boracic acid solution.
REGULARITY IN FEEDING
From earliest infancy the baby should be nursed by the "clock," and
not by the "squawk." Until he reaches his sixth-month birthday, he is
fed with unerring regularity every three hours during the day. Asleep
or awake he is put to the breast, while during the night he is allowed
to sleep as long over the three-hour period as he will. Babies are
usually nursed at night: during the early weeks, at nine o'clock in
the evening, at midnight, and at six o'clock in the morning. After
four months all nursing after ten P. M. may be omitted.
The baby is ordinarily allowed to remain at the breast for about
twenty minutes. He may often be satisfied with one breast if the milk
is plentiful; if not, he is given both breasts; and may we add the
following injunction? insist that nothing shall go into your baby's
mouth but your own breast milk and warm or cool-boiled water; no
sugar, whiskey, paregoric, or soothing syrup should be given, no
matter how he cries. Never give a baby food merely to pacify him or to
stop his crying; it will damage him in the end. More than likely he is
thirsty, and milk to him is what bread and meat are to you, neither of
which you want when you are thirsty.
POSITION OF MOTHER DURING THE NURSING
A perfectly comfortable position during nursing for both mother and
babe is necessary for satisfactory results. During the lying-in period
the mother should rest well over on her side with her arm up and her
hand under her head, the other hand supports the breast and assists in
keeping the nipple in the baby's mouth, as well as preventing the
breast from in any way interfering with baby's breathing. A rolled
pillow is placed at the mother's back for support.
After the mother leaves the bed, she will find a low chair most
convenient when nursing the baby, and if an ordinary chair be used,
she will find that a footstool adds greatly to her comfort. Once
during the forenoon and once during the afternoon the nursing mother
will find it a wonderful source of rest and relaxation if she removes
all tight clothing, dons a comfortable wrapper, and lies down on the
bed to nurse her babe; and as the babe naps after the feed, she
likewise should doze and allow mother nature to restore, refresh, and
fit her for restful and happy motherhood.
Worry, grief, fatigue, household cares, loss of sleep, social
debauches, emotional sprawls--all debilitate the mother, and usually
decrease the flow of milk.
NURSING WHEN ANGRY AND OVERHEATED
Overheating, irritability, and sudden anger, almost invariably tend to
raise the blood-pressure, which means the entry into the blood stream
of an increased amount of epinephrin, which disturbs the baby greatly,
often throwing him into convulsions or other sudden, acute illness.
Menstruation often interferes with the nursing mother, the milk
becoming weaker at this time; however, if the infant continues to gain
and the mother feels comparatively well, no attention need be paid to
this fact.
Another pregnancy demands a drying up of the breast at once, as the
tax is too great on the mother.
THE STOOLS
The stools of the breast-fed baby do not require as much attention as
those of the bottle-fed child. In cases of constipation, after four
months, from one teaspoon up to one-half cup of unsweetened prune
juice may be given one hour before the afternoon feed.
In instances of colic with signs of fermentation in the stool, the
mother may take several doses (under her physician's orders) of common
baking soda; or, if she is constipated, calcined magnesia will usually
right the condition. Nature's mother milk is so beautifully adapted to
the baby's needs that it is the rule for baby to have perfectly normal
stools.
SYMPTOMS OF SUCCESSFUL NURSING
A happy baby is a satisfied baby. He lies quietly in a sleepy, relaxed
condition if he has enough to eat, provided he is otherwise
comfortable and dry. He awakens at the end of two hours and perhaps
cries; but plain, unsweetened, warm, boiled water quenches his
thirst, and he lies content for another hour, when he is regularly
nursed. He gains on an average of about one ounce a day.
EARMARKS OF UNSUCCESSFUL NURSING
Constant discomfort, vomiting, fretful crying, passing and belching of
gas, colicky pain, disturbed sleep, greenish stools with mucus, are
among the more prominent earmarks of unsuccessful nursing. These
symptoms appearing in a pale, flabby, listless, indifferent or cross
baby, with steady loss of weight continued over a period of three or
four weeks, point to "nursing trouble;" which, if not corrected, will
lead to that much dreaded infantile condition--malnutrition.
Bolting of food or overeating results in vomiting and gas, and thus
interferes with normal nursing, as also may tongue-tie. A condition in
the mouth, medically known as "stomatitis," and commonly known as
"thrush," often gives rise to a fretful cry when nursing is attempted.
In the first place, the baby cannot "hold on" to the nipple; while, in
the second place, it hurts his inflamed mouth when he makes an effort
to nurse.
Long continued nursing covering three-fourths of an hour or more,
seizing of the nipple for a moment and then discarding it, apparently
in utter disgust, are the earmarks of very scanty milk supply and
should receive immediate attention.
AIDS TO THE MILK SUPPLY
Believing that many more mothers than do so should nurse their babies,
we have carefully tabulated a number of aids to the milk supply, which
we hope will be most earnestly tried before the baby is taken from the
breast--for so many, many more bottle-fed babies die during the first
year than the breast fed. The dangers of infection, the worry of the
food preparation, the uncertainty of results, all call for a most
untiring effort on the part of every doctor, nurse, and mother, in
their endeavors to secure maternal nursing. The following is a summary
of "aids to the milk supply:"
1. Regular periodical sucking of the breasts from the day of baby's
birth.
2. Systematic applications of alternate hot and cold compresses,
followed by massage to the breasts.
3. Three good nourishing meals each day, eaten with merriment and
gladness of heart.
4. A glass of "cream gruel," milk, cocoa, or eggnog at the close of
each meal, with a glass just before retiring.
5. Three outings each day in the open air.
6. Nurse the baby regularly and then turn its care over to another,
you seek the out of doors and engage in walking, rowing, riding and
other pleasurable exercise.
7. Take a daily nap.
8. You can bank on fretting and stewing over the hot cook stove to
decrease your milk. It seldom fails to spoil it.
9. Regular body bathing, with cold friction rubs to the skin.
10. A happy, carefree mental state. Nothing dries up milk so rapidly
as worry, grief, or nagging.
11. The administration, preferably in the early days, of desiccated
bovine placenta; although it may be given at any time during the
period of nursing.
WHEN THE BABY SHOULD NOT BE NURSED
As much as we desire maternal nursing for the babe, there do occur
instances and conditions which demand a change to artificial feeding,
such as the following:
1. A new pregnancy.
2. Mothers with uncontrollable tempers.
3. Cases of breast abscess.
4. Prolonged illness of the mother with high fever.
5. Wasting diseases such as tuberculosis, Bright's disease, heart
disease, etc.
6. Maternal syphilis.
7. When maternal milk utterly fails, or is wholly inadequate.
When a maternal anesthetic is to be administered, or in case of
inflammation of the breast or during a very short illness not covering
more than two or three days, then the breast pump may be used
regularly every three hours to both breasts; the baby may be
artificially fed and then returned to the breast after the effects of
the anesthetic has worn off or the temperature has been normal for
twenty-four hours.
There may also appear definite indications in certain children which
make it imperative that the nursing child should early be weaned.
These manifestations of disordered nutrition and failing health
admonish us to put the baby on properly modified milk, or to transfer
it to a wet nurse.
These conditions are:
1. Progressive loss in weight.
2. A bad diarrhea of long standing; one which does not yield to the
usual remedies, at least not as long as the baby continues to feed
from the breast. These diarrheas are especially serious when
accompanied by a steady loss in weight.
3. Excessive vomiting accompanied by progressive loss in weight.
THE WET NURSE
Because of the rarity of good, healthy wet nurses, it is always better
to attempt to feed the baby with scientifically modified milk (not
proprietary foods), good, clean, cow's milk properly modified to suit
the weight and age of the child. We put weight first, for we prepare
food for so many pounds of baby rather than for the number of months
old he is.
If modified food has failed and the best specialist within your reach
orders a wet nurse; she must have the following qualifications:
1. She must be free from tuberculosis and syphilis.
2. She should be between twenty and thirty years of age.
3. She should abstain from all stimulants.
4. She should be amiable, temperate, and should sense her
responsibility.
If an unmarried mother of her first child is engaged as a wet nurse,
she should not be "stuffed" or allowed to overeat, which is commonly
the result of moving her from her lower life into more comfortable
surroundings, or given ale or beer to increase her milk. She should
continue her normal eating, take light exercise, which does not mean
the scrubbing of floors or doing the family washing, and live under
the same hygienic regime outlined for the nursing mother. Should she
be the mother of the second or third illegitimate child, then she is
quite likely to be mentally deficient and she should not be engaged.
Her own babe will have to be fed artificially as very few mothers can
endure the strain of two suckling children.
The baby's own mother should keep general supervision and not turn her
babe entirely over to the care of the wet nurse. Remember always that
no one in the wide world will ever take the same mother interest in
your offspring that can spring from your own mother heart.
CHAPTER XVI
THE BOTTLE-FED BABY
In taking up the subject of the bottle-fed baby, we must repeat that
the only perfect baby food on earth is the milk that comes from the
breast of a healthy mother.
But sudden illness, accident, chronic maladies, or possibly the death
of the mother, often throw the helpless babes out into a world of many
sorts and kinds of artificial foods--foods that are prepared by
modifying cow's, ass', or goat's milk; foods arranged by the addition
to the milk of various specially prepared cereals, albumens or malted
preparations, otherwise known as "proprietary foods." We shall
endeavor, then, in this chapter and in that on "the feeding problem,"
to lay down certain general suggestions to both the nurse and the
mother, which may assist them in their effort to select the food which
will more nearly simulate nature's wondrous mother-food, and which
will, at the same time, be best suited to some one particular baby.
THE HOURLY SCHEDULE
The normal baby, from birth to six months, should receive properly
prepared nourishment every three hours, beginning the day usually at
six A. M., the last feeding being at nine P. M. During the early weeks
an additional bottle is given at midnight, but this is usually
discarded at four months, at which time the last feeding should be
given at about ten instead of at nine at night.
Should the baby continue to awaken during the night before six in the
morning, unless he is under weight, a bottle of warm, boiled,
unsweetened water should be given.
QUANTITY OF FOOD
The quantity of food to be given is always determined by the size of
the baby's stomach, which, of course, depends somewhat upon the age of
the child; for instance, the stomach of the average baby one week old
holds about one ounce, while at the age of three months the stomach
holds five ounces; so it would not only be folly to give two ounces at
one week and seven ounces at three months, but it would also be very
detrimental to the babe, causing severe symptoms due to the
overloading of the stomach.
Careful study of the size of the stomach at different ages in infancy,
together with the quantity of milk drawn from the breast by a nursing
baby, has led to the following conclusions regarding the capacity of
the baby's stomach:
AGE QUANTITY
1--4 weeks 1--2 ounces
4 weeks--3 months 2½--4 ounces
3 months--6 months 4--6 ounces
6 months--1 year 6--8 ounces
REFRIGERATOR NECESSITY
It is highly important that the day's feedings be kept in a cold
place, free from the odors of other foods as well as free from dust,
flies, and filth. In order that this may be accomplished, the
well-protected bottles, each containing its baby-meal, are placed in a
covered pail containing ice and water. This covered receptacle is now
put in an ice box; and, in order that our most economical reader--one
who may feel that she cannot afford to keep up the daily expense of
the family refrigerator--may herself prepare a simple home
refrigerator, the following directions are given (Fig. 9).
HOMEMADE ICE BOX
Procure a wooden box about eighteen inches square and sixteen or
eighteen inches deep and put four inches of sawdust into the bottom;
now fill in the space between a ten-quart pail, which is set in the
middle of the box with more sawdust. A cover for the box is now lined
with two or three inches of newspaper, well tacked on, and is
fastened to the box by hinges. We are now ready for the inside pail of
ice, into which is carefully placed the well-protected bottles of
milk, all of which is then set into the ten-quart pail in the box.
Five cents worth of ice each day will keep baby's food cool, clean,
and provide protection against the undue growth of germs.
[Illustration: Fig. 9. Homemade Ice Box]
PREPARING THE BOTTLE
At each feeding hour, one of baby's bottled meals is taken from the
ice box and carefully dipped in and out of a deep cup of hot water. A
very convenient receptacle is a deep, quart aluminum cup, which may be
readily carried about. The hot water in the cup should amply cover the
milk in the bottle (Fig. 10).
To test the warmth allow a few drops to fall on the inner side of the
arm, where it should feel quite warm, never hot. A baby's clean woolen
stocking is now drawn over the bottle, which keeps it warm during the
feeding. No matter how great the danger of offending a fond
grandparent or a much adored friend never allow anyone to put the
nipple in her mouth to make the test for warmth of baby's food.
There are many contrivances, both electrical and alcoholic, for
heating baby's bottle, many of which are both convenient and
inexpensive.
POSITION DURING FEEDING
And now we realize that we are about to advise against the
time-honored injunction which has been handed down from "Grandma This"
and "Mother That" to all young mothers who have lived in their
neighborhoods: "My dear young mother, if you can't nurse your precious
infant, you can at least 'mother it' at the nursing time by holding it
in your arms and gently rocking it to and fro as you hold the bottle
to its lips." This so-called "mothering" has resulted in
regurgitation, belching, and numerous other troubles, as well as the
formation of the "rocking habit."
A young mother came running into my office one day saying: "Doctor, it
won't work, the food's all wrong; my baby is not going to live, for
he throws up his food nearly all the time." We arranged to be present
when the next feeding time came and watched the proceedings. A dear
old friend had told her "she must 'mother' her baby at the nursing
time," and so she had held the child in a semi-upright position as she
endeavored to hold the bottle as near her own breast as was possible.
The hole in the nipple was a bit large, which occasioned the
subsequent bolting of the food, and then to continue the "mothering"
she swayed him to and fro, all of which was interrupted suddenly by
the vomiting of a deluge of milk.
[Illustration: Fig. 10. Heating the Bottle]
I drew the shade in an adjoining room, opened the windows, and into a
comfortable carriage-bed I placed the baby on his side. Seating myself
beside him I held the warm, bottled meal as he nursed. Several times I
took it from his mouth, or so tipped it that "bolting" was impossible.
Gradually, carefully, and slowly, I took the empty bottle away from
the sleepy babe, and as I closed the door the mother said in anxious
amazement: "He won't forget I'm his mother if I don't hold him while
he nurses?" You smile as I smiled at this girl-mother's thought; but,
nevertheless there are many like her--anxious, well-meaning, but
ignorant.
The infant stomach is little more than a tube, easily emptied if the
baby's position is not carefully guarded after nursing. No bouncing,
jolting, patting, rocking, or throwing should take place either just
before, during, or immediately after meals.
TIME ALLOWANCE FOR ONE FEEDING
From twelve to twenty minutes is long enough time to spend at a bottle
meal. The nipple hole may have to be made larger, or a new nipple with
a smaller hole may have to be purchased. When new, you should be able
to just see a glimmer of light through the hole, and if the infant is
too weak to nurse hard, or the hole too small, it may be made larger
by a heated hatpin run from the inside of the nipple out; great care
must be taken, else you will do it too well. If the nipple hole is too
large, bolting is the sure result; while too small a hole results in
crying and anger on the part of the hungry child, because he has to
work too hard to get his meal.
AFTER THE FEED
We have seen some mothers, in their anxiety to prevent the sucking in
of air from the emptied bottle, rush in and jerk the nipple from the
going-to-sleep babe so forcibly that all thoughts of sleep vanished
and a crying spell was initiated. The tactful mother is the quiet one
who slowly, quietly, draws the empty bottle with its "much loved
nipple" from the lips. If you observe that the babe is going to sleep,
with an occasional superficial draw at the nipple, wait a moment; he
will drop it himself, and you can pick it up as you quietly leave the
room. In all instances, whether it be indoors or out of doors, arrange
the babe in a comfortable sleeping position, remembering that nursing
is warm exercise and the babe gets uncomfortably sweaty if
overbundled, especially about the head and neck. No one should
unnecessarily touch the babe immediately after feeding; even his
diaper may be changed without awakening him while he is thus lying
quietly in his bed.
INTERVALS BETWEEN MEALS
The three-hour interval is reckoned from the beginning of the meal,
and not from its close. More than two hours is spent in the stomach
digestion, and any food or sweetened water which may enter between
meals only tends to cause indigestion and other disturbances. And that
this important organ may have a bit of rest, we fix the interval at
three hours, which in our experience and that of many other
physicians, has yielded good results. As a rule we have no
regurgitation and no sour babies on the three-hour schedule. Sick
babies, very weak babies, and their feeding time, will be discussed in
a later chapter.
ADDITIONAL FOODS
At six months, and often as early as four, in cases of constipation,
unsweetened, well-strained prune juice may be given, beginning with
one-half teaspoon one hour before the afternoon feed and increasing it
daily until two tablespoons are taken. At six months, both orange
juice and vegetable broths are given, whose vegetable salts add a very
important food element to the baby's diet--an element which our
grandmothers thought could only be obtained through the time-honored
"bacon rind" of by-gone days.
Orange juice is also unsweetened and well strained, and is
administered in increasing amounts, beginning with one-half teaspoon
one hour before the afternoon feeding, until the juice of a whole
orange is greedily enjoyed by the time of the first birthday. The
vegetable juices are obtained from cut-up spinach, carrots, tomatoes,
and potatoes, strained, with a flavor of salt and onion--really a
bouillon--and is given just before the bottle at the six P. M.
feeding. They are also begun in teaspoon amounts.
FOOD FOR THE TRAVELING BABE
Baby travel should be reduced to a sheer necessity; never should the
babe be subjected to the exposure of disease germs, the change of
food, the possibilities of draughts and chilling, for merely a
pleasure trip--the risks are too great and the possibilities of future
trouble too far reaching.
If you are in touch with the milk laboratory of a large city, you will
find that they make a specialty of preparing feedings which are good
for a number of days for the traveling baby, and we strongly advise
that their preparations be accepted; but in the event of not being in
touch with such a laboratory we suggest the making of a carrying
ice-box covered with wicker, which must be kept replenished with ice.
Food kept in such a device may be kept fresh for twenty-four to
forty-eight hours. Plans other than the laboratory preparations or the
ice-box are risky, and should not be depended upon.
Many of our railway dining cars now pick up fresh, certified milk at
stations along the line for use on their tables, and where such is the
case fresh preparations of milk may be made on a trans-continental
trip by the aid of an alcohol stove. Malted milk may also be used,
provided you have accustomed the baby to its use a week before leaving
home, by the gradual substitution of a fourth to a half ounce each day
in the daily food; all of which, of course, should be done under your
physician's direction.
If possible, leave baby at home in his familiar, comfortable
environment in the care of a trained nurse and a trusted relative, and
under the supervision of the baby's own physician. He is much better
off, much more contented, and we are all aware of the fact that
contentment and familiarity of sights and people promote good
appetite, good digestion, and happiness--the very essentials of
success in baby feeding. We speak touchingly and sympathetically to
the mother who must leave her babe; and likewise we wish to cheer her
as we remind her that by wireless messages and night letters it is
possible to keep in touch with loved ones though a thousand miles
away.
The sanitation and modification of cow's milk, as well as stools,
etc., are taken up in later chapters.
RULES FOR THE BOTTLE-FED
1. Never play with a baby during or right after a meal.
2. Lay the baby on his side when nursing the bottle.
3. Three full hours should intervene between feedings.
4. Don't give the food too hot--it should just be warm.
5. Make the test for warmth on the inner side of your arm.
6. Give a drink of water between each meal if awake.
7. Never save the left-overs for baby.
8. If possible, give three feedings each day in the cool air, with
baby comfortably warm.
9. Do not jump, bounce, pat, or rock baby during or after meals.
10. Never coax baby to take more than he wants, or needs.
11. No solid foods are given the first year.
12. Orange juice may be given at six months; while, after four months,
unsweetened prune juice is better than medicine for the bowels.
CHAPTER XVII
MILK SANITATION
Cow's milk, like mother's milk, is made up of solids and water. In a
previous chapter we learned that in one-hundred parts of mother's
milk, eighty-seven parts were water and thirteen parts were solid.
These thirteen parts of solids consist of sugar, proteins, and salts;
this is likewise the case with cow's milk, except that in the case of
the cow's milk, the sugar is decreased while the proteins are
increased as will be noted by the accompanying comparative analysis:
MOTHER'S MILK
Fat % 4.00
Sugar 7.00
Proteins 1.50
Salts 0.20
Water 87.30
------
% 100.00
COW'S MILK
Fat % 4.00
Sugar 4.50
Proteins 3.50
Salts 0.75
Water 87.25
-----
% 100.00
Mother's milk is absolutely sterile, that is, free from the presence
of germs; on the other hand, cow's milk is anything but sterile--the
moment it leaves the udder it begins to accumulate numerous bacteria,
all of which multiply very rapidly. Cow's milk is generally
twenty-four to forty-eight hours old before it can possibly reach the
baby. It is just as important to keep in mind these facts of milk
contamination--dirt, filth, flies, and bacteria--as it is to plan for
the modification of cow's milk for the purpose of making it more
nearly resemble mother's milk. While mother's milk has about the same
percentage of fat as cow's milk, it is almost twice as rich in sugar,
and has only one-fourth to one-third as much protein. This protein is
vastly different from that found in cow's milk, which you recall has a
tough curd, as seen in cottage cheese. While mother's milk contains a
small amount of casein similar to that found in the cheese of the
cow's milk, the principal protein constituent is of another kind
(lactalbumin), and is much more easy of digestion than the casein of
cow's milk.
This is a most important point to remember, because the baby's stomach
is not at first adapted to the digestion of the heavier and tougher
protein curds of cow's milk. It requires time to accustom the infant
stomach to perform this heavier work of digestion. There are a number
of factors which must be borne in mind in the modification of milk,
whether it be cow's milk, or goat's milk (for many European physicians
use goat's milk entirely in the artificial feeding of infants):
namely, the cleanliness of the milk, the acidity of milk, the
difference in the curd, the percentage of sugar, and the presence of
bacteria.
SUGAR
In the modification of cow's milk, sugar must be added to make up for
the sugar which is decreased when the water was added to reduce the
protein. There are several sorts of sugar used in the modification of
milk. These sugars are not added to sweeten the milk alone, but to
furnish a very important element needed for the growth of the baby.
Sugar is the one element which the infant requires in the largest
amount.
Milk sugar is probably most universally used in the modification of
milk, but a good grade of milk sugar is somewhat expensive, costing
from thirty to sixty cents a pound, and this places it beyond the
reach of many mothers. It is added to the food mixtures in the
proportion of one ounce to every twenty ounces of food. Cane sugar
(table sugar) may also be used, but it must be clean and of good
quality. It is used in rather less quantity than that of milk sugar,
usually from one-half to one-third of an ounce by measure to each
twenty ounces of food. Dextri-maltose (malt sugar) is very easy of
digestion and may be used in the modification of milk. Maltose seems
to help the children to gain more rapidly in weight than when only
milk or cane sugar is used. It is also exceedingly useful in
constipation, as its action is more laxative than any of the other
sugars; but it should not be given to children who vomit habitually or
have loose stools.
ACIDITY
Like mother's milk, the cow's milk is neutral as it comes from the
udder; but, on standing, it quickly changes, soon becoming slightly
acid, as shown by testing with blue litmus paper. In fact, what is
known as ordinarily fresh milk, if subjected to the litmus paper test,
always gives an acid reaction. This acidity is neutralized by adding
lime water to the formula in the proportion of one ounce to each
twenty-ounce mixture. Ordinary baking soda is sometimes prescribed by
physicians in place of the lime water. In the event of obstinate
constipation, milk of magnesia is sometimes added to the day's
feedings.
CREAM
There may be procured in any large city an instrument called the cream
gauge, which registers approximately (not accurately) the richness of
milk. Some milk, even though rich, parts with its cream very slowly;
while some poor milk allows nearly all the cream quickly to rise to
the surface. We know of no way for the mother to determine the amount
of cream (without the cream gauge) except by the color and richness of
the milk. In cities it is very convenient to send a specimen of the
milk to the laboratories to be examined by experts, who will gladly
render a report to both physician and mother.
The lactometer is a little instrument used to estimate the specific
gravity of milk. An ordinary urinometer such as used by physicians
in estimating the specific gravity of urine may also be used. The
specific gravity of cow's milk should not register below 1028 or above
1033.
[Illustration: Fig. 11. A Sanitary Dairy
_Courtesy of Lakewood Farm_
_Courtesy of Lakewood Farm_]
HERD MILK
Milk from a single cow is not to be desired for baby's food because of
its liability to vary from day to day, not to mention the danger of
the cow's becoming sick. Authorities have agreed that herd milk of
Holstein or ordinary grade cows is best for infant feeding. This
mixed-herd milk contains just about the proper percentage of fat;
whereas, if Jersey milk must be used, some of the cream should be
taken away. Our milk should come from healthy cows which have been
tested for tuberculosis at least every three months.
Annatto is sometimes added to milk to increase its richness of color.
To test for annatto proceed as follows: To a couple of tablespoons of
milk add a pinch of ordinary baking soda. Insert one-half of a strip
of filter paper in the milk and allow it to remain over night. Annatto
will give a distinct orange tint to the paper. The commonly used milk
preservatives are boracic acid, salicylic acid, and formaldehyde, any
of which may be readily detected by your health officials.
SANITARY DAIRIES
In close proximity to most large cities there is usually to be found
one or more sanitary dairies. It is a joy indeed to visit a farm of
this kind with its airy stables and concrete floors, which are washed
with water coming from a hose. The drainage is perfect--all filth is
immediately carried off (Fig. 11). The cows are known to be free from
tuberculosis, actinomycosis (lumpy jaw), and foot and mouth disease.
The milkmen on this farm wear washable clothes at the milking time,
and their hands are painstakingly cleansed just before the milking
hour. Previous to the milking the cattle have been curried outside the
milking room and their udders have received a careful washing. The
milkman grasps the teat with clean hands, while the milk is allowed to
flow through several thicknesses of sterilized gauze into the sanitary
milking pail. This milk is at once poured into sterile bottles, is
quickly cooled and shipped in ice to the substations where the
delivery wagon is waiting. In the ideal delivery wagon there are
shallow vats of ice in which the bottles are placed, thus permitting
the milk to reach the baby's home having all the while been kept at a
temperature just above the freezing point.
And why all this trouble? Why all this worry over temperature and
cleanliness? Babies were not so cared for in the days of our
grandmothers. The old-fashioned way of milking the cows with dirty
clothes and soiled hands, while cattle were more or less covered with
manure, with their tails switching millions of manure germs into the
milking pail, produced a milk laden not only with manure germs--the
one great cause of infantile diarrhea--but also swarming with numerous
other mischief making microbes. Even tuberculosis, that much dreaded
disease germ of early infancy, may come from the dairy hands as well
as from infected cows.
There used to be many dairymen like the old farmer who, when
interrogated by the health commissioner concerning the cleanliness of
his milk, laughed as he reached down into the bottom of a pail of
yellow milk and grabbing up a handful of manure and straw, said:
"That's what makes the youngsters grow." But it does not make them
grow; it often causes them to die, and even if they do live, they live
in spite of such contaminated food, for the germ which is always found
in the colon of the cow (_coli communis_), probably kills more babies
every year than any other single thing.
It is possible to reduce the growth of these germs by keeping the milk
at a very low temperature from the time it leaves the cow until the
moment it gets to the home refrigerator. Those which survive this
process of refrigeration may be quickly rendered harmless by
pasteurizing or sterilizing at the time of preparing baby's food.
In the absence of the modern sanitary dairy, we would suggest that the
milk supply be improved by giving attention to the following:
The cattle should be tested for tuberculosis every three months. The
walls of the cowhouse should be whitewashed three times a year. The
manure should be stored outside the barn. The floor of the cowhouse
should be sprinkled and swept each day. The cattle should be kept
clean--curried each day, and rubbed off with a damp cloth before
milking. The udders should be washed before each milking. The milker
can wear a clean white gown or linen duster which should be washed
every two days, while his hands should be washed just before the
milking. The milking pail should be of the covered sanitary order. The
barn should be screened.
CERTIFIED MILK
Immediately after leaving the cow, the milk should be cooled to at
least 45 F. It should at once be put into bottles that have been
previously sterilized and then be tightly covered, and should be kept
in ice water until ready for consumption. No matter how carefully the
milk is handled, it is infected with many bacteria, but if it is
quickly cooled, the increase of the bacteria is greatly retarded.
Under no circumstances buy milk from a grocery store out of a large
can. Go to your health officer and encourage him in his campaign for
sanitary dairies and certified milk.
Such milk as we have described under the head of sanitary dairies,
when it has been tested by the board of health and has received the
approval of the medical profession, is known as "certified milk;" and,
although the price is usually fifteen to twenty cents a quart, when
compared with the cost of baby's illness it will prove to be cheaper
than the dirty milk which sickens and kills the little folks.
There is no doubt that the increased use of "certified milk" has been
a great factor in the reduction of deaths from infant diarrhea in
recent years.
BOILING THE MILK
When certified milk cannot be had, it is absolutely dangerous to give
raw, unboiled, or unpasteurized milk to the baby, particularly in warm
weather; for the countless millions of manure germs found in each
teaspoon of ordinary milk not only disturbs the baby's digestion, but
actually makes him sick, causing colic, diarrhea, and cholera
infantum. The only way this milk can be rendered safe is by cooking
it--actually killing the bacteria. This process of boiling, however,
does not make good milk out of bad milk nor clean milk out of that
which is dirty, it simply renders the milk less dangerous.
There are two methods of killing bacteria--sterilization and
pasteurization. By sterilization is meant the process of rendering the
milk germ free by heating, by boiling. Many of the germs found in milk
are comparatively harmless, merely causing the souring of milk; but
other microbes are occasionally present which cause serious diseases,
such as measles, typhoid and scarlet fever, diphtheria, tuberculosis,
and diarrhea. It is always necessary to heat the milk before using in
warm weather, and during the winter it is also important when
infectious or contagious diseases are prevalent.
Milk should be sterilized when intended for use on a long journey, and
may be eaten as late as two or three days afterward.
To sterilize milk, place it in a well-protected kettle and allow to
boil for one hour and then rapidly cool. This process renders it more
constipating, and for some children many of its nutritive properties
seem to be destroyed, as scurvy is often the result of its prolonged
use. When a child must subsist upon boiled milk for a long period, he
should be given the juice of an orange each day. Children are not
usually strong and normal when fed upon milk of this character for
indefinite periods. All living bacteria (except the spores or eggs)
may be destroyed by boiling milk for one or two minutes.
PASTEURIZATION
When baby is to use the milk within twenty-four hours,
"pasteurization" is better than boiling as a method of destroying
microbes.
There are many pasteurizers on the market which may be depended upon,
among which are the Walker-Gordon Pasteurizer, and Freeman's
Pasteurizer; but in the absence of either of these pasteurization may
be successfully accomplished by the following method:
On the bottom of a large kettle filled with cold water, place an
ordinary flatiron stand upon which is put a folded towel. On this
place the bottle of milk as it comes from the dairyman, with the cap
of the bottle loosened. The cold water in the kettle should come up to
within an inch of the top of the bottle of milk. Heat this water
quickly up to just the boiling point--until you see the bubbles
beginning to rise to the top. The gas is then turned down or the
kettle is placed on the back of the range and held at this
near-boiling point for thirty minutes, after which it is taken to the
sink and cold water is turned into the water in the kettle, until the
bottle of milk is thoroughly cooled. It is now ready to be made up
into the modified food for baby.
Never let pasteurized milk stand in the room, nor put it near the ice
when warm. It must be cooled rapidly, as described above; that is,
within fifteen or twenty minutes.
The "spores" of the milk are not killed by pasteurization and they
hatch out rapidly unless the milk is kept very cold, and, as already
stated, it should be used within twenty-four hours after
pasteurization.
THE CARE OF BOTTLED MILK
The certified milk or the ordinary milk that has been delivered to
your home and is to be used without pasteurization or sterilization,
should receive the following care:
1. It should be placed at once in a portion of the ice box that is not
used to store such foods as radishes, cabbage, meats or any other open
dishes of food whose odors would quickly be absorbed by the milk. The
milk should never be left standing on the doorsteps in the sun, for
many reasons: the sun heats the milk, encourages the growth of
bacteria, and a passing cat or dog, whose mouth often contains the
germs of scarlet fever, tonsilitis, and diphtheria, should it be
hungry, laps the tops of the bottles, particularly in the winter when
the cream has frozen and is bulging over the edge.
2. It should never be kept in the warm kitchen, as when visiting her
sick baby we discovered one young mother doing. In answer to my
question, she explained; "Doctor, we do not take ice in the winter
time, everything is ice outdoors, so I just set the bottle outside the
window bringing it in whenever I need to give the baby some food. I
forget to put it out sometimes, but really now, does it matter?" It
really matters much, for you see, reader, the milk is first freezing
then thawing and it is rendered entirely unfit for the baby.
3. Milk should be kept covered and protected from dust and flies; it
should be kept in glass jars which have been sterilized by boiling
before being filled, and then placed in the refrigerator. If the milk
is sour, or if there is any sediment in the bottle, it is unfit for
baby's use.
CHAPTER XVIII
HOME MODIFICATION OF MILK
In a previous chapter it was found from comparing the analysis of
mother's milk with that of cow's milk, that they widely differed in
the proteins and sugar. The art of so changing cow's milk that it
conforms as nearly as is possible to mother's milk is known as
"modification." Where protein, sugar, and fat are given in proper
amounts, healthy infants get along well; but when either the fats or
proteins are given in excess, or when the digestion of the child is
deranged, there is often no end of mischief.
There are two groups of milk formulas that are useful. First, those in
which the fats and proteins are about the same, known as "whole milk,"
or "straight" milk mixtures; second, those in which the fats are used
in larger proportions than proteins, and known as "top milk"--milk
taken from the upper part of the bottle after the cream has risen. And
since the larger proportion of babies take the lower fats or "whole
milk" formulas, and seem to get along better than the babies who have
the "top milk" formulas, we will first take up the consideration of
the modification of whole milk.
PREPARATION FOR MODIFICATION
To begin with, everything that comes in contact with the preparation
of baby's food must be absolutely clean. The table on which the
articles are placed, and any towel that comes in contact with the
articles or the mother's hands, or those of the nurse, must be
thoroughly scrubbed.
There is only one way to prepare the utensils that are to be used in
making the baby's food, and that is to put them in a large kettle and
allow them to boil hard for fifteen minutes just before they are to
be used. The articles needed are (Fig. 12):
1. As many bottles as there are feedings in one day.
2. A nipple for each bottle.
3. Waxed paper for each bottle top.
4. Rubber bands for each bottle.
5. A two-quart pitcher.
6. A long-handled spoon for stirring the food.
7. A tablespoon.
8. A fork.
9. An eight-ounce, graduated measuring glass.
10. A bottle of lime water.
11. A fine-mesh, aluminum strainer.
12. A square of sterile gauze for straining the food (should be boiled
for fifteen minutes with the utensils).
13. One plate, and later a double boiler (14).
15. The sugar.
16. The milk.
17. Ready for the ice box.
18. Refrigeration.
BOTTLES AND NIPPLES
There is but one bottle which can be thoroughly washed and cleaned,
and that is the wide-mouthed bottle. It should hold eight ounces and
should have the scale in ounces blown in the side (Fig. 10). The
nipple for this bottle is a large, round breast from which projects a
short, conical nipple, which more nearly resembles the normal breast
than do the old-fashioned nipples so frequently seen on the
small-necked nursing bottles. There is a great advantage in this, in
that the baby cannot grasp the nipple full length and thus cause
gagging. These bottles and nipples are known as the "Hygeia," and have
proven to be a great source of comfort to the baby as well as to the
mother or nurse whose duty it is to keep them clean. There are a
number of other nursing bottles on the market, which, if they are
used, must be thoroughly cleansed with a special bottle brush each
day. The neck is small and the nipple is small and great care must be
taken in the cleansing of both of them.
CARE OF BOTTLES AND NIPPLES
When there is a bottle for each individual feeding in the day,
immediately after each nursing both bottle and nipple should be
rinsed in cold water and left standing, filled with water, until the
bottles for one day's feeding have all been used. The nipples should
be scrubbed, rinsed, and wiped dry and kept by themselves until their
boiling preparation for the following day's feeding.
[Illustration: Fig. 12. Articles Needed for Baby's Feeding]
If the same bottle is to be used for the successive feedings during
the day, it should be rinsed, washed with soap and water, and both
bottle and nipple placed in cold water and brought quickly to the
boiling point and allowed to boil for fifteen minutes. No bottles or
nipples must ever be used after a mere rinsing; boiling, preceded by a
thorough washing in soap and water, must take place before they are
used a second time.
New nipples are often hard and need to be softened, which is readily
done by either prolonged boiling or rubbing them in the hands.
All new bottles should be annealed by placing them on the stove in a
dishpan of cold water and allowing them to boil for twenty minutes,
and then allowing them to remain in the water until they are cold.
When bottles are treated in this manner they do not break so readily
when being filled with boiling water or hot food.
PREPARING THE FOOD
In a large preserving kettle place all the utensils needed in the
preparation of the food--pitcher, spoon, fork, measuring glass,
bottles, nipples, cheesecloth for straining, agate cup, wire strainer,
in fact everything that is to be used in the preparation of the food.
Now fill the kettle with cold water and place over the gas and allow
to boil for fifteen minutes. On a well-scrubbed worktable place a
clean dish towel, and on this put the utensils and the bottles right
side up. The nipples on being taken out of the boiling water will dry
of themselves; they should be placed in a glass-covered jar until they
are needed for each individual feeding, the nipples not being placed
on the bottles as they go to the ice box.
Having been given your formula by your physician, proceed in the
following way. Suppose we were preparing the food for a normal
two-months old baby that weighed ten pounds, with the prescription as
follows:
BABY SMITH.
R_{x}
Whole Milk ounces 11
Cane Sugar level tablespoons 2
Boiled Water ounces 12½
Lime Water ounces 1
Amount at Each Feeding ounces 3½
Number of Bottles 7
Interval Between Feedings hours 3
DETAILS OF PREPARATION
Two level tablespoons of cane sugar are placed in the agate cup and
dissolved in a small amount of boiling water. The solution should be
perfectly clear, and if it does not clear up put it over the heat for
a few moments.
This is now turned into the eight-ounce measuring glass which is then
filled with boiling water and emptied into the two-quart pitcher. We
need four and one-half more ounces of boiling water to complete the
prescription requirement of twelve and one-half ounces.
The bottle of milk, if properly certified, need not be pasteurized;
but if it is not, it should have been previously pasteurized while the
utensils were boiling according to the suggestions found in the
chapter on "milk sanitation." The top of the milk bottle should be
thoroughly rinsed and wiped dry, and after a thorough shaking of the
milk, the cover is removed with the sterile fork and eleven ounces are
measured out by measuring glass and poured into the pitcher. All is
now stirred together with an ounce of lime water, which should never
look murky, but should be as clear as the clearest water and should
always be kept in the ice box when not in use.
The sterile cheesecloth which has been boiled for fifteen minutes is
now put over the nose of the pitcher, the contents of which is
accurately measured into the seven clean, empty bottles, each
containing three and one-half ounces. Over the top of each of the
nursing bottles is placed a generous piece of waxed paper which is
held down by a rubber band. Each meal for the day is now contained in
a separate bottle, and all are placed in a covered pail of water
containing ice, and put in the ice box.
If the prescription for the baby's food contains gruel, it is prepared
in the following manner:
Suppose the baby is eight months old and the prescription called for
two level tablespoons of flour and eight ounces of boiled water. The
two level tablespoons of flour, whether it be wheat (ordinary bread
flour), or barley flour, are put into a cup and stirred up with cold
water, just as you would stir up a thickening for gravy; now measure
out eight ounces of water and allow it to come to a boil in the inner
pan of the double boiler, into which the thin paste is stirred until
it comes to a boil. After boiling for twenty minutes, remeasure in the
measuring glass and what water has been lost by evaporation must be
added to complete accurately the prescription requirement of eight
ounces; this is now added to the other ingredients of the
prescription.
TABLE FOR INFANT FEEDING
We now offer a monthly schedule--a table which is the result of our
experience in feeding hundreds of babies in various sections of
Chicago. It is not a schedule for the sick baby, but it is a carefully
tabulated outline for the normal, healthy, average child ranging from
one week to one year in age. In offering this table we remind the
mother, if the baby is six months old and not doing well on the food
it is getting and a change is desired by both mother and physician,
that it is far better to begin with the second or third month's
prescription and quickly work up to the sixth month's. This change may
often be accomplished in two or three days.
In all large cities there are to be found milk laboratories which make
it their business to fill prescriptions for the modification of milk
under the direction of baby specialists. This milk can be absolutely
relied upon. In specialized diet kitchens in many large hospitals,
these feeding prescriptions also may be filled.
ARTIFICIAL FEEDING SCHEDULE
==========+========+=======+=======+=======+========+=======+========+
Age | | | | | | | Amount |
| Baby's | Whole | Cane | Wheat | Boiled | Lime | at |
| Weight | Milk | Sugar | Flour | Water | Water | Feeding|
----------|--------|-------|-------|-------|--------|-------|--------|
| | | Level | Level | | | |
| Pounds |Ounces | Table-| Table-| Ounces | Ounces| Ounces |
| | | spoon | spoon | | | |
----------|--------|-------|-------|-------|--------|-------|--------|
1 week | 7½ | 2½ | 1 | | 5 | ½ | 1 |
----------|--------|-------|-------|-------|--------|-------|--------|
2 weeks | 7½ | 4½ | 1½ | | 9 | ½ | 2 |
----------|--------|-------|-------|-------|--------|-------|--------|
3 weeks | 7¾ | 7 | 2 | | 10 | ½ | 2½ |
----------|--------|-------|-------|-------|--------|-------|--------|
4 weeks | 8 | 9 | 2 | | 11 | 1 | 3 |
----------|--------|-------|-------|-------|--------|-------|--------|
2 months | 10 | 11 | 2 | | 12½ | 1 | 3½ |
----------|--------|-------|-------|-------|--------|-------|--------|
3 months | 12 | 15 | 2 | ½ | 15 | 1 | 4½ |
----------|--------|-------|-------|-------|--------|-------|--------|
4 months | 13 | 18 | 2½ | 1 | 13½ | 1½ | 5½ |
----------|--------|-------|-------|-------|--------|-------|--------|
5 months | 14 | 21 | 2½ | 1½ | 13½ | 1½ | 6 |
----------|--------|-------|-------|-------|--------|-------|--------|
6 months | 15 | 23 | 2½ | 1½ | 10½ | 1½ | 7 |
| | | | | | | |
----------|--------|-------|-------|-------|--------|-------|--------|
7 months | 16 | 25 | 2 | 1½ | 8½ | 1½ | 7 |
| | | | | | | |
----------|--------|-------|-------|-------|--------|-------|--------|
8 months | 17 | 27 | 1½ | 2 | 8 | 1½ | 7¼ |
| | | | | | | |
----------|--------|-------|-------|-------|--------|-------|--------|
9 months | 18 | 29 | 1 | 2 | 8 | 2 | 7¾ |
| | | | | | | |
----------|--------|-------|-------|-------|--------|-------|--------|
10 months | 19 | 30 | ¾ | 2 | 8 | 2 | 8 |
| | | | | | | |
----------|--------|-------|-------|-------|--------|-------|--------|
11 months | 20 | 31 | ½ | 2 | 8 | 2 | 9 |
| | | | | | | |
----------|--------|-------|-------|-------|--------|-------|--------|
12 months | 21 | 32 | | | 7 | 2 | 9 |
| | | | | | | |
| | | | | | | |
----------|--------|-------|-------|-------|--------|-------|--------|
18 months | 24 | 36 | | | | | 12 |
| | | | | | | |
----------+--------+-------+-------+-------+--------+-------+--------+
==========+=========+==========+=========+==========+========
Age | Number | Interval | | Soups | Total
| of | Between | Fruit | and | Daily
|Feedings | Feedings | Juices | Broths |Calories
----------|---------|----------|---------|----------|--------
| | | | |
| in 24 | Hours | | |
| Hours | | | |
----------|---------|----------|---------|----------|--------
1 week | 8 | 3 | | | 112
----------|---------|----------|---------|----------|--------
2 weeks | 7 | 3 | | | 184
----------|---------|----------|---------|----------|--------
3 weeks | 7 | 3 | | | 267
----------|---------|----------|---------|----------|--------
4 weeks | 7 | 3 | | | 309
----------|---------|----------|---------|----------|--------
2 months | 7 | 3 | | | 351
----------|---------|----------|---------|----------|--------
3 months | 7 | 3 | | | 447
----------|---------|----------|---------|----------|--------
4 months | 6 | 3 | | | 553
----------|---------|----------|---------|----------|--------
5 months | 6 | 3½ | | | 628
----------|---------|----------|---------|----------|--------
6 months | 5 | 4 | one | one | 680
| | |teaspoon |tablespoon|
----------|---------|----------|---------|----------|--------
7 months | 5 | 4 | two | ¼ | 732
| | |teaspoons| cup |
----------|---------|----------|---------|----------|--------
8 months | 5 | 4 |one-half | ¼ | 767
| | | orange | cup |
----------|---------|----------|---------|----------|--------
9 months | 5 | 4 | one | ½ | 854
| | | orange | cup |
----------|---------|----------|---------|----------|--------
10 months | 5 | 4½ | one | ¾ | 875
| | | orange | cup |
----------|---------|----------|---------|----------|--------
11 months | 5 | 5 | one | 1 | 906
| | | orange | cup |
----------|---------|----------|---------|----------|--------
12 months | 5 | 5 | one | 1 cup |
| | | orange | arrowroot| 950
| | | | cracker |
----------|---------|----------|---------|----------|--------
18 months | 3 | 6 | toast, gravies, baked
| | | potato and apple, etc.
----------+---------+----------+---------+----------+--------
Note 1 ounce of whole milk equals 21 calories
1 level tablespoon of cane sugar equals 60 calories
1 level tablespoon of milk sugar equals 45 calories
1 level tablespoon of flour equals 25 calories
The juice of 1 average orange equals 75 calories
1 cup of average bouillon equals about 100 calories
(This table is calculated on the basis of about 45 calories for each
pound of baby weight)
TOP-MILK FORMULA
Top milk is the upper layer of milk which has been removed after
standing a certain number of hours in a milk bottle or any other tall
vessel with straight sides. It contains most of the cream and varying
amounts of milk. It may be removed by a small cream dipper which holds
one ounce, or it may be taken off with a siphon, but it should never
be poured off. To obtain seven per cent top milk which is the one most
ordinarily used in the preparation of top milk formulas, we take off
varying amounts--according to the quality of the milk--which Doctor
Holt describes as follows:
From a rather poor milk, by removing the upper eleven ounces from
a quart, or about one-third the bottle.
From a good average milk, by removing the upper sixteen ounces,
or one-half the bottle.
From a rich Jersey milk, by removing the upper twenty-two ounces,
or about two-thirds the bottle.
Cream is often spoken of as if it were the fat in milk. It is really
the part of the milk which contains most of the fat and is obtained by
skimming, after the milk has stood usually for twenty-four hours; this
is known as "gravity cream." It is also obtained by an apparatus
called a separator; this is known as "centrifugal cream," most of the
cream now sold in cities being of this kind. The richness of any cream
is indicated by the amount of fat it contains.
The usual gravity cream sold has from sixteen to twenty per cent fat.
The cream removed from the upper part (one-fifth) of a bottle of milk
has about sixteen per cent fat. The usual centrifugal cream has
eighteen to twenty per cent fat. The heavy centrifugal cream has
thirty-five to forty per cent fat.
The digestibility of cream depends much upon circumstances. Many
serious disturbances of digestion are caused by cream.
It is convenient in calculation to make up twenty ounces of food at a
time. The first step is to obtain the seven per cent milk, then to
take the number of ounces that are called for in the formula desired.
One should not make the mistake of taking from the top of the bottle
only the number of ounces needed in the formula, as this may be quite
a different per cent of cream and give quite a different result.
There will be required in addition, one ounce of milk sugar and one
ounce of lime water in each twenty ounces. The rest of the food will
be made up of boiled water.
These formulas written out would be as follows:
FORMULA FROM SEVEN PER CENT MILK
I II III IV V VI VII VIII IX
Oz. Oz. Oz. Oz. Oz. Oz. Oz. Oz. Oz.
7 per cent milk 2 3 4 5 6 7 8 9 10
Milk sugar 1 1 1 1 1 ¾ ¾ ¾ ¾
Lime water 1 1 1 1 1 1 1 1 1
Boiled water 17 16 15 14 13 12 11 10 9
--- --- --- --- --- --- --- --- ---
20 20 20 20 20 20 20 20 20
The approximate composition of these formulas expressed in percentages
are as follows:
Formula Fat Sugar Proteins
I 0.70 5.00 0.35
II 1.00 6.00 0.50
III 1.40 6.00 0.70
IV 1.75 6.00 0.87
V 2.00 6.00 1.00
VI 2.40 6.00 1.20
VII 2.80 6.00 1.40
VIII 3.10 6.00 1.55
IX 3.50 6.00 1.75
It is necessary to make the food weak at first because the
infant's stomach is intended to digest breast milk, not cow's
milk; but if we begin with a very weak cow's milk the stomach can
be gradually trained to digest it. If we began with a strong milk
the digestion might be seriously upset.
Usually we begin with number one on the second day; number two on the
fourth day; number three at seven to ten days; but after that make the
increase more slowly. A large infant with a strong digestion will bear
a rather rapid increase and may be able to take number five by the
time it is three or four weeks old. A child with a feeble digestion
must go much slower and may not reach number five before it is three
or four months old.
It is important with all children that the increase in the food
be made very gradually. It may be best with many infants to
increase the milk by only half an ounce in twenty ounces of food,
instead of one ounce at a time, as indicated in the tables. Thus,
from three ounces the increase would be to three and one-half
ounces; from four ounces to four and one-half ounces, etc. At
least two or three days should be allowed between each increase
in the strength of the food.
PEPTONIZED MILK
Another modification which at times may be ordered by your physician
is peptonized milk. Since it is infrequent for the proteins of milk to
be the cause of indigestion, peptonized milk has only a limited use,
chiefly in cases of acute illness. The milk is peptonized in the
following manner:
Place the peptonizing powder (it is procurable in tubes or tablets
from the drug store) in a small amount of milk, and after being well
dissolved, put into the bottle or pitcher with the plain or modified
milk, after which the whole is shaken up together. The bottle is then
put into a large pitcher containing water heated to about 110° F. or
as warm as would bear the hand comfortably, and left for ten or twenty
minutes (if the milk is to be partially peptonized). To completely
peptonize the milk, two hours are required. Either of these formulas
is only used on the advice of a physician.
BUTTERMILK
In many cases of chronic intestinal indigestion, buttermilk is used in
place of the milk. It is prepared as follows: After the cream has been
taken from the milk and it has been allowed to come to a boil, it is
cooled to just blood heat. A buttermilk tablet, having first been
dissolved in a teaspoonful of sterile water, is now stirred into the
quart of warmed, skimmed milk and allowed to stand at room temperature
for twenty-four hours at which time it should look like a smooth
custard. With a sterile whip this is now beaten and is ready for the
sugar and the boiled water which is added according to the written
prescription from the doctor.
CONDENSED MILK
Under no circumstances should condensed milk be used as the sole food
of the baby for more than one month. Children often gain upon it, but
as a rule they have little resistance, and they are very prone to
develop rickets and oftentimes scurvy; and, as noted elsewhere, orange
juice should always be administered at least once during the
twenty-four hours as long as condensed milk is used.
Of all the brands of condensed milk, those only should be selected
which contain little or no cane sugar. Perhaps the "Peerless Brand" of
evaporated milk is the most reliable and in the preparation of food
from this evaporated milk the same amount of sugar, etc., should be
added as we do in the preparation of "whole milk" or "top milk."
We do not in any way advise the use of condensed milk. Fresh milk
should always be used where it is obtainable, but in traveling it
sometimes has to be used. Holt says, "It should be diluted twelve
times for an infant under one month and six to ten times for those who
are older."
Malted milk is a preparation suitable in some cases where fresh cow's
milk is not obtainable. Even better than condensed milk, this food
will be found serviceable in traveling, or in instances where only
very bad cow's milk is within reach.
SPECIAL FOODS
Most patent foods are made up of starches and various kinds of sugars,
and some of them have dried milk or dried egg albumin added. Many
flours under fanciful names are sold on the market today. For
instance, one flour with a very fanciful name is simply the old
fashioned "flour ball" that our great, great grandmothers made; and,
by the way, perhaps there is no flour for which we are more grateful
in the preparation of infant food than the flour ball which is
prepared as follows: A pound of flour is tied tightly in a cheesecloth
and is put into a kettle of boiling water which continues to boil for
five or six hours, at the end of which time the cheesecloth is
removed and the hard ball, possibly the size of an orange, is placed
on a pie pan and allowed slowly to dry out in a low temperatured oven.
At the end of two or three hours, the ball, having sufficiently dried,
has formed itself into a thick outer peel which is removed, while the
heart which is very hard and thoroughly dry, is now grated on a clean
grater, and this flour has perhaps helped more specialists to serve
more sick babies than any other form of starch known. It is used just
as any other flour is used--wet up into a paste, made into a gruel,
which is boiled for twenty minutes before it is added to the milk.
Whey is sometimes used in the preparation of sick babies' food and is
prepared as follows:
To a pint of fresh lukewarm cow's milk are added two teaspoons of
essence of pepsin, liquid rennet or a junket tablet. It is
stirred for a moment, then allowed to stand until firmly
coagulated, which is then broken up and the whey strained off
through a muslin.
The heavy proteins remain in the curd, and the protein that goes
through with the whey is chiefly the lactalbumin.
CHAPTER XIX
THE FEEDING PROBLEM
A friend of ours who presides over a court of domestic relations in a
large city, recently told us that he believed much trouble was caused
in families--many divorces, occasioned, and many desertions
provoked--because improperly fed babies were cross and irritable and
so completely occupied the time of the mother, who, herself, knew
nothing about mothercraft or the art of infant feeding. Consequently,
the home was neglected and unhappy, quarreling abounded and failure,
utter failure, resulted. The children were constantly cross, and so
much of the mother's time was consumed in caring for these irritable,
half-fed babies, that the home was disheveled, the meals never ready,
the husband's home-coming was a dreaded occurrence, and he,
endeavoring to seek rest and relaxation, usually sought for it in the
poolroom or the saloon, with the usual climax which never fails to
bring the time-honored results of debauch--despair and desertion.
In the beginning of this book we paid our respects to the present-day
educational system which does not provide an adequate compulsory
course in which all women could be given at least a working knowledge
of home making and the care and feeding of the babies; so that
statement need not be repeated in this chapter. But we wish to add, in
passing, that ignorance is the basis and the foundation of more
unhappy homes, broken promises, panicky divorces, and shattered hopes,
as well as of more deaths during the first year of infancy, than any
other cause. And in speaking of its relationship to babycraft, we
believe that ignorance concerning normal stools, how many times a day
the bowels should move; how much a baby's stomach holds; how often he
should be fed, etc.--I say it is ignorance of these essential details
that lies at the bottom of many problems which come up during the
first year, particularly the "feeding problem."
INFANT WELFARE
In the city of Chicago at the time of this writing, the Infant Welfare
Association maintains over twenty separate stations where meetings are
held for mothers, where lectures are delivered on the care and feeding
of babies. Babies are brought to these stations week in and week out;
they are weighed and measured and, if bottle-fed, nurses are sent to
the homes to teach the mother how properly to modify the milk in
accordance with the physician's orders. The health authorities of our
city also maintain several such stations where mothers and babies may
have this efficient help. A corps of nurses are employed to carry out
the instructions and to follow up the mothers and the babies in their
homes, and thus the death rate has been greatly reduced, not only in
our city but in all such cities where baby stations have been
instituted. In a certain ward in Philadelphia the death rate was
reduced forty-four per cent in one year after the baby stations were
established.
CHOOSING A FORMULA
There are three classes of infants who require weak-milk mixtures to
begin with: namely, the baby who has been previously nursed and whose
mother's milk has utterly failed; the baby just weaned; and the infant
whose power to digest is low. If these children were six months old,
and the formula best suited to them is unknown, we must begin with a
formula suited to a two- or three-month-old child and quickly work up
to the six-month formula, which may often be accomplished within two
or three days.
THE BOTTLE-FED BABY
When a baby is getting on well with his food, he should show the
following characteristics: He should have a good appetite; should have
no vomiting or gas; he should cry but little; and he should sleep
quietly and restfully. His bowels should move once or twice in
twenty-four hours. His stool should be a pasty homogeneous mass. He
should possess a clear skin and good color. He should show some gain
each week--from four to eight ounces--and he should also show mental
development.
As long as a baby appears happy and gains from four to eight ounces a
week and seems comfortable and well satisfied, the feeding mixture
should not be changed or increased.
MAKE CHANGES GRADUALLY
In our experience with the artificial feeding of infants, we have come
to look upon the practice of gradually changing the food formula as
the most important element in successful baby feeding.
We recall one mother in the suburbs who came to us with her baby who
had been feeding on a certain proprietary food. She declared that it
"just couldn't take cow's milk." She admitted "it was not doing well,"
and so she would like to have help. The baby was old enough, had it
been normal, to have been taking whole milk for some time. We recall
our having the mother prepare the proprietary food just as she had
been used to preparing it, and each day we had her throw away one-half
ounce and put in one-half ounce of whole milk, this mixture she fed
the baby for two days.
The next time, we had her take out one ounce of the mixture and put in
one ounce of whole milk, which we fed the baby for three successive
days; and then one and one-half ounces were substituted which was fed
to the baby for four days; and thus we carefully, slowly, and
gradually withdrew the proprietary food and substituted fresh,
certified cow's milk. It took us a month to complete the change, but
we are glad to add that it was done without in the least disturbing
the child.
Now, had the change been made abruptly--in a day or two, or three
days--the baby would probably have been completely upset, while both
the mother and the doctor would have been greatly discouraged. Many
mothers and even some physicians have jumped from one baby food to
another baby food; they have tried this and they have tried that,
until the poor child, having been the victim of a number of such
dietetic experiments, finally succumbed.
We cannot urge too strongly the fact that, as a rule, whenever a
change is made from one food to another, it should be done gradually,
unless it be the change of a single element such as that of a very
high per cent of cream found in top milk mixtures, when it seems to be
a troublesome element in the milk. No bad effects will follow the
quick change to skimmed milk with added sugar, starches, etc; but in
changing from a proprietary food to a milk mixture, the change should
always be made gradually, the quantity of the new food being increased
gradually. Milk should be increased by quarter (1/4) ounce additions,
and it should not be increased more than one ounce in one week; while
the mixture should not be increased as long as the baby is gaining
satisfactorily. A wise mother and an experienced physician can usually
see at a glance when a child is doing well--by the color and
consistency of the stools, the child's appetite, his sleep, and his
general disposition.
COMMON MISTAKES IN FORMULAS
First and foremost, we believe a great mistake is often made in using
too heavy cream mixtures; babies as a rule do not stand the use of too
high a percentage of cream. Formulas that call for whole milk should
contain four per cent fat or cream; and while babies often gain
rapidly on the higher percentage of cream found in a rich Jersey milk,
nevertheless, sooner or later serious disturbances of digestion
usually occur. Herd milk is, therefore, better for the babies because
in the "whole milk" of the herd of Holsteins we have only about four
per cent fat.
Another common mistake is too heavy feeding at the time of an attack
of indigestion; even the usual feeding may be too heavy during this
time of indisposition. It is not at all uncommon for us to dilute
baby's food to one-third its strength at the time of an acute illness.
Still another trouble maker is dirt--dirt on the dish-towel, dirt on
the nipple, dirt in the milk, dirt on the mother's hands. Dirt is an
ever present evil and an endless trouble maker, as evidenced by stool
disturbances, indigestion, fretful days, and sleepless nights. A dirty
refrigerator is another factor which has been responsible for much
illness and distress.
Indigestion is often brought on because a nurse, caretaker, or
possibly the mother, not wishing to go down to the refrigerator in the
middle of the night, brings up the food early in the evening and
allows it to become warm--to remain in a thermos bottle--and we are
sure that had they been able to see the enormous multiplication of
germs because of this warm temperature, they would never have given
occasion for such an increase in bacteria just to save themselves a
trifle of inconvenience.
Still another common mistake is to use one formula too long; a feeding
mixture which was good for four or possibly six weeks, must be changed
as the child grows older and his requirements become greater. Let the
weight, stools, general disposition and sleep of the child be your
guides, and with these in mind errors in feeding can be quickly
detected and minor mistakes speedily rectified.
SYMPTOMS OF DISSATISFACTION
Some of the pointed questions which are put to a young mother who
brings her child into the office of the baby specialist, are the
following:
Does the baby seem satisfied after his feeding?
Does he suck his fist?
How much does he gain each week in weight?
Does he sleep well?
Does the baby vomit?
What do his bowel movements look like?
Will you please send a stool to the office?
With the intelligent answers to these questions--after knowing the
birth weight and the age of the child and its general nervous
disposition--the physician can formulate some conclusion as to the
babe's general condition and can usually find a feeding formula that
will make him grow.
Vomiting, restlessness, sleeplessness and the condition of the
bowels, are the telltales which indicate whether or not the food is
being assimilated; and the stools may vary all the way from hard
bullet-like lumps to a green diarrhea.
Babies do not thrive well in large institutions where the food is so
often made up in a wholesale manner, for the simple reason that the
food elements are not suited to the need of each individual baby. Some
infants are unable to digest raw milk, and for them sterilized or
boiled milk should be tried; others require a fat-free mixture such as
skimmed milk, while still others may need buttermilk for a short time.
Babies require individual care, particularly in their food, and the
good or bad results are plainly shown in the stools, weight, sleep,
etc.
FLATULENCE
Flatulence is an excessive formation of gas in the stomach and bowels
leading to distension of the abdomen and the belching of gas, and
often the bringing up of a sour, pungent, watery fluid.
Flatulence is seen in infants suffering from intestinal indigestion
and the food is nearly always at fault. This condition is the result
of the faulty digestion of the sugar and starches--particularly the
starch--which should be immediately reduced. In such conditions the
addition of a slight amount of some alkaline (such as soda, magnesia
or lime water) to the food often produces good results. Great patience
must be exercised with a child that suffers from flatulence, for
immediate improvement can hardly be expected; time is required for the
restoration of good digestion.
VOMITING
Vomiting is perhaps more often the result of over feeding or too
frequent feeding than anything else. A healthy, breast-fed baby may
now and then regurgitate a bit, but it simply spills over because it
is too full. We do not refer to this as vomiting, we refer to the
belching up or vomiting of very sour or acrid milk which leaves a sour
odor on the clothing. This can all usually be rectified by lengthening
the intervals from two to three hours and preventing bolting of food
by getting a nipple whose hole is not so large. Too much cream in the
food will also sometimes cause vomiting.
Too frequent feeding at night is another cause of vomiting. When the
stomach is full, the failure to lay the baby down quietly, as is so
often seen in those homes where bouncing and jolting are practiced,
may also result in vomiting.
Vomiting may be the first sign of many acute illnesses such as scarlet
fever, measles, pneumonia, whooping cough, etc.
The treatment for acute vomiting is simple. All foods should be
withheld--nothing but plain, sweetened water should be administered,
while it is often advisable to give a dose of castor oil. A physician
should be called at once if the vomiting continues, and not until the
vomiting has entirely ceased for a number of hours and water is easily
retained, should food be given, and even then it should be begun on
very weak mixtures.
OVER-FEEDING
The size of the child's stomach should be the guide to the quantity of
food given, and attention is called to the table given in a previous
chapter. All food taken in excess of his needs lies in his stomach and
intestines only to ferment and cause wind and colic. The symptoms of
over-feeding are restlessness, sleeplessness, stationary weight (or
loss in weight), and oftentimes these very symptoms are interpreted by
the mother as sufficient evidence that the baby needs more food; and
so the reader can see the terrible havoc which is soon wrought where
such ignorance reigns.
WEIGHT
The weighing time should immediately follow a bowel movement and just
before a feeding time; then, and only then, we have the real weight of
baby, as a retained bowel movement may often add from four to five
ounces to the child's weight. There should be a careful record of each
weighing, for there may develop a great difference if different
members of the family endeavor to keep the weight in their minds. The
normal baby should gain four to eight ounces a week up to six months,
and from then on the weekly gain is from two to four ounces; in other
words, by six months the baby should double his birth weight and at
the end of a year his weight should be three times the birth weight. A
stationary or diminishing weight demands careful attention; a good
doctor should be called at once. Likewise, a very rapid increase in
weight is not to be desired, as we do not want a fat baby, but we do
desire a well-proportioned and alert baby, and, as someone has said,
it is better to have little or no gain during the excessive heat than
to upset the digestion by over-feeding, designed to keep the baby
gaining.
In weighing, usually the outside garments are removed, leaving on a
shirt, band, diaper, and stockings with the necessary pins; the little
fellow thus protected is placed into the weighing basket and at each
successive weighing, these same clothes or others just like them are
always included in the weight, and it should be so reported to the
physician.
THE STOOLS
In the chapter "Baby's Early Care," the first stools were described in
detail, and there we learned that the dark, tarry, meconium stools are
quickly changed within a week to the normal canary-yellow stool,
having the odor of sour milk.
The bottle-fed babies' stools differ somewhat in appearance; they are
thicker and a lighter color, but should always be homogeneous if the
food is well digested. They do not have nearly the number of bowel
movements each day that the breast-fed baby does. If a bottle-fed
baby's bowels move once a day and he seems perfectly well otherwise,
we are satisfied. And curds (white lumps), or mucus (sedimentary,
slimy phlegm), indicate that the food is not well digested.
BOTTLE FEEDING AND CONSTIPATION
A bottle baby may be constipated because the proteins are too high,
the fat too high, the food of an insufficient quantity or quality, or
the milk have been boiled, while weak babies really may lack the
muscular power to produce a bowel movement. With the help of your
physician endeavor to arrive at the cause of the constipation, and,
if the baby is two or three months old, from one to two teaspoons of
unsweetened prune juice may be administered. Milk of magnesia may be
added to the food (leaving out the lime water), or a gluten
suppository may be used.
The change from milk sugar to malt sugar has helped many infants;
while the giving of orange juice (after six months) is very beneficial
in many cases. A small amount of sweet oil may be injected into the
rectum which will lubricate the hard lumps and thus favor comfortable
evacuation. The periodicity of the bowel movement (at definite times
each day) is a matter of great importance. Immediately after a meal,
if the child is old enough, he should be placed on the toilet chair. A
bit of cotton, well anointed with vaseline and inserted into the
rectum just before meals, will often aid in producing a bowel movement
shortly after the meal has been taken.
Abdominal massage should be administered in all instances of
constipation, beginning with light movements and gradually increasing,
with well-oiled hands.
DIARRHOEA
Diarrhoea usually accompanies acute intestinal indigestion and is so
often associated with the common disorders of infancy that we refer
the reader to the chapter "Common Disorders of Infancy." Dark stools
should always be saved for the physician to observe, as they
frequently contain blood. Stools full of air bubbles with pungent sour
odor show fermentation; in which cases the starches should be reduced,
if not entirely taken away from the food mixtures. Green stools mean
putrefaction from filth-germs; a thorough cleansing of the bowel
should be immediately followed by a reduction in the strength of the
food and the boiling of the milk.
REGULATION OF THE STOOLS
At a certain time each day the napkin should be removed and the child
should be held out over a small jar. It is surprising to note how
quickly and readily the little fellow cooperates. Diaper experiences
may be limited to much less than a year if the mother has patience
enough and the baby has the normal intelligence to enter into this
regulation regime. We recall one caretaker who complained bitterly
because the child under her care constantly wet his diaper; so the
caretaker was instructed to keep a daily schedule of the baby's
actions for five days; and, to her surprise, she discovered that the
baby urinated about the same time each day. A regularity was also
noted concerning the bowel movements.
The variations in the time of the urinations were only fifteen or
twenty minutes, so nearly did the kidneys act at the same time each
day. The caretaker was instructed to remove the diaper and hold the
baby out at the earliest occurrence on the daily schedule, and, to the
astonishment of the entire family, no further accidents occurred, and
the child soon acquired the habit of letting them understand when he
was about to wet his diaper. Bowel movements may be regulated more
easily than the urination. After the child is about a year old, very
few accidents should occur.
MIXED FEEDING
In many instances, and particularly if the infant is under six months
of age, and where he has had to have additional feeding from the
bottle--under such circumstances the breast milk may be continued as
"partial feeding," at least until the baby has reached his ninth or
tenth month, at which time it may be wholly discontinued.
At each nursing time the baby empties both breasts, and the amount he
draws may readily be estimated by carefully weighing him before and
after each nursing. By referring to the directions in a previous
chapter, the quantity of food needed for his size and age may be
determined; while the deficit is made up from a bottle of milk
containing properly modified cow's milk.
If the mother's health admits, or if the breasts continue to secrete a
partial meal for the babe, mixed feeding should be continued until
after the ninth or tenth month, when it can gradually be reduced from
four or five times each day to once or twice a day, until it is
finally omitted altogether. In the meantime, the baby is gradually
getting stronger food and at eleven or twelve months the little fellow
is able to subsist and thrive upon whole milk.
INFANT FEEDING PUZZLES
It is very difficult to explain how some babies thrive on some certain
food while others grow thin and speedily go into a decline on the same
régime. The hereditary tendencies and predispositions undoubtedly have
a great deal to do with such puzzling cases.
Again, sometimes a slight variation in technic or some other trifling
error in connection with the preparation of the baby's food, may be
more or less responsible for the variation in the results obtained. No
two mothers will prepare food exactly alike even when both are
following the same printed directions and these slight discrepancies
are enough to upset some delicately balanced baby.
On the other hand, some babies are born with such strong digestive
powers and such a powerful constitution that they are easily able to
survive almost any and all blunders as regards artificial feeding,
while at the same time they also manifest the ability to surmount a
score of other obstacles which the combined ignorance and carelessness
of their parents or caretakers unknowingly place in the pathway of
early life which these little folks must tread.
The fact that so many babies do so well on such unscientific feeding
only serves to demonstrate the old law of "the survival of the
fittest"--they are born in the world with an enormous endowment of
"survival qualities"--and in many cases the little fellows thrive and
grow no matter how atrociously they are fed.
There may be other factors in the explanation of why some babies do so
well on such poor care, but heredity is the chief explanation, while
adaptation is the other. If the little fellows can survive for a few
weeks or a few months, the human machine possesses marvelous powers of
adaptation, and we find here the explanation why many a neglected baby
pulls through.
INFANT FOODS
Rickets and scurvy have so often followed the prolonged use of the
so-called "infant foods" which have flooded the market for the past
decade, that intelligent physicians unanimously agree that they are
injurious and quite unfit for continued use in the feeding of infants.
If they are prescribed to replace milk during an acute illness, or at
other times when the fats and proteins should be withheld for a short
period, both the physician and the mother should be in the possession
of definite and exact knowledge as to just what they do and do not
contain. To provide such knowledge, we present the analysis (Holt) of
some of the more commonly used infant foods.
1. _The Milk Foods._ Nestle's Food is perhaps the most widely known.
The others closely resembling it in composition are the Anglo-Swiss,
the Franco-Swiss, the American-Swiss, and Gerber's Food. These foods
are essentially sweetened, condensed milk evaporated to dryness, with
the addition of some form of flour which has been dextrinized; they
all contain a large proportion of unchanged starch.
2. _The Liebig or Malted Foods._ Mellin's Food may be taken as a type
of the class. Others which resemble it more or less closely are
Liebig's, Horlick's Food, Hawley's Food, malted milk, and cereal milk.
Mellin's food is composed principally (eighty per cent) of soluble
carbohydrates. They are derived from malted wheat and barley flour,
and are composed chiefly of a mixture of dextrins, dextrose, and
maltose.
3. _The Farinaceous Foods._ These are Imperial Granum, Ridge's Food,
Hubbell's Prepared Wheat, and Robinson's Patent Barley. The first
consists of wheat flour previously prepared by baking, by which a
small proportion of the starch--from one to six per cent--has been
converted into sugar.
In chemical composition these four foods are very similar to each
other, consisting mainly of unchanged starch which forms from
seventy-five to eighty per cent of their solid constituents.
4. _Miscellaneous Foods._ Under this head may be mentioned Carnrick's
Soluble Food and Eskay's Food.
The composition of the foods mentioned is given in the accompanying
table.
COMPOSITION OF INFANT FOODS
Malted
Nestle's Mellin's Eskay's Milk
Ingredients Food Food Food (Horlick's)
Per cent Per cent Per cent Per cent
Fat 5.50 0.24 1.16 8.78
Proteins 14.34 11.50 5.82 16.35
Cane Sugar 25.00 ... ... ...
Dextrose ... ... } 53.46[1] ...
Lactose (milk sugar) 6.57 ... } } 49.15[2]
Maltose } 27.36 60.80 ... }
Dextrins } 19.20 14.35 18.80
Carbohydrates (soluble) 58.93 80.00 67.81 67.95
Starch 15.39 ... 21.21 ...
Inorganic Salts 2.03 3.59 1.30 3.86
Water 3.81 4.73 2.70 3.06
Ridge's Imperial Carnrick's
Ingredients Food Granum Food
Per cent Per cent Per cent
Fat 1.11 1.04 7.45
Proteins 11.81 14.00 10.25
Cane Sugar ... ... ...
Dextrose 0.52 0.42 ...
Lactose (milk sugar) ... ...
Maltose ... ...
Dextrins 1.28 1.38 ...
Carbohydrates (soluble) 1.80 1.80 27.08
Starch 76.21 73.54 37.37
Inorganic Salts 0.49 0.39 4.42
Water 8.58 9.23 3.42
[1] Chiefly Lactose.
[2] Largely Maltose.
CHAPTER XX
BABY'S BATH AND TOILET
From earliest girlhood, women have loved their dolls, and one of the
greatest joys connected with the adored experience was the
make-believe bath and the dressing of the make-believe baby; so now,
when we are the happy possessors of real live dolls, we should go
about the task with the same lightheartedness of a score of years ago
when we hugged, kissed, bathed, and dressed our dolls. There is one
big advantage now, the doll won't break; but, we sigh as we stop to
think, we can't stick pins into it as we all did into the sawdust
bodies of our dolls those years and years ago.
THE FIRST WEEK
In the chapter on "Baby's Early Care," this subject was fully
discussed and we only wish to repeat, in passing, that before baby's
bath or toilet is undertaken the hands of the mother, nurse, or
caretaker must be scrupulously clean. And while the first day's bath
usually consists of sweet oil, albolene, or benzoated lard, if the new
baby happens to come during the very warm days of July or August and
the oil seems to irritate the soft downy skin, as it often does during
those hot days, a simple sponge bath may be substituted. The cord
dressing remains as the doctor left it, and if there be any
interference, let it be subject to his orders.
The cord usually drops off, and the abdomen is entirely healed by the
seventh to the tenth day, after which time baby is daily sponged for
another week. And now we will describe in detail the simplest, easiest
manner of administering an oil bath or a sponge bath.
GIVING THE BATH
A large pillow or a folded soft comfort is placed on a table in a warm
room--temperature not below 75 F. On baby's tray near by, and within
reaching distance, are the boracic acid solution in a small cup, a
medicine dropper, the warm saucer of oil, the toothpick applicators
(made by twisting cotton about one end, making sure the sharp end of
the pick is well protected), a glass jar of small cotton balls made
from sterile absorbent cotton, the castile soap, talcum powder, needle
and thread. A vessel of warm water, several old, soft, warmed towels
and the clean garments required, complete the layout.
Into the warm, soft blanket on the pillow or comfort we place the
partially undressed baby, for the binder, diaper, and socks are not
removed until the head-and-face toilet is completed.
The top of the head, behind the ears, the folds of the neck, and the
armpits are now gently but thoroughly rubbed with oil, which is then
all rubbed off with a soft linen towel. The eyes next receive two or
three drops of the boracic acid solution, put in by the aid of the
medicine dropper, while, with a separate piece of cotton, the surplus
solution is wiped off each eye, rubbing from the nose outward.
Then with the applicator made by wrapping cotton about the end of a
toothpick, oil is put into each nostril, all the time exercising the
utmost care not to harm the tender mucous membrane. The ears are also
carefully cleansed with a squeezed-out dip of boracic acid on the
applicator.
Unless there is an inflammation present in the mouth, and the
physician in attendance has ordered mouth swabbing, do not touch it;
for much harm is done the mucous membrane of the baby's mouth by the
forceful manner in which much of the swabbing is done. The face and
head are then washed with warm water; very little soap is needed and,
when used, must be most thoroughly rinsed off.
THE SECOND WEEK
And now during the second week, we proceed to sponge the baby's body;
the hands are washed with soap and rinsed, and, only those who have
performed this feat know just how tightly they hold shut their little
fists. These hands must be relaxed, and all the lint, dirt, and
perspiration be thoroughly washed away. The arms, shoulders, chest,
and back are then sponged. All the time the nurse or caretaker is
standing while carrying out this most pleasant task. At any time she
may quickly cover the babe and stop for this or that with no
inconvenience to herself or the child.
After the thorough drying of baby's upper body, a bit of talcum is put
under the arms, in the folds of neck, etc., and the shirt is slipped
on. Next the band, diaper, and stockings are removed and after first
oiling the groin and the folds of the thighs and the buttocks, the
same sponging, drying, and powdering is done here as on the upper
body.
The band is now applied, and _sewed on_. The diaper, stockings,
booties, and--if a winter baby--the skirt and outing flannel gown (for
babies should wear only night dresses for the first two or three
weeks) are now slipped over the feet and drawn upward, and baby is
ready for nursing or for his nap.
TEMPERATURE OF BATHS
First few weeks, 100 F.; early infancy, 98 F.; after six months, 97
F., cooling down to 90 F.
A wooden bath thermometer may be purchased for twenty-five cents and
it should be in every home where babies are bathed. In the absence of
a thermometer do not depend upon the hand to determine temperature.
Thrust the bared elbow into the water and if it is just
comfortable--neither hot or cool--it is probably about the correct
temperature for baby. Do not shock the baby by dashes of cold water,
for, while it may amuse an onlooker, it unnecessarily frightens your
child, and, subconsciously, he learns to dread his bath.
THE BATHING PLACE
If the bathroom is warm--temperature 75 F.--that is the most logical
place for the bath, provided baby has his own tub. Place a couple of
strong slats several inches wide across the big tub, six inches apart,
and on this place the baby's tub. Of course, care must be exercised
to prevent slipping by means of properly fitted cleats on the under
surface of the slats. The mother should always stand to bathe her baby
and the small tub should be placed at such a height that she neither
has to stoop nor bend. Thus the bathing of the baby becomes a pleasure
instead of a "job" or an "irksome task."
If the bathroom is not warm then the kitchen table or a small table
pulled up near the stove is a place par excellence for the dip.
Many boils seen on young baby's tender skin have been traced to the
careless use of the family tub to bathe the baby in. Not until the
child is two or three years of age, when his skin has become more
toughened, should he be allowed to use the family tub.
FREQUENCY OF BATHS
To begin with, we never bathe either a baby or an adult immediately
after a full meal. From one hour to one and one half hours should
intervene.
The frequency of baths depends somewhat upon the season of the year,
the vitality of the child, and the warmth of the home.
We have seen many infants who were bathed too often. The vitality
expended upon the necessary reaction following a tub bath was too much
for the little fellow; the daily bath was stopped and a semi-weekly
bath substituted, much to the gain of the child. Of course in this
instance the hands, face, and buttocks received a daily sponging.
The oil bath may be administered daily. In robust children the tub
bath may be a daily affair; while in pale, anemic little folks, the
tub bath is perhaps better given twice a week. In hot summer days a
sponge bath may be given many times a day.
BEST HOUR FOR BATHING
Again this depends upon several factors; the warmth of the house or
apartment, the vitality of the child, and the kind of bath to be
administered.
An oil bath may be given any time--often it may be administered
entirely under the bed clothes, only care must be taken to keep oil
from the blankets.
Many of our mothers prefer to give the tub bath at five o'clock in the
afternoon, when the house is thoroughly warm, and the child is thereby
prepared for the long night's sleep. Before dressing in the morning an
oil bath or rub may be given in such cases.
If the forenoon is selected as the time for bathing the child, then an
hour just before the mid forenoon meal is the best. In either event,
be regular about it--do it at the same time every day. Let the
caretaker attend to her many duties, and, as far as possible, mothers,
bathe your baby yourself. The folds of the skin, the creases in the
neck, the clenched fists, must all receive particular care, and no one
in all the world will ever care as you--the mother--cares.
SOAP AND WATER
Select a soap free from irritants and excess of alkalis. There are few
kinds that equal the old-fashioned, white castile soap our
grandmothers used.
Very hard water which makes the skin rough and sore may be improved by
boiling, but if possible substitute rain water for it. A flannel bag
tied over the faucet and changed each day will help to clarify muddy
water, provided the stream flows gently through it.
ROUTINE OF THE TUB BATH
Just as we directed the nurse or caretaker to stand while the oil rub
or sponge bath was given, so we admonish the mother to stand while the
tub bath is given. First, get everything in readiness for the bath as
directed for the oil bath, and then the baby's tub setting on the
securely cleated slats placed across the top of the family tub may be
filled with water by means of a hose attached to the faucet. The
temperature should be 100 F. when baby is dipped in to be rinsed.
The head and face toilet are identical with that described before, and
with the baby undressed and wrapped in a warm towel placed inside
the warm blanket on the pillow or comfort as before mentioned, we
proceed with a good lather of castile soap and water to lather the
baby's body all over--under the arms, the neck, chest, groins, thighs,
buttocks, legs, feet, and between the toes, while the genitals also
receive their share of attention. The foreskin of the boy baby is
gently pushed back and cleansed thoroughly; while the vulva of the
little girl baby, having first been swabbed with boracic acid, is now
gently lathered and cleansed. Now grasp the ankles and legs with the
right hand and support the upper back and neck and shoulders with the
left and gently lower the baby into the water in a semi-reclining
position (See Fig. 13). The water should cover the shoulders. Keep a
good firm supporting left hand under the head, neck, and shoulders,
and with the right, rinse all soap from the body.
[Illustration: Fig. 13. Supporting the Baby for the Bath]
After this is thoroughly done, lift the baby out onto a fresh warm
towel inside the warm blanket on the pillow, and remain standing,
while you gently pat (never rub) the baby dry. All the little folds,
creases, and places between fingers and toes, are carefully patted
_dry_, and where any two skin surfaces rub together put on a bit of
talcum.
The dressing takes place in the manner already described--first the
shirt, then the band (sewed on), the diaper, stockings, skirt, and
gown.
Please note that the soap bath is contra-indicated (should not be
given) in case of eczema.
BABY'S DAILY RUB
This soap bath should be administered for cleanliness only, and should
be given twice a week. If a tub bath is to be given on other days,
after the routine head and face toilet, the baby is simply dipped into
the water and the soft skin gently rubbed.
If the sponge or tub bath is given in the afternoon just before the
long sleep at night, then the oil rub should take place before the
mid-forenoon meal; and likewise, if the sponge or tub bath is given
during the mid forenoon, then the oil rub or dry hand rub is given
before the going-to-bed time. The rub should be a daily procedure for
the first two years. Nothing rougher than the soft palm of the hand
should be rubbed on baby's soft skin.
USE AND ABUSE OF TALCUM
Babies have come to my clinic with _cakes_ of talcum under their arms,
and particularly between their thighs and in the crease of the
buttocks. Here the well-meaning but thoughtless mother had reasoned,
"a little is good; more is better" which is not always the case.
Talcum is not used to replace careful drying, and it should never be
found in quantities on the baby's skin any more than you would expect
to find quantities of face powder caked in the creases of the neck or
behind the ears of an adult. The skin is first cleaned, then patted
entirely dry, and, as a finishing touch, a bit of talcum is put on by
means of a puff.
TONIC AND MEDICATED BATHS
Tonic baths are usually given to older children when they are able to
enter into the sport and frolic of a cool bath. Baths are called tonic
because they call forth from the body a reaction--a sort of
circulatory rebound. This rebound or reaction brings the blood to the
skin, increases the circulation, and tones up the nerves. The room
should be properly warmed and, if necessary, some form of exercise be
continued after the bath to prevent the chill that sometimes follows a
poorly administered bath.
In the case of the anemic child, after six months of age, the mother's
hand dipped in cold water may briskly rub the chest and back until it
glows or becomes red. The child should enjoy this bath. Never frighten
a child by throwing cold water on it or by giving it a too sudden cold
plunge; great harm may be permanently done by these efforts to
"toughen the baby."
The simple medicated baths may be administered according to the
following directions:
_Salt._ Use half a teacup of common salt or sea salt to each gallon of
water. The salt should first be dissolved in a cup of warm water to
prevent the sharp particles from pricking the skin. The doctor
sometimes orders a salt bath.
_Starch._ Add a cup of ordinary, cooked laundry starch for every
gallon of water in the bath.
_Soda._ A soda bath requires two tablespoons of ordinary baking soda
to a gallon of water, dissolving it in a little water before adding it
to the bath.
_Bran._ Make a cotton bag of cheesecloth or other thin material, six
inches square. Fill loosely with bran. Soak the bag in the bath water,
squeezing it frequently until the water becomes milky.
Starch, soda, and bran baths are often used in place of the ordinary
soap and water bath when the skin is inflamed, as in cases of chafing
or prickly heat.
FEAR OF BATHS
Force and harshness are not likely to cause baby to overcome very much
of the fear of a tub bath. Patience, perseverance, and purposeful
diversion of mind will bring sure results.
In the case of a very young baby, have a helper stretch a towel across
the filled baby tub, lay the baby in it, with its head well supported,
and then gently lower the towel into the water, keeping the head out.
(Most anyone would fear an all-over ducking, if he had ever been
completely ducked into water by a careless or mischievous friend).
In the case of older children, celluloid ducks, fish, or boats may
float about on the water, and the entire bath be forgotten by the
little fellow's enjoyment of "his boats."
OUT OF DOOR BATHING
Although a baby under two years should never be given a sea bath,
a word of caution about sea bathing for young children may not be
amiss. The cruelty with which well-meaning parents treat young,
tender children by forcibly dragging them into the surf, a
practice which may be seen at any seaside resort in the summer,
can have no justification. The fright and shock that a sensitive
child is thus subjected to is more than sufficient to undo any
conceivable good resulting from the plunge. On the other hand, a
child who is allowed to play on the warm sand and becomes
accustomed to the water slowly and naturally will soon learn to
take delight in the buffeting of the smaller waves, but he
should not be permitted to remain more than a minute or two in
the water, and should be thoroughly dried, dressed immediately,
and not left to run about the beach in wet clothing.
MILK CRUST
Any roughness on the scalp must receive immediate attention. This
roughness, or milk crust, is entirely avoidable; it is the result of
accumulated oil and dirt. When it has formed a complete crust or cake,
it may quickly become eczematous and require a physician's advice;
however, in the beginning, at the first sight of brown patches or
roughness, oil the scalp thoroughly at night with vaseline or cold
cream, which should be gently rubbed off in the morning.
This vaseline or cold cream should be applied repeatedly, several
nights in succession, followed by the morning's gentle rubbing and
daily washing of the head. Often the washing with water must be
entirely avoided; only sweet oil or vaseline being used in those cases
where the crusting seems to be persistent.
THE EYES, EARS, AND NOSE
At birth the eyes are particularly cared for. First, the mucus is
gently swabbed off the closed lids from the nose side outward, and
then follows the application of one drop of twenty per cent argyrol or
two per cent silver nitrate, either of which thoroughly disinfects the
eye and prevents the growth or development of any bacteria that may
have gotten into the child's eye during the descent of the head
through the birth canal. The neglect of this procedure may sometimes
result in lifelong blindness.
Under no circumstances should "a mere cold in the eyes" be neglected;
it may result in blindness. Call your physician at once, and if he is
not at hand, wash out the eye thoroughly every hour with warmed ten
per cent boracic acid solution, by means of a medicine dropper, using
a separate piece of cotton for each eye, for if the slightest bit of
discharge be carried from one eye to the other an inflammation will
quickly appear.
From birth, especially during the first week, baby's eyes are very
sensitive to light; hence they must be carefully protected. Babies
should be so placed during their outings, sleep, or naps, that they do
not directly gaze at either the sunlight or sky. The lining of the
hood of the carriage should be green, instead of white, as much eye
strain is thus prevented.
The daily care of the normal, well eye has been already described, and
while it need not be reiterated, we may say, in passing, that if the
eyelid be at all inclined to be sticky or adherent, never use force,
but instead, gently swab with boracic acid. As a preventive of this
condition, a little vaseline from the tube may be rubbed on the edges
of the lids at night.
In the toilet of the ears, never attempt to introduce anything beyond
the external ear, which may be carefully cleansed with a soft cloth.
It is often found necessary to apply oil to the creases behind the
ears before the daily bath. There should be no irritation, redness, or
roughness present, all such conditions being readily prevented by the
use of oil or vaseline before the bath.
With the sharp point removed, make a cotton applicator out of a
toothpick, and gently (with no force, whatever) introduce vaseline or
oil into the nose. This should be a part of baby's daily toilet. Any
stoppage of mucus or snuffiness in the nose should be reported at once
to baby's physician. Young babies often have adenoids.
CARE OF THE MOUTH
Leave the well mouth alone until the teeth appear, and then keep the
teeth very clean (allowing no particles of milk to accumulate at their
bases) with a soft bit of cotton and gentle rubbing. When a child
attains the age of two, he should have his own toothbrush; previous to
this time all food particles should be removed from between the teeth
with waxed silk floss. All decay should be promptly attended to by a
competent dentist.
Thrush and ulcers are often caused, not prevented, by the frequent
wiping out of baby's tender mouth. The treatment of thrush and other
mouth infections will be considered in a later chapter, "The Common
Disorders of Infancy."
THE CARE OF THE GENITAL ORGANS
Before the bath, the baby girl's genitals are carefully swabbed
between all the folds with boracic acid solution. The foreskin of the
boy baby should be pushed well back and washed gently with water. If
the foreskin of the male child be long, tight, or adherent,
circumcision is advised. See our chapter, "Teaching Truth."
The genitals of both the boy and girl should be kept scrupulously
clean every day, with as little handling as possible, and, upon the
appearance of the least swelling, discharge, or even redness, the
physician's attention should be at once called to it. In a later
chapter, the subject of irregularities of sex habits will be taken up.
CARE OF THE BUTTOCKS
Often, because of irritating bowel movements, the buttocks become
reddened, chafed, and sometimes raw in places. Some poor little babies
are sometimes roughly rubbed--scoured on the buttocks--much like the
kitchen sink, many times a day, and it is not surprising that they
become reddened, chafed, and very much inflamed.
The buttocks require a gentle swabbing and thoroughgoing "patting dry"
after each soiling or wetting of the diaper, but no soap is required
in this region but once a day, and even then it should be used
sparingly.
When the buttocks are inflamed, after a good cleansing with water and
a thorough drying, vaseline or zinc ointment should be applied on a
piece of sterile cotton, and this application should be repeated after
each changing of the diaper. Wet diapers should be removed at once,
for the acidity of the urine causes more chafing. A dusting powder
composed of starch two parts, and boracic acid one part, may be dusted
on after a cleansing with oil.
Great care should be exercised in the thorough daily rinsing of the
diapers as well as in the tri-weekly boil in the laundry. White soap
only should be used in their cleansings; no washing sodas or other
powders should be used.
OTHER SPECIAL CARE
Under the arms and in the creases of the neck the skin sometimes
becomes irritated because of neglect. To prevent such chafing the
following program should be carefully carried out:
1. Not too much soap--and no strong soap.
2. Careful rinsing of the skin area.
3. Avoid harsh rubbing, but thoroughly dry.
4. The use of talcum powder in all folds of the skin.
With a fine camel's hair brush the hair should receive its brushing
after the cleansing of the scalp. Combs are for just one purpose and
that is to part the hair. The brush should be used to do all the
smoothing.
While the frequent trimming of the hair has no marked effect upon its
growth, yet the comfort the little girls enjoy, especially during the
warm-weather months, should not be denied them.
And certainly the boy should become a boy when he puts on trousers and
not be made the laughing stock of his mirthful companions just because
his "beautiful long curls are much admired by the mother and his
aunts."
The finger nails should be trimmed round with the scissors, while all
hangnails are properly cared for every day. Toe nails should be cut
straight across and the corners never rounded off. Many ingrowing
nails may be thus avoided.
CHAPTER XXI
BABY'S CLOTHING
The Eden story suggests that in the beginning of our racial experience
artificial clothing was unnecessary; but after a time, in that
selfsame garden, proper clothing became an important problem and has
remained so ever since. Everybody seems to agree, however, that baby's
clothing in particular should at least be comfortable. It may give the
child great discomfort because it may be too warm, or it may not be
warm enough, or it may be too tight, and so, in the discussion of
baby's clothing in this chapter, we are going to keep in mind these
two things--comfort and heat.
GENERAL SUGGESTIONS
The choice of material demands some thought and attention. As a rule,
baby's clothing materials should be light in weight, good moisture
absorbers, and at the same time able to retain the body heat. Most
layettes have the common fault of being prematurely outgrown; and so
it is well to allow for ample growth in making baby's first clothes.
Since the principal object of clothing is to insure a uniform body
temperature, it is important that the mother be constantly on her
guard to keep the baby cool enough in the summer and warm enough in
the winter.
The mothers of various races and nations have their own ideas
concerning the clothing of their babies. One mother will wrap her baby
in cotton, which is held in place by means of a roller bandage, and as
you visit this home during the first week of baby's life, you will be
handed a little mummy-shaped creature--straight as a little poker--all
wrapped up in cotton and a roller bandage. The surprising feature is
that the baby does not seem to complain.
In another district of the city we find the baby dressed in starched
clothes, ribbon sashes, bright ribbon bows on its arms and around its
neck. At first glance you wonder if the little child is not many years
older and is about to make a visit to a county fair, but on inquiry we
find that he has only been prepared for the event of circumcision on
the eighth day.
And if you go into the forest of primeval days you will find another
mother bandaging her baby to a board, head and all, and he seems to
live and thrive in his little woven nest strapped on the back of his
Indian mother.
Other babies in the warmer portions of the earth have almost less than
nothing on, and are left to be swung by the breezes in little baskets
tied to the boughs of trees; being taken up only when it is time to
feed.
BABY'S LAYETTE
In preparing an outfit for the newcomer it is wise to provide for the
necessities only, because of the fact that since the baby grows very
fast the layette will soon have to be discarded; it is always possible
to get more clothing after the baby is here and started on his little
career. We offer the following list of essentials for the new born
baby:
Slips 8 to 10
Skirts (flannel) 3
Shirts 3
Light-weight wool wrappers 2
Abdominal bands 3 to 5
Diapers (first size) 2 doz.
Diapers (third size) 2 doz.
Stockings, pairs 3
Booties, pairs 3
Nightgowns 7
Handling blankets 2
Silkaline puffs 2
Baby blankets, pair 1
Hair or cotton mattress 1
Basinet 1
BANDS AND SHIRTS
The binder should be made of an unhemmed strip of flannel six inches
wide and twenty inches long, so that it goes around the abdomen once
with a small overlap. This binder should be sewed on instead of being
pinned, and serves the purpose of holding the dressings of the cord in
place. It is usually worn from four to six weeks, when it is replaced
by a silk and wool barrel-shaped band with shoulder straps and tabs at
the bottom, both front and back, to which may be pinned the diaper.
This band is worn through the first three or four years to protect the
abdomen from drafts and chilling, thus guarding against those
intestinal disturbances which are caused by sudden weather changes.
There is great danger of having the bellyband too tight, and, in the
early weeks, it is often the cause of great discomfort--often
interfering with the normal expansion of the stomach at meal time.
No matter what the season, the new-born baby should be clothed in a
light-weight silk and wool shirt, preferably the second size. After
the first month, if the weather is exceedingly warm, this woolen shirt
may be displaced by a thin silk or lisle shirt. In buying the
second-size shirts always secure the stretchers at the same time, for
in the laundering they soon shrink so that they are very uncomfortable
for the young babe.
DIAPERS
There are a number of materials on the market from which comfortable
diapers may be made for the baby. The cotton stockinet (ready-made
shaped diaper) is excellent, fitting smoothly at the waist, while it
is large and baggy at the seat, thus permitting not only a comfortable
feeling but the free use of the hips, without the bulkiness of the
ordinary diaper.
The large square of cheesecloth is easily laundered, and if an inside
pad is used makes a very acceptable diaper.
The stork diapers are made of materials resembling turkish toweling
and are used to some extent. This diaper should not be confused with
the stork rubber diaper which will be spoken of later.
Birdseye cotton is popular and extensively used. It absorbs quickly,
and is much lighter in weight than linen. The first- and third-size
widths should be purchased as a part of the layette, and the number of
diapers needed depends upon the opportunities to wash them out, for
diapers are never used but once without washing; they should always be
quickly rinsed and dried in the sunshine if possible. So if there are
good laundry privileges, and daily washing is possible, the mother can
get along with fewer diapers, but no less than four dozen should be
provided.
The diaper pad will be found convenient and serviceable in the early
days when the skin of the child is so very tender. This pad should be
pieces of clean old linen or small pads of absorbent cotton.
CHANGING THE DIAPER
During the mother's waking hours, the diaper should be changed as soon
as it is soiled or wet. If the child cries during the night it should
be changed immediately, but the mother should not feel called upon to
lay awake nights merely to change the baby's napkin when it is soiled.
If she places a pad underneath the baby, which will absorb the urine
quickly, he often does not awaken or become chilled. The pad should be
sufficiently thick to ensure that the nightgown does not get wet.
RUBBER DIAPERS
Rubber sheeting diapers of any description should never be used. Avoid
all patent diapers with a covering or an inner lining of rubber, for,
like the rubber diaper, they not only irritate the child but also
retain moisture and heat, which produce such irritation and itching
that the subsequent "habit-scratching" often lays the foundation for
future bad practices. It is far better for the mother to carry about
with her, whenever it is necessary to take the baby away from home, a
rubber pad which she puts on her lap underneath the little fellow,
thus affording ample protection to herself without in the least
harming the baby.
STOCKINGS AND BOOTIES
During the winter months merino stockings are required, while during
the summer months a thin wool or silk stocking is sufficient; on the
extremely hot days thin cotton hose may be worn. During infancy, the
stockings should be fastened to the diaper with safety pins, while on
the second-year child, hose supporters attached to the waist are found
very convenient.
A friend told me the other day of a mother who told her the following
story: "Do you know, I don't have any trouble any more about my baby
keeping up his socks for I have fixed it so they won't come off any
more. Every time I looked at his feet he had kicked off his socks and
they were no good to him at all, so I took little chunks of brown
laundry soap, moistened them and rubbed his legs, as well as the
inside of his socks and I never, never have any more trouble with them
coming off."
It does not seem possible in this enlightened age that a mother could
be so ignorant as to keep the socks up with brown soap, but the friend
assured me it was a true story, and while it may shock some of my
readers as it did me, I must add, in passing to another subject, that
the use of round garters on little babies and young children is just
about as shocking.
During the fall, winter, and spring, booties are worn on top of the
stockings. These booties should be crocheted or knitted out of the
heavy Germantown yarn, and there should be enough of them so that the
child may have a clean pair on every day.
SKIRTS AND PETTICOATS
The flannel petticoat is made with yokes instead of bands, and during
the fall, winter, and spring these yokes are made of flannel like the
skirt and should have long sleeves of the same material. The yokes
should be made large enough so that they may be used during the entire
first year (the plait in the front can easily be taken out when the
baby is six months old so that it may be used much longer than if the
yoke is made without a plait). For the hot summer months, the yokes
should be a thin cotton material without sleeves; and, if the baby is
housed in an over-heated apartment, this fact should be borne in mind
and the winter skirt should be made accordingly. We have found,
however, that the baby who is amply protected and uniformly dressed,
does not require the outer bundlings that the poorly dressed child
requires. Part wool and cotton materials are very comfortable in the
overheated city apartments. White skirts are not necessary for small
babies. They only add extra weight and it is always foolish to put
anything on a small baby simply for looks.
NIGHTGOWNS, WRAPPERS, AND SLIPS
The nightgowns should be made of soft cotton flannel or stockinet. The
latter is really the better, and can be purchased in sizes up to two
years; it is absorbent, easily laundered, and may be conveniently
drawn up at the bottom by means of a drawstring.
At least seven nightgowns are needed. A fresh nightgown should be used
each day and each night during the first four or five weeks of baby's
life; while as he gets older (two or three years), the night drawers
with feet in them are used to advantage.
The wrappers are usually made of challis, nun's veiling, cashmere, or
other light woolen materials which can be readily washed. They are
very serviceable to wear over the baby's thin slips and on cool nights
they may be used over the nightdress. They should be simply made,
containing no heavy seams, and at the neck there should be the
simplest kind of a soft band that will in no way produce friction or
in any other way irritate the baby's skin.
Slips are usually made of some very soft material such as nainsook,
batiste, pearline, or sheer lawn cloth. Twenty-seven inches is the
length that will be found both comfortable and convenient. All laces,
ruffles, and heavy bands which will scratch or irritate should be
avoided as eczema is often caused by such mistakes.
SLEEPING BAG
The sleeping bag is of inestimable value, affording extra and secure
covering for the child, and peace of mind for the mother. In the early
weeks it should be made of light flannel, but as the child gets older
the sleeping blanket is made according to illustration (See Fig. 5) by
merely folding a blanket in such a manner that the child cannot
possibly uncover himself. The mother can sleep undisturbed, knowing
that the baby is always safely protected by at least one warm blanket
cover.
COMMON FAULTS WITH MOST LAYETTES
As a usual thing the first clothes are made too small. The sleeves are
too short as well as too small around. There is nothing more
uncomfortable than a tight sleeve. Everyone of our readers knows that,
and we recall one poor little fellow who kept up a fretful cry until
we took the scissors and cut the tightly stretched sleeve up to and
including the arm hole. He then relaxed and went to sleep. Sleeves
should be made two inches longer than they are needed at first, and it
is a very simple matter to pin them up or turn them back at the wrist.
They should be loose and roomy.
The yokes of the dresses usually are too tight before the slips are
discarded. Heavy seams and raw seams irritate and often make ugly
impressions on the baby's skin.
Usually the first layette is profusely embroidered, and, while it is
beautiful to look at, the mother feels when she sees it outgrown so
quickly that a lot of vital energy was wasted on garments that
mattered so little as long as baby was comfortable. Baby is dear and
sweet enough without the fuss and furbelows of such elaborate
garments.
Heavy materials are sometimes used where lighter ones would serve
better.
ERRORS IN CLOTHING
A soiled garment should never be put back on the baby. Dirt draws
flies, and flies are breeders of disease. Sour-smelling garments
should be changed at once. They are likely to make the baby sick and
interfere with his appetite if left on indefinitely. The care of the
diaper has already been mentioned.
The main symptom of too much clothing is sweating, and when the baby
sweats something must come off. If he has perspired so much that his
clothes are moist, the clothing should be changed and the skin well
dried with talcum powder. The feet and hands should be kept warm, but
the little head should always be kept cool. When the baby is crying
and getting his daily exercise, remove some of the covering, loosen
his diaper, and let him kick and wave his arms in perfect freedom.
When the baby's feet and hands are cool he is not warm enough. Cotton
underskirts cannot be used in the dead of winter on little babies.
They do not hold the body heat as woolen garments do. The baby's feet
should always be warm and this is particularly necessary in poorly
nourished children. The outer wrapper of woolen material should be
added to such baby's clothing. It is a safe rule to follow that if
baby's hands are warm and he is not sweating, he is "just about
right."
SHORT CLOTHES
At the age from four to six months, baby's clothes are shortened. This
should not take place at the beginning of winter if it can be avoided.
If the first layette has consisted of only the necessary garments,
they are nearly worn out by the time the short clothes are due; of
those that do remain, the sleeves should be lengthened, the arm holes
enlarged, and all the little waists let out. Creeping garments and
bibs are now added to baby's outfit, as well as leggings and other
necessities for outdoor wear. Remember that all garments must be
loose--then baby is happy.
About the same number of garments are found necessary for the short
clothes as were required at first; except that a large number of
creeping rompers should be added. These creeping rompers should not be
made of dark materials that do not show the soil. We desire the dirt
to be seen that we may keep the baby clean, and if the creeping romper
is made of a firm, white material it may be boiled in the laundry,
thus affording ample and thorough cleansing.
We attributed a sick spell of one baby to the dark-blue calico
creeping romper which he wore day in and day out because it "did not
show" the soil. White ones are much to be preferred, not only for
looks but chiefly for sanitary reasons.
CAPS AND WRAPS
The cap should be made of a material that will protect from drafts and
cold air, but not of such heavy materials as will cause too much
sweating. There are a number of outside wraps that can be purchased
ready-made and which are comfortable, convenient, and warm. They
should be long enough not only to cover the baby's feet well, but to
pin up over the feet, thus giving good protection from winds and
drafts.
During the summer months nainsook caps or other thin materials are to
be preferred to the heavy crocheted caps that are sometimes worn by
babies. No starch should be used in the caps or strings, and there
should be no ruffles to scratch the delicate skin of the baby. In all
these outer garments, as well as the under garments, the irritation of
the skin must be constantly borne in mind, as eczema is often produced
in this manner.
THE FIRST SHOES
The first shoe that is usually worn during the creeping days is a soft
kid shoe without hard soles. It is important that this soft shoe be
worn to protect the child's foot from chilling drafts while creeping
about.
As the baby nears one year of age the hard-sole shoe is secured which
must be wide, plenty long and comfortable in every respect, and
without heels. Rubbers and overshoes may be worn on damp and cold
days. Moccasins and slippers do not give sufficient support to the
ankles, so, when the baby begins to walk, the shoes should be high and
of sufficient support to the tender ankles.
PLAY SUITS
As the baby grows up into the child, the tiny clothes are laid aside
and the boy is given substantial garments that in no way remind him of
girls' clothing. A child's feelings should be respected in this
manner, and while it often adds joy to the mother's heart to see her
boy "a baby still," remember that he is not only chagrined but is
nervously upset by these "sissy clothes."
A child three or four years of age should still wear the woolen binder
supported from the shoulders, over which is the union suit, stockings,
and the buttoned waist from which hang the hose supporters. The most
comfortable and easily laundered garment we know of for the small lad
is the "romper," which should be made of washable materials that may
be readily boiled. For cool days a Buster Brown coat of the same
material, with patent-leather belt, may be slipped on over this
washable romper--which completes the boyish outfit.
We recall the pleasant days with our own little fellow when he was
between the ages of two and one-half and five years. We were often
compelled to be away from home--on the train, in the hotel--and when
traveling we used a black, smooth silk material which was made up into
rompers with low neck and short sleeves. There were three such
rompers, and two Buster Brown coats with wide, black, patent-leather
belts which completed the traveling outfit. During the warm days on
the train the coat was folded carefully and laid aside. In the early
morning and in the cool of the evening the coat was put on, and he
always looked neat and clean. At night, before undressing him, the
entire front of the romper was cleansed with a soapy washcloth,
rinsed, and rubbed dry with a towel, and, after carefully spreading to
avoid wrinkles, it was hung over the foot of the bed. The coats were
sponged or pressed once or twice a week, and this simple outfit served
its purpose so well that it was repeated three different summers.
The little girl as she leaves her babyhood days should be put into
garments that do not necessitate the constant admonition, "Keep your
dress down, dear." We like to see knickerbockers, the exact color of
the dress, made for every outfit, in which the little girl may kick,
lie down, jump, dance, climb--do anything she pleases--unmindful of
the fact that her "dress is not down." The same undergarments are used
for the little girl as were mentioned for the little boy.
WINTER GARMENTS
Always bear in mind the over-heating of the child with heavy garments
indoors, and the danger of skin chilling and drafts on going out to
play in this over-heated condition. Let the children dress comfortably
cool in the house, and as they go out to play add rubber boots or
leggings and rubbers, sweaters, caps with ear laps or the stockinet
cap. Allow them the utmost freedom in clothes, and always encourage
romping in the cool frosty air.
CLOTHING RULES
Do not overload the baby with clothing.
Dress according to the temperature of the day and not the season of
the year.
Avoid starched garments.
Avoid tight bellybands or old-fashioned pinning blankets.
Change all clothes night and morning.
Use woolen shirts and bands.
See that hands and feet are always warm.
Protect the abdomen night and day with the band.
Use the sleeping bag on cold nights.
Baby should sleep in loose stockings at night.
Avoid chilling the child.
Use hot water bags if necessary.
CHAPTER XXII
FRESH AIR, OUTINGS, AND SLEEP
Fresh air is just as important and necessary for the baby as for the
adult. Neither baby, youth, nor adult can receive the full benefit of
his food--in fact it can not be burned up without the oxygen--without
an abundance of fresh air. During the early weeks of life, the air
baby breathes must be warm; nevertheless, it must be warmed _fresh_
air, for baby requires fresh air just as much as he needs pure food.
INDOOR AIRING
The delicate child often requires more fresh air than does the normal
baby. Both appetite and sleep are improved by fresh air. The digestion
is better, the cheeks become pink, and all the signs of health are
seen in the child who is privileged to breathe fresh air.
During the early days, say after the third week, baby should be well
wrapped up with blanket and hood, tucked snugly in his basinet or
carriage, while the windows are opened wide and the little fellow is
permitted to enjoy a good airing. Even in the winter months the
windows may be raised in this way for a few minutes each day. These
"airings" may be for ten minutes at first, and, as the child grows
older, they may be gradually increased to four or five hours daily.
The carriage or basket should stand near the window, but not in a
direct draft.
OUTDOOR LIFE
In summer, a baby one week old may be taken out of doors for a few
minutes each day; in the spring and fall, when baby is one month old,
it may go out for an airing; while, during the winter months, the
airing had better be taken indoors until he is about two months old,
and even at that age he should go out only on pleasant days and should
always be well protected from the wind.
A young baby may enjoy the fresh air in his carriage or crib on the
porch, on the roof under suitable awnings, in the yard, under the
trees, and even on the fire escape. In fact, at proper age and in
season, he may spend most of his time out of doors in the fresh air,
if he has proper protection from the sun, wind, and insects.
BEST HOURS FOR AIRING
During the balmy days of summer and early autumn, baby may spend most
of the time outdoors between seven in the morning and sunset. During
the cooler days of winter and the cool and windy days of spring, the
best hours for the airing are to be found between eleven in the
morning and three in the afternoon.
At six weeks, perhaps an hour a day in the fresh air is sufficient;
while at six months, four to six hours a day are a necessity, and from
then on--the more the better.
Now we realize that the mother of the farm household does not always
have as much time to take the baby out for his airings as many of our
city mothers; but we suggest to this busy mother that the baby be
rolled out on the porch or in the yard, within her sight and hearing,
and allowed to enjoy the fresh air while the mother continues her
work.
It is virtually a crime to try to keep baby in the kitchen, hour after
hour, while the busy mother is engaged at her tasks. A hammock, a crib
on casters, or a carriage, is just the coziest place in the world for
baby--out on the porch.
THE COUNTRY BABY
The average city baby really gets more fresh air than ninety per cent
of the country babies. Our city apartments are usually steam heated,
and our windows are open in the winter nearly as much as in the
summer. The country home is often only partially heated by two or
three stoves. The windows are closed in summer to keep out the dust,
heat, and flies, in the winter to shut out the cold, and so the baby
who lives in such a home has little chance to get fresh air.
The city mother is constantly talked to about the benefits of fresh
air. The daily paper brings its health column to her, her pastor talks
of it on Sunday, and--best of all--the older children come home from
school and reiterate the doctrine of fresh air that is constantly
being preached to them at school.
Screen the windows, rural mother, and oil the roads in front of your
residence, and then keep your windows open. Remember that baby's
health is of more value than the meadow lot or even a fortune later on
in life. Plan for a new heating plant, if necessary, so that the home
can be both warmed and ventilated during the winter.
WHEN NOT TO TAKE BABY OUT
If a sheltered corner of the porch is within the reach of the mother,
we can hardly think of a time when the baby cannot be taken out. It
may rain, the wind may blow, it may snow or even hail, but baby lies
in his snug little bed with a hot water bottle or a warmed soapstone
at his feet. As long as the finger tips are warm, we may know he is
warm all over, and a long nap is thus enjoyed in the cool fresh air.
When the sheltered corner of the porch is lacking, we wish to caution
the mother concerning the following weather conditions:
1. When the weather is excessively hot, take him out only in the early
morning and late in the afternoon.
2. In extremely cold, below zero, weather, let his airing be indoors.
3. Sharp and cold winds may do much mischief to baby's ears, as well
as blow much mischief-making dust into his nose and eyes. In the case
of dust or sand storms, baby remains in the house.
4. All little people enjoy the rain, and only when the raincoat,
rubbers, and umbrella are missing should they be robbed of the
"rainy-day fun". In the case of baby's outing on rainy days, ample
roof protection is the only factor to be considered; if it is
adequate, then take him out; if it is lacking, let the airing be done
indoors.
WINTER OUTINGS
The very young baby is taken out for a fifteen-minute airing during
the noon hour when he is two months old; before this time he receives
his airing indoors. The interval is gradually lengthened until most of
the time between eleven and three is spent out of doors. The reddened
cheeks, the increased appetite, all tell the story of the invigorating
benefits of cool, fresh air. Most babies dislike heavy veils, and they
may be avoided by a fold of the blanket arranged as a protection
shield from the wind.
The wind shield, procurable wherever baby carriages are sold, should
be a part of the outdoor equipment, as it greatly helps in the
protection of the baby.
The wind should never blow in his face; neither should he lie,
unprotected, asleep or awake to gaze up into the sunshine or the
sky--or even at a white lining of the hood of his carriage. The lining
should be a shade of green, preferably dark green. And while it may be
necessary during the summer to suspend a netting over the carriage to
protect from flies, mosquitoes, etc., it should never lie on his face.
OPEN WINDOWS
Many of our readers recall with sadness of heart a little hunchback
child or a life-long invalid confined to a bed or wheel chair because
some careless but well-meaning caretaker or mother left an open window
unguarded; and--in an unlooked for moment--baby crawled too near,
leaned out too far, and fell to the ground. The little fellow was
picked up crippled for life; and so while it is very essential to
baby's health to have open windows, admitting fresh air, they should
be amply guarded. Screens afford protection if well fastened, and in
their absence a slat three inches wide and one inch thick may be
securely fastened across the opening, thus preventing all such
tragedies with their life-long regrets.
SLEEP
If any of our readers have seen a new-born baby immediately after he
has been washed, dressed, and comfortably warmed, they have observed
that he usually goes to sleep at once, and that he generally sleeps
from four to six hours. Babies, especially new-born babies, need just
four things: warmth, food, water, and sleep.
And while the babies sleep they are not to be disturbed by the fond
mother's caresses and cuddling--feeling of the tiny hands, smoothing
out the soft cheek, or stroking his silky hair--for all such mothers
are truly sowing for future trouble. Let baby absolutely alone while
sleeping, and let this rule be maintained even if some important guest
must be disappointed. If such cannot wait till baby wakens, then he
must be content with the mental picture drawn from the mother's vivid
description of baby--his first smile, his first tooth, his first
recognition of the light, etc. The wise mother cat never disturbs her
sleeping kittens.
SLEEP REQUIREMENTS
Sleeping, eating, and growing occupy the whole time of young babies.
Until they are two months old they need from eighteen to twenty hours
sleep out of each twenty-four; and not less than sixteen hours up to
the end of the first year.
At six months, baby should sleep right through the night from six in
the evening until six in the morning, with a ten o'clock feed, which
should be given quietly, in a darkened room, the babe being
immediately returned to his bed.
At two or three years of age, twelve to fourteen hours of sleep is
required; while at four to five years, eleven to twelve hours are
needed; when they attain the age of thirteen years they should still
have ten hours of unbroken sleep each night.
As a general rule, children should sleep alone; even in the case of
two brothers or two sisters, separate beds are far better than a
double bed for both hygienic and moral reasons.
Baby should have a separate bed. The temptation to nurse him on the
least provocation, as well as the danger of overlying, are reasons
enough for such an arrangement.
PUTTING BABY TO SLEEP
At five-thirty in the afternoon, baby should be undressed, rubbed or
bathed, made perfectly comfortable, and fed; then, my mother reader,
he should be laid down in his little bed and allowed to go to sleep,
without any coaxing, singing, rocking, or even holding his hand.
Babies will do this very thing and continue to do it if you never
begin to rock, jolt, bounce, or sing to them; and, mind you, if you do
sing to them or rock them, or even sit near without doing anything but
"just hold their tiny hands," there will come a time when you greatly
desire to do something else--you have many urgent duties awaiting
you--and baby not being old enough to understand the circumstances,
begins to wail out his feeling of neglect and abuse. It is nothing
short of wicked thus to spoil a child.
We have seen so many beautiful babies go to sleep by themselves
without any patting, dangling, or rocking, that we encourage and urge
every mother to begin right, for if the little one never knows
anything about rocking and pattings he will never miss them; and even
if the baby is spoiled through extra attention which sickness often
makes necessary, then at the first observance of the tendency on the
part of the child to insist on the rocking, or the presence of a light
in the sleeping-room, or the craving for a pacifier, we most strongly
urge the mothers to stick to the heroic work of "letting him cry it
out."
The notion that the household must move about on tiptoes is not only
unnecessary but perfectly ridiculous. From the very hour of his birth,
let the child become accustomed to the ordinary noises of the home,
and if this plan is early started he will prove a blessing and a ray
of sunshine to the family and not an autocrat to whom all must bow and
bend the knee.
BEDTIME AND SLEEPING POSITION
Bedtime is regulated somewhat by the hour of rising in the morning.
Usually, up to two years, baby is put to bed from five to six P. M.
Regularity is urged in maintaining the bedtime hour.
The seven o'clock bedtime hour is later established and continued
until the young child attains school age, when retiring at the curfew
hour of eight o'clock gives our boy or girl from ten to eleven hours
of sleep, which is essential to proper growth, calm nerves, and an
unruffled temper.
The first few days finds our little fellow sleeping nine-tenths of his
time. Let him lie on his right side, for this favors the complete
closure of the fetal heart valve, the foramen ovale.
Whether baby lies on his stomach, his side, or with the hands over his
head is of little or no consequence. His position should be changed
first from one side to the other until he is old enough to turn
himself.
WAKING UP AT NIGHT
Before baby is three months old, he should receive nourishment during
the night at nine and twelve, and again at six in the morning. After
four or five months a healthy child should not be fed between the
hours of ten P. M. and six A. M. At this age, many children sleep
right through from six P. M. to six A. M. without food.
After five months, if a healthy baby awakens between ten P. M. and six
A. M. warm water may be given from a bottle; he soon forgets about
this and the night's sleep becomes unbroken. There are many other
reasons than the need of food that cause the wakefulness of the child;
and since the baby should, after a few months, sleep undisturbed and
peacefully, if he is wakeful and restless--crying out in a peevish
whine--and then quiets down for a few moments only to cry out again,
you may suspect one of a half-dozen different things. Let us,
therefore, summarize the things which may disturb baby's sleep:
1. _Lack of Fresh Air._ Babies cannot sleep peacefully in a hot,
stuffy room, or in a room filled with the fumes of an oil lamp turned
low. A crying fretful baby often quiets down as if by magic, providing
he is not hungry and the diaper is dry, when taken into a cool room
with fresh air. After the first two months the temperature of the
sleeping room should be fairly cool and fresh.
2. _Clothes and Bedding._ The night clothes may be irritating and
causing perspiration, while the bedding may be wrapped too snugly
about the child. If baby's neck is warm and moist, you may know that
he is too warm. If the diaper is wet it should be changed at once. One
of the worst habits a baby can possibly get into is to become so
accustomed to a wet diaper that it does not annoy him. In cold
weather he is changed under the bed clothing without exposure or
chilling. It may be the bedding is cold and, if so, it should be
warmed up by the use of the photophore previously described, or by
means of the flannel-covered hot water bottle.
3. _The Food._ Too little, too much, or the wrong kind of food, will
disturb baby's sleep. Indigestion is very easily produced in babies
who are improperly fed. For instance, the mother's milk may be lacking
in nourishment and baby may really be hungry; or, as in the case of a
bottle-fed baby, it is usually due to over feeding. Many mothers we
have known who sleep with their babies or who sleep very near them,
nurse them every time they wake up or murmur, and this soon becomes
one of the biggest causes of disturbed sleep.
4. _Spoiling._ A lighted nursery or bedroom, rocking to sleep, jolting
the carriage over a door sill or up and down, the habit of picking
baby up the moment he cries, late rompings--any and all of these may
disturb sleep, as well as unsettle the tender nervous system of the
child, thus laying the foundation for future nervousness,
neurasthenia, and possibly hysteria. This is particularly true in the
case of the children who have nervous parents.
5. _Reflex Causes._ Wakefulness is sometimes due to reflex nervous
causes such as the need for circumcision, or the presence of adenoids,
enlarged tonsils or worms. Does baby have to breathe through his
mouth? Then you may suspect adenoids or other conditions which should
be removed.
6. _Chronic Disorders._ The presence of scurvy or syphilis causes the
child to cry out sharply as if in acute pain, while in older children
tuberculosis of the spine or hip is attended by a sharp, painful
crying out during sleep. Malnutrition or anemia are also conditions
which greatly disturb sleep.
7. _Soothing Syrups._ Untold trouble, both physical and nervous, is
bound to follow the giving of soothing syrups. These medicines soothe
by knocking the nerves senseless and never by removing the cause. They
contain morphin, opium, cocain, heroin, and other drugs which deaden
pain, and are most dangerous to give baby.
DAILY NAPS
The morning nap from the sixth month on should be from two to three
hours long, out on the porch, well protected; while the afternoon nap
may be from one to one and a half hours long with an interval of two
or three hours before bedtime. The child should be wakened at regular
intervals for feedings during the day--every three hours until he is
six months old, and then every four hours. These naps should be taken
in a cool place--on the porch, on the roof, in the yard, under a tree,
or on the protected fire escape.
If the nap is to be taken indoors, then lower the windows from the top
and darken the room. All children should take daily naps until they
are five or six years old.
CHAPTER XXIII
BABY HYGIENE
Possibly if all our babies could grow up in a mild, warm climate, out
of doors, where they were cared for by mothers who had nothing else to
do but enjoy nature in a garden, their babies unhampered by clothes
and other conventionalities inflicted upon us by our present standards
of living--well, if that were our environment, probably this chapter
on baby hygiene would not need to be written. But realizing that
variable climatic conditions, the indoor life, and the necessary
bundling up with clothes, all tend to increase the ever-present danger
of infection from thickly settled peoples and their domestic
pets--these facts, together with the further fact that modern social
conditions make it necessary for some mothers to toil long hours--all
these influences, I say, considered separately or combined, make it
imperative for us to give thoroughgoing consideration to the
essentials of baby hygiene. The subjects of fresh air, sleep, bathing,
etc., have been duly discussed in previous chapters.
WATER DRINKING
As soon as the newborn baby has been washed and dressed, before he is
put to sleep, he is given two teaspoons of warm, boiled water in a
sterile bottle with a clean nipple. This is repeated every two hours
when he is awake, until he is old enough to ask for water himself.
This water should contain no sugar, or anything else--just clean,
boiled water. It is better to give this water from a bottle; for in
case of enforced weaning, this practice of taking his water from a
bottle, will have made him acquainted with that method of feeding.
URINATION
The baby may pass very little urine during the first day or two of his
life, but if the warm, boiled water is administered regularly, the
urine will soon become more abundant.
As the child nears two years of age, if put to bed at six P. M. he
should be taken up at ten or eleven to urinate.
In older children, bed wetting is often corrected by serving the last
meal not later than four P. M. and not allowing any liquids after that
hour.
The physician should be consulted in all instances where the habit of
bed wetting extends beyond three years. The subject will be treated
more fully in a later chapter.
EXERCISE
A baby pen, lifted up from the floor, well protected at the sides, and
covered with mosquito bar--if exposed to flies or mosquitoes--affords
splendid opportunity for exercise. Here the little fellow may lay on a
well-padded mattress and kick, move his arms, and otherwise roll about
to his own satisfaction. It should not be in the direct sunshine, but
rather in a protected, somewhat shady place, yet where the air is pure
and fresh.
Much exercise is obtained from the daily cry. Here, the arms, legs,
hands and feet, as well as the body, are all exercised until the baby
is pink. A good rebound of blood is flowing through the well-warmed
skin, while the baby is greatly benefited by such daily exercise.
Later on, "creeping" is urged, but not forced. With regard to
standing--he will pull himself up on his feet just as soon as nature
qualifies him, and so he needs no urging or coaxing in this matter.
Older children should be encouraged in active romping, games, etc.,
rather than to spend the entire day in the more sedentary amusements,
puzzle pictures, etc.
It is a most abnormal situation when a three-, or four-year-old child
is content to sit quietly all day. There is usually something
seriously wrong with a child who never soils his rompers, who never
makes a noise, and who does not seem to enjoy normal play and fun.
Let the little folks early learn that the home is theirs to enjoy and
that their little friends are welcome; and thus you may be spared such
a reproof as one little lad of four unknowingly gave his mamma. His
little friend was approaching the stairs of the play room, when the
thoughtless mother carelessly and impatiently remarked: "Oh, are you
going to bring Ned upstairs? you'll make so much noise." The little
host met his friend at the top with the words: "They don't want boys
in the house, we'd better go outdoors." The mother "woke up" and
arranged a little "party" upstairs for the two husky, healthy--and
noisy--boys.
During the creeping days remember that the floor is the coolest part
of the room, and in the absence of the creeping pen, which is "built
up" two feet above the floor, extra clothing should be put upon the
child while on the floor. During the damp days of early spring and the
cool days of late fall, as well as on the bleak days of winter, baby
is better off if he is kept off the floor. It is a fine plan to put a
number of table boards on top of the springs of the baby's bed; in
this way a sort of pen is produced which is high above the cold floor
and the baby is content to spend much of his time in this little pen,
happy with his playthings.
KISSING THE BABY
We most strongly protest against the haphazard, promiscuous kissing of
babies. Many forms of disease, such as tuberculosis, syphilis,
diphtheria, influenza, common colds, etc., may be carried to the child
in this way.
The baby, notwithstanding his attractiveness, his beauty, and his
grace, should not be overfondled. Kissing the hand is not much better
than the mouth, for the hand quickly finds its way to the mouth. If it
be necessary to kiss a baby, then let the kissing be done on the back
of the neck or on top of his head, but never on the face or hand.
SUCKLING HABITS
There came into the office one day a woman forty or more years of age,
whose mouth was markedly disfigured, and on my inquiring as to the
probable cause she said: "Doctor, it is the result of sucking my thumb
when I was a mere child, too young to know better, and every time I
look into the glass, which I assure you is only when I am compelled
to, I curse my parents for not breaking me of that habit." The
indulgent parents were hated and despised for neglecting their duty,
because of the disfigurement which resulted from this unrestrained
habit of early childhood.
Thumb sucking, finger sucking, or pacifier sucking, are all filthy
habits, and should be early discouraged. To aid in overcoming the
habit of sucking the thumb or biting the fingernails, the ends of the
fingers and edges of the nails may be painted with a solution of aloes
or quinine. In extreme cases, a splint may be placed on the anterior
bend of the elbow, thus preventing the possibility of raising the hand
to the mouth.
The "sugar teat" of our mother's generation has passed, as has also
the "mumbling" of food for the young child; we no longer give the
babies concentrated sugar, nor do we "chew" our children's food at the
table.
Extreme cases of chalk or dirt eating have been noted; such tendencies
are decidedly abnormal, and require medical attention.
KEEP BABY WARM
Much colic and fretfulness may be avoided if baby is kept warm. The
finger tips are a good thermometer, for if they are warm the feet
usually are. "Bundling" is unnecessary, but careful attention should
be paid to keeping the feet and hands warm without making the child
sweat; that is an art, and all mothers should attain it. An extra
flannel wrapper and a pair of heavy wool booties in the winter are
good warmth producers. Cotton flannel petticoats should be replaced by
warm woolen ones, and when the baby begins to get about on his hands
and knees a pair of loosely fitting wool tights, made from discarded
woolen underwear are of inestimable comfort and value. In the effort
to avoid draughts and body chilling, ever bear in mind baby's need of
fresh air and the dangers of sweating, for the sudden cooling of a
sweating child is a forerunner of pneumonia, cold catching, diarrhoea,
and other troubles.
BABY'S TEMPERATURE
During early infancy, baby's temperature sometimes varies greatly; for
instance, a rectal temperature may register 97.5 or 100.5 F. while the
child may be in perfectly good health.
The baby's temperature should be taken at the rectum--which should
normally register 99.5 F. This temperature, as stated above, may
register 100.5 F., with no other symptoms of illness. In taking rectal
temperature the thermometer should remain in place two minutes.
The groin is the next best place to take the temperature; here the
thermometer should remain five minutes, and the registry is usually a
degree lower than that of the rectum.
The baby's temperature usually is a good guide to the severity of any
illness. In case the temperature runs above 101 F. the physician
should always be notified and his orders carefully followed. Slight
causes often produce a high temperature of 103 to 105 F. for a short
time; but such a temperature of long duration means serious trouble
and demands expert advice and attention. Abnormal temperature will be
more fully considered in that section of this work entitled "Common
Disorders of Infancy."
BABY BOUNCING
The common custom of bouncing or trotting baby on the knee is a
harmful one. The young and growing nervous system of the child is
decidedly injured by this constant jolting and jiggling, to say
nothing of the "spoiling" effects of this practice. There is a vast
difference between the sensitive nervous system of the infant, with
its liability to shock and disturbances, and that of the settled and
developed nervous system of an adult. The strength of the mother or
nurse is so great that the jarring not only often causes indigestion
and vomiting in the infant, but sometimes also lays the foundation for
"wrecked nerves" in later life.
The tossing of baby in the air comes in for the same condemnation.
Baby is not "our plaything," and must not be bounced and tossed about
like a rubber ball.
CARRIAGES AND GO-CARTS
The first carriage should be roomy and comfortable. The bed should be
thirty-three inches long and fourteen inches wide, and should be
twenty-eight or thirty inches from the floor. The wheels should be
rubber tired. The cover should be a good sized hood containing a dark
lining, and provided with a wind shield. This dark lining creates a
neutral shade for the eyes and protects them from the glare of the sun
and the bright skies.
The bed of the carriage should be soft and warm; and, with the size
before mentioned, there is ample room for the "tucking in" with warm
blankets, which are first spread out on the bed and then the baby
placed into the blanket, after which it is brought up and over him.
The folding go-cart and the small carrying-basket are to be used only
in an emergency. They are convenient in traveling or shopping for the
mother who has no maid or caretaker with whom to leave the baby; but
they are not satisfactory pleasure vehicles, neither should the baby
be left to sit fastened in one of these carts for any great length of
time.
The mattress of the carriage should be of hair, while needed warmth
may be secured by the use of a thick, light-weight woolen blanket,
placed under the child and brought up and around him.
A top covering for the carriage must have washing or dry cleaning
qualities. A crocheted afghan, a washable embroidered cover, or a firm
silk puff, are good covers. The one thing to be remembered is that
everything about the carriage soils readily, and if this thought
enters into the selection of fabrics, you will not be disappointed
when cleaning time comes.
The carriage pillow should be of down, except in the very hot months,
when hair is preferable. Simple, easily laundered slips may be made
from two men's-size handkerchiefs.
BOW LEGS
Particularly in boys and men, bow legs are not only awkward but are a
noticeable deformity; even the little folks notice them and often
remark about it, as did one child who sat profoundly eyeing a very
important visitor who stood before the cheerfully lighted grate
warming himself. The little fellow suddenly exclaimed, "Oh, Mister,
look out! You're warping." Such a painful experience might have been
saved this distinguished gentleman had his mother or caretaker not
urged his standing too soon; and at the same time had fed him on the
proper food, so as to avoid "rickets." The ossification or hardening
of the bones of the legs continues all through childhood and is often
interfered with by improper feeding during the first two years of
life. Urging the little people to stand too early is to be
discouraged. Nature prepares them for it when the right time comes;
which time varies--thin children standing and walking usually much
earlier than heavy children.
LIFTING THE BABY
A very young baby should be lifted from his bed by grasping the
clothing below the feet with the right hand, while the left hand slips
underneath the back and with spreading fingers supports the neck and
head. It is then raised upon the left arm. During the early months the
entire spine must be supported in this manner (See Fig. 6). In
grasping a baby under the arms or about the waist, undue pressure is
made upon the abdomen and chest. Serious injury often follows the
careless lifting of the older child by his wrists or hands. The
throwing or whirling of the older children by the arms is strongly
condemned. Dislocations have followed such careless so-called fun.
PREVENTION OF FALLS
In the selection of the high chair, care should be given to the
possibility of overturning. Fortunately, baby's bones are only
partially ossified, else he would sustain many fractures in the
frequent falls and bumps. When we pause to consider the thoughtless
manner in which many babies are left on beds and in unguarded chairs,
it is not strange that they fall so often.
Open windows must be carefully protected by well-fastened screens or
by slats of wood. Beds afford a good place for a romp or play, but
high-backed chairs should be placed at the side to prevent a fall. A
strap across the waist should be fastened to the sides of the carriage
to prevent falling out. Everything possible should be done to prevent
falls. Outdoor hammocks are exceedingly dangerous for the baby. Never
leave a child in one unguarded. A little caution, a large amount of
common sense--the "good use of brains"--will prevent scars and other
lifelong deformities.
THE BABY'S BREASTS
Never allow anyone to manipulate or "break down" a swollen breast in a
girl or boy baby during the first week or two. This swelling occurs
often and should not be interfered with. A hot compress of boracic
acid solution may be applied, after which a piece of sterile gauze
should be placed over the swollen part and held on by a muslin
bandage. Secure medical attention if the swelling does not go down in
a day or two.
VISITING
Unless absolutely necessary, babies should not be taken on trains and
street cars; nor should they take long journeys into the country to
attend "reunions." Infections accompany crowds, and baby is far better
off at home, in the quiet of his natural surroundings, than he is in
the dust, closeness, and bustle of illy ventilated cars, streets,
shops, movies, or even at church. Many an infant has been sacrificed
by a train journey to "show him off" to the fond grandparents; scores
of babies acquire whooping cough at the movies; and many a baby has
nearly lost his life by catching measles, scarlet fever, or diphtheria
at church; while the only thing accomplished by the church experiment
was the spoiling of the entire service by its fretful, tired cry--the
infant's only means of protest.
THE RUNABOUT BABY
"Runabouts" are the little folks between the age of one and three
years, and they require good care, good feeding, and warm and
comfortable dressing.
In general, they need the same fresh air, daily outings, and daily
naps of the younger child. Their hands need washing oftener, and their
clothing, which is usually a play romper, should be either of white or
fast colors that it may be most thoroughly boiled, thus getting a
good disinfection. Their eyes, nose, and ears, as well as the genital
organs, all require the most rigid daily cleanliness.
The "bugbear" second summer need not be feared by the mother who takes
particular care to see that:
1. The drinking water is boiled or distilled.
2. The orange is not overripe.
3. The banana is not underripe or overripe and is not eaten
in chunks.
4. The milk is fresh and pasteurized.
5. The baby does not eat candy, ice cream, or other forbidden
foods.
6. The baby's bowels move daily.
7. He does not remain dirty.
8. He naps daily.
9. He is protected from dust, flies, flees, and mosquitoes.
10. He does not go visiting, to church, shops, or "movies."
The second summer is no harder than the first, as good clean water,
easily digested foods, and good general hygiene are all a baby needs
at this time. A large army of little folks grow up in spite of the
little care they get and the place in which they live. Did they not
possess good vital resistance, sound nerves, and good digestion, the
children of the "slums" and of the "ghetto" would quickly succumb to
their unhygienic surroundings.
TOYS
In selecting toys for the infant, it must be borne in mind that they
will be put to the mouth, and hence they should not be:
1. Toys with sharp points.
2. Small enough to swallow, or to push into the nose.
3. Covered with hair or wool.
4. Glass that is easily broken.
5 Painted toys.
6. Toys that may be taken apart and the small parts swallowed.
7. Paper books that may be chewed or torn.
Bear in mind that babies are easily amused with such simple toys as:
1. A half-dozen clothes pins.
2. An aluminum pan and a spoon.
3. Rubber toys (easily washed).
4. Celluloid dolls, ducks, and other floating toys.
5. Blocks.
6. A large rubber ball.
The older children have wonderfully good times out of doors with a
spade, a cart, and the sandpile. Boys most thoroughly enjoy a track
with its engine and cars, switches, etc. They build sham
fortifications, truly works of art, with their blocks, while the girls
are happiest with dolls and household sets. However, occasionally we
meet a mother who has a girl who is really a boy in her tastes for
toys, and so we say to that mother: give the little girl the desire of
her heart; if it's a train instead of a doll, or a toy gun instead of
a doll's trunk, well and good, let her have them. What we want are
free and easy, natural, children. They are much more likely to have
good nerves, clean thoughts, sound digestion, and equalized
circulation.
CHAPTER XXIV
GROWTH AND DEVELOPMENT
The newborn baby comes into the world in an absolutely helpless
condition and completely unconscious of his surroundings. He
unconsciously performs certain acts, such as opening his eyes, crying,
urination, movement of the bowels, and even nursing of the breast; but
there is probably no distinct voluntary action connected with any of
these acts. All of his senses at birth are practically dormant, but as
the days and weeks go by, they begin to awaken.
SPECIAL SENSES
The baby cries, but the tears do not actually flow over the lids until
he is three or four months old, and while the baby may fix his eyes
upon objects and distinguish light from darkness, he will not wink nor
blink when the finger is brought close to the eye. Vision is probably
not complete until the beginning of the third month.
Infants are said to be deaf for the first twenty-four to forty-eight
hours after birth, and some authorities hold that they are deaf for
several days.
Taste is early developed, as a newborn baby will often repeatedly show
a desire to taste sweet things, while if sour or bitter things are put
to the tongue, it shows its displeasure.
HAIR AND SCALP
The newborn baby usually comes into the world with a good head of
hair, but the end of the first or second week witnesses the falling
out of much of this hair, and falling may continue for even another
week or two. The hair is often worn off on the back of the head
because of constant friction upon the pillow.
Children differ greatly in the growth of hair. Some of them come into
the world with heavy hair, and others lose it quickly and remain
nearly bald-headed until after the first year.
As the second hair grows in, it is usually lighter than it was at
birth and lighter than it will be later in life, as the hair has a
tendency to grow darker as the years go by.
The scalp should receive the care already mentioned. As the hair comes
in it should be shampooed once in two weeks and brushed often, making
it healthy and vigorous.
MISSHAPEN HEADS
It is wise to turn the baby first on one side and then on the other
and not allow him to sleep night after night on one side of his head.
The newborn head may be misshapen by laying the child constantly on
one side, and the ear may be misshapen if it is allowed to curl under
or become pressed forward. Markedly protruding ears may be partially
corrected by having the child wear a well-ventilated cap made for the
purpose.
THE SALIVA
Many mothers think that the presence of drooling or the excessive flow
of saliva is associated with teeth cutting. While it may be associated
with the teeth, this is not usually the case; it is more probably due
to the beginning of a new function of secretion. The newborn baby has
only enough saliva to furnish moisture for the mouth, and not until
the age of four or five months does saliva really flow, and since the
teeth appear a bit later we often confuse the institution of a new
secretion with the oncoming teeth.
SENSATIONS AND RECOGNITION
The young baby manifests a number of sensations early in its career.
Hunger and satisfaction as well as comfort and discomfort seem to be
recognized by the little fellow. He early learns that the approach of
someone when he cries usually means that he is to be taken up, and he
usually ceases crying as soon as he is taken up. He early manifests a
sense of comfort when he is cuddled; there also is early present a
manifestation of the desire to sleep, and the satisfying pleasure of a
drink of water.
At the age of three months he has recognized many things such as the
light or a bright object. He distinctly recognizes his mother and
often smiles at her approach. He recognizes his hands at four months,
and now begins to recognize other members of the household aside from
his mother. Even as early as one month, he may smile at his mother. At
two months of age he will often smile at other members of the family.
He laughs out loud or chuckles during the fourth or fifth month. But,
on the whole, he must be considered as just a little animal whose
greatest needs are to have his appetite and thirst satisfied, his
little body clothed, and his little nerves put to rest--to sleep.
SITTING ALONE
At four months the normal baby will hold up his head; and if he is
supported at the back with a pillow, he will sit erectly--holding his
head up--at six months; while at eight months or not later than nine,
the normal child should sit alone on the floor with no support. Later
in the ninth month he often manifests a desire to bear his weight upon
his feet. Care is here urged that the mother protect the little fellow
at this time and not allow him to rest his weight upon his feet but a
moment or two at a time.
He will reach for a ball suspended from the top of his carriage or bed
as early as the fifth month. About this time he discovers his toes
while in his bath. He will handle a rattle at six or seven months, and
shows delight in such toys.
DENTITION
In both the upper and lower jawbones of the newborn infant there are
hidden away in snug little cavities two sets of tiny teeth; the first
set, or milk teeth, and the second set, or permanent teeth. These
rudimentary teeth grow as the baby grows and push their way up or down
from the jawbones until they finally make their appearance through the
gums. The milk teeth appear in a definite way and in five definite
groups.
There should be no physical disturbance at the appearance of the
teeth, which is a physiological process, and it is to be deplored that
all of the ills of babyhood are laid upon the teeth with the careless
remark: "Oh, its his teeth!" Many, many illnesses are neglected
because our inexperienced mother has been told that she can expect
"anything to happen when the baby is cutting its teeth." Now, it is
true that the babies of many families do have trouble in cutting their
teeth, but the majority of babies cut their teeth comfortably and the
first knowledge anyone has of it is the appearance of the tooth
itself. As the teeth push their way nearer the surface of the gums,
there is a broadening and a hardening of the gums themselves, and it
is the exception rather than the rule that the baby needs any help in
cutting his teeth.
Usually by the time the baby is seven months old it has two central
teeth on the lower jaw (the central incisors), which constitute the
first group. The second group of teeth to appear is the four upper
central teeth which are all through by the time the baby is twelve
months old, and are often through at ten months. Then there is a pause
of from one to three months before the next teeth appear--the four
anterior molars. As these four anterior molars come in, the two
lateral incisors appear on the lower jaw, which now gives us, by the
time the baby is fourteen or fifteen months old, four central teeth
upper, four central teeth lower, and the four anterior molars, which
make twelve teeth.
Another pause of two or three months and then we get the four canine,
which fill in the space between the first molars and the front teeth.
The canine on the upper jaw are commonly known as the eye teeth, while
the canine teeth on the lower jaw are spoken of as the stomach teeth.
This brings us to the age of eighteen to twenty-four months, when
there is still another pause of two or three months, after which time
the big teeth or the four posterior molars appear, which completes the
first set of twenty teeth--the milk teeth. When baby is twenty months
old the milk teeth are often all in. The complete set should appear
not later than the thirtieth month.
During the life of the milk teeth the child should be taken to the
dentist at least once a year, better once in six months, for all
defective teeth must be properly and promptly cared for. Inexpensive
but sanitary fillings should be placed in all decayed teeth, for the
roots of the first teeth are very soft and infection readily spreads
to the jaws and the permanent teeth and serious trouble often begins
thus early.
If dentition is seriously delayed, investigation should be started
concerning the general condition of the child, for this delay often
accompanies ill health.
When the child is six years old, the mother should be watchful, for it
is at this time that the first permanent teeth appear just behind the
last molar of the milk teeth. They do not replace any of the teeth
present, and many times they come through and decay without receiving
any attention. It is seldom necessary to assist these milk teeth as
they come through the gum, and should the gums become highly colored
and swollen it is not wise to lance them, for if the teeth are not
ready to come through immediately, the gum only toughens the more and
makes the real cutting still more painful.
This is the time to cut down the baby's food as well as to look for
other digestive disturbances, for the number of stools may increase
and vomiting may occur, and by reducing the quantity and quality of
the food and encouraging abundant water drinking, much trouble may be
avoided. Under no circumstances urge the baby to eat when he refuses
his food, when the gums seem swollen and red during the teething time.
You will find that he will enjoy orange juice, pineapple juice, or
prune juice. All of these digestive symptoms are simply the result of
"feeling bad," and if heavy food of his regular feeding is greatly
diminished he will get along much better than if fed his regular
allowance of food.
APPEARANCE OF THE TEETH
The normal child has:
Six teeth at one year.
Twelve teeth at one and one-half years.
Sixteen teeth at two years.
Twenty teeth at two and one-half years.
When the child is six years old the first permanent tooth appears just
back of the last of the milk teeth. By the time he is seven, the four
central teeth, two above and two below, are out and the new ones begin
to appear. The order of their appearances is as follows:
Four first molars 6 years
Four central incisors 7 years
Four lateral incisors 8 years
Four first bicuspids 9 to 10 years
Four second bicuspids 10 to 11 years
Four canines 11 to 13 years
Four second molars 12 to 15 years
Four third molars 17 to 25 years
DENTAL SUGGESTIONS
A better plan than to lance swollen gums is to rub them gently with
ice wrapped in a soft cloth, or to dip the finger in ice water and rub
the gums--this often gives the baby much relief.
Often the baby finds comfort in biting on an ivory ring, but the
utmost care must be used in keeping it clean and avoiding
contamination by allowing it to drop on the floor.
Convulsions are never the symptoms of teething. Consult a physician at
once, as such seizures probably spring from causes other than
teething.
Cleansing of the teeth should be carried out systematically every
morning by means of a piece of cotton which has been dipped in a
boric-acid solution or a solution of bicarbonate of soda (common
baking soda). A soft brush may be used for cleansing, and when there
are particles of food between the teeth they should be removed by
strands of waxed floss.
Throughout life, frequent visits should be made to the dentist; during
early childhood days he should be on the lookout for symptoms which
indicate deformity--narrow jaws and other conditions which affect the
permanent teeth. During adolescence and adult life the teeth should be
examined every six months and cleansings of the mouth should become a
part of the daily toilet.
THE WEIGHT
During the first year, nothing gives us so much information concerning
the child's general well-being as the weight. Such a record will not
only enlighten the mother concerning the development of the child, but
the grown-up child appreciates the record and preserves it along with
the other archives of babyhood days. Every Sunday morning, when the
father is at home, the baby should be weighed and an accurate record
kept. It is important that the baby be weighed each time in the same
garments--shirt, band, diaper, and stockings--for every ounce must be
accounted for.
Until the baby is five or six months old he should gain from four to
eight ounces a week. Anything short of this is not enough and should
be reported to the physician. After six months the gain is about a
pound each month. This varies somewhat; possibly during the tenth and
eleventh month the gain is lessened, but by the close of the first
year the baby should have trebled its birth weight.
Dr. Griffith gives us the following very interesting bit of
information concerning the weight of boys and girls after the first
year, and to him also belongs the credit for the accompanying table
showing the growth, height, and weight of the child up to sixteen
years of age.
After the first year we notice that, taking it all together,
there is a gradual increase in the number of pounds and a
decrease in the number of inches added yearly, four inches being
gained in both the second and third years, three inches in the
fourth and fifth years, and after this two inches a year. The
gain in weight is four pounds yearly from the age of three to
that of seven years, then five, then six, and then about nine
pounds. It sometimes happens that at about the age of nine in
girls and eleven in boys there is almost a cessation of growth
for a short time. Later, at about twelve years, girls take on a
particularly rapid growth, and decidedly exceed boys of the same
age in weight, and sometimes in height also. At fifteen or
sixteen years the rapidity of growth in girls, both in weight and
height, will be greatly diminished, while boys of this age will
often begin to develop very rapidly, and will soon materially
exceed the other sex in both respects.
TABLE SHOWING GROWTH IN HEIGHT AND WEIGHT
Age. Height. Weight.
Birth 19 inches. 7 lbs. 8 oz.
1 week 7 " 7½ "
2 weeks 7 " 10½ " } Gained 1 oz.
3 weeks 8 " 2 " } a day;
1 month 20½ inches 8¾ " } 7 oz. a week
2 months 21 " 10¾ " }
3 months 22 " 12¼ " } {Gained 3/4 oz. a day;
4 months 23 " 13¾ " } {5-1/2 oz. a week.
5 months 23½ " 15 " } {Double original weight.
6 months 24 " 16¼ " } {Gained 2/3 oz. a day;
{4-2/3 oz. a week.
{
7 months 24½ " 17¼ " } {
8 months 25 " 18¼ " } {Gained 1/2 in. a month.
9 months 25½ " 18¾ " } {
10 months 26 " 19¾ " } {Gained about 1 lb. a month.
11 months 26½ " 20½ " } {
1 year 27 " 21½ " } {Treble original weight.
2 years 31 " 27 " } {
3 years 35 " 32 " } {Gain 4 in. a year.
4 years 37½ " 36 " } Double original length.
5 years 40 " 40 " } {Gained 3 in. and 4 lbs.
} {a year.
6 years 43 " 44 " } {Gained 2 in and 4 lbs.
7 years 45 " 48 " } {a year.
8 years 47 " 53 " } {Gained 2 in. and 5 lbs.
9 years 49 " 58 " } {a year.
10 years 51 " 64 " } {Gained 2 in. and 6 lbs.
11 years 53 " 70 " } {a year.
12 years 55 " 79 " }
13 years 57 " 88 " }
14 years 59 " 100 " } {Gained 2 inches and
15 years 61 " 109 " } {about 9 lbs. a year.
16 years 63 " 117 " }
GENERAL DEVELOPMENT
The accompanying illustration (Fig. 14), taken from Dr. Yale,
represents the developmental changes at one, five, nine, thirteen,
seventeen, and twenty-one years. Each figure is divided into four
equal parts, and as we watch the development from the baby who at one
year, as Dr. Yale says, is four heads high, at the age of twenty-one
the legs and the trunk have much outgrown the growth of the head, so
that at this age the head is only two-thirteenths or less of the whole
length of the body. The legs have grown more rapidly and equal
one-half the entire body length. The trunk has not kept pace with the
legs, for as you will see from the diagram the line reaches the navel
of the child in one year, while in the adult it is much lower. The
rapid growth of the legs is accomplished after nine years of age.
[Illustration: Fig. 14. Developmental Changes]
The proportions of the head, chest, and abdomen are exceedingly
important in the growing child. At the end of the first year the head,
chest, and abdomen are about uniform in circumference. The head may
measure one-fourth of an inch more, but the chest and abdomen should
both measure eighteen inches in circumference at this time. Should
the head or the abdomen be two inches larger than the chest; the
attention of the physician should be called to it, for either are
indicative of conditions that should be carefully investigated.
NORMAL BREAST WEANING
As a general rule the normal, healthy, breast-fed baby is given a
feeding of a bottle each day after he is ten months old. These bottles
are increased in number until, by the time the baby is a year old, he
is gradually weaned from the breast. Should the ninth month of baby's
life arrive in the hot summer months we urge the mothers to continue
breast feeding, with possibly the addition of some fruit juices, as
noted elsewhere, until early autumn. Under no circumstances should the
baby be weaned and compelled to use cow's milk during the season of
the year when the risks of contamination are greatest. If the baby is
nursed up to the close of his first year he hardly need be trained to
use the bottle, but may take his food from a cup. From one to two
months should always be consumed in weaning the baby, unless sudden
weaning is necessitated by ill health, as noted elsewhere. The baby
should have, if possible, from thirty to forty days to accustom
himself to cow's milk exclusively.
If the child is weaned slowly there should be no trouble with the
breasts, but in the instance of sudden weaning the mother should
restrict her liquids, put on a tight breast binder, and for a day or
two should take a dose of a saline cathartic, which will assist in
taking care of the liquids and thus decrease the secretion of milk.
NORMAL BOTTLE WEANING
If the bottle food is agreeing with the baby he should be allowed to
use it up to the end of the first year when he will be given whole
milk with possibly the addition of a little lime water. We see no
reason why the child should give up his bottle during the second year
unless other food is refused--unless he will not accept other food
than from his bottle--and if you are convinced that he has formed the
"bottle habit," then the milk should be put into a tiny cup or glass,
and he should learn to sip it along with his solid foods; but if he
takes his other foods without any hesitancy, then we know no reason
why he should not take his milk in this comfortable manner from his
bottle at least two or three feedings each day.
If you desire to wean him from his bottle, serve the first part of it
with a spoon from a cup or glass and then give him the remainder in
the bottle. The beautiful picture of a big, robust baby lying on his
back, knees flexed, both hands holding his beloved bottle still
lingers in my mind as one of the pleasant memories of my lad's
babyhood days, and at the close of the second year, when the beloved
bottle was left behind, I believe I missed something as well as did
the lad.
I recall no difficulty with his taking the food from a cup. The
success of all normal weanings is due entirely to the fact that it is
done gradually and slowly, and under no circumstances should it be
roughly and abruptly attempted--particularly in case of the bottle
feeding.
TRAINING THE BOWELS AND BLADDER
Reference is made to this subject in another part of this book--where
we went into the detail of keeping the daily record of these
physiological occurrences--and it was found that the bowels moved and
the bladder was emptied at about the same time each day. Any mother,
caretaker, or nurse, who will take the time to keep a daily record of
the hours of defecation and urination, will observe the time carefully
and will catch the child on nearly every occasion before an accident
occurs. Often as early as four months the bowels will move in an
infant's chamber at regular times each day. The nurse or mother places
this receptacle in her lap and holds the child gently and carefully
upon it. A little later it can be made to sit on a special chair
prepared for the purpose, and at eight or nine months by careful
training the urination can be controlled, and by the end of the first
year the diapers ought to be discontinued.
If the child has not learned to control the bladder by the age of two
years, medical attention should be called to the fact and remedial
measures instituted.
BABY'S SPEECH
The baby should begin to talk at one year. He early learns to say
"mamma" and "papa," and gradually adds nouns to his vocabulary, so
that at eighteen months the normal child should have a vocabulary of
one hundred to one hundred and fifty words. As he nears the two-year
mark, he has acquired a few simple verbs and he can possibly put three
words together, such as, "Willie wants drink." Pronouns come in late,
as we all recall that the young child usually speaks of himself by his
own name.
Children are born mimics. If you talk baby talk to them, they will
talk baby talk back. For instance, a well known author told us just
the other day that for many years no other name was given to the
sewing machine in his house but the word "mafinge," and not until he
went to school did he correct the word "bewhind," for in the nursery
he learned the line "wagging their tails bewhind them." Baby talk is
very cunning, and often the adult members of the family pick it up and
keep it up for years, and only when they are exposed in public, as one
mother was on a suburban platform by her four-year-old lad shouting,
"Mamma, too-too tain tumin, too-too tain tumin," do they sense their
responsibility and realize how difficult it is to form new habits.
This poor mother tried in vain to have her little fellow say, as did
another little lad two and one-half years old, "Mother, the train's
coming; let's get on."
Many words of our beloved language at best are hard to understand; so
let us speak correct English to the little folks and they will reward
us by speaking good English in return.
If at two years the child makes no attempt at speech, suspicions
should be aroused concerning mutism or other serious nervous defects.
Medical advice should be sought.
DEFECTIVE SPEECH
All guttural tones which may be occasioned by adenoids or enlarged
tonsils, all lisping, stuttering, or defective speech of all words
should be taken in hand at the very start, as they are usually
overcome by constant repetition of the correct manner of speaking the
particular word in question. Children of defective speech need special
training, and should in no way be allowed rapidly to repeat little
nursery rhymes, as oftentimes this rapid repetition of rhymes by a
child with hereditary nervous defects may occasion stuttering or
stammering later on.
CALISTHENICS
Special exercise should not be forced upon young children. Physical
culture, along with many other things intended for sedentary adults,
should never be forced upon little folks who get all of the exercise
they need in the many journeys they take building their blocks,
sailing their boats, tearing down imaginary houses, making imaginary
journeys--from morning until night the little feet are kept
busy--never stopping until the sandman comes at sleepy time. Do not
yourself attempt to stimulate a child who seems backward. Consult your
physician. You had much better put a child out to grow up in the yard
by himself with his sandpile than to force calisthenics or advance
physical training upon him.
BOW LEGS AND WALKING
Do not attempt to hasten nature in aiding the child to walk. Let him
creep, roll, slide, or even hunch along the floor--wait until he pulls
himself to his feet and gradually acquires the art of standing alone.
If he is overpersuaded to take "those cute little steps" it may result
in bow legs, and then--pity on him when he grows up. Sometimes flat
foot is the result of early urging the child to rest the weight of the
body upon the undeveloped arch. A defect in the gait or a pigeon toe
is hard to bear later on in life. A certain amount of pigeon-toeing is
natural and normal. If the baby is heavy he will not attempt to walk
at twelve months. He will very likely wait until fourteen or fifteen
months. The lighter-weight children sometimes walk as early as eleven
months, but they should all be walking at eighteen months, and if not,
it is usually indicative of backward mentality.
If the training of the bowels and bladder will replace the diapers
with drawers, the baby will attempt to walk sooner than when
encumbered with a bunglesome bunch of diaper between the thighs. The
little fellow runs alone at sixteen months and thoroughly enjoys it,
and the wise mother will pay no attention to the small bumps which are
going to come plentifully at this particular time.
SUMMARY OF BABY'S DEVELOPMENT
He discovers his hands at three or four months. At six months he sits
alone, plays with simple objects, grasps for objects, and laughs aloud
from the third to the fifth month. He says "goo goo" at four or five
months. At one year he should stand with support, listen to a watch
tick, follow moving objects, know his mother, play little games, such
as rolling a ball, should have trebled his birth weight, and have at
least six teeth, and should use three words in short sentences. At
eighteen months he should say "mamma" spontaneously, walk and run
without support, should have quite a vocabulary, should be able to
perform small errands like "pick up the book," and should have twelve
to sixteen teeth. At two years he should be interested in pictures,
able to talk intelligently, and know where his eyes, nose, mouth,
hands, and feet are. At three years, he should enumerate the objects
in a picture, tell his surname, and repeat a sentence with six words.
In the case of a premature baby or a very delicate child, or as a
result of a prolonged illness or a very severe sickness, such as
spinal meningitis, the time of these mental and physical developments
may all be postponed, while rickets, which will be spoken of later, is
often the cause of late sitting, late standing, and late walking.
DIET AFTER THE FIRST YEAR
Milk is the principal article of diet during the second year. It
should be given with regularity at distinct intervals of four meals a
day. It may be given from the nursing bottle, unless the child has
acquired the bottle habit and refuses to eat anything else but the
food from his bottle, in which case it should be given from a cup.
Beginning with the sixth month, aside from his milk, be it breast
milk or bottle milk, he is to be given orange juice once each day as
well as the broth from spinach and other vegetables. This is necessary
to give the child certain salts which are exceedingly essential to the
bottle baby.
At the close of the year when he is taking whole milk he should be
given arrowroot cracker, strained apple sauce, prune pulp, fig pulp,
mashed ripe banana (mashed with a knife), a baked potato with sauce or
gravy (avoiding condiments), and a coddled egg. Fruit juices may be
added to the diet, such as grape, pineapple, peach, and pear juice.
Later in the second year he may be given stale bread and butter, and
for desserts he may have cup custard, slightly sweetened junket, and
such fruit desserts as baked apple and baked pear.
We do not think it is necessary to give children much meat or meat
juices. We appreciate that there is a diversity of opinion upon this
subject, but we do not hesitate to say that in the families where meat
is little used, the children seem to grow up in the normal manner with
sound healthy bodies, sometimes having never tasted it. When meat is
used, it should be well cooked to avoid contamination with such
parasites as tapeworm and trichina; it should also be well chewed
before swallowing, as many of the intestinal disturbances of the older
children are due to the swallowing of unmasticated food such as
half-chewed banana, chunks of meat, rinds of fruit, and the skins of
baked potatoes.
Let the children's diet be simply planned, well cooked, thoroughly
masticated, and above all things have regular meal hours, and no
"piecing" between meals; and if the mother begins thus early with her
little fellow, she will be rewarded some later day by hearing him say
to some well-meaning neighbor, who has just given him a delicious
cookie or a bit of candy: "Thank you, I will keep it until meal time."
Children learn one of the greatest lessons of self control in
following the teaching that nothing should pass the lips between meals
but water or a fruit-ade. Children in the second year require four
meals a day, one of which is usually only the bottle or a cup of milk.
These meals are usually taken at six, ten, two, and six in the
evening. Oftentimes this early six o'clock meal is just a bottle or
cup of milk, as may also be the evening meal.
CANDY
Now, a word about candy. Pure candy is wholesome and nourishing. It is
high in calorific value, and children should be allowed to have it if
it does not enter the stomach in solutions stronger than ten or
fifteen per cent. We can see at a glance that chocolate creams,
bonbons, and other soft candies should never be given to children.
Candies that they can suck, such as fruit tablets, stick candy,
sunshine candy, and other hard confections that are pure, and free
from mineral colorings and other concoctions such as are commonly used
in the cheaper candies, may safely be given at the close of the
meals--but never between meals.
All such articles as tea, coffee, beer, soft candies, condiments,
pastries, and fried foods, should be positively avoided in the case of
all children under five and six years of age.
The diet from now on will be considered in the chapter "Diet and
Nutrition."
PART III
THE CHILD
PART III
THE CHILD