By courtesy of The New York Times

New York’s Better Baby

The Eugenic Marriage

A Personal Guide to the
New Science of Better
Living and Better Babies

By W. GRANT HAGUE, M. D.

College of Physicians and Surgeons (Columbia
University), New York; Member of County Medical
Society, and of the American Medical Association

In Four Volumes

VOLUME II

New York

THE REVIEW OF REVIEWS COMPANY

1914

Copyright, 1913, by
W. Grant Hague

Copyright, 1914, by
W. Grant Hague

[Pg iii]

TABLE OF CONTENTS

Sex Hygiene for the Boy

CHAPTER XII

BUILDING OUR BOYS

A word to parents—Interest in sex hygiene—The “Social
Evil”—Ten millions suffering with venereal diseases in
the United States—Immorality not confined to large cities—Venereal
diseases common in country places—What are
the consequences of venereal disease to the boy?—Gonorrhea,
or clap—Symptoms of gonorrhea in the male—Complications
of gonorrhea—Syphilis, or the “pox”—How
syphilis is acquired—Syphilis attacks every organ in
the body—Not possible to tell when cured—The chancre—Systematic,
or constitutional symptoms—Mucous
patches and ulcers—Syphilis of the blood vessels and
lymphatic glands—The interior organs—Brain and spinal
cord—The nose, eye, ear, throat—Hair and nails—What
the boy with venereal disease may cause in others—The
infected wife—A girl’s fate when she marries—Young
wife rendered sterile—Young wife made to miscarry—Is
the husband to blame—Building the man—Age of puberty—”Internal
Secretion” Page 139

CHAPTER XIII

THE PARENTS AND THE BOY

Abuse of the procreative function—The continent life—Provide
the environment necessary to the clean life—The
period of procreative power—Self-abuse—Masturbation—Treatment
of masturbation—Night losses or wet
dreams—Causes of night emissions—Sexual excesses—Treatment
of sexual excesses—What parents should
know about the so-called “social evil” before speaking
with authority to the boy—The need of enlightenment in
sexual matters—”No one told me, I did not know”—Fake
medical treatment of venereal diseases—Sowing wild oats—Should
circumcision be advised Page 153

Sex Hygiene for the Girl

CHAPTER XIV

A MOTHER’S DUTY TO HER DAUGHTER

What a mother should tell her little girl—Where do babies
come from—How baby birds and fish come from eggs—How
other animals have little nests of their own—The
duty of mothers to instruct and direct—What a
mother should tell her daughter—Every mother should[Pg iv]
regard this duty as sacred—Every female child is a possible
future mother—Motherhood the highest function of
the sex—Health the one necessary essential—Symptoms
of the first, or beginning menstruation—The period of
puberty in the female—Changes in the reproductive
organs at puberty—The female generative organs—The
function of the reproductive organs—The age of puberty
in the female—The function of the ovary—The function
of the womb—Why menstruation occurs every twenty-eight
days—The male or papa egg—The function of the
spermatozoa—”Tell the whole story”—”How do these
spermatozoa get there”—The union of the species—”How
can a baby live in there for such a long time”—How the
baby gets its nourishment in the womb—Girls must not
become mothers Page 173

CHAPTER XV

PREPARING FOR MOTHERHOOD

Menstruation—Irregular menstruation—Changes in the
quantity of the flow—How the womb is held in place—Symptoms
of menstruation—Menstruation should not be
accompanied with pain—Don’t give your daughters
patent medicines, or “Female Regulators”—Take your
daughter to the doctor—Leucorrhea in girls—Bathing
when menstruating—Constipation and displaced wombs—Dress
and menstruation—Absence of menstruation, or
amenorrhea—Treatment of amenorrhea—Painful menstruation,
or dysmenorrhea—Causes of dysmenorrhea—Treatment
of dysmenorrhea—Sterility in the female—Conditions
which affect the fertility of women—Climate,
station in life, season of the year, age, the tendency
to miscarry—Causes of sterility in the female—Displacement
of womb—Diseases of womb, ovaries, or tubes—Malformations—Lacerations—Tumors—
Leucorrhea—Physical
debility—Obesity—Special poisons—”Knack
of miscarrying”—Miscarriage—Cause of miscarriage—The
course and symptoms of miscarriage—What to do
when a miscarriage is threatened—Treatment of
threatened miscarriage—Treatment of inevitable miscarriage—After
treatment of miscarriage—The tendency
to miscarriage Page 187

The Baby

CHAPTER XVI

HYGIENE AND DEVELOPMENT OF THE BABY

What to prepare for the coming baby—Care of the newly-born
baby—The first bath—Dressing the cord—Treatment
after the cord falls off—A pouting navel—Bathing
baby—Clothing the baby—Baby’s night clothes—Care of[Pg v]
the eyes—Care of the mouth and first teeth—Care of the
skin—Care of the genital organs—Amusing baby—Temperature
in children—The teeth—The permanent teeth—Care
of the teeth—Dentition—Treatment of teething—How
to weigh the baby—Average weight of a male baby—Average
weight of a female baby—Average height of a
male child—The rate of growth of a child—Pulse rate in
children—Infant records, why they should be kept—”Growing
pains” Page 209

CHAPTER XVII

BABY’S FEEDING HABITS

Overfeeding baby—Intervals of feeding—How long should a
baby stay at the breast—Vomiting between feedings—Regularity
of feeding—Why is regularity of feeding important—A
baby never vomits—What is the significance
of so-called vomiting after feedings—Mother’s milk that
is unfit for baby—Fresh air for baby—Air baths for baby Page 223

CHAPTER XVIII

BABY’S GOOD AND BAD HABITS—FOOD FORMULAS

Baby’s bed—The proper way to lay baby in bed—Baby should
sleep by itself—How long should a baby sleep—Why
a baby cries—The habitual crier—The habit of feeding
baby every time it cries—The habit of walking the floor
with baby every time it cries—Jouncing, or hobbling baby—Baby
needs water to drink—The evil habit of kissing
baby—Establishing toilet habits—Baby’s comforter—What
can be done to lessen the evil effects of the comforter
habit—Beef juice—Beef juice by the cold process—Mutton
broth—Mutton broth with cornstarch or arrowroot—Chicken,
veal, and beef broths—Scraped beef or
meat pulp—Junket or curds and whey—Whey—Barley
water—Barley water gruel or barley jelly—Rice, wheat
or oat water—Imperial Granum—Albumen water—Dried
bread—Coddled egg Page 235

Artificial Feeding

CHAPTER XIX

ARTIFICIAL FEEDING

Elementary principles of milk modification—The secret of the
efficiency of mothers’ milk—Two important factors in
successful artificial feeding—Every child is a problem in
itself—Proprietary foods of little value as infant foods—Their[Pg vi]
value is in the milk added to them—The credit belongs
to the cow—Difference between human and cow’s
milk—What “top-milk” feeding means—Utensils necessary
for home modification of milk—Artificial feeding
from birth to the twelfth month—How to measure “top-milk”—Easy
bottle-feeding method—Condensed milk
feeding—Objections to condensed milk feeding Page 249

CHAPTER XX

ARTIFICIAL FEEDING (continued)

How to prepare milk mixtures—Sterilizing the food for the
day’s feeding—How to test the temperature of the food
for baby—When to increase the quality or quantity of
food—Food allowable during the first year in addition to
milk—Beef-juice—White of egg—Orange juice—Peptonized
milk—The hot or immediate process—The cold
process—Partially peptonized milk—Completely peptonized
milk—Uses of peptonized milk—Objections to
peptonized milk—What a mother should know about
baby’s feeding bottle and nipple—Should a mother put
her baby on artificial food if her supply of milk during
the first two weeks is not quite enough to satisfy it—Certain
conditions justify the adoption of artificial feeding
from the beginning—Mothers’ mistakes in the
preparation of artificial food—Feeding during the second
year—Sample meals for a child three years of age—The
diet of older children—Meats, vegetables, cereals, bread,
desserts, fruits Page 259

What Mothers Should Know

CHAPTER XXI

THE EDUCATION OF THE MOTHER

What mothers should know about the care of children during
illness—A sick child should be in bed—The diet of the
sick child—A child is the most helpless living thing—The
delicate child—How to feed the delicate child—How
to bathe the delicate child—Airing the delicate child—Habits
of the delicate child—Indiscriminate feeding—Poor
appetite—Loss of appetite—Treatment of loss of
appetite—Overeating in infancy—What correct eating
means—Bran as a food—Breakfast for a child at school—Lunch
for a child at school—Bran muffins for school
children—Bran muffins in constipation—Hysterical children—What
a mother should know about cathartics and[Pg vii]
how to give a dose of castor oil—Castor oil—Calomel—Citrate
of Magnesium—When to use castor oil—When
to use calomel—Vaccination—Time for vaccination—Methods
of vaccination—Symptoms of successful vaccination Page 277

CHAPTER XXII

CONSTIPATION IN INFANTS AND CHILDREN

Constipation—Regularity of bowel function—The function of
the stomach—Fermentation—Incomplete constipation—Importance
of a clean bowel—A daily movement of the
bowel necessary—Constipation in breast-fed infants—Treatment
of constipation in breast-fed infants—Constipation
in bottle-fed infants—Treatment of constipation
in bottle-fed infants—Constipation in children over two
years of age—Diet list for constipation in children—Bran
muffins in constipation—Treatment of obstinate constipation—Oil
injections in constipation Page 303

CHAPTER XXIII

CONSTIPATION IN WOMEN

Chief cause of constipation in women—Constipation a cause
of domestic unhappiness—The requirements of good
health—The cost of constipation—Constipation and social
exigencies—One of the important duties of mothers—Constipation
and diseases of women—Constipation is always
harmful—Constipation and pregnancy—Explanation
of incomplete constipation—Causes of constipation—Negligence—Lack
of exercise—Lack of water—Lack of
bulk in the food taken—Abuse of cathartic drugs and
aperient waters—Overeating—Treatment of constipation
in women Page 315

SEX HYGIENE FOR THE BOY

[Pg 139]

CHAPTER XII

BUILDING OUR BOYS

A Word to Parents.—Within recent times the subject
of sex hygiene has been freely discussed by members of
the medical profession and through them the general
public has been made more or less acquainted with the
problem. It has therefore acquired a degree of genuine
interest which speaks well for the future of the eugenic
ideal. Eugenics is based to a very large extent upon the
principles underlying sex hygiene.

As a result of this widespread interest and investigation,
we have discovered that the only method that promises
actual progress, is to talk plainly and to tell the
actual truth. The day of the prude has passed. To
attempt to achieve results in the education of youth in[Pg 140]
sex problems, without giving, facts, is wasted effort.
To give facts we must explain each problem so that its
principles may be clearly understood and its meaning
grasped. To point out the duty of youth is not sufficient.
They must be shown why it is to their best interest to
live the clean life. In every department of education we
are beginning to appreciate that to achieve results it
must be based upon the individual equation. This is
why we have found it necessary to assert that it is the
duty of parents to make sex hygiene a personal matter
and to acquaint their children with the facts relating to
this problem. It has been discovered, however, that a
very large percentage of parents are inadequately informed
on these subjects, in fact they know practically
nothing about the actual facts which they are supposed
to teach. I shall try to tell the story in a way which
every parent will understand.

When a boy reaches the age of puberty he is susceptible
to sexual desire. If he has not been told the story
of his growth from boyhood to man’s estate he will
either begin to abuse himself, or he will be later enticed
to commit himself to intercourse with some unclean
female and he will acquire a disease as a result.

Inasmuch as it has been asserted that practically every
boy has been addicted to self-abuse at some time, and
that eighty per cent. of all males, between the ages of
sixteen and thirty years, are victims of venereal disease,
it would seem justifiable to assume that the boys who
are informed of the facts in time are the boys who constitute
the percentage who escape. This, of course, may
not be literally true, but it is a reasonable assumption.

While self-abuse is a pernicious habit and may be attended
with serious consequences, it is not a disease and,
as will be explained later, it can be cured. It is therefore
a menace to the individual, not to the race, and
consequently need not concern us at the present time.
On the other hand the venereal diseases are not to be
considered as individual problems since they affect the
welfare of the race. The venereal diseases which we
will consider are gonorrhea and syphilis.

The Social Evil.—It has been estimated that there are[Pg 141]
more than ten millions of people in this country to-day
suffering from the effects of venereal diseases. In New
York city alone, there are two million victims suffering
from the direct or indirect consequences of these diseases.
It has been authoritatively asserted that, out of every
ten men between the ages of sixteen and thirty, eight
have, or have had, one or other of these diseases. When
it is remembered that these diseases are not merely temporary
incidents, but that they may be regarded as
practically incurable in the vast majority, because of
antagonistic social conditions and ignorance, and that
they are highly infectious, we may begin to realize how
important they are from the standpoint of race regeneration.

Statistics of these conditions are never reliable because
much of the evil is hidden and lied about. It is quite
probable,—if the estimates were based upon absolute
knowledge—that the extent of the prevalency of these
diseases would be greatly increased rather than reduced.
It is however a fact, that the combined ravages of the
Great White Plague, leprosy, yellow fever, and small-pox,
are merely incidents compared to the effects which the
venereal diseases have had upon mankind. It is useless
to think that these diseases can be driven out of the land.
Any hope of this nature is the impression of the dreamer.
By a propaganda of education, by the spread of the
eugenic idea and ideal, we may, however, reasonably hope
to minimize the evil and, at least, to protect the innocent.

The Sources of Immorality.—It is a fallacious idea to
assume that the sources of immorality are confined to
the large cities. This is far from the truth. In smaller
towns and country places the diseases are quite common
and conditions there tend to the spread of the contagion
in a more intimate and a more harmful way. The individuals
who are most likely to become affected are those
most liable to succumb to temptation and whose home
ties are of the best. There are many instances on record
where one or two loose women spread the infection
all over the country communities, infecting boys and
men alike. No one can estimate what the final effect
of such an epidemic may mean or how many innocent[Pg 142]
individuals may have their lives wrecked as a direct consequence.
It is because these consequences are the product
of ignorance in a very large percentage of the cases
that there is such urgent need for enlightenment. It is
at least our plain duty to tell the boy the actual facts—to
post him with reference to consequences. The more
thoroughly we instruct him in the elementary facts relative
to the venereal diseases, the safer he will be from
temptation, and if he possesses this knowledge and acquires
disease, he will be more likely to immediately seek
competent aid and advice.

WHAT ARE THE CONSEQUENCES OF VENEREAL
DISEASE TO THE BOY HIMSELF?

Gonorrhea or “Clap.”—This is the most frequent of
the venereal diseases. It is also the most serious. It is
an unfortunate fact, that in the past,—and even to-day—boys
have been told that gonorrhea is no worse than
“a bad cold.” This lie has been responsible for much
evil and a great amount of unnecessary suffering and
misery.

Gonorrhea is caused by a germ, obtained, as a rule,
during intercourse with an infected person. This germ
is called gonococcus. It thrives on any mucous membrane;
it is not, therefore, limited to the sexual organs.
For this reason it may attack any part of the body where
mucous membrane is. It is particularly liable to damage,
sometimes seriously and permanently, the eye. It
may be spread from one person to another, or from any
infected article to a person in numerous ways. The innocent
may thus suffer as a result of the carelessness of
the vicious.

The Symptoms of Gonorrhea in the Male are slight
itching and burning of the mouth of the urethra. This
is noticeable at any time from the third to the fourteenth
day after exposure. These symptoms become
more pronounced and a slight discharge appears. The
patient is compelled to urinate frequently and it is painful
and difficult. The discharge increases, it becomes
thicker and looks like ordinary yellow pus. If the case
is a severe one, the discharge may be blood stained, and[Pg 143]
if this symptom is present urination is more painful and
more frequent.

In about ten days the disease reaches its height; it
remains stationary for a number of weeks and then
slowly, seemingly, gets better. The discharge grows
thinner, less in quantity and lighter in color. It may
refuse, despite the most careful and efficient treatment,
to stop altogether; it is then known as “gleet.” If the
discharge stops completely the patient is apparently cured,
as far as any external manifestation of the disease is
concerned. In seventy-five per cent. of the cases, however,
this apparent cure is no cure at all, as will be seen
later.

Certain complications are likely to arise in the course
of gonorrhea. The infection itself may be of such an
acute or virulent type, that it invades the deeper structures
of its own accord and despite the most careful, competent
treatment; or if the treatment is not adequate
or skillful it may be forced backward; or through neglect
in not beginning the right kind of treatment in
times, a simple infection may grow in degree into a
serious disease, and invade the more important structures.
In this way are produced disease of the bladder, prostate
gland, seminal vesicles, testicles, and of the kidneys.
Gonorrheal rheumatism may follow, and even disease
of the lining membrane of the heart, and death.

When disease of the deeper parts occur the patient
is frequently incapacitated and compelled to go to bed.
He may have chills, fever and sweats, intense pain and
the passage of bloody urine. He may have to be operated
upon, and his general health may be permanently wrecked.
So long as the germs are present there is danger despite
the most scientific treatment. It is not the quality of
the treatment that is at fault, it is the presence of the
germs; and since it is impossible to pursue any certain
method of eradication, we must continue treatment—as
long as the germs are present—and hope for favorable
results. The infection may last for many years. The
germs having found entrance into the small tubes in
the interior organs they can only be dislodged with
difficulty, if at all. These pockets of germs may be excited[Pg 144]
to renewed activity by sexual intercourse, or by
injury to the parts, and may reinfect the patient at any
times. In a very considerable number of these cases
where the deeper structures are involved, the patient
may recover from the acute or painful period of the
disease, only to find that he is sterile. There are many
such cases, and the most vindictive individual who may
believe that every who sins should be punished will
admit that sterility, as the price of a moment’s forgetfulness,
is a terrible fee to pay.

Syphilis, or the “Pox,” is an infectious, germ blood
disease. It is most frequently acquired through sexual
intercourse.

It may be acquired by direct contact with a diseased
person. In order to render such contact effective, it is
essential that the skin of the healthy person be abraded,
or the contact may be directly on a mucous membrane,
as the mouth in the act of kissing.

It may be acquired by using any article which has been
used by a syphilitic, as a drinking cup, or towel.

It may be acquired through hereditary transmission.

Surgeons frequently contract syphilis while operating
on, or examining patients who have the disease. Dentists
may convey it by means of instruments which have
not been rendered aseptic, or thoroughly clean. Using
a towel which has been used by a syphilitic has many
times conveyed the infection to an innocent party. For
this reason the roller towel has been done away with,
and some states have legislated against its use in
hotels and other public places. To use dishes, spoons,
tobacco pipe, beer glasses, etc., which have been used
by one having the disease is an absolutely certain way
of being infected. Cigars which may have been made
by a syphilitic will infect whoever smokes them with the
virus of the disease. Syphilis has been known to have
been caught from using the church communion cup. The
public drinking-cup has been a prolific source of syphilitic
dissemination to innocents. Legislators are just waking
up to the danger that lurks in this institution and it
will no doubt be done away with, not only in public places,
but on all railroad and steamboat lines.[Pg 145]

An infected mother can transmit syphilis to her child.
If the father is affected, but not the wife, the child may
escape.

Syphilis attacks every organ in the human body. The
actual degree of infection has no relation to the size or
character of the external manifestations. The external
evidence may be minute and insignificant, while the
internal extent and ravages of the disease may be tremendous
and of large proportions. Many men when
asked regarding incidents of the long ago, may state,
“Oh, yes, I had a chancre twenty-five years ago, but it
was a very small affair and soon healed up and was
cured.” Yet that same little chancre, that made only
a mild impression on the man’s mind, may, and most
probably will, be the direct cause of that man’s death.

It is not possible to tell with absolute certainty that an
individual is suffering with syphilis by any known test.
The most recent one—the Wassermann test—is not absolute
by any means.

The first symptoms, or what is known as the initial
lesion of syphilis, is the chancre.

The Chancre is a small, hard tumor, or it may be a
small ulcer with a hard base, or it may simply appear
as a thin small patch on any mucous membrane. It is
not painful, it can be moved if taken between the fingers,
showing it is not attached to the deep structures,
and when it is so moved it is not tender or sore. Any
little lump which ulcerates located on the genitals must
be regarded with suspicion. Boys and men should not
be satisfied with any offhand statement that, “it is nothing.”
It may be a chancre, and it may be exceedingly
serious if not properly diagnosed.

Systemic, or constitutional symptoms, begin to show
themselves any time from the sixth to the tenth week
after the appearance of the chancre.

Eruptions of the Skin characterize every case of
syphilis. They occur in all degrees from the mild rash
to the foul ulcer. The ulcerative process is very often
extensive and loathsome.

Mucous Patches and Ulcers affect the mucous membranes.
The mouth and throat are favorite locations[Pg 146]
for these lesions. They occur in the anus and rectum,
and may be mistaken in that region for other serious
conditions. Men who drink and smoke suffer as a
rule severely from mucous patches in the mouth and
throat.

Syphilis attacks the blood vessels and the lymphatic
glands. These cases may have been unrecognized, and
may have existed for many years. A man may die
from a rupture of a blood vessel in the brain during
middle life as a consequence of a forgotten, supposedly
cured case of syphilis many years before.

The Interior Organs may be attacked by syphilis.
As a result we get disease of the liver, heart, stomach,
kidneys, lungs, and other parts. It has been suggested
that many diseases affecting these organs, for which
treatment proves unsatisfactory, may have had their
origin in a former syphilis.

The Brain and Spinal Cord are quite often the seat
of syphilitic affections. A tumor, known by the name
of “gumma,” is the result. The blood vessels of the entire
nervous system may be affected and, as a consequence,
we often see cases of paralysis, apoplexy, epilepsy,
locomotor ataxia and death.

The Nose, Eye, Ear, Throat, are frequently very seriously
compromised as a result of the syphilitic poison.
Deformity, caused by rotting of the bones of these parts
is not infrequent. Loss of voice, or smell, or hearing,
or sight, may result.

The Hair and Nails may fall out. The bones may
ulcerate and rot. The organs of procreation usually
participate in the degenerative process. Virility is destroyed,
and impotence is quite common after a severe
attack.

WHAT THE BOY WITH VENEREAL DISEASE MAY
CAUSE IN OTHERS

Gonorrhea.—When the average boy acquires gonorrhea
he frequently does not know, for many weeks, that
he is the victim of a dangerous, infectious disease. He
appreciates probably, that it relates to the sexual indiscretion[Pg 147]
he was guilty of, and feels that it is something
to be ashamed of. He therefore hides his condition, confides
in no one, and blindly hopes it will get better somehow
or at some time. Meantime the disease, which may
have been mild at the beginning, is gradually gaining
ground and strength, and his neglect may eventuate in
lifelong misery. No means are taken to guard against
spreading the infection, the discharge may lodge on his
fingers and he may infect his eyes and may lose his sight
because he did not know that the discharge is one of
the most dangerous fluids known. It may get on water-closet
seats and infect others. Eventually he is compelled
to seek aid, and he may, after a long period, be freed
from the immediate consequences of his folly. At a
later date he marries, and as previously explained, he
infects his wife. This is the beginning of much of the
domestic infelicity that is so prevalent to-day, and, inasmuch
as it is a subject that should be thoroughly understood
by every woman and mother, I shall carefully and
clearly explain its significance and its consequences.

Let us first, however, briefly consider what may occur
to others if the boy is unfortunate enough to acquire
syphilis. Again the boy fails to comprehend the nature
of his affliction. There is imminent danger of the members
of his household becoming infected. He uses the
same dishes, spoons, towels, and utensils, any one of
which may convey the disease to his father, mother, sister,
or brother. He may use the common drinking glass
in school, college, or office, and spread the disease in
this way. He may kiss any member of his family, or
a baby, and infect them. He may have his hair cut,
or be shaved, and the virus may be spread around in this
way if the barber does not sterilize the article used,—which
he never does. He may drink at a soda fountain,
or at a saloon, and the next individual to use the same
glass may acquire the disease. He is a menace to the
individual, to the community, and to the race. Wives
often acquire syphilis from their husbands.

The Infected Wife.—It has been previously stated that
eight out of every ten males between the ages of sixteen
and thirty, have had or have, gonorrhea or syphilis.[Pg 148]
Seventy-five per cent. of these cases have not been cured.
About thirty-five per cent. of these are destined to infect
wife, or wife and children, and in all probability
many others.

If a young wife acquires infection from her husband,
she is exactly in the same condition as the diseased boy,—she
does not know what ails her, so she wastes precious
time in unprofitable worry. Why should she know what
the trouble is? She came to the marriage bed pure, and
clean, and healthy. Her previous education did not include
instruction which would even help her to guess
what the trouble might be. She is simply conscious of
new distressing conditions which she does not understand.
She may try to believe that these conditions are
incidental to the change in her life. Shortly, however,
the discharge, which she has had for a number of weeks,
and which she thought was only a leucorrhea, or “the
whites,” becomes so profuse and nasty that she begins
douching. This procedure simply blinds her to the true
nature of the affection, and in the end she is driven,
ashamed and reluctant, to consult a physician. She may
be informed that her condition is bad, and that it will
be necessary that she submit to a course of treatment.
After a time the physician may succeed in tiding her over
the immediate consequences of the gonorrheal infection
she innocently acquired. She may soon after become
pregnant, and she may miscarry as a result of the old
trouble, or she may carry the child the full period. When
the child is born it may be blind and this defect is a
consequence of the old infection to the mother from
the father. If the mother is syphilitic the child most
likely will inherit all the horrible possibilities of transmitted
blood-poison.

Pregnancy frequently “lights up” any old, gonorrheal
infection in the female, so this young wife fails to completely
recover after the confinement. She is able to
be about, but her strength refuses to be restored. It
may be months later when she begins to suffer pain
and to realize that she is quite sick. She develops a
fever and may have a chill. The physician discovers that
she has pus in her tubes and there is danger of peritonitis[Pg 149]
or general blood poisoning. The old germs have
been roused and are active. Unfortunately they are located
where it is impossible to dislodge them without
resorting to a serious operation. It is now a problem of
saving her life. She is taken to the hospital and her
womb, tubes, and ovaries, are removed—she is unsexed.

Young wives are being operated on every day, in every
city in the civilized world for just such causes. It is a
notorious fact, that, in every city in the world, the number
of operations that are daily being performed on
women, is increasing appallingly. Every surgeon knows
that eighty per cent. of these operations are caused, directly
or indirectly, by these diseases, and in almost every
case in married women, they are obtained innocently from
their own husbands. It is rare to find a married woman
who is not suffering from some ovarian or uterine trouble,
or some obscure nervous condition, which is not amenable
to the ordinary remedies, and a very large percentage of
these cases are primarily caused by infection obtained
in the same way.

When a girl marries she does not know what fate has
in store for her, nor is there any possible way of knowing,
under the present marriage system. If she begets a
sickly, puny child,—assuming she herself has providentially
escaped immediate disease,—she devotes all her
mother love and devotion to her child, but she is fighting
a hopeless fight as I previously explained when I stated
that one-half of the total effort of one-third of the race,
is expended in combating conditions against which no
successful effort is possible. Even her prayers are futile,
because the wrong is implanted in the constitution of the
child and the remedy is beyond her power to find. These
are the tragedies of life, which no words may adequately
describe, and compared to which the incidental troubles
of the world at large are as nothing.

If the conditions are not as bad as those depicted above,
the original infection may have rendered her sterile. If
the germs reached the womb and tubes, the inflammatory
process may close these tubes, with the result that conception
is impossible. In these cases the woman has to
bear the stigma and disgrace of a childless union, though[Pg 150]
she is not the guilty party. Many husbands are sterile,
however, as a result of venereal disease. It is claimed
that eighty per cent. of childless marriages are caused
by sterility of the male partner. Curiously and unfortunately
these men never suspect themselves. The
wife is the delinquent member, in their estimation. She
is the victim of jest and suspicion, and later of jibes and
insults. Many women have had their lives rendered
miserable and unhappy because of this suspicion. They
are compelled by their husbands to submit to examination
and unpleasant and painful treatment and operations with
the intention of rectifying a defective condition that does
not exist. Many conscientious physicians refuse to treat
women patients against whom the charge of sterility is
made, before subjecting the husbands to thorough examination, and,
since eighty per cent. of childless marriages
are due to sterility in the male, this is a just and
reasonable course to pursue.

During the course of all this domestic trouble and
tragedy, the young wife’s health has suffered—she scarcely
enjoys one day of good health. Her mental condition
is even worse. She submits to innuendo and insult under
the impression that she is the unwitting cause of all the
domestic wretchedness and often wishes she had never
entered the marriage state. We must remember that
these conditions wreck ideals and homes, and that they
frequently render inefficient both husband and wife. The
economic business of marriage becomes a failure, ambition
is crushed and hope dies in the heart.

If the mother has been inoculated with the virus of
syphilis her existence is equally wretched; her health is
ruined; her efficiency is forever mortgaged. If she becomes
pregnant she will most likely abort and she will go
on aborting for years, in the effort to bring children into
the home, accusing herself meantime and submitting to
the reflections which are heaped upon her, while the real
culprit is the husband. He assumes an injured and innocent
attitude and behaves as if he had been imposed
upon by marriage with a woman who cannot carry out
her marital contract.

If she gives birth to a child or children, they are[Pg 151]
syphilitic. They may be deformed, or they may be feeble-minded
or idiots. They may live at home for years,
always ailing, always sick. They may develop epilepsy,
St. Vitus’ dance, skin disease, or mental vagaries, and
they may have to be put into institutions for the feeble-minded,
or they may die by inches at home.

Is the Husband to Blame?—If a boy had gonorrhea
a number of years before entering the marriage state,
was treated for it by a physician, until all symptoms had
disappeared and had enjoyed apparent good health in the
interim, and had never been told any of the facts regarding
probable consequences, is it just to blame him if he
infects his wife? It is certain no man would willingly
subject his bride to the risk of infection, with all its horrible
consequences. These conditions exist as a result of
the prudish attitude of society in the past toward all
questions affecting sex hygiene. We have not told all
the truth to the boy. Whatever knowledge he may have
had was gained from companions, or from individuals
who knew the garbled facts only. There is of course
no excuse for the man who acquires disease after marriage
and conveys it to his wife or children. This is a
very different situation and one which should merit the
severest condemnation and punishment. We are, however,
only interested in the boy at present and will not
take up the reader’s time with a discussion of the “social
evil” from this standpoint.

Building a Man.—When the boy is about fifteen years
of age certain changes begin to manifest themselves. He
grows more rapidly, a growth in which his whole system
participates. His bones grow bigger and stronger, his
muscles increase in size, even his heart, and lungs, and
liver, and his digestive system accommodate themselves
to this transformation; the voice changes and hair begins
to grow on his face. The mental process also keeps pace
with the new order of things. He thinks differently and
he sees from a new viewpoint. Nature is making a man
out of a boy.

These changes were not understood in the past, but we
are beginning to appreciate the reason for this evolutionary
process. We have discovered that the cause depends[Pg 152]
upon certain active changes which take place in the
sex organs. About this time the testicles begin to be
active. For years these glands have been preparing themselves
for this work, so they first grow rapidly, increasing
in size until they are about eight times bigger than they
were before this time, then they begin to pour into the
circulation a secretion which stimulates changes in all
other parts of the body and is directly responsible for the
wonderful change that is evident in the stature of the
boy’s body.

This substance or “internal secretion” must not be
confused with the semen. The internal secretion is simply
the substance which nature employs in the developing
process and is responsible for the degree of growth and
quality of manhood which the boy manifests. The semen,
on the other hand, is the procreative or fertilizing fluid
which enables a man to beget offspring. When a boy
understands this process it aids him in appreciating the
importance of his sex organs and a little thought enables
him to understand that if he abuses these organs he will
seriously interfere with his own development. This
process goes on for a number of years, until the boy
reaches maturity. Any act or habit which weakens the
quality of this secretion will deplete his powers and
render him physically and mentally inefficient. To make
a man, nature must be permitted to work in her own way.
You cannot improve on her methods nor can you break
her laws with impunity.

[Pg 153]

CHAPTER XIII

THE PARENTS AND THE BOY

Abuse of the Procreative Function.—Breeders of animals
have discovered that to breed from very young stock
is not good. The quality and stamina of the progeny is
lowered and the vitality of the parent stock is reduced.
It is not a good economic proposition.

Boys should therefore be taught that any form of
sexual indulgence is harmful before the period of full
growth.

Nature did not intend that the procreative function
should be exercised by individuals who were not fully developed.
The perpetuation of the species must not depend
upon the license of immaturity. The instinct of sex-attraction
must not be debased to serve a puerile, rather
than a holy purpose.

Sexual indulgence in any form, and in any degree, at
any age prior to full maturity is a perversion of the primal
instinct of race perpetuation. The practice has a more
intimate and a more personal association with growing
boys, however, than a merely altruistic reference. Any
indulgence of this character at this time is physically
and mentally injurious. No boy can hope ever to acquire
the full measure of his possible development as an efficient
working or thinking machine if he wastes his vital[Pg 154]
forces in unnatural liberties. He should be taught this
truth in an emphatic manner by those responsible for his
education.

There is a false idea prevalent that a continent life is
harmful. So far as continence relates to immaturity, it
may be strongly and justly asserted that it is probably
the most important factor in the conservation of health
and strength. The retention of the procreative fluids, at
a time when nature is opposed to their loss, enables the
growing economy to utilize them in the conservation of
nervous energy and virility. If a boy dissipates these
energizing fluids, he deprives his body of the richest
products which he is capable of manufacturing at a time
when he needs every aid in the building up of a physically
and mentally sound and vigorous constitution. There
cannot exist a normal development if the body is deprived
of the essential ingredients necessary to growth and
mental vigor.

There was a time when young men were actually
taught that sexual intercourse was necessary to develop
full manhood. This was followed by a period of silence,
which has practically extended to recent times. Both of
these systems are pernicious. We know that sexual intercourse
is not necessary to the development of mature
normal manhood or womanhood. On the contrary, we
know that continence, not incontinence, is an absolute
essential to the growth of full sexual, virile maturity, as
well as to the growth of efficient and healthy manhood
and womanhood.

We must appeal to a boy’s reason and show him the
personal side of clean living. When he understands that
to attain success in every department of human effort,—on
the baseball and football fields, in the ring, in
gymnastic contents, in examinations, in social intercourse,
in trades and professions,—a continent life is the only
means possible that promises success, he will give the
appeal consideration.

We must employ all the safety devices possible to
guard against the inclination of youth to wander. Regular
exercise is one of the very best institutions in this
respect. If we can instill into our boys a love of manly[Pg 155]
sports and encourage every effort in this direction, we
will be doing much to minimize the growth of any tendency
toward incontinence. We must provide the environment
necessary to right living. The home should
be attractive and we should permit the boy to have
privileges even at the expense of the housekeeping decorum.
His companions should be made welcome if they
are the right kind of intimates, and the parents should
enter into the life of the boy and try to look at “things”
from his standpoint.

The Period of Procreative Power.—The procreative
ability begins at puberty. There is no fixed period at
which it may be said to end. From puberty until the
period of physical maturity, it grows in vigor and it remains
stationary until middle life, when it gradually
declines. The standard of virility is unquestionably an
individual problem. It depends upon the various factors
that contribute to good health and longevity. It may be
stated that the boy who abused his procreative function,
during the period of immaturity, will not enjoy, during
the mature period of his sexual life, a normal standard
of vigor, nor will he carry the ability into old age, to the
same relative degree, as he would, and as he had the
innate promise to do—if he had led a normal continent
existence. It may also be stated here that there is no
effective remedial measures known, that will “bring
back” the procreative ability if it is lost as a result of
disobeying natural laws. Drugs and treatments by quacks
to cure impotence are impositions and fakes. Money
and time spent in the pursuit of this dream is money and
time wasted.

Self-Abuse or Masturbation.—By self-abuse is meant
the production of the venereal orgasm, with or without
emission, by any means other than the natural union
of the sexes.

It is a fact that the large majority of boys acquire
the habit of self-abuse at some time. This is a very
serious reflection upon parent, teacher, and physician,
because it is through ignorance of the elementary principles
of sex hygiene that this condition continues to
exist. If they were warned against the possibility of[Pg 156]
self-abuse arising in innocent ways, as well as in more
reprehensible ways, they would exert their influence
against its acquirement. If however a boy discovers
accidentally a condition of which he was innocent, and
of which he does not know the significance, it is human
nature that he should investigate the phenomenon and
in the end suffer as a consequence. In the effort to
relieve some local irritation he may handle himself and
be led into a dangerous practice. He does not know that
the practice may have serious results—in fact he does
not know he is doing anything wrong. Many boys have
practically ruined their physical health and become
morally irresponsible because no one—neither parent,
teacher, physician, nor friend—told them of their danger.
This is unjust, but great strides are being made in this
direction and we may reasonably hope, that in the not
far distant future, every boy will be plainly told the
true facts about himself.

Most boys acquire this habit from other boys, but as
we have intimated it is possible to acquire it in what
are termed innocent ways. Sometimes the sensation
which leads to it is discovered by sliding down banisters;
or it may be that climbing trees or poles first awakens
the feeling. Very young children are sometimes taught
the vice by depraved nurses. Local irritation, as has
been stated, may necessitate itching and handling the
parts and in this way the vice is begun. The results are
the same, no matter how the habit may have originated.

If the habit is persisted in, the muscular system suffers,—the
muscles become weak and flabby; the patient develops
weariness and languor and loses his mental and
physical vigor. He is no longer forceful or energetic,
his efficiency is impaired and as a consequence his nervous
system begins to show signs of depleted strength. He
cannot concentrate his thoughts, he falls behind in his
studies, his mental effort is sluggish, he becomes diffident
and shy, shuns society, loses confidence in himself, is
morbid and emotional and may even think of suicide.

It is astonishing how indulgence in this habit may
affect the moral nature of a boy. First of all, he is
no longer frank and open. He becomes shifty and[Pg 157]
suspicious and will not look you squarely in the face.
A boy cannot become a slave to this habit without it
affecting his mind. He invites debasing thoughts,—the
old pure and clean method of thought and living no
longer satisfy. His imagination even becomes corrupt
and his moral nature and moral sense is perverted until
he no longer seems to be able to tell the difference between
right and wrong. He has little regard for the
truth and if occasion demands it he will lie without appreciating
the dishonorable part he is playing. In the
end his will power is lost—even the effort to save himself
is too feeble to succeed—he is a slave to the habit,
his health and strength ruined.

If every boy could realize the possible end of this evil
habit he would make an effort to rid himself of it before
he becomes its victim and its slave. It may be
easy to abandon the practice in the beginning. The
longer he continues it, however, the less chance he has
of finally mastering it, until, if he persists beyond a
certain point, it is a matter of serious question whether
he will ever be able to free himself from its grip. If the
boy has lost the will power to carry out his resolves, no
number of good desires or resolutions will avail. And
it is just this will power that the wasting of the semen
saps little by little away.

Treatment.—What can we do for these boys? Most
of them can do much for themselves by simply stopping
the practice. There are, of course, others who need
careful management before the habit may be controlled
and health restored. It is well to always remember to
be tactful and patient and kind to these boys. Many
of them are standing on the brink of despair, weak in
body and weak in mind. They do not know where to
turn to look for a friend—the right kind of a friend.
It is a terrible thought that your own boy may be abjectly
miserable in his own home because he is harboring
a secret that is wrecking his health, and, though he
may long for sympathy and a helping hand, neither his
father nor mother have invited his confidence or spoken
to him about these things. A watchful mother can
usually tell when her boy becomes addicted to this habit.[Pg 158]
He will show it in his manner, he will not be free and
open, he will want to be by himself. Later he will show
the effects of the abusive treatment he is subjecting himself
to in his appearance. He will be sunken-eyed,
pimply-faced, pasty-skinned, shiftless, sneaking, silent,
unmanly. No mother can fail to note these signs and
she should suspect the cause and take steps to tactfully
reach him before he has ruined his health absolutely.

We would advise regular exercise of a vigorous kind.
Tire out the body so that sleep may be sound. Cold
baths, followed by brisk rub-downs; no intoxicants, light
meals, plenty of drinking water morning and night. The
bowels should be regular every day. He should sleep
alone on a hard bed in a well-aired room with light covering.
He should keep busy every minute of the day and
he should not think of himself at all.

The boy must realize that his salvation rests with himself.
After he knows the real danger which the habit
carries with it, he must be on his guard every moment
to abstain. If he does not he may rest assured that
the practice will ruin his health, render him, a business
failure and deprive him of all happiness during the rest
of his life.

Night Losses or “Wet-Dreams.”—A so-called wet-dream
is an unconscious emission of semen during sleep.
The discharge may or may not be accompanied with an
erotic dream.

After a certain age—which may be from the twelfth
or fourteenth year—a boy may discover that he has discharged
some substance during his sleep. He finds the
discharge on his night clothes and it naturally puzzles
him greatly. He may be entirely unconscious of the
whole proceeding, having slept soundly during the night,
or he may wake up to find the fluid actually discharging.

If a boy has not been told of this phenomenon he may
regard it as a form of self-abuse of which he may have
heard and as a consequence he may worry himself sick,
as the night emissions continue to occur from time to
time. Many pure-minded boys have been rendered miserable,
and their efficiency and health have suffered as[Pg 159]
a result of just such an experience. It is, therefore,
proper that they should fully understand the true significance
of these occurrences.

Causes of Night Emissions.—I have explained how
nature makes a man out of a boy. During this maturing
process the testicles are very active organs—their function
is to manufacture or secrete the fertilizing fluid or
semen. This maturing process begins actively, as I
stated, about the age of fifteen, though in some boys it
frequently occurs earlier, sometimes as early as the
twelfth year. When the testicle begins to grow at this
time they manufacture more semen than the little pockets
can hold, so nature adopts the method of permitting the
surplus to escape during sleep. These night emissions,
therefore, are perfectly natural losses, and need cause
absolutely no distress of mind whatever. The frequency
with which they may occur depends altogether upon the
temperament of the boy. If the boy is a strong, active,
athletic boy, they may not be so frequent in him as they
may be in a quiet, studious boy. The system of the
athletic boy seems to utilize more of this surplus than
the quieter existence of the studious boy calls for. If
the discharge does not occur oftener than once every
two weeks, it may be regarded as normal and natural.
Should they become more frequent than this, the boy
should inform his mother or father and the family physician
should be consulted. It may be that he is in need
of a tonic, or special instructions regarding his method
of living and his mode of exercising. Whatever the
cause may be, it can be corrected, and the best plan is
to give it attention as soon as it is noted that the losses
are too frequent.

Sexual Excesses.—It is well known to the medical
profession that the marital relation is frequently practiced
to excess. The same indictment may be passed on
what may be termed extra-marital relations. No one
has ever formulated a general sexual standard which
could be safely regarded as normal. Too many individual
conditions of temperament and health enter into
the proposition to permit of a standard being formulated.
It must, therefore, be regarded as an individual question[Pg 160]
to be adjusted, if necessary, by the family physician.
What may safely be regarded as normal and harmless
in one, constitutes, for many reasons, excess in another.
When a man performs hard physical or mental labor, his
sexual aptitude or capacity is limited, and this limitation
cannot be exceeded without risk. Such a limitation may
not constitute an excess in a man whose occupation does
not call for a great expenditure of physical or mental
energy. Any indulgence which produces exhaustion is
excessive.

The age of the individual has undoubtedly much to
do with his sexual endurance. A young, virile adult
will tolerate a sexual expenditure which would seriously
affect the health and vigor of an older man.

Environment and inclination are factors in determining
the standard of some people. If the marital relations
are participated in simply to preserve peace and harmony
in the home, they are productive of harm even if indulged
in moderately.

The symptoms of sexual excess are much the same as
those of self-abuse. To a certain extent, however, they
are favorably influenced, because the conditions under
which the relationship is practiced are natural, because
the participants are matured physically, and because there
is no element of worry over the probable effects.

Sexual excess defeats its own purpose, because it engenders
a lack of desire and consequently it is to a certain
extent a self-limiting process. We must also remember
that excess entails consequences just as the breaking
of any natural law is followed by retribution of some
kind. In these cases we find that discomfort follows
excess. The parts become irritated and congested and
disease of the prostate gland always follows.

Treatment.—Stop the excess by self-control and self-restraint.
Employ all the aids dictated by an intelligent
perusal of the laws of sex hygiene. Preserve the general
health. It may be necessary to resort to local treatment,
because, if the parts have been abused by excessive indulgence,
there is always more or less irritation and congestion
present. This condition affects the nerves, suggestive
reflex sensations are produced by a congested[Pg 161]
prostate and the patient becomes morbid. It is essential
for such patients to consult a physician whose local treatment
will stop the sensitiveness in the parts and relieve
him so that he may carry out his programme of restoration
unhampered by conditions which are only amenable
to local treatment.

What Parents Should Know About the So-Called
“Social Evil” Before Speaking With Authority to
“The Boy.”—To be qualified to speak with authority, or
convincingly, to a boy upon sex hygiene, the parents must
be familiar with, and well versed in the subject. The
facts related in the preceding pages must be thoroughly
understood. No parent can study these facts intelligently
without being impressed with the importance of the subject;
without realizing that it is absolutely essential that
the fundamental principles of sex hygiene should be
taught to the rising generation; without acknowledging
the tremendous part for evil which prudery and ignorance
play in the education of youth; and without being convinced
that most of the evil is the product of ignorance
on the part of the boy, and that parents are in a large
sense to blame if they fail to impart the necessary knowledge
in time.

The need for enlightenment in sexual matters is a
product of existing conditions. Civilization and the social
environment are developing along a plane which subjects
the youth to temptations that practically did not exist in
the past. There is a broader and looser code of ethics.
Business monopolizes the entire time of the father, and
social and political unrest and misdirected ambition distracts
the mother. The son or daughter has a wider
latitude and a freer reign than they once had. The opportunities
for promiscuous intimacies are easier, and the
public conveniences and utilities lend themselves to the
designs of evil-intentioned and loose-moraled women.
The ease of travel, the laxity of laws, the theater, with
its unchaste and indecent plays, the moving picture
snows, the vaudeville resorts, whose highest priced
“talent” is some voluptuous female, who has cultivated
the art of draping nudity with suggestiveness and singing
immoral songs, all tend to give youth a false impression[Pg 162]
of the reality of life and to make the path of the degenerate
easy and profitable. The rich are growing
richer, and their children are pampered and overfed and
underrestrained. Time hangs heavily on their hands and
their only mental effort is to devise new methods and new
ways of satisfying the lust of liberty and overstimulated
desire. The poor are growing poorer, and to “keep in the
ring,” to live and dress beyond their means as many do,
it is necessary to have an unexacting standard of morals.
In this way the promiscuous libertine is evolved,—the
most insidious and dangerous product of present day
civilization, and the most pernicious factor in the spread
of immoral impulses and indecent diseases.

Parents must accept these institutions and agencies as
necessary instruments of evil and adopt measures to nullify
their attractiveness. Eternal vigilance is the price of
success, but the quality of the vigilance must be dictated
by love, not by suspicion and distrust.

When the parent can convince the boy that the knowledge
is imparted, not with the intention of depriving him
of what he may construe as his natural liberties and
rights, but with the single intention of adding to the sum
total of his pleasure and success, he will look more kindly
upon any proposition that suggests a course of conduct
that leads to clean living. Sex hygiene will eventually
find a natural place in the scheme of education. It will
be taught to male and female alike. In the meantime,
however, we must begin by educating the educators—the
parents. In the beginning, their task will not be easy.
There will be much to overcome, much ignorance,
prudery, false modesty, hypocrisy; there will be much
vicious teaching and evil example to live down. But we
cannot hope to achieve results in the noblest cause, save
by patient, intelligent, and persistent effort and by self-sacrifice
and a constant enthusiasm. The aim is to tell
all,—all the truth,—so that we may never be assailed by
the cry, “No one told me, I did not know,” from the loved
lips of son or daughter gone astray.

The Father and the Boy.—The right kind of father
can always find the time and the way to awaken in the
heart of the boy the spirit of companionship. No boy[Pg 163]
living will resent the fellowship of the right kind of
father. It depends upon the father! If the spirit of
chumminess does not exist between you and your boy, you
are at fault, you have made a mistake, you have missed
your opportunity, you “did not go about it in the right
way and in the right spirit.” Try again—it may not be
too late.

The father who adopts the habit of taking his boys
(and his girls too) out for long walks, at least every Sunday,
and who spends an hour with them every evening—is
the right kind of father. One who has never tested the
merit of walks with children cannot possibly appreciate
the enjoyment and benefit that can accrue from them.
It is not only the physical good that results, nor the inspiration
which one may draw from nature, but the concrete
advantages that come from the fellowship with the
children are a new and a real experience—this is what
counts. You will have opportunities of sewing seeds in
their minds that will grow into a harvest that will
astonish you. Children in the right mood—and they
are in the right mood when they are happy, and they are
happy out in the open with an interesting companion—are
alert, and responsive, and eager to be told “things,”
and this mood can be put to marvelous use by the “right
kind of father.” The father who wanders forth with the
fixed purpose of thinking out some business problem during
the walk and permits the children to find their own
amusement is the wrong kind of father. He must choose
to be a child again, he must desire to please them, he must
make an effort to be in harmony with them, he must draw
on his experience to interest them, he must talk to them
entertainingly of every interesting problem which the
walk itself suggests or he must formulate a plan and
select a subject with a definite educational scheme in view.
We can, in a most effective way, begin to build their
characters, and, by the right kind of talk and enthusiasm,
he can determine their resolves to be honest, truthful, just,
clean, sympathetic. He can instill into them, in a
thousand different ways, the determination and inspiration
to succeed. It is a wonderful and a precious chance,
and it will make the “right kind of father” more just,[Pg 164]
more sympathetic, more optimistic, and it will make him
young again and more successful. Try it.

Implant in the hearts of your children a love of home,
make the evening meal and hour by the fireside a period
of congenial fellowship, when all the little irritable ruffles
of the day may be ironed out and swept away. The secret
is to be intimate. Tell them the secret of success from
your standpoint, how happiness is gained only by being
efficient and successful, and that, to be efficient, one must
be energetic and healthy. Drum into their ears the truth
that life is a battle, and only the brave “win out,” and
health is the one essential necessity. It is astonishing how
such talks will impress young minds. They will remind
you of things you said, that made a lasting impression on
them, long after you have forgotten the incident.

A father can, in this way, by talking of the future to his
boy, convey to him the high hopes he entertains of the
great success the boy is going to achieve—you establish
a standard in the boy’s mind, and he unconsciously hopes
to attain that standard. If you have impressed him with
the necessity of preserving his health and strength, as an
essential to success, he will be slow to yield to any temptation
that may interfere with his plans. This reasoning
may sound quixotic to some people, but it is the truth.
Many a boy has been inspired to success by the knowledge
that his mother or father believed in him, and was
confident he would be a leader. He strove to justify the
pride and confidence of those who held him dear, and
he won out.

To retain his health, therefore, is the first impulse to be
conveyed to the boy. When he recognizes this truth, it is
an easy task to instill a love of exercise, gymnastics,
swimming, fresh air, cleanliness and temperance in him.
If these are attained, you will have tided him over the
tendency to self-abuse, and you will have rendered him
less likely to yield to evil suggestion or temptation. His
confidence in you will be whole-hearted and implicit.
You can do anything with him at the psychological
moment. It is now time to talk of more intimate matters.
Carefully and tactfully, the father approaches the fundamental
truths of sex hygiene.[Pg 165]

The selection of a subject for a text as a means from
which to advance toward the real facts is sometimes of
importance. It must not appear as though the subject
was designedly chosen. If it follows in a natural way
it will more thoroughly interest the boy and he will have
swallowed a large dose of truth before he is impressed
with the personal viewpoint. A passing trotting horse
has served me a number of times for intimate talks with
boys on heredity and kindred subjects. I invite the boy
to watch how the horse uses his legs, and how rhythmically
and beautifully he places his feet, and how his whole attitude
serves the end for which he is exerting himself—to
gain speed. Tell the boy the story of how professional
breeders have achieved such marvelous results; how for
generations the “strain” has been kept clean and pure,
how any descendant of a great sire, who showed any
habit detrimental to the development of the highest racing
qualities—no matter how trivial the disability might be—was
cast aside, experience having taught that it does not
pay to waste effort and time on any horse whose physical
or mental characteristics are not up to the highest
standard. Such a horse will not win, and it is only
“wins” that count.

Change the subject to human beings. Tell him how
the race maintains its standard; but show him the difference
between the methods employed. How the horse
has his mate selected because of the female’s good qualities,
so that the offspring may possess like qualities, if
not better, and that the selection is made by men who
know their business, and have had long experience in the
work. How, on the other hand, a young man with no experience
is permitted to choose any woman he may fancy
irrespective of her qualifications. As a consequence, we
have all kinds of children, good and bad, feeble and
strong, honest and dishonest, some degenerates from
birth, some criminal, and many diseased and inefficient,
few of them “winners.” It is an easy matter to preach
a little sermon from this text. Show him how essential
it is to select the mother of one’s children wisely, to know
if there is disease in the future wife’s blood, if her family
history is good, if her temperament is suited to his, if her[Pg 166]
domestic qualities are satisfactory, if her principles are
moral and normal, and if she understands and appreciates
the true object and function of marriage. Show him also
the element of justice involved in the marriage contract;
that he must give what he exacts, that if he expects a
healthy and normal wife, he must be healthy and normal
himself; if he expects purity and cleanliness he must give
purity and cleanliness; if he expects to mate with a fit
female he must be an efficient and fit male. Remember
that every act, deed, thought, and aspiration is regulated
by laws which one cannot fool with, or disobey, without
reaping a harvest which will conquer, crush and ruin
you, no matter how clever or smart you may think yourself.

Show him the wisdom of the breeders’ habit of never
permitting sexual liberties in a too young stallion. For
the same reason the boy must conserve his strength and
virility for the marriage state and for the function of
procreation.

In a further talk, the father may extend this subject
and gradually lead up to the “consequences” of the unclean
life. The boy will be ready for this talk and will
evince an interest in it that will be encouraging and
promising.

The talk about the science of mating the horses he will
understand readily and thoroughly, and he will not fail
to see the point when you switch to man and apply the
same principles. Then when you show how mismating is
responsible for poor children quality and how disease
accounts for feeble-minded and degenerate offspring, he
will be fairly well posted, and he will be ready to imbibe
more details, and you will have done much of your duty.
His curiosity will be quickened and his interest is
awakened. It depends upon the father. If your boy is
honest and clean, open and decent, he will not fall without
a fight, and while he is fighting he is maturing. If your
picture of the consequences of the venereal diseases has
been effective and vivid, he will grow up with a healthy
horror of them. If your conduct as a father has been
wise and exemplary, and if your home has the right kind
of environment, and the right kind of mother in it, you[Pg 167]
have done all a father can do to help the boy over the
rough spots. The proper kind of encouragement and the
right kind of vigilance, and books which will satisfy the
boy’s craving for more knowledge along this line is all
that is needed to help the boy to “win out.”

Fake Medical Treatment for Venereal Diseases.—Parents
should in every possible way discourage the use
of patent medicines and fake medical methods of curing
these diseases. Untold harm has been done to boys and to
women by these nostrums.

In every instance the motive underlying the methods of
people selling these things is to frighten the patients into
the belief that their condition is more serious than it is in
order to justify a long and expensive course of treatment.

Their work is carelessly performed, and frequently
they are directly responsible for the development of complication
and dangerous sequelæ. The promises of
speedy cures are false, and, not infrequently, methods of
black-mailing have been known to follow an expensive
and unsuccessful course of treatment.

There is no class of disease in which the help and
honesty of the legitimate medical profession is needed
more than in the treatment of the venereal diseases.
Parents should see to it that the family physician is
prescribing any strange medicine that may appear in the
boy’s room, and not some unknown individual who may
be an impostor and a blackmailer.

Sowing Wild Oats.—Writers of fiction and others of
a more serious trend of thought have recognized the sowing
of wild oats as an institution which, if it does not
merit the full approval of society’s moral code, is, at
least, tolerated. No serious consequences befall the offender.
On the contrary, the libertine is the type of hero
who receives the commendatory quips of erotic dames
and the questionable interest of hysterical maidens.

Women of easy morals are always willing to espouse
the cause of the “black sheep,” and to further the
matrimonial success of the penitent roué. Many mothers
are willing to marry their daughters to the polished villain
of society, who is known as a rake and debauchee, if his[Pg 168]
family connections are desirable. It has been even held
that a youth who did not “sow his wild oats” was of
doubtful stamina.

That many able men have sown wild oats is indisputable,
and that many men who are respectful husbands,
have also gone “through the mill” is also true, but this
need not blind us to the fact that thousands upon
thousands, who could have been successful men of affairs
and creditable husbands and fathers, have been utterly
ruined, as a result of having sown wild oats. No man
is a better man because of a past record of licentious
habits. The man who sows and escapes the harvest is
lucky. The man who reaps, reaps in abundance. Most
men regret the lapses of youth. Most of these lapses
would never have occurred if the impulse could have been
governed by the reasoning of maturity. These acts are
the promptings of an impetuosity which may be entirely
foreign to the individual’s innate character, but brought
out by promiscuous circumstances and the ignorance and
license of youth. If we can protect youth, by an adequate
knowledge of the consequences, we will furnish
the means to tide over the impressionable period. Until
a healthy maturity of judgment will assume the task unaided.

The effects of the wild oats’ theory are too tragically
evident to need any argumentative refutation. The
statistics of the prevalency of venereal diseases alone is
sufficient; the results of these diseases are more than
enough.

Study the records of the jails and prisons, courts and
asylums, hospitals and health resorts, think of the
hundreds of thousands of diseased and deformed and
mentally inferior children, of the multitude of paretics,
melancholies, ataxics, maniacs, syphilitics,—all the
products of “wild oats,”—and ask if the wild oats’ theory
is justifiable.

Think of the ruined homes, the wretched lives of fallen
women, the hopeless prayers of abandoned wives, the
loneliness and misery of parents neglected and forgotten,
the “bastards” and fatherless children, the drunkards and
criminals and tramps—all weeds of the wild oats’ harvest.[Pg 169]

Then reflect upon the tragedies, the suicides of the betrayed
and of the diseased, the bank thief, the broken
hearts of deserted and hungry children, the army of
inefficients—around whose necks hang wild oats’ medals,
the men of big business, who constantly fight the effects
of early incontinence and abuse, and the thousands who
go to early graves, and then ask, in all justice, if the sowing
of wild oats needs justification.

Who supports the thousands of prostitutes? Who
made them? Wherever you find pauperism, crime,
drunkenness, insanity, idleness, immorality, vice and
disease, you will find that the sower of wild oats has
traveled the path and left his stain and his footprints
there.

Should Circumcision be Advised?—The answer to the
above question is “Yes,” in every instance. If circumcision
is done early,—during the first two weeks of life,—the
operation is without danger and practically without
pain. In quite a considerable percentage of all males,
circumcision is an absolute necessity. For excellent
medical reasons, about which your family physician can
inform you, every boy should be circumcised.

[Pg 173]

CHAPTER XIV

A MOTHER’S DUTY TO HER DAUGHTER

What a Mother Should Tell Her Little Girl.—Every
little girl should be told the Story of Life by her mother.
It should be told in simple language, so that the little girl
will understand. Very early in life the little girl will be
prompted to inquire of her mother “Where do babies
come from?” It is wrong to give an evasive reply to
this natural inquiry or to postpone telling the story, because
they will be told it by playmates and will receive
very wrong and very crude impressions of this wonderful
subject.

Every mother knows enough of life to tell her little girl
its story in a way that will impress her with the sacredness
of God’s beautiful reproductive plan. She should
begin by telling her a story about how the birds live.
How at a certain season of the year they choose a mate[Pg 174]
and go housekeeping. They build a nest, and when it is
all nicely finished, the mother bird lays her eggs. Then
the papa and mamma bird take turns and sit on the eggs
to keep them warm, and after a time the egg breaks and
a little bird is born into the world. They feed the little
baby birds until their feathers grow, and when they are
old enough they fly away from their home and begin life
by themselves.

Many questions will be asked as the mother tells the
story in her own words, and the correct answers to these
questions will fill in all the difficult-to-understand points.
The story of how the fish lay eggs in shallow water so
that the sun may keep them warm and hatch them out will
interest also. Be careful to impress upon them that
there is always a mamma and a papa, a male and a female
bird and fish,—that this is necessary because God made
it so, and we must obey His wish. When the little girl
fully understands the story of the egg bird, and egg fish,
the mother can tell how the Creator thought out a different
plan for other animals like the dog, horse, lion,
elephant, and cow. He knew that it would neither be safe
nor possible for these animals to stay at home long
enough to sit on eggs and hatch their babies, so he made
a nest for them inside of their bodies. There they would
be warm and would always be with their mammas no
matter what they were doing. So we come to the answer
to their question: “Where do babies come from?”

These interesting stories, according to the intelligence
and sincerity of the mother, can be taken advantage of,
to impress the little girl with the importance of many of
the lessons of life. For example, her attention can be
drawn to the fact that man and woman are the highest
types of living things that God made. No other living
thing, animal, or fish, or bird, or tree, or flower, can talk,
and think, and reason as man and woman can. Because
of this faculty—to think and reason—the human family
are always trying to find out what can be done with all
the other things God made. We try to find out what the
different rocks are good for; what the different trees are
good for, and the different kinds of earth, and animals,
and birds, and fishes, and everything in the world. We[Pg 175]
study these, and we learn much, and we are made happier
and more comfortable by what we learn. For example,
by studying horses, and feeding and breeding them carefully,
and training them, and caring for them, we can
make stronger horses and better and faster horses; by
studying trees, and planting them in soil best suited to
them, and giving them plenty of water to drink, we can
compel these trees to grow better apples and pears and
peaches. In the same way we can produce better strawberries,
and oranges, and grapes, and we can grow flowers
with sweeter smells and prettier colors. We do all
this by training these animals and trees to grow a certain
way, to eat certain food, to drink pure water, and we
protect them from the cold and sometimes from the sun
if it is too hot. Our faculty to think and reason has
taught us just what is good for them, and we compel them
to obey our laws. As a result they become strong and
more healthy. Now show the little girl how important
she is; how much more precious she is than a tree, or
animal, or flower, and how much more necessary it is that
we, mammas and papas, should use our ability to think
and reason in her interest. Show her how we have found
out all about babies and little girls and how we know
just what to do to make strong and healthy, and pure,
and good, and clean men and women of all the little boys
and girls in the world. Tell her that this is what mother
is doing now, training her and compelling her to do the
things that will make her a strong and a good mother
when she grows older. Let her distinctly understand that
it is the duty of mothers to instruct and to correct their
little daughters when they do any wrong. Mothers know,
because they have had experience in these matters, and
they know just how a little girl must live, and dress,
and eat, and behave, in order to be strong and pure, and
good. So when mother reproves and corrects, it is because
she knows that what you are doing to merit a correction
is not for your ultimate good. Show them that
all young things, and young animals, and young babies,
and young girls, must be compelled to obey certain rules
and laws, otherwise they would not grow up to be strong
and healthy. Sometimes a rose bush grows up among[Pg 176]
stones and weeds, but it never thrives, it is always more
or less sick. It does not grow strong, its flowers are poor
little sickly things compared to the roses on a bush that is
planted in proper soil, and carefully tended and pruned,
and watered. So would the little girl turn out if she grew
up in bad company and did not have a mother to guard
and guide her,—to prune her when she was growing careless.
Everything in this world has a meaning, and when
mother tells you that you must not do a certain thing you
very much want to do, she has a very good reason for
telling you not to do it. You may not know the reason,
but you should have confidence in your mother, you
should believe that she knows what is best, and that she
would not inflict pain or cause you suffering unless she
knew it was for your good. The young horse does not
understand why a halter is put around its neck and is
made to run around in a circle until it is tired. It would
much rather enjoy itself in its own care-free, and happy
way. And when finally a full set of harness is put on, and
it is put into the shafts of a wagon and tied there, and
made to pull it and its driver many weary miles the horse
does not like it, and he rebels strenuously. He is, however,
compelled to obey in the end, and he finally consents
to become a useful horse.

It is exactly the same way with every little boy and
girl. We are put into this world for a certain purpose,
and we must all work. Now parents know this, and they
know just how to prepare little girls and boys for this
work. They therefore ask them to do many things that
are not pleasant or agreeable but which must be done in
order to prepare them for the work ahead.

WHAT A MOTHER SHOULD TELL HER DAUGHTER

Your daughter is now about fourteen years of age.
She is about to pass from girlhood to womanhood and
she should know more of life’s story. The mother will
now tell her the complete story in the form of little talks,
based upon the following facts as texts. Each mother
will doubtless add to the story as conditions justify and
as the education of the mother and daughter may dictate.
A multitude of little side talks can be wisely indulged in[Pg 177]
to make clear any uncertain or doubtful explanation, and
every one of these incidental excursions can be made exceedingly
interesting if wisely and opportunely chosen.
Always remember, however, to emphasize the sacredness
of the story. Do not permit your daughter to get the impression
that you are telling her something that simply
has to be told, just as you told her the correct way to
boil an egg. Let her realize and get the impression that
this is the most serious and most wonderfully interesting
story in existence, the most important story she will ever
hear. Let her understand that motherhood, for which she
is now preparing, is the duty God assigned her in this
world: that that duty must be carried out, and that she
must do nothing, nor leave anything undone, to interfere
with its accomplishment. Do not only impress her with
the story itself, but let your own explanation be so emphatically
serious, that she will deeply appreciate its
momentous significance—an occasion to be remembered
all her life.

If she gets the proper impression from you at this time
she will never treat the subject lightly, or permit it to be
promiscuously discussed within her hearing.

Begin by telling her that she is about to enter the most
important period of her life. Explain why this is so in the
following way, in your own words. If we admit every
female child to be a future mother, and motherhood the
highest function possible to the sex, then the awakening
of the sex organs and the mother instinct, must be the
most important developmental episode in the life story of
every woman. If this is so, then it follows that every girl
should enter this period in the very best physical health
possible, in order to reap the best results incident to this
evolutionary period. We impress and warn her, therefore,
that, as her system is about to undergo important
changes, she must be particularly careful of her health.
A little mistake at this time may be followed by more
serious consequences than if made at any other time in
her life. If a girl is to become a mother, certain changes
must occur in her body before the nest, of which we
previously wrote, can be made ready. God did not overlook
anything when He peopled the earth; He therefore[Pg 178]
wisely planned that these changes in the female should
occur at a time when the girl is strong and healthy.

The Period of Puberty in the Female. Symptoms of
Beginning Menstruation.—At about the age of fourteen
these changes begin to give evidence of existence. They
affect the girl’s whole system and the mother must be
especially patient and sympathetic. Her disposition may
change, she may want to be alone, and she may be more
or less melancholy. She will be dissatisfied with the
things that previously interested her. She will tire easily,
and she may have many spasmodic pains from time to
time. The wise mother will tactfully see that she takes
plenty of nourishing food and systematic exercise, and
that she gets enough sleep in a well-aired room. There
are other physical changes which are observable at this
age. The girl grows taller, the figure broadens out, the
hips widen, the bust enlarges, and the waist line increases
in size. These are all part of the great change from girlhood
to womanhood.

Changes in the Reproductive Organs.—The principal
change takes place in the reproductive organs themselves,
and it is very essential that she should have a clear mental
picture of just what is meant by “reproductive” organs
and their location in her body. We mean by this
term the group of organs which are concerned in creating
and nourishing a child until it is old enough to be born
into the world.

The Female Generative Organs.—These organs are
the womb or uterus, two ovaries, two fallopian tubes
and the vagina. The womb or uterus is the “nest.”
It is about the size of and is shaped like a pear. It is
hollow, however, though its walls are quite thick. The
ovaries are about the size of a peach stone and lie at the
side of the womb,—one on either side. The fallopian
tubes connect the ovaries with the womb. The vagina
connects the womb with the outside world,—it is sometimes
known as the birth canal. In the very lowest part
of the abdomen, or belly, in front, is the bladder, which
collects the urine until it is necessary to pass it out.
In the back part of this region is the rectum; it collects
all the undigested food, etc., from the intestinal canal.[Pg 179]
Between these two,—the bladder and rectum,—we find
the reproductive organs, the womb, ovaries and vagina,
described above.

The Function of the Reproductive Organs.—It will
be difficult, even for mothers, to acquire a clear understanding
of the function of the reproductive or generative
organs. It is an exceedingly interesting process,
however, and it is well worth a patient, attentive study to
clearly understand the brief description we give of it.
If you acquire a distinct mental picture of the problem
you will be able to tell your daughter a story that will be
of intense interest to her, and a tale that is interesting
is impressive and is productive of thought and reflection.
That is the condition of mind we want daughters
to be in when they hear this story.

The human ovaries begin to prepare themselves for
their life work when the girl is about eight years of
age. When they are ripe, or ready to perform this duty,
the girl menstruates for the first time. This is known
as the age of “puberty,” which implies that she has developed,
passed from girlhood into womanhood. After
having reached the age of puberty it is possible to become
a mother.

The Age of Puberty.—There is no fixed age at which
the first menstruation takes place. Some girls develop
quicker than others,—a condition that depends upon
the health and type of girl. A strong, robust, full-blooded
girl will menstruate at an earlier age, than will
a sickly anemic girl. The average age is fourteen years,
though there is no reason to worry if a girl does not
menstruate for a number of years later. In warm climates
the age of puberty is from two to four years earlier
than in more temperate climates.

The Function of the Ovary.—Just what takes place
in each ovary when it is ripe is best explained by likening
an ovary to an orange,—though of course the ovary
is very much smaller than an orange, as was previously
noted. If you make a cut in an orange and squeeze it,
you express some of its juice and most likely you will
also express one or more seeds. The seeds of the ovaries
are called “ovules,” and the process by which it expresses[Pg 180]
them is called “ovulation.” Of course there
is no actual squeezing of the ovary,—the ovules grow
in the ovary, and as they ripen they come to the surface,
and when actually ripe, the part of the surface of the
ovary to which they come, opens up (like a flower unfolding
when in bloom), and they fall out. The ovule
we may regard as the human female egg, and one ripens
and falls out every twenty-eight days.

When the egg falls out of the ovary it falls into the
tube which carries it into the womb. This tube you
will remember is called the fallopian tube. The ovule
or egg is now in the cavity of the womb where we will
leave it for the present.

The Function of the Womb.—While these changes
are going on in the ovary, the womb is also preparing
itself for its share of the work. The lining or internal
surface of the womb is composed of mucous membrane,
much the same as the interior lining of the mouth and
throat. This lining becomes congested with blood, and
is so intensely swollen at the time when the ovule or
egg reaches the womb, that it is ready to rupture and
bleed all over its surface. Just whether it will rupture
and bleed, depends upon whether the egg is going
to grow into a child or not. If it is not going to grow
into a child, it immediately bleeds freely, and continues
to bleed, until the whole lining of the womb and egg
is passed out into the outer world. This takes four or
five days and constitutes “menstruation.” After menstruation
is over, the womb begins again to prepare itself
for the coming of the next ovule or egg, and as this
occurs every twenty-eight days, menstruation is commonly
termed the “monthly periods.”

Why Menstruation Occurs Every Twenty-Eight
Days.—The reason why the womb does this every twenty-eight
days is because it is impossible to tell just when
the womb will be called upon to nourish and support
a child. If it did not get rid of the old blood, it would
not be in a healthy condition to nourish and take care
of a baby, nor would its interior be ready to supply
new fresh blood for the growth of the infant. Hence
nature constructs and builds a new “nest” in the interior[Pg 181]
of the womb each month. It very much resembles
the new home into which the bride and groom, go to
begin housekeeping.

When you told your little girl the story of life, you particularly
drew her attention to the important fact that
every living thing is created by the union of a male
and female principle, and, therefore, has a mamma and
papa. This applies to trees, flowers, vegetables, fish,
animals, birds, insects,—every living thing, including
human beings. We have seen that the ovule from the
ovary is the female egg, or principle. It is the part
the female contributes toward the future child. Before
a child is possible, however, the ovule must meet the
egg from the male.

The Male or Papa Egg.—The male or papa egg is
called a “spermatozoa.” It reaches the interior of the
womb through the lower opening, which you will remember
opens into the vagina. Emphasize to your daughter
that the female ovule or egg, and the male egg, or
spermatozoa, are minute objects, so microscopically
small that a hundred million of them could comfortably
lie upon a ten-cent piece.

The Function of the Spermatozoa.—God gave the
male spermatozoa the power to move. To watch them
under the microscope you would imagine you were looking
into a bowl of water, in which there were hundreds
of little fish all squirming around. But the most wonderful
thing about them is, they can only move in an upward
direction,—they seemingly cannot move downward, or
sideways. If you think for a moment you will understand
why God gave them this marvelous property.
When the male semen is deposited in the female vagina,
there are thousands of these minute, living, moving
spermatozoa in it. The womb is above the vagina, and
the female egg is in the womb, consequently, to reach
this egg, the spermatozoa must travel upward. To travel
in any other direction would be fruitless energy. There
is only one female egg, but there are thousands of male
eggs, or spermatozoa; it is easy, therefore, to comprehend
how one of these spermatozoa should exactly be in line
with the female egg in its upward path, since there are so[Pg 182]
many of them. It is only necessary that one should meet
the female egg in order to impregnate it.

The shape of the male principle, or spermatozoa, is
exactly like a little tadpole, and you no doubt recall that
a tadpole has a minute tail, the movement of which
enables it to swim around. So has the spermatozoa, and
by the incessant movement of this microscopic tail they
all move upward as soon as discharged by the male. I
told you that God gave the male-germ life. It is necessary
now to explain the character of this life. It is very
brief; it is estimated that they are active for two hours,
and then become inactive, or die. The best way to explain
the brief activity to your daughter, is to liken the
spermatozoa, to a mechanical toy, which is wound up
to go for a certain time. After it runs out it becomes
inactive; this is exactly what happens to the little human
tadpole. If during this brief life none of them has
happened to reach the female egg, pregnancy does not
take place and menstruation occurs. On the other hand,
if this were not so,—if these spermatozoa were active
for a longer period, pregnancy would almost be certain
to take place every time the womb was not already occupied
with a pregnancy.

Tell the Whole Story.—When a mother reaches this
stage of the wondrous tale she will be asked by an innocent
girl,—”How do these spermatozoa get there?” or,
“You have not told me where these tadpoles came from”
or, “I don’t understand how these spermatozoa got into
the vagina” or, “I don’t know why you call these the
male egg when they are in mamma.” It does not matter
how it is expressed, the intent is plain enough. I have
said, that an innocent girl will ask this question, the
implication being that one who is not innocent will
refrain from asking this question. A girl who knows the
answer will not ask, because, if she is familiar with this
subject before her mother thinks it wise and proper to
tell her, she obtained her information from a source
which, most likely, insinuated a suggestive, or evil, meaning
into the explanation, consequently she would be afraid,
or ashamed, to ask the question. An innocent girl, on
the other hand, would rightly ask for information which[Pg 183]
is obviously kept back, and which she has a right to
know, since a complete, and intelligent understanding of
the story depends upon the elucidation asked. If it is
proper to tell part of the story, it is essential to tell all
of it. Tell it in your own words in this way:

When God conceived the human race He ensured its
perpetuation by designing a method whereby this would
be rendered possible: He did more; He wisely decided
that the function, involving the very existence of the
human race, should be attended with a sentient gratification.
He further instilled into the fundamental economy
of mankind, sex attraction, which is involuntary, undeniable,
and unquenchable. If God conceived the means
and the method, no human mind in possession of its
faculties should see evil where it does not exist. It was
by Him designed that the male organ of reproduction
should deposit its germinating fluid in the vagina of the
female, and this is accomplished by a union of species.

The one set of reproductive organs is a complement of
the other, and essential to the other. It is by this act that
the male spermatozoa is enabled to complete the function
of fecundation.

If now we assume the male and female element to
have met and united, menstruation does not take place.
The egg or embryo (the future child) begins to grow,
and it remains in the womb for two hundred and eighty
days from the day when the male and female egg met.
It is quite natural for an intelligent girl to ask her mother
to explain, “How a baby can live in there for such a long
time,” or “What makes it grow if it does not get anything
to eat or drink.”

How the Baby Gets its Nourishment in the
Womb.—These questions can be answered in this way.
While the baby is in its little comfortable home it gets
everything it needs. You are in your home now. If
you wanted a drink, what would you do? Wouldn’t you
go to the water faucet and draw a glass of water? The
water comes to you through a pipe, right into your home,
you don’t have to go out of the house to get it. And if
you wanted light when it is dark you would turn on the
gas and light it. It, too, comes into your home through[Pg 184]
a pipe. Now baby gets its air; and food, and all it needs
to drink in just that way. There are two little pipes
which go into its nest or home, and then into the baby’s
body at the navel, and through these pipes fresh blood
runs in and out. When mother breathes, her blood sucks
up oxygen from the air in her lungs, and the blood carries
oxygen to every part of her body. In this way, all
parts are supplied with the proper quantity of air. Now
the baby is simply a new part of mamma as long as it is
in its nest in her body, so it too gets air in this way.
When mother eats, the food is taken into her stomach and
it is there changed into liquid and so prepared, that when
it passes into the intestines, the part of the food that is
good for her, is sucked up into the blood, and the blood
carries it to every part of her body. It distributes whatever
is needed to all parts, and as the baby is a part, it
gets its share. The other pipe carries the blood back
again, out of the baby for new supplies, and as this is
going on all the time, there is no danger of the baby
starving in any way, or at any time.

When your daughter understands this, show her how
important it is that mothers should be in good health,
otherwise the baby will not get good food, it will not be
properly nourished and will be born a poor, little sickly
child. Little girls, consequently, should try to eat properly,
exercise regularly, and do everything their mothers
tell them, so that when they become mothers, they will be
able to nourish their babies and not bring into the world
poor little starved infants.

Girls Must not Become Mothers.—We have previously
stated that girls can become mothers when they
have reached the age of puberty. God did not intend,
however, that girls at the age of twelve or fourteen
should become mothers, because their bodies are not
strong enough, nor are they fully grown, nor have they
the experience, to undertake the physical task and
responsibility of bringing a baby into the world. We
know this from experience, because we have seen the
sickly babies such girls have, and we have seen how much
these girl mothers suffer, and how they ruin their health,
by trying to do what God did not intend they should do.[Pg 185]
Even the trees teach us this lesson. An orange tree will
bring out buds, which would develop into oranges, when
it is two years old. The experienced farmer, however,
will pluck these buds off, and will do so every year, till
the tree is five years old. If he allowed the tree to bear
fruit during its young years, the oranges would not be
good, or sweet, or large; so he waits until the tree has
grown and is strong and healthy, when its fruit will be
large and sweet. An orange tree of this type will have
better fruit, and will continue to produce this good
variety for many years. A tree allowed to bear fruit
when two years old will never have first class oranges,
nor will it continue to have, even poor oranges, as long
as the other.

[Pg 187]

CHAPTER XV

PREPARING FOR MOTHERHOOD

MENSTRUATION

We have explained in the previous chapter what
menstruation is, its frequency, its significance and its
origin. There are a number of its common characteristics
with which the mother and daughter should be acquainted.

Irregular Menstruation.—Menstruation may occur
once (the first time) and fail to recur the following
month or for a number of months. This need cause no
alarm as long as the general health remains good. It
will come again in its own time. Nervousness may cause
a suspension of menstruation. This is quite common in
school girls who are driven too hard at school, whose[Pg 188]
sleep is interfered with, whose appetite is poor and who
are allowed too many social indiscretions, as parties,
dances, etc., where late hours are observed, all of which
should be put aside until school life is over. Sometimes
menstruation will temporarily stop if the girl goes away
from home on a visit.

Sometimes the quantity will be greater than at other
times, and a very scant flow, after it has been free and
regular may cause apprehension. Various causes may be
responsible for a decrease, catching cold, sitting on cold
steps or cold ground, wearing damp clothes, nervousness,
mental worry, physical exhaustion, insufficient food and
exercise, and anemia, may cause it. For these reasons a
girl should be exceedingly careful of her health, she
should guard against catching cold. Do not change the
underwear until certain that the weather is far enough
advanced in season to justify such a change. She should
not become exhausted or worry. In all cases of suppression,
or of increased flow, a physician should be
consulted at once, and girls should be instructed to tell
their mothers of any change in the character of the
“periods,” as soon as it occurs. Mothers should instruct
their daughters to rest the first day of their monthly flow,
and all during the menstruation they should refrain from
any unusual activity. Even play should be moderated and
abstained from entirely if there is any pain. In order
that the girl fully appreciates why these rules are laid
down, it is advisable to explain just how the womb is held
in place in her body.

This appears to the writer as being a particular important
point. A girl must not be expected to give these
matters the serious consideration they merit unless she
thoroughly understands the reasons why. An explanation,
in the form of even an intelligent talk, will soon be
forgotten. If, however, a definite, concrete picture, is
impressed upon her; if she actually sees in her mind the
process that is going on, she will understand why it is
necessary to do as she is told. If the mother will therefore
assure herself that the daughter actually knows what
is being accomplished in her womb at the menstrual
period, she will carry out the instructions more faithfully.[Pg 189]

How the Womb is Held in Place.—The human
uterus, or womb, is held in its proper place in much the
same way as a clothes pin sits on a clothes line. The
heavier part is the upper part, and that part is held in
place partly by resting on the rectum behind, and the
bladder in front. When menstruation occurs, the body
of the womb becomes much heavier because of the increased
amount of blood in its interior. This added
weight increases its liability to tip over, and if any extra
strain or effort is made at this time it will become tipped,
or as the physician calls it, displaced. If a womb becomes
displaced, every menstruation afterward will be painful
and prolonged,—sometimes excessively so. A displaced
womb becomes congested and unhealthy. It causes
leucorrhea or a chronic discharge, makes a nervous wreck
of the woman, results in sterility and frequently in a
dangerous operation. There are, therefore, ample reasons
for watchfulness and care on the part of the growing
girl.

Symptoms of Menstruation.—After menstruation is
established there should be no actual pain at each period.
There are, however, certain undefined feelings,—premonitory
symptoms,—which may be explained in the
following terms:—A day or two before the date on which
the menstruation is expected, the girl will appreciate that
“her sickness” is coming. She will not, or should not,
complain of pain, but will state that she has a bearing
down feeling, is a little more nervous than usual, has no
desire to go into company, and wants to be more or less
her own entertainer. The “sick” period usually lasts four
or five days. The second day is the most important.

Menstruation Should Not be Accompanied With
Pain.—If any actual pain accompanies menstruation, either
before or after it is established, the mother should
at once take the daughter to the family physician. Menstruation
is a natural, physiological act and should not be
accompanied with actual distress or pain. It is astonishing
how many mothers will allow their daughters to
suffer needlessly, for months and years, because of the
mistaken idea that “since the pain is there, it must be,”
or because she—the mother—suffered, so also must the[Pg 190]
daughter suffer. There is no more unfortunate mistake,
and many a girl’s health and happiness has been blasted
because of this misbelief. The cause of the pain is, in
a vast majority of the cases, a very simple one, and can
be removed in a very brief time.

Should the menstrual period last too long, be too frequent,
or be in any way not what it should be, consult
your physician. If you are not sure of “what it should
be,” or if you have any doubt, ask your doctor. Don’t let
any false pride or feeling of modesty on your part, or on
the part of your daughter, dictate your policy under such
circumstances. Don’t take the advice of your friends or
neighbors in a matter so vital. It is too important, and
they are not qualified to “guess” any more than you are.
Don’t, if you have any respect for yourself, or love for
your child, begin dosing her with the advertised patent
medicines and “Female Regulators” for which so much
is claimed, and which seem to “just suit” your daughter’s
case at this particular time. Take her to the doctor,
whose advice you value (or you should not have him as a
family physician), who has no interest at stake except to
help you and your child, and whose fee is no more than
the price of one of these bottles of advertised poison. He
is the only one qualified to speak with authority on such
a momentous subject, and you will never spend a dollar
to better advantage. Warn your daughter not to speak
about “her sickness” to other girls.

Especial attention should be paid to cleanliness during
this period. The mistaken idea that bathing of any kind
at this time may have disastrous consequences is responsible
for much of this neglect. If proper care is taken
warm sponge baths, in a warm room, will not cause any
trouble. Unpleasant odors can be avoided by sponging
the parts with a warm solution, into which a mild antiseptic
is put, upon changing the cloths.

Leucorrhea in Girls.—It has been stated above that a
displaced womb may cause leucorrhea or a discharge. It
must be remembered that leucorrhea, or “whites,” may
occur in girls as well as in married women. It can also
result from catching cold during the menstrual period.
Another mistaken idea is that girls should not take[Pg 191]
douches for fear of injuring the hymen. This is erroneous,
and while they are entirely unnecessary in a
vast majority of cases it is sometimes absolutely essential
to douche in order to cure leucorrhea. When they are
given, it is advisable to use the small nozzle that comes
with every douche bag set.

Constipation and Displaced Wombs.—When the picture
is fresh in the mind of the girl, of how the womb
is held upright in her body, the mother should speak to
her about the serious results that may occur from constipation.
If the rectum is full of hardened feces the
womb will be pushed out of place, and if under these
circumstances straining is necessary to empty the bowel,
and if this condition is habitual, constipation may be the
actual cause of displacement of the womb.

Dress and Menstruation.—It is also an opportune time
to demonstrate to what extent serious results may follow
mistakes in dressing. The habit of permitting growing
girls to constrict the waist, to bind and pull the abdomen
by too tight garters, or too tight corset, is wrong, and no
mother should permit it. In another part of the book,
this matter is taken up more fully, but if it is explained
to the girl while she is considering the subject of menstruation,
she may more quickly and more fully appreciate
its significance.

Absence of Menstruation—Amenorrhea.—The absence
of menstruation after it has been established, does
not, as a rule, indicate any disease of the womb or female
sexual organs. It is to be regarded merely as a symptom
and can be, as previously stated, safely ignored if the
general health is good. If the general condition is poor,
and the quantity and quality of the blood deficient, it is a
provision of nature to suppress menstruation in the interest
of the general health. For this reason it is safe to
disregard the amenorrhea and build up the bodily strength.
This explains why some girls pass the usual age of
puberty and show no signs of menstruating. They are
poorly developed sexually, through deficiency of blood.
If, on the other hand, a girl should have all the symptoms
of menstruation every month, but no flow, she should be
examined by a physician to determine if there is any[Pg 192]
obstruction to the escape of blood. Total absence of any
symptoms of menstruation extending into adult life, may
indicate an absence of the sexual organs. During the
first year after puberty it is quite natural for menstruation
to be irregular; after the function is thoroughly established
there are many causes that may be responsible for
its temporary absence.

Causes of Amenorrhea.—Any condition or circumstance
which reduces the general health or impoverishes
the quality or quantity of the blood and weakens the
nervous system, will result in a stoppage of the monthly
periods. Among these are insufficient food and exercise,
overwork, overstudy, exposure to cold, sitting on cold
steps or gold ground, wearing damp clothes, bathing in
cold water at the beginning of menstruation, powerful
emotions, as great fright, anger, anxiety; acute diseases,
such as typhoid fever, cholera, the infectious skin diseases;
chronic diseases such as Bright’s disease, heart disease,
consumption; anemia and chlorosis are very common
causes. Obesity or an overfat condition will cause an
early suppression of the menses which may result in a
fruitless marriage. Displacement of the womb and other
local disorders frequently result in scanty or delayed
menstruation. Anxiety lest pregnancy may occur in
the newly married may cause a delay in the periods. A
radical change of climate or sometimes a visit to the
country, or changed circumstances may stop the flow for
the time being.

Treatment.—The treatment of amenorrhea, or absence
of menstruation, will depend on the underlying
cause. A careful investigation should be made into the
mode of life and the hygienic surroundings of the patient.
Her general health and her mental condition should be
inquired into. If the patient is not in good health, or is
not obtaining exercise in the open air, or if she is a
victim of mental worry or of domestic unhappiness, or
if any sufficient cause exists for the amenorrhea it must
be removed before any treatment may be expected to relieve
the condition. If the patient is a married woman
the possibility of pregnancy should always be borne in
mind, and no radical treatment instituted until this has[Pg 193]
been excluded. If the absence of menstruation is dependent
upon defective development of the sexual organs
we cannot expect much from any treatment. The amenorrhea
from exhaustive diseases will usually correct itself
with, or soon after, the establishment of convalescence.
In diseases which tend to death, as in consumption, heart
disease, etc., the function is never reestablished. A very
common habit of most people is to regard the absence of
the monthly periods as the cause of their ill health. It
is not, it is the result of the ill health. Get rid of the bad
health and the menses will take care of themselves. That
form of amenorrhea which is the result of change of
climate or surroundings will regulate itself as soon as the
victim becomes acclimated or reconciled to the change, or
returns home if the visit is of brief duration.

As a general routine treatment, good wholesome food,
regular hours, fresh air, sunlight, and judicious exercise,
with such other measures as may be suggested by the
condition of the blood and nervous system, are the indications
in the way of treatment. Anemia and chlorosis
(poor blood) should be treated by the administration of
iron in some form. Obesity should be reduced by diet,
exercise, and such other treatment as may be found efficient
and not detrimental to health. Overwork, mental
and physical, should be stopped, and sedentary habits
changed to a more active out-door life. The acute suppression
from exposure to cold, wearing of damp clothes,
sitting on cold stones or cold or damp ground, sea bathing
in very cold water, is very often associated with an acute
inflammation of the womb itself and calls for rest in bed,
laxatives to open the bowel, hot application to the lower
part of the abdomen and a teaspoonful of Hayden’s
Viburnum in a glass of hot water every four hours until
relieved. The use of the sitz bath is frequently successful
if taken at night followed by a laxative and a hot drink.

Painful Menstruation—Dysmenorrhea.—Most, if not
all, victims of painful menstruation are of a nervous
temperament. Dysmenorrhea is simply one symptom of
the general nervous condition. The nervousness may be
acquired or it may be the result of heredity. In girls it
has been found to be an accompaniment of the overwork[Pg 194]
and worry of school and student life. Girls who suffer
greatly from it while in school are entirely free during
vacation from school.

There is a type of painful menstruation known as
neuralgic dysmenorrhea. This is simply a local expression
of a general neuralgic tendency. It comes under
conditions which favor neuralgias in other parts of the
body. Girls and women affected with this type of dysmenorrhea
are often anemic, hysterical, and not infrequently
the victims of malaria, rheumatism, or other
diseases which tend to impoverish the blood and reduce
nerve vitality. The pain resembles neuralgia elsewhere.
It comes and goes, it may last a brief time or a long time,
it may be very mild or very severe. The pain bears no
fixed relation to the flow, it may proceed, accompany or
follow it.

Mechanical dysmenorrhea is that form in which a
mechanical impediment exists to the escape of the menstrual
fluid. The internal canal may be too small, displacement,
growths, either inside or out of the womb,
faulty development, or frequently simple congestion will
act as an obstruction and cause pain from tension. The
pain accompanying mechanical dysmenorrhea is very different
from the neuralgic type. It comes on gradually,
increases slowly until it is very severe and stops suddenly.
A gush of blood from the womb announces the
fact that the obstruction has been overcome and the
womb has emptied itself; as soon as this occurs the pain
ceases.

In the mechanical variety there are frequently clots
in the menstrual flow. Inasmuch as this type may be
caused by imperfect development of the womb, it is
common to find that pain has characterized the monthly
periods from the time of the first menstruation. It may,
however, as stated above, be caused by growths which
had their beginning at a later period.

Treatment.—For the neuralgic variety the treatment
should be general. The whole object is to build up the
general health. Fresh air, sunlight, out-door exercise,
plain, substantial food, regular hours, pleasant surroundings,
and such medication as may be indicated, should be[Pg 195]
the course to follow. The bowels should be kept regular
and digestion aided in every way possible, if necessary
by rest from school, or work, or by a change of air and
scene. If the patient is inclined to malaria she must
take quinine and live in a locality free from that tendency.
If rheumatic she should take the remedies advised
in that disease and avoid colds, wet clothes, or sitting
in cold, badly ventilated rooms, churches or theatres.
If there are no distinct evidences of special tendencies,
general tonics may be given to advantage. These should
consist chiefly of iron, arsenic, phosphous, nux vomica,
cod liver oil, etc.

The treatment of mechanical dysmenorrhea of course
implies removal of the cause. As this necessitates operative
procedure, or at least an examination by a physician,
it is best left in his hands.

STERILITY

Sterility means the inability to become a parent. A
woman who is sterile cannot become a mother. She is
for some reason unable to have a baby.

A childless union is frequently the cause of much unhappiness.
There is something lacking in the expression
“a childless home.” It seems a paradox, as home is inherently
associated with children and happiness. It has
been stated that one out of every eight marriages is barren.
The average time which elapses after marriage and
the birth of the first child is seventeen months. Physicians
agree that if a woman goes over three years after marriage
without having a baby her chances of having one
are small. If children are desired, and they usually are
by childless parents, every effort should be made within
the first three years to ascertain the cause of the sterility,
and if it can be rectified. The barrenness may be dependent
upon some physical defect which will quickly
respond to the proper medical treatment. It is well to
remember, however, that the defect is not always the
woman’s. In every six childless marriages about one
is due to sterility in the husband. The age of the greatest
fertility in women is between twenty and twenty-four[Pg 196]
years. It is rare to find a barren woman between these
years. Nature evidently intended that the duties of maternity
should be assumed between the twenty and twenty-fourth
year. If married before the age of twenty the
statistics prove that barrenness exists in one woman in
every twelve. If married after the twenty-fourth year
the chances of having children decreases with the age
of the woman.

If a mother goes for three consecutive years without
becoming pregnant the chances are that she will have
no more children. Consequently if other children are
desired it is unsafe to rest upon the assumption that a
woman will again be a mother simply because she has
been one in the past. Many conditions could, and may,
have occurred since the last pregnancy (and may be as
a result of that pregnancy) to change her natural fertility
into a condition of temporary sterility. An examination
should therefore be made before too long an
interval elapses and the facts learned. It will usually
be found in such cases that a displacement or laceration,
or at most, some cause easily remedied is immediately
responsible for the apparent barrenness.

CONDITIONS WHICH AFFECT THE FERTILITY OF
WOMEN

Climate.—It is a well-known fact that more children
are born in southern regions than in northern countries.
It may be asserted, therefore, that climate affects the
fertility of the race.

Station in Life.—Children are more numerous among
the poor than among those who are wealthy and enjoy
the luxury of riches. This condition cannot, however,
be construed as a true expression of fertile efficiency.
It is more a comparison of ethics, and when we express
it thus we are giving it its most charitable name.

Season of the Year.—The spring of the year, being
more favorable to fecundity, exerts an influence over the
increase of population. Nursing mothers are as a rule
sterile until after weaning time. This is not always so
however, and the possibility of pregnancy taking place[Pg 197]
while nursing a baby, and before menstruation is reestablished
must be reckoned with as it occurs quite
frequently.

Age.—Age may be said to affect the fertility of women
inasmuch as sterility is the natural and proper condition
before menstruation is established and after menstruation
ceases.

The Tendency to Miscarry.—Because a woman has
never given birth to a living child is no proof that she
is sterile. Many women have the ability to conceive but
for some reason they have acquired the misfortune, or the
“knack,” of miscarrying. This is a condition of the
gravest significance and will be considered at length in
its proper place.

The influence of a temporary separation has had excellent
results in a great many historical cases. Where
the married couple seem to be lacking in some one or
other of the emotional or temperamental qualifications,
it is advisable to suggest a temporary separation. When
this period has expired and they resume marital relationship
the element of novelty, acting as a stimulus, quite
frequently reestablishes a fertility that was seemingly suspended,
or awakens it if conception has never previously
taken place.

There are a great many cases on record where, conditions
having remained the same, women have become
fertile after years of seeming barrenness. It is impossible
to explain, or to satisfactorily understand these
cases. It is quite common to note cases in which women
have never become pregnant until a number of years
after marriage, even when the desire to have children
existed. There is one case on record of a woman married
at eighteen, but although both herself and her husband
enjoyed habitual good health, conception did not
take place until she was forty-eight years of age when
she bore a healthy child. Women should not, therefore,
become easily discouraged in the hope of having a baby,
especially when they have a clean history, and a healthy
body. The conditions may change and may become
favorable when hope is about to die.[Pg 198]

CAUSES OF STERILITY IN WOMEN

Inasmuch as it is necessary to consult a competent
physician in all cases of sterility, it is not necessary to
go into detail regarding each possible cause, other than
to explain how each may produce barrenness. It will
be observed that a competent physician is specified and
advised in these cases. This is very important because
many advertising, or “quack” doctors, particularly solicit
these kind of cases. They are not competent to be trusted
with such cases and will likely effect more harm than
good. A woman should not hesitate to consult the best
available medical authority if she is a victim of sterility.
There is nothing to be ashamed of. It is a perfectly
proper medical situation and should receive the best
medical advice and investigation. The following are the
more frequent causes of absolute sterility.

(A) Displacement of womb.

(B) Diseases of womb, ovaries or fallopian tubes.

(C) Malformations.

(D) Lacerations or tears of mouth of womb.

(E) Tumor.

(F) Leucorrhea.

(G) Physical debility.

(H) Special blood poisons.

(I) Great obesity.

(J) Anemia.

(K) Self-abuse.

(L) Habitual alcoholism.

(M) Lack of moderation in the marital relations.

(N) Certain diseases may be associated with barrenness:
cancer, diabetes, consumption, Bright’s disease, etc.

(O) Certain temperamental conditions may be associated
with barrenness: lack of affinity, frigidity.

THE KNACK OF MISCARRYING

Displacement of Womb.—In many instances the primary
cause of the displaced womb was some energetic,
muscular effort, made while the victim was yet a girl,—probably
before menstruation began. Whatever act first[Pg 199]
caused a slight tilting of the womb, must necessarily have
been an unusual physical effort, and as girls are getting
more and more strenuous we may look for more trouble
in this direction in the future. Inasmuch as a slight tilting
of the womb gradually gets worse it is a reasonable
expectation to believe that sterility is a natural sequence
to displacement. The girl may have been the victim of
painful menstruation which was neglected, because not
quite painful enough to compel medical relief, which is
sought for only as a last resource unfortunately under
the circumstances. Intercourse may also have been more
or less painful,—a condition which again is mistakenly
and imprudently borne in silence and left to take care
of itself. But when persistent sterility faces her, the
woman seeks medical assistance and her trouble is discovered.
As the displacement is found to be the cause
of her sterility, its correction, which is a comparatively
easy medical problem, not only cures the barrenness but
happily relieves her of the menstrual distress and all
other pain.

The treatment for displacement consist of placing
medicated pieces of wool or cotton, called tampons, in the
vagina in such a position as to hold the womb, as nearly
in its proper place as is possible. After a time nature will
so strengthen the ligaments that they will hold the womb
and a cure is, therefore, affected. The length of time
necessary to cure depends upon the length of time the
displacement has existed. It may take, from two to
four months. When the displacement is of long standing
and is accompanied with more or less inflammation,
adhesions sometimes grow between the womb and the
adjacent organs. It is necessary to resort to surgery
in such cases, but the result is always good and the danger
practically nothing.

Disease of the Womb, Ovaries or Fallopian Tubes.—Disease
of the womb, ovaries, and fallopian tubes, which
renders the victim sterile, is as a rule the direct result of
infection. Such infection is conveyed by the husband to
the wife. This is quite a common condition. The simple
fact that such conditions exist leads us to hope
that the time is not far distant when it will be compulsory[Pg 200]
for all participants in the marriage ceremony to
submit to a thorough physical examination. By this
means, and by this means only, will the innocent be
protected. No one can conceive, unless he has been identified,
as a physician, with one of the large metropolitan
hospital clinics, of the extent of this class of disease,
and of the frightful suffering caused, and innocent lives
ruined, by infection conveyed in this way. It is a tragic
corollary to the marriage vow “for better or for worse.”

If a woman is fortunate enough to fall into the hands
of an honorable physician, who will tactfully explain
to her the serious significance of her condition and obtain
her consent to treat her until she is cured, which
in all probability will include a surgical operation, and
will do so with diligence, without regard to the size of the
bill, she will indeed be a lucky woman. It is from
women who are suffering with such diseases,—most of
them without the slightest idea of what ails them,—that
the venders of advertised nostrums reap their fortunes,
and it is from the same victims that most of the
advertised medical “quacks” look for their blood-money.
The great difficulty, however, lies in the failure of the
woman to appreciate the seriousness of her condition, and
as a consequence she fails to understands why it should
take so long to cure her. She loses confidence in her
physician, she buys certain “cures” recommended to her
by Mrs. Busybody and later tries other physicians and
ends by losing faith in herself. Meantime she grows
worse and worse. There are thousands such. It may
be here stated without fear of contradiction that if the
public in general would repose more confidence in the
medical profession, there would be much less suffering,
much less sorrow, fewer regrets, fewer irresponsible
“isms,” and cults, because there would be fewer disappointed
individuals to support them. If the medical
profession would condescend to employ the tactics and
devices of those questionable, fashionable agencies that
claim the power to cure human suffering, it could quickly
reap the profit and the laudation that it now escapes
because it keeps the faith.

The way to be cured of any disease, if it is curable,[Pg 201]
is to engage a reputable physician and follow his instructions
implicitly. Let him understand you expect
him to see you through your trouble and let him know
you have confidence in him. There isn’t one physician
in a thousand who will cheat you under these circumstances.

Malformation.—Under this heading are all those cases
of sterility resulting from imperfect generative organs.
These are products of a failure on the part of nature
to furnish or develop the structures participating in the
propagation of the species. The entire generative organs
are sometimes wanting. The womb may have failed
for some reason to grow with the rest of the body, it
remains (as it is known) as an “infantile womb.” Occasionally
the womb grows together, that is, it is solid
instead of being a hollow organ. The mouth of the womb
may be too small, representing what is called “a pin head
opening.” The natural opening is large enough to admit
a lead pencil, a “pin head opening” would not be
larger than the lead in the pencil. The latter condition
is quite a common cause of sterility and is readily amenable
to treatment. Most of the malformations which
produce sterility are impossible to cure.

Lacerations or Tears in Mouth of Womb.—This subject
is fully discussed on another page of this volume.

Tumor.—A tumor may be so situated as to prevent
conception, or it may involve the body of the womb
constituting a reason in itself for sterility.

Leucorrhea.—Leucorrhea or “the whites” may be of
such an acid character as to kill the spermatozoa in the
vagina, or it may be of such volume as to render impregnation
impossible. The treatment of this condition
is discussed elsewhere.

Physical Debility.—When the general health is bad,
no matter from what cause, sterility usually exists. This
lack of vitality may be due to chronic disease, or it may
have been caused by a very severe acute illness, such
as typhoid fever. One’s mode of living, if unhygienic,
may be responsible for continued bad health and a consequent
sterility.

Obesity.—Very fat women are usually barren. If a[Pg 202]
woman rapidly accumulates fat after marriage she as a
rule does not have more than one or two children.
Women often become stout immediately after the child
bearing age ceases.

Special Poisons.—Certain special poisons in the blood
cause sterility by producing miscarriage.

MISCARRIAGE

By the term “miscarriage” we mean that for some
reason the progress of pregnancy has been interrupted
and the fetus is expelled from the womb. A miscarriage
or abortion (both terms meaning the same—the difference
between the two terms is a technical one and need not
concern us here) can occur any time after conception
up to approximately the seventh month, when, if labor
takes place, the child may be born alive. The condition
would then be termed a premature labor. A miscarriage
or abortion is an immature labor and implies an immature
or dead child.

The condition is a serious one no matter whether it
is attended with grave symptoms or apparently no symptoms.
If it occurs shortly after conception, during the
first few months of married life it is serious, if not in its
physical consequences, it is in its significance, because it
establishes the tendency to miscarry,—a tendency that
may result in great mental distress because of the worry
and fear it engenders, and of sorrow and heartache because
it may blast the hope of parentage. Such a miscarriage
may take place at once after conception. If so,
the following menstruation may be delayed for a week
or so and is then a little more profuse than is customary.
This will be the only indication that a life has been
sacrificed that the young wife may have, and frequently
the significance of such an occurrence is never understood,
yet the tendency to miscarry is nevertheless established,
and a seeming sterility is apparently the fate of
the woman. It is, therefore, of the greatest importance
that extreme care should be taken to bring the first
pregnancy to a successful consummation. A young wife
should realize that she is apt to become pregnant at[Pg 203]
any time. Her conduct therefore should be such at
least as not to harm the life principle with which she has
been entrusted. To this end any excessive sexual activity
should be strictly avoided.

Causes of Miscarriage.—Any strenuous physical effort
must be guarded against. Included in such efforts
may be the following: dancing, running, jumping, surf-bathing,
sewing on a machine, sweeping, washing, house-cleaning,
moving furniture, etc. Sometimes the primary
cause of a miscarriage is to be found in some hygienic
act, such as a hot bath, too prolonged or too many hot
douches near the menstrual periods. A blow or a fall,
even a fright or shock may cause a miscarriage. Anything
that violently shakes or agitates the womb, which
may at this time be irritable because of its condition,
will be sufficient to excite it to contract and miscarry.
Hence violent coughing or vomiting should be avoided
if possible; horseback riding, jolting in a carriage, convulsions,
hysterical crying, may also be the causative
factors. Displacement of the womb by limiting its tendency
to grow when pregnant, may cause it to miscarry.
Very severe general diseases such as small-pox, pneumonia,
etc., will cause the womb to empty itself. Disease
of the fetus or the presence of syphilis in either of
the parents will also have the same result.

The Course and Symptoms of Miscarriage.—The
cause of a miscarriage or abortion is much the same as
an ordinary labor at term. Whatever interrupts the pregnancy
causes the death of the fetus. The dead fetus
acts as a foreign body and excites the womb to contract
as it does during an ordinary confinement. The contractions
open up the mouth of the womb and the fetus
is expelled together with its membranes and after-birth.
The significant and the most important symptom of a
miscarriage or abortion is hemorrhage or bleeding from
the privates. The flow of blood may not amount to
much or it may be excessive and alarming; it may not
be constant, it may come from time to time in the form
of clots.

The next significant and important symptom of miscarriage
or abortion is pain. The pain, like the flow of[Pg 204]
blood, may be only slight or it may be very severe, sometimes
it is absent in very early miscarriage. As a rule
the pain is severe when the miscarriage occurs after
pregnancy has lasted for a number of months.

A miscarriage or abortion is said to be “complete”
when the fetus with its membranes and after-birth is
expelled clean and whole, or in other words when the
womb empties itself completely. A miscarriage or abortion
is said to be “incomplete” when some part of the
embryo is left in the womb.

What to Do When a Miscarriage is Threatened.—When
a woman, who is pregnant, begins to flow she
should at once go to bed and keep perfectly quiet and
send for a physician. A miscarriage is a treacherous
condition and is so regarded by all medical men. It
may not amount to much or it may, on the other hand,
develop into a serious situation. The immediate danger
is from hemorrhage; the ultimate or remote danger is
sepsis or blood poisoning. The condition is one that
can only be taken in charge by a qualified physician in
whose hands we can safely leave the conduct of the
case.

As a general rule it is quite safe to assert that a
woman will not bleed enough at the beginning of a miscarriage
to do any permanent harm. Consequently there
is no occasion for unnecessary alarm. She must, however,
as stated above, heed the warning and go to bed,
keep perfectly quiet and send for a physician. If she
fails to follow this advice it is quite possible that she may
have a hemorrhage during the course of the miscarriage
of a sufficiently serious character to endanger her life
or from the effects of which she may suffer for the
remainder of her life.

There is practically no danger during the course of
or after a “complete” miscarriage. The danger which
may ensue from an “incomplete” miscarriage is hemorrhage
and a form of poisoning caused by the absorption
into the system of putrifying products of the part of the
dead embryo left in the womb.

There are a large number of cases of criminal abortion
in which septic poisoning occurs caused by the[Pg 205]
utensils or instruments used in inducing the abortion.
All of these cases are operative cases which must be
attended to promptly to save life.

Treatment of Threatened Miscarriage.—Not all of
the cases of beginning miscarriage end in miscarriage.
If the physician is sent for in time he can very frequently
give directions that will, if carried out faithfully, avert
the disaster. Success is more likely to attend those cases
in which the trouble has been caused by some accidental
injury, as a fall, or blow, or extra exertion. This is
more especially the case if the woman has previously
borne children, is healthy and in good condition and
whose womb is known not to be diseased. In these cases
there is a partial separation of the fetus from the wall
of the womb, which causes the bleeding. The physician
will direct that the woman be put to bed, in a quiet,
darkened room. He will instruct the nurse to sterilize the
external genital region: a sterile gauze dressing is then
left in place. Some form of prescription will be given to
diminish the patient’s nervous fear and to allay any tendency
on the part of the womb to contract. It is always
essential and very important to save everything that
passes from the womb during the course of a threatened
miscarriage in order that the physician may know
exactly just what the condition is. Each cloth, each
clot of blood will have to be examined before the proper
treatment can be pursued in safety.

When the miscarriage cannot be prevented it is called
an “Inevitable miscarriage.”

Treatment of an Inevitable Miscarriage.—In these
cases every precaution is taken, just as in a normal confinement,
to avert blood poisoning. The hands, instruments,
dressings, etc., are carefully rendered sterile and
the whole field must be surgically clean. The physician
will conduct the case as conditions justify and as the
situation develops.

After Treatment of a Miscarriage.—It is one of the
many thankless tasks of a physician’s life to insist on
each patient staying in bed at least ten days after a miscarriage.
The average woman and frequently the intelligent
woman fails to appreciate the absolute necessity[Pg 206]
for this procedure. It is necessary and it is the
physician’s duty to insist on it being done in the interest
of the woman. Many of the multitude of diseases of
women are caused by disregarding advice on such occasions.

The Tendency to Miscarry.—If a woman, for any
reason, has had a miscarriage, her womb will tend to
miscarry at the same period during a subsequent pregnancy.
If the miscarriage should occur during her first
pregnancy the tendency to miscarry will be greater than
if acquired after she has had a baby.

This is one of the reasons why young wives often
fail to have children. They “get rid” of the first one or
two, because they are not ready to have children, or
because they want some enjoyment themselves before
they are tied down with a family. Having established
the habit their womb has been educated to abort, and it
will keep this habit up, much to their astonishment and
chagrin.

Young wives should therefore faithfully follow out all
the rules of the Hygiene of Pregnancy laid down by their
physician, and which are given in detail in this book.[Pg 207]

Courtesy of New York World

At Work with the Calipers

[Pg 208]

THE BABY

[Pg 209]

CHAPTER XVI

HYGIENE AND DEVELOPMENT OF THE
BABY

What to Prepare For the Coming Baby.—The
physician should instruct the young wife just what to
provide for the coming baby. The following list will
be found useful as a general guide.

Simplicity, warmth, and freedom are the essentials in
latter-day baby clothes. It is cheaper to make the clothes
than to buy them. Excellent and accurate paper patterns
can be obtained, giving the quantity of material necessary
and suggesting the kind and quality best suited for
the purpose. These patterns may be obtained from the
Butterick Publishing Company in New York City.

Care of the Newly-Born Baby.—After the nurse has
completed her duties with the mother after the confinement,
she will prepare to give baby its first bath.

The bath should be given in a warm room. This is
a matter that should receive more consideration than
has been given it. Nurses do not as a rule attach much
importance to this duty, while in reality it is a most important
one. I have seen trained nurses make ready to
give baby its first bath in rooms, during the night, that
were not heated adequately. I am convinced that many
babies have been victims of this careless habit to the extent
of grafting on them the tendency to catarrhal colds
and bronchitis because of undue exposure at this critical
period. If one will remember that a baby has just been[Pg 211]
removed from an environment where the temperature
was suitable and constant, to one in which it needs a large
degree of artificial heat until such time as it may become
accustomed to the change, one may appreciate the risk
taken in exposing the child for even a short time. The
mother should therefore warn the nurse not to undertake
the baby’s first bath until the temperature and other conditions
are favorable. Many nurses and other individuals
have the impression, without knowing why, that the
baby should be cleansed and bathed immediately after
birth. This is not at all necessary. If the conditions are
not favorable, it would be far better to wrap the baby
snugly in a warm blanket—first having put a diaper on—and
place it in its crib with a hot water bottle near it and
defer the bathing until the following forenoon. By that
time the baby will be adapted to its new surroundings;
its lungs will have become accustomed to the air which
it is breathing for the first time; the mother will have
been rendered comfortable; in other words, the conditions
and the environment will be favorable for the baby
and for a better performance of the duty.

The next important feature of the first bath is that it
should be done in the quickest time consistent with
efficient service. Only the necessary exposure should be
indulged in. It is not necessary that the baby should be
exposed to the admiring inspection of every member of
the household—there will be plenty of time for that without
risking the health of the child. A pan of water at a
temperature of 100° F. should be placed on a stool in
front of the nurse. The nurse should have on a rubber
apron, and on top of this, an ordinary apron and a warm
bath towel laid over her knees. The child should be
gently rubbed with warm sweet oil to remove the vernix
caseosa (the greasy substance which is on all babies when
born to a lesser or greater extent). Particular attention
is to be given to all folds of the skin, as under the arms,
in the fold of the neck, in the groin, behind the ears,
etc., because in these parts the substance is thickest and
if not carefully removed it will cake, and cause painful
eruptions and sores, which may bleed and render the infant
extremely uncomfortable. It is not necessary to[Pg 212]
expose the whole body at one time while applying the
oil. The lower half may be covered with a warm soft
towel while the nurse is oiling the upper part, and vice
versa. After the body has been thoroughly oiled it should
be cleansed with water at the proper temperature, in
which pure castile soap has been dissolved. Absorbent
cotton only should be used to wash the baby. All the
washing is done with the baby on the nurse’s knee; it is
not put into the water.

The baby should be mopped dry with sterile gauze,
or with a soft sterile towel, the cord dressed and the
flannel band adjusted. It should then be completely
dressed and put to the nipple and later to sleep.

Dressing the Cord.—The cord should be covered with
powder and sterile gauze. The powder to use should
be plain subnitrate of bismuth. If there is any reason
to use another powder the physician will write a prescription
for it according to indications. The subnitrate
of bismuth will be found much better than any ordinary
talcum or toilet powder, many of which do not make good
dressing powders.

Very few nurses know how to dress the cord. It seems
to be impossible to impress them with the need of frequent
attention to the cord. Fresh powder should be
put on every time the diaper is removed, every time the
infant urinates, and at other times during the day. The
cord should be kept absolutely dry. Putting on powder
twice daily will not keep the cord dry and many nurses
are too lazy to bother to do it oftener. You cannot make
a mistake in putting on too much powder, you can make
a serious mistake by not putting on enough. Every time
the cord is powdered it should be lifted up, away from
the skin of the abdomen, and the powder put below it.
The cord should be slightly drawn out and the powder
applied round its base where it meets the skin. Many
nurses are afraid to touch or handle the cord—they find
it easier to neglect it. The mother should see that the
nurse dresses the cord at least five times every day.

Applying the Sterile Gauze to the Cord.—A piece of
gauze, six inches square is taken, a hole is cut the size of
a ten-cent piece out of the center, the cord is drawn[Pg 213]
through the hole, the gauze folded lengthwise over the
cord and then sidewise, and this is held in place by the
binder. This piece of gauze will adhere to the cord and
will most likely be removed with the cord on the fifth
day. If it should fall off, another piece may be put on
in the same way.

If the cord does not fall off until very late it is because
it has not been attended to rightly or because it was a
very thick cord.

Treatment After the Cord Falls Off.—The stump of
the cord should be powdered with the same powder used
on the cord; a pad two inches square of sterile gauze
and quite thick should be held over the stump for a number
of days by the abdominal binder. This is used to
prevent a possible rupture. After a week the size of the
pad may be reduced, but a small pad should be used over
the stump of the cord for a month or more.

A Pouting Navel.—If the stump of the cord should
protrude, a piece of strong pasteboard, the size of a fifty-cent
piece, should be wrapped in soft gauze and placed
over the navel, over this a gauze pad, and if necessary
this should be held in place by a strip of adhesive plaster,
though the binder is usually sufficient if it is put on carefully.
If this pad is held properly and worn for a month
the tendency to protrusion or rupture will have passed
away. These pads may of course, be removed when the
baby is being bathed and put back again before the binder
is applied.

Bathing Baby.—A baby should not be put into water
for a bath until after the cord has been off for forty-eight
hours.

During the first few months the temperature of the
water should be 98° F. The temperature of the water
should be taken with a bath thermometer; it should not
be guessed at. A bath thermometer is an inexpensive
commodity and it will be in daily use in many ways in a
home where there is a baby—it should therefore be procured
wherever possible. The room should be warm;
there should be no draughts. The mother or nurse should
cultivate the habit of bathing baby quickly and with system.
Everything should be ready and at hand. A little[Pg 214]
salt in the water will tend to strengthen the skin; it will
also relieve any superficial rashes or excoriations which
may be on the skin. Four tablespoonfuls to a gallon of
water will be sufficient. The sea salt sold in the stores
may be used in lesser quantities.

By the end of the fifth month the temperature of the
water may be reduced to 95° F., and by the end of the
first year to 90° F. After the first year the mother should
accustom the child to a quick sponge with cool water on
the chest and spine immediately after the bath. This
simple means, if kept up, will often prevent the development
of colds and bronchial troubles so common to children
in temperate latitudes.

The best time to give the warm bath is at night. In
the morning a cold sponge bath is desirable. This should
be given as described in the chapter on cold sponge or
shower baths.

In certain children bathing seems to depress their entire
system. They do not react well even to a warm bath.
They remain blue or pale around the mouth and eyes;
bathing should therefore be carefully undertaken with
these children until such time as they acquire strength.

Clothing of Baby.—The baby should wear a woolen
shirt, with a high neck and long sleeves. The abdominal
binder may be worn for the first three months. It is not
necessary after that time. If worn longer the habit is
acquired and chronic indigestion may ensue when it is
ultimately taken off. If the baby is very thin it may be
wise to leave it on, simply for its warming effect, for a
few months longer. If the child is normal and healthy
the binder should be left off permanently after three
months. The band for the first four weeks should be
made of plain flannel; after this period a knitted band
with shoulder straps is the better article. All petticoats
and skirts should be supported from the shoulders.
Stockinet is a good material for diapers; it is soft, warm,
and pliable.

Baby’s feet should be warm always. Cold feet are
frequently responsible for colic and gastro-intestinal
troubles. A hot water bottle should be placed in the
carriage if the weather is cold, but care should be taken[Pg 215]
to see that it does not touch the feet, otherwise it may
burn them. The same measure may be adopted in the
baby’s crib if the feet are cold.

During the summer the outer clothing should be made
of the thinnest quality of material possible, and the underclothing
of the finest flannel or gauze. Body heat may
be maintained during changes of temperature by extra
outer wraps—not by dressing the baby in clothes that
keep it too hot and uncomfortable all the time.

The main object to be attained in clothing the baby
is to ensure a sufficient protection, but the clothing must
be light, warm, loose, and non-irritating. Don’t bundle
up the arms and legs so that they cannot be moved; don’t
pin them so tight that the child cannot breathe properly
and don’t put the band on so that the child is in torture
all the time from inability to move the abdomen.

Baby’s Night Clothes.—The night clothing should be
the same as that worn during the day, but it should be
loose and of the lightest flannel material. For older
children a thin woolen shirt (not the one worn during
the day) and a suit of union clothing with feet is best.

The mistake must not be made to cover children too
warmly at night. They can do with relatively less than
adults. Too much covering will render the sleep restless,
will encourage nightmare, and in older children
will engender bad habits. Delicate children especially
must not be over-covered at night.

For the first few months children should sleep in a
darkened room.

Care of the Eyes.—The eyes should be cleansed for
the first few days with a saturated solution of boracic
acid. They should be protected from the direct light for
two or three weeks after birth.

Care of the Mouth and First Teeth.—Boiled cooled
water should be used to cleanse the mouth every morning
after the bath. A soft piece of sterile gauze should
used for this purpose. The mother must guard
against using too much force in cleaning the mouth of
an infant.

The milk teeth should receive attention. If they are
allowed to become dirty they will become carious and[Pg 216]
cause bad breath and neuralgia. Teeth of this character
are a menace to health because they harbor germs and
in this way infect the mouth and cause stomach troubles.
Teeth that are carious should be filled or removed.

Care of the Skin.—The skin of a baby, because of its
delicate character, is susceptible to the slightest changes
in the weather or to the condition of the digestive organs.
Babies are frequently subject to rashes, intertrigo, excoriations,
eczema, and other skin affections. It is much
easier to prevent these conditions than to cure them.
Cleanliness, not only in giving a daily efficient bath, but
in every other respect, is essential. Castile soap only
should be used, and no rubbing indulged in, simply mopping
the parts with gauze well saturated with soapy
water. All napkins should be removed as soon as soiled.
If the skin is easily chafed the child should be bathed in
salt water or water in which bran is mixed as explained
in the chapter on bran baths.

The baby should be well powdered with a good quality
of toilet powder. Ordinary starch, or talcum, or the
stearate of zinc is suitable. Fat infants should be powdered
in all the skin folds; otherwise they are sure to
chafe.

Care of the Genital Organs.—The mother should make
it a habit to remove any dirt from the genitals of the
baby during the morning bath. Fecal matter sometimes
gets into the folds of the female baby; this should be
removed promptly. In older female children, dirt and
dust get into the genitals which often has to be removed
carefully with a soft piece of cloth. An exceedingly
chronic form of inflammation is often seen in poor children
because of neglect of these parts.

In male babies the mother must daily push back the
foreskin and clean under it. If this is not done the
natural secretion will gather there and cause much
trouble. If the foreskin is long, the child should be circumcised;
if it is not long it must be pushed back daily
for a number of weeks; otherwise it will contract and it
may be necessary to operate on it at a later date. If this
is not faithfully attended to the prepuce will become adherent,
the child becomes nervous and irritable, and it[Pg 217]
may become addicted to self-abuse at a very early date—simply
because the mother is derelict in the performance
of her duty. If you are afraid to do your duty, don’t
neglect it, ask the doctor to show you just what has to be
done and just how it should be done. You will find it to
be a simple matter when you know how, as most things
are.

Amusing Baby.—Mothers should understand that it is
not necessary to amuse a baby under one year of age.
Their nervous systems are not ready for any such sport.
To excite a baby to laughter is to subject it to a shock
which may injure it. The healthy development of the
brain of a child demands quiet and restful surroundings.
It should sleep, eat, and be allowed to amuse itself in a
natural way.

Temperature in Children.—The normal temperature
in a child varies more than it does in an adult. The rectal
range may be between 98° and 99.5° F. and may be normal
to that particular child. A rectal temperature of
97.5° F. or of 100.5° F. is of no importance unless it
continues.

The best place to take the temperature in a child is the
rectum and the next best place is in the groin. The
temperature will always be from a half to a full degree
higher in the rectum than in the groin. The thermometer
should be left in the rectum for two minutes, and in the
groin for five minutes.

The temperature in a child is a very fair guide as to
the severity of the disease. It must be remembered, however,
that a child will develop a temperature of two or
three degrees from a very slight cause. It is not the
height of the fever that is significant, but rather the duration
of the fever that is important. A fever of 102° F.
in a child may only mean a slight indigestion which will
wholly disappear after a laxative is given, while the same
degree of temperature in an adult usually means something
much more serious. The degree of the temperature
therefore should not occasion unnecessary worry; if, however,
it continues and if the child shows other signs of
illness, it may be regarded as indicating an abnormal condition
which should be immediately found out. A temperature[Pg 218]
of 100° F. to 102° F. usually means a mild illness,
and one of 104° F. or over, a serious sickness.

It is not advisable that the ordinary mother should
possess a clinical thermometer. There are many occasions
when a child will have a fever which should not
cause any worry; if the mother gets the thermometer
habit, she will many times occasion unnecessary calls of
the physician only to learn that they are false fears.

The Teeth.—There is no definite time at which the
first teeth appear. They usually come between the sixth
and eighth months. They may not, however, come until
much later; or they may come earlier than the sixth
month; and yet the child may be perfectly healthy. They
come as a rule in the following order:

They may not come in the above regular order even in
well children. The upper front teeth may come first.
If the child is sickly there may be marked irregularity
in the order in which they appear. Twenty teeth comprise
the first set.

The Permanent Teeth.—This set consists of thirty-two
teeth. They begin about the sixth year and they are
usually not complete until the twentieth year. They appear
in the following order:[Pg 219]

Care of the Teeth.—The teeth should be given attention
as soon as they appear. It is an excellent custom
to wash the teeth and gums twice daily with a piece of
clean absorbent cotton rolled round the finger of the
mother and dipped in a saturated solution of boracic
acid. This should be done up to the second year. After
the second year a soft brush should be used and the teeth
thoroughly cleaned morning and night with pure castile
soap or a powder. The teeth of every child should be
examined by a dentist every six months. All cavities
should be filled with a soft filling. The milk teeth should
not decay, but should fall out, or be forced out by the
second set. A child should be taught to gargle early and
a mouth wash should be used morning and night.

Dentition.—As a general rule the process of teething
is accompanied by some symptoms. There may be fever,
restlessness, and loss of appetite; though in many cases
there are absolutely no symptoms. Some children seem
to teethe hard, others easily. The same child may have
some teeth without pain, and with others it may suffer
severely. The condition of the child at the time, its age,
and the season of the year undoubtedly have an influence.
Children who are sickly and puny may have much difficulty
while teething.

The degree of sickness varies quite considerably. There
may only be, as stated above, slight fever, restlessness,
with loss of appetite; or there may be, in addition to
these symptoms, a pronounced fermentative diarrhea,
which may lead to serious intestinal diseases; frequently
there is a cough. This is more apt to be the case if the
child is teething during the hot season.

Treatment.—When dentition affects the child’s disposition
it is a good plan to reduce the feeding in quantity
and quality for the time being. If the child is bottle-fed,[Pg 220]
two ounces can be taken out of each bottle and one
ounce of boiled water added. If the child is breast-fed,
he should be given two ounces of warm, boiled water
before each feeding, and the actual feeding time at the
breast shortened.

Rubbing the gum over the erupting tooth with a clean
cloth may aid in helping it through. If the child is very
restless and has lost sleep, the cloth may be moistened
with brandy and water. Lancing the gum, though it is
seldom done now-a-days, is justified in a few cases.
Teething is not the cause of actual disease as was once
thought, but it must be remembered that a child whose
vitality is reduced by fever, restlessness, loss of appetite,
loss of sleep, and irregular bowels, is more susceptible
to disease than when enjoying robust health.

Sometimes a child will have a fever for one or two
weeks during a hard dentition. There is apt to be more
or less intestinal indigestion and fermentation at this time
and as a consequence actual intestinal disease may develop.
To avoid such a possibility it is an excellent plan
to give an occasional dose of castor oil to clean thoroughly
the whole intestinal canal. This should be done
irrespective of the condition of the bowel, because frequently
a diarrhea is caused by retained fermenting
products.

Mothers must not acquire the habit of attributing all
symptoms to the teething process simply because the
child is teething. It must be remembered that a child
may get a disease, or an ailment, while teething, that
has nothing to do with teething. If this is neglected,
serious consequences may result. Many children have
lost their lives by a mother’s carelessness in this way.
Be on the safe side, consult your doctor; let him assume
the responsibility.

How to Weigh the Baby.—The test of weight is one
of the most satisfactory we possess as an indication of
physical progress and health. It is not an absolute test,
but it may safely be relied upon. The fattest baby is not
necessarily the healthiest. A gradual and a uniform increase
is a satisfactory growth. At birth a baby weighs,
on an average, from seven to eight pounds, though some[Pg 221]
babies weighing less are equally healthy. The normal
and customary gain is from four to six ounces every
week after birth.

The baby should be weighed about the same time of
the day each week, and before a meal.

The average weight of a male child at different ages
is as follows:

A female child weighs about one-fifteenth less than a
male child, as a rule.

Table showing the average height of a male child, at
different ages:

The Rate of Growth of a Child.—A child grows most
rapidly during its first year—six to seven inches; from
fourth to sixteenth, about two inches annually; thence to
twentieth, one inch. Commonly, a child at two and a
half years has attained half of its ultimate adult stature.
The diseases of youth always accelerate growth.

Pulse Rate in Children and Adults.—Normal Pulse,—of
new born, 130 to 140, per minute; first year, 105 to
115; second year, 106 to 115; third year, 95 to 105; fifth[Pg 222]
to twelfth year, 80 to 90; thirteenth to twenty-first year,
75 to 80; twenty-first to sixtieth year, 70 to 75; in old
age, 75 to 85.

Infant Records.—A record should be kept by the
mother of every child which would embrace exact data
as to weight, diet, size, development of mental power,
teeth, ailments, sickness, pains, etc., with dates and any
information which would aid in recalling exact conditions.
Such records are of the utmost value in a number
of ways. They help in giving suggestions as to diet, general
health, and mental qualities of the child in question,
and they aid in furnishing what physicians call “past
history,” which past history has a very valuable significance
in estimating the character and importance of
sickness during later years.

Such a record is also of importance in comparing a
child’s development with what is regarded as standard
development, and also with the growth and development
of other children in or out of the family.

If a child should thus be found to fall seriously below
the standard and yet not appear actually sick, a very
thorough and routine investigation should be instituted
to discover if possible the cause. Some error might thus
be detected which might seriously affect the child’s future
growth and well-being.

The date of the closing of the soft spot on the baby’s
head should be noted, and if it is still open, when it should
be closed, it might mean that the child has a serious brain
condition. The soft spot should close between the eighteenth
and twenty-fourth months. The family physician
should be notified if the soft spot is open later than the
second year, as he may want to investigate the cause.

Should the child be unusually backward in walking,
and when it does so should limp and feel pain in the
knees, it should be examined for any symptom of hip
joint disease, of which these are the earliest signs.

If the child complains of so-called “growing pains,”
keep in mind that these are rheumatic and may need attention.
There are no such pains as actual “growing
pains,” that is, pains caused by the child growing.

[Pg 223]

CHAPTER XVII

BABY’S FEEDING HABITS

Overfeeding Baby.—Every nursing mother should
have printed and hung up, so she may read it every time
she nurses her child, the following motto: “DON’T
OVERFEED BABY.” Few, if any, babies die of willful
starvation: many die as a result of overfeeding. Mistaken
kindness and lack of judgment are responsible
for one-half of all the troubles of infancy. Babies require
much less than is constantly given them. The
stomach of a baby at birth will not hold more than one
ounce, which is two tablespoonfuls; and at two months it
will not hold more than three tablespoonfuls; and at six
months, six or seven tablespoonfuls. Read these quantities
once again carefully and try to realize the significance of
the smallness of them. A baby is just like a little pig;
it will go on feeding as long as it is allowed. The
baby does not reason; it has no judgment; it depends
upon its mother’s judgment. If the mother is false
to the trust the baby overloads its stomach. A swollen,
distended, overloaded stomach causes indigestion. A
baby with indigestion is a colicky, fretty, sick baby.
Overfeeding, therefore, is the beginning of lots of trouble
to the mother, and needless pain and suffering and sickness
to the baby. A simple matter, but it is one of the
most difficult lessons nursing mothers have to learn.

Overfeeding is most apt to occur at night. Many
mothers put the child to the nipple for its regular feeding
and fall asleep; the child keeps on nursing at intervals[Pg 224]
until twice the proper quantity is taken; or she
gives it the nipple or the bottle if it cries, without regard
to whether it is the proper feeding time or not.
The habit of overfeeding is very common in infants
who are suffering from indigestion. They cry frequently,
and are irritable most of the time; nothing
seems to satisfy them but the nipple. Taking the warm
milk into the stomach seems to allay the distress for
the time being, so mothers get into the habit of quieting
them in this way. The cry of the drinking man, whom
we try to sober up, is: “Just one more drink and I’ll
quit.” You give the drink and in a little while the
demand is repeated. If the mother understood the seriousness
of this practice of giving the child the nipple
or bottle at irregular times, she would not do it.

Overfeeding an infant may lay the foundation for a
lifelong ailment. The excess of food remains in the
stomach or bowels undigested. If you remember that
this mass of undigested matter is confined in a small
space which is both warm and damp, it will be easily
understood that putrefaction is the inevitable outcome.
As a result of this putrefaction there are produced certain
ptomaines and leucomaines. These poisons are carried
through the body, causing “auto-intoxication” which
upsets and irritates the child’s nervous system and may
cause very serious consequences, as it frequently produces
sudden death from apoplexy and “heart failure”
in the adult. These children are always restless, fretful,
continually uncomfortable, sleepless and colicky. They
lose weight, the stomach becomes distended and a gastritis
or inflammation of the stomach results.

Frequently a mother with such a fretful baby, seeing
her child getting thinner and thinner, will think
that it is not getting enough to eat, and will proceed
to add to the trouble by giving the child more to eat.

Mothers must therefore learn not to overfeed their
infants; not to imagine that a failure to gain weight
means the need of more food (if the quality of the
food being given is wrong, will increasing the quantity
of bad food do any good?); not to feed irregularly,
no matter how insistent the child may be.[Pg 225]

Intervals of Feeding.—The physician will give instructions
regarding the feeding of the newly born baby for
the first few days. After the first few days and up to
the beginning of the third month, it should be fed every
two hours from 7 a. m. until 9 p. m., and twice during
the night between 9 p. m. and 7 a. m., when the regular
two-hours’ interval again begins for the following day.
The two night feedings should be about 1 and 4:30 a. m.

After the third month, and up to the sixth month, feed
every three hours and once during the night. From the
sixth month until weaned, every three and one-half or
four hours, and not at all during the night.

While it has been pointed out that regularity of feeding
is absolutely essential, the above schedule is not to
be regarded as an absolute guide. It is a general guide,—approximately
it will be found correct in a large majority
of cases. Each baby is a rule unto itself. The quantity
of the mother’s milk will dictate the interval after the
first month and for each month as the baby grows. If a
mother with no milk to spare, is nursing a big, strong,
husky baby, the three-hour interval during the day may
have to be shortened to two and one-half hours. As
a rule, however, these exceptions are better regulated
by attention to the time the baby is given at each nursing
to fill its stomach.

How Long Should a Baby Stay at the Breast?—Babies
differ as to their method of feeding; some of
them seem to like to nurse a moment or two and then
look around; others seem to regard nursing as a serious
business, and resent any effort to take the nipple away
until they have finished. A baby should be taught to
nurse methodically; it should not be allowed to play
the nipple. Let it fill its stomach and put it
down as quickly as possible. A mother will very soon
know just how long it takes the baby to fill its little
stomach, and when she finds this out she should time
it by the clock. When the supply of milk is sufficient,
and the child is strong, and nurses freely, eight to twelve
minutes are sufficient. After it is taken away from the
breast it must be left quiet till the next feeding.

Other babies, according to the ability they evince to[Pg 226]
nurse, even when the milk runs freely, require a longer
time,—from twelve to fifteen minutes. The rule, however,
is never to allow them to nurse so long that when
they are taken away the milk runs out of the mouth.
If this occurs, cut down the length of time they are
at the breast, and always time the length of feeding by
the clock,—don’t guess at it.

Children Who “Vomit” Between Feedings.—When
a child habitually brings up food between feedings it is
usually a symptom of gastric indigestion. In these cases
it is advisable to add lime-water to each feeding, and
to remove some of the fat in each feeding. If improvement
does not follow remove more of the fat by removing
some of the cream from the top of the bottle
before shaking it.

Remove from the bottle four ounces of cream and
shake before preparing the food from what is left. If
the child improves after a few days remove only three
ounces, then in a few days remove two ounces and later
one ounce. After a time, sufficiently long to permit the
stomach to become accustomed to the graded amounts
of fat, the former diet of whole milk can be again resumed.

Never decrease the interval of feeding of a baby who
is bringing up parts of its meal between feedings;
it is frequently advisable to increase the interval. If
a child is colicky and is bringing up lots of gas in
addition to some food, one-half grain of benzoate of
soda may be added to each ounce of food given and
continued for a number of weeks if necessary. When
the gas is located in the intestines and is not brought
up, it must be made to pass downward. Attention to
the bowels is of great importance in these cases and it
may be necessary to peptonize the milk for some time. A
reduction of the sugar and starch in the feeding frequently
cures this condition. (See “Colic.”)

There are children who continue to have symptoms of
indigestion and who do not thrive despite various changes
in the quantity and quality of the feedings. It may be
necessary to obtain a wet nurse for them, as it is with
“the delicate child.” If a wet nurse cannot be obtained,[Pg 227]
or if the age will permit, a substitute may be tried.
Borden’s Eagle brand of condensed milk, canned, is probably
the best substitute under these circumstances. Condensed
milk should never be used as a continuous food;
as a substitute, however, for a few weeks it is often
invaluable. With an infant of three or four months
it should be used at the beginning in the proportion of
one ounce of the milk to sixteen ounces of plain boiled
water or barley water. The proper quantity, whatever the
child is taking (four or six ounces according to the
age) at the time, can be taken from the sixteen ounces
and fed to the child. As the symptoms improve the
milk should be diluted less and less, 1 to 14, 1 to 10,
and so on until the proper strength is reached. After
the child has been on the condensed milk for a month
it should be changed back to cow’s milk, using of course
a diluted formula until the child becomes accustomed
to the change. Condensed milk, if used as a permanent
food, will fatten babies, but their vitality is very deficient,
the muscles flabby, and the resistance to disease exceedingly
poor. They are apt to develop rickets and
sometimes scurvy.

Regularity of Feeding.—One of the very first, and
one of the most important factors in contributing to
the good health and the comfort of a baby is absolute
regularity in feeding. A regular interval of feeding is
particularly essential during the first month of a baby’s
life.

Despite the explicit way in which young mothers are
instructed in this respect, it is one of the disappointing
incidents of the practice of medicine to observe how
many of these mothers fail to heed the advice. We have
personally tried to find an explanation for this astonishing
carelessness, and have come to the conclusion that
it is not due to intentional forgetfulness, but rather to
an inexplicable failure to appreciate that the physician
means exactly what he says.

If, for example, specific instructions are given to feed,
or nurse, the child every two hours (and by “specific
instructions” it is meant, that the physician takes time
to explain in detail the instructions he gives—that the[Pg 228]
instructions are not incidental to the call, but part of
the call;—that the advice is given not as a choice of
what is desirable, but as an absolute rule to follow; and
carefully explains why it is imperative to do as he says;
and is satisfied the mother understands what he means)
it would seem that there could be no possible reason
why the directions should not be faithfully carried out.
Yet such is not the case in many instances, and the excuses
given by mothers for failure are so trivial and
annoying that they show a failure to appreciate that
they are dealing with a serious problem—a problem
affecting human life. They fail to understand that fatal
consequences may follow their negligence. They treat
the baby problem exactly as they would a household
incident, and as they do not consider it important whether
the breakfast dishes are washed at 9 a. m. or at twelve
noon, neither do they consider it important whether the
baby is fed at 9 a. m. or an hour later. When mothers
learn that the attention they must give their babies is
essentially different from the attention they give ordinary
household duties, the problem of raising children with
success and comfort will be greatly simplified.

If the instructions are to feed the baby at certain intervals,
do so at all hazards. To offer the foolish excuse
that the baby was asleep when feeding time came, is no
excuse at all; as a matter of fact the baby should be
asleep at each feeding time, if it is healthy. Wake it
and feed it, for, as will be shown later, it is the constant
regularity that counts. It will be more difficult to institute
regular feeding intervals during the first month,
because a healthy baby is very difficult to wake up, even
to be fed, during the first few weeks of life. It is absolutely
essential, however, that it should be wakened:
otherwise the tendency to overfill the stomach at the next
feeding will lead to indigestion and colic.

Why is Regularity of Feeding Important?—Because
a baby’s stomach holds a very small quantity, and experience
has taught us that a baby will thrive better on
small quantities given frequently, rather than large quantities
at longer intervals. The smaller the baby, the smaller
the quantity to begin with. Some babies weigh from[Pg 229]
five to seven pounds at birth, while others weigh from
nine to twelve pounds. It would be unreasonable to expect
a very small baby to be able to hold and digest as
much as a very large baby. Considerable common sense
and the exercise of some judgment is therefore necessary
on the part of the uninstructed mother, as to just the right
quantity to give. Fortunately, a little experience will
enable the observant mother quickly to solve this important
problem. Nature promptly furnishes the
symptoms which will correctly guide her. Before considering
the significance of these symptoms let us appreciate
certain facts common to all babies, and we will
more easily interpret the meaning of the special symptoms
the baby will furnish.

First of all the baby never vomits. The ejection of
food, therefore, is dependent upon a condition, not a
disease. If milk runs out of its mouth immediately, or
within a few moments, after a feeding, the explanation is
that it was fed too much; it does not vomit, the stomach
simply overflows. It is exactly like trying to put more
milk into a cup after it is full,—it will not hold more, it
overflows.

The significance of this symptom, therefore, is that the
quantity of the feeding is wrong (it is not the baby’s
stomach that is at fault,—it is the mother’s judgment).
Reduce the quantity of each feeding and you will quickly
cure it. If the milk does not overflow soon after a feeding,
the baby will appear satisfied and will go to sleep,
and will sleep until it is time for the next feeding. It
may not do this, however. In half an hour, or a little
longer, after the feeding, it wakes, it begins to fret and
cry, and very soon it suddenly belches gas and ejects a
mouthful of milk, after which it will rest quietly for a
few moments, when it will begin fretting all over again.
It may keep up this performance for an hour, or until
the next feeding, and if so it is exhausted and unfit to
carry on the digestive process. It is in these cases where
most mothers make serious mistakes. This is the beginning
of real trouble, and the family physician is the
only one qualified to give advice under such circumstances.
Remember the warning given regarding heeding the advice[Pg 230]
of every busybody just at this time. Your baby’s
health is at stake; maybe its life depends upon what you
choose to do.

What is the Significance of “Vomiting” After Feedings
in Babies?—Let us examine the difference between
the milk which overflowed immediately after the feeding
and the milk which the baby ejects one-half hour or so
later, and which is now being considered.

The first milk looks like ordinary milk (breast milk), or
if the baby is being fed from the bottle, it looks just like
the mixture in the bottle. It not only looks like what it
took, but it smells just like it. Now examine the other;
we find it looks like curdled milk, it is lumpy, and we immediately
can tell that it is sour, because it smells sour
and looks sour.

The explanation of the first overflow (immediately
after the feeding) was the too great quantity; the explanation
of the second overflow (one-half hour or so after the
feeding), is the wrong quality of milk. The quantity was
right because none overflowed right after the feeding,
but the quality was wrong. Again, it is not the baby’s
stomach that is at fault,—it is the quality of the milk.

How do we know this? Because of what takes place
in the baby’s stomach during the one-half hour between
the feeding and the time of the overflow of the sour milk.
The quantity being right, why should the baby have any
trouble if the quality is correct? It should not. Therefore
by changing the quality (not the quantity as in the
former case) we cure the trouble, thus proving the quality
of the milk to be at fault.

What took place in the baby’s stomach in the intervening
half hour? The quality being wrong, the little
stomach could not digest the mixture quick enough.
Fermentation set in, gas was evolved, and as the stomach
was full before the gas was manufactured (and as more
and more gas is manufactured when food ferments), the
stomach overflowed and out of the baby’s mouth comes
gas, and sour, fermenting, curdled milk. This process
goes on until fermentation stops, or until the little
stomach has just enough left to fill it and no more. But
think what this is,—a sour mass of rotting, indigestible,[Pg 231]
curdled milk,—and that is what this baby is expected to
live and thrive on.

Some babies seem to have trouble from the very first
day of life. Either they will not retain the food, or the
food fails to agree with them. If the baby is put upon
artificial food at once, these troubles are, of course, not
unexpected (because the right artificial food may not be
first chosen for the particular baby), but it is not always
the artificially fed baby that gives us trouble, and it is
sometimes difficult to find the cause for such trouble in
a baby who has had nothing but its mother’s milk since
it was born.

The cause of stomach trouble in a baby a few days old,
fed exclusively on mother’s milk, is invariably to be found
in the quality of the milk.

The quality of the mother’s milk may be affected in a
number of ways which will render it unfit for the baby.
For example, if the mother for any reason becomes sick,
and has a high fever shortly after confinement, it will
affect her milk and render it unfit temporarily.

If the mother worries or becomes highly nervous during
the first few days of her baby’s life, she will so affect
her milk as to render it unfit for baby. If a baby is fed
for a number of days after its birth by its mother, and it
should prove afterward that she has not enough milk to
continue feeding it, and has finally to put it on artificial
food, the baby will most likely have acquired slight
stomach ailments that may be troublesome for some time,
because in this case both the quality and the quantity were
no doubt wrong. Constipation in the mother will also
cause trouble. The child will develop colic and extreme
irritability until the mother’s condition is relieved.

Each of these conditions affecting the milk of the
nursing mother usually demands a change of food for the
baby, and the substitution of the proper artificial food
will invariably immediately correct the trouble. In some
cases, however, the quality of the mother’s milk is not
dependent upon a temporary temperamental condition,
but is caused by errors in diet, or conduct, or both. The
milk of a physically tired, worn-out mother, is not good,
no matter whether the exhaustion is caused by actual[Pg 232]
physical labor or by the exactions of a strenuous social
programme. The milk of a mother who persists in eating
irregularly, or who willfully caters to an appetite
which craves the rich, highly seasoned articles of diet,
or who attempts to satisfy a legitimate hunger by drinking
large quantities of stale tea or coffee and eating
bread, is unfit for her baby.

These cases are amenable to the proper treatment,
which of course means, that the mother must change her
conduct if at fault, and live strictly upon the diet prescribed
elsewhere for nursing mothers.

If these troubles occur in babies who have been fed exclusively
upon artificial food, an entire change of food
is frequently necessary.

FRESH AIR FOR BABY

Baby’s first journey out of doors depends upon so many
contingencies that no specific age can be given when it
would be perfectly safe to take it.

First, the weather and season of the year should be
considered. The baby should not be taken out at all
when it is wet, or foggy, or very humid; nor when it is
extremely cold.

Second, the vigor or vitality of the individual child
must be considered. Some children can safely be taken
out if the weather is propitious when two weeks old,
others cannot be taken out without risk until they are two
months old, regardless of the weather conditions. If a
child is robust at birth, and nurses well, and increases in
weight from the beginning, he can be taken out when he
is two weeks old while the sun shines during the middle
of the day. If a child is small and puny when born, and
begins to have nursing troubles from the beginning, does
not increase in weight, is fretting, and crying, and sleeps
spasmodically, it would be unsafe to take it out before the
sixth week unless it is at a season of the year which
would justify exposure to the sunshine.

The question of suitable clothing will be important,
and will decide the advisability as to when the baby
should go out. Every baby should be dressed in wool[Pg 233]
weather is not too distinctly bad. Remember always to [Transcriber’s note: words missing
in text]
from neck to ankles. Its head should be warmly clad.
Dressed thus and well wrapped in blankets, a healthy
child is ready for an out-door trip at any time, if the [Transcriber’s note: words
missing in text]
have plenty of blankets below the child as well as above it,
if it is in a baby carriage. In very cold weather the child
should be buried in blankets, and a hot water bottle can
be wrapped in near his feet. Great care must be taken
that the water in the bottle is not too hot, and that it
does not actually touch the skin. No matter how many or
how few blankets are used, the face should be exposed
directly to the fresh air. When the air is very gusty, or
high, a light veil can be laid over the face, but never at
any other time.

Air Baths for Babies.—Babies necessarily require
plenty of exercise and plenty of fresh air, as has been
pointed out. It is a splendid custom to allow the baby to
lie naked after his bath for half an hour. If the room is
comfortably warm, select a spot that is free from
draughts, and lay the baby on a pillow or two and let him
kick and coo. In the sun by the window, his head and
especially the eyes shaded from the direct rays of the
sun, is an excellent place in the summer time. The influence
of the direct sun rays on the little naked body is
conducive to good sturdy health, good nerves, and sound
sleep.

[Pg 235]

CHAPTER XVIII

BABY’S GOOD AND BAD HABITS. FOOD
FORMULAS

BABY’S BED

The Proper Way to Lay Baby in Its Bed.—The baby
should be accustomed to sleep by itself from the day of its
birth. Mothers have been known to smother their babies
during sleep. The mother may pull the bed-clothing over
the baby’s head during the night and thus deprive it fresh
air. A mother is much more apt to nurse her baby regularly
and to do it more efficiently, if she is compelled to
get up to do it. If she occupies the same bed with baby,
she may fall asleep while nursing him; the baby consequently
nurses too long, fills his stomach too full, and
soon develops indigestion and colic in addition to acquiring
a very bad habit.

For the first few weeks an ordinary basket arrangement
is all that is necessary. As soon as the baby begins
to move around it should have a regular baby crib, so
that possible accidents may be avoided.

When the baby is placed in bed after a feeding, it
should be laid upon its back, being tilted slightly toward
its right side. By placing a soft, small pillow, under its[Pg 236]
left side, the baby will rest more on its right side, which
is the proper position. The reason of this is because
the liver of a child grows quicker and larger than any
other organ, and it is on the right side. By placing the
child on this side, it prevents the heavy liver from
sagging over on the little full stomach. If the child were
laid on its left side, the liver would crowd the full stomach
and embarrass the heart, and cause pain and restlessness.
Frequently a change of position fully to the right side,
when a child has been restless or crying, and especially
if it has been lying on its back, will at once relieve it and
allow it to go to sleep again. It is the knowledge of
these little things that count in babyhood.

How Long Should a Baby Sleep?—A perfectly
healthy baby should sleep, while very young, eighteen or
twenty hours out of the twenty-four. As it grows older
it will sleep less. It should have, and nothing should
interfere with its having, two sound naps every day,—one
in the forenoon after its bath, and the other in the
afternoon. When four or five months old, it should also
sleep from 7 p. m. until 10 p. m., then it should be
fed and allowed to sleep until morning. It has been
aptly said, that, “a child might easily overeat, but he
practically never oversleeps.” During the second year a
child should sleep twelve hours at night, and about two
hours during the day. The twelve-hour night rest should
be continued until the child is six years of age. The
practice of taking a nap at noon is a very good one, and
it should be encouraged as long as possible. It can
usually be kept up until the child begins school life. The
strenuous activity of childhood, makes some such rest
highly desirable, and the result will necessarily be a
stronger body, a better disposition, and firmer nerves
than otherwise. The practice of retiring early should be
strictly enforced during childhood. Children of two
years of age, should retire at 6:30 p. m., or at latest
at 7 p. m., those from three to five years, may remain
up an additional hour. At thirteen or fourteen the regular
bedtime should be at 8:30 p. m. There is no
justification for the late hours which growing children
are allowed to keep, especially in large cities.[Pg 237]

Regular sleep is largely a matter of habit, and if the
infant is started right, with suitable feedings, given at
definite times, followed by the proper periods of sleep,
but little trouble will be experienced with sleeplessness.
When sleep is disturbed and broken, it means bad habits,
unsuitable food, minor forms of indigestion, or positive
illness of some kind. Sleep is absolutely essential in infancy
and all through childhood for purposes of growth.
It is wrong to permit a child to sleep too much during
the day; it will become a habit, and it will not sleep well
during the night as a consequence. In order to prevent
or break this habit, the child should be kept in a well-lighted
room and should be amused and entertained so
as to keep it awake. The nap during the middle of the
day is an exceedingly important factor in keeping the
average child in good physical condition. It is a valuable
adjunct in preventing, and in treating, nervousness in
children. Children who are anemic should be encouraged
to sleep long and freely in well-aired rooms.

Why a Baby Cries.—As has been stated, every healthy
baby should cry for half an hour each day. Nature suggests,
demands this as an essential exercise. Muscular
movements involving a greater part of the whole body
accompany the act of crying and furnish this necessary
exercise. It is of great importance to an adequate and
uniform development of the lungs; deep breathing is
necessary to lusty crying, hence the lungs are expanded
and the blood renewed and oxygenated. Crying is also
of material aid in moving the baby’s bowels. Babies in
perfect health will, however, cry under any of the following
circumstances, and doubtless under circumstances
of lesser importance and frequency when frightened or
uncomfortable from hunger or position, soiled napkins,
inflamed buttocks, earache, pain, from heat or cold, unsuitable
clothing, and during difficult bowel movement,
when displeased or angry. Children slightly but painfully
ill may cry incessantly for an hour or two. Thus,
with intestinal colic, when the cry is loud and continuous
until the child is relieved or until he falls asleep from
exhaustion.

The healthy, well trained child seldom causes trouble;[Pg 238]
it is the rule for it to be happy and good natured in its
own way.

The Habitual Crier.—If a child becomes a habitual
crier, it is because it is uncomfortable and unhappy.
There are restless, often vigorous, crying, whining infants,
and the trouble, as a rule, is in the intestinal tract.
Badly managed, “spoiled babies” cry from inattention,
and when left alone. If they are taken up and talked to,
the crying ceases, thus proving that it was not pain or
discomfort that was causing the crying. In the case of
the habitual crier we try to find out the cause of the
bowel trouble and cure it; the spoiled infant we discipline
rigidly, or leave it alone if its parents prefer that kind of
baby.

The Habit of Feeding Baby Every Time It Cries.—The
habit of regular feeding will, if persisted in and
successfully established, render advice on this subject unnecessary.
So also will the explanation of the evil of
overfeeding have its effect on mothers. Apart from
these reasons, however, the habit of feeding baby every
time it cries is a pernicious one, and no doubt the mother,
who will be striving to faithfully follow instructions, will
have to overcome the advice of meddling friends who
will regard it as a cruelty to allow the baby to cry. Do
not give in to these busy-bodies; insist on attending to
your own affairs, but be absolutely sure baby is not crying
for a just cause. A child can only cry; that is its only
language, but it cries for many things other than the
nipple or the bottle. Examine it carefully,—a wet diaper
a pin, an uncomfortable position, a drink of water, any
of these may be the cause.

It is just as essential that a child should cry as that
it should sleep. Every healthy child should cry for
twenty or thirty minutes every twenty-four hours. Nature
calls for this as an exercise in order to develop the
lungs; therefore, if there is no just cause for the crying
you must regard it as a necessary evil, even if you
look upon it as a domestic affliction.

The Habit of Walking the Floor With Baby Every
Time It Cries.—This is another habit that is indulged
in to the sorrow and ridicule of the race. If you are a[Pg 239]
victim of this habit, you have yourself to blame. It is a
matter of education, or habit, pure and simple, and, like
all bad habits, it is difficult to break away from. In the
preceding paragraph, you have been told that when baby
wants something, or is uncomfortable, it employs the
language nature gave it,—it cries. No child ever cried
to be walked up and down the floor in the dead of the
night. Begin at the beginning, when it first cries, find
out why it is crying. Offer it a little water if it is not
feeding time. Examine its diaper and if soiled change
it. It may be overdressed and consequently hot, perspiring,
and uncomfortable; change its position. Find out
if any pin is open and hurting it; loosen the binder so it
can breathe easily. If it is a colicky child follow the
instructions given in the treatment of colic. Be patient
the first few nights, and be thorough, because you may
discover why it cries and each discovery will help you
next time. If you discover something wrong, some
reasonable excuse for the crying, does it not prove the
folly of walking the floor? If it wants a drink of water,
or if its diaper is wet, how is walking the floor going to
cure it, or how can you expect the baby to stop crying
when you so unjustly construe its reasonable and its only
way of asking a favor? If walking the floor stops its
crying, it stops it by exhausting the child, not by relieving
it of its little ailment.

Jouncing or Hobbling Baby.—This is another habit
that should be frowned upon. So many persons are addicted
to this form of baby torture, that it is astonishing
more immediate harm does not result from it. Be particularly
careful not to indulge in it, or permit anyone else
to do it immediately after feeding. If you form the
habit of putting baby down at once after each feeding, as
you have been instructed to do, the opportunity to jounce
it will not exist. A little reasoning will clearly convince
you that to subject a baby to violent exercise when its
stomach is full would interrupt digestion and so shake
the full stomach hat it would distend it and cause indigestion.
You would not think of exercising yourself
after a meal; why exercise a baby?

Baby Needs Water to Drink.—Boil a quantity of[Pg 240]
water each morning, put in a clean bottle, and keep in
a cool place. Give the baby some, three or four times
daily between feedings. One teaspoonful is enough to
begin with, and as it grows older it will take more. It
may not always take the water but it will take what it
wants, and it needs some every day; it is therefore your
duty, inasmuch as baby cannot ask for it, to offer it
regularly each day as part of your daily routine.

KISSING

A child should never be kissed on the mouth by anyone,
not even its own parents.

Kissing should not be allowed among children. If any
kissing is done it should be on the brow, never on the
mouth, hands, or fingers.

Many diseases are carried by this pernicious habit, and
you cannot afford to have baby’s health jeopardized by
this promiscuous and unnecessary liberty.

ESTABLISHING TOILET HABITS

When baby reaches the age of three months, a regular
systemized effort should be made to educate it to “habits
of cleanliness.” Nothing can be done in this direction
previous to this age, as a child at that period of its life
is scarcely conscious of the natural functions of its body.
Each time a baby, after the third month, is making an
effort to move its bowels, the nurse or mother should go
to it as it lies in its crib, and talk to it by making a certain
sound or say a certain word—whichever word or words
you want to educate your child to say, when it wants to
move its bowels. By constant attention and effort in
this direction, a child with quick perception and initiative
will soon associate the sound and the function, and it will
begin to make the sound when the function is about to be
performed. As soon as it begins to make this sound, if
prior to the act of moving the bowels, the child should
be immediately taken up and held on a chamber, into
which some hot water has been put, and encouraged to[Pg 241]
relieve itself, the nurse or mother still repeating the
sound, or word, or words.

Having successfully accomplished this programme a
number of times, the child should be encouraged and
petted every time it gives a satisfactory warning, and
discouraged and reproved every time it wets or soils its
napkin. A little later, say about six months, the child
should be held on the chamber at a certain time each
morning and evening, thus encouraging it to move its
bowels regularly twice daily. The careful carrying out
of a scheme such as the above will establish regular,
cleanly habits, and will to a very large extent guard
against constipation in the future.

Baby’s Comforter.—The discovery and introduction of
the comforter or rubber teat was an unfortunate episode
in someone’s life. By the careless, conscienceless nurse,
or thoughtless mother, it is regarded as a real comfort
and blessing. Any temporary comfort, however, which
the nurse or mother may enjoy as a result of its use, is
at the expense of the health of the child. Its use is a
serious reflection upon the good intention and intelligence
of the mother who permits her child to use one. It is a
bad habit from every viewpoint possible. In order that
mothers, open to conviction and capable of reasoning,
may appreciate the character of the harm done by the
use of the comforter, we will briefly record these conditions:

1st. The constant sucking pulls upon the delicate structures
of the mouth and throat, and so impairs the health
tone of these structures that they become flaccid and
feebly nourished. This to a certain degree causes
adenoids, enlarged tonsils, loose palate and weak throat,
with the constant tendency to winter colds and coughs,
and to catarrh.

2nd. It causes an excessive flow of saliva. Saliva
should only be stimulated previous to stomach digestion.
By causing an excessive flow of saliva into an empty
stomach, the digestive powers are interfered with, and
seriously weakened. Stomach trouble, and consequently
intestinal disease, may therefore be caused by the seemingly
innocent comforter.[Pg 242]

3rd. A constantly used comforter always causes disease
of the mouth. Mucous erosions, canker sores, little ulcers,
etc., are produced in this way.

4th. The use of the comforter makes it impossible to
put the child to sleep, or even to leave it alone, without
first placing it in its mouth.

5th. To stifle a baby’s cry, by pushing the comforter
into its mouth, is as bad as giving it chloroform to mask
a serious and dangerous pain. If may have a just reason
for crying, as is explained elsewhere, and if that reason
is not searched for and found, it may mean serious
trouble later.

6th. Actual deformities of the mouth are produced by
constant use of the comforter. The continuous sucking
affects the gums, pushes them out of shape and position,
and the teeth as a consequence come at wrong angles,
thus causing unsightly deformities, which last throughout
the life of the child.

7th. The worst fault of the comforter is to be found
in its uncleanliness. We are quite satisfied that the use
of the comforter will be legislated against one of these
days. If preventive medicine means anything, it must
certainly reckon with the comforter in the very near
future. Have you ever watched your baby suck on its
comforter? If you have, you must have noted the tireless
energy with which it works its tiny jaws and tongue.
Suddenly the comforter slips from the little mouth and
baby begins to cry, attracting the attention of the mother,
or nurse, or little sister, who promptly, recognizing the
trouble, pounces on the offending comforter, which has
fallen to the floor, and with a perfunctory wipe replaces
it in baby’s mouth. It is done just as we have written it,
many thousand times, and yet the problem of infant
mortality is represented as a vexatious mystery. The
newspapers solicit charitable aid, and write eloquent appeals
regarding the necessity of sending a few babies
to the seashore in the summer time or to supply a few
with ice during the hot spells. A hundred other energetic
enthusiasts send forth their laudable effort to raise the
standard of child hygiene, yet the manufacturers of the
comforter, and the ignorant mother and nurse who use it,[Pg 243]
do more harm in one day than all the honest effort of
these combined forces can neutralize in a year.

The rubber comforter is one of the most fertile causes
of infection and illness in babies because of the peculiar
adaptability to collecting germs which it possesses.

When the comforter is finally discarded the habit of
sucking is so firmly established that the child will suck
its thumb for many years after. This results in further
disease and deformity to the growing mouth and throat,
and also to the thumb.

After a child has used a pacifier or comforter for some
time it invariably becomes a mouth breather. A mouth-breathing
child is very apt to catch cold and as a consequence
of the habit may become catarrhal or tubercular.

What Can be Done to Lessen the Evil Effects of the
“Comforter” Habit?—It is a most difficult habit to cure
when once established. The very least that can be done
is to keep the comforter scrupulously clean, washing it
several times daily. To have not one, but two or three,
kept in a saturated solution of boracic acid, ready to put
into the baby’s mouth should one be required to replace
another that has fallen out. We should furnish a large
shield to prevent it being swallowed. We can try the
method of weaning the baby from the comforter by tying
a ribbon to it and to the child’s bodice. The system is
gradually to shorten the ribbon until it becomes too short
for the baby to suck in comfort. It will then gradually
grow away from the habit.

FOOD FORMULAS

Beef Juice.—Take one pound of round steak and broil it
slightly. Press the juice out with a lemon squeezer, or, with
a meat-press. Season with salt and serve hot or cold as desired.
If it is heated after it has once been cold, it should not
be overheated as this will coagulate the albumen which will appear
as flakes floating on the surface of the juice.

Beef Juice by the Cold Process.—Take one pound of finely
chopped round steak, six ounces of cold water, a pinch of salt;
place in a covered jar and stand on ice, or in a cool place, six
hours. This mixture should be shaken from time to time.
Strain and squeeze all the juice out by placing the meat in a
coarse cloth and twisting it very hard. Season and feed as
above.[Pg 244]

Beef juice made in this way is more nutritious than that made
from the steak when broiled; it is not, however, quite so palatable.

Beef juice made in either of the above ways is much more
nutritious than the beef extracts sold ready to use.

Mutton Broth.—Take one pound of finely chopped lean
mutton, including some of the bone, one pint of cold water and
a pinch of salt, cook for three hours over a slow fire down to
half a pint, adding water to make up this quantity if necessary;
strain through muslin. When it is cold remove the fat and
add more salt if required. It may be fed warm or cold in the
form of a jelly.

Mutton Broth With Cornstarch or Arrowroot.—Add to the
above sufficient cornstarch or arrowroot to thicken, cook for
ten minutes and then add three ounces of milk, or one ounce
of thick cream, to a half pint of broth. This makes a nutritious
and extremely palatable broth.

Chicken, Veal, and Beef Broths.—These may be made and
used in the same way as mutton broth.

Scraped Beef or Meat Pulp.—Take a rare piece of round
or sirloin steak, cut the outer part away, scrape or shred with
a blunt knife. Cutting the meat into small pieces is not satisfactory.
One teaspoonful to one tablespoonful may be given
well salted, to a child a year and a half old. It is best to begin
with a small dose and work up to the larger to accustom the
digestive apparatus to its use.

Junket, or Curds and Whey.—Take one pint of warm fresh
cow’s milk, a pinch of salt, a teaspoonful of granulated sugar,
to which add two teaspoonfuls of Fairchild’s essence of pepsin
and allow the mixture to stand until firmly coagulated—this may
take about twenty minutes—place in the ice box until thoroughly
cold. Nutmeg may be added for older children and adults.

Whey.—The coagulated milk prepared as above is broken
up with a fork and the whey is strained off through cheesecloth.
If a stimulant is desired, brandy, in the proportion of one teaspoonful
to six tablespoonfuls of the whey may be added.

Barley Water.—One level tablespoonful of Robinson’s barley
is rubbed up with a little cold water, to this is added one
pint of boiled water containing a pinch of salt. The mixture
should be stirred while the water is being added. Cook for
thirty minutes in a double boiler and strain. Enough boiling
water should be added to the mixture to make up the full pint
if any has boiled away.

Barley Gruel or Barley Jelly.—Repeat the above process,
but instead of using one tablespoonful of the barley powder,
use from two to four according to the consistency of the gruel
or jelly desired.

Barley water may be made from the grains. A formula for
this process will be found in the chapter on artificial feeding.

Rice, Wheat, or Oat Water.—These are made from the rice,[Pg 245]
wheat, or oat flour in the same way as barley water described
above. They may be made from the grains also, using the same
proportions as in the making of barley water.

Imperial Granum.—This is prepared in the same way as the
barley flour above described.

Albumen Water.—Take half a pint of cold water, the white
of one fresh egg, a pinch of salt, and a teaspoonful of brandy,
shake and feed from a spoon or from a bottle. This is frequently
used in cases of vomiting, or in irritable stomachs. It is
often retained when all other food is rejected.

Dried Bread.—Cut either stale or fresh bread into thin
slices and place in the open oven. When it is dried and crisp
but not browned it may be given to children in preference to
crackers.

Coddled Egg.—A fresh egg with the shell intact is placed in
boiling water which is immediately removed from the fire. The
egg is allowed to remain in the water for eight minutes when it
is ready for use. The white only should be used if the digestion
is poor.

ARTIFICIAL FEEDING

[Pg 249]

CHAPTER XIX

ARTIFICIAL FEEDING

Elementary Principles of Milk Modification.—Mothers
who have to raise their children on artificial food
should understand the elementary principles of milk
modification. They should know, for example, that the
one object of milk modification is to render it as nearly
an exact substitute for mother’s milk, according to the
age of the child, as is possible. If we could do this
with scientific exactness, artificial feeding would be a
simple process. We cannot, however; nor has there
ever been devised a method by which we may hope successfully
to duplicate mother’s milk. It is a comparatively
simple matter for the efficient chemist to analyze
the breast milk of any nursing mother; and it is quite
possible to duplicate the milk according to the analysis,
with chemical exactness, but the two fluids will not be
the same. There is present in the mother’s milk something
which synthetic chemistry cannot discover. This
something is nature’s secret,—it is akin to the life-giving
principle which is contained in the germinal fluid, and
in the hen’s egg. We cannot therefore hope to build
up an artificial food that contains this mysterious life-giving
principle which is the secret of the efficiency of
maternal milk,—we can only hope to approximate it.[Pg 250]
It is possible that we might be successful so far as its
nursing efficiency is concerned, if all children were alike,
if all children were of a uniform standard of health.
As a matter of fact, no two babies are exactly alike.
And while the mother of each child undoubtedly secretes
a milk suitable to the degree of healthfulness of her
own child, the same milk might not be equally suitable
to another child. The milk, therefore, that is manufactured
to agree with an average mother’s milk is dependent
for its success upon the vitality of the child to
which it is fed. If that child is not a well child, according
to an accepted standard, the milk will not agree with
it, even though it is the best possible substitute for an
average breast milk.

We have consequently two factors to consider in successful
or efficient artificial feeding:

It is the lack of a uniform health standard in children
that gives to artificial feeding all its difficulties.
It renders the successful artificial feeding of children a
personal or individual problem. Some children,—those
who approximate a standard of health for their age;
in other words, “well” children,—thrive on a milk modification
that experience has taught us is suitable for
well children of their age. Others, and they are in the
majority, have to be fed on a modification which actual
test proves to agree with their digestive capabilities.
Every artificially fed child therefore must be studied
from its own individual standpoint. A certain modification
of milk may not agree with a child fed every two
and one-half hours, which will be found to agree if fed
in the same quantity, to the same child, every
three hours. The slightest change, a change which
would seem to be so insignificant in itself as not to
justify serious consideration, may mean the difference
between normal healthfulness and constant ill health.
A food that is too strong for a child’s digestive ability,
and which causes vomiting, colic, and diarrhea, may be
rendered exactly right by the slightest modification
one of its constituents. To effect such a change quickly[Pg 251]
and successfully, one must be trained to interpret the
symptoms correctly and to know how to make the change
in the modification of the milk. Mothers cannot be expected
to possess this degree of skill: they should therefore
refrain from experimenting, because an experiment
on a baby is not only dangerous, but ethically it
is criminal. Call the family physician; put the burden
on his shoulder.

It is this element of uncertainty in our ability to effect
a standard modification of milk that has afforded manufacturers
the rich opportunity of putting on the market
various baby foods for which much is claimed. These
foods are really substitutes for the inefficiency of the
average mother. There is no real justification for their
use. If all mothers were clean, faithful, and efficient,
there is no reason why each one could not be taught
to modify cow’s milk to suit her child, just as satisfactorily,
or more so, than a manufacturer who never saw
her child. The manufacturers, however, do the work,
and the naturally ignorant or lazy and inefficient mother,
is willing to pay for the extra cost of labor, to save
herself the trouble on the one hand, and to subject her
child to a series of experiments in order to discover the
manufactured food that is particularly adapted to her
particular baby on the other hand. We believe that
most mothers have never considered the question from
this standpoint; that most mothers adopt this method
of artificial feeding at the direct suggestion of their
family physician, and are not, therefore, responsible.
These foods do not contain the nutritional elements
necessary to healthy growth; or as they exist in normal
breast milk; or as they can be approximated in
ordinary milk modification at home. Proprietary foods
are of decidedly poor value in infant nutrition, and
should not be used. They have a value, however,
in certain diseased conditions, but within a very small
range. As a food for a healthy growing infant, they
should not be used, and when the average physician
appreciates this fact, and so instructs the mothers of
the country, it will be to the distinct advantage of the
race in every respect. Proprietary foods to which fresh[Pg 252]
cow’s milk is added, are not foods at all,—they depend
upon the milk so far as any nutritional value is concerned;
and it would be far safer to modify at home a
good milk than to buy a proprietary food, the analysis
of which cannot be depended upon. The credit for the fat,
healthy babies we see advertised does not belong to
the manufacturers, but to the cow whose milk you add
to the manufacturer’s sugar.

The proprietary beef foods are also valueless as infant
foods. In certain illnesses, when we want a mild
stimulant, a teaspoonful or two in hot water may have
a certain value, but that is all. The beef juice of home
manufacture is much more valuable.

Difference Between Human and Cow’s Milk.—The
composition of cow’s milk is as follows:

The composition of an average human breast milk
is as follows:

It will be observed from a comparison of the above
tables that cow’s milk is much richer in proteids (the
substances which form with water the curd of sour milk)
than is human milk. If one remembers that cow’s milk is
manufactured by nature primarily for the feeding of
calves, not for babies, and that the stomach of a calf
is intended to exist exclusively on vegetable products,
and that nature is preparing it for this purpose, and
feeds it a food when young that will enable it to grow
so as to be adapted for that purpose, one can understand
that the problem of the modification of cow’s milk to
suit the stomach of a baby is not by any means a simple
matter. Since the proteids are so much in excess in
cow’s milk, we must dilute cow’s milk with twice its
bulk or more of water to render it fit food for a new
born baby. If we dilute cow’s milk to this extent to get
the proteid percentage right, we immediately disarrange[Pg 253]
the percentage of the cream or fat. We overcome this
difficulty by taking the cream from the top of the bottle
and diluting it because it is richer in fat and does not
need so much dilution. This is the explanation of the
so-called “top-milk feeding.” The percentage of sugar
represents another problem. The percentage of sugar
in cow’s milk compared with the sugar in human milk
is deficient, so we add milk-sugar to the cow’s milk
to make up the deficient percentage.

There is yet another feature which we must rectify;
cow’s milk is acid, while human milk is alkaline. To overcome
this difference we add lime-water. We must also
take into consideration that cow’s milk is ordinarily full of
germs, while human milk is free from them; to overcome
this danger we resort to heating the milk to a degree
which experience has taught us will kill all germs.
Cooked milk is not as wholesome as uncooked milk, and
it has a tendency to cause constipation. We have to a
certain extent overcome the need for cooking all milk
for babies, as will be noted later, but in summer time,
unless the milk is known to be pure and free from germs,
it is advisable to sterilize it.

UTENSILS NECESSARY FOR HOME MODIFICATION
OF MILK

A detailed description of the proper kinds of bottles
and nipples will be found elsewhere. The measuring
glass or graduate should be wide-mouthed. It is not
safe to spoon the top-milk off, nor is it safe to pour it
out. Absorbent cotton should be provided to close the
nursing bottles when filled and left standing in the ice
box.[Pg 254]

ARTIFICIAL FEEDING FROM BIRTH TO THE
TWELFTH MONTH

The following formulas for the different ages may be
found useful for well babies:

From the third to the tenth day:

Ten feedings in twenty-four hours; 1-1/2 to 2 ounces at each
feeding.

From the tenth to the twenty-first day:

Nine to ten feedings in twenty-four hours; 1-1/2 to 2 ounces
at each feeding.

From third to the sixth week:

Eight to nine feedings in twenty-four hours; 2 or 3 ounces at
each feeding.

From sixth week to the third month:

Seven to eight feedings in twenty-four hours; 2-1/2 to 4 ounces
at each feeding.

From third to fifth month:

After this age two bottles of milk are required, 16 ounces
being taken from the top of each bottle and mixed.

Six feedings in twenty-four hours; 4 to 5 ounces at each
feeding.

From the fifth to the seventh month:

Six feedings in twenty-four hours; 5 to 7 ounces at each feeding.

From the seventh to the ninth month:

Five to seven feedings in twenty-four hours; 6 to 8 ounces at
each feeding.

From the ninth to the twelfth month:

Five to six feedings in twenty-four hours; 7 to 9 ounces at
each feeding.

It will be observed that 16 ounces of top-milk is used
to make the various formulas from. This means that
the mother will dip off, with a Chapin dipper, 16 ounces
from the top of a bottle of milk which has stood for
four or five hours to allow the cream to rise; she
will then mix this and take from the mixture the number
of ounces called for in the formula she is using according
to the age of the child. The ordinary milk that is delivered
in New York City may be assumed to have stood
the four or five hours necessary. This may not be so,
however, in the country, as it is frequently delivered
there as soon as it is milked. In such cases the mother
will permit it to stand in the ice box until the cream
has risen.

When the mother is about to make the mixture called
for in feeding from the third to the fifth month she
will observe that 18 ounces of milk is called for. Now
since she only uses 16 ounces of the top-milk from one
bottle this will not be enough. She must therefore use
16 ounces from two bottles of milk; this she will mix
together and from this mixture she will take the 18
ounces wanted. Whatever milk is left over may be
used for ordinary table purposes.[Pg 256]

EASY BOTTLE-FEEDING METHOD

The following formulas and instructions for bottle-feeding
are taken from the Rules for the Care of Infants
and Young Children which are used by Dr. Kerley at
the out-patient department of the Babies’ Hospital and
give the simplest and easiest means of bottle-feeding:

Barley-Water.—The barley-water used in the above
formulas may be made in the following way: To two
teaspoonfuls of pearl barley, add one quart of water,
and boil continuously for six hours, keeping the quantity
up to a quart by the addition of water; strain through
coarse muslin. The barley will be better if it is soaked[Pg 257]
for a number of hours, or over night, before cooking.
The water in which it is soaked is not used.

An equally good barley-water may be made in an
easier way by using Robinson’s prepared barley. This
may be procured in the drug stores. It is only necessary
to take one even tablespoonful of this barley to twelve
ounces of water and cook for twenty minutes.

Condensed Milk.—When the mother cannot afford to
buy bottled milk from the wagon, when she has no ice-chest
and cannot afford to buy ice, she should not attempt
cow’s-milk feeding, but may use canned condensed
milk as a substitute during the hot months only. The can,
when opened, should be kept in the coolest place in the
apartment, carefully wrapped in clean white paper or in a
clean towel. The feeding hours are the same as for fresh
cow’s milk:

“Under three months of age: Condensed milk one-half
to one teaspoonful; barley-water, two to four ounces.

“Third to sixth month: Condensed milk, one to two
teaspoonfuls; barley-water, four to six ounces.

“Sixth to ninth month: Condensed milk, two to three
teaspoonfuls; barley-water, six to eight ounces.

“Ninth to twelfth month: Condensed milk, three teaspoonfuls;
barley-water, eight to nine ounces.”

Objections to Condensed Milk Feeding.—Condensed
milk is not to be recommended as a permanent food
where good cow’s milk can be obtained. In most cases
it should be used as the sole food for a few weeks only.
It may be used when the digestion is impaired for some
reason. If the symptoms are intestinal it will be more
apt to agree than if they are caused by stomach ailments.
The symptoms of intestinal disturbances are,—colic, flatulence
(gas), curds or specks in the stools, constipation
or diarrhea. It will not be found suitable if the child is
simply vomiting.

The objections to condensed milk are: It is very rich
in sugar and very deficient in proteids and fat. Children
fed on condensed milk often gain very rapidly in weight
but have little strength or resistance. They do not fight
disease well for this reason; they are apt to develop
rickets and scurvy.

[Pg 259]

CHAPTER XX

ARTIFICIAL FEEDING—CONTINUED

HOW TO PREPARE MILK MIXTURES

The mother should always remember, that the secret
of success in raising a baby efficiently on artificial food
is to be cleanly and to be exact. The bottles and the
nipples must be scrupulously clean; the hands of the
mother must be clean; the water used must be boiled and
each ingredient must be measured exactly.

First dissolve the sugar in the boiled water, which
must be the exact quantity; then remove the top-milk and
measure the exact amount wanted in the graduate, pour
into the jar, add the water and sugar mixture, and finally
the lime water.

It is always desirable to make the entire quantity for
the day at one time. After the total quantity has been
mixed in the jar, fill each bottle with the amount for each
feeding, put in a cotton stopper, and place the bottles in
the ice box.

In measuring the sugar, it should be remembered that[Pg 260]
two scant dipperfuls equal one ounce by weight of the
sugar.

When each individual bottle is to be filled, do it with
the aid of the glass funnel which has been previously
sterilized.

Sterilizing the Food For the Day’s Feeding.—The
simplest method is to place the two-quart jar containing
the milk mixture for the next twenty-four hours’ feeding
upon a saucer in the bottom of an open pan, and then to
pour enough tepid water into the pan (outside of the
jar) until it will come up as high as the milk level. The
water in the pan is then brought slowly to the boiling
point. The pan is then moved to the back of the stove
and left for half an hour. The jar is then removed and
rapidly cooled by allowing cool water to flow over the
outside; the individual bottles filled and put in the ice
box.

It is always wise to taste the milk before making up
the day’s feeding to be sure it is not sour. The milk
from a herd of good cows is always better than the milk
from one cow no matter how good that one cow may
be.

When about to feed the baby, the bottle is taken out
of the ice box and heated to the desired temperature in
a water bath. The temperature of the milk can be tested
by allowing a few drops to fall on the wrist; it should
feel warm, not hot; it should not be tasted by putting the
bottle to the mouth of the nurse, or mother, as it may
become infected by doing so. A flannel cover, or bag,
should be made to fit the bottle and it should be put on
while the baby is nursing so that the milk may retain its
heat. The baby must not be disturbed while nursing, nor
should he be jounced or carried around after nursing.
These habits cause vomiting and indigestion. He should
be put in his crib.

When to Increase the Quality or Quantity of Food.—Children
of the same age may have different digestive
abilities. A strong, robust child may be permitted to
take a richer quality of milk than a weak, puny infant
of the same age. If the quality or quantity of each feeding
is too weak or small for the baby he will be dissatisfied[Pg 261]
and he will cry after the feeding. In such cases, if
the bowel discharges are natural and yellow without
curds or white specks, and if he is not gaining sufficiently
in weight, the next stronger formula may be tried. If it
is decided to put him on the stronger mixture, it is wise
to cut the quantity down for a day or two in order to
test out his digestive ability. If the stools remain good
after three days, the quantity may be slowly increased
until the amount in the recipe is allowed. It is a much
more serious risk to overfeed the baby than to underfeed
him. If too large a quantity is given, he may vomit it at
once, or he may develop colic with intestinal indigestion.
Such babies lose weight, become fretful and irritable,
even though the appetite may remain good. If too strong
a quality is given he may vomit sour, buttery-smelling
milk, or have colic, and pass curds in the stool. If this
happens it may be necessary to go back to a weak formula
and work up from that standard. This is always a
tedious and anxious experience and may lay the foundation
for digestive disturbances for a long time. Don’t
be too anxious to increase the quality, or quantity, of
your baby’s food. It is much better to go slow and have
a well baby, than to try to force matters and get into all
kinds of trouble. No science calls for more elementary
common sense, than the science of infant therapy.

Digestive disturbances incident to this period are fully
explained in the chapter on Diseases of Children.

FOOD ALLOWABLE DURING THE FIRST YEAR, IN
ADDITION TO MILK

About the twelfth month the baby should receive plain
milk mixtures instead of the top-milk heretofore used in
making up the food. At first the milk may be plain milk
from an ordinary bottle shaken up. Of this he may take
five ounces, to which may be added three ounces of barley
water. The barley water may be gradually withdrawn,
an ounce at a time, replacing this amount with milk, until
the child is taking eight ounces of milk and two ounces
of barley water. Later plain mixed milk will be suitable
for a child about the fourteenth month.

Barley water may be added to the milk at any time[Pg 262]
after the third month in place of the plain boiled water
in the preceding formulas. It is advisable to do this if
there is any trouble with digestion, or if there are curds
in the stools. Some children take more kindly to barley
water than plain water at a very early age.

Beef Juice.—The juice squeezed from broiled steak
may be given a child at about the eighth or ninth month,
or, in cases of anemia, earlier than this. It is given
before the milk feeding, diluted with an equal amount
of water. At first a teaspoonful of the extracted juice
should be given with the same quantity of water; increase
every four days until at the end of two or three
weeks two tablespoonfuls are given.

White of Egg.—Place an egg in boiling water and
allow the water to cool with an egg in it. In ten minutes
the white of the egg will be coagulated and ready for use.
It may be used in place of the beef juice if the latter does
not agree and may be begun at the sixth month and given
once daily. One-half of the white of the egg should be
tried, then at the end of a week, if it agrees with the
child, the whole white of one egg may be given.

Orange Juice.—This juice has a good effect on the
bowels and may be given even to very young children
who are disposed to be constipated. It is also of benefit
in counteracting the effect of boiled milk. The juice
should be extracted from fresh oranges and strained.
One teaspoonful may be given at first one hour before a
feeding. The amount may be increased until four teaspoonfuls,
or one tablespoonful, are given daily.

Peptonized Milk.—The object of peptonization of milk
is partly or wholly to digest the casein, or curd, of the
milk before feeding.

Fairchild’s Peptonizing Powder is used for this
purpose. The powder is put up in tubes, and instructions
are furnished in each box as to its use.

There are two methods of using the powders:

The Hot or Immediate Process.—Fifteen minutes before
feeding add from one-eighth to one-quarter of the
contents of a tube to the milk mixture in the nursing
bottle ready for use. The bottle is then put in water at a
temperature of from 110° to 120° F., and allowed to[Pg 263]
remain in the water for fifteen minutes. The amount
of the powder used and the temperature of the water
depend upon the amount of milk in the nursing bottle.

The Cold Process.—Four ounces of cold water are
put into a clean quart bottle and the powder from one of
the tubes. Shake the mixture thoroughly until the
powder is dissolved. Add a pint of cold fresh milk, shake
the bottle again and place directly on ice. When any of
this milk is used the bottle should be again shaken and
put immediately back on ice.

If necessary this process may be modified so that
partially or completely peptonized milk may be made.

Partially Peptonized Milk.—Put four ounces of water
and a whole tube of powder into a clean pan and stir well;
add a pint of cold milk and heat to the boiling point,
stirring the mixture all the time. There should be
enough heat to bring the milk to the boiling point in ten
minutes. Allow the mixture to cool somewhat and strain
into a clean jar, cork tightly and keep in a cool place.
Shake the jar before and after using any of the contents.

If partially peptonized milk is properly prepared it
should not become bitter.

Completely Peptonized Milk.—Put four ounces of
cold water and the powder contained in one of the tubes
into a clean quart bottle and shake thoroughly. Add a
pint of cold fresh milk and shake again; then place the
bottle in a pan of warm water about 115° F., or not too
hot to place the hand in comfortably. Keep the bottle
in the water bath for thirty minutes; then place the bottle
directly on ice.

Uses of Peptonized Milk.—Partially peptonized milk
is useful in young infants who have difficulty in digesting
the curd of milk. Completely peptonized milk is frequently
used during attacks of indigestion. It is used
also to tide a delicate infant over a period when for some
reason the digestive apparatus refuses to digest and assimilate
even dilute mixtures. It is of value also in acute
or chronic illness when the child has to be fed through a
tube. When it is necessary to feed per rectum peptonized
foods are often selected in preference to others.[Pg 264]

Objections to Peptonized Milk.—Complete peptonization
of milk renders the milk bitter. For this reason
many children will not take it. Very young children
whose sense of taste is not developed may be induced to
take it after a few days. It is not wise to continue its
use long because the function of the stomach will become
accustomed to the use of predigested food and refuse to
work when called upon. If it is used for a number of
weeks it is wise to stop it gradually in order to permit the
stomach to resume its function in a normal way.

What a Mother Should Know About Baby’s Feeding
Bottle and Nipple.—In the first place, always buy
round bottles,—round everywhere, inside and out,—there
should be no corners anywhere. The reason for this is,
that bottles that are round everywhere, are easily cleaned,
and can be thoroughly cleaned, and having no corners
they do not lend themselves to collecting dirt and
bacteria. When these bottles are first bought they should
be boiled. After each feeding they should be thoroughly
washed with soap or washing powder. A long-handled
bottle brush should be used to help clean the bottle.
After the bottle has been thoroughly rinsed a number
of times with hot water, it should be set aside filled with
warm water into which one teaspoonful of bicarbonate
of soda has been put. Before filling them with the freshly
prepared food each morning the bottles should be boiled.
Every mother with a bottle-fed baby should buy a dozen
bottles, all of the same kind and size to begin with. This
is a great advantage for a number of important reasons,
two or three of which I will mention:

1st. Having enough bottles means that each bottle will
be used once only during the twenty-four hours; there
is less chance therefore of a bottle being cleaned carelessly.

2nd. Having a fresh bottle for each feeding permits all
of the food for twenty-four hours being made at one
time. This ensures uniformity of quality of each feeding.

3rd. By cleaning all the bottles at one time (previous to
filling) it is more apt to be done thoroughly; and by
making all the food for a day at one time it is more[Pg 265]
apt to be correct than if each feeding was made separately.

The baby’s nipple should be made of plain black rubber.
It should not be too thick because it is necessary to turn
it inside out in order to clean it thoroughly. The hole
in the nipple should not be too large—if the child can
empty the bottle in less time than fifteen minutes the
hole is too large. If the milk drops out but does not
run it is about right. Don’t buy nipples too long or
too large. A long nipple tends to gag the child and cause
vomiting. A large nipple prevents the child from sucking
properly and usually allows the food to be taken too
quickly and with air, which causes colic and indigestion.
It is well to have always half a dozen nipples of the right
kind on hand. When new, nipples should be boiled before
using. After each feeding the nipple should be
washed in borax and water on both sides, then it should
be put in a dish containing fresh, cold, borax water and
left there until again required. A large portion of the
success of raising healthy, bottle-fed babies is in being
everlastingly clean in the details of caring for the bottles
and nipples which are in daily use.

Should a Mother Put Her Baby on Artificial Food
if Her Supply of Milk, During the First Two Weeks,
is Not Quite Enough to Satisfy It?—This is a question
that cannot be answered by a simple yes or no. A great
deal depends upon circumstances, and these circumstances
must be weighed and counterweighed before an answer
is given. It is a serious matter, in our judgment it is a
criminal proceeding for a physician to advise the use of
an artificial food without exhausting every aid and
means to preserve and increase the mother’s milk. This
is a subject in need of earnest missionaries in all walks
of life, and it should be the duty of every woman’s club
and gathering to voice the conviction of the highest
womanhood by advocating the use of mother’s milk with
every child born. A woman who can and will not nurse
her own child is scarcely deserving of the name of
mother.

It does not seem quite human to deprive a baby of the
milk which rightfully belongs to it; yet in certain walks
of life this is not an uncommon procedure. On the other[Pg 266]
hand the percentage of women able to nurse their children
is decreasing. This is especially true as applied to
cities, though it is also true, in a less degree, in the rural
districts. One eminent authority states that less than
twenty-five per cent. of the well-to-do mothers, who have
earnestly and intelligently attempted to nurse their babies,
succeed in doing so for a period longer than three months.
This authority also says: “An intellectual city mother
who is able to nurse her child successfully for the entire
first year is almost a phenomenon.” Women nowadays
have so many diversified interests, that the primal duty of
maternal nursing is not at all a fashionable function. If,
however, the mother is willing, and has conscientiously
tried to nurse her baby, and after seven or eight days it is
found that she has not enough milk to satisfy it, and if the
quality seems to be good, some expedient should be immediately
adopted to tide the condition over until the
mother resumes her customary household routine. The
safest expedient under these circumstances is to alternate
the feedings; one feeding from both breasts of the
mother, and the next an artificial food. Some arrangement
of this kind is the just and the safest way, because a
very large percentage of mothers suffer from inactivity
while lying in bed after a confinement. This inactivity
expresses itself in a failure of some of the organs to
perform their duty properly. This may affect the quantity,
and sometimes the quality, of the milk, but it is, as a
rule, quickly rectified as soon as the mother is up and
active.

If, however, the milk is still found to be inadequate
after she is up and has resumed her usual habits, and if
her health is good, and she is eating well, it is distinctly
best to put the child exclusively on an artificial diet.

CERTAIN CONDITIONS JUSTIFY THE ADOPTION
OF ARTIFICIAL FEEDING FROM
THE BEGINNING

1st. Woman suffering with any wasting disease such a
cancer or tuberculosis. (One of these days, and very
soon we hope, it will be legally impossible for a tubercular
or cancerous patient to become a mother.)[Pg 267]

2nd. When a mother is the victim of any of the serious
childbed complications such as convulsions, kidney
disease, extensive loss of blood or blood poisoning, or
runs a high temperature because of some disease occurring
at the same time as the confinement, as, for example,
appendicitis, scarlet fever, typhoid fever, etc.

3rd. Epilepsy, chorea, insanity, are also conditions
which render artificial feeding necessary.

It is much wiser immediately to put the child on
artificial feeding if there is a justifiable reason for it than
to experiment, because any experiment at this time is
almost certain not to be in favor of the child. Artificial
feeding is a comparatively easy and successful problem,
provided it is begun with healthy digestive organs. If
you keep the child at the breast of a mother whose milk
is inadequate in quantity or quality, or both, for two or
three days, and then begin artificial feeding, the child’s
stomach is already unable to perform its duty, and you
have to treat it with the greatest degree of care and attention,
and probably begin with a weak food, until you
regain the lost ground.

Mothers’ Mistakes in the Preparation of Artificial
Food.—Another interesting condition which is quite common,
is the tendency on the part of the mother to fail to
follow instructions correctly,—even though written or
printed,—regarding the preparation of the baby’s food.
When the baby is not thriving and gaining steadily in
weight, or is fretty and cries a good deal, and does not
rest and sleep peacefully, something, of course, is wrong.
If, after a careful physical examination of the child,
nothing is found to justify these symptoms, a physician
invariably finds, if he questions the mother closely, that
she has mistaken the instructions and is preparing the
food wrongly.

Infinite care in every little detail is the price of success
in raising babies as well as in every other field of human
endeavor. Revise carefully your method of preparing
baby’s food if there is any trouble such as is described
above. Despite your absolute assurance that you are
making no mistake, do not be surprised to find that you
are not following directions to the letter, and because of[Pg 268]
this unintentional mistake, your negligence is responsible
for your baby’s condition. Go over the instructions with
your husband, and let him follow your method of preparation,
as you repeat it. He may detect the mistake if any
exists,—two heads are always better than one. So important
is this matter that the following two actual cases
will demonstrate how easy it is to make a mistake, despite
the absolute confidence of the mother, in each case, that
she was following the printed directions correctly:

I was called to see a baby whose mother informed me
that it was having a great deal of trouble. It was apparently
not thriving; its bowels were bad; it constantly
cried, and seemed to be suffering from colic and indigestion.
The mother stated that it lay with its legs
constantly drawn up and passed enormous quantities of
gas. The baby certainly looked sick. It had been a small
baby at birth; and at three months it weighed only six
pounds. After a careful examination, I could find nothing
in the physical condition of the child itself, which
satisfactorily explained the condition, and had made up
my mind that the food upon which it was being exclusively
fed, and upon which it had been fed since birth,
was not agreeing with it. Before recommending a change
of food, I asked the mother to state in detail just how
she prepared it.

The directions printed on the can in which the food
was bought called for so many ounces of a certain quality
of “top milk.” She thought this meant simply so many
ounces off the top of a bottle of milk, which, of course,
meant that she was feeding her baby exclusively a very
rich cream and absolutely no milk. The result was that
the baby—small and weak to begin with—could not
digest this rich mixture, so it gradually lost vitality, as
the mother kept increasing the strength of the food, according
to the age, as directed by the instructions, until
it was completely knocked out. I pointed out her mistake
and suggested a change in her methods; she was instructed
to use the formula for a child of two months,
instead of the one for three months, as she was doing.
The child immediately began to pick up and in the course
of six weeks was entirely cured, and had gained considerably[Pg 269]
in weight. This mother was a careful, clean,
painstaking, attentive nurse, and it was a long time before
she forgave herself for the mistake. The mistake here was
a little matter, but the results were big and convincing.

The second case was that of a child of about the same
age, but in this instance it had been a robust, healthy
child when born, and of normal weight and size. The
mother nursed it for about one month, when her milk
failed, and it was put upon a well-known, patent barley
preparation. The food seemed to agree with it for a
time, but, as the mother explained, the child soon seemed
to be dissatisfied at each feeding,—it gave her the impression
that it was not getting enough to eat, so she
increased the quantity. Despite this increase of food, it
was apparent that the baby was getting weaker, and
more and more irritable, and sleepless, until there was
no rest night or day for the mother or baby. About this
time the child began to “swell up” as if dropsical; it lost
its healthy color and looked as if made of wax. It was
very evident that the child was being starved, yet this
scarcely seemed probable when the actual quantity of
food consumed was considered. The directions on the
can of this food, called for a certain amount of the barley
powder to be mixed with boiled water; and in an additional
paragraph it was directed to mix this with a
certain amount of milk. When I requested the mother to
state how she prepared the food, I was astonished to
learn that she had evidently never read the second
paragraph of the directions. She was feeding her baby
on barley powder and boiled water,—an excellent starvation
diet. When her attention was called to the grave
carelessness she had been guilty of, she was the most
contrite mother I ever knew. As soon as the milk was
added to the food the baby immediately began to thrive
was very soon a robust, healthy infant.

Of course these were errors of bad judgment and
gross negligence of which few mothers would be guilty,
but these types of mistakes come to the attention of
physicians frequently, and emphasize the need of constant
vigilance in every detail in the management of babies if
we wish to achieve success.[Pg 270]

FEEDING DURING THE SECOND YEAR

At the beginning of the second year the child should
be fed at the following hours, 6 and 10 a. m., 2, 6, and
10 p. m.

Early in the second year the child should be taught
to drink from a cup.

A proper diet for a child of twelve months, of average
development, would be as follows:

6 a. m. Milk and barley water, or milk and oat gruel,
in the proportion of seven ounces of milk to three ounces
of the diluent.

9 a. m. The juice of an orange (strained).

10 a. m. The same as at 6 a. m.

2 p. m. Chicken broth with rice or stale bread crumbs,
six ounces; or a light boiled egg mixed with stale bread
crumbs; or beef juice, three ounces. Milk and gruel
same as at 6 a. m., but four ounces only.

6 p. m. Two tablespoonfuls of cereal jelly in eight
ounces of milk; a piece of stale bread and butter. (The
jelly is made by cooking the cereal for three hours the
day before it is wanted; it should then be strained through
a colander; oatmeal, barley, or wheat may be used.)

10 p. m. Same as at 6 a. m.

About the fifteenth month the cereals may be given
much thicker and fed with a spoon. The child can at
this time take a number of various fruit juices. Orange
juice is the best. Carefully strained juice of ripe peaches,
strawberries, raspberries, may be given in reasonable
amounts, one or two tablespoonfuls, once daily. Custard,
cornstarch, plain rice pudding, junket, wheatena, cornmeal,
hominy, oatmeal, zwieback, bran biscuit, each with
butter, may be added in reasonable quantities between
the eighteenth and twenty-fourth months. When cereals
are given they should be thoroughly cooked, usually for
three hours, and strained. When apple sauce is given to
a child about the second year it should contain very little
sugar and baked apples should be fed without cream.
Water must be given to the child between meals especially
during the summer. It should be boiled and cooled
kept in a cool place. The following schedule for a child
about the third year constitutes a good average diet for
a healthy child:

TABLE OF STANDARDS

(As Adopted and Copyrighted by the American Medical Society)

PHYSICAL DEVELOPMENT

[Transcriber’s Note: The ages were difficult to read and may not all be correct.]

MENTAL DEVELOPMENT

[Pg 271]

Breakfast:—(7 to 8 o’clock) Oatmeal, hominy or
cracked wheat (cooked three hours), served with milk,
a little salt but very little sugar. A soft egg, boiled,
poached, or coddled. Stale bread and butter. One glass
of warm milk. At 10 o’clock, the juice of one orange.

Dinner:—(12 o’clock) Strained soup, four ounces.
Chop, roast beef, steak, chicken, small quantity of any
one. Baked potato and cooked rice, or spaghetti. A
selection of green vegetables may be made from asparagus
tips, string beans, peas, spinach, cauliflower, carrots;
they should be cooked until very soft, and mashed or put
through a sieve. For dessert, plain rice pudding or bread
pudding, stewed prunes, baked or stewed apple, junket,
custard or cornstarch. A glass of milk or water.

Supper:—(6 o’clock) Cereal; farina, arrowroot, cream
of wheat, wheatena (each cooked two hours), with salt
but no sugar. Give two or three tablespoonfuls. Drink
of milk with stale bread and butter. Twice a week,
a little plain ice cream, or junket, custard or cornstarch.

Three meals a day at this time are better than more
frequent feedings. The child has a better appetite and
much better digestion. It may be found necessary to
give delicate children a luncheon at 3 o’clock. A glass
of milk and a Graham wafer, or a cup of broth and a
zwieback, will answer the purpose. Children recovering
from serious illness will need more frequent nourishment.
Up to the sixth year the diet may conform to the above
schedule, increasing the individual quantities as circumstances
may warrant.

THE DIET OF OLDER CHILDREN (FROM SIX TO
TEN YEARS)

After the sixth year the diet will conform to the adult
diet, with certain exceptions. The important exceptions
are as follows: All meats are to be excluded except roast
beef, steak, lamb chops, roast lamb, mutton chop; all
meats should be cooked rare and either scraped or finely[Pg 272]
divided. They should be broiled or roasted, never fried,
and never given oftener than once daily, and then only in
small quantity. Pies, rich puddings, pastries of all kinds,
gravies, sauces, all highly seasoned dishes; wine, beer,
coffee, tea, should never be given to children. Ham,
bacon, sausage, pork, liver, kidney, game, and all dried
and salted meats, codfish, mackerel and halibut, are
particularly bad.

The following articles are permissible: Broiled
chicken, shad, bass. The “platter gravy” from a roast
is very nourishing if given in small amounts. Milk
should continue to form an important part of the dietary
up to the tenth year. It should be clean and fresh but
not too rich. Sometimes it is found advisable to dilute
the milk with water that has been boiled and cooled.
Some children will take it if a pinch of salt or bicarbonate
of soda is put into it, and they will digest it
easier and better. They should never be allowed to take
more than one quart daily and frequently less will do
more good. Cream is not good for children of this
age. Eggs are valuable; they should never be given
fried or in the form of omelets, they are best given
boiled, poached or coddled and only slightly cooked. It
is never necessary to give more than one egg at a meal.
There are children with whom eggs do not agree; these
children are disposed to “biliousness.”

Vegetables.—Certain vegetables are objectionable at
this age: Raw celery, radishes, raw onions, cucumbers,
tomatoes, lettuce, corn, lima beans, cabbage, egg plant.
The following are good: White potatoes (never fried),
spinach, peas, asparagus tips, string beans,
celery, young beets, carrots, squash, turnips, boiled
onions and cauliflower. It is important to remember
that all vegetables should be thoroughly cooked; they
cannot be cooked too much. After boiling for some
time the water should be drained off and fresh water
used to complete cooking. Vegetables should be fed
in small quantities. From the third to the tenth year
they form an important and essential part of the diet
of all children. After the tenth year they can be eaten
as served to adults, and other vegetables may then be[Pg 273]
added. As a rule salads of all kinds should be omitted
until after the twelfth year.

Cereals.—Children should not be allowed to eat too
much cereal at one meal,—never more than one small
saucerful. Cereals should be properly cooked. It is
not safe to adhere strictly to the directions on the package
of any cereal. As a rule they require much longer
cooking. They are best cooked in a double boiler. They
may be served with milk, salt, and not more than one
teaspoonful of sugar.

Bread.—Fresh bread is never allowable. Graham
wafers, oatmeal crackers, Huntley and Palmer breakfast
biscuits, bran muffins, rye bread, corn bread, stale
rolls, are all suitable to growing children.

Hot bread, fresh rolls, buckwheat or griddle cakes,
all sweet cakes, are objectionable.

Desserts.—The only permissible desserts for this age
are junket, custards, plain rice, or sago; or bread pudding.
The only safe rule to follow so far as “sweet
things” are concerned, is not to give them at all. This
applies to candy, ice cream, pies, pastries, jam, syrups,
preserved fruits, nuts and dried fruits. The parent who
indulges a child to “a taste,” is guilty of a bad habit,
and it can only lead to trouble.

Fruits.—These should always be fresh and selected
with care. Fruit is the most important article of diet
to a child of this age. Up to five years it is safest to
use only cooked fruits and fresh fruit juices: of these
the juice from sweet oranges, grape fruit, peaches, strawberries,
and raspberries may be given. Stewed or baked
apples, apple sauce, figs, prunes, peaches, apricots, pears
are excellent because of their effect on the bowels. When
the bowels are loose, and especially in hot weather, great
care must be taken when fruit of any kind is used. The
pulp of any fruit should never be used; cherries, bananas,
pineapples, and berries are not to be given to children.
Milk should never be allowed at the same meal when sour
fruit is served.

WHAT MOTHERS SHOULD KNOW

[Pg 277]

CHAPTER XXI

Joseph H. Choate.

THE EDUCATION OF THE MOTHER

WHAT MOTHERS SHOULD KNOW ABOUT THE
CARE OF CHILDREN DURING ILLNESS

Every child has a certain amount of vitality and resistance.
When illness comes it should be our duty to
maintain the vitality and resistance to the highest degree.
We should, therefore, irrespective of the nature of the
illness, surround the child with all the conditions that
will minister to the preservation of whatever strength and
vitality the child has. Experience has taught us that there
are certain requirements that should be carried out in
the general management of sick children.

A Sick Child Should be in Bed.—In the first place a
sick child should be in bed. There is no exception to[Pg 278]
this rule. It is impossible to do justice to a child if
you allow him to dissipate his strength and exhaust himself
moving from place to place while he is sick. A
mother should not forget that it is she who must exercise
wisdom and decide what is best for her child. The
judgment of a sick person is not to be relied upon, and
it would be wrong to submit to the whims and fancies
of an ailing child, if these are known to be medically
disadvantageous to its best interests.

Quiet surroundings are essential in all acute illnesses.
The nurse should be congenial to the child. If the
patient demands the presence of the mother she should
remain, but she should not try to entertain him or interfere
with the nurse.

The clothing of the patient should be the ordinary
night-dress which is worn in health. In no disease is
any special kind, or quantity of clothing required.

The temperature of the room should be 68° F. Thermometers
are cheap and an exact knowledge of the degree
of heat in a sickroom is an essential requisite. Nothing
drains the vitality during sickness quicker than varying
degrees of heat and cold. It uses up nerve force and
energy and renders the patient irritable and difficult to
manage.

The strictest attention should be paid to the ventilation
of the sickroom. We are learning more and more
that fresh air is essential to the speedy cure of all diseases
and to the general well-being of the patient. A direct,
continuous communication between the sickroom and out-of-doors
is imperative. It is a splendid measure to use
two rooms for the patient and to change him twice daily,
and to air thoroughly the unused room.

The sickroom itself should be large and in a quiet
part of the house. In summer time the windows may
be wide open, in winter months the degree of ventilation
can be regulated by the thermometer.

Many mothers fail to appreciate that drinking water
is an important requisite in all ailments of childhood,
should be given freely, but it should be known to be
absolutely pure. The same rule applies to sponging the
patient. It must be done every day; sometimes it is[Pg 279]
necessary to do it more often, but if so it will be so
directed by the attending physician.

The Diet of the Sick Child.—Prescribing the diet of
the sick child is an important undertaking. It should
be remembered that during sickness the digestive capacity
is reduced; consequently the food must be lessened
in quantity and in strength. If the patient is an
infant at breast the best way to accomplish our purpose
is to give before each feeding two ounces of boiled water,
cooled to the temperature of the body. This dilutes the
mother’s milk and renders it more easy of digestion. If
bottle-fed, it is accomplished by replacing one-half of
the milk with water. In certain diseases milk is totally
withdrawn, but these cases will be noted when discussing
the treatment of the various diseases. With older children,
we give milk diluted with water, or gruels, soups,
or cereals, as conditions warrant.

Needless interference with the patient must not be indulged
in. Sleep and quiet are essential features of
nature’s reparative process. It is seldom necessary to
disturb a sick child for the giving of food or medicine
oftener than every second or third hour. Medicine may
always be given with food. Meddlesome interference,
talkative attendants, or excessive noise may exhaust a
child and may prolong and render dangerous or fatal
a condition that would otherwise go on to recovery.

One satisfactory movement of the bowel daily is essential
to the comfort and progress of a sick person. If this
does not take place naturally, it should be obtained by
an enema.

At the beginning of any illness in childhood it is a
safe procedure to give a dose of a suitable cathartic as
soon as it is discovered that the child is sick.

A Child is the Most Helpless Living Thing.—Nature
endows the young of every species—except those
of the human family—with certain instincts, which, when
developed, govern and control their lives absolutely. The
technical definition of an instinct is an exceedingly complicated
word picture. It is only essential to an intelligent
understanding of our subject that the reader should
have a definite idea of the difference between an act that[Pg 280]
is the result of a process of reasoning and an act that is
the result of an instinct. If a man finds his way out
of his burning home he will stay out as long as there
is any danger. The crudest kind of reasoning will teach
this lesson. A horse, on the other hand—and incidentally
it may be noted that a horse is regarded as an intelligent
animal—if led out of a burning stable and let loose,
will immediately reënter and be burned to death. The
horse is the victim of instinct; he obeys the unconquerable
instinct to return to his stall—he cannot reason
as the man can that a home that is burning is not a
proper place to seek safety in. When an ostrich fears
danger he buries his head in the sand, under the impression
that if his head is out of sight he is safe from
danger. This is his instinctive plan of procedure in the
presence of danger, and it is the plan of every ostrich,
everywhere, always. A little reasoning would show them
how foolish the idea is—but they cannot reason. That
is the province of man alone. If the first member of a
flock of sheep jumps over a fence to get into the next
field, every member of the flock will follow, each one
jumping the fence, though there may be an open gate
between the two fields a few yards away. Instinct dictates
the plan to the sheep as they have received instructions
from their ancestors always to “follow the lead.”
This is their hereditary legacy and they cannot disobey
it.

Animals are born with instincts which need only circumstances
to bring them out. Now a baby is not born
with instincts of this character,—it has not even the instinct
to help itself; it cannot find the breasts that were
made for it; it is more helpless than the baby cat or dog
or worm. Therefore a baby in whose brain the potential
faculty of reason is slumbering must of necessity begin
its career wholly dependent upon the supervision and
love of its mother, until such time as it may be capable
of reasoning for itself. Motherhood is therefore the
supreme privilege of womanhood. It cannot be superseded,
hence the fundamental factor in any system of race
culture, or in any system of infant mortality, must tend
to raise the quality and the intelligence of motherhood[Pg 281]
as a basic necessity. Motherhood at the present time,
though the most important and sacred profession in
the world, is almost exclusively carried on by unskilled
labor. The maternal instinct is deeply rooted and universal;
its absence must be regarded as an abnormality,
or as a product of misdirected education. The requisites
for the mothers of the future should be absolute physical
health and love of children.

If nature endowed a baby with instincts there would
be no need for reason or education. Education cannot
teach a cat how to nurse or wash a kitten any better
than it does,—its instinct is good enough. The mother
of a human baby, however, is not born with the instinct
which enables her to care for her baby equally as well
as the cat cares for her kitten. She must be educated
or taught to care for it. She can then care for it better
than the cat cares for the kitten, and she can be taught
to bake, to sew, to read; to play on the piano, which a cat
cannot be taught. So while a baby may be the most
helpless living thing at one stage of its career it has in
it—in the faculty of reasoning—the ability to become the
Lord of all the Earth and of all the animals therein.
To limit the environment of a child by imposing instincts
upon it, would be to limit its inherent freedom.
To be obliged to obey a prescribed instinctive law would
rob mankind of his creative or reasoning faculty, and
that would be to lower him to the level of the brute creation.
Reason is of no use if our acts are already determined
for us. There are therefore good reasons why
the human baby should be, at the moment of its birth,
the most helpless living thing; and as a consequence
it is imperative, if the eugenic ideal is worthy of attainment,
that every baby should have the benefit of
trained and efficient care and education.

THE DELICATE CHILD

There is a certain standard by which we measure the
physical and mental development of children. This standard
we regard as the evidence of normal development.
Some children exceed these requirements; they[Pg 282]
are bigger and stronger at a given age than the average
child at the same age. There are other children who
cannot be called sick, but who are physically and mentally
inferior to the average standard, whom we designate
as “delicate.” These children are not as big, or
as strong, or as heavy, as other children of the same
age. They are born with a reduced vitality, or through
mismanagement in early infancy they have acquired a
subnormal standard of development. Children born of
parents who are not of standard vitality are predisposed
to be delicate. If the parents are of average development,
and the delicacy of the child is acquired by mismanagement,
the proper dietetic and hygienic management
will, as a rule, promptly result in a satisfactory
restoration to normal health.

Treatment.—When a mother awakes to the knowledge
that her child is delicate; when she understands that
her child’s vitality is not what it should be, and when
she resolves to “do something” in the interest of her
child, she is on the right road, and we hope to encourage
her in the good intention. We would however
tell her that her effort must be thorough, and that she
must be patient and persevering. If she does not falter
in well doing she will succeed beyond her expectation,
and the satisfaction she will experience in noting the
evidences of returning health and strength in the appearance
and conduct of her child, should be ample recompense
for the effort made and the time bestowed.

She must begin with a definite knowledge of just what
she intends doing; she must know, however, what must
be done and she must begin at the beginning and build
from a sure foundation. It is therefore absolutely essential
to ascertain if there is any actual disease underlying
the reduced vitality which is responsible for the delicacy
of the child; this necessitates a thorough examination by
a competent physician. If you are assured there is no
disease present, no tuberculosis, no syphilis, no malaria,
and that debilitating conditions, such as adenoids, sexual
abnormalities, the results of self-abuse, skin disease, do
not exist, then certain fixed rules can be laid down, and
definite principles followed in the daily management.[Pg 283]

Weight, as a Standard of Development.—It has been
stated elsewhere in this book that one of the safest
guides to follow, as to whether a child is thriving, is
its weight. This can be relied upon as a general rule.
A child should therefore be weighed regularly every
week. If it is not gaining an average of four ounces
weekly it is not thriving up to standard. When the
average is below four ounces there is something wrong
with the quality or quantity of the food.

How to Feed the Delicate Child.—If the child is
breast-fed and the weight standard, as evidenced by the
weekly averages, is persistently below normal, we must
find a substitute for the mother’s milk. If the child is
bottle-fed and it is demonstrated that it is impossible to
maintain normal development on cow’s milk, a wet-nurse
should be obtained. After the child is weaned, or put
upon a more liberal diet, milk should continue to be the
chief article of diet. From the first to the third year a
child should take one quart of milk daily in addition to
the other food. There are some children, however, who
seemingly cannot take milk without getting indigestion;
they should be put on skimmed milk, to which may be
added a small quantity of sugar to make up for the loss
of fat. Mothers must be certain that too much milk is
not given, or the desire for other necessary food will
diminish.

After the first year it is a very good plan to give one
teaspoonful of scraped beef daily. If this is well borne,
two may be given and later three. It can be given immediately
before the regular feeding of cereal and milk.
From the twelfth to the sixteenth month eggs may be
given: at first one-half, and later a whole egg mixed
with bread crumbs. Various vegetables should also be
given cooked in the form of a purée. If at any time the
child should refuse the food, or act as if it had no appetite,
leave the milk out of the diet; this may then restore
the appetite and it will take the other food freely; the
milk can be resumed later.

As the child grows older, the distaste for milk may
grow, or he may be one of those children with whom
milk really does not agree; in either event, do not hesitate[Pg 284]
to leave it out of the child’s dietary. These children
should be encouraged to eat plenty of good butter on their
bread and crackers. Butter will not only agree with
them, but it will supply any fat deficiency in the general
diet. The diet may now consist of milk (unless it disagrees),
cereals cooked three hours, raw or rare meat,
poultry, eggs, vegetables, purées, cooked and raw fruit,
bread, crackers.

How to Bathe the Delicate Child.—Regular daily
baths are particularly of benefit to the delicate child,
despite the prevailing fear that they may catch cold.
The salt bath is advised and the time to take it is just
before retiring. The room should be warm and the temperature
of the water should be 90° F.: it should not
last longer than five minutes, and the water should be
cooled down to 70° F., before the child is removed from
the bath. While the cold water is running in, the surface
of the body should be briskly rubbed with the
mother’s hands and after removal the child should be
dried with a fairly coarse bath towel to ensure a good
reaction. Very delicate children need not have the temperature
of the water reduced; others may stand water
of 80° F., but no lower. In the poorly nourished it is
frequently advantageous to rub the body, after drying,
with olive oil or goose oil. This aids nutrition and because
of the massage it aids circulation. In some older
children a daily cold spinal douche seems to act particularly
well. If the child does not promptly react from
the effect of the cold water it is best to discontinue it.

Airing the Delicate Child.—Delicate children should,
above all things, be assured of the maximum amount
of fresh air and sunlight. Many mothers entertain the
idea that these children are disposed to take cold easily,
if in the open air,—which is not the case. All children
need an abundance of fresh air and the delicate need it
particularly. The season of the year and the character
of the weather will, of course, dictate just how much
open-air exercise they may take.

If the weather is very cold and the air damp, or if
there is a very cold high wind, it is best to remain indoors;
otherwise the child should remain out for four[Pg 285]
or five hours. Indoor airing is obtained by dressing
the child to go out-doors, putting him in his carriage,
and leaving him before an open window in a room of
good size with all the doors closed so as not to create a
draught.

Habits of the Delicate Child.—The amount of sleep
necessary for a delicate child is the same as for a normal
child of the same age. The room should always be well
aired, night and day, and should be devoted to the exclusive
use of the child.

These children should never be allowed to sit on the
floor. It is always a difficult matter to avoid this, but
it must be religiously guarded against; otherwise a cold
is the inevitable result.

A change of air is sometimes advisable and essential,
especially during the hot, humid weather of July and
August. Much better results will be obtained by sending
these children to the mountains than to the seashore.

Delicate children should always be clothed warmly,
but not too warmly. The feet and legs must always be
kept comfortable. Moderate exercise, short of fatigue,
is necessary. A midday nap after the noon meal should
be taken every day. The child should be undressed and
put to bed for two hours and left there, whether it sleeps
or not. This applies to delicate children of all ages.

The education of delicate children should be postponed
until the health is restored. They should, however, be
made to obey and they should be taught good habits.
When school work begins it should be made light and
easy. They should not go to school before the eighth
year, and then not unless physically fit. They should
not play at rough games or with rough companions,
though it is not wise to shield them too much. Their
habits and peculiarities should be studied and every possible
effort made to direct them kindly and wisely so
that they may contribute to their own upbuilding.

A systematic observance of these suggestions will save
many lives and will aid very considerably in producing
stronger men and women. Infinite patience, tact and
self-sacrifice is necessary, but the results in every case
justify the measures adopted.[Pg 286]

Indiscriminate Feeding: Poor Appetite.—In considering
many of the diseases of childhood the term “indiscriminate
feeding” is used. An explanation of just what
is meant by this will be of decided advantage. There
are two fundamental essentials in the successful feeding
of infants and children: regularity and suitable food.

A child whose feeding intervals are not regular and
whose food is unsuitable is a victim of indiscriminate
feeding.

The lack of observance of the regularity rule always
leads to loss of appetite and indigestion.

Loss of appetite is a serious condition in a growing
child and may give infinite trouble. Indigestion in a
growing child is unnecessary, unfortunate, and frequently
is the one factor that spoils an entire life. It
is unnecessary, because it means and is caused by neglect
on the part of the mother; it is unfortunate, because it
always paves the way for any serious ailment that is
epidemic or “in the air”; and it is important, because it
very frequently weakens the stomach and renders it
unfit for normal digestion for a long period, if not for
life.

If for some reason a child’s appetite becomes poor
and it is not properly managed until the appetite is restored
to normal, indiscriminate feeding is always the
result.

The reason for the poor appetite may be because the
child is kept indoors too long, or because it is being
fed on unsuitable food, or is living in unsanitary surroundings,
or many other reasons, sometimes trifling
reasons, may cause it. When a child will not eat at
meal time, the mother feels that it should eat sometime,
so she encourages it to eat between meals, and because
of a mistaken kindness she breaks the law of regularity,—a
law that can never be broken without serious results
following. A child in this condition becomes a disturber
of the peace; the parents can do nothing with him;
he insists on eating just what he likes and when he
likes; and he chooses, as a rule, candy, cake, pastries,
ice cream, tea, coffee. Indigestion follows, the child loses
weight, is languid and listless and constipated.[Pg 287]

When finally the physician is called in he finds it
necessary to go back to first principles. He lays down
the law in a definite, stern way, and the mother and the
child must obey. Most parents know and admit they
are doing wrong to give in to a whimsical child, and
if they would only make up their minds to conquer when
conquering is easy they would save themselves many
heartaches, many regrets, and the child much suffering
and much possible permanent injury as a consequence.
Usually one parent is willing to be master but the other
lacks the mental equipment to meet the issue, and argues,
as he or she imagines, in favor of the child. The parent
whose instinct is correct, whose judgment is true, whose
interpretation of the situation is just, should not be dissuaded,
or argued away from his or her duty. If it is
the first real problem in your domestic experience in
which a decided stand must be made, make it without
fear and without hesitation, and carry it through to the
bitter end. Results will justify and vindicate you.

The general treatment of these children will be found
outlined in the following paragraph on Loss of Appetite.

Loss of Appetite.—If a child complains of not being
hungry, and will not take enough food, and if this condition
continues for some time, we must regard the
matter as being abnormal and find the cause. This is
necessary because a child must eat in order to maintain
a certain standard of growth and vitality. These children
are not sick; they are active and continue to play
as usual and they sleep soundly, but they have no appetite.
One of the most frequent causes of this condition
is too frequent feedings. Some children are naturally
small eaters. They thrive and maintain a satisfactory
weight; their system seems not to demand large quantities
or even ordinary quantities of food. Parents observe
this habit of little eating and begin to coax and
bribe the child to eat more at meal time, and to eat
between meals. In this way the child really overeats,
the appetite becomes capricious, and the stomach rebels.
In a very short time the condition of “loss of appetite”
is established as a consequence. Another cause is the[Pg 288]
drinking of too much milk, and yet another and very
common cause is indiscriminate eating of candy, cakes
crackers, and fruit between meals. Children who are
fed at the table with adults eat things they should not
eat, and spoil their digestive organs and loss of appetite
is the result. The Scotch custom of compelling children
to eat at a separate table is an excellent one. They
are not tempted to ask for things they cannot have. Lack
of fresh air and exercise frequently results in impaired
appetite.

Treatment.—The very first thing to do with these children
is to stop any habit that may be responsible for
the loss of appetite. If the child has been eating between
meals, stop it absolutely. If too much milk has
been taken, stop milk entirely. If the child has not
been getting enough fresh air, or if it has been sleeping
in a badly ventilated room, or if baths have been too infrequent,
rectify the fault. If eating at the family table
and fed indiscriminately, change the programme; feed
him before the family sits down to meals. Now regulate
the time of feeding to suit the age of the child and
adhere to strict regularity. It is a pernicious and absolutely
wrong custom to force children to eat, or to
coax them to eat when they do not want to eat. Loss
of appetite will never be cured by forced feeding, or
by reducing the interval between feedings, or by giving
the child stronger or more concentrated food under
the mistaken idea that in this way the loss of appetite
can be “made up.” The interval of feeding should rather
be lengthened than otherwise in order to give the digestive
organs an opportunity to regain the normal desire
for food. Pay strict attention to the bowels. Be certain
the child has a daily satisfactory movement and that he
drinks frequently between meals.

If the child does not promptly respond to the proper
hygienic and dietary treatment as outlined above there
are two things that can be done:

1st: Send the child away. A change of scene and
climate will sometimes work like a charm in these cases,
and will, after a reasonable length of time, establish a
permanently good appetite.[Pg 289]

2nd: If this is not possible, as sometimes it may not
be with poor patients, then we can give the child suitable
tonics.

Overeating.—The large majority of individuals eat
too much. Most of us would enjoy better health, better
spirits, and greater efficiency if we consumed from one-third
to one-half less food than we habitually do.

Every living organism requires a certain amount of
nourishment according to the work performed and to
replenish wear and tear; when food is supplied in excess,
the system cannot utilize it, but it is compelled to rid
itself of the excess in some way. The work involved
in this eliminating process is exceedingly detrimental to
the various organs and to the individual. To overeat
is to overwork, and to overwork a machine or an animal
is not only poor economy but bad judgment. If the
digestive apparatus is required to work overtime, it is
a self-evident assumption that the various organs will
not digest efficiently the food necessary for ordinary existence.
If the necessary nourishment is not adequately
digested, the general health will suffer as a consequence.
If the general health is below standard the individual will
not be competent to carry on the requirements of a normal,
healthy life.

We must, however, give some thought to the effect
which the excess of food exerts upon the human machine.

Nature provides and maintains a standard relationship
between the capacity of the individual and his needs.
A child has a digestive capacity to digest and assimilate
a quantity of food sufficient for his growth and proper
nourishment; an adult maintains the same standard according
to his requirements. All the other organs are
adjusted to harmonize with this scheme. If we overeat,
the immediate result is to disorganize this relationship
between the various organs; hence we have a multitude
of effects which manifest themselves in various ways
as a direct result of overeating. The combined general
effect expresses itself in the form of what is regarded
as poor health and a low standard of efficiency. When a
larger quantity of food is taken into the stomach than[Pg 290]
it can properly digest within a reasonable time, two
conditions immediately follow. The stomach itself is
dilated and the food is not thoroughly digested. If the
habit is persisted in, indigestion, and later chronic gastritis
ensues. The direct symptoms of these conditions
are given in detail in another part of this book. Very
few individuals, however, appreciate the indirect consequences
of overeating and of indiscriminate eating on
the general health. It is impossible to tabulate in so
many words the effect which this habit has on efficiency
and temperament. We read and hear a great deal to-day
about efficiency. Now, an individual’s efficiency
is an expression of that individual’s health standard or
capacity. To be 100 per cent. efficient one must enjoy
good health. It would be absurd to expect a high standard
of efficiency from an individual with a low standard
of health. Poor health means poor vitality. Vitality
is the mark of the master. Without vitality one can
never dominate. All the great achievements of the race
have been consummated by those who conserved their
vitality. No single factor contributes a larger percentage
of inefficients and failures than overeating. The man
or woman who, from habit or experience, has learned the
lesson of right eating and living need not be lacking in
efficiency, nor need they despair of the attainment of
success.

Symptoms of Overeating.—Efficiency depends not
only upon one’s capacity to perform, but upon the character
of the performance. The spirit must be willing
to perform. The overeater is heavy, phlegmatic, indifferent,
lacking in energy, tact and initiative. She is constantly
subjecting her system to needless overwork;
she is depressed, nervous, imaginative and she is not
ambitious. She is a victim of self-poisoning, of constipation,
indigestion, headaches, flatulency, neuralgia, vertigo,
and melancholia. An overeater never enjoys good
health, never is efficient, and cannot possibly be successful.

To enjoy good health one should know how to select
food and how to combine and proportion it. It has been
said that the American people are a race of dyspeptics,[Pg 291]
and it must be admitted that the assertion is more or less
true. There are millions of people who suffer from
indigestion in some degree, and it may justly be said
that indigestion has its beginning in overeating, in some
form. It may not be overeating in actual bulk, but it
is overeating some article or articles that do not agree
with the individual, and the fact that certain articles
do not agree is unquestionably dependent upon the
nervous temperament of the American people—and the
temperament of a people is a product of the kind of
existence the people subject themselves to. We are,
therefore, unwittingly, victims of our environment.

Correct eating means simple eating—only a few things
at a time. Food should be selected according to one’s
age and occupation, and according to the season of the
year. To eat habitually large quantities and at the same
time a large variety is suicide pure and simple. If one
dared to make the experiment of cutting down one’s diet
one-half, it is absolutely certain the effect would be immediate
benefit. The benefit would not only be manifest
in the physical betterment, but the efficiency and general
well-being would be greatly enhanced. It is not
the kind of food that makes a dyspeptic, but the quantity.
A well person need not consider whether a certain kind
of food will or will not agree, providing she does not
eat too freely of that food, or combine it with other food.
The combination of which may in itself form too much
of one kind at a time.

Some people imagine, for example, that oatmeal porridge
does not agree with them. When the matter is
inquired into, however, it is found that they habitually
eat bread, eggs, and other articles, with coffee at the
the same meal with the porridge. From this combination
they experience distress and blame the porridge. If these
would take a plate of oatmeal porridge with
cream and salt, and some stewed fruit for breakfast
they would not experience any trouble, and this would
be an ample meal for the ordinary individual. It is not
the porridge, but the unsuitable combination, that is at
fault. The same may be said of milk. Many people state
that they cannot take milk and they deprive themselves[Pg 292]
of one of the very best articles of diet because of this
idea. There are very few people in the world who cannot
take milk in some way. It is not the milk that is
at fault; it is the combination of it with other less nutritious
articles that is the cause of the distress. Even
candy is responsible for thousands of cases of indigestion.
Anyone may safely take a reasonable quantity of good
candy, but if it is taken at a wrong time, or combined
with other articles, it may readily produce indigestion.

Indiscriminate eating and overeating are prolific causes
of rheumatism, kidney disease, heart disease, liver
troubles, obesity, arteriosclerosis, and apoplexy. These
diseases are notoriously on the increase and must be
construed as a direct consequence of the tendency of the
American people to overeat and to eat indiscriminately.

Bran as a Food.—In the chapter on constipation there
may be found a formula for making bran muffins. These
muffins are invaluable to children in health, and to the
victim of indigestion or constipation, whether child or
adult. One muffin with each meal will solve the problem
of constipation in growing children without the use
of drugs or other aid. They will regulate the bowels
of adults in many instances without resorting to drugs.

Raw fruit in season, or stewed fruit, or a baked apple,
with a light boiled egg and one bran muffin, is an ample
and a nourishing breakfast for a child at school.

For lunch the same child should have a plate of thoroughly
done vegetable soup, a bran muffin, and more
fruit. After school, a glass of milk with two or three
Graham wafers may be given.

For dinner the child at school may have a mixed meal.
This meal should not be later than six-thirty o’clock
and the child should retire at eight-thirty at the latest.
A bran muffin should be taken with this meal unless the
child’s bowels are too loose.

Mothers should insist on their children eating these
muffins. If a child eats only what it likes it will not
eat what is good for it. If the mother insists in the right
way she will win; if she does not the child will win.
If the child wins, the mother is the wrong kind of mother.
I do not know of any other single article of diet that[Pg 293]
is of such value to growing children as these bran muffins.
Children who eat them regularly will have less sickness
than other children; they will be strong, healthy and full
of energy. The bran in itself is not responsible for this
list of excellent acquirements, but the regular eating of
the bran is. Most ailments of children are of gastro-intestinal
origin; bran keeps the entire length of the
gastro-intestinal tract sweet and clean; if the child eats
a bran muffin with each meal it will not have much desire
or much room for any other form of bread or pastry.
If white bread or pastry is abstained from the child
will not have indigestion, or constipation, and hence it
will not be constantly poisoning itself as most children
do whose diet is not restricted and whose bowels are
more or less constipated.

These muffins should be made of the ordinary unsifted
bran. If this is not procurable the sifted bran (Johnstone’s)
may be employed. This bran may be bought in
any good grocery.

Modern milling methods, modern cookery, and modern
methods of forced farming, have each contributed their
share of rendering food inert and frequently deleterious.
The miller has extracted the coarse cellulose from the
various flours in the effort to manufacture a product
suitable to the super-civilized public demand. This cellulose
is absolutely essential to gastric and intestinal
digestion, and if children are deprived of it constipation
and indigestion are the natural result. Forced farming
accomplishes the same effect—the fiber of the vegetable
is deficient. Bran is rich in mineral salts, iron, protein,
and phosphates, and gives to growing children the ingredients
which ordinary food is deficient in. Bran
prevents intestinal fermentation and children who eat
it are free from intestinal gas and putrefaction. It harmonizes
chemically with all other foods. Children
should be made to take it every day as a matter of self-preservation
and of duty.

Hysterical Children.—Hysteria is not a disease of infancy
or of young children. It is seen as a rule after
the eight year. Male as well as female children may
be the victims to an equal degree. It is much more[Pg 294]
frequently seen in the offspring of parents who are
themselves nervous, or alcoholic, or who suffer from
insanity, or have insanity in the family history. If these
children in addition to the hereditary influence suffer
from stomach or intestinal disease, or general poor health
and are overworked at school, they are very apt to become
hysterical.

They are capricious, indifferent, and excitable. Their
disposition is irritable; they frequently exhibit fits of
great excitability of temper and passion. They cry or
weep without cause. They often have hallucinations and
while asleep have attacks resembling night terrors. They
complain of pains in the joints, and are frequently treated
for disease that does not exist. Such condition as hysterical
cough, spasm of the muscles of the face, mouth,
eyes, and of the neck exist and are difficult to diagnose
from real disease. These children complain of painful
sensations and sensitive areas and exaggerate all symptoms
unnecessarily.

The possibility of curing these patients is good, providing
the treatment is faithfully carried out. It is less
favorable when marked hereditary influences are strong.

Treatment.—In all children of distinctly nervous type
and especially those of nervous parents, the first essential
duty is to develop their muscular system. Try in
every way to make healthy animals of them. Attention
and treatment should not be directed toward the nervous
system. If the child is made strong by out-door life,
good plain, digestible food, early hours, regular sleep
in thoroughly aired rooms, regular bathing, and if the
school work is conducted with moderation and judgment,
the nerves and the nervous temperament will participate
in the healthy growth which will follow as a
result. Tea and coffee should be forbidden. Exciting
books and questionable entertainment as given in picture
shows and theaters must not be allowed. If older members
of the family, or parents, are excitable and nervous
the children should be sent away to the country from
them.

They should be put in charge of a person who will
exercise firm control over them. It may be necessary[Pg 295]
to take these patients away from other children, and isolate
them under proper control until they are able to
control themselves. They should be interested in exercise
that compels them to work; they should live and if convenient
sleep out of doors; and they should take iron or
cod liver oil, or any other indicated tonic. If they complain
of pain they should receive cold-water douches, or
the cold pack, or the shower bath; and they should be
put to bed and treated firmly but kindly. Attention to
the bowels is always essential, because these children
are as a rule the victims of chronic constipation.

What a Mother Should Know About Cathartics and
How to Give a Child a Dose of Castor Oil.—Broadly
speaking there are three kinds of cathartics. I
will, in a simple way, explain their action so that a
mother may know which one to select under certain circumstances.
Frequently a mother is told by her physician
to “keep the bowels of her child open.” Few
mothers know how to keep the bowels open, and as this
is an important matter, every mother should know the
reason why “any” laxative or cathartic is not always
suitable.

Castor Oil.—This is one of the oldest and one of the
best cathartics we possess for children. It is a mechanical
cathartic; it acts in exactly the same way as a street-cleaning
machine. It cleans the street by sweeping or
pushing everything before it.

Calomel—This is a chemical cathartic. It acts through
the blood. When it is absorbed by the blood its chemical
ingredients act on certain nerves as irritants. These
nerves excite the liver and bowel to action and an evacuation
is the result.

Citrate of Magnesia.—This is a saline laxative. It
acts by drawing out of the bowel wall enough liquid
from the blood to sweep the contents out. It may be
likened to the street cleaner who flushes and cleans the
street by means of a hose pipe attached to the water
hydrant.

Under what condition should a mother use these remedies?
Castor oil is ordinarily the best cathartic in childhood;
it is not, however, always the best. Most ailments[Pg 296]
of children are of gastro-intestinal origin—they have
either overeaten or they have eaten the wrong kind of
food. The stomach and bowel are overloaded: they must
be cleaned out. We want a mechanical cathartic, one
that will push everything ahead of it, so we use castor
oil. When a child needs a cleaning out, use castor oil.
By a “cleaning out” we mean, when we know he has
eaten too much of a questionable variety of food, as pastries,
cakes, fruit, ice cream, etc., as children do at parties;
or when he has eaten unripe fruit, as green apples, etc.;
or when for some reason he is constipated and complains
of not feeling well, use castor oil.

If you decide to use castor oil, use enough. A large
dose will act promptly and with less pain and with more
certain results than a small dose.

It is always safe and it is always best to decide upon
castor oil as the proper remedy, if the child has no fever.
If he has a fever he will most likely vomit castor oil
when another kind of cathartic would stay on the stomach.

Castor oil works more effectively, more thoroughly,
and is less likely to be vomited if given on an empty
stomach, so we give it two hours after eating and we
give no food for two hours after it is taken.

Castor oil is distinctly of advantage in many chronic
diseases of the intestines because of its healing properties.
In chronic colitis, for example, when the child is suffering
with malnutrition, irregular bowel action with an
odor, and mucous or bloody stools, a combination of
castor oil and salol, in emulsion, in small doses,—to which
a small quantity of opium may be added or withheld
according to the frequency of the movements,—with an
occasional colon irrigation, is sometimes invaluable.

Mothers must remember that castor oil is not good
in the treatment of constipation, because its after effect
is to constipate, consequently we would not use it “to
keep the bowels open,”—it is only of use to clean the
bowel out thoroughly when that is indicated.

How to Give a Dose of Castor Oil—The best way to
give a child castor oil is as follows: Place the bottle
containing the oil on its side on a piece of ice in the ice
box; chill it thoroughly. Take a tablespoon and smear[Pg 297]
it with butter; pour the ice cold oil into the spoon; it
will stick together like a piece of chewing gum and
it will slide out of the buttered spoon in one lump.
In this way it will not spread over the mouth and teeth
and throat, leaving a bad taste, but will go straight and
surely into the stomach. The child cannot swallow some
and retain enough in the mouth to sputter it all over itself
and only get half a dose; it will not nauseate it, because it
practically is tasteless if given cold, and the stomach will
tolerate the cold oil much better than when given in the
ordinary way.

A baby can be given oil in the same way, but in smaller
doses. When the teaspoon is put into the mouth of a baby
it should be immediately turned on its side so that it will
keep the mouth open. If the nose is held closed and the
mouth wide open for a few seconds the baby cannot spit
the oil out—it must swallow, and if the oil sticks together
as cold oil will, it gets the whole dose. It usually takes
two persons to give a baby a dose of oil—one to open the
mouth and give the medicine, the other to hold the nose
and arms.

Calomel.—The general indication for calomel is fever.
When a child develops a disease it immediately gets a
temperature, and very frequently the fever is quite high
because the slightest ailment gives a child fever. When
fever begins, digestion practically stops, it is therefore
imperative to clean the whole gastro-intestinal canal;
otherwise the undigested material will putrefy and poison
the entire system and render the disease more serious
than it need be.

Now we select in such conditions calomel for two
reasons:

First, because the presence of fever indicates that infection
of the blood is taking place; this may come either
from the intestinal canal itself, or from the germs of the
disease with which the child is suffering. Since calomel
acts chemically through the blood it is the cathartic
indicated.

Second, because a cathartic like castor oil does not
act through the blood and it would most likely be vomited
by a fevered stomach.[Pg 298]

Certain conditions indicate calomel; biliousness and
jaundice, for example, because it has a specific action
on the liver and if the liver is at fault calomel is the
proper remedy.

Calomel is best given in small divided doses, 1-10 of
a grain every half hour, for ten doses. It is best given
combined with soda; every drug store carries tablets of
calomel and soda for this reason.

Calomel should never be given in the treatment of
constipation, nor should it be used indiscriminately by
mothers, as much harm may result. It has its specific
use as indicated above, but it should never be used
under any other circumstances.

Citrate of Magnesia.—This is a mild laxative. After
the bowels have been thoroughly opened with castor oil
or calomel, small doses of citrate of magnesia may be
given for a few days, “to keep the bowels open.” There
is no danger or harm in its use if used for this purpose.
It must not be used, however, in the treatment of constipation
of children for the simple reason that you cannot
cure constipation by the use of drugs of any kind.
Laxatives of this type have become a national curse.
Adults, especially women, use them constantly. All
these advertised saline laxative waters work by weakening
the blood—when a dose is taken the chemicals in it
draw through the bowel wall blood serum, and produce,
because of the excess of this watery fluid, large, and
frequently many, liquid movements.

If this practice is continued, as it often is every day,
the quality of the blood will suffer seriously, and many
individuals are the victims of neuralgic pains, headaches,
nervousness, insomnia, anemia, and general broken health
as a direct consequence of this pernicious habit.

Mothers will try to remember, therefore, that drugs
and saline waters have no place in the treatment of
constipation in children or themselves. Constipation must
be treated by diet, exercise regular living and by the
observance of hygienic and sanitary common-sense
rules.[Pg 299]

VACCINATION

Time for Vaccination.—The best time to vaccinate a
child is during the first three months if he is healthy.
The reason for selecting so early a period is because
the constitutional disturbances are much less at this time
than in later childhood. It should not be done during
active dentition. If the child is delicate if his nutrition
is bad it should be deferred until a later time. Children
suffering from eczema or from any skin disease or those
syphilitic should not be vaccinated until it is compulsory,
or until exposed to small-pox.

Methods of Vaccinating.—It is customary in America
to vaccinate at one point rather than to make a number
of inoculations as is the custom in some other countries.
The leg or the arm is the usual location selected. In
infants the sore can be protected better on the leg; in
children of the run-about age, the arm is the better location
because it can be kept at rest easier.

Before vaccinating the skin should be rendered surgically
clean; this can be done by washing with soap and
water, drying and then rubbing with alcohol. The wound
should be left uncovered for about twenty minutes to
dry, it may then be covered with a bandage, or with a
vaccine shield. The part should not be washed for
twenty-four hours.

The Symptoms of Successful Vaccination.—Nothing
is noticed until the third or fourth day, when a red
papule appears. In the course of the following day a
vesicle appears; this vesicle enlarges until it reaches its
full development on the ninth day. The size of the vesicle
is about one-half inch in diameter; it is surrounded with
a reddish inflammatory area for about two inches. The
vesicle begins to dry and is shortly a dark crust which
remains from one to three weeks and then falls off.
It leaves a bluish scar which soon turns white and the
part is roughened and honeycombed. During the period
when the vaccination is at its height the child suffers
from fever and irritability and loss of appetite.

If vaccination does not “take” in an infant it should
be done two or three times and if then unsuccessful it[Pg 300]
should be repeated every year until it takes. The fact
that vaccination does not take does not imply that the
child would not take small-pox but rather that the vaccine
used is not suitable. There are some children, however,
who seem to be immune to vaccination.

Sometimes the symptoms are more severe than those
enumerated; this seems to depend upon the susceptibility
of the child. The vesicle may be much larger and the
area of inflammation much more dense and angry. The
fever may be higher and may last longer; there may be
a general rash and the degree of depression more profound.
Vesicles may be produced on other parts of the
body as a result of scratching. Mothers must always
remember that vaccination is a surgical wound to begin
with and that it is capable of infection in the same way
as are other wounds, and that any result coming from
such an infection is not due to the vaccine or to the
process of vaccination, but to the infection. Many people
get unjust ideas about vaccination from just such cases.
If the mother is not cleanly or neglects the vaccinated
area and permits it to become infected she must not
and others should not decry vaccination as a consequence.
Anyone who doubts the virtue of vaccination is condemning
himself; he is simply ignorant of the accumulation
of evidence in favor of it and assumes a position
without any possible justification. The mortality of vaccination
is stated by Voigt from statistics to be 35 in
2,275,000 cases. In fact, all the deaths are from causes
which are preventable and no doubt the result of direct
carelessness on the part of the operator or the mother.

Treatment.—The mother must understand in what
way she may contribute to the successful termination of
a case of vaccination. She should see that the part upon
which the child is to be vaccinated is absolutely clean
so far as she can make it with soap and water. She
should see that the part is allowed to dry thoroughly
after vaccination. She should not wash the part for at
least twenty-four hours. If a vaccine shield is put on
she should not disturb it. If the mother is prepared
to do her part faithfully a vaccine shield is not necessary
from a medical standpoint and in some cases it is[Pg 301]
objectionable. A simple, clean bandage is all that is necessary.
It is very important that the child be kept from
scratching the part; most of the troubles of vaccination
come from this habit. It is desirable that the limb
should be kept at rest during the stage when the process
is at its height. If the vesicle discharges it is necessary
that the area should be kept clean and dusted with boracic
acid. If the wound becomes infected it must be treated
by a physician. The mother must not resort to home
remedies in such cases unless she is prepared to take the
consequences, which may be serious.

[Pg 303]

CHAPTER XXII

CONSTIPATION IN INFANTS AND CHILDREN

CONSTIPATION. REGULARITY OF BOWEL
FUNCTION

The most frequent cause of ill health and inefficiency
in the human race is inattention to regulation of the bowel
function. Good health depends upon many causes of
which good blood is an absolutely necessary requisite.
Good blood depends upon what feeds and sustains it.
There are other contributing factors, such as the proper
kind of exercise, the proper amount and quality of fresh
air, the method of living, etc., but these are all food
in a sense. The food we take in is acted upon by the
various digestive juices until everything is extracted from
it that contributes to the building up of the body. Whatever
is left, whatever the body does not want, is immediately,
or within a reasonable time, passed out in the
form of a movement of the bowels.

If any part of the digestive function is deficient, impaired
health, or mental and physical inefficiency expressed
in the form of indigestion, is the result. If[Pg 304]
the bowel is at fault, constipation is the usual consequence.
A perfectly healthy living machine must maintain
a perfect digestion and regular bowel movements.

The Function of the Stomach is to mix and churn
the food, and to add certain ingredients to the mixture
so that before it is carried into the intestines it is (as
far as it is the stomach’s duty to render it) ready to be
absorbed into the system. Before it reaches that part
of the intestine which absorbs, it is acted upon again and
certain other ingredients are added to it by certain other
digestive organs. In time it is in shape to be used and
it is sent along on its way. As it passes onward the little
sucking glands in the wall of the bowel suck up all the
liquid element in the mass of food. The liquid element in
the mass is the food itself, rendered liquid by the stomach
and other digestive organs and juices. The remaining
solid mass is that part of the food which the body cannot
use and does not want. By the time the liquid element
is absorbed, the solid mass (always kept moving
by the bowel wall) has reached the rectum, ready to be
passed out at once, or very soon, provided—and upon
this provision depends the success of the entire process,—it
has all been done within a certain time. If the stomach
takes too long to do its work we have indigestion. If
the bowel takes too long to do its work we have constipation.

Fermentation.—Now let us consider the matter from
another standpoint. If food stays too long in the stomach
it begins to ferment. When anything ferments it makes
and evolves gas. You, no doubt, have noticed many
times how the cork pops out of a bottle if its contents
are “working,” or fermenting. If you watch that bottle
you will notice that it is quietly or actively evolving air
bubbles. That is gas,—gas manufactured by the process
of fermentation. This is exactly the process that goes on
in the stomach or bowel of a dyspeptic, and it is this collection
of foul, poisonous gas that causes the distress and
bloated feeling which every dyspeptic suffers from after
eating,—if it is this “flatulent” type of indigestion which
is present.

The Significance of Constipation.—If the food takes[Pg 305]
too long to pass through the bowel it causes, as we have
stated, constipation. What is the real significance of
constipation? It means that in passing through the bowel
the food has given up all its liquid element (which is all
its nourishing element), but the bowel has been too slow
in passing it along. Consequently it is not ready to be
expelled while it is yet a harmless semi-solid mass. It
stays in the bowel too long—it begins to putrefy, bacteria
attack it, and it is soon a semi-liquid, foul, rotting mass.
The sucking glands in the intestinal wall continue to
suck—that is their duty. They cannot discriminate between
what is good and what is bad—they simply go on
absorbing whatever is there to absorb. So there are
absorbed into the system liquid and gaseous products
which are poison.

This process has been called by a number of names;
“self-poisoning” explains the condition thoroughly. The
other names are, auto-infection, auto-intoxication, enteric-infection,
enteric-toxemia, intestinal indigestion.

The condition is a serious one, because it is absolutely
impossible to feel well, or to enjoy good health, while it
lasts. The feeling of being constantly sick, yet not sick
enough to stop working or to demand a radical cure, affects
a woman’s efficiency, interferes with her capacity
to work, her ability to render the home an abode of contentment,
to be an agreeable companion, or to adequately
take care of her children.

The constant absorption of intestinal poisons affects
the system itself,—the symptoms are headache, neuralgia,
loss of appetite, nervousness, insomnia, vertigo, inability
to concentrate, lassitude, indigestion. The condition
which we name constipation is therefore one of supreme
importance. From a medical standpoint, it is the biggest
problem in the whole realm of disease. It is the most
significant hygienic function of life, and it is becoming
more and more important, and more and more a problem.
Every modern factor upon which physical efficiency seems
to depend is an enemy to the systematic regulation of
this function. Our method of hurried and indiscriminate
eating, our system of strenuous living, our unsanitary environment,
our business activity, our method of pursuing[Pg 306]
pleasure, take no account of, and resent the time devoted
to cultivating, as a hygienic necessity, this toilet requirement.
This imperative call of nature is pushed aside by
the child at play, by the housewife for a duty which could
wait, by the merchant for an engagement. It is particularly
an American disease, and it is uniquely an American
woman’s affliction. It is a curious commentary on the
intelligence of the American people, who are ordinarily
alert and analytical, to realize how few of them really
know how serious a matter constipation is. They don’t
know because they have given the matter absolutely no
thought. They have accepted it as a mere matter of
fact, almost of fate.

Incomplete Constipation.—There is a type of constipation
that is not known to the average person and not
well understood by those few who know of its existence.
In this form of constipation there is a daily bowel movement
but the movement is not complete. The bowel does
not thoroughly empty itself; it has established this habit
because of conditions under which it has had to do its
work. If a woman neglects herself, becomes muscularly
inactive, does not take proper out-door exercise, grows fat
and lazy, eats irregularly and indiscriminately,—the bowel
suffers with the rest of the system. The woman may
have a healthy appetite, may eat the wrong things at
the wrong time, yet the bowel is supposed to go on acting
rightly, but it does not. It, too, becomes lazy and acquires
bad habits, and this form of incomplete constipation
is the result. These patients look healthy and get
little sympathy for any pains they may have. They may
even gain in weight; they get headaches once in a while,
and if they go shopping or visiting they don’t feel quite
well afterward. They are suffering from the effects of
chronic constipation, though their bowels are apparently
regular. They are marching onward toward apoplexy
or Bright’s disease of the kidney.

Importance of a Clean Bowel.—Every mother, sooner
or later, observes that a physician always thoroughly
cleans out the bowel of a sick child at once, no matter
what the character of the sickness is. He does this for
two reasons,—first, because he knows that the great[Pg 307]
majority of children’s ailments are of gastro-intestinal
origin; second, if the origin of the disease is not in the
stomach or bowels, experience has taught him that if
the bowels are clean at the beginning of a disease, that
disease will run a milder and shorter course than if
complicated with a condition of self-poisoning. If a
child develops fever the digestive function stops; whatever
food is in the stomach or bowel will promptly
ferment and putrefy because of the abnormal heat caused
by the fever and the arrested digestion. If this is not
cleaned out at once the self-poisoning process begins.

The above is a suggestive admission for a physician
to make. It simply means that the vast majority of the
calls made by a physician on ailing children are caused
by errors in diet and can be completely cured by a dose of
castor oil or calomel, or, better still, need never occur.

A mother who neglects, who is guilty of inattention to
the conditions of her child’s bowel, fails in one of the
most important duties of motherhood. I know as a father
and a physician that if a child’s bowel acts regularly and
thoroughly, that child is fortified to the highest efficient
degree against the multitude of little ailments common
to all children. A clean bowel means good blood, good
digestion, ability to exercise properly, to sleep soundly
and to think clearly. Such a child will resist infection
and throw off the minor troubles that pave the way for
serious sickness. It is a secret worth knowing.

A Daily Movement of the Bowel Necessary.—In
order to preserve good health one thorough movement of
the bowel is necessary daily. A baby may have two or
three and enjoy robust health. A larger daily number
suggests an abnormal condition of the bowel and an investigation
should be made. If a nursing baby’s bowels
do not move before bedtime it should be given an injection
of equal parts of glycerine and hot water, one-half
cupful; or an enema of soap and water, or a glycerine
suppository. When a child is six months old, in some
sooner, it should be put on the stool at a certain time
every morning. This will aid in the establishment of the
habit, as a child soon understands why it is made to assume
this position and acts accordingly.[Pg 308]

The condition referred to above and which we termed
incomplete constipation may affect the nursing infant.
A child’s bowels may move daily and yet the child will
suffer from constipation. If the movements are watched
it will be observed that certain children strain when at
stool, and after a time succeed in passing hard, dry lumps
or balls of fecal matter. Such a movement is a certain
indication that the bowel is not emptying itself satisfactorily
and that a constant toxemia or poisoning is
going on. Very faithful efforts should be made to
remedy this condition by the use of articles of diet that
are known to be laxative, otherwise the condition is one
that will “grow” with the child and establish an obstinate
chronic constipation with all its miseries and dangers.

Constipation in Breast-Fed Infants.—Many nursing
infants thrive and gain in weight, yet they are constipated.
Before you drug your baby be sure the fault is not your
own. Many mothers are responsible for the constipation
with which baby suffers. If the mother is constipated,
so will the child be. Cure the constipation of the mother
and the baby’s bowels will regulate themselves. Nursing
mothers who are large tea-drinkers have irregular bowels
as a rule. A baby whose mother is lazy or indolent, who
does not take a reasonable amount of exercise, whose diet
is faulty and whose hours are bad, is a sufferer from
constipation. The mother’s life must be regulated, her
diet and habits corrected, and the instructions carried out
as already recommended. The breast milk should
be examined and if any cause for constipation exists in
it, it should be rectified as suggested elsewhere.

If it is thought advisable to resort to drugs for the
immediate relief of the constipation of infants, the best
ones are the aromatic fluid extract of cascara sagrada;
milk of magnesia with equal parts of the aromatic syrup
of rhubarb given in doses of one to three teaspoonfuls
daily.

Irrigations, enemas, and suppositories should not be
used continuously. The habit is a bad one. The parts
become accustomed to their use and fail to act. If
the child is passing dry and hard stools it is of advantage
to inject two ounces of warm sweet oil at night, allowing[Pg 309]
it to remain in the bowel until the following morning.
See page 312.

Constipation in Bottle-Fed Infants.—It is much
easier to treat the constipation of bottle-fed babies than
of those breast-fed, because the food can be changed to
ensure regular bowel movements. The first change to
be made in a bottle-fed baby who is habitually constipated
is to add more cream to the food. The way to do
this is to take out of the bottle of each feeding one tablespoonful
of the food and put in its place one tablespoonful
pure cream. If this change partly rectifies the bowel
ailment, add more cream until the bowels are of the
proper consistency. Milk given constipated babies should
be raw, never boiled, as boiled milk will always aggravate
the trouble.

The use of oatmeal water instead of plain water in
making the baby’s food may cure the bowel trouble.
Taking the sugar of milk out of the baby’s food and
putting in its place the same quantity of Mellin’s food
will sometimes cure the constipation.

One or two teaspoonfuls of milk of magnesia put into
one feeding daily, or fifteen drops to one tablespoonful
of the aromatic fluid extract of cascara sagrada will move
the bowels. Orange juice, strained, two teaspoonfuls
twice daily, is an excellent remedy and should be tried
in every case. Sweet oil and pure cod liver oil, in doses
of thirty drops to two teaspoonfuls three times daily
after feedings, if the little patient is poorly nourished.
If the stools remain hard and dry, an injection of two
ounces of warm sweet oil at bedtime is an excellent
method of aiding the bowel. The oil should remain in
the bowel all night. This lubricates the parts, softens
the fecal mass and stimulates the gut to perform its own
work. See page 312.

Constipation in Children Over Two Years of Age.—Most
children when put upon a varied diet after the
nursing days are over are relieved of any constipation
which may have existed up to that time. There are a
few, however, whose condition does not seem to improve.
These children need attention. We should first insist
on regular habits. A child should be told that its[Pg 310]
bowels must move every morning after breakfast. If
this is absolutely insisted upon the child will soon recognize
the uselessness of fighting the proposition and
submit. If at any time a conscientious effort is made
to move the bowel without result after fifteen minutes
it is wise to use a glycerine suppository so that the bowel
will empty itself.

It has been stated in another part of this book that
there are children with whom milk does not agree. Experience
has taught us that milk, especially milk that
has been boiled, causes more cases of constipation in
growing children than all other causes combined. Find
out if it is milk that is the cause in any individual case.
While these children cannot take whole milk just as
it comes from the dairy without suffering in a great
many ways, they can take milk and water, or milk and
oatmeal water, prepared in the following way, without
becoming constipated. A bottle of fresh milk is allowed
to stand in a cool place for five hours, when the
top ten ounces are skimmed off with a Chapin dipper
and mixed with twelve ounces of oatmeal gruel or plain
water. This can be used as a drink.

Parents can select from the following list of articles
such combinations as may be suitable to constitute the
regular meals of a constipated child:

Malted milk is agreeable and advisable as a drink.

Orange juice or a scraped raw apple is allowable
at this time. Constipated children should eat plenty[Pg 311]
of good butter. Olive oil, two or three teaspoonfuls
after each meal, is excellent. It can be kept up for
months to advantage. Older children may eat raw and
cooked fruits, figs, dates, baked potatoes, poultry, and
fish. One or two raw apples or a peach or orange may
be given daily. A strict observance of the above rules
and diet will result in normal movements of the bowel
if persisted in for a reasonable time. It may be necessary
occasionally to use a suppository or an enema now
and again until the habit is established.

In children from five to fifteen years of age the use
of bran muffins, with fruit, etc., as described above, will
effect a cure of constipation without having to resort
to drugs. I have cured many cases of constipation in
growing children with these muffins without making
any other change in their diet or habits.

RECIPE FOR BRAN MUFFINS

Drugs may be of temporary service in some cases.
A pill of cascara sagrada is the best for this purpose.
It should not be continued for more than two weeks.
Castor oil, calomel, and other frequently-used cathartics
should never be used in simple constipation.

TREATMENT OF OBSTINATE CONSTIPATION

There are cases that resist treatment of the kind described
above. Diet and drugs do not succeed in establishing[Pg 312]
the habit of daily bowel movements. In these
cases radical treatment is imperative. The diet should
be the same as that described above, but it will be found
advisable to cut out milk altogether. Cereals can be
taken with sugar and butter instead of milk. The oil
injection plan of Professor Kerley has given me excellent
results. I quote his comments upon and method
of giving it:—

“Oil Injections.”—”For this purpose a soft-bulb
syringe of four ounces’ capacity is ordered. Over the
hard rubber tip is place a small sized adult rectal tube
or a No. 18 American catheter. The catheter or tube
is cut so that but nine inches remain for use. The cut
end is forced over the small, hard rubber tip of the
syringe. A fountain syringe is impracticable for this
purpose, as it is soon destroyed by the oil and rendered
unfit for use. Besides, sufficient pressure is not produced
to force the oil into the gut even with a high
elevation of the bag. The child is placed on his back
or on his left side. The syringe is filled with oil, the
tube is lubricated, and passed through the rectum as
far as it can go. When it has been passed to the full
nine inches, as may readily be done with a little practice,
the syringe is emptied and the tube withdrawn.
The injection should be given after the child has been
placed in bed for the night. It is our object to have
the oil retained during the night. If a passage of the
bowels is produced at the time, or if the oil leaks out during
the night, a small quantity should be used. In some
of my patients I have been able to use but one ounce.
In very few, indeed, does it cause an evacuation at the
time. If there is a tendency to leakage a napkin should
be worn to avoid soiling the bed-linen. The following
morning after breakfast, the child is placed on the vessel
and kept there until a bowel movement results or until
fifteen minutes have elapsed. In a great many cases
if the constipation has been obstinate for months, the
bowel will be at once evacuated. When this does not
occur in fifteen minutes, a glycerine suppository is inserted,
which invariably produces an evacuation. This
use of the suppository, according to my observation,[Pg 313]
can usually be dispensed with in a very few days; the
use of the oil, however, may have to be continued for
several weeks. When the child has had the oil nightly
and an evacuation the next morning without assistance
for two weeks, I direct that the oil be omitted for a
night and the effect noted. If the usual passage occurs
after breakfast, the oil is given for five nights and then
omitted. If the case progresses satisfactorily the use
of the oil is gradually omitted, being given at first every
second night, then every third, fourth, or fifth night, etc.
A considerable number of cases have been completely
relieved in two months. In the event of no passage
following the omission of the oil, its use is continued
for two weeks longer, when it is again omitted for a
night.” To illustrate this point the following case is
cited.

“Illustrative Case.—A boy three years of age had
never had a bowel evacuation without drugs, soap enemas,
or suppositories since birth, and finally these were no
longer effective. The mother, thoroughly frightened,
brought the child to me. Eight months of diet and the
use of the oil were required before he was entirely well.
It is now three months since the local treatment was
discontinued and the bowel function remains normal.

“The diet with the absence of milk must be continued
for months after the patient is apparently well, and
he must not be allowed to pass a single morning without
an evacuation at the usual time. In assuming the
management of one of these cases I explain to the
mother or nurse that the treatment is not pleasant for
the child or the attendant, and that it may have to be
persisted in for weeks, and unless she is willing to carry
it out to the end, it would better not be undertaken.
I assure her, however, that with her coöperation, which
is usually readily given, the child will make a complete
recovery. Cases that are slow in responding to treatment,
I usually give the additional advantage of abdominal
massage from twenty minutes to one-half hour,
before the child is placed at stool. The massage should
practiced by one skilled in the work.

“The above local measures apply particularly to children[Pg 314]
after the eighteenth month. They may be used
earlier, however, following out the diet along the lines
laid down for bottle-fed children who suffer from constipation.
In very young children a smaller amount of
oil should be used, never more than two ounces, usually
one ounce is all that is required. When the oil treatment
is under way, whatever the age of the patient,
laxative drugs should not be given.”

[Pg 315]

CHAPTER XXIII

CONSTIPATION IN WOMEN

It has been stated that constipation is almost universal
among the women of America. It is a fact that very
few American women enjoy, to a reasonable degree, a
permanently satisfactory bowel condition. Constipation
is an acquired habit and unquestionably negligence is
the primary and the chief cause of it. The negligence,
no doubt, begins at a very early age; it is at least an
established habit before any intelligent, consecutive effort
is made to remedy it. Inasmuch as women are the mothers
of the race, and as their part in the scheme of life is
the supreme one; and as constipation has been shown to
be a serious, far-reaching, significant disease, a very sincere
and persistent crusade should be made to educate
women as to its importance. For a less altruistic purpose,
tremendous popular movements have been carried
to success. For a less service rendered to the race names
have achieved renown. In addition to the symptoms
stated in the preceding paper, the condition which we
now desire to emphasize is the effect of the constant
self-poisoning on the general health and its effect upon a
woman’s reproductive efficiency.

The poison being constantly absorbed, means general
bad health, bad health to a degree depending upon the
degree of constipation which is the cause of the poisoning.
It may be simply that the woman does not wholly
enjoy good health, or that she is completely incapacitated[Pg 316]
because of chronic bad health, or any degree of indifferent
health between these two extremes.

If the degree of poison is sufficient to cause habitual
poor health, its effect upon the blood must be bad, and
the effect of the bad blood upon the nervous system and
the other vital organs cannot be good. Now if this
process has been going on for many years, the condition
of the woman, who is its victim, as an efficient machine,
compared with the woman in whom this condition never
did exist, must be very different indeed. This condition
of affairs—inasmuch as constipation is so common in
women—must have a tremendous significance when estimating
the vitality and efficiency of the coming generation.

We might go much further and yet be sure of our
position, and maintain that it is this national autotoxemia,
this scourge of womanhood, that is to a great extent responsible
for the characteristic American “vice of neurasthenia,”
and of the domestic infelicity and unhappiness
which are so common in the large cities of this country.
If we add to the intestinal autotoxemia of constipation,
the tendency to, or vice of, indiscriminate eating and
drinking—of which the American people are particularly
guilty—we would be on firmer ground. In fact we
would feel that we had pointed out the one underlying
cause of most of the domestic irritability prevalent to-day,
which is of serious importance, and which is, fortunately,
capable of correction. It is a matter of everlasting
and continuous education.

The Requirements of Good Health.—There are certain
fundamental basic requirements which are essential
to good health: fresh air, good water, a reasonable amount
of physical and mental exercise, nutritious food, freedom
from unnecessary and unreasonable worry, frequent bathing,
and a daily movement of the bowels. The reason
why constipation is of such serious importance is because
it is the only basic requirement of good health that
afflicts a large majority of the race at the same time.
The health of so many is being undermined by this one
affliction, that it dominates all other factors that have
any bearing upon posterity. A woman may enjoy all[Pg 317]
the essential conditions necessary to good health, yet
she may be constipated, and the presence of this condition
will undermine, in her constitution, all the benefits
she derives from her advantageous environments. It
will do more; it will be responsible for the disposition,—the
temperament,—of that woman. The natural disposition
of that woman may be an amicable one; if it were
allowed to express itself naturally it would be kind,
gentle, considerate, affectionate. No woman, however,
the victim of chronic constipation, can preserve an equable
temperament or an amicable disposition. It is impossible—with
her nerves being constantly poisoned—that she
can hold the symptoms of that condition in abeyance.
She must be irritable and nervous and sick of herself
and everything and everybody. The home as a direct
result suffers; its atmosphere is not one of contentment
and peace and affection. Constipation, therefore, blights
the home and the influence of one blighted home may
have a far-reaching effect on the story of the human race.
It is responsible also for that woman’s mental attitude
outside the home. Instead of exerting an optimistic influence,
her whole existence is a message of pessimism
and discouragement. Multiply these influences and messages
to correspond with the prevalence of the disease
and we have a condition that is tremendously significant,
a condition that is really a pressing economic issue. A
constipated woman is an anti-eugenist—a eugenic
atrocity.

We have no desire to create a false impression or to
build up a foolish fear. Are we justified in regarding
this as one of the most important, if not the most important,
disease condition; the most menacing physical
vice, which the human race has to combat? Let us
offer the following brief facts in witness of our stand:

The Cost of Constipation.—It has been estimated that
consumption (the great white plague) kills one-tenth
of all the human race. Cancer kills half as many, or
one in every twenty. Constipation, and the diseases
which are caused directly by it, kills one in every three
of all the people on the civilized globe.

Constipation has been responsible for the expenditure[Pg 318]
of millions of dollars in advertising in the newspapers
alone,—more, probably, than has been spent in advertising
remedies for all other diseases combined. Do
you suppose this money was a donation? Do you suppose
these keen, alert interpreters of the spirit of the
times, the up-to-date business men, were not and are
not aware that constipation is the “universal disease”?

Every drug store, in every civilized spot on earth, has
its shelves loaded down with constipation remedies; dinner
pills, liver pills, cathartic pills, tablets in all possible
coatings and combinations, mineral waters from a multitude
of springs, aperient drinks by the dozen, laxative
teas and cordials, cathartic oils and emulsions. If the
demand for these articles should cease most of the drug
stores would close up.

Many millions of dollars have been made and are
being made by various men and concerns, who have
devised ingenious mechanical agencies which are supposed
to cure, and in curing renew the lost health caused
by constipation. We have in mind in this connection,
a man who conceived the ingenious plan of putting the
opening of an ordinary fountain syringe in the middle
instead of at the end and made a fortune out of it.
In this opening he places an upright nozzle, and instead
of hanging the bag up and allowing the water to run
into the bowel, he has the patient sit on the bag and
thereby the water is forced into the bowel. He has written
a two-hundred page book on the advantages of
this idea, and his “literature” contains the names of
famous men and women in all walks of life who use
his device. The name of one of the famous judges of
the Supreme Court of the United States was there;
another was the name of a popular operatic beauty who
writes for the daily press little essays on “How to be
beautiful!” and “How to keep well!” He deserves his
success. He is an emancipator and has doubtless done
a great deal of good. His success demonstrates, beyond
contradiction, the prevalence of the malady under discussion,
and it must be remembered that he is only
one of hundreds who garner from the same ample
harvest.[Pg 319]

If we could estimate in value the economic loss sustained
by the race because of the inefficiency of the
victims of intestinal intoxication, due to constipation,
the sum would be colossal. Even then it would only
represent the direct economic deficiency—it would not
express, nor could any figure adequately represent, the
indirect loss sustained by the race because of the temperamental
characteristics, which are the products of
intestinal poisoning, and which produce domestic tragedies
and economic failures.

Has this array of evidence any meaning, or does it
just happen to be so? We leave it to the reader; if it
stimulates thought, or pricks a conscience it will have
done its duty.

Constipation and Social Exigencies.—The cause of
constipation in women, whose social station commands
every sanitary, hygienic, and dietary luxury, is their
method of living, the food they eat, and the negligence
which is almost obligatory because of social exactions.
If constipation did not so frequently accompany “good”
living (which is the modern name for overeating and
drinking) we would have thousands and thousands of
healthy, robust, contented women, fit and willing to assume
the onerous duties concomitant with motherhood.
All their enthusiasm, however, is expended in the effort
to keep “in the ring,” to overcome the effects of the
poison of constipation, to preserve their youth and freshness,
to undo what neglect has accomplished. It is because
of the failure of this simple function that my lady
seeks the masseur, the facial artist, the society doctor,
the beauty expert, and the thousand and one agencies,
which an extravagant and profligate age has made necessary
to foster the efficiency of its votaries.

I am optimistic, however, regarding the future. I believe
the human race is improving, despite the disadvantageous
surroundings and conditions which hamper
honest effort and stultify truth. A higher efficiency is
the goal, and the intention is to obtain this desideratum
by fair and by just means. There is an awakening, an
unrest, a groping for knowledge in almost every field of
human endeavor, and there is none in which the yearning[Pg 320]
for fact, for truth, for instruction, is stronger and keener,
than in the world-wide movement in the interest of a
better motherhood, and in a more serious study of child
life. It is an encouraging sign, a hopeful promise, of
what the future has in store.

One of the Important Duties of Mothers.—The immediate
lesson to be learnt from the facts just recounted
is to instruct mothers in their duty toward their daughters.
If each mother would retain the confidence of her
daughter sufficient to instruct her in the duties which
are important, how much needless suffering would be
saved. To know as a matter of fact whether the
daughter’s bowels are in good condition will appeal to all
who read this as being of very great importance. It is
not only necessary to know if they have a movement
every day, it is necessary to know the character of the
daily movement; whether it is hard and dry and necessitates
straining,—the evil consequences of which, in
young girls, is very serious indeed,—or if it is habitually
loose and suggestive of what has been described as incomplete
constipation.

If the mothers of America would consecrate themselves
to this simple task, who could tell in mere words
the effect it would have on the race yet unborn? There
are problems of scientific intent, and of fancy names,
that engage the attention of philanthropically inclined
ladies, and which are emblazoned on the society columns
of the daily press, of much less importance to the human
family than the homely duty we ask mothers to devote
themselves to.

Constipation and Diseases of Women.—Constipation
is present in a very large majority of the cases of diseases
of women. It may be caused by disease of the womb,
or it may cause disease of the womb. There is no
question about the bad effect constipation has upon all
diseases of this type. In many cases it is absolutely impossible
to effect a cure without first curing the accompanying
constipation.

We seldom appreciate how severe a degree of constipation
a growing girl will submit to without seeking relief.
Some of the worst cases of constipation that have been[Pg 321]
known, have been in girls between the ages of sixteen
and twenty. The mechanical effects of such a condition
can well be imagined. The constant, severe straining,
necessary to evacuate the bowel, has, in very many instances,
produced congestion and displacement of the
womb and ovaries. It is not observed at this time, or
if observed it is not understood, and thus is laid the
foundation for years of neurasthenia, helplessness, and
disease.

The more we investigate the ramifications of constipation
the more we learn of its seriousness and of its significance.

Constipation is Always Harmful.—There is no period
in life when constipation can be borne with impunity.
Youth, with its virility and vitality, will endure its consequences
with an apparent negation, so far as positive or
specific results are concerned, but it is only an apparent
impunity. There is always a certain amount of strength
built up, held in reserve as a heritage of youth, which
will withstand a certain amount of physical license, but
if this reserve is assailed by an unnecessary imposition,
and is successfully undermined, there will be infinitely
less reserve to call upon in the legitimate battle of life.
Life is too real, too concentrated, too strenuous, and
health is too precious to be wilfully wasted in any form
of self-abuse.