,illustration3 ,by courtesy of ,the ,new ,york ,times ,,new ,,york',s ,,better ,,baby ,little ,hiss ,johanna ,wiggers1 who won the first prize in ,new ,york's ,better ,babies ,contest by scoring #ajj points1 is the type of little girl that will make the best mothers1 and the better race tomorrow4 ,her score card showed2 age1 #bh months2 weight1 #cc lbs4 #ad ozs42 height1 #ce-a_/b inches2 circumference of head1 #ai-a_/b inches3 circumference of chest1 #bj inches2 lateral diameter of chest1 #f inches2 diameter of chest from front to back1 #d-a_/b inches2 length of arm to tip of middle finger1 #ad-a_/b inches2 length of leg to the sole of the foot1 #af-a_/b inches2 total1 #ajj points4 ,the ,eugenic ,marriage ,a ,personal ,guide to the ,new ,science of ,better ,living and ,better ,babies ,by ,w4 ,,grant ,,hague1 ,m4 ,d4 ,college of ,physicians and ,surgeons 7,columbia ,university71 ,new ,york2 ,member of ,county ,medical ,society1 and of the ,american ,medical ,association ,in ,four ,volumes ,,volume ,,ii ,new ,york ,,the ,,review ,,of ,,reviews ,,company #aiad ,copyright1 #aiac1 by ,w4 ,,grant ,,hague ,copyright1 #aiad1 by ,w4 ,,grant ,,hague ,,table ,,of ,,contents ,,sex ,,hygiene ,,for ,,the ,,boy ,,chapter ,,xii ,,building ,,our ,,boys ,,page ,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 boy8--,gonorrhea1 or clap--,symptoms of gonorrhea in the male--,complications of gonorrhea--,syphilis1 or the pox--,how syphilis is acquired--,syphilis attacks every organ in the body--,not possible to tell when cured--,the chancre--,systematic1 or constitutional symptoms--,mucous patches and ulcers--,syphilis of the blood vessels and lymphatic glands--,the interior organs--,brain and spinal cord--,the nose1 eye1 ear1 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 444 ,,page #aci ,,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--,trea tment 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 me1 ,i did not know--,fake medical treatment of venereal diseases--,sowing wild oats--,should circumcision be advised 444 ,,page #aec ,,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 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 first1 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 444 ,,page #agc ,,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 medicines1 or ,female ,regulators--,take your daughter to the doctor--,leucorrhea in girls--,bathing when menstruating--,constipation and displaced wombs--,dress and menstruation--,absence of menstruation1 or amenorrhea--,treatment of amenorrhea--,painful menstruation1 or dysmenorrhea--,causes of dysmenorrhea--,treatment of dysmenorrhea--,sterility in the female--,conditions which affect the fertility of women--,climate1 station in life1 season of the year1 age1 the tendency to miscarry--,causes of sterility in the female--,displacement of womb--,diseases of womb1 ovaries1 or tubes--,malformations--,lacerations--,tu mors--,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 444 ,,page #ahg ,,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 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 records1 why they should be kept--,growing pains 444 ,,page #bji ,,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 444 ,,page #bbc ,,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--,jouncing1 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--,chicken1 veal1 and beef broths--,scraped beef or meat pulp--,junket or curds and whey--,whey--,barley water--,barley water gruel or barley jelly--,rice1 wheat or oat water--,imperial ,granum--,albumen water--,dried bread--,coddled egg 444 ,,page #bce ,,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 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 444 ,,page #bdi ,,chapter ,,xx ,,artificial ,,feeding 7continued7 ,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--,meats1 vegetables1 cereals1 bread1 desserts1 fruits 444 ,,page #bei ,,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 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 444 ,,page #bgg ,,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 444 ,,page #cjc ,,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 444 ,,page #cae ,,sex ,,hygiene ,,for ,,the ,,boy ,,chapter ,,xii ,the evil that men do lives after them4 ,the good is often interred with them4 ,the pleasure in living is to meet temptation and not yield to it4 ,elmer ,lee1 ,m4 ,d4 ,,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 ,boy8--,gonorrhea1 or ,clap--,symptoms of ,gonorrhea in the ,male--,complications of ,gonorrhea--,syphilis1 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 ,nose1 ,eye1 ,ear1 ,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 ,blame8--,building the ,man--,age of ,puberty--,internal ,secretion4 ,a ,,word ,,to ,,parents4--,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 problem4 ,it has therefore acquired a degree of genuine interest which speaks well for the future of the eugenic ideal4 ,eugenics is based to a very large extent upon the principles underlying sex hygiene4 ,as a result of this widespread interest and investigation1 we have discovered that the only method that promises actual progress1 is to talk plainly and to tell the actual truth4 ,the day of the prude has passed4 ,to attempt to achieve results in the education of youth in sex problems1 without giving1 facts1 is wasted effort4 ,to give facts we must explain each problem so that its principles may be clearly understood and its meaning grasped4 ,to point out the duty of youth is not sufficient4 ,they must be shown why it is to their best interest to live the clean life4 ,in every department of education we are beginning to appreciate that to achieve results it must be based upon the individual equation4 ,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 problem4 ,it has been discovered1 however1 that a very large percentage of parents are inadequately informed on these subjects1 in fact they know practically nothing about the actual facts which they are supposed to teach4 ,i shall try to tell the story in a way which every parent will understand4 ,when a boy reaches the age of puberty he is susceptible to sexual desire4 ,if he has not been told the story of his growth from boyhood to man's estate he will either begin to abuse himself1 or he will be later enticed to commit himself to intercourse with some unclean female and he will acquire a disease as a result4 ,inasmuch as it has been asserted that practically every boy has been addicted to self-abuse at some time1 and that eighty per cent4 of all males1 between the ages of sixteen and thirty years1 are victims of venereal disease1 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 escape4 ,this1 of course1 may not be literally true1 but it is a reasonable assumption4 ,while self-abuse is a pernicious habit and may be attended with serious consequences1 it is not a disease and1 as will be explained later1 it can be cured4 ,it is therefore a menace to the individual1 not to the race1 and consequently need not concern us at the present time4 ,on the other hand the venereal diseases are not to be considered as individual problems since they affect the welfare of the race4 ,the venereal diseases which we will consider are gonorrhea and syphilis4 ,,the ,,social ,,evil4--,it has been estimated that there are more than ten millions of people in this country to-day suffering from the effects of venereal diseases4 ,in ,new ,york city alone1 there are two million victims suffering from the direct or indirect consequences of these diseases4 ,it has been authoritatively asserted that1 out of every ten men between the ages of sixteen and thirty1 eight have1 or have had1 one or other of these diseases4 ,when it is remembered that these diseases are not merely temporary incidents1 but that they may be regarded as practically incurable in the vast majority1 because of antagonistic social conditions and ignorance1 and that they are highly infectious1 we may begin to realize how important they are from the standpoint of race regeneration4 ,statistics of these conditions are never reliable because much of the evil is hidden and lied about4 ,it is quite probable1--if the estimates were based upon absolute knowledge--that the extent of the prevalency of these diseases would be greatly increased rather than reduced4 ,it is however a fact1 that the combined ravages of the ,great ,white ,plague1 leprosy1 yellow fever1 and small-pox1 are merely incidents compared to the effects which the venereal diseases have had upon mankind4 ,it is useless to think that these diseases can be driven out of the land4 ,any hope of this nature is the impression of the dreamer4 ,by a propaganda of education1 by the spread of the eugenic idea and ideal1 we may1 however1 reasonably hope to minimize the evil and1 at least1 to protect the innocent4 ,,the ,,sources ,,of ,,immorality4--,it is a fallacious idea to assume that the sources of immorality are confined to the large cities4 ,this is far from the truth4 ,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 way4 ,the individuals who are most likely to become affected are those most liable to succumb to temptation and whose home ties are of the best4 ,there are many instances on record where one or two loose women spread the infection all over the country communities1 infecting boys and men alike4 ,no one can estimate what the final effect of such an epidemic may mean or how many innocent individuals may have their lives wrecked as a direct consequence4 ,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 enlightenment4 ,it is at least our plain duty to tell the boy the actual facts--to post him with reference to consequences4 ,the more thoroughly we instruct him in the elementary facts relative to the venereal diseases1 the safer he will be from temptation1 and if he possesses this knowledge and acquires disease1 he will be more likely to immediately seek competent aid and advice4 ,,what ,,are ,,the ,,consequences ,,of ,,venereal ,,disease ,,to ,,the ,,boy ,,himself8 ,,gonorrhea ,,or ,,clap4--,this is the most frequent of the venereal diseases4 ,it is also the most serious4 ,it is an unfortunate fact1 that in the past1--and even to-day--boys have been told that gonorrhea is no worse than a bad cold4 ,this lie has been responsible for much evil and a great amount of unnecessary suffering and misery4 ,gonorrhea is caused by a germ1 obtained1 as a rule1 during intercourse with an infected person4 ,this germ is called gonococcus4 ,it thrives on any mucous membrane2 it is not1 therefore1 limited to the sexual organs4 ,for this reason it may attack any part of the body where mucous membrane is4 ,it is particularly liable to damage1 sometimes seriously and permanently1 the eye4 ,it may be spread from one person to another1 or from any infected article to a person in numerous ways4 ,the innocent may thus suffer as a result of the carelessness of the vicious4 ,,the ,,symptoms ,,of ,,gonorrhea ,,in ,,the ,,male are slight itching and burning of the mouth of the urethra4 ,this is noticeable at any time from the third to the fourteenth day after exposure4 ,these symptoms become more pronounced and a slight discharge appears4 ,the patient is compelled to urinate frequently and it is painful and difficult4 ,the discharge increases1 it becomes thicker and looks like ordinary yellow pus4 ,if the case is a severe one1 the discharge may be blood stained1 and if this symptom is present urination is more painful and more frequent4 ,in about ten days the disease reaches its height2 it remains stationary for a number of weeks and then slowly1 seemingly1 gets better4 ,the discharge grows thinner1 less in quantity and lighter in color4 ,it may refuse1 despite the most careful and efficient treatment1 to stop altogether2 it is then known as gleet4 ,if the discharge stops completely the patient is apparently cured1 as far as any external manifestation of the disease is concerned4 ,in seventy-five per cent4 of the cases1 however1 this apparent cure is no cure at all1 as will be seen later4 ,certain complications are likely to arise in the course of gonorrhea4 ,the infection itself may be of such an acute or virulent type1 that it invades the deeper structures of its own accord and despite the most careful1 competent treatment2 or if the treatment is not adequate or skillful it may be forced backward2 or through neglect in not beginning the right kind of treatment in times1 a simple infection may grow in degree into a serious disease1 and invade the more important structures4 ,in this way are produced disease of the bladder1 prostate gland1 seminal vesicles1 testicles1 and of the kidneys4 ,gonorrheal rheumatism may follow1 and even disease of the lining membrane of the heart1 and death4 ,when disease of the deeper parts occur the patient is frequently incapacitated and compelled to go to bed4 ,he may have chills1 fever and sweats1 intense pain and the passage of bloody urine4 ,he may have to be operated upon1 and his general health may be permanently wrecked4 ,so long as the germs are present there is danger despite the most scientific treatment4 ,it is not the quality of the treatment that is at fault1 it is the presence of the germs2 and since it is impossible to pursue any certain method of eradication1 we must continue treatment--as long as the germs are present--and hope for favorable results4 ,the infection may last for many years4 ,the germs having found entrance into the small tubes in the interior organs they can only be dislodged with difficulty1 if at all4 ,these pockets of germs may be excited to renewed activity by sexual intercourse1 or by injury to the parts1 and may reinfect the patient at any times4 ,in a very considerable number of these cases where the deeper structures are involved1 the patient may recover from the acute or painful period of the disease1 only to find that he is sterile4 ,there are many such cases1 and the most vindictive individual who may believe that every who sins should be punished will admit that sterility1 as the price of a moment's forgetfulness1 is a terrible fee to pay4 ,,syphilis1 ,,or ,,the ,,pox1 is an infectious1 germ blood disease4 ,it is most frequently acquired through sexual intercourse4 ,it may be acquired by direct contact with a diseased person4 ,in order to render such contact effective1 it is essential that the skin of the healthy person be abraded1 or the contact may be directly on a mucous membrane1 as the mouth in the act of kissing4 ,it may be acquired by using any article which has been used by a syphilitic1 as a drinking cup1 or towel4 ,it may be acquired through hereditary transmission4 ,surgeons frequently contract syphilis while operating on1 or examining patients who have the disease4 ,dentists may convey it by means of instruments which have not been rendered aseptic1 or thoroughly clean4 ,using a towel which has been used by a syphilitic has many times conveyed the infection to an innocent party4 ,for this reason the roller towel has been done away with1 and some states have legislated against its use in hotels and other public places4 ,to use dishes1 spoons1 tobacco pipe1 beer glasses1 etc41 which have been used by one having the disease is an absolutely certain way of being infected4 ,cigars which may have been made by a syphilitic will infect whoever smokes them with the virus of the disease4 ,syphilis has been known to have been caught from using the church communion cup4 ,the public drinking-cup has been a prolific source of syphilitic dissemination to innocents4 ,legislators are just waking up to the danger that lurks in this institution and it will no doubt be done away with1 not only in public places1 but on all railroad and steamboat lines4 ,an infected mother can transmit syphilis to her child4 ,if the father is affected1 but not the wife1 the child may escape4 ,syphilis attacks every organ in the human body4 ,the actual degree of infection has no relation to the size or character of the external manifestations4 ,the external evidence may be minute and insignificant1 while the internal extent and ravages of the disease may be tremendous and of large proportions4 ,many men when asked regarding incidents of the long ago1 may state1 ,oh1 yes1 ,i had a chancre twenty-five years ago1 but it was a very small affair and soon healed up and was cured4 ,yet that same little chancre1 that made only a mild impression on the man's mind1 may1 and most probably will1 be the direct cause of that man's death4 ,it is not possible to tell with absolute certainty that an individual is suffering with syphilis by any known test4 ,the most recent one--the ,wassermann test--is not absolute by any means4 ,the first symptoms1 or what is known as the initial lesion of syphilis1 is the chancre4 ,,the ,,chancre is a small1 hard tumor1 or it may be a small ulcer with a hard base1 or it may simply appear as a thin small patch on any mucous membrane4 ,it is not painful1 it can be moved if taken between the fingers1 showing it is not attached to the deep structures1 and when it is so moved it is not tender or sore4 ,any little lump which ulcerates located on the genitals must be regarded with suspicion4 ,boys and men should not be satisfied with any offhand statement that1 it is nothing4 ,it may be a chancre1 and it may be exceedingly serious if not properly diagnosed4 ,systemic1 or constitutional symptoms1 begin to show themselves any time from the sixth to the tenth week after the appearance of the chancre4 ,,eruptions ,,of ,,the ,,skin characterize every case of syphilis4 ,they occur in all degrees from the mild rash to the foul ulcer4 ,the ulcerative process is very often extensive and loathsome4 ,,mucous ,,patches ,,and ,,ulcers affect the mucous membranes4 ,the mouth and throat are favorite locations for these lesions4 ,they occur in the anus and rectum1 and may be mistaken in that region for other serious conditions4 ,men who drink and smoke suffer as a rule severely from mucous patches in the mouth and throat4 ,syphilis attacks the blood vessels and the lymphatic glands4 ,these cases may have been unrecognized1 and may have existed for many years4 ,a man may die from a rupture of a blood vessel in the brain during middle life as a consequence of a forgotten1 supposedly cured case of syphilis many years before4 ,,the ,,interior ,,organs may be attacked by syphilis4 ,as a result we get disease of the liver1 heart1 stomach1 kidneys1 lungs1 and other parts4 ,it has been suggested that many diseases affecting these organs1 for which treatment proves unsatisfactory1 may have had their origin in a former syphilis4 ,,the ,,brain ,,and ,,spinal ,,cord are quite often the seat of syphilitic affections4 ,a tumor1 known by the name of gumma1 is the result4 ,the blood vessels of the entire nervous system may be affected and1 as a consequence1 we often see cases of paralysis1 apoplexy1 epilepsy1 locomotor ataxia and death4 ,,the ,,nose1 ,,eye1 ,,ear1 ,,throat1 are frequently very seriously compromised as a result of the syphilitic poison4 ,deformity1 caused by rotting of the bones of these parts is not infrequent4 ,loss of voice1 or smell1 or hearing1 or sight1 may result4 ,,the ,,hair ,,and ,,nails may fall out4 ,the bones may ulcerate and rot4 ,the organs of procreation usually participate in the degenerative process4 ,virility is destroyed1 and impotence is quite common after a severe attack4 ,,what ,,the ,,boy ,,with ,,venereal ,,disease ,,may ,,cause ,,in ,,others ,,gonorrhea4--,when the average boy acquires gonorrhea he frequently does not know1 for many weeks1 that he is the victim of a dangerous1 infectious disease4 ,he appreciates probably1 that it relates to the sexual indiscretion he was guilty of1 and feels that it is something to be ashamed of4 ,he therefore hides his condition1 confides in no one1 and blindly hopes it will get better somehow or at some time4 ,meantime the disease1 which may have been mild at the beginning1 is gradually gaining ground and strength1 and his neglect may eventuate in lifelong misery4 ,no means are taken to guard against spreading the infection1 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 known4 ,it may get on water-closet seats and infect others4 ,eventually he is compelled to seek aid1 and he may1 after a long period1 be freed from the immediate consequences of his folly4 ,at a later date he marries1 and as previously explained1 he infects his wife4 ,this is the beginning of much of the domestic infelicity that is so prevalent to-day1 and1 inasmuch as it is a subject that should be thoroughly understood by every woman and mother1 ,i shall carefully and clearly explain its significance and its consequences4 ,let us first1 however1 briefly consider what may occur to others if the boy is unfortunate enough to acquire syphilis4 ,again the boy fails to comprehend the nature of his affliction4 ,there is imminent danger of the members of his household becoming infected4 ,he uses the same dishes1 spoons1 towels1 and utensils1 any one of which may convey the disease to his father1 mother1 sister1 or brother4 ,he may use the common drinking glass in school1 college1 or office1 and spread the disease in this way4 ,he may kiss any member of his family1 or a baby1 and infect them4 ,he may have his hair cut1 or be shaved1 and the virus may be spread around in this way if the barber does not sterilize the article used1--which he never does4 ,he may drink at a soda fountain1 or at a saloon1 and the next individual to use the same glass may acquire the disease4 ,he is a menace to the individual1 to the community1 and to the race4 ,wives often acquire syphilis from their husbands4 ,,the ,,infected ,,wife4--,it has been previously stated that eight out of every ten males between the ages of sixteen and thirty1 have had or have1 gonorrhea or syphilis4 ,seventy-five per cent4 of these cases have not been cured4 ,about thirty-five per cent4 of these are destined to infect wife1 or wife and children1 and in all probability many others4 ,if a young wife acquires infection from her husband1 she is exactly in the same condition as the diseased boy1--she does not know what ails her1 so she wastes precious time in unprofitable worry4 ,why should she know what the trouble is8 ,she came to the marriage bed pure1 and clean1 and healthy4 ,her previous education did not include instruction which would even help her to guess what the trouble might be4 ,she is simply conscious of new distressing conditions which she does not understand4 ,she may try to believe that these conditions are incidental to the change in her life4 ,shortly1 however1 the discharge1 which she has had for a number of weeks1 and which she thought was only a leucorrhea1 or the whites1 becomes so profuse and nasty that she begins douching4 ,this procedure simply blinds her to the true nature of the affection1 and in the end she is driven1 ashamed and reluctant1 to consult a physician4 ,she may be informed that her condition is bad1 and that it will be necessary that she submit to a course of treatment4 ,after a time the physician may succeed in tiding her over the immediate consequences of the gonorrheal infection she innocently acquired4 ,she may soon after become pregnant1 and she may miscarry as a result of the old trouble1 or she may carry the child the full period4 ,when the child is born it may be blind and this defect is a consequence of the old infection to the mother from the father4 ,if the mother is syphilitic the child most likely will inherit all the horrible possibilities of transmitted blood-poison4 ,pregnancy frequently lights up any old1 gonorrheal infection in the female1 so this young wife fails to completely recover after the confinement4 ,she is able to be about1 but her strength refuses to be restored4 ,it may be months later when she begins to suffer pain and to realize that she is quite sick4 ,she develops a fever and may have a chill4 ,the physician discovers that she has pus in her tubes and there is danger of peritonitis or general blood poisoning4 ,the old germs have been roused and are active4 ,unfortunately they are located where it is impossible to dislodge them without resorting to a serious operation4 ,it is now a problem of saving her life4 ,she is taken to the hospital and her womb1 tubes1 and ovaries1 are removed--she is unsexed4 ,young wives are being operated on every day1 in every city in the civilized world for just such causes4 ,it is a notorious fact1 that1 in every city in the world1 the number of operations that are daily being performed on women1 is increasing appallingly4 ,every surgeon knows that eighty per cent4 of these operations are caused1 directly or indirectly1 by these diseases1 and in almost every case in married women1 they are obtained innocently from their own husbands4 ,it is rare to find a married woman who is not suffering from some ovarian or uterine trouble1 or some obscure nervous condition1 which is not amenable to the ordinary remedies1 and a very large percentage of these cases are primarily caused by infection obtained in the same way4 ,when a girl marries she does not know what fate has in store for her1 nor is there any possible way of knowing1 under the present marriage system4 ,if she begets a sickly1 puny child1--assuming she herself has providentially escaped immediate disease1--she devotes all her mother love and devotion to her child1 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 race1 is expended in combating conditions against which no successful effort is possible4 ,even her prayers are futile1 because the wrong is implanted in the constitution of the child and the remedy is beyond her power to find4 ,these are the tragedies of life1 which no words may adequately describe1 and compared to which the incidental troubles of the world at large are as nothing4 ,if the conditions are not as bad as those depicted above1 the original infection may have rendered her sterile4 ,if the germs reached the womb and tubes1 the inflammatory process may close these tubes1 with the result that conception is impossible4 ,in these cases the woman has to bear the stigma and disgrace of a childless union1 though she is not the guilty party4 ,many husbands are sterile1 however1 as a result of venereal disease4 ,it is claimed that eighty per cent4 of childless marriages are caused by sterility of the male partner4 ,curiously and unfortunately these men never suspect themselves4 ,the wife is the delinquent member1 in their estimation4 ,she is the victim of jest and suspicion1 and later of jibes and insults4 ,many women have had their lives rendered miserable and unhappy because of this suspicion4 ,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 exist4 ,many conscientious physicians refuse to treat women patients against whom the charge of sterility is made1 before subjecting the husbands to thorough examination1 and1 since eighty per cent4 of childless marriages are due to sterility in the male1 this is a just and reasonable course to pursue4 ,during the course of all this domestic trouble and tragedy1 the young wife's health has suffered--she scarcely enjoys one day of good health4 ,her mental condition is even worse4 ,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 state4 ,we must remember that these conditions wreck ideals and homes1 and that they frequently render inefficient both husband and wife4 ,the economic business of marriage becomes a failure1 ambition is crushed and hope dies in the heart4 ,if the mother has been inoculated with the virus of syphilis her existence is equally wretched2 her health is ruined2 her efficiency is forever mortgaged4 ,if she becomes pregnant she will most likely abort and she will go on aborting for years1 in the effort to bring children into the home1 accusing herself meantime and submitting to the reflections which are heaped upon her1 while the real culprit is the husband4 ,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 contract4 ,if she gives birth to a child or children1 they are syphilitic4 ,they may be deformed1 or they may be feeble-minded or idiots4 ,they may live at home for years1 always ailing1 always sick4 ,they may develop epilepsy1 ,st4 ,vitus' dance1 skin disease1 or mental vagaries1 and they may have to be put into institutions for the feeble-minded1 or they may die by inches at home4 ,,is ,,the ,,husband ,,to ,,blame8--,if a boy had gonorrhea a number of years before entering the marriage state1 was treated for it by a physician1 until all symptoms had disappeared and had enjoyed apparent good health in the interim1 and had never been told any of the facts regarding probable consequences1 is it just to blame him if he infects his wife8 ,it is certain no man would willingly subject his bride to the risk of infection1 with all its horrible consequences4 ,these conditions exist as a result of the prudish attitude of society in the past toward all questions affecting sex hygiene4 ,we have not told all the truth to the boy4 ,whatever knowledge he may have had was gained from companions1 or from individuals who knew the garbled facts only4 ,there is of course no excuse for the man who acquires disease after marriage and conveys it to his wife or children4 ,this is a very different situation and one which should merit the severest condemnation and punishment4 ,we are1 however1 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 standpoint4 ,,building ,a ,,man4--,when the boy is about fifteen years of age certain changes begin to manifest themselves4 ,he grows more rapidly1 a growth in which his whole system participates4 ,his bones grow bigger and stronger1 his muscles increase in size1 even his heart1 and lungs1 and liver1 and his digestive system accommodate themselves to this transformation2 the voice changes and hair begins to grow on his face4 ,the mental process also keeps pace with the new order of things4 ,he thinks differently and he sees from a new viewpoint4 ,nature is making a man out of a boy4 ,these changes were not understood in the past1 but we are beginning to appreciate the reason for this evolutionary process4 ,we have discovered that the cause depends upon certain active changes which take place in the sex organs4 ,about this time the testicles begin to be active4 ,for years these glands have been preparing themselves for this work1 so they first grow rapidly1 increasing in size until they are about eight times bigger than they were before this time1 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 body4 ,this substance or internal secretion must not be confused with the semen4 ,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 manifests4 ,the semen1 on the other hand1 is the procreative or fertilizing fluid which enables a man to beget offspring4 ,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 development4 ,this process goes on for a number of years1 until the boy reaches maturity4 ,any act or habit which weakens the quality of this secretion will deplete his powers and render him physically and mentally inefficient4 ,to make a man1 nature must be permitted to work in her own way4 ,you cannot improve on her methods nor can you break her laws with impunity4 ,,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--,tre atment 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 ,evil1 ,before ,speaking with ,authority to the ,boy--,the ,need of ,enlightenment in ,sexual ,matters--,no ,one ,told ,me1 ,i ,did ,not ,know--,fake ,medical ,treatment of ,venereal ,diseases--,sowing ,wild ,oats--,should ,circumcision be ,advised8 ,,abuse ,,of ,,the ,,procreative ,,function4--,breeders of animals have discovered that to breed from very young stock is not good4 ,the quality and stamina of the progeny is lowered and the vitality of the parent stock is reduced4 ,it is not a good economic proposition4 ,boys should therefore be taught that any form of sexual indulgence is harmful before the period of full growth4 ,nature did not intend that the procreative function should be exercised by individuals who were not fully developed4 ,the perpetuation of the species must not depend upon the license of immaturity4 ,the instinct of sex-attraction must not be debased to serve a puerile1 rather than a holy purpose4 ,sexual indulgence in any form1 and in any degree1 at any age prior to full maturity is a perversion of the primal instinct of race perpetuation4 ,the practice has a more intimate and a more personal association with growing boys1 however1 than a merely altruistic reference4 ,any indulgence of this character at this time is physically and mentally injurious4 ,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 forces in unnatural liberties4 ,he should be taught this truth in an emphatic manner by those responsible for his education4 ,there is a false idea prevalent that a continent life is harmful4 ,so far as continence relates to immaturity1 it may be strongly and justly asserted that it is probably the most important factor in the conservation of health and strength4 ,the retention of the procreative fluids1 at a time when nature is opposed to their loss1 enables the growing economy to utilize them in the conservation of nervous energy and virility4 ,if a boy dissipates these energizing fluids1 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 constitution4 ,there cannot exist a normal development if the body is deprived of the essential ingredients necessary to growth and mental vigor4 ,there was a time when young men were actually taught that sexual intercourse was necessary to develop full manhood4 ,this was followed by a period of silence1 which has practically extended to recent times4 ,both of these systems are pernicious4 ,we know that sexual intercourse is not necessary to the development of mature normal manhood or womanhood4 ,on the contrary1 we know that continence1 not incontinence1 is an absolute essential to the growth of full sexual1 virile maturity1 as well as to the growth of efficient and healthy manhood and womanhood4 ,we must appeal to a boy's reason and show him the personal side of clean living4 ,when he understands that to attain success in every department of human effort1--on the baseball and football fields1 in the ring1 in gymnastic contents1 in examinations1 in social intercourse1 in trades and professions1--a continent life is the only means possible that promises success1 he will give the appeal consideration4 ,we must employ all the safety devices possible to guard against the inclination of youth to wander4 ,regular exercise is one of the very best institutions in this respect4 ,if we can instill into our boys a love of manly sports and encourage every effort in this direction1 we will be doing much to minimize the growth of any tendency toward incontinence4 ,we must provide the environment necessary to right living4 ,the home should be attractive and we should permit the boy to have privileges even at the expense of the housekeeping decorum4 ,his companions should be made welcome if they are the right kind of intimates1 and the parents should enter into the life of the boy and try to look at things from his standpoint4 ,,the ,,period ,,of ,,procreative ,,power4--,the procreative ability begins at puberty4 ,there is no fixed period at which it may be said to end4 ,from puberty until the period of physical maturity1 it grows in vigor and it remains stationary until middle life1 when it gradually declines4 ,the standard of virility is unquestionably an individual problem4 ,it depends upon the various factors that contribute to good health and longevity4 ,it may be stated that the boy who abused his procreative function1 during the period of immaturity1 will not enjoy1 during the mature period of his sexual life1 a normal standard of vigor1 nor will he carry the ability into old age1 to the same relative degree1 as he would1 and as he had the innate promise to do--if he had led a normal continent existence4 ,it may also be stated here that there is no effective remedial measures known1 that will bring back the procreative ability if it is lost as a result of disobeying natural laws4 ,drugs and treatments by quacks to cure impotence are impositions and fakes4 ,money and time spent in the pursuit of this dream is money and time wasted4 ,,self-,,abuse ,,or ,,masturbation4--,by self-abuse is meant the production of the venereal orgasm1 with or without emission1 by any means other than the natural union of the sexes4 ,it is a fact that the large majority of boys acquire the habit of self-abuse at some time4 ,this is a very serious reflection upon parent1 teacher1 and physician1 because it is through ignorance of the elementary principles of sex hygiene that this condition continues to exist4 ,if they were warned against the possibility of self-abuse arising in innocent ways1 as well as in more reprehensible ways1 they would exert their influence against its acquirement4 ,if however a boy discovers accidentally a condition of which he was innocent1 and of which he does not know the significance1 it is human nature that he should investigate the phenomenon and in the end suffer as a consequence4 ,in the effort to relieve some local irritation he may handle himself and be led into a dangerous practice4 ,he does not know that the practice may have serious results--in fact he does not know he is doing anything wrong4 ,many boys have practically ruined their physical health and become morally irresponsible because no one--neither parent1 teacher1 physician1 nor friend--told them of their danger4 ,this is unjust1 but great strides are being made in this direction and we may reasonably hope1 that in the not far distant future1 every boy will be plainly told the true facts about himself4 ,most boys acquire this habit from other boys1 but as we have intimated it is possible to acquire it in what are termed innocent ways4 ,sometimes the sensation which leads to it is discovered by sliding down banisters2 or it may be that climbing trees or poles first awakens the feeling4 ,very young children are sometimes taught the vice by depraved nurses4 ,local irritation1 as has been stated1 may necessitate itching and handling the parts and in this way the vice is begun4 ,the results are the same1 no matter how the habit may have originated4 ,if the habit is persisted in1 the muscular system suffers1--the muscles become weak and flabby2 the patient develops weariness and languor and loses his mental and physical vigor4 ,he is no longer forceful or energetic1 his efficiency is impaired and as a consequence his nervous system begins to show signs of depleted strength4 ,he cannot concentrate his thoughts1 he falls behind in his studies1 his mental effort is sluggish1 he becomes diffident and shy1 shuns society1 loses confidence in himself1 is morbid and emotional and may even think of suicide4 ,it is astonishing how indulgence in this habit may affect the moral nature of a boy4 ,first of all1 he is no longer frank and open4 ,he becomes shifty and suspicious and will not look you squarely in the face4 ,a boy cannot become a slave to this habit without it affecting his mind4 ,he invites debasing thoughts1--the old pure and clean method of thought and living no longer satisfy4 ,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 wrong4 ,he has little regard for the truth and if occasion demands it he will lie without appreciating the dishonorable part he is playing4 ,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 habit1 his health and strength ruined4 ,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 slave4 ,it may be easy to abandon the practice in the beginning4 ,the longer he continues it1 however1 the less chance he has of finally mastering it1 until1 if he persists beyond a certain point1 it is a matter of serious question whether he will ever be able to free himself from its grip4 ,if the boy has lost the will power to carry out his resolves1 no number of good desires or resolutions will avail4 ,and it is just this will power that the wasting of the semen saps little by little away4 ,,treatment4--,what can we do for these boys8 ,most of them can do much for themselves by simply stopping the practice4 ,there are1 of course1 others who need careful management before the habit may be controlled and health restored4 ,it is well to always remember to be tactful and patient and kind to these boys4 ,many of them are standing on the brink of despair1 weak in body and weak in mind4 ,they do not know where to turn to look for a friend--the right kind of a friend4 ,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 health1 and1 though he may long for sympathy and a helping hand1 neither his father nor mother have invited his confidence or spoken to him about these things4 ,a watchful mother can usually tell when her boy becomes addicted to this habit4 ,he will show it in his manner1 he will not be free and open1 he will want to be by himself4 ,later he will show the effects of the abusive treatment he is subjecting himself to in his appearance4 ,he will be sunken-eyed1 pimply-faced1 pasty-skinned1 shiftless1 sneaking1 silent1 unmanly4 ,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 absolutely4 ,we would advise regular exercise of a vigorous kind4 ,tire out the body so that sleep may be sound4 ,cold baths1 followed by brisk rub-downs2 no intoxicants1 light meals1 plenty of drinking water morning and night4 ,the bowels should be regular every day4 ,he should sleep alone on a hard bed in a well-aired room with light covering4 ,he should keep busy every minute of the day and he should not think of himself at all4 ,the boy must realize that his salvation rests with himself4 ,after he knows the real danger which the habit carries with it1 he must be on his guard every moment to abstain4 ,if he does not he may rest assured that the practice will ruin his health1 render him1 a business failure and deprive him of all happiness during the rest of his life4 ,,night ,,losses ,,or ,,wet-,,dreams4--,a so-called wet-dream is an unconscious emission of semen during sleep4 ,the discharge may or may not be accompanied with an erotic dream4 ,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 sleep4 ,he finds the discharge on his night clothes and it naturally puzzles him greatly4 ,he may be entirely unconscious of the whole proceeding1 having slept soundly during the night1 or he may wake up to find the fluid actually discharging4 ,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 sick1 as the night emissions continue to occur from time to time4 ,many pure-minded boys have been rendered miserable1 and their efficiency and health have suffered as a result of just such an experience4 ,it is1 therefore1 proper that they should fully understand the true significance of these occurrences4 ,,causes ,,of ,,night ,,emissions4--,i have explained how nature makes a man out of a boy4 ,during this maturing process the testicles are very active organs--their function is to manufacture or secrete the fertilizing fluid or semen4 ,this maturing process begins actively1 as ,i stated1 about the age of fifteen1 though in some boys it frequently occurs earlier1 sometimes as early as the twelfth year4 ,when the testicle begins to grow at this time they manufacture more semen than the little pockets can hold1 so nature adopts the method of permitting the surplus to escape during sleep4 ,these night emissions1 therefore1 are perfectly natural losses1 and need cause absolutely no distress of mind whatever4 ,the frequency with which they may occur depends altogether upon the temperament of the boy4 ,if the boy is a strong1 active1 athletic boy1 they may not be so frequent in him as they may be in a quiet1 studious boy4 ,the system of the athletic boy seems to utilize more of this surplus than the quieter existence of the studious boy calls for4 ,if the discharge does not occur oftener than once every two weeks1 it may be regarded as normal and natural4 ,should they become more frequent than this1 the boy should inform his mother or father and the family physician should be consulted4 ,it may be that he is in need of a tonic1 or special instructions regarding his method of living and his mode of exercising4 ,whatever the cause may be1 it can be corrected1 and the best plan is to give it attention as soon as it is noted that the losses are too frequent4 ,,sexual ,,excesses4--,it is well known to the medical profession that the marital relation is frequently practiced to excess4 ,the same indictment may be passed on what may be termed extra-marital relations4 ,no one has ever formulated a general sexual standard which could be safely regarded as normal4 ,too many individual conditions of temperament and health enter into the proposition to permit of a standard being formulated4 ,it must1 therefore1 be regarded as an individual question to be adjusted1 if necessary1 by the family physician4 ,what may safely be regarded as normal and harmless in one1 constitutes1 for many reasons1 excess in another4 ,when a man performs hard physical or mental labor1 his sexual aptitude or capacity is limited1 and this limitation cannot be exceeded without risk4 ,such a limitation may not constitute an excess in a man whose occupation does not call for a great expenditure of physical or mental energy4 ,any indulgence which produces exhaustion is excessive4 ,the age of the individual has undoubtedly much to do with his sexual endurance4 ,a young1 virile adult will tolerate a sexual expenditure which would seriously affect the health and vigor of an older man4 ,environment and inclination are factors in determining the standard of some people4 ,if the marital relations are participated in simply to preserve peace and harmony in the home1 they are productive of harm even if indulged in moderately4 ,the symptoms of sexual excess are much the same as those of self-abuse4 ,to a certain extent1 however1 they are favorably influenced1 because the conditions under which the relationship is practiced are natural1 because the participants are matured physically1 and because there is no element of worry over the probable effects4 ,sexual excess defeats its own purpose1 because it engenders a lack of desire and consequently it is to a certain extent a self-limiting process4 ,we must also remember that excess entails consequences just as the breaking of any natural law is followed by retribution of some kind4 ,in these cases we find that discomfort follows excess4 ,the parts become irritated and congested and disease of the prostate gland always follows4 ,,treatment4--,stop the excess by self-control and self-restraint4 ,employ all the aids dictated by an intelligent perusal of the laws of sex hygiene4 ,preserve the general health4 ,it may be necessary to resort to local treatment1 because1 if the parts have been abused by excessive indulgence1 there is always more or less irritation and congestion present4 ,this condition affects the nerves1 suggestive reflex sensations are produced by a congested prostate and the patient becomes morbid4 ,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 treatment4 ,,what ,,parents ,,should ,,know ,,about ,,the ,,so-,,called ,,social ,,evil ,,before ,,speaking ,,with ,,authority ,,to ,,the ,,boy4--,to be qualified to speak with authority1 or convincingly1 to a boy upon sex hygiene1 the parents must be familiar with1 and well versed in the subject4 ,the facts related in the preceding pages must be thoroughly understood4 ,no parent can study these facts intelligently without being impressed with the importance of the subject2 without realizing that it is absolutely essential that the fundamental principles of sex hygiene should be taught to the rising generation2 without acknowledging the tremendous part for evil which prudery and ignorance play in the education of youth2 and without being convinced that most of the evil is the product of ignorance on the part of the boy1 and that parents are in a large sense to blame if they fail to impart the necessary knowledge in time4 ,the need for enlightenment in sexual matters is a product of existing conditions4 ,civilization and the social environment are developing along a plane which subjects the youth to temptations that practically did not exist in the past4 ,there is a broader and looser code of ethics4 ,business monopolizes the entire time of the father1 and social and political unrest and misdirected ambition distracts the mother4 ,the son or daughter has a wider latitude and a freer reign than they once had4 ,the opportunities for promiscuous intimacies are easier1 and the public conveniences and utilities lend themselves to the designs of evil-intentioned and loose-moraled women4 ,the ease of travel1 the laxity of laws1 the theater1 with its unchaste and indecent plays1 the moving picture snows1 the vaudeville resorts1 whose highest priced talent is some voluptuous female1 who has cultivated the art of draping nudity with suggestiveness and singing immoral songs1 all tend to give youth a false impression of the reality of life and to make the path of the degenerate easy and profitable4 ,the rich are growing richer1 and their children are pampered and overfed and underrestrained4 ,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 desire4 ,the poor are growing poorer1 and to keep in the ring1 to live and dress beyond their means as many do1 it is necessary to have an unexacting standard of morals4 ,in this way the promiscuous libertine is evolved1--the most insidious and dangerous product of present day civilization1 and the most pernicious factor in the spread of immoral impulses and indecent diseases4 ,parents must accept these institutions and agencies as necessary instruments of evil and adopt measures to nullify their attractiveness4 ,eternal vigilance is the price of success1 but the quality of the vigilance must be dictated by love1 not by suspicion and distrust4 ,when the parent can convince the boy that the knowledge is imparted1 not with the intention of depriving him of what he may construe as his natural liberties and rights1 but with the single intention of adding to the sum total of his pleasure and success1 he will look more kindly upon any proposition that suggests a course of conduct that leads to clean living4 ,sex hygiene will eventually find a natural place in the scheme of education4 ,it will be taught to male and female alike4 ,in the meantime1 however1 we must begin by educating the educators--the parents4 ,in the beginning1 their task will not be easy4 ,there will be much to overcome1 much ignorance1 prudery1 false modesty1 hypocrisy2 there will be much vicious teaching and evil example to live down4 ,but we cannot hope to achieve results in the noblest cause1 save by patient1 intelligent1 and persistent effort and by self-sacrifice and a constant enthusiasm4 ,the aim is to tell all1--all the truth1--so that we may never be assailed by the cry1 ,no one told me1 ,i did not know1 from the loved lips of son or daughter gone astray4 ,,the ,,father ,,and ,,the ,,boy4--,the right kind of father can always find the time and the way to awaken in the heart of the boy the spirit of companionship4 ,no boy living will resent the fellowship of the right kind of father4 ,it depends upon the father6 ,if the spirit of chumminess does not exist between you and your boy1 you are at fault1 you have made a mistake1 you have missed your opportunity1 you did not go about it in the right way and in the right spirit4 ,try again--it may not be too late4 ,the father who adopts the habit of taking his boys 7and his girls too7 out for long walks1 at least every ,sunday1 and who spends an hour with them every evening--is the right kind of father4 ,one who has never tested the merit of walks with children cannot possibly appreciate the enjoyment and benefit that can accrue from them4 ,it is not only the physical good that results1 nor the inspiration which one may draw from nature1 but the concrete advantages that come from the fellowship with the children are a new and a real experience--this is what counts4 ,you will have opportunities of sewing seeds in their minds that will grow into a harvest that will astonish you4 ,children in the right mood--and they are in the right mood when they are happy1 and they are happy out in the open with an interesting companion--are alert1 and responsive1 and eager to be told things1 and this mood can be put to marvelous use by the right kind of father4 ,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 father4 ,he must choose to be a child again1 he must desire to please them1 he must make an effort to be in harmony with them1 he must draw on his experience to interest them1 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 view4 ,we can1 in a most effective way1 begin to build their characters1 and1 by the right kind of talk and enthusiasm1 he can determine their resolves to be honest1 truthful1 just1 clean1 sympathetic4 ,he can instill into them1 in a thousand different ways1 the determination and inspiration to succeed4 ,it is a wonderful and a precious chance1 and it will make the right kind of father more just1 more sympathetic1 more optimistic1 and it will make him young again and more successful4 ,try it4 ,implant in the hearts of your children a love of home1 make the evening meal and hour by the fireside a period of congenial fellowship1 when all the little irritable ruffles of the day may be ironed out and swept away4 ,the secret is to be intimate4 ,tell them the secret of success from your standpoint1 how happiness is gained only by being efficient and successful1 and that1 to be efficient1 one must be energetic and healthy4 ,drum into their ears the truth that life is a battle1 and only the brave win out1 and health is the one essential necessity4 ,it is astonishing how such talks will impress young minds4 ,they will remind you of things you said1 that made a lasting impression on them1 long after you have forgotten the incident4 ,a father can1 in this way1 by talking of the future to his boy1 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 mind1 and he unconsciously hopes to attain that standard4 ,if you have impressed him with the necessity of preserving his health and strength1 as an essential to success1 he will be slow to yield to any temptation that may interfere with his plans4 ,this reasoning may sound quixotic to some people1 but it is the truth4 ,many a boy has been inspired to success by the knowledge that his mother or father believed in him1 and was confident he would be a leader4 ,he strove to justify the pride and confidence of those who held him dear1 and he won out4 ,to retain his health1 therefore1 is the first impulse to be conveyed to the boy4 ,when he recognizes this truth1 it is an easy task to instill a love of exercise1 gymnastics1 swimming1 fresh air1 cleanliness and temperance in him4 ,if these are attained1 you will have tided him over the tendency to self-abuse1 and you will have rendered him less likely to yield to evil suggestion or temptation4 ,his confidence in you will be whole-hearted and implicit4 ,you can do anything with him at the psychological moment4 ,it is now time to talk of more intimate matters4 ,carefully and tactfully1 the father approaches the fundamental truths of sex hygiene4 ,the selection of a subject for a text as a means from which to advance toward the real facts is sometimes of importance4 ,it must not appear as though the subject was designedly chosen4 ,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 viewpoint4 ,a passing trotting horse has served me a number of times for intimate talks with boys on heredity and kindred subjects4 ,i invite the boy to watch how the horse uses his legs1 and how rhythmically and beautifully he places his feet1 and how his whole attitude serves the end for which he is exerting himself--to gain speed4 ,tell the boy the story of how professional breeders have achieved such marvelous results2 how for generations the strain has been kept clean and pure1 how any descendant of a great sire1 who showed any habit detrimental to the development of the highest racing qualities--no matter how trivial the disability might be--was cast aside1 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 standard4 ,such a horse will not win1 and it is only wins that count4 ,change the subject to human beings4 ,tell him how the race maintains its standard2 but show him the difference between the methods employed4 ,how the horse has his mate selected because of the female's good qualities1 so that the offspring may possess like qualities1 if not better1 and that the selection is made by men who know their business1 and have had long experience in the work4 ,how1 on the other hand1 a young man with no experience is permitted to choose any woman he may fancy irrespective of her qualifications4 ,as a consequence1 we have all kinds of children1 good and bad1 feeble and strong1 honest and dishonest1 some degenerates from birth1 some criminal1 and many diseased and inefficient1 few of them winners4 ,it is an easy matter to preach a little sermon from this text4 ,show him how essential it is to select the mother of one's children wisely1 to know if there is disease in the future wife's blood1 if her family history is good1 if her temperament is suited to his1 if her domestic qualities are satisfactory1 if her principles are moral and normal1 and if she understands and appreciates the true object and function of marriage4 ,show him also the element of justice involved in the marriage contract2 that he must give what he exacts1 that if he expects a healthy and normal wife1 he must be healthy and normal himself2 if he expects purity and cleanliness he must give purity and cleanliness2 if he expects to mate with a fit female he must be an efficient and fit male4 ,remember that every act1 deed1 thought1 and aspiration is regulated by laws which one cannot fool with1 or disobey1 without reaping a harvest which will conquer1 crush and ruin you1 no matter how clever or smart you may think yourself4 ,show him the wisdom of the breeders' habit of never permitting sexual liberties in a too young stallion4 ,for the same reason the boy must conserve his strength and virility for the marriage state and for the function of procreation4 ,in a further talk1 the father may extend this subject and gradually lead up to the consequences of the unclean life4 ,the boy will be ready for this talk and will evince an interest in it that will be encouraging and promising4 ,the talk about the science of mating the horses he will understand readily and thoroughly1 and he will not fail to see the point when you switch to man and apply the same principles4 ,then when you show how mismating is responsible for poor children quality and how disease accounts for feeble-minded and degenerate offspring1 he will be fairly well posted1 and he will be ready to imbibe more details1 and you will have done much of your duty4 ,his curiosity will be quickened and his interest is awakened4 ,it depends upon the father4 ,if your boy is honest and clean1 open and decent1 he will not fall without a fight1 and while he is fighting he is maturing4 ,if your picture of the consequences of the venereal diseases has been effective and vivid1 he will grow up with a healthy horror of them4 ,if your conduct as a father has been wise and exemplary1 and if your home has the right kind of environment1 and the right kind of mother in it1 you have done all a father can do to help the boy over the rough spots4 ,the proper kind of encouragement and the right kind of vigilance1 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 out4 ,,fake ,,medical ,,treatment ,,for ,,venereal ,,diseases4--,parents should in every possible way discourage the use of patent medicines and fake medical methods of curing these diseases4 ,untold harm has been done to boys and to women by these nostrums4 ,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 treatment4 ,their work is carelessly performed1 and frequently they are directly responsible for the development of complication and dangerous sequelae4 ,the promises of speedy cures are false1 and1 not infrequently1 methods of black-mailing have been known to follow an expensive and unsuccessful course of treatment4 ,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 diseases4 ,parents should see to it that the family physician is prescribing any strange medicine that may appear in the boy's room1 and not some unknown individual who may be an impostor and a blackmailer4 ,,sowing ,,wild ,,oats4--,writers of fiction and others of a more serious trend of thought have recognized the sowing of wild oats as an institution which1 if it does not merit the full approval of society's moral code1 is1 at least1 tolerated4 ,no serious consequences befall the offender4 ,on the contrary1 the libertine is the type of hero who receives the commendatory quips of erotic dames and the questionable interest of hysterical maidens4 ,women of easy morals are always willing to espouse the cause of the black sheep1 and to further the matrimonial success of the penitent roue4 ,many mothers are willing to marry their daughters to the polished villain of society1 who is known as a rake and debauchee1 if his family connections are desirable4 ,it has been even held that a youth who did not sow his wild oats was of doubtful stamina4 ,that many able men have sown wild oats is indisputable1 and that many men who are respectful husbands1 have also gone through the mill is also true1 but this need not blind us to the fact that thousands upon thousands1 who could have been successful men of affairs and creditable husbands and fathers1 have been utterly ruined1 as a result of having sown wild oats4 ,no man is a better man because of a past record of licentious habits4 ,the man who sows and escapes the harvest is lucky4 ,the man who reaps1 reaps in abundance4 ,most men regret the lapses of youth4 ,most of these lapses would never have occurred if the impulse could have been governed by the reasoning of maturity4 ,these acts are the promptings of an impetuosity which may be entirely foreign to the individual's innate character1 but brought out by promiscuous circumstances and the ignorance and license of youth4 ,if we can protect youth1 by an adequate knowledge of the consequences1 we will furnish the means to tide over the impressionable period4 ,until a healthy maturity of judgment will assume the task unaided4 ,the effects of the wild oats' theory are too tragically evident to need any argumentative refutation4 ,the statistics of the prevalency of venereal diseases alone is sufficient2 the results of these diseases are more than enough4 ,study the records of the jails and prisons1 courts and asylums1 hospitals and health resorts1 think of the hundreds of thousands of diseased and deformed and mentally inferior children1 of the multitude of paretics1 melancholies1 ataxics1 maniacs1 syphilitics1--all the products of wild oats1--and ask if the wild oats' theory is justifiable4 ,think of the ruined homes1 the wretched lives of fallen women1 the hopeless prayers of abandoned wives1 the loneliness and misery of parents neglected and forgotten1 the bastards and fatherless children1 the drunkards and criminals and tramps--all weeds of the wild oats' harvest4 ,then reflect upon the tragedies1 the suicides of the betrayed and of the diseased1 the bank thief1 the broken hearts of deserted and hungry children1 the army of inefficients--around whose necks hang wild oats' medals1 the men of big business1 who constantly fight the effects of early incontinence and abuse1 and the thousands who go to early graves1 and then ask1 in all justice1 if the sowing of wild oats needs justification4 ,who supports the thousands of prostitutes8 ,who made them8 ,wherever you find pauperism1 crime1 drunkenness1 insanity1 idleness1 immorality1 vice and disease1 you will find that the sower of wild oats has traveled the path and left his stain and his footprints there4 ,,should ,,circumcision ,,be ,,advised8--,the answer to the above question is ,yes1 in every instance4 ,if circumcision is done early1--during the first two weeks of life1--the operation is without danger and practically without pain4 ,in quite a considerable percentage of all males1 circumcision is an absolute necessity4 ,for excellent medical reasons1 about which your family physician can inform you1 every boy should be circumcised4 ,,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 ,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 ,first1 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 ,mothers4 ,,what ,a ,,mother ,,should ,,tell ,,her ,,little ,,girl4--,every little girl should be told the ,story of ,life by her mother4 ,it should be told in simple language1 so that the little girl will understand4 ,very early in life the little girl will be prompted to inquire of her mother ,where do babies come from8 ,it is wrong to give an evasive reply to this natural inquiry or to postpone telling the story1 because they will be told it by playmates and will receive very wrong and very crude impressions of this wonderful subject4 ,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 plan4 ,she should begin by telling her a story about how the birds live4 ,how at a certain season of the year they choose a mate and go housekeeping4 ,they build a nest1 and when it is all nicely finished1 the mother bird lays her eggs4 ,then the papa and mamma bird take turns and sit on the eggs to keep them warm1 and after a time the egg breaks and a little bird is born into the world4 ,they feed the little baby birds until their feathers grow1 and when they are old enough they fly away from their home and begin life by themselves4 ,many questions will be asked as the mother tells the story in her own words1 and the correct answers to these questions will fill in all the difficult-to-understand points4 ,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 also4 ,be careful to impress upon them that there is always a mamma and a papa1 a male and a female bird and fish1--that this is necessary because ,god made it so1 and we must obey ,his wish4 ,when the little girl fully understands the story of the egg bird1 and egg fish1 the mother can tell how the ,creator thought out a different plan for other animals like the dog1 horse1 lion1 elephant1 and cow4 ,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 babies1 so he made a nest for them inside of their bodies4 ,there they would be warm and would always be with their mammas no matter what they were doing4 ,so we come to the answer to their question3 ,where do babies come from8 ,these interesting stories1 according to the intelligence and sincerity of the mother1 can be taken advantage of1 to impress the little girl with the importance of many of the lessons of life4 ,for example1 her attention can be drawn to the fact that man and woman are the highest types of living things that ,god made4 ,no other living thing1 animal1 or fish1 or bird1 or tree1 or flower1 can talk1 and think1 and reason as man and woman can4 ,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 made4 ,we try to find out what the different rocks are good for2 what the different trees are good for1 and the different kinds of earth1 and animals1 and birds1 and fishes1 and everything in the world4 ,we study these1 and we learn much1 and we are made happier and more comfortable by what we learn4 ,for example1 by studying horses1 and feeding and breeding them carefully1 and training them1 and caring for them1 we can make stronger horses and better and faster horses2 by studying trees1 and planting them in soil best suited to them1 and giving them plenty of water to drink1 we can compel these trees to grow better apples and pears and peaches4 ,in the same way we can produce better strawberries1 and oranges1 and grapes1 and we can grow flowers with sweeter smells and prettier colors4 ,we do all this by training these animals and trees to grow a certain way1 to eat certain food1 to drink pure water1 and we protect them from the cold and sometimes from the sun if it is too hot4 ,our faculty to think and reason has taught us just what is good for them1 and we compel them to obey our laws4 ,as a result they become strong and more healthy4 ,now show the little girl how important she is2 how much more precious she is than a tree1 or animal1 or flower1 and how much more necessary it is that we1 mammas and papas1 should use our ability to think and reason in her interest4 ,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 healthy1 and pure1 and good1 and clean men and women of all the little boys and girls in the world4 ,tell her that this is what mother is doing now1 training her and compelling her to do the things that will make her a strong and a good mother when she grows older4 ,let her distinctly understand that it is the duty of mothers to instruct and to correct their little daughters when they do any wrong4 ,mothers know1 because they have had experience in these matters1 and they know just how a little girl must live1 and dress1 and eat1 and behave1 in order to be strong and pure1 and good4 ,so when mother reproves and corrects1 it is because she knows that what you are doing to merit a correction is not for your ultimate good4 ,show them that all young things1 and young animals1 and young babies1 and young girls1 must be compelled to obey certain rules and laws1 otherwise they would not grow up to be strong and healthy4 ,sometimes a rose bush grows up among stones and weeds1 but it never thrives1 it is always more or less sick4 ,it does not grow strong1 its flowers are poor little sickly things compared to the roses on a bush that is planted in proper soil1 and carefully tended and pruned1 and watered4 ,so would the little girl turn out if she grew up in bad company and did not have a mother to guard and guide her1--to prune her when she was growing careless4 ,everything in this world has a meaning1 and when mother tells you that you must not do a certain thing you very much want to do1 she has a very good reason for telling you not to do it4 ,you may not know the reason1 but you should have confidence in your mother1 you should believe that she knows what is best1 and that she would not inflict pain or cause you suffering unless she knew it was for your good4 ,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 tired4 ,it would much rather enjoy itself in its own care-free1 and happy way4 ,and when finally a full set of harness is put on1 and it is put into the shafts of a wagon and tied there1 and made to pull it and its driver many weary miles the horse does not like it1 and he rebels strenuously4 ,he is1 however1 compelled to obey in the end1 and he finally consents to become a useful horse4 ,it is exactly the same way with every little boy and girl4 ,we are put into this world for a certain purpose1 and we must all work4 ,now parents know this1 and they know just how to prepare little girls and boys for this work4 ,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 ahead4 ,,what ,a ,,mother ,,should ,,tell ,,her ,,daughter ,your daughter is now about fourteen years of age4 ,she is about to pass from girlhood to womanhood and she should know more of life's story4 ,the mother will now tell her the complete story in the form of little talks1 based upon the following facts as texts4 ,each mother will doubtless add to the story as conditions justify and as the education of the mother and daughter may dictate4 ,a multitude of little side talks can be wisely indulged in to make clear any uncertain or doubtful explanation1 and every one of these incidental excursions can be made exceedingly interesting if wisely and opportunely chosen4 ,always remember1 however1 to emphasize the sacredness of the story4 ,do not permit your daughter to get the impression that you are telling her something that simply has to be told1 just as you told her the correct way to boil an egg4 ,let her realize and get the impression that this is the most serious and most wonderfully interesting story in existence1 the most important story she will ever hear4 ,let her understand that motherhood1 for which she is now preparing1 is the duty ,god assigned her in this world3 that that duty must be carried out1 and that she must do nothing1 nor leave anything undone1 to interfere with its accomplishment4 ,do not only impress her with the story itself1 but let your own explanation be so emphatically serious1 that she will deeply appreciate its momentous significance--an occasion to be remembered all her life4 ,if she gets the proper impression from you at this time she will never treat the subject lightly1 or permit it to be promiscuously discussed within her hearing4 ,begin by telling her that she is about to enter the most important period of her life4 ,explain why this is so in the following way1 in your own words4 ,if we admit every female child to be a future mother1 and motherhood the highest function possible to the sex1 then the awakening of the sex organs and the mother instinct1 must be the most important developmental episode in the life story of every woman4 ,if this is so1 then it follows that every girl should enter this period in the very best physical health possible1 in order to reap the best results incident to this evolutionary period4 ,we impress and warn her1 therefore1 that1 as her system is about to undergo important changes1 she must be particularly careful of her health4 ,a little mistake at this time may be followed by more serious consequences than if made at any other time in her life4 ,if a girl is to become a mother1 certain changes must occur in her body before the nest1 of which we previously wrote1 can be made ready4 ,god did not overlook anything when ,he peopled the earth2 ,he therefore wisely planned that these changes in the female should occur at a time when the girl is strong and healthy4 ,,the ,,period ,,of ,,puberty ,,in ,,the ,,female4 ,,symptoms ,,of ,,beginning ,,menstruation4--,at about the age of fourteen these changes begin to give evidence of existence4 ,they affect the girl's whole system and the mother must be especially patient and sympathetic4 ,her disposition may change1 she may want to be alone1 and she may be more or less melancholy4 ,she will be dissatisfied with the things that previously interested her4 ,she will tire easily1 and she may have many spasmodic pains from time to time4 ,the wise mother will tactfully see that she takes plenty of nourishing food and systematic exercise1 and that she gets enough sleep in a well-aired room4 ,there are other physical changes which are observable at this age4 ,the girl grows taller1 the figure broadens out1 the hips widen1 the bust enlarges1 and the waist line increases in size4 ,these are all part of the great change from girlhood to womanhood4 ,,changes ,,in ,,the ,,reproductive ,,organs4--,the principal change takes place in the reproductive organs themselves1 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 body4 ,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 world4 ,,the ,,female ,,generative ,,organs4--,these organs are the womb or uterus1 two ovaries1 two fallopian tubes and the vagina4 ,the womb or uterus is the nest4 ,it is about the size of and is shaped like a pear4 ,it is hollow1 however1 though its walls are quite thick4 ,the ovaries are about the size of a peach stone and lie at the side of the womb1--one on either side4 ,the fallopian tubes connect the ovaries with the womb4 ,the vagina connects the womb with the outside world1--it is sometimes known as the birth canal4 ,in the very lowest part of the abdomen1 or belly1 in front1 is the bladder1 which collects the urine until it is necessary to pass it out4 ,in the back part of this region is the rectum2 it collects all the undigested food1 etc41 from the intestinal canal4 ,between these two1--the bladder and rectum1--we find the reproductive organs1 the womb1 ovaries and vagina1 described above4 ,,the ,,function ,,of ,,the ,,reproductive ,,organs4--,it will be difficult1 even for mothers1 to acquire a clear understanding of the function of the reproductive or generative organs4 ,it is an exceedingly interesting process1 however1 and it is well worth a patient1 attentive study to clearly understand the brief description we give of it4 ,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 her1 and a tale that is interesting is impressive and is productive of thought and reflection4 ,that is the condition of mind we want daughters to be in when they hear this story4 ,the human ovaries begin to prepare themselves for their life work when the girl is about eight years of age4 ,when they are ripe1 or ready to perform this duty1 the girl menstruates for the first time4 ,this is known as the age of puberty1 which implies that she has developed1 passed from girlhood into womanhood4 ,after having reached the age of puberty it is possible to become a mother4 ,,the ,,age ,,of ,,puberty4--,there is no fixed age at which the first menstruation takes place4 ,some girls develop quicker than others1--a condition that depends upon the health and type of girl4 ,a strong1 robust1 full-blooded girl will menstruate at an earlier age1 than will a sickly anemic girl4 ,the average age is fourteen years1 though there is no reason to worry if a girl does not menstruate for a number of years later4 ,in warm climates the age of puberty is from two to four years earlier than in more temperate climates4 ,,the ,,function ,,of ,,the ,,ovary4--,just what takes place in each ovary when it is ripe is best explained by likening an ovary to an orange1--though of course the ovary is very much smaller than an orange1 as was previously noted4 ,if you make a cut in an orange and squeeze it1 you express some of its juice and most likely you will also express one or more seeds4 ,the seeds of the ovaries are called ovules1 and the process by which it expresses them is called ovulation4 ,of course there is no actual squeezing of the ovary1--the ovules grow in the ovary1 and as they ripen they come to the surface1 and when actually ripe1 the part of the surface of the ovary to which they come1 opens up 7like a flower unfolding when in bloom71 and they fall out4 ,the ovule we may regard as the human female egg1 and one ripens and falls out every twenty-eight days4 ,when the egg falls out of the ovary it falls into the tube which carries it into the womb4 ,this tube you will remember is called the fallopian tube4 ,the ovule or egg is now in the cavity of the womb where we will leave it for the present4 ,,the ,,function ,,of ,,the ,,womb4--,while these changes are going on in the ovary1 the womb is also preparing itself for its share of the work4 ,the lining or internal surface of the womb is composed of mucous membrane1 much the same as the interior lining of the mouth and throat4 ,this lining becomes congested with blood1 and is so intensely swollen at the time when the ovule or egg reaches the womb1 that it is ready to rupture and bleed all over its surface4 ,just whether it will rupture and bleed1 depends upon whether the egg is going to grow into a child or not4 ,if it is not going to grow into a child1 it immediately bleeds freely1 and continues to bleed1 until the whole lining of the womb and egg is passed out into the outer world4 ,this takes four or five days and constitutes menstruation4 ,after menstruation is over1 the womb begins again to prepare itself for the coming of the next ovule or egg1 and as this occurs every twenty-eight days1 menstruation is commonly termed the monthly periods4 ,,why ,,menstruation ,,occurs ,,every ,,twenty-,,eight ,,days4--,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 child4 ,if it did not get rid of the old blood1 it would not be in a healthy condition to nourish and take care of a baby1 nor would its interior be ready to supply new fresh blood for the growth of the infant4 ,hence nature constructs and builds a new nest in the interior of the womb each month4 ,it very much resembles the new home into which the bride and groom1 go to begin housekeeping4 ,when you told your little girl the story of life1 you particularly drew her attention to the important fact that every living thing is created by the union of a male and female principle1 and1 therefore1 has a mamma and papa4 ,this applies to trees1 flowers1 vegetables1 fish1 animals1 birds1 insects1--every living thing1 including human beings4 ,we have seen that the ovule from the ovary is the female egg1 or principle4 ,it is the part the female contributes toward the future child4 ,before a child is possible1 however1 the ovule must meet the egg from the male4 ,,the ,,male ,,or ,,papa ,,egg4--,the male or papa egg is called a spermatozoa4 ,it reaches the interior of the womb through the lower opening1 which you will remember opens into the vagina4 ,emphasize to your daughter that the female ovule or egg1 and the male egg1 or spermatozoa1 are minute objects1 so microscopically small that a hundred million of them could comfortably lie upon a ten-cent piece4 ,,the ,,function ,,of ,,the ,,spermatozoa4--,god gave the male spermatozoa the power to move4 ,to watch them under the microscope you would imagine you were looking into a bowl of water1 in which there were hundreds of little fish all squirming around4 ,but the most wonderful thing about them is1 they can only move in an upward direction1--they seemingly cannot move downward1 or sideways4 ,if you think for a moment you will understand why ,god gave them this marvelous property4 ,when the male semen is deposited in the female vagina1 there are thousands of these minute1 living1 moving spermatozoa in it4 ,the womb is above the vagina1 and the female egg is in the womb1 consequently1 to reach this egg1 the spermatozoa must travel upward4 ,to travel in any other direction would be fruitless energy4 ,there is only one female egg1 but there are thousands of male eggs1 or spermatozoa2 it is easy1 therefore1 to comprehend how one of these spermatozoa should exactly be in line with the female egg in its upward path1 since there are so many of them4 ,it is only necessary that one should meet the female egg in order to impregnate it4 ,the shape of the male principle1 or spermatozoa1 is exactly like a little tadpole1 and you no doubt recall that a tadpole has a minute tail1 the movement of which enables it to swim around4 ,so has the spermatozoa1 and by the incessant movement of this microscopic tail they all move upward as soon as discharged by the male4 ,i told you that ,god gave the male-germ life4 ,it is necessary now to explain the character of this life4 ,it is very brief2 it is estimated that they are active for two hours1 and then become inactive1 or die4 ,the best way to explain the brief activity to your daughter1 is to liken the spermatozoa1 to a mechanical toy1 which is wound up to go for a certain time4 ,after it runs out it becomes inactive2 this is exactly what happens to the little human tadpole4 ,if during this brief life none of them has happened to reach the female egg1 pregnancy does not take place and menstruation occurs4 ,on the other hand1 if this were not so1--if these spermatozoa were active for a longer period1 pregnancy would almost be certain to take place every time the womb was not already occupied with a pregnancy4 ,,tell ,,the ,,whole ,,story4--,when a mother reaches this stage of the wondrous tale she will be asked by an innocent girl1--,how do these spermatozoa get there8 or1 ,you have not told me where these tadpoles came from or1 ,i don't understand how these spermatozoa got into the vagina or1 ,i don't know why you call these the male egg when they are in mamma4 ,it does not matter how it is expressed1 the intent is plain enough4 ,i have said1 that an innocent girl will ask this question1 the implication being that one who is not innocent will refrain from asking this question4 ,a girl who knows the answer will not ask1 because1 if she is familiar with this subject before her mother thinks it wise and proper to tell her1 she obtained her information from a source which1 most likely1 insinuated a suggestive1 or evil1 meaning into the explanation1 consequently she would be afraid1 or ashamed1 to ask the question4 ,an innocent girl1 on the other hand1 would rightly ask for information which is obviously kept back1 and which she has a right to know1 since a complete1 and intelligent understanding of the story depends upon the elucidation asked4 ,if it is proper to tell part of the story1 it is essential to tell all of it4 ,tell it in your own words in this way3 ,when ,god conceived the human race ,he ensured its perpetuation by designing a method whereby this would be rendered possible3 ,he did more2 ,he wisely decided that the function1 involving the very existence of the human race1 should be attended with a sentient gratification4 ,he further instilled into the fundamental economy of mankind1 sex attraction1 which is involuntary1 undeniable1 and unquenchable4 ,if ,god conceived the means and the method1 no human mind in possession of its faculties should see evil where it does not exist4 ,it was by ,him designed that the male organ of reproduction should deposit its germinating fluid in the vagina of the female1 and this is accomplished by a union of species4 ,the one set of reproductive organs is a complement of the other1 and essential to the other4 ,it is by this act that the male spermatozoa is enabled to complete the function of fecundation4 ,if now we assume the male and female element to have met and united1 menstruation does not take place4 ,the egg or embryo 7the future child7 begins to grow1 and it remains in the womb for two hundred and eighty days from the day when the male and female egg met4 ,it is quite natural for an intelligent girl to ask her mother to explain1 ,how a baby can live in there for such a long time1 or ,what makes it grow if it does not get anything to eat or drink4 ,,how ,,the ,,baby ,,gets ,,its ,,nourishment ,,in ,,the ,,womb4--,these questions can be answered in this way4 ,while the baby is in its little comfortable home it gets everything it needs4 ,you are in your home now4 ,if you wanted a drink1 what would you do8 ,wouldn't you go to the water faucet and draw a glass of water8 ,the water comes to you through a pipe1 right into your home1 you don't have to go out of the house to get it4 ,and if you wanted light when it is dark you would turn on the gas and light it4 ,it1 too1 comes into your home through a pipe4 ,now baby gets its air2 and food1 and all it needs to drink in just that way4 ,there are two little pipes which go into its nest or home1 and then into the baby's body at the navel1 and through these pipes fresh blood runs in and out4 ,when mother breathes1 her blood sucks up oxygen from the air in her lungs1 and the blood carries oxygen to every part of her body4 ,in this way1 all parts are supplied with the proper quantity of air4 ,now the baby is simply a new part of mamma as long as it is in its nest in her body1 so it too gets air in this way4 ,when mother eats1 the food is taken into her stomach and it is there changed into liquid and so prepared1 that when it passes into the intestines1 the part of the food that is good for her1 is sucked up into the blood1 and the blood carries it to every part of her body4 ,it distributes whatever is needed to all parts1 and as the baby is a part1 it gets its share4 ,the other pipe carries the blood back again1 out of the baby for new supplies1 and as this is going on all the time1 there is no danger of the baby starving in any way1 or at any time4 ,when your daughter understands this1 show her how important it is that mothers should be in good health1 otherwise the baby will not get good food1 it will not be properly nourished and will be born a poor1 little sickly child4 ,little girls1 consequently1 should try to eat properly1 exercise regularly1 and do everything their mothers tell them1 so that when they become mothers1 they will be able to nourish their babies and not bring into the world poor little starved infants4 ,,girls ,,must ,,not ,,become ,,mothers4--,we have previously stated that girls can become mothers when they have reached the age of puberty4 ,god did not intend1 however1 that girls at the age of twelve or fourteen should become mothers1 because their bodies are not strong enough1 nor are they fully grown1 nor have they the experience1 to undertake the physical task and responsibility of bringing a baby into the world4 ,we know this from experience1 because we have seen the sickly babies such girls have1 and we have seen how much these girl mothers suffer1 and how they ruin their health1 by trying to do what ,god did not intend they should do4 ,even the trees teach us this lesson4 ,an orange tree will bring out buds1 which would develop into oranges1 when it is two years old4 ,the experienced farmer1 however1 will pluck these buds off1 and will do so every year1 till the tree is five years old4 ,if he allowed the tree to bear fruit during its young years1 the oranges would not be good1 or sweet1 or large2 so he waits until the tree has grown and is strong and healthy1 when its fruit will be large and sweet4 ,an orange tree of this type will have better fruit1 and will continue to produce this good variety for many years4 ,a tree allowed to bear fruit when two years old will never have first class oranges1 nor will it continue to have1 even poor oranges1 as long as the other4 ,,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 ,menstruation1 or ,amenorrhea--,treatment of ,amenorrhea--,painful ,menstruation1 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 ,womb1 ,ovaries1 or ,tubes--,malformations--,lacerations--,t umors--,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 ,miscarriage4 ,,menstruation ,we have explained in the previous chapter what menstruation is1 its frequency1 its significance and its origin4 ,there are a number of its common characteristics with which the mother and daughter should be acquainted4 ,,irregular ,,menstruation4--,menstruation may occur once 7the first time7 and fail to recur the following month or for a number of months4 ,this need cause no alarm as long as the general health remains good4 ,it will come again in its own time4 ,nervousness may cause a suspension of menstruation4 ,this is quite common in school girls who are driven too hard at school1 whose sleep is interfered with1 whose appetite is poor and who are allowed too many social indiscretions1 as parties1 dances1 etc41 where late hours are observed1 all of which should be put aside until school life is over4 ,sometimes menstruation will temporarily stop if the girl goes away from home on a visit4 ,sometimes the quantity will be greater than at other times1 and a very scant flow1 after it has been free and regular may cause apprehension4 ,various causes may be responsible for a decrease1 catching cold1 sitting on cold steps or cold ground1 wearing damp clothes1 nervousness1 mental worry1 physical exhaustion1 insufficient food and exercise1 and anemia1 may cause it4 ,for these reasons a girl should be exceedingly careful of her health1 she should guard against catching cold4 ,do not change the underwear until certain that the weather is far enough advanced in season to justify such a change4 ,she should not become exhausted or worry4 ,in all cases of suppression1 or of increased flow1 a physician should be consulted at once1 and girls should be instructed to tell their mothers of any change in the character of the periods1 as soon as it occurs4 ,mothers should instruct their daughters to rest the first day of their monthly flow1 and all during the menstruation they should refrain from any unusual activity4 ,even play should be moderated and abstained from entirely if there is any pain4 ,in order that the girl fully appreciates why these rules are laid down1 it is advisable to explain just how the womb is held in place in her body4 ,this appears to the writer as being a particular important point4 ,a girl must not be expected to give these matters the serious consideration they merit unless she thoroughly understands the reasons why4 ,an explanation1 in the form of even an intelligent talk1 will soon be forgotten4 ,if1 however1 a definite1 concrete picture1 is impressed upon her2 if she actually sees in her mind the process that is going on1 she will understand why it is necessary to do as she is told4 ,if the mother will therefore assure herself that the daughter actually knows what is being accomplished in her womb at the menstrual period1 she will carry out the instructions more faithfully4 ,,how ,,the ,,womb ,,is ,,held ,,in ,,place4--,the human uterus1 or womb1 is held in its proper place in much the same way as a clothes pin sits on a clothes line4 ,the heavier part is the upper part1 and that part is held in place partly by resting on the rectum behind1 and the bladder in front4 ,when menstruation occurs1 the body of the womb becomes much heavier because of the increased amount of blood in its interior4 ,this added weight increases its liability to tip over1 and if any extra strain or effort is made at this time it will become tipped1 or as the physician calls it1 displaced4 ,if a womb becomes displaced1 every menstruation afterward will be painful and prolonged1--sometimes excessively so4 ,a displaced womb becomes congested and unhealthy4 ,it causes leucorrhea or a chronic discharge1 makes a nervous wreck of the woman1 results in sterility and frequently in a dangerous operation4 ,there are1 therefore1 ample reasons for watchfulness and care on the part of the growing girl4 ,,symptoms ,,of ,,menstruation4--,after menstruation is established there should be no actual pain at each period4 ,there are1 however1 certain undefined feelings1--premonitory symptoms1--which may be explained in the following terms3--,a day or two before the date on which the menstruation is expected1 the girl will appreciate that her sickness is coming4 ,she will not1 or should not1 complain of pain1 but will state that she has a bearing down feeling1 is a little more nervous than usual1 has no desire to go into company1 and wants to be more or less her own entertainer4 ,the sick period usually lasts four or five days4 ,the second day is the most important4 ,,menstruation ,,should ,,not ,,be ,,accompanied ,,with ,,pain4--,if any actual pain accompanies menstruation1 either before or after it is established1 the mother should at once take the daughter to the family physician4 ,menstruation is a natural1 physiological act and should not be accompanied with actual distress or pain4 ,it is astonishing how many mothers will allow their daughters to suffer needlessly1 for months and years1 because of the mistaken idea that since the pain is there1 it must be1 or because she--the mother--suffered1 so also must the daughter suffer4 ,there is no more unfortunate mistake1 and many a girl's health and happiness has been blasted because of this misbelief4 ,the cause of the pain is1 in a vast majority of the cases1 a very simple one1 and can be removed in a very brief time4 ,should the menstrual period last too long1 be too frequent1 or be in any way not what it should be1 consult your physician4 ,if you are not sure of what it should be1 or if you have any doubt1 ask your doctor4 ,don't let any false pride or feeling of modesty on your part1 or on the part of your daughter1 dictate your policy under such circumstances4 ,don't take the advice of your friends or neighbors in a matter so vital4 ,it is too important1 and they are not qualified to guess any more than you are4 ,don't1 if you have any respect for yourself1 or love for your child1 begin dosing her with the advertised patent medicines and ,female ,regulators for which so much is claimed1 and which seem to just suit your daughter's case at this particular time4 ,take her to the doctor1 whose advice you value 7or you should not have him as a family physician71 who has no interest at stake except to help you and your child1 and whose fee is no more than the price of one of these bottles of advertised poison4 ,he is the only one qualified to speak with authority on such a momentous subject1 and you will never spend a dollar to better advantage4 ,warn your daughter not to speak about her sickness to other girls4 ,especial attention should be paid to cleanliness during this period4 ,the mistaken idea that bathing of any kind at this time may have disastrous consequences is responsible for much of this neglect4 ,if proper care is taken warm sponge baths1 in a warm room1 will not cause any trouble4 ,unpleasant odors can be avoided by sponging the parts with a warm solution1 into which a mild antiseptic is put1 upon changing the cloths4 ,,leucorrhea ,,in ,,girls4--,it has been stated above that a displaced womb may cause leucorrhea or a discharge4 ,it must be remembered that leucorrhea1 or whites1 may occur in girls as well as in married women4 ,it can also result from catching cold during the menstrual period4 ,another mistaken idea is that girls should not take douches for fear of injuring the hymen4 ,this is erroneous1 and while they are entirely unnecessary in a vast majority of cases it is sometimes absolutely essential to douche in order to cure leucorrhea4 ,when they are given1 it is advisable to use the small nozzle that comes with every douche bag set4 ,,constipation ,,and ,,displaced ,,wombs4--,when the picture is fresh in the mind of the girl1 of how the womb is held upright in her body1 the mother should speak to her about the serious results that may occur from constipation4 ,if the rectum is full of hardened feces the womb will be pushed out of place1 and if under these circumstances straining is necessary to empty the bowel1 and if this condition is habitual1 constipation may be the actual cause of displacement of the womb4 ,,dress ,,and ,,menstruation4--,it is also an opportune time to demonstrate to what extent serious results may follow mistakes in dressing4 ,the habit of permitting growing girls to constrict the waist1 to bind and pull the abdomen by too tight garters1 or too tight corset1 is wrong1 and no mother should permit it4 ,in another part of the book1 this matter is taken up more fully1 but if it is explained to the girl while she is considering the subject of menstruation1 she may more quickly and more fully appreciate its significance4 ,,absence ,,of ,,menstruation--,,amenorrhea4--,the absence of menstruation after it has been established1 does not1 as a rule1 indicate any disease of the womb or female sexual organs4 ,it is to be regarded merely as a symptom and can be1 as previously stated1 safely ignored if the general health is good4 ,if the general condition is poor1 and the quantity and quality of the blood deficient1 it is a provision of nature to suppress menstruation in the interest of the general health4 ,for this reason it is safe to disregard the amenorrhea and build up the bodily strength4 ,this explains why some girls pass the usual age of puberty and show no signs of menstruating4 ,they are poorly developed sexually1 through deficiency of blood4 ,if1 on the other hand1 a girl should have all the symptoms of menstruation every month1 but no flow1 she should be examined by a physician to determine if there is any obstruction to the escape of blood4 ,total absence of any symptoms of menstruation extending into adult life1 may indicate an absence of the sexual organs4 ,during the first year after puberty it is quite natural for menstruation to be irregular2 after the function is thoroughly established there are many causes that may be responsible for its temporary absence4 ,,causes ,,of ,,amenorrhea4--,any condition or circumstance which reduces the general health or impoverishes the quality or quantity of the blood and weakens the nervous system1 will result in a stoppage of the monthly periods4 ,among these are insufficient food and exercise1 overwork1 overstudy1 exposure to cold1 sitting on cold steps or gold ground1 wearing damp clothes1 bathing in cold water at the beginning of menstruation1 powerful emotions1 as great fright1 anger1 anxiety2 acute diseases1 such as typhoid fever1 cholera1 the infectious skin diseases2 chronic diseases such as ,bright's disease1 heart disease1 consumption2 anemia and chlorosis are very common causes4 ,obesity or an overfat condition will cause an early suppression of the menses which may result in a fruitless marriage4 ,displacement of the womb and other local disorders frequently result in scanty or delayed menstruation4 ,anxiety lest pregnancy may occur in the newly married may cause a delay in the periods4 ,a radical change of climate or sometimes a visit to the country1 or changed circumstances may stop the flow for the time being4 ,,treatment4--,the treatment of amenorrhea1 or absence of menstruation1 will depend on the underlying cause4 ,a careful investigation should be made into the mode of life and the hygienic surroundings of the patient4 ,her general health and her mental condition should be inquired into4 ,if the patient is not in good health1 or is not obtaining exercise in the open air1 or if she is a victim of mental worry or of domestic unhappiness1 or if any sufficient cause exists for the amenorrhea it must be removed before any treatment may be expected to relieve the condition4 ,if the patient is a married woman the possibility of pregnancy should always be borne in mind1 and no radical treatment instituted until this has been excluded4 ,if the absence of menstruation is dependent upon defective development of the sexual organs we cannot expect much from any treatment4 ,the amenorrhea from exhaustive diseases will usually correct itself with1 or soon after1 the establishment of convalescence4 ,in diseases which tend to death1 as in consumption1 heart disease1 etc41 the function is never reestablished4 ,a very common habit of most people is to regard the absence of the monthly periods as the cause of their ill health4 ,it is not1 it is the result of the ill health4 ,get rid of the bad health and the menses will take care of themselves4 ,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 change1 or returns home if the visit is of brief duration4 ,as a general routine treatment1 good wholesome food1 regular hours1 fresh air1 sunlight1 and judicious exercise1 with such other measures as may be suggested by the condition of the blood and nervous system1 are the indications in the way of treatment4 ,anemia and chlorosis 7poor blood7 should be treated by the administration of iron in some form4 ,obesity should be reduced by diet1 exercise1 and such other treatment as may be found efficient and not detrimental to health4 ,overwork1 mental and physical1 should be stopped1 and sedentary habits changed to a more active out-door life4 ,the acute suppression from exposure to cold1 wearing of damp clothes1 sitting on cold stones or cold or damp ground1 sea bathing in very cold water1 is very often associated with an acute inflammation of the womb itself and calls for rest in bed1 laxatives to open the bowel1 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 relieved4 ,the use of the sitz bath is frequently successful if taken at night followed by a laxative and a hot drink4 ,,painful ,,menstruation--,,dysmenorrhea4--,most1 if not all1 victims of painful menstruation are of a nervous temperament4 ,dysmenorrhea is simply one symptom of the general nervous condition4 ,the nervousness may be acquired or it may be the result of heredity4 ,in girls it has been found to be an accompaniment of the overwork and worry of school and student life4 ,girls who suffer greatly from it while in school are entirely free during vacation from school4 ,there is a type of painful menstruation known as neuralgic dysmenorrhea4 ,this is simply a local expression of a general neuralgic tendency4 ,it comes under conditions which favor neuralgias in other parts of the body4 ,girls and women affected with this type of dysmenorrhea are often anemic1 hysterical1 and not infrequently the victims of malaria1 rheumatism1 or other diseases which tend to impoverish the blood and reduce nerve vitality4 ,the pain resembles neuralgia elsewhere4 ,it comes and goes1 it may last a brief time or a long time1 it may be very mild or very severe4 ,the pain bears no fixed relation to the flow1 it may proceed1 accompany or follow it4 ,mechanical dysmenorrhea is that form in which a mechanical impediment exists to the escape of the menstrual fluid4 ,the internal canal may be too small1 displacement1 growths1 either inside or out of the womb1 faulty development1 or frequently simple congestion will act as an obstruction and cause pain from tension4 ,the pain accompanying mechanical dysmenorrhea is very different from the neuralgic type4 ,it comes on gradually1 increases slowly until it is very severe and stops suddenly4 ,a gush of blood from the womb announces the fact that the obstruction has been overcome and the womb has emptied itself2 as soon as this occurs the pain ceases4 ,in the mechanical variety there are frequently clots in the menstrual flow4 ,inasmuch as this type may be caused by imperfect development of the womb1 it is common to find that pain has characterized the monthly periods from the time of the first menstruation4 ,it may1 however1 as stated above1 be caused by growths which had their beginning at a later period4 ,,treatment4--,for the neuralgic variety the treatment should be general4 ,the whole object is to build up the general health4 ,fresh air1 sunlight1 out-door exercise1 plain1 substantial food1 regular hours1 pleasant surroundings1 and such medication as may be indicated1 should be the course to follow4 ,the bowels should be kept regular and digestion aided in every way possible1 if necessary by rest from school1 or work1 or by a change of air and scene4 ,if the patient is inclined to malaria she must take quinine and live in a locality free from that tendency4 ,if rheumatic she should take the remedies advised in that disease and avoid colds1 wet clothes1 or sitting in cold1 badly ventilated rooms1 churches or theatres4 ,if there are no distinct evidences of special tendencies1 general tonics may be given to advantage4 ,these should consist chiefly of iron1 arsenic1 phosphous1 nux vomica1 cod liver oil1 etc4 ,the treatment of mechanical dysmenorrhea of course implies removal of the cause4 ,as this necessitates operative procedure1 or at least an examination by a physician1 it is best left in his hands4 ,,sterility ,sterility means the inability to become a parent4 ,a woman who is sterile cannot become a mother4 ,she is for some reason unable to have a baby4 ,a childless union is frequently the cause of much unhappiness4 ,there is something lacking in the expression a childless home4 ,it seems a paradox1 as home is inherently associated with children and happiness4 ,it has been stated that one out of every eight marriages is barren4 ,the average time which elapses after marriage and the birth of the first child is seventeen months4 ,physicians agree that if a woman goes over three years after marriage without having a baby her chances of having one are small4 ,if children are desired1 and they usually are by childless parents1 every effort should be made within the first three years to ascertain the cause of the sterility1 and if it can be rectified4 ,the barrenness may be dependent upon some physical defect which will quickly respond to the proper medical treatment4 ,it is well to remember1 however1 that the defect is not always the woman's4 ,in every six childless marriages about one is due to sterility in the husband4 ,the age of the greatest fertility in women is between twenty and twenty-four years4 ,it is rare to find a barren woman between these years4 ,nature evidently intended that the duties of maternity should be assumed between the twenty and twenty-fourth year4 ,if married before the age of twenty the statistics prove that barrenness exists in one woman in every twelve4 ,if married after the twenty-fourth year the chances of having children decreases with the age of the woman4 ,if a mother goes for three consecutive years without becoming pregnant the chances are that she will have no more children4 ,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 past4 ,many conditions could1 and may1 have occurred since the last pregnancy 7and may be as a result of that pregnancy7 to change her natural fertility into a condition of temporary sterility4 ,an examination should therefore be made before too long an interval elapses and the facts learned4 ,it will usually be found in such cases that a displacement or laceration1 or at most1 some cause easily remedied is immediately responsible for the apparent barrenness4 ,,conditions ,,which ,,affect ,,the ,,fertility ,,of ,,women ,,climate4--,it is a well-known fact that more children are born in southern regions than in northern countries4 ,it may be asserted1 therefore1 that climate affects the fertility of the race4 ,,station ,,in ,,life4--,children are more numerous among the poor than among those who are wealthy and enjoy the luxury of riches4 ,this condition cannot1 however1 be construed as a true expression of fertile efficiency4 ,it is more a comparison of ethics1 and when we express it thus we are giving it its most charitable name4 ,,season ,,of ,,the ,,year4--,the spring of the year1 being more favorable to fecundity1 exerts an influence over the increase of population4 ,nursing mothers are as a rule sterile until after weaning time4 ,this is not always so however1 and the possibility of pregnancy taking place while nursing a baby1 and before menstruation is reestablished must be reckoned with as it occurs quite frequently4 ,,age4--,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 ceases4 ,,the ,,tendency ,,to ,,miscarry4--,because a woman has never given birth to a living child is no proof that she is sterile4 ,many women have the ability to conceive but for some reason they have acquired the misfortune1 or the knack1 of miscarrying4 ,this is a condition of the gravest significance and will be considered at length in its proper place4 ,the influence of a temporary separation has had excellent results in a great many historical cases4 ,where the married couple seem to be lacking in some one or other of the emotional or temperamental qualifications1 it is advisable to suggest a temporary separation4 ,when this period has expired and they resume marital relationship the element of novelty1 acting as a stimulus1 quite frequently reestablishes a fertility that was seemingly suspended1 or awakens it if conception has never previously taken place4 ,there are a great many cases on record where1 conditions having remained the same1 women have become fertile after years of seeming barrenness4 ,it is impossible to explain1 or to satisfactorily understand these cases4 ,it is quite common to note cases in which women have never become pregnant until a number of years after marriage1 even when the desire to have children existed4 ,there is one case on record of a woman married at eighteen1 but although both herself and her husband enjoyed habitual good health1 conception did not take place until she was forty-eight years of age when she bore a healthy child4 ,women should not1 therefore1 become easily discouraged in the hope of having a baby1 especially when they have a clean history1 and a healthy body4 ,the conditions may change and may become favorable when hope is about to die4 ,,causes ,,of ,,sterility ,,in ,,women ,inasmuch as it is necessary to consult a competent physician in all cases of sterility1 it is not necessary to go into detail regarding each possible cause1 other than to explain how each may produce barrenness4 ,it will be observed that a competent physician is specified and advised in these cases4 ,this is very important because many advertising1 or quack doctors1 particularly solicit these kind of cases4 ,they are not competent to be trusted with such cases and will likely effect more harm than good4 ,a woman should not hesitate to consult the best available medical authority if she is a victim of sterility4 ,there is nothing to be ashamed of4 ,it is a perfectly proper medical situation and should receive the best medical advice and investigation4 ,the following are the more frequent causes of absolute sterility4 7,a7 ,displacement of womb4 7,b7 ,diseases of womb1 ovaries or fallopian tubes4 7,c7 ,malformations4 7,d7 ,lacerations or tears of mouth of womb4 7,e7 ,tumor4 7,f7 ,leucorrhea4 7,g7 ,physical debility4 7,h7 ,special blood poisons4 7,i7 ,great obesity4 7,j7 ,anemia4 7,k7 ,self-abuse4 7,l7 ,habitual alcoholism4 7,m7 ,lack of moderation in the marital relations4 7,n7 ,certain diseases may be associated with barrenness3 cancer1 diabetes1 consumption1 ,bright's disease1 etc4 7,o7 ,certain temperamental conditions may be associated with barrenness3 lack of affinity1 frigidity4 ,,the ,,knack ,,of ,,miscarrying ,,displacement ,,of ,,womb4--,in many instances the primary cause of the displaced womb was some energetic1 muscular effort1 made while the victim was yet a girl1--probably before menstruation began4 ,whatever act first caused a slight tilting of the womb1 must necessarily have been an unusual physical effort1 and as girls are getting more and more strenuous we may look for more trouble in this direction in the future4 ,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 displacement4 ,the girl may have been the victim of painful menstruation which was neglected1 because not quite painful enough to compel medical relief1 which is sought for only as a last resource unfortunately under the circumstances4 ,intercourse may also have been more or less painful1--a condition which again is mistakenly and imprudently borne in silence and left to take care of itself4 ,but when persistent sterility faces her1 the woman seeks medical assistance and her trouble is discovered4 ,as the displacement is found to be the cause of her sterility1 its correction1 which is a comparatively easy medical problem1 not only cures the barrenness but happily relieves her of the menstrual distress and all other pain4 ,the treatment for displacement consist of placing medicated pieces of wool or cotton1 called tampons1 in the vagina in such a position as to hold the womb1 as nearly in its proper place as is possible4 ,after a time nature will so strengthen the ligaments that they will hold the womb and a cure is1 therefore1 affected4 ,the length of time necessary to cure depends upon the length of time the displacement has existed4 ,it may take1 from two to four months4 ,when the displacement is of long standing and is accompanied with more or less inflammation1 adhesions sometimes grow between the womb and the adjacent organs4 ,it is necessary to resort to surgery in such cases1 but the result is always good and the danger practically nothing4 ,,disease ,,of ,,the ,,womb1 ,,ovaries ,,or ,,fallopian ,,tubes4--,disease of the womb1 ovaries1 and fallopian tubes1 which renders the victim sterile1 is as a rule the direct result of infection4 ,such infection is conveyed by the husband to the wife4 ,this is quite a common condition4 ,the simple fact that such conditions exist leads us to hope that the time is not far distant when it will be compulsory for all participants in the marriage ceremony to submit to a thorough physical examination4 ,by this means1 and by this means only1 will the innocent be protected4 ,no one can conceive1 unless he has been identified1 as a physician1 with one of the large metropolitan hospital clinics1 of the extent of this class of disease1 and of the frightful suffering caused1 and innocent lives ruined1 by infection conveyed in this way4 ,it is a tragic corollary to the marriage vow for better or for worse4 ,if a woman is fortunate enough to fall into the hands of an honorable physician1 who will tactfully explain to her the serious significance of her condition and obtain her consent to treat her until she is cured1 which in all probability will include a surgical operation1 and will do so with diligence1 without regard to the size of the bill1 she will indeed be a lucky woman4 ,it is from women who are suffering with such diseases1--most of them without the slightest idea of what ails them1--that the venders of advertised nostrums reap their fortunes1 and it is from the same victims that most of the advertised medical quacks look for their blood-money4 ,the great difficulty1 however1 lies in the failure of the woman to appreciate the seriousness of her condition1 and as a consequence she fails to understands why it should take so long to cure her4 ,she loses confidence in her physician1 she buys certain cures recommended to her by ,mrs4 ,busybody and later tries other physicians and ends by losing faith in herself4 ,meantime she grows worse and worse4 ,there are thousands such4 ,it may be here stated without fear of contradiction that if the public in general would repose more confidence in the medical profession1 there would be much less suffering1 much less sorrow1 fewer regrets1 fewer irresponsible isms1 and cults1 because there would be fewer disappointed individuals to support them4 ,if the medical profession would condescend to employ the tactics and devices of those questionable1 fashionable agencies that claim the power to cure human suffering1 it could quickly reap the profit and the laudation that it now escapes because it keeps the faith4 ,the way to be cured of any disease1 if it is curable1 is to engage a reputable physician and follow his instructions implicitly4 ,let him understand you expect him to see you through your trouble and let him know you have confidence in him4 ,there isn't one physician in a thousand who will cheat you under these circumstances4 ,,malformation4--,under this heading are all those cases of sterility resulting from imperfect generative organs4 ,these are products of a failure on the part of nature to furnish or develop the structures participating in the propagation of the species4 ,the entire generative organs are sometimes wanting4 ,the womb may have failed for some reason to grow with the rest of the body1 it remains 7as it is known7 as an infantile womb4 ,occasionally the womb grows together1 that is1 it is solid instead of being a hollow organ4 ,the mouth of the womb may be too small1 representing what is called a pin head opening4 ,the natural opening is large enough to admit a lead pencil1 a pin head opening would not be larger than the lead in the pencil4 ,the latter condition is quite a common cause of sterility and is readily amenable to treatment4 ,most of the malformations which produce sterility are impossible to cure4 ,,lacerations ,,or ,,tears ,,in ,,mouth ,,of ,,womb4--,this subject is fully discussed on another page of this volume4 ,,tumor4--,a tumor may be so situated as to prevent conception1 or it may involve the body of the womb constituting a reason in itself for sterility4 ,,leucorrhea4--,leucorrhea or the whites may be of such an acid character as to kill the spermatozoa in the vagina1 or it may be of such volume as to render impregnation impossible4 ,the treatment of this condition is discussed elsewhere4 ,,physical ,,debility4--,when the general health is bad1 no matter from what cause1 sterility usually exists4 ,this lack of vitality may be due to chronic disease1 or it may have been caused by a very severe acute illness1 such as typhoid fever4 ,one's mode of living1 if unhygienic1 may be responsible for continued bad health and a consequent sterility4 ,,obesity4--,very fat women are usually barren4 ,if a woman rapidly accumulates fat after marriage she as a rule does not have more than one or two children4 ,women often become stout immediately after the child bearing age ceases4 ,,special ,,poisons4--,certain special poisons in the blood cause sterility by producing miscarriage4 ,,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 womb4 ,a miscarriage or abortion 7both terms meaning the same--the difference between the two terms is a technical one and need not concern us here7 can occur any time after conception up to approximately the seventh month1 when1 if labor takes place1 the child may be born alive4 ,the condition would then be termed a premature labor4 ,a miscarriage or abortion is an immature labor and implies an immature or dead child4 ,the condition is a serious one no matter whether it is attended with grave symptoms or apparently no symptoms4 ,if it occurs shortly after conception1 during the first few months of married life it is serious1 if not in its physical consequences1 it is in its significance1 because it establishes the tendency to miscarry1--a tendency that may result in great mental distress because of the worry and fear it engenders1 and of sorrow and heartache because it may blast the hope of parentage4 ,such a miscarriage may take place at once after conception4 ,if so1 the following menstruation may be delayed for a week or so and is then a little more profuse than is customary4 ,this will be the only indication that a life has been sacrificed that the young wife may have1 and frequently the significance of such an occurrence is never understood1 yet the tendency to miscarry is nevertheless established1 and a seeming sterility is apparently the fate of the woman4 ,it is1 therefore1 of the greatest importance that extreme care should be taken to bring the first pregnancy to a successful consummation4 ,a young wife should realize that she is apt to become pregnant at any time4 ,her conduct therefore should be such at least as not to harm the life principle with which she has been entrusted4 ,to this end any excessive sexual activity should be strictly avoided4 ,,causes ,,of ,,miscarriage4--,any strenuous physical effort must be guarded against4 ,included in such efforts may be the following3 dancing1 running1 jumping1 surf-bathing1 sewing on a machine1 sweeping1 washing1 house-cleaning1 moving furniture1 etc4 ,sometimes the primary cause of a miscarriage is to be found in some hygienic act1 such as a hot bath1 too prolonged or too many hot douches near the menstrual periods4 ,a blow or a fall1 even a fright or shock may cause a miscarriage4 ,anything that violently shakes or agitates the womb1 which may at this time be irritable because of its condition1 will be sufficient to excite it to contract and miscarry4 ,hence violent coughing or vomiting should be avoided if possible2 horseback riding1 jolting in a carriage1 convulsions1 hysterical crying1 may also be the causative factors4 ,displacement of the womb by limiting its tendency to grow when pregnant1 may cause it to miscarry4 ,very severe general diseases such as small-pox1 pneumonia1 etc41 will cause the womb to empty itself4 ,disease of the fetus or the presence of syphilis in either of the parents will also have the same result4 ,,the ,,course ,,and ,,symptoms ,,of ,,miscarriage4--,the cause of a miscarriage or abortion is much the same as an ordinary labor at term4 ,whatever interrupts the pregnancy causes the death of the fetus4 ,the dead fetus acts as a foreign body and excites the womb to contract as it does during an ordinary confinement4 ,the contractions open up the mouth of the womb and the fetus is expelled together with its membranes and after-birth4 ,the significant and the most important symptom of a miscarriage or abortion is hemorrhage or bleeding from the privates4 ,the flow of blood may not amount to much or it may be excessive and alarming2 it may not be constant1 it may come from time to time in the form of clots4 ,the next significant and important symptom of miscarriage or abortion is pain4 ,the pain1 like the flow of blood1 may be only slight or it may be very severe1 sometimes it is absent in very early miscarriage4 ,as a rule the pain is severe when the miscarriage occurs after pregnancy has lasted for a number of months4 ,a miscarriage or abortion is said to be complete when the fetus with its membranes and after-birth is expelled clean and whole1 or in other words when the womb empties itself completely4 ,a miscarriage or abortion is said to be incomplete when some part of the embryo is left in the womb4 ,,what ,,to ,,do ,,when ,a ,,miscarriage ,,is ,,threatened4--,when a woman1 who is pregnant1 begins to flow she should at once go to bed and keep perfectly quiet and send for a physician4 ,a miscarriage is a treacherous condition and is so regarded by all medical men4 ,it may not amount to much or it may1 on the other hand1 develop into a serious situation4 ,the immediate danger is from hemorrhage2 the ultimate or remote danger is sepsis or blood poisoning4 ,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 case4 ,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 harm4 ,consequently there is no occasion for unnecessary alarm4 ,she must1 however1 as stated above1 heed the warning and go to bed1 keep perfectly quiet and send for a physician4 ,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 life4 ,there is practically no danger during the course of or after a complete miscarriage4 ,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 womb4 ,there are a large number of cases of criminal abortion in which septic poisoning occurs caused by the utensils or instruments used in inducing the abortion4 ,all of these cases are operative cases which must be attended to promptly to save life4 ,,treatment ,,of ,,threatened ,,miscarriage4--,not all of the cases of beginning miscarriage end in miscarriage4 ,if the physician is sent for in time he can very frequently give directions that will1 if carried out faithfully1 avert the disaster4 ,success is more likely to attend those cases in which the trouble has been caused by some accidental injury1 as a fall1 or blow1 or extra exertion4 ,this is more especially the case if the woman has previously borne children1 is healthy and in good condition and whose womb is known not to be diseased4 ,in these cases there is a partial separation of the fetus from the wall of the womb1 which causes the bleeding4 ,the physician will direct that the woman be put to bed1 in a quiet1 darkened room4 ,he will instruct the nurse to sterilize the external genital region3 a sterile gauze dressing is then left in place4 ,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 contract4 ,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 is4 ,each cloth1 each clot of blood will have to be examined before the proper treatment can be pursued in safety4 ,when the miscarriage cannot be prevented it is called an ,inevitable miscarriage4 ,,treatment ,,of ,,an ,,inevitable ,,miscarriage4--,in these cases every precaution is taken1 just as in a normal confinement1 to avert blood poisoning4 ,the hands1 instruments1 dressings1 etc41 are carefully rendered sterile and the whole field must be surgically clean4 ,the physician will conduct the case as conditions justify and as the situation develops4 ,,after ,,treatment ,,of ,a ,,miscarriage4--,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 miscarriage4 ,the average woman and frequently the intelligent woman fails to appreciate the absolute necessity for this procedure4 ,it is necessary and it is the physician's duty to insist on it being done in the interest of the woman4 ,many of the multitude of diseases of women are caused by disregarding advice on such occasions4 ,,the ,,tendency ,,to ,,miscarry4--,if a woman1 for any reason1 has had a miscarriage1 her womb will tend to miscarry at the same period during a subsequent pregnancy4 ,if the miscarriage should occur during her first pregnancy the tendency to miscarry will be greater than if acquired after she has had a baby4 ,this is one of the reasons why young wives often fail to have children4 ,they get rid of the first one or two1 because they are not ready to have children1 or because they want some enjoyment themselves before they are tied down with a family4 ,having established the habit their womb has been educated to abort1 and it will keep this habit up1 much to their astonishment and chagrin4 ,young wives should therefore faithfully follow out all the rules of the ,hygiene of ,pregnancy laid down by their physician1 and which are given in detail in this book4 ,illustration3 ,courtesy of ,new ,york ,world ,,at ,,work ,,with ,,the ,,calipers ,watching carefully the physical development of the child month by month is one of those many little things which may result in disaster if neglected4 ,abnormal development1 or lack of development1 should be promptly reported to the physician1 as it may be a warning of serious trouble4 ,for the table of standards1 mental and physical1 adopted by the ,american ,medical ,society see page #bga4 ,,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 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 ,records1 ,why ,they ,should be ,kept--,growing ,pains4 ,,what ,,to ,,prepare ,,for ,,the ,,coming ,,baby4--,the physician should instruct the young wife just what to provide for the coming baby4 ,the following list will be found useful as a general guide4 ,an ordinary clothes basket1 padded and lined1 is quite sufficient for the first month2 or1 a baby crib1 which may be cheap or expensive as the individual taste dictates4 ,the ,taylor crib is probably the handiest and best one on the market4 ,pin cushion2 ,puff-box and puff2 ,soap box containing pure castile soap2 ,hair brush and fine comb2 ,two wash cloths2 ,four ounces of crystal boracic acid1 a saturated solution of which is used for cleansing baby's eyes and mouth2 ,one pound of good absorbent cotton2 ,a flexible tube of white vaseline2 ,a bath thermometer2 ,a package of sterile gauze2 ,a half dozen baby towels1 good quality2 ,a soft1 white1 good blanket1--one and one-half yards square2 ,one pair small blunt pointed scissors2 ,a package of the best safety pins2 ,three or four dozen bird's-eye cotton diapers4 ,first size1 eighteen inches square4 ,second size1 twenty-five inches square2 ,one yard of soft white flannel for belly bands2 each band should be five inches wide1 by twenty-four inches long4 ,two silk and wool shirts2 ,three flannel shirts 7all shirts should be high necked1 long sleeved1 and open down the front72 ,three ,eiderdown wrappers2 ,three ,cashmere sacques2 ,three pads for crib2 ,six dresses2 ,six petticoats 7they should be thirty-three inches long from neck to hem2 they should be turned up at the bottom for about four inches and should button there to keep the feet warm2 if it is desired to use pinning blankets for the first two months in place of the petticoats1 they should be made of soft white flannel with cotton bands72 ,six night slips2 ,six pair socks2 ,two cloaks2 ,two hoods2 ,one dozen bibs4 ,simplicity1 warmth1 and freedom are the essentials in latter-day baby clothes4 ,it is cheaper to make the clothes than to buy them4 ,excellent and accurate paper patterns can be obtained1 giving the quantity of material necessary and suggesting the kind and quality best suited for the purpose4 ,these patterns may be obtained from the ,butterick ,publishing ,company in ,new ,york ,city4 ,,care ,,of ,,the ,,newly-,,born ,,baby4--,after the nurse has completed her duties with the mother after the confinement1 she will prepare to give baby its first bath4 ,the bath should be given in a warm room4 ,this is a matter that should receive more consideration than has been given it4 ,nurses do not as a rule attach much importance to this duty1 while in reality it is a most important one4 ,i have seen trained nurses make ready to give baby its first bath in rooms1 during the night1 that were not heated adequately4 ,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 period4 ,if one will remember that a baby has just been removed from an environment where the temperature was suitable and constant1 to one in which it needs a large degree of artificial heat until such time as it may become accustomed to the change1 one may appreciate the risk taken in exposing the child for even a short time4 ,the mother should therefore warn the nurse not to undertake the baby's first bath until the temperature and other conditions are favorable4 ,many nurses and other individuals have the impression1 without knowing why1 that the baby should be cleansed and bathed immediately after birth4 ,this is not at all necessary4 ,if the conditions are not favorable1 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 forenoon4 ,by that time the baby will be adapted to its new surroundings2 its lungs will have become accustomed to the air which it is breathing for the first time2 the mother will have been rendered comfortable2 in other words1 the conditions and the environment will be favorable for the baby and for a better performance of the duty4 ,the next important feature of the first bath is that it should be done in the quickest time consistent with efficient service4 ,only the necessary exposure should be indulged in4 ,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 child4 ,a pan of water at a temperature of #ajj deg4 ,f4 should be placed on a stool in front of the nurse4 ,the nurse should have on a rubber apron1 and on top of this1 an ordinary apron and a warm bath towel laid over her knees4 ,the child should be gently rubbed with warm sweet oil to remove the vernix caseosa 7the greasy substance which is on all babies when born to a lesser or greater extent74 ,particular attention is to be given to all folds of the skin1 as under the arms1 in the fold of the neck1 in the groin1 behind the ears1 etc41 because in these parts the substance is thickest and if not carefully removed it will cake1 and cause painful eruptions and sores1 which may bleed and render the infant extremely uncomfortable4 ,it is not necessary to expose the whole body at one time while applying the oil4 ,the lower half may be covered with a warm soft towel while the nurse is oiling the upper part1 and vice versa4 ,after the body has been thoroughly oiled it should be cleansed with water at the proper temperature1 in which pure castile soap has been dissolved4 ,absorbent cotton only should be used to wash the baby4 ,all the washing is done with the baby on the nurse's knee2 it is not put into the water4 ,the baby should be mopped dry with sterile gauze1 or with a soft sterile towel1 the cord dressed and the flannel band adjusted4 ,it should then be completely dressed and put to the nipple and later to sleep4 ,,dressing ,,the ,,cord4--,the cord should be covered with powder and sterile gauze4 ,the powder to use should be plain subnitrate of bismuth4 ,if there is any reason to use another powder the physician will write a prescription for it according to indications4 ,the subnitrate of bismuth will be found much better than any ordinary talcum or toilet powder1 many of which do not make good dressing powders4 ,very few nurses know how to dress the cord4 ,it seems to be impossible to impress them with the need of frequent attention to the cord4 ,fresh powder should be put on every time the diaper is removed1 every time the infant urinates1 and at other times during the day4 ,the cord should be kept absolutely dry4 ,putting on powder twice daily will not keep the cord dry and many nurses are too lazy to bother to do it oftener4 ,you cannot make a mistake in putting on too much powder1 you can make a serious mistake by not putting on enough4 ,every time the cord is powdered it should be lifted up1 away from the skin of the abdomen1 and the powder put below it4 ,the cord should be slightly drawn out and the powder applied round its base where it meets the skin4 ,many nurses are afraid to touch or handle the cord--they find it easier to neglect it4 ,the mother should see that the nurse dresses the cord at least five times every day4 ,,applying ,,the ,,sterile ,,gauze ,,to ,,the ,,cord4--,a piece of gauze1 six inches square is taken1 a hole is cut the size of a ten-cent piece out of the center1 the cord is drawn through the hole1 the gauze folded lengthwise over the cord and then sidewise1 and this is held in place by the binder4 ,this piece of gauze will adhere to the cord and will most likely be removed with the cord on the fifth day4 ,if it should fall off1 another piece may be put on in the same way4 ,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 cord4 ,,treatment ,,after ,,the ,,cord ,,falls ,,off4--,the stump of the cord should be powdered with the same powder used on the cord2 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 binder4 ,this is used to prevent a possible rupture4 ,after a week the size of the pad may be reduced1 but a small pad should be used over the stump of the cord for a month or more4 ,a ,,pouting ,,navel4--,if the stump of the cord should protrude1 a piece of strong pasteboard1 the size of a fifty-cent piece1 should be wrapped in soft gauze and placed over the navel1 over this a gauze pad1 and if necessary this should be held in place by a strip of adhesive plaster1 though the binder is usually sufficient if it is put on carefully4 ,if this pad is held properly and worn for a month the tendency to protrusion or rupture will have passed away4 ,these pads may of course1 be removed when the baby is being bathed and put back again before the binder is applied4 ,,bathing ,,baby4--,a baby should not be put into water for a bath until after the cord has been off for forty-eight hours4 ,during the first few months the temperature of the water should be #ih deg4 ,f4 ,the temperature of the water should be taken with a bath thermometer2 it should not be guessed at4 ,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 possible4 ,the room should be warm2 there should be no draughts4 ,the mother or nurse should cultivate the habit of bathing baby quickly and with system4 ,everything should be ready and at hand4 ,a little salt in the water will tend to strengthen the skin2 it will also relieve any superficial rashes or excoriations which may be on the skin4 ,four tablespoonfuls to a gallon of water will be sufficient4 ,the sea salt sold in the stores may be used in lesser quantities4 ,by the end of the fifth month the temperature of the water may be reduced to #ie deg4 ,f41 and by the end of the first year to #ij deg4 ,f4 ,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 bath4 ,this simple means1 if kept up1 will often prevent the development of colds and bronchial troubles so common to children in temperate latitudes4 ,the best time to give the warm bath is at night4 ,in the morning a cold sponge bath is desirable4 ,this should be given as described in the chapter on cold sponge or shower baths4 ,in certain children bathing seems to depress their entire system4 ,they do not react well even to a warm bath4 ,they remain blue or pale around the mouth and eyes2 bathing should therefore be carefully undertaken with these children until such time as they acquire strength4 ,,clothing ,,of ,,baby4--,the baby should wear a woolen shirt1 with a high neck and long sleeves4 ,the abdominal binder may be worn for the first three months4 ,it is not necessary after that time4 ,if worn longer the habit is acquired and chronic indigestion may ensue when it is ultimately taken off4 ,if the baby is very thin it may be wise to leave it on1 simply for its warming effect1 for a few months longer4 ,if the child is normal and healthy the binder should be left off permanently after three months4 ,the band for the first four weeks should be made of plain flannel2 after this period a knitted band with shoulder straps is the better article4 ,all petticoats and skirts should be supported from the shoulders4 ,stockinet is a good material for diapers2 it is soft1 warm1 and pliable4 ,baby's feet should be warm always4 ,cold feet are frequently responsible for colic and gastro-intestinal troubles4 ,a hot water bottle should be placed in the carriage if the weather is cold1 but care should be taken to see that it does not touch the feet1 otherwise it may burn them4 ,the same measure may be adopted in the baby's crib if the feet are cold4 ,during the summer the outer clothing should be made of the thinnest quality of material possible1 and the underclothing of the finest flannel or gauze4 ,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 time4 ,the main object to be attained in clothing the baby is to ensure a sufficient protection1 but the clothing must be light1 warm1 loose1 and non-irritating4 ,don't bundle up the arms and legs so that they cannot be moved2 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 abdomen4 ,,baby',s ,,night ,,clothes4--,the night clothing should be the same as that worn during the day1 but it should be loose and of the lightest flannel material4 ,for older children a thin woolen shirt 7not the one worn during the day7 and a suit of union clothing with feet is best4 ,the mistake must not be made to cover children too warmly at night4 ,they can do with relatively less than adults4 ,too much covering will render the sleep restless1 will encourage nightmare1 and in older children will engender bad habits4 ,delicate children especially must not be over-covered at night4 ,for the first few months children should sleep in a darkened room4 ,,care ,,of ,,the ,,eyes4--,the eyes should be cleansed for the first few days with a saturated solution of boracic acid4 ,they should be protected from the direct light for two or three weeks after birth4 ,,care ,,of ,,the ,,mouth ,,and ,,first ,,teeth4--,boiled cooled water should be used to cleanse the mouth every morning after the bath4 ,a soft piece of sterile gauze should used for this purpose4 ,the mother must guard against using too much force in cleaning the mouth of an infant4 ,the milk teeth should receive attention4 ,if they are allowed to become dirty they will become carious and cause bad breath and neuralgia4 ,teeth of this character are a menace to health because they harbor germs and in this way infect the mouth and cause stomach troubles4 ,teeth that are carious should be filled or removed4 ,,care ,,of ,,the ,,skin4--,the skin of a baby1 because of its delicate character1 is susceptible to the slightest changes in the weather or to the condition of the digestive organs4 ,babies are frequently subject to rashes1 intertrigo1 excoriations1 eczema1 and other skin affections4 ,it is much easier to prevent these conditions than to cure them4 ,cleanliness1 not only in giving a daily efficient bath1 but in every other respect1 is essential4 ,castile soap only should be used1 and no rubbing indulged in1 simply mopping the parts with gauze well saturated with soapy water4 ,all napkins should be removed as soon as soiled4 ,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 baths4 ,the baby should be well powdered with a good quality of toilet powder4 ,ordinary starch1 or talcum1 or the stearate of zinc is suitable4 ,fat infants should be powdered in all the skin folds2 otherwise they are sure to chafe4 ,,care ,,of ,,the ,,genital ,,organs4--,the mother should make it a habit to remove any dirt from the genitals of the baby during the morning bath4 ,fecal matter sometimes gets into the folds of the female baby2 this should be removed promptly4 ,in older female children1 dirt and dust get into the genitals which often has to be removed carefully with a soft piece of cloth4 ,an exceedingly chronic form of inflammation is often seen in poor children because of neglect of these parts4 ,in male babies the mother must daily push back the foreskin and clean under it4 ,if this is not done the natural secretion will gather there and cause much trouble4 ,if the foreskin is long1 the child should be circumcised2 if it is not long it must be pushed back daily for a number of weeks2 otherwise it will contract and it may be necessary to operate on it at a later date4 ,if this is not faithfully attended to the prepuce will become adherent1 the child becomes nervous and irritable1 and it may become addicted to self-abuse at a very early date--simply because the mother is derelict in the performance of her duty4 ,if you are afraid to do your duty1 don't neglect it1 ask the doctor to show you just what has to be done and just how it should be done4 ,you will find it to be a simple matter when you know how1 as most things are4 ,,amusing ,,baby4--,mothers should understand that it is not necessary to amuse a baby under one year of age4 ,their nervous systems are not ready for any such sport4 ,to excite a baby to laughter is to subject it to a shock which may injure it4 ,the healthy development of the brain of a child demands quiet and restful surroundings4 ,it should sleep1 eat1 and be allowed to amuse itself in a natural way4 ,,temperature ,,in ,,children4--,the normal temperature in a child varies more than it does in an adult4 ,the rectal range may be between #ih deg4 and #ii4e deg4 ,f4 and may be normal to that particular child4 ,a rectal temperature of #ig4e deg4 ,f4 or of #ajj4e deg4 ,f4 is of no importance unless it continues4 ,the best place to take the temperature in a child is the rectum and the next best place is in the groin4 ,the temperature will always be from a half to a full degree higher in the rectum than in the groin4 ,the thermometer should be left in the rectum for two minutes1 and in the groin for five minutes4 ,the temperature in a child is a very fair guide as to the severity of the disease4 ,it must be remembered1 however1 that a child will develop a temperature of two or three degrees from a very slight cause4 ,it is not the height of the fever that is significant1 but rather the duration of the fever that is important4 ,a fever of #ajb deg4 ,f4 in a child may only mean a slight indigestion which will wholly disappear after a laxative is given1 while the same degree of temperature in an adult usually means something much more serious4 ,the degree of the temperature therefore should not occasion unnecessary worry2 if1 however1 it continues and if the child shows other signs of illness1 it may be regarded as indicating an abnormal condition which should be immediately found out4 ,a temperature of #ajj deg4 ,f4 to #ajb deg4 ,f4 usually means a mild illness1 and one of #ajd deg4 ,f4 or over1 a serious sickness4 ,it is not advisable that the ordinary mother should possess a clinical thermometer4 ,there are many occasions when a child will have a fever which should not cause any worry2 if the mother gets the thermometer habit1 she will many times occasion unnecessary calls of the physician only to learn that they are false fears4 ,,the ,,teeth4--,there is no definite time at which the first teeth appear4 ,they usually come between the sixth and eighth months4 ,they may not1 however1 come until much later2 or they may come earlier than the sixth month2 and yet the child may be perfectly healthy4 ,they come as a rule in the following order3 #a4 ,the two lower middle teeth1 #f to #h months4 #b4 ,the four upper middle teeth1 #h to #aj months4 #c4 ,one on each side of two lower middle teeth1 #h to #ab months4 #d4 ,one on each side1 above and below1 back of above teeth 7four in all71 #ab to #ae months4 #e4 ,the next one on each side1 above and below1 back of those already in 7four in all71 #ah to #bd months4 #f4 ,the four back teeth on each side1 above and below1 #bd to #cj months4 ,at #a year a child should have #f teeth ,at #a-a-b years a child should have #ab teeth ,at #b years a child should have #af teeth ,at #b-a-b years a child should have #bj teeth ,they may not come in the above regular order even in well children4 ,the upper front teeth may come first4 ,if the child is sickly there may be marked irregularity in the order in which they appear4 ,twenty teeth comprise the first set4 ,,the ,,permanent ,,teeth4--,this set consists of thirty-two teeth4 ,they begin about the sixth year and they are usually not complete until the twentieth year4 ,they appear in the following order3 ,first molars #f years ,incisors #g to #h years ,bicuspids #i to #aj years ,canines #ab to #ad years ,second molars #ab to #ae years ,third molars #ag to #be years ,,care ,,of ,,the ,,teeth4--,the teeth should be given attention as soon as they appear4 ,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 acid4 ,this should be done up to the second year4 ,after the second year a soft brush should be used and the teeth thoroughly cleaned morning and night with pure castile soap or a powder4 ,the teeth of every child should be examined by a dentist every six months4 ,all cavities should be filled with a soft filling4 ,the milk teeth should not decay1 but should fall out1 or be forced out by the second set4 ,a child should be taught to gargle early and a mouth wash should be used morning and night4 ,,dentition4--,as a general rule the process of teething is accompanied by some symptoms4 ,there may be fever1 restlessness1 and loss of appetite2 though in many cases there are absolutely no symptoms4 ,some children seem to teethe hard1 others easily4 ,the same child may have some teeth without pain1 and with others it may suffer severely4 ,the condition of the child at the time1 its age1 and the season of the year undoubtedly have an influence4 ,children who are sickly and puny may have much difficulty while teething4 ,the degree of sickness varies quite considerably4 ,there may only be1 as stated above1 slight fever1 restlessness1 with loss of appetite2 or there may be1 in addition to these symptoms1 a pronounced fermentative diarrhea1 which may lead to serious intestinal diseases2 frequently there is a cough4 ,this is more apt to be the case if the child is teething during the hot season4 ,,treatment4--,when dentition affects the child's disposition it is a good plan to reduce the feeding in quantity and quality for the time being4 ,if the child is bottle-fed1 two ounces can be taken out of each bottle and one ounce of boiled water added4 ,if the child is breast-fed1 he should be given two ounces of warm1 boiled water before each feeding1 and the actual feeding time at the breast shortened4 ,rubbing the gum over the erupting tooth with a clean cloth may aid in helping it through4 ,if the child is very restless and has lost sleep1 the cloth may be moistened with brandy and water4 ,lancing the gum1 though it is seldom done now-a-days1 is justified in a few cases4 ,teething is not the cause of actual disease as was once thought1 but it must be remembered that a child whose vitality is reduced by fever1 restlessness1 loss of appetite1 loss of sleep1 and irregular bowels1 is more susceptible to disease than when enjoying robust health4 ,sometimes a child will have a fever for one or two weeks during a hard dentition4 ,there is apt to be more or less intestinal indigestion and fermentation at this time and as a consequence actual intestinal disease may develop4 ,to avoid such a possibility it is an excellent plan to give an occasional dose of castor oil to clean thoroughly the whole intestinal canal4 ,this should be done irrespective of the condition of the bowel1 because frequently a diarrhea is caused by retained fermenting products4 ,mothers must not acquire the habit of attributing all symptoms to the teething process simply because the child is teething4 ,it must be remembered that a child may get a disease1 or an ailment1 while teething1 that has nothing to do with teething4 ,if this is neglected1 serious consequences may result4 ,many children have lost their lives by a mother's carelessness in this way4 ,be on the safe side1 consult your doctor2 let him assume the responsibility4 ,,how ,,to ,,weigh ,,the ,,baby4--,the test of weight is one of the most satisfactory we possess as an indication of physical progress and health4 ,it is not an absolute test1 but it may safely be relied upon4 ,the fattest baby is not necessarily the healthiest4 ,a gradual and a uniform increase is a satisfactory growth4 ,at birth a baby weighs1 on an average1 from seven to eight pounds1 though some babies weighing less are equally healthy4 ,the normal and customary gain is from four to six ounces every week after birth4 ,the baby should be weighed about the same time of the day each week1 and before a meal4 ,the average weight of a male child at different ages is as follows3 ,birth #g-a_/b lbs4 #c weeks #h lbs4 #a month #h-a_/b lbs4 #c months #ab lbs4 #d months #ac-a_/b lbs4 #e months #ae lbs4 #f months #ae-a_/b lbs4 #g months #ag lbs4 #i months #ai lbs4 #a year #ba lbs4 #a-a_/b years #bc lbs4 #b years #bf-a_/b lbs4 #c years #ca-a_/b lbs4 #d years #ce-a_/b lbs4 #e years #dj lbs4 #f years #de lbs4 #g years #di lbs4 #h years #ed lbs4 #i years #ei lbs4 #aj years #fe-a_/b lbs4 ,a female child weighs about one-fifteenth less than a male child1 as a rule4 ,table showing the average height of a male child1 at different ages3 ,at birth #bj-a_/b in4 #f months #bf in4 #a year #bi in4 #b years #cb-a_/b in4 #c years #ce in4 #d years #ch in4 #e years #da-a_/b in4 #f years #dd in4 #g years #df in4 #h years #dh in4 #i years #ej in4 #aj years #eb in4 ,,the ,,rate ,,of ,,growth ,,of ,a ,,child4--,a child grows most rapidly during its first year--six to seven inches2 from fourth to sixteenth1 about two inches annually2 thence to twentieth1 one inch4 ,commonly1 a child at two and a half years has attained half of its ultimate adult stature4 ,the diseases of youth always accelerate growth4 ,,pulse ,,rate ,,in ,,children ,,and ,,adults4--,normal ,pulse1--of new born1 #acj to #adj1 per minute2 first year1 #aje to #aae2 second year1 #ajf to #aae2 third year1 #ie to #aje2 fifth to twelfth year1 #hj to #ij2 thirteenth to twenty-first year1 #ge to #hj2 twenty-first to sixtieth year1 #gj to #ge2 in old age1 #ge to #he4 ,,infant ,,records4--,a record should be kept by the mother of every child which would embrace exact data as to weight1 diet1 size1 development of mental power1 teeth1 ailments1 sickness1 pains1 etc41 with dates and any information which would aid in recalling exact conditions4 ,such records are of the utmost value in a number of ways4 ,they help in giving suggestions as to diet1 general health1 and mental qualities of the child in question1 and they aid in furnishing what physicians call past history1 which past history has a very valuable significance in estimating the character and importance of sickness during later years4 ,such a record is also of importance in comparing a child's development with what is regarded as standard development1 and also with the growth and development of other children in or out of the family4 ,if a child should thus be found to fall seriously below the standard and yet not appear actually sick1 a very thorough and routine investigation should be instituted to discover if possible the cause4 ,some error might thus be detected which might seriously affect the child's future growth and well-being4 ,the date of the closing of the soft spot on the baby's head should be noted1 and if it is still open1 when it should be closed1 it might mean that the child has a serious brain condition4 ,the soft spot should close between the eighteenth and twenty-fourth months4 ,the family physician should be notified if the soft spot is open later than the second year1 as he may want to investigate the cause4 ,should the child be unusually backward in walking1 and when it does so should limp and feel pain in the knees1 it should be examined for any symptom of hip joint disease1 of which these are the earliest signs4 ,if the child complains of so-called growing pains1 keep in mind that these are rheumatic and may need attention4 ,there are no such pains as actual growing pains1 that is1 pains caused by the child growing4 ,,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--,mothers ,milk ,that is ,unfit for ,baby--,fresh ,air for ,baby--,air ,baths for ,baby4 ,,overfeeding ,,baby4--,every nursing mother should have printed and hung up1 so she may read it every time she nurses her child1 the following motto3 ,,don',t ,,overfeed ,,baby4 ,few1 if any1 babies die of willful starvation3 many die as a result of overfeeding4 ,mistaken kindness and lack of judgment are responsible for one-half of all the troubles of infancy4 ,babies require much less than is constantly given them4 ,the stomach of a baby at birth will not hold more than one ounce1 which is two tablespoonfuls2 and at two months it will not hold more than three tablespoonfuls2 and at six months1 six or seven tablespoonfuls4 ,read these quantities once again carefully and try to realize the significance of the smallness of them4 ,a baby is just like a little pig2 it will go on feeding as long as it is allowed4 ,the baby does not reason2 it has no judgment2 it depends upon its mother's judgment4 ,if the mother is false to the trust the baby overloads its stomach4 ,a swollen1 distended1 overloaded stomach causes indigestion4 ,a baby with indigestion is a colicky1 fretty1 sick baby4 ,overfeeding1 therefore1 is the beginning of lots of trouble to the mother1 and needless pain and suffering and sickness to the baby4 ,a simple matter1 but it is one of the most difficult lessons nursing mothers have to learn4 ,overfeeding is most apt to occur at night4 ,many mothers put the child to the nipple for its regular feeding and fall asleep2 the child keeps on nursing at intervals until twice the proper quantity is taken2 or she gives it the nipple or the bottle if it cries1 without regard to whether it is the proper feeding time or not4 ,the habit of overfeeding is very common in infants who are suffering from indigestion4 ,they cry frequently1 and are irritable most of the time2 nothing seems to satisfy them but the nipple4 ,taking the warm milk into the stomach seems to allay the distress for the time being1 so mothers get into the habit of quieting them in this way4 ,the cry of the drinking man1 whom we try to sober up1 is3 ,just one more drink and ,i'll quit4 ,you give the drink and in a little while the demand is repeated4 ,if the mother understood the seriousness of this practice of giving the child the nipple or bottle at irregular times1 she would not do it4 ,overfeeding an infant may lay the foundation for a lifelong ailment4 ,the excess of food remains in the stomach or bowels undigested4 ,if you remember that this mass of undigested matter is confined in a small space which is both warm and damp1 it will be easily understood that putrefaction is the inevitable outcome4 ,as a result of this putrefaction there are produced certain ptomaines and leucomaines4 ,these poisons are carried through the body1 causing auto-intoxication which upsets and irritates the child's nervous system and may cause very serious consequences1 as it frequently produces sudden death from apoplexy and heart failure in the adult4 ,these children are always restless1 fretful1 continually uncomfortable1 sleepless and colicky4 ,they lose weight1 the stomach becomes distended and a gastritis or inflammation of the stomach results4 ,frequently a mother with such a fretful baby1 seeing her child getting thinner and thinner1 will think that it is not getting enough to eat1 and will proceed to add to the trouble by giving the child more to eat4 ,mothers must therefore learn not to overfeed their infants2 not to imagine that a failure to gain weight means the need of more food 7if the quality of the food being given is wrong1 will increasing the quantity of bad food do any good872 not to feed irregularly1 no matter how insistent the child may be4 ,,intervals ,,of ,,feeding4--,the physician will give instructions regarding the feeding of the newly born baby for the first few days4 ,after the first few days and up to the beginning of the third month1 it should be fed every two hours from #g ,a4 ,m4 until #i ,p4 ,m41 and twice during the night between #i ,p4 ,m4 and #g ,a4 ,m41 when the regular two-hours' interval again begins for the following day4 ,the two night feedings should be about #a and #d3cj ,a4 ,m4 ,after the third month1 and up to the sixth month1 feed every three hours and once during the night4 ,from the sixth month until weaned1 every three and one-half or four hours1 and not at all during the night4 ,while it has been pointed out that regularity of feeding is absolutely essential1 the above schedule is not to be regarded as an absolute guide4 ,it is a general guide1--approximately it will be found correct in a large majority of cases4 ,each baby is a rule unto itself4 ,the quantity of the mother's milk will dictate the interval after the first month and for each month as the baby grows4 ,if a mother with no milk to spare1 is nursing a big1 strong1 husky baby1 the three-hour interval during the day may have to be shortened to two and one-half hours4 ,as a rule1 however1 these exceptions are better regulated by attention to the time the baby is given at each nursing to fill its stomach4 ,,how ,,long ,,should ,a ,,baby ,,stay ,,at ,,the ,,breast8--,babies differ as to their method of feeding2 some of them seem to like to nurse a moment or two and then look around2 others seem to regard nursing as a serious business1 and resent any effort to take the nipple away until they have finished4 ,a baby should be taught to nurse methodically2 it should not be allowed to play the nipple4 ,let it fill its stomach and put it down as quickly as possible4 ,a mother will very soon know just how long it takes the baby to fill its little stomach1 and when she finds this out she should time it by the clock4 ,when the supply of milk is sufficient1 and the child is strong1 and nurses freely1 eight to twelve minutes are sufficient4 ,after it is taken away from the breast it must be left quiet till the next feeding4 ,other babies1 according to the ability they evince to nurse1 even when the milk runs freely1 require a longer time1--from twelve to fifteen minutes4 ,the rule1 however1 is never to allow them to nurse so long that when they are taken away the milk runs out of the mouth4 ,if this occurs1 cut down the length of time they are at the breast1 and always time the length of feeding by the clock1--don't guess at it4 ,,children ,,who ,,vomit ,,between ,,feedings4--,when a child habitually brings up food between feedings it is usually a symptom of gastric indigestion4 ,in these cases it is advisable to add lime-water to each feeding1 and to remove some of the fat in each feeding4 ,if improvement does not follow remove more of the fat by removing some of the cream from the top of the bottle before shaking it4 ,remove from the bottle four ounces of cream and shake before preparing the food from what is left4 ,if the child improves after a few days remove only three ounces1 then in a few days remove two ounces and later one ounce4 ,after a time1 sufficiently long to permit the stomach to become accustomed to the graded amounts of fat1 the former diet of whole milk can be again resumed4 ,never decrease the interval of feeding of a baby who is bringing up parts of its meal between feedings2 it is frequently advisable to increase the interval4 ,if a child is colicky and is bringing up lots of gas in addition to some food1 one-half grain of benzoate of soda may be added to each ounce of food given and continued for a number of weeks if necessary4 ,when the gas is located in the intestines and is not brought up1 it must be made to pass downward4 ,attention to the bowels is of great importance in these cases and it may be necessary to peptonize the milk for some time4 ,a reduction of the sugar and starch in the feeding frequently cures this condition4 7,see ,colic47 ,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 feedings4 ,it may be necessary to obtain a wet nurse for them1 as it is with the delicate child4 ,if a wet nurse cannot be obtained1 or if the age will permit1 a substitute may be tried4 ,borden's ,eagle brand of condensed milk1 canned1 is probably the best substitute under these circumstances4 ,condensed milk should never be used as a continuous food2 as a substitute1 however1 for a few weeks it is often invaluable4 ,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 water4 ,the proper quantity1 whatever the child is taking 7four or six ounces according to the age7 at the time1 can be taken from the sixteen ounces and fed to the child4 ,as the symptoms improve the milk should be diluted less and less1 #a to #ad1 #a to #aj1 and so on until the proper strength is reached4 ,after the child has been on the condensed milk for a month it should be changed back to cow's milk1 using of course a diluted formula until the child becomes accustomed to the change4 ,condensed milk1 if used as a permanent food1 will fatten babies1 but their vitality is very deficient1 the muscles flabby1 and the resistance to disease exceedingly poor4 ,they are apt to develop rickets and sometimes scurvy4 ,,regularity ,,of ,,feeding4--,one of the very first1 and one of the most important factors in contributing to the good health and the comfort of a baby is absolute regularity in feeding4 ,a regular interval of feeding is particularly essential during the first month of a baby's life4 ,despite the explicit way in which young mothers are instructed in this respect1 it is one of the disappointing incidents of the practice of medicine to observe how many of these mothers fail to heed the advice4 ,we have personally tried to find an explanation for this astonishing carelessness1 and have come to the conclusion that it is not due to intentional forgetfulness1 but rather to an inexplicable failure to appreciate that the physician means exactly what he says4 ,if1 for example1 specific instructions are given to feed1 or nurse1 the child every two hours 7and by specific instructions it is meant1 that the physician takes time to explain in detail the instructions he gives--that the instructions are not incidental to the call1 but part of the call2--that the advice is given not as a choice of what is desirable1 but as an absolute rule to follow2 and carefully explains why it is imperative to do as he says2 and is satisfied the mother understands what he means7 it would seem that there could be no possible reason why the directions should not be faithfully carried out4 ,yet such is not the case in many instances1 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 life4 ,they fail to understand that fatal consequences may follow their negligence4 ,they treat the baby problem exactly as they would a household incident1 and as they do not consider it important whether the breakfast dishes are washed at #i ,a4 ,m4 or at twelve noon1 neither do they consider it important whether the baby is fed at #i ,a4 ,m4 or an hour later4 ,when mothers learn that the attention they must give their babies is essentially different from the attention they give ordinary household duties1 the problem of raising children with success and comfort will be greatly simplified4 ,if the instructions are to feed the baby at certain intervals1 do so at all hazards4 ,to offer the foolish excuse that the baby was asleep when feeding time came1 is no excuse at all2 as a matter of fact the baby should be asleep at each feeding time1 if it is healthy4 ,wake it and feed it1 for1 as will be shown later1 it is the constant regularity that counts4 ,it will be more difficult to institute regular feeding intervals during the first month1 because a healthy baby is very difficult to wake up1 even to be fed1 during the first few weeks of life4 ,it is absolutely essential1 however1 that it should be wakened3 otherwise the tendency to overfill the stomach at the next feeding will lead to indigestion and colic4 ,,why ,,is ,,regularity ,,of ,,feeding ,,important8--,because a baby's stomach holds a very small quantity1 and experience has taught us that a baby will thrive better on small quantities given frequently1 rather than large quantities at longer intervals4 ,the smaller the baby1 the smaller the quantity to begin with4 ,some babies weigh from five to seven pounds at birth1 while others weigh from nine to twelve pounds4 ,it would be unreasonable to expect a very small baby to be able to hold and digest as much as a very large baby4 ,considerable common sense and the exercise of some judgment is therefore necessary on the part of the uninstructed mother1 as to just the right quantity to give4 ,fortunately1 a little experience will enable the observant mother quickly to solve this important problem4 ,nature promptly furnishes the symptoms which will correctly guide her4 ,before considering the significance of these symptoms let us appreciate certain facts common to all babies1 and we will more easily interpret the meaning of the special symptoms the baby will furnish4 ,first of all the baby never vomits4 ,the ejection of food1 therefore1 is dependent upon a condition1 not a disease4 ,if milk runs out of its mouth immediately1 or within a few moments1 after a feeding1 the explanation is that it was fed too much2 it does not vomit1 the stomach simply overflows4 ,it is exactly like trying to put more milk into a cup after it is full1--it will not hold more1 it overflows4 ,the significance of this symptom1 therefore1 is that the quantity of the feeding is wrong 7it is not the baby's stomach that is at fault1--it is the mother's judgment74 ,reduce the quantity of each feeding and you will quickly cure it4 ,if the milk does not overflow soon after a feeding1 the baby will appear satisfied and will go to sleep1 and will sleep until it is time for the next feeding4 ,it may not do this1 however4 ,in half an hour1 or a little longer1 after the feeding1 it wakes1 it begins to fret and cry1 and very soon it suddenly belches gas and ejects a mouthful of milk1 after which it will rest quietly for a few moments1 when it will begin fretting all over again4 ,it may keep up this performance for an hour1 or until the next feeding1 and if so it is exhausted and unfit to carry on the digestive process4 ,it is in these cases where most mothers make serious mistakes4 ,this is the beginning of real trouble1 and the family physician is the only one qualified to give advice under such circumstances4 ,remember the warning given regarding heeding the advice of every busybody just at this time4 ,your baby's health is at stake2 maybe its life depends upon what you choose to do4 ,,what ,,is ,,the ,,significance ,,of ,,vomiting ,,after ,,feedings ,,in ,,babies8--,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 later1 and which is now being considered4 ,the first milk looks like ordinary milk 7breast milk71 or if the baby is being fed from the bottle1 it looks just like the mixture in the bottle4 ,it not only looks like what it took1 but it smells just like it4 ,now examine the other2 we find it looks like curdled milk1 it is lumpy1 and we immediately can tell that it is sour1 because it smells sour and looks sour4 ,the explanation of the first overflow 7immediately after the feeding7 was the too great quantity2 the explanation of the second overflow 7one-half hour or so after the feeding71 is the wrong quality of milk4 ,the quantity was right because none overflowed right after the feeding1 but the quality was wrong4 ,again1 it is not the baby's stomach that is at fault1--it is the quality of the milk4 ,how do we know this8 ,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 milk4 ,the quantity being right1 why should the baby have any trouble if the quality is correct8 ,it should not4 ,therefore by changing the quality 7not the quantity as in the former case7 we cure the trouble1 thus proving the quality of the milk to be at fault4 ,what took place in the baby's stomach in the intervening half hour8 ,the quality being wrong1 the little stomach could not digest the mixture quick enough4 ,fermentation set in1 gas was evolved1 and as the stomach was full before the gas was manufactured 7and as more and more gas is manufactured when food ferments71 the stomach overflowed and out of the baby's mouth comes gas1 and sour1 fermenting1 curdled milk4 ,this process goes on until fermentation stops1 or until the little stomach has just enough left to fill it and no more4 ,but think what this is1--a sour mass of rotting1 indigestible1 curdled milk1--and that is what this baby is expected to live and thrive on4 ,some babies seem to have trouble from the very first day of life4 ,either they will not retain the food1 or the food fails to agree with them4 ,if the baby is put upon artificial food at once1 these troubles are1 of course1 not unexpected 7because the right artificial food may not be first chosen for the particular baby71 but it is not always the artificially fed baby that gives us trouble1 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 born4 ,the cause of stomach trouble in a baby a few days old1 fed exclusively on mother's milk1 is invariably to be found in the quality of the milk4 ,the quality of the mother's milk may be affected in a number of ways which will render it unfit for the baby4 ,for example1 if the mother for any reason becomes sick1 and has a high fever shortly after confinement1 it will affect her milk and render it unfit temporarily4 ,if the mother worries or becomes highly nervous during the first few days of her baby's life1 she will so affect her milk as to render it unfit for baby4 ,if a baby is fed for a number of days after its birth by its mother1 and it should prove afterward that she has not enough milk to continue feeding it1 and has finally to put it on artificial food1 the baby will most likely have acquired slight stomach ailments that may be troublesome for some time1 because in this case both the quality and the quantity were no doubt wrong4 ,constipation in the mother will also cause trouble4 ,the child will develop colic and extreme irritability until the mother's condition is relieved4 ,each of these conditions affecting the milk of the nursing mother usually demands a change of food for the baby1 and the substitution of the proper artificial food will invariably immediately correct the trouble4 ,in some cases1 however1 the quality of the mother's milk is not dependent upon a temporary temperamental condition1 but is caused by errors in diet1 or conduct1 or both4 ,the milk of a physically tired1 worn-out mother1 is not good1 no matter whether the exhaustion is caused by actual physical labor or by the exactions of a strenuous social programme4 ,the milk of a mother who persists in eating irregularly1 or who willfully caters to an appetite which craves the rich1 highly seasoned articles of diet1 or who attempts to satisfy a legitimate hunger by drinking large quantities of stale tea or coffee and eating bread1 is unfit for her baby4 ,these cases are amenable to the proper treatment1 which of course means1 that the mother must change her conduct if at fault1 and live strictly upon the diet prescribed elsewhere for nursing mothers4 ,if these troubles occur in babies who have been fed exclusively upon artificial food1 an entire change of food is frequently necessary4 ,,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 it4 ,first1 the weather and season of the year should be considered4 ,the baby should not be taken out at all when it is wet1 or foggy1 or very humid2 nor when it is extremely cold4 ,second1 the vigor or vitality of the individual child must be considered4 ,some children can safely be taken out if the weather is propitious when two weeks old1 others cannot be taken out without risk until they are two months old1 regardless of the weather conditions4 ,if a child is robust at birth1 and nurses well1 and increases in weight from the beginning1 he can be taken out when he is two weeks old while the sun shines during the middle of the day4 ,if a child is small and puny when born1 and begins to have nursing troubles from the beginning1 does not increase in weight1 is fretting1 and crying1 and sleeps spasmodically1 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 sunshine4 ,the question of suitable clothing will be important1 and will decide the advisability as to when the baby should go out4 ,every baby should be dressed in wool weather is not too distinctly bad4 ,remember always to ,transcriber's note3 words missing in text from neck to ankles4 ,its head should be warmly clad4 ,dressed thus and well wrapped in blankets1 a healthy child is ready for an out-door trip at any time1 if the ,transcriber's note3 words missing in text have plenty of blankets below the child as well as above it1 if it is in a baby carriage4 ,in very cold weather the child should be buried in blankets1 and a hot water bottle can be wrapped in near his feet4 ,great care must be taken that the water in the bottle is not too hot1 and that it does not actually touch the skin4 ,no matter how many or how few blankets are used1 the face should be exposed directly to the fresh air4 ,when the air is very gusty1 or high1 a light veil can be laid over the face1 but never at any other time4 ,,air ,,baths ,,for ,,babies4--,babies necessarily require plenty of exercise and plenty of fresh air1 as has been pointed out4 ,it is a splendid custom to allow the baby to lie naked after his bath for half an hour4 ,if the room is comfortably warm1 select a spot that is free from draughts1 and lay the baby on a pillow or two and let him kick and coo4 ,in the sun by the window1 his head and especially the eyes shaded from the direct rays of the sun1 is an excellent place in the summer time4 ,the influence of the direct sun rays on the little naked body is conducive to good sturdy health1 good nerves1 and sound sleep4 ,,chapter ,,xviii ,,baby',s ,,good ,,and ,,bad ,,habits4 ,,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--,jouncing1 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--,chicken1 ,veal1 and ,beef ,broths--,scraped ,beef or ,meat ,pulp--,junket or ,curds and ,whey--,whey--,barley ,water--,barley ,water ,gruel or ,barley ,jelly--,rice1 ,wheat or ,oat ,water--,imperial ,granum--,albumen ,water--,dried ,bread--,coddled ,egg4 ,,baby',s ,,bed ,,the ,,proper ,,way ,,to ,,lay ,,baby ,,in ,,its ,,bed4--,the baby should be accustomed to sleep by itself from the day of its birth4 ,mothers have been known to smother their babies during sleep4 ,the mother may pull the bed-clothing over the baby's head during the night and thus deprive it fresh air4 ,a mother is much more apt to nurse her baby regularly and to do it more efficiently1 if she is compelled to get up to do it4 ,if she occupies the same bed with baby1 she may fall asleep while nursing him2 the baby consequently nurses too long1 fills his stomach too full1 and soon develops indigestion and colic in addition to acquiring a very bad habit4 ,for the first few weeks an ordinary basket arrangement is all that is necessary4 ,as soon as the baby begins to move around it should have a regular baby crib1 so that possible accidents may be avoided4 ,when the baby is placed in bed after a feeding1 it should be laid upon its back1 being tilted slightly toward its right side4 ,by placing a soft1 small pillow1 under its left side1 the baby will rest more on its right side1 which is the proper position4 ,the reason of this is because the liver of a child grows quicker and larger than any other organ1 and it is on the right side4 ,by placing the child on this side1 it prevents the heavy liver from sagging over on the little full stomach4 ,if the child were laid on its left side1 the liver would crowd the full stomach and embarrass the heart1 and cause pain and restlessness4 ,frequently a change of position fully to the right side1 when a child has been restless or crying1 and especially if it has been lying on its back1 will at once relieve it and allow it to go to sleep again4 ,it is the knowledge of these little things that count in babyhood4 ,,how ,,long ,,should ,a ,,baby ,,sleep8--,a perfectly healthy baby should sleep1 while very young1 eighteen or twenty hours out of the twenty-four4 ,as it grows older it will sleep less4 ,it should have1 and nothing should interfere with its having1 two sound naps every day1--one in the forenoon after its bath1 and the other in the afternoon4 ,when four or five months old1 it should also sleep from #g ,p4 ,m4 until #aj ,p4 ,m41 then it should be fed and allowed to sleep until morning4 ,it has been aptly said1 that1 a child might easily overeat1 but he practically never oversleeps4 ,during the second year a child should sleep twelve hours at night1 and about two hours during the day4 ,the twelve-hour night rest should be continued until the child is six years of age4 ,the practice of taking a nap at noon is a very good one1 and it should be encouraged as long as possible4 ,it can usually be kept up until the child begins school life4 ,the strenuous activity of childhood1 makes some such rest highly desirable1 and the result will necessarily be a stronger body1 a better disposition1 and firmer nerves than otherwise4 ,the practice of retiring early should be strictly enforced during childhood4 ,children of two years of age1 should retire at #f3cj ,p4 ,m41 or at latest at #g ,p4 ,m41 those from three to five years1 may remain up an additional hour4 ,at thirteen or fourteen the regular bedtime should be at #h3cj ,p4 ,m4 ,there is no justification for the late hours which growing children are allowed to keep1 especially in large cities4 ,regular sleep is largely a matter of habit1 and if the infant is started right1 with suitable feedings1 given at definite times1 followed by the proper periods of sleep1 but little trouble will be experienced with sleeplessness4 ,when sleep is disturbed and broken1 it means bad habits1 unsuitable food1 minor forms of indigestion1 or positive illness of some kind4 ,sleep is absolutely essential in infancy and all through childhood for purposes of growth4 ,it is wrong to permit a child to sleep too much during the day2 it will become a habit1 and it will not sleep well during the night as a consequence4 ,in order to prevent or break this habit1 the child should be kept in a well-lighted room and should be amused and entertained so as to keep it awake4 ,the nap during the middle of the day is an exceedingly important factor in keeping the average child in good physical condition4 ,it is a valuable adjunct in preventing1 and in treating1 nervousness in children4 ,children who are anemic should be encouraged to sleep long and freely in well-aired rooms4 ,,why ,a ,,baby ,,cries4--,as has been stated1 every healthy baby should cry for half an hour each day4 ,nature suggests1 demands this as an essential exercise4 ,muscular movements involving a greater part of the whole body accompany the act of crying and furnish this necessary exercise4 ,it is of great importance to an adequate and uniform development of the lungs2 deep breathing is necessary to lusty crying1 hence the lungs are expanded and the blood renewed and oxygenated4 ,crying is also of material aid in moving the baby's bowels4 ,babies in perfect health will1 however1 cry under any of the following circumstances1 and doubtless under circumstances of lesser importance and frequency when frightened or uncomfortable from hunger or position1 soiled napkins1 inflamed buttocks1 earache1 pain1 from heat or cold1 unsuitable clothing1 and during difficult bowel movement1 when displeased or angry4 ,children slightly but painfully ill may cry incessantly for an hour or two4 ,thus1 with intestinal colic1 when the cry is loud and continuous until the child is relieved or until he falls asleep from exhaustion4 ,the healthy1 well trained child seldom causes trouble2 it is the rule for it to be happy and good natured in its own way4 ,,the ,,habitual ,,crier4--,if a child becomes a habitual crier1 it is because it is uncomfortable and unhappy4 ,there are restless1 often vigorous1 crying1 whining infants1 and the trouble1 as a rule1 is in the intestinal tract4 ,badly managed1 spoiled babies cry from inattention1 and when left alone4 ,if they are taken up and talked to1 the crying ceases1 thus proving that it was not pain or discomfort that was causing the crying4 ,in the case of the habitual crier we try to find out the cause of the bowel trouble and cure it2 the spoiled infant we discipline rigidly1 or leave it alone if its parents prefer that kind of baby4 ,,the ,,habit ,,of ,,feeding ,,baby ,,every ,,time ,,it ,,cries4--,the habit of regular feeding will1 if persisted in and successfully established1 render advice on this subject unnecessary4 ,so also will the explanation of the evil of overfeeding have its effect on mothers4 ,apart from these reasons1 however1 the habit of feeding baby every time it cries is a pernicious one1 and no doubt the mother1 who will be striving to faithfully follow instructions1 will have to overcome the advice of meddling friends who will regard it as a cruelty to allow the baby to cry4 ,do not give in to these busy-bodies2 insist on attending to your own affairs1 but be absolutely sure baby is not crying for a just cause4 ,a child can only cry2 that is its only language1 but it cries for many things other than the nipple or the bottle4 ,examine it carefully1--a wet diaper a pin1 an uncomfortable position1 a drink of water1 any of these may be the cause4 ,it is just as essential that a child should cry as that it should sleep4 ,every healthy child should cry for twenty or thirty minutes every twenty-four hours4 ,nature calls for this as an exercise in order to develop the lungs2 therefore1 if there is no just cause for the crying you must regard it as a necessary evil1 even if you look upon it as a domestic affliction4 ,,the ,,habit ,,of ,,walking ,,the ,,floor ,,with ,,baby ,,every ,,time ,,it ,,cries4--,this is another habit that is indulged in to the sorrow and ridicule of the race4 ,if you are a victim of this habit1 you have yourself to blame4 ,it is a matter of education1 or habit1 pure and simple1 and1 like all bad habits1 it is difficult to break away from4 ,in the preceding paragraph1 you have been told that when baby wants something1 or is uncomfortable1 it employs the language nature gave it1--it cries4 ,no child ever cried to be walked up and down the floor in the dead of the night4 ,begin at the beginning1 when it first cries1 find out why it is crying4 ,offer it a little water if it is not feeding time4 ,examine its diaper and if soiled change it4 ,it may be overdressed and consequently hot1 perspiring1 and uncomfortable2 change its position4 ,find out if any pin is open and hurting it2 loosen the binder so it can breathe easily4 ,if it is a colicky child follow the instructions given in the treatment of colic4 ,be patient the first few nights1 and be thorough1 because you may discover why it cries and each discovery will help you next time4 ,if you discover something wrong1 some reasonable excuse for the crying1 does it not prove the folly of walking the floor8 ,if it wants a drink of water1 or if its diaper is wet1 how is walking the floor going to cure it1 or how can you expect the baby to stop crying when you so unjustly construe its reasonable and its only way of asking a favor8 ,if walking the floor stops its crying1 it stops it by exhausting the child1 not by relieving it of its little ailment4 ,,jouncing ,,or ,,hobbling ,,baby4--,this is another habit that should be frowned upon4 ,so many persons are addicted to this form of baby torture1 that it is astonishing more immediate harm does not result from it4 ,be particularly careful not to indulge in it1 or permit anyone else to do it immediately after feeding4 ,if you form the habit of putting baby down at once after each feeding1 as you have been instructed to do1 the opportunity to jounce it will not exist4 ,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 indigestion4 ,you would not think of exercising yourself after a meal2 why exercise a baby8 ,,baby ,,needs ,,water ,,to ,,drink4--,boil a quantity of water each morning1 put in a clean bottle1 and keep in a cool place4 ,give the baby some1 three or four times daily between feedings4 ,one teaspoonful is enough to begin with1 and as it grows older it will take more4 ,it may not always take the water but it will take what it wants1 and it needs some every day2 it is therefore your duty1 inasmuch as baby cannot ask for it1 to offer it regularly each day as part of your daily routine4 ,,kissing ,a child should never be kissed on the mouth by anyone1 not even its own parents4 ,kissing should not be allowed among children4 ,if any kissing is done it should be on the brow1 never on the mouth1 hands1 or fingers4 ,many diseases are carried by this pernicious habit1 and you cannot afford to have baby's health jeopardized by this promiscuous and unnecessary liberty4 ,,establishing ,,toilet ,,habits ,when baby reaches the age of three months1 a regular systemized effort should be made to educate it to habits of cleanliness4 ,nothing can be done in this direction previous to this age1 as a child at that period of its life is scarcely conscious of the natural functions of its body4 ,each time a baby1 after the third month1 is making an effort to move its bowels1 the nurse or mother should go to it as it lies in its crib1 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 say1 when it wants to move its bowels4 ,by constant attention and effort in this direction1 a child with quick perception and initiative will soon associate the sound and the function1 and it will begin to make the sound when the function is about to be performed4 ,as soon as it begins to make this sound1 if prior to the act of moving the bowels1 the child should be immediately taken up and held on a chamber1 into which some hot water has been put1 and encouraged to relieve itself1 the nurse or mother still repeating the sound1 or word1 or words4 ,having successfully accomplished this programme a number of times1 the child should be encouraged and petted every time it gives a satisfactory warning1 and discouraged and reproved every time it wets or soils its napkin4 ,a little later1 say about six months1 the child should be held on the chamber at a certain time each morning and evening1 thus encouraging it to move its bowels regularly twice daily4 ,the careful carrying out of a scheme such as the above will establish regular1 cleanly habits1 and will to a very large extent guard against constipation in the future4 ,,baby',s ,,comforter4--,the discovery and introduction of the comforter or rubber teat was an unfortunate episode in someone's life4 ,by the careless1 conscienceless nurse1 or thoughtless mother1 it is regarded as a real comfort and blessing4 ,any temporary comfort1 however1 which the nurse or mother may enjoy as a result of its use1 is at the expense of the health of the child4 ,its use is a serious reflection upon the good intention and intelligence of the mother who permits her child to use one4 ,it is a bad habit from every viewpoint possible4 ,in order that mothers1 open to conviction and capable of reasoning1 may appreciate the character of the harm done by the use of the comforter1 we will briefly record these conditions3 #ast4 ,the constant sucking pulls upon the delicate structures of the mouth and throat1 and so impairs the health tone of these structures that they become flaccid and feebly nourished4 ,this to a certain degree causes adenoids1 enlarged tonsils1 loose palate and weak throat1 with the constant tendency to winter colds and coughs1 and to catarrh4 #bnd4 ,it causes an excessive flow of saliva4 ,saliva should only be stimulated previous to stomach digestion4 ,by causing an excessive flow of saliva into an empty stomach1 the digestive powers are interfered with1 and seriously weakened4 ,stomach trouble1 and consequently intestinal disease1 may therefore be caused by the seemingly innocent comforter4 #crd4 ,a constantly used comforter always causes disease of the mouth4 ,mucous erosions1 canker sores1 little ulcers1 etc41 are produced in this way4 #dth4 ,the use of the comforter makes it impossible to put the child to sleep1 or even to leave it alone1 without first placing it in its mouth4 #eth4 ,to stifle a baby's cry1 by pushing the comforter into its mouth1 is as bad as giving it chloroform to mask a serious and dangerous pain4 ,if may have a just reason for crying1 as is explained elsewhere1 and if that reason is not searched for and found1 it may mean serious trouble later4 #fth4 ,actual deformities of the mouth are produced by constant use of the comforter4 ,the continuous sucking affects the gums1 pushes them out of shape and position1 and the teeth as a consequence come at wrong angles1 thus causing unsightly deformities1 which last throughout the life of the child4 #gth4 ,the worst fault of the comforter is to be found in its uncleanliness4 ,we are quite satisfied that the use of the comforter will be legislated against one of these days4 ,if preventive medicine means anything1 it must certainly reckon with the comforter in the very near future4 ,have you ever watched your baby suck on its comforter8 ,if you have1 you must have noted the tireless energy with which it works its tiny jaws and tongue4 ,suddenly the comforter slips from the little mouth and baby begins to cry1 attracting the attention of the mother1 or nurse1 or little sister1 who promptly1 recognizing the trouble1 pounces on the offending comforter1 which has fallen to the floor1 and with a perfunctory wipe replaces it in baby's mouth4 ,it is done just as we have written it1 many thousand times1 and yet the problem of infant mortality is represented as a vexatious mystery4 ,the newspapers solicit charitable aid1 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 spells4 ,a hundred other energetic enthusiasts send forth their laudable effort to raise the standard of child hygiene1 yet the manufacturers of the comforter1 and the ignorant mother and nurse who use it1 do more harm in one day than all the honest effort of these combined forces can neutralize in a year4 ,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 possesses4 ,when the comforter is finally discarded the habit of sucking is so firmly established that the child will suck its thumb for many years after4 ,this results in further disease and deformity to the growing mouth and throat1 and also to the thumb4 ,after a child has used a pacifier or comforter for some time it invariably becomes a mouth breather4 ,a mouth-breathing child is very apt to catch cold and as a consequence of the habit may become catarrhal or tubercular4 ,,what ,,can ,,be ,,done ,,to ,,lessen ,,the ,,evil ,,effects ,,of ,,the ,,comforter ,,habit8--,it is a most difficult habit to cure when once established4 ,the very least that can be done is to keep the comforter scrupulously clean1 washing it several times daily4 ,to have not one1 but two or three1 kept in a saturated solution of boracic acid1 ready to put into the baby's mouth should one be required to replace another that has fallen out4 ,we should furnish a large shield to prevent it being swallowed4 ,we can try the method of weaning the baby from the comforter by tying a ribbon to it and to the child's bodice4 ,the system is gradually to shorten the ribbon until it becomes too short for the baby to suck in comfort4 ,it will then gradually grow away from the habit4 ,,food ,,formulas ,,beef ,,juice4--,take one pound of round steak and broil it slightly4 ,press the juice out with a lemon squeezer1 or1 with a meat-press4 ,season with salt and serve hot or cold as desired4 ,if it is heated after it has once been cold1 it should not be overheated as this will coagulate the albumen which will appear as flakes floating on the surface of the juice4 ,,beef ,,juice ,,by ,,the ,,cold ,,process4--,take one pound of finely chopped round steak1 six ounces of cold water1 a pinch of salt2 place in a covered jar and stand on ice1 or in a cool place1 six hours4 ,this mixture should be shaken from time to time4 ,strain and squeeze all the juice out by placing the meat in a coarse cloth and twisting it very hard4 ,season and feed as above4 ,beef juice made in this way is more nutritious than that made from the steak when broiled2 it is not1 however1 quite so palatable4 ,beef juice made in either of the above ways is much more nutritious than the beef extracts sold ready to use4 ,,mutton ,,broth4--,take one pound of finely chopped lean mutton1 including some of the bone1 one pint of cold water and a pinch of salt1 cook for three hours over a slow fire down to half a pint1 adding water to make up this quantity if necessary2 strain through muslin4 ,when it is cold remove the fat and add more salt if required4 ,it may be fed warm or cold in the form of a jelly4 ,,mutton ,,broth ,,with ,,cornstarch ,,or ,,arrowroot4--,add to the above sufficient cornstarch or arrowroot to thicken1 cook for ten minutes and then add three ounces of milk1 or one ounce of thick cream1 to a half pint of broth4 ,this makes a nutritious and extremely palatable broth4 ,,chicken1 ,,veal1 ,,and ,,beef ,,broths4--,these may be made and used in the same way as mutton broth4 ,,scraped ,,beef ,,or ,,meat ,,pulp4--,take a rare piece of round or sirloin steak1 cut the outer part away1 scrape or shred with a blunt knife4 ,cutting the meat into small pieces is not satisfactory4 ,one teaspoonful to one tablespoonful may be given well salted1 to a child a year and a half old4 ,it is best to begin with a small dose and work up to the larger to accustom the digestive apparatus to its use4 ,,junket1 ,,or ,,curds ,,and ,,whey4--,take one pint of warm fresh cow's milk1 a pinch of salt1 a teaspoonful of granulated sugar1 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 cold4 ,nutmeg may be added for older children and adults4 ,,whey4--,the coagulated milk prepared as above is broken up with a fork and the whey is strained off through cheesecloth4 ,if a stimulant is desired1 brandy1 in the proportion of one teaspoonful to six tablespoonfuls of the whey may be added4 ,,barley ,,water4--,one level tablespoonful of ,robinson's barley is rubbed up with a little cold water1 to this is added one pint of boiled water containing a pinch of salt4 ,the mixture should be stirred while the water is being added4 ,cook for thirty minutes in a double boiler and strain4 ,enough boiling water should be added to the mixture to make up the full pint if any has boiled away4 ,,barley ,,gruel ,,or ,,barley ,,jelly4--,repeat the above process1 but instead of using one tablespoonful of the barley powder1 use from two to four according to the consistency of the gruel or jelly desired4 ,barley water may be made from the grains4 ,a formula for this process will be found in the chapter on artificial feeding4 ,,rice1 ,,wheat1 ,,or ,,oat ,,water4--,these are made from the rice1 wheat1 or oat flour in the same way as barley water described above4 ,they may be made from the grains also1 using the same proportions as in the making of barley water4 ,,imperial ,,granum4--,this is prepared in the same way as the barley flour above described4 ,,albumen ,,water4--,take half a pint of cold water1 the white of one fresh egg1 a pinch of salt1 and a teaspoonful of brandy1 shake and feed from a spoon or from a bottle4 ,this is frequently used in cases of vomiting1 or in irritable stomachs4 ,it is often retained when all other food is rejected4 ,,dried ,,bread4--,cut either stale or fresh bread into thin slices and place in the open oven4 ,when it is dried and crisp but not browned it may be given to children in preference to crackers4 ,,coddled ,,egg4--,a fresh egg with the shell intact is placed in boiling water which is immediately removed from the fire4 ,the egg is allowed to remain in the water for eight minutes when it is ready for use4 ,the white only should be used if the digestion is poor4 ,,artificial ,,feeding ,,chapter ,,xix ,,artificial ,,feeding ,elementary ,principles of ,milk ,modification--,the ,secret of the ,efficiency of ,mother's ,milk--,two ,important ,factors in ,successful ,artificial ,feeding--,every ,child is a ,problem in ,itself--,proprietary ,foods of ,little ,value as ,infant ,foods--,their ,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 ,feeding4 ,,elementary ,,principles ,,of ,,milk ,,modification4--,mothers who have to raise their children on artificial food should understand the elementary principles of milk modification4 ,they should know1 for example1 that the one object of milk modification is to render it as nearly an exact substitute for mother's milk1 according to the age of the child1 as is possible4 ,if we could do this with scientific exactness1 artificial feeding would be a simple process4 ,we cannot1 however2 nor has there ever been devised a method by which we may hope successfully to duplicate mother's milk4 ,it is a comparatively simple matter for the efficient chemist to analyze the breast milk of any nursing mother2 and it is quite possible to duplicate the milk according to the analysis1 with chemical exactness1 but the two fluids will not be the same4 ,there is present in the mother's milk something which synthetic chemistry cannot discover4 ,this something is nature's secret1--it is akin to the life-giving principle which is contained in the germinal fluid1 and in the hen's egg4 ,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 milk1--we can only hope to approximate it4 ,it is possible that we might be successful so far as its nursing efficiency is concerned1 if all children were alike1 if all children were of a uniform standard of health4 ,as a matter of fact1 no two babies are exactly alike4 ,and while the mother of each child undoubtedly secretes a milk suitable to the degree of healthfulness of her own child1 the same milk might not be equally suitable to another child4 ,the milk1 therefore1 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 fed4 ,if that child is not a well child1 according to an accepted standard1 the milk will not agree with it1 even though it is the best possible substitute for an average breast milk4 ,we have consequently two factors to consider in successful or efficient artificial feeding3 #a4 ,our inability to duplicate exactly mother's milk4 #b4 ,the lack of a uniform health standard in children4 ,it is the lack of a uniform health standard in children that gives to artificial feeding all its difficulties4 ,it renders the successful artificial feeding of children a personal or individual problem4 ,some children1--those who approximate a standard of health for their age2 in other words1 well children1--thrive on a milk modification that experience has taught us is suitable for well children of their age4 ,others1 and they are in the majority1 have to be fed on a modification which actual test proves to agree with their digestive capabilities4 ,every artificially fed child therefore must be studied from its own individual standpoint4 ,a certain modification of milk may not agree with a child fed every two and one-half hours1 which will be found to agree if fed in the same quantity1 to the same child1 every three hours4 ,the slightest change1 a change which would seem to be so insignificant in itself as not to justify serious consideration1 may mean the difference between normal healthfulness and constant ill health4 ,a food that is too strong for a child's digestive ability1 and which causes vomiting1 colic1 and diarrhea1 may be rendered exactly right by the slightest modification one of its constituents4 ,to effect such a change quickly and successfully1 one must be trained to interpret the symptoms correctly and to know how to make the change in the modification of the milk4 ,mothers cannot be expected to possess this degree of skill3 they should therefore refrain from experimenting1 because an experiment on a baby is not only dangerous1 but ethically it is criminal4 ,call the family physician2 put the burden on his shoulder4 ,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 claimed4 ,these foods are really substitutes for the inefficiency of the average mother4 ,there is no real justification for their use4 ,if all mothers were clean1 faithful1 and efficient1 there is no reason why each one could not be taught to modify cow's milk to suit her child1 just as satisfactorily1 or more so1 than a manufacturer who never saw her child4 ,the manufacturers1 however1 do the work1 and the naturally ignorant or lazy and inefficient mother1 is willing to pay for the extra cost of labor1 to save herself the trouble on the one hand1 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 hand4 ,we believe that most mothers have never considered the question from this standpoint2 that most mothers adopt this method of artificial feeding at the direct suggestion of their family physician1 and are not1 therefore1 responsible4 ,these foods do not contain the nutritional elements necessary to healthy growth2 or as they exist in normal breast milk2 or as they can be approximated in ordinary milk modification at home4 ,proprietary foods are of decidedly poor value in infant nutrition1 and should not be used4 ,they have a value1 however1 in certain diseased conditions1 but within a very small range4 ,as a food for a healthy growing infant1 they should not be used1 and when the average physician appreciates this fact1 and so instructs the mothers of the country1 it will be to the distinct advantage of the race in every respect4 ,proprietary foods to which fresh cow's milk is added1 are not foods at all1--they depend upon the milk so far as any nutritional value is concerned2 and it would be far safer to modify at home a good milk than to buy a proprietary food1 the analysis of which cannot be depended upon4 ,the credit for the fat1 healthy babies we see advertised does not belong to the manufacturers1 but to the cow whose milk you add to the manufacturer's sugar4 ,the proprietary beef foods are also valueless as infant foods4 ,in certain illnesses1 when we want a mild stimulant1 a teaspoonful or two in hot water may have a certain value1 but that is all4 ,the beef juice of home manufacture is much more valuable4 ,,difference ,,between ,,human ,,and ,,cow',s ,,milk4--,the composition of cow's milk is as follows3 ,fat 7represented by cream7 #d ,sugar #d ,proteids 7represented by curd7 #d ,the composition of an average human breast milk is as follows3 ,fat #d ,sugar #g ,proteids #a-a_/b ,it will be observed from a comparison of the above tables that cow's milk is much richer in proteids 7the substances which form with water the curd of sour milk7 than is human milk4 ,if one remembers that cow's milk is manufactured by nature primarily for the feeding of calves1 not for babies1 and that the stomach of a calf is intended to exist exclusively on vegetable products1 and that nature is preparing it for this purpose1 and feeds it a food when young that will enable it to grow so as to be adapted for that purpose1 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 matter4 ,since the proteids are so much in excess in cow's milk1 we must dilute cow's milk with twice its bulk or more of water to render it fit food for a new born baby4 ,if we dilute cow's milk to this extent to get the proteid percentage right1 we immediately disarrange the percentage of the cream or fat4 ,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 dilution4 ,this is the explanation of the so-called top-milk feeding4 ,the percentage of sugar represents another problem4 ,the percentage of sugar in cow's milk compared with the sugar in human milk is deficient1 so we add milk-sugar to the cow's milk to make up the deficient percentage4 ,there is yet another feature which we must rectify2 cow's milk is acid1 while human milk is alkaline4 ,to overcome this difference we add lime-water4 ,we must also take into consideration that cow's milk is ordinarily full of germs1 while human milk is free from them2 to overcome this danger we resort to heating the milk to a degree which experience has taught us will kill all germs4 ,cooked milk is not as wholesome as uncooked milk1 and it has a tendency to cause constipation4 ,we have to a certain extent overcome the need for cooking all milk for babies1 as will be noted later1 but in summer time1 unless the milk is known to be pure and free from germs1 it is advisable to sterilize it4 ,,utensils ,,necessary ,,for ,,home ,,modification ,,of ,,milk ,one dozen round1 eight-ounce nursing bottles4 ,one dozen black rubber nipples4 ,one eight-ounce measuring glass or graduate4 ,one brush for cleaning bottles4 ,one two-quart glass preserve jar for mixing the various ingredients4 ,one one-ounce ,chapin dipper1 for removing the top-milk4 ,one glass funnel4 ,a detailed description of the proper kinds of bottles and nipples will be found elsewhere4 ,the measuring glass or graduate should be wide-mouthed4 ,it is not safe to spoon the top-milk off1 nor is it safe to pour it out4 ,absorbent cotton should be provided to close the nursing bottles when filled and left standing in the ice box4 ,,artificial ,,feeding ,,from ,,birth ,,to ,,the ,,twelfth ,,month ,the following formulas for the different ages may be found useful for well babies3 ,from the third to the tenth day3 ,milk 7top #af oz47 #c ounces4 ,lime-water #a_/b ounce4 ,milk-sugar #a ounce4 ,boiled water to make #af ounces4 ,ten feedings in twenty-four hours2 #a-a_/b to #b ounces at each feeding4 ,from the tenth to the twenty-first day3 ,milk 7top #af oz47 #f ounces4 ,lime-water #a-a_/b ounces4 ,milk-sugar #a-a_/b ounces4 ,water to make #bd ounces4 ,nine to ten feedings in twenty-four hours2 #a-a_/b to #b ounces at each feeding4 ,from third to the sixth week3 ,milk 7top #af oz47 #aj ounces4 ,lime-water #b-a_/b ounces4 ,milk-sugar #b ounces4 ,water to make #cb ounces4 ,eight to nine feedings in twenty-four hours2 #b or #c ounces at each feeding4 ,from sixth week to the third month3 ,milk 7top #af oz47 #ab ounces4 ,milk-sugar #b ounces4 ,lime-water #c ounces4 ,water to make #cb ounces4 ,seven to eight feedings in twenty-four hours2 #b-a_/b to #d ounces at each feeding4 ,from third to fifth month3 ,after this age two bottles of milk are required1 #af ounces being taken from the top of each bottle and mixed4 ,milk 7top #af oz47 #ah ounces4 ,milk-sugar #b ounces4 ,lime-water #d ounces4 ,water to make #dj ounces4 ,six feedings in twenty-four hours2 #d to #e ounces at each feeding4 ,from the fifth to the seventh month3 ,milk 7top #af oz47 #ba ounces4 ,milk-sugar #b ounces4 ,lime-water #e ounces4 ,water to make #db ounces4 ,six feedings in twenty-four hours2 #e to #g ounces at each feeding4 ,from the seventh to the ninth month3 ,milk 7top #af oz47 #bg ounces4 ,milk-sugar #b-a_/b ounces4 ,lime-water #f ounces4 ,water to make #dh ounces4 ,five to seven feedings in twenty-four hours2 #f to #h ounces at each feeding4 ,from the ninth to the twelfth month3 ,milk 7top #af oz47 #ce ounces4 ,milk-sugar #b-a_/b ounces4 ,lime-water #f ounces4 ,water to make #ef ounces4 ,five to six feedings in twenty-four hours2 #g to #i ounces at each feeding4 ,it will be observed that #af ounces of top-milk is used to make the various formulas from4 ,this means that the mother will dip off1 with a ,chapin dipper1 #af ounces from the top of a bottle of milk which has stood for four or five hours to allow the cream to rise2 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 child4 ,the ordinary milk that is delivered in ,new ,york ,city may be assumed to have stood the four or five hours necessary4 ,this may not be so1 however1 in the country1 as it is frequently delivered there as soon as it is milked4 ,in such cases the mother will permit it to stand in the ice box until the cream has risen4 ,when the mother is about to make the mixture called for in feeding from the third to the fifth month she will observe that #ah ounces of milk is called for4 ,now since she only uses #af ounces of the top-milk from one bottle this will not be enough4 ,she must therefore use #af ounces from two bottles of milk2 this she will mix together and from this mixture she will take the #ah ounces wanted4 ,whatever milk is left over may be used for ordinary table purposes4 ,,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 ,dr4 ,kerley at the out-patient department of the ,babies' ,hospital and give the simplest and easiest means of bottle-feeding3 ,,bottle-,,feeding4--,the bottle should be thoroughly cleansed with borax and hot water 7one teaspoonful of borax to a pint of water7 and boil before using4 ,the nipple should be turned inside out1 scrubbed with a brush1 using hot borax water4 ,the brush should be used for no other purpose4 ,the bottle and nipple should rest in plain boiled water until wanted4 ,never use grocery milk4 ,use only bottled milk which is delivered every morning4 ,from ,may #ast to ,october #ast the milk should be boiled five minutes immediately after receiving4 ,children of the same age vary greatly as to the strength and amount of food required4 ,a mixture1 when prepared1 should be put in a covered glass fruit-jar and kept on the ice4 ,for the average baby the following mixture will be found useful3 ,for a child under six weeks of age3 ,nine ounces of milk1 twenty-seven ounces of barley-water1 four teaspoonfuls of granulated sugar4 ,feed from two to three ounces at two and one-quarter hour intervals1 nine feedings in twenty-four hours4 ,sixth to the twelfth week3 ,twelve ounces milk1 twenty-four ounces barley-water1 five teaspoonfuls sugar4 ,feed from three to four ounces at each feeding4 ,third to the sixth month3 ,eighteen ounces of milk1 thirty ounces of barley-water1 six teaspoonfuls of sugar4 ,feed four to six ounces at three-hour intervals1 seven feedings in twenty-four hours4 ,sixth to the ninth month3 ,twenty-four ounces milk1 twenty-four ounces barley-water1 six teaspoonfuls granulated sugar4 ,feed six to eight ounces at three-hour intervals1 six feedings in twenty-four hours4 ,ninth to twelfth month3 ,thirty-eight ounces milk1 twelve ounces barley-water1 six teaspoonfuls of granulated sugar4 ,feed seven to nine ounces at three and one-half hour intervals1 five feedings in twenty-four hours4 ,,barley-,,water4--,the barley-water used in the above formulas may be made in the following way3 ,to two teaspoonfuls of pearl barley1 add one quart of water1 and boil continuously for six hours1 keeping the quantity up to a quart by the addition of water2 strain through coarse muslin4 ,the barley will be better if it is soaked for a number of hours1 or over night1 before cooking4 ,the water in which it is soaked is not used4 ,an equally good barley-water may be made in an easier way by using ,robinson's prepared barley4 ,this may be procured in the drug stores4 ,it is only necessary to take one even tablespoonful of this barley to twelve ounces of water and cook for twenty minutes4 ,,condensed ,,milk4--,when the mother cannot afford to buy bottled milk from the wagon1 when she has no ice-chest and cannot afford to buy ice1 she should not attempt cow's-milk feeding1 but may use canned condensed milk as a substitute during the hot months only4 ,the can1 when opened1 should be kept in the coolest place in the apartment1 carefully wrapped in clean white paper or in a clean towel4 ,the feeding hours are the same as for fresh cow's milk3 ,under three months of age3 ,condensed milk one-half to one teaspoonful2 barley-water1 two to four ounces4 ,third to sixth month3 ,condensed milk1 one to two teaspoonfuls2 barley-water1 four to six ounces4 ,sixth to ninth month3 ,condensed milk1 two to three teaspoonfuls2 barley-water1 six to eight ounces4 ,ninth to twelfth month3 ,condensed milk1 three teaspoonfuls2 barley-water1 eight to nine ounces4 ,,objections ,,to ,,condensed ,,milk ,,feeding4--,condensed milk is not to be recommended as a permanent food where good cow's milk can be obtained4 ,in most cases it should be used as the sole food for a few weeks only4 ,it may be used when the digestion is impaired for some reason4 ,if the symptoms are intestinal it will be more apt to agree than if they are caused by stomach ailments4 ,the symptoms of intestinal disturbances are1--colic1 flatulence 7gas71 curds or specks in the stools1 constipation or diarrhea4 ,it will not be found suitable if the child is simply vomiting4 ,the objections to condensed milk are3 ,it is very rich in sugar and very deficient in proteids and fat4 ,children fed on condensed milk often gain very rapidly in weight but have little strength or resistance4 ,they do not fight disease well for this reason2 they are apt to develop rickets and scurvy4 ,,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 ,milk1 ,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--,meats1 ,vegetables1 ,cereals1 ,bread1 ,desserts--,fruits4 ,,how ,,to ,,prepare ,,milk ,,mixtures ,the mother should always remember1 that the secret of success in raising a baby efficiently on artificial food is to be cleanly and to be exact4 ,the bottles and the nipples must be scrupulously clean2 the hands of the mother must be clean2 the water used must be boiled and each ingredient must be measured exactly4 ,first dissolve the sugar in the boiled water1 which must be the exact quantity2 then remove the top-milk and measure the exact amount wanted in the graduate1 pour into the jar1 add the water and sugar mixture1 and finally the lime water4 ,it is always desirable to make the entire quantity for the day at one time4 ,after the total quantity has been mixed in the jar1 fill each bottle with the amount for each feeding1 put in a cotton stopper1 and place the bottles in the ice box4 ,in measuring the sugar1 it should be remembered that two scant dipperfuls equal one ounce by weight of the sugar4 ,when each individual bottle is to be filled1 do it with the aid of the glass funnel which has been previously sterilized4 ,,sterilizing ,,the ,,food ,,for ,,the ,,day',s ,,feeding4--,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 pan1 and then to pour enough tepid water into the pan 7outside of the jar7 until it will come up as high as the milk level4 ,the water in the pan is then brought slowly to the boiling point4 ,the pan is then moved to the back of the stove and left for half an hour4 ,the jar is then removed and rapidly cooled by allowing cool water to flow over the outside2 the individual bottles filled and put in the ice box4 ,it is always wise to taste the milk before making up the day's feeding to be sure it is not sour4 ,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 be4 ,when about to feed the baby1 the bottle is taken out of the ice box and heated to the desired temperature in a water bath4 ,the temperature of the milk can be tested by allowing a few drops to fall on the wrist2 it should feel warm1 not hot2 it should not be tasted by putting the bottle to the mouth of the nurse1 or mother1 as it may become infected by doing so4 ,a flannel cover1 or bag1 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 heat4 ,the baby must not be disturbed while nursing1 nor should he be jounced or carried around after nursing4 ,these habits cause vomiting and indigestion4 ,he should be put in his crib4 ,,when ,,to ,,increase ,,the ,,quality ,,or ,,quantity ,,of ,,food4--,children of the same age may have different digestive abilities4 ,a strong1 robust child may be permitted to take a richer quality of milk than a weak1 puny infant of the same age4 ,if the quality or quantity of each feeding is too weak or small for the baby he will be dissatisfied and he will cry after the feeding4 ,in such cases1 if the bowel discharges are natural and yellow without curds or white specks1 and if he is not gaining sufficiently in weight1 the next stronger formula may be tried4 ,if it is decided to put him on the stronger mixture1 it is wise to cut the quantity down for a day or two in order to test out his digestive ability4 ,if the stools remain good after three days1 the quantity may be slowly increased until the amount in the recipe is allowed4 ,it is a much more serious risk to overfeed the baby than to underfeed him4 ,if too large a quantity is given1 he may vomit it at once1 or he may develop colic with intestinal indigestion4 ,such babies lose weight1 become fretful and irritable1 even though the appetite may remain good4 ,if too strong a quality is given he may vomit sour1 buttery-smelling milk1 or have colic1 and pass curds in the stool4 ,if this happens it may be necessary to go back to a weak formula and work up from that standard4 ,this is always a tedious and anxious experience and may lay the foundation for digestive disturbances for a long time4 ,don't be too anxious to increase the quality1 or quantity1 of your baby's food4 ,it is much better to go slow and have a well baby1 than to try to force matters and get into all kinds of trouble4 ,no science calls for more elementary common sense1 than the science of infant therapy4 ,digestive disturbances incident to this period are fully explained in the chapter on ,diseases of ,children4 ,,food ,,allowable ,,during ,,the ,,first ,,year1 ,,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 food4 ,at first the milk may be plain milk from an ordinary bottle shaken up4 ,of this he may take five ounces1 to which may be added three ounces of barley water4 ,the barley water may be gradually withdrawn1 an ounce at a time1 replacing this amount with milk1 until the child is taking eight ounces of milk and two ounces of barley water4 ,later plain mixed milk will be suitable for a child about the fourteenth month4 ,barley water may be added to the milk at any time after the third month in place of the plain boiled water in the preceding formulas4 ,it is advisable to do this if there is any trouble with digestion1 or if there are curds in the stools4 ,some children take more kindly to barley water than plain water at a very early age4 ,,beef ,,juice4--,the juice squeezed from broiled steak may be given a child at about the eighth or ninth month1 or1 in cases of anemia1 earlier than this4 ,it is given before the milk feeding1 diluted with an equal amount of water4 ,at first a teaspoonful of the extracted juice should be given with the same quantity of water2 increase every four days until at the end of two or three weeks two tablespoonfuls are given4 ,,white ,,of ,,egg4--,place an egg in boiling water and allow the water to cool with an egg in it4 ,in ten minutes the white of the egg will be coagulated and ready for use4 ,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 daily4 ,one-half of the white of the egg should be tried1 then at the end of a week1 if it agrees with the child1 the whole white of one egg may be given4 ,,orange ,,juice4--,this juice has a good effect on the bowels and may be given even to very young children who are disposed to be constipated4 ,it is also of benefit in counteracting the effect of boiled milk4 ,the juice should be extracted from fresh oranges and strained4 ,one teaspoonful may be given at first one hour before a feeding4 ,the amount may be increased until four teaspoonfuls1 or one tablespoonful1 are given daily4 ,,peptonized ,,milk4--,the object of peptonization of milk is partly or wholly to digest the casein1 or curd1 of the milk before feeding4 ,fairchild's ,peptonizing ,powder is used for this purpose4 ,the powder is put up in tubes1 and instructions are furnished in each box as to its use4 ,there are two methods of using the powders3 ,,the ,,hot ,,or ,,immediate ,,process4--,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 use4 ,the bottle is then put in water at a temperature of from #aaj deg4 to #abj deg4 ,f41 and allowed to remain in the water for fifteen minutes4 ,the amount of the powder used and the temperature of the water depend upon the amount of milk in the nursing bottle4 ,,the ,,cold ,,process4--,four ounces of cold water are put into a clean quart bottle and the powder from one of the tubes4 ,shake the mixture thoroughly until the powder is dissolved4 ,add a pint of cold fresh milk1 shake the bottle again and place directly on ice4 ,when any of this milk is used the bottle should be again shaken and put immediately back on ice4 ,if necessary this process may be modified so that partially or completely peptonized milk may be made4 ,,partially ,,peptonized ,,milk4--,put four ounces of water and a whole tube of powder into a clean pan and stir well2 add a pint of cold milk and heat to the boiling point1 stirring the mixture all the time4 ,there should be enough heat to bring the milk to the boiling point in ten minutes4 ,allow the mixture to cool somewhat and strain into a clean jar1 cork tightly and keep in a cool place4 ,shake the jar before and after using any of the contents4 ,if partially peptonized milk is properly prepared it should not become bitter4 ,,completely ,,peptonized ,,milk4--,put four ounces of cold water and the powder contained in one of the tubes into a clean quart bottle and shake thoroughly4 ,add a pint of cold fresh milk and shake again2 then place the bottle in a pan of warm water about #aae deg4 ,f41 or not too hot to place the hand in comfortably4 ,keep the bottle in the water bath for thirty minutes2 then place the bottle directly on ice4 ,,uses ,,of ,,peptonized ,,milk4--,partially peptonized milk is useful in young infants who have difficulty in digesting the curd of milk4 ,completely peptonized milk is frequently used during attacks of indigestion4 ,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 mixtures4 ,it is of value also in acute or chronic illness when the child has to be fed through a tube4 ,when it is necessary to feed per rectum peptonized foods are often selected in preference to others4 ,,objections ,,to ,,peptonized ,,milk4--,complete peptonization of milk renders the milk bitter4 ,for this reason many children will not take it4 ,very young children whose sense of taste is not developed may be induced to take it after a few days4 ,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 upon4 ,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 way4 ,,what ,a ,,mother ,,should ,,know ,,about ,,baby',s ,,feeding ,,bottle ,,and ,,nipple4--,in the first place1 always buy round bottles1--round everywhere1 inside and out1--there should be no corners anywhere4 ,the reason for this is1 that bottles that are round everywhere1 are easily cleaned1 and can be thoroughly cleaned1 and having no corners they do not lend themselves to collecting dirt and bacteria4 ,when these bottles are first bought they should be boiled4 ,after each feeding they should be thoroughly washed with soap or washing powder4 ,a long-handled bottle brush should be used to help clean the bottle4 ,after the bottle has been thoroughly rinsed a number of times with hot water1 it should be set aside filled with warm water into which one teaspoonful of bicarbonate of soda has been put4 ,before filling them with the freshly prepared food each morning the bottles should be boiled4 ,every mother with a bottle-fed baby should buy a dozen bottles1 all of the same kind and size to begin with4 ,this is a great advantage for a number of important reasons1 two or three of which ,i will mention3 #ast4 ,having enough bottles means that each bottle will be used once only during the twenty-four hours2 there is less chance therefore of a bottle being cleaned carelessly4 #bnd4 ,having a fresh bottle for each feeding permits all of the food for twenty-four hours being made at one time4 ,this ensures uniformity of quality of each feeding4 #crd4 ,by cleaning all the bottles at one time 7previous to filling7 it is more apt to be done thoroughly2 and by making all the food for a day at one time it is more apt to be correct than if each feeding was made separately4 ,the baby's nipple should be made of plain black rubber4 ,it should not be too thick because it is necessary to turn it inside out in order to clean it thoroughly4 ,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 large4 ,if the milk drops out but does not run it is about right4 ,don't buy nipples too long or too large4 ,a long nipple tends to gag the child and cause vomiting4 ,a large nipple prevents the child from sucking properly and usually allows the food to be taken too quickly and with air1 which causes colic and indigestion4 ,it is well to have always half a dozen nipples of the right kind on hand4 ,when new1 nipples should be boiled before using4 ,after each feeding the nipple should be washed in borax and water on both sides1 then it should be put in a dish containing fresh1 cold1 borax water and left there until again required4 ,a large portion of the success of raising healthy1 bottle-fed babies is in being everlastingly clean in the details of caring for the bottles and nipples which are in daily use4 ,,should ,a ,,mother ,,put ,,her ,,baby ,,on ,,artificial ,,food ,,if ,,her ,,supply ,,of ,,milk1 ,,during ,,the ,,first ,,two ,,weeks1 ,,is ,,not ,,quite ,,enough ,,to ,,satisfy ,,it8--,this is a question that cannot be answered by a simple yes or no4 ,a great deal depends upon circumstances1 and these circumstances must be weighed and counterweighed before an answer is given4 ,it is a serious matter1 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 milk4 ,this is a subject in need of earnest missionaries in all walks of life1 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 born4 ,a woman who can and will not nurse her own child is scarcely deserving of the name of mother4 ,it does not seem quite human to deprive a baby of the milk which rightfully belongs to it2 yet in certain walks of life this is not an uncommon procedure4 ,on the other hand the percentage of women able to nurse their children is decreasing4 ,this is especially true as applied to cities1 though it is also true1 in a less degree1 in the rural districts4 ,one eminent authority states that less than twenty-five per cent4 of the well-to-do mothers1 who have earnestly and intelligently attempted to nurse their babies1 succeed in doing so for a period longer than three months4 ,this authority also says3 ,an intellectual city mother who is able to nurse her child successfully for the entire first year is almost a phenomenon4 ,women nowadays have so many diversified interests1 that the primal duty of maternal nursing is not at all a fashionable function4 ,if1 however1 the mother is willing1 and has conscientiously tried to nurse her baby1 and after seven or eight days it is found that she has not enough milk to satisfy it1 and if the quality seems to be good1 some expedient should be immediately adopted to tide the condition over until the mother resumes her customary household routine4 ,the safest expedient under these circumstances is to alternate the feedings2 one feeding from both breasts of the mother1 and the next an artificial food4 ,some arrangement of this kind is the just and the safest way1 because a very large percentage of mothers suffer from inactivity while lying in bed after a confinement4 ,this inactivity expresses itself in a failure of some of the organs to perform their duty properly4 ,this may affect the quantity1 and sometimes the quality1 of the milk1 but it is1 as a rule1 quickly rectified as soon as the mother is up and active4 ,if1 however1 the milk is still found to be inadequate after she is up and has resumed her usual habits1 and if her health is good1 and she is eating well1 it is distinctly best to put the child exclusively on an artificial diet4 ,,certain ,,conditions ,,justify ,,the ,,adoption ,,of ,,artificial ,,feeding ,,from ,,the ,,beginning #ast4 ,woman suffering with any wasting disease such a cancer or tuberculosis4 7,one of these days1 and very soon we hope1 it will be legally impossible for a tubercular or cancerous patient to become a mother47 #bnd4 ,when a mother is the victim of any of the serious childbed complications such as convulsions1 kidney disease1 extensive loss of blood or blood poisoning1 or runs a high temperature because of some disease occurring at the same time as the confinement1 as1 for example1 appendicitis1 scarlet fever1 typhoid fever1 etc4 #crd4 ,epilepsy1 chorea1 insanity1 are also conditions which render artificial feeding necessary4 ,it is much wiser immediately to put the child on artificial feeding if there is a justifiable reason for it than to experiment1 because any experiment at this time is almost certain not to be in favor of the child4 ,artificial feeding is a comparatively easy and successful problem1 provided it is begun with healthy digestive organs4 ,if you keep the child at the breast of a mother whose milk is inadequate in quantity or quality1 or both1 for two or three days1 and then begin artificial feeding1 the child's stomach is already unable to perform its duty1 and you have to treat it with the greatest degree of care and attention1 and probably begin with a weak food1 until you regain the lost ground4 ,,mothers' ,,mistakes ,,in ,,the ,,preparation ,,of ,,artificial ,,food4--,another interesting condition which is quite common1 is the tendency on the part of the mother to fail to follow instructions correctly1--even though written or printed1--regarding the preparation of the baby's food4 ,when the baby is not thriving and gaining steadily in weight1 or is fretty and cries a good deal1 and does not rest and sleep peacefully1 something1 of course1 is wrong4 ,if1 after a careful physical examination of the child1 nothing is found to justify these symptoms1 a physician invariably finds1 if he questions the mother closely1 that she has mistaken the instructions and is preparing the food wrongly4 ,infinite care in every little detail is the price of success in raising babies as well as in every other field of human endeavor4 ,revise carefully your method of preparing baby's food if there is any trouble such as is described above4 ,despite your absolute assurance that you are making no mistake1 do not be surprised to find that you are not following directions to the letter1 and because of this unintentional mistake1 your negligence is responsible for your baby's condition4 ,go over the instructions with your husband1 and let him follow your method of preparation1 as you repeat it4 ,he may detect the mistake if any exists1--two heads are always better than one4 ,so important is this matter that the following two actual cases will demonstrate how easy it is to make a mistake1 despite the absolute confidence of the mother1 in each case1 that she was following the printed directions correctly3 ,i was called to see a baby whose mother informed me that it was having a great deal of trouble4 ,it was apparently not thriving2 its bowels were bad2 it constantly cried1 and seemed to be suffering from colic and indigestion4 ,the mother stated that it lay with its legs constantly drawn up and passed enormous quantities of gas4 ,the baby certainly looked sick4 ,it had been a small baby at birth2 and at three months it weighed only six pounds4 ,after a careful examination1 ,i could find nothing in the physical condition of the child itself1 which satisfactorily explained the condition1 and had made up my mind that the food upon which it was being exclusively fed1 and upon which it had been fed since birth1 was not agreeing with it4 ,before recommending a change of food1 ,i asked the mother to state in detail just how she prepared it4 ,the directions printed on the can in which the food was bought called for so many ounces of a certain quality of top milk4 ,she thought this meant simply so many ounces off the top of a bottle of milk1 which1 of course1 meant that she was feeding her baby exclusively a very rich cream and absolutely no milk4 ,the result was that the baby--small and weak to begin with--could not digest this rich mixture1 so it gradually lost vitality1 as the mother kept increasing the strength of the food1 according to the age1 as directed by the instructions1 until it was completely knocked out4 ,i pointed out her mistake and suggested a change in her methods2 she was instructed to use the formula for a child of two months1 instead of the one for three months1 as she was doing4 ,the child immediately began to pick up and in the course of six weeks was entirely cured1 and had gained considerably in weight4 ,this mother was a careful1 clean1 painstaking1 attentive nurse1 and it was a long time before she forgave herself for the mistake4 ,the mistake here was a little matter1 but the results were big and convincing4 ,the second case was that of a child of about the same age1 but in this instance it had been a robust1 healthy child when born1 and of normal weight and size4 ,the mother nursed it for about one month1 when her milk failed1 and it was put upon a well-known1 patent barley preparation4 ,the food seemed to agree with it for a time1 but1 as the mother explained1 the child soon seemed to be dissatisfied at each feeding1--it gave her the impression that it was not getting enough to eat1 so she increased the quantity4 ,despite this increase of food1 it was apparent that the baby was getting weaker1 and more and more irritable1 and sleepless1 until there was no rest night or day for the mother or baby4 ,about this time the child began to swell up as if dropsical2 it lost its healthy color and looked as if made of wax4 ,it was very evident that the child was being starved1 yet this scarcely seemed probable when the actual quantity of food consumed was considered4 ,the directions on the can of this food1 called for a certain amount of the barley powder to be mixed with boiled water2 and in an additional paragraph it was directed to mix this with a certain amount of milk4 ,when ,i requested the mother to state how she prepared the food1 ,i was astonished to learn that she had evidently never read the second paragraph of the directions4 ,she was feeding her baby on barley powder and boiled water1--an excellent starvation diet4 ,when her attention was called to the grave carelessness she had been guilty of1 she was the most contrite mother ,i ever knew4 ,as soon as the milk was added to the food the baby immediately began to thrive was very soon a robust1 healthy infant4 ,of course these were errors of bad judgment and gross negligence of which few mothers would be guilty1 but these types of mistakes come to the attention of physicians frequently1 and emphasize the need of constant vigilance in every detail in the management of babies if we wish to achieve success4 ,,feeding ,,during ,,the ,,second ,,year ,at the beginning of the second year the child should be fed at the following hours1 #f and #aj ,a4 ,m41 #b1 #f1 and #aj ,p4 ,m4 ,early in the second year the child should be taught to drink from a cup4 ,a proper diet for a child of twelve months1 of average development1 would be as follows3 #f ,a4 ,m4 ,milk and barley water1 or milk and oat gruel1 in the proportion of seven ounces of milk to three ounces of the diluent4 #i ,a4 ,m4 ,the juice of an orange 7strained74 #aj ,a4 ,m4 ,the same as at #f ,a4 ,m4 #b ,p4 ,m4 ,chicken broth with rice or stale bread crumbs1 six ounces2 or a light boiled egg mixed with stale bread crumbs2 or beef juice1 three ounces4 ,milk and gruel same as at #f ,a4 ,m41 but four ounces only4 #f ,p4 ,m4 ,two tablespoonfuls of cereal jelly in eight ounces of milk2 a piece of stale bread and butter4 7,the jelly is made by cooking the cereal for three hours the day before it is wanted2 it should then be strained through a colander2 oatmeal1 barley1 or wheat may be used47 #aj ,p4 ,m4 ,same as at #f ,a4 ,m4 ,about the fifteenth month the cereals may be given much thicker and fed with a spoon4 ,the child can at this time take a number of various fruit juices4 ,orange juice is the best4 ,carefully strained juice of ripe peaches1 strawberries1 raspberries1 may be given in reasonable amounts1 one or two tablespoonfuls1 once daily4 ,custard1 cornstarch1 plain rice pudding1 junket1 wheatena1 cornmeal1 hominy1 oatmeal1 zwieback1 bran biscuit1 each with butter1 may be added in reasonable quantities between the eighteenth and twenty-fourth months4 ,when cereals are given they should be thoroughly cooked1 usually for three hours1 and strained4 ,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 cream4 ,water must be given to the child between meals especially during the summer4 ,it should be boiled and cooled kept in a cool place4 ,the following schedule for a child about the third year constitutes a good average diet for a healthy child3 ,,table ,,of ,,standards 7,as ,adopted and ,copyrighted by the ,american ,medical ,society7 ,,physical ,,development ,transcriber's ,note3 ,the ages were difficult to read and may not all be correct4 ,age in ,months ,weight ,height ,circumference of head ,circumference of chest ,circumference of abdomen ,lat4 ,diameter of chest ,chest front to back ,length of arm ,length of leg ---------------------------------------- --------------------------------------- lbs4 in4 in4 in4 in4 in4 in4 in4 in4 #f #ag #bg #ag-a_/b #ag-a_/b #ag-a_/b #e #d-a_/b #aj #aj #i #ai #bh #ah #ah #ah #e #d-a_/b #aa #aa #ab #bj #bi #ah-a_/b #ah-a_/b #ah-a_/b #e #d-c_/d #ab #ab-a_/b #af #bc #cj #ah-a_/b #ah-a_/b #ah-a_/b #e-a_/b #e #ab-a_/b #ac-a_/b #ba #bd #ca #ah-a_/b #ai-a_/b #ai-a_/d #f #e #ad #ae #bd #be #cb #ai #bj #ai-a_/b #f #e #ad-a_/b #ae-a_/b #bh #bg #cc-a_/b #ai #bj #ai-a_/b #f #e #ad-c_/d #ae-c_/d #cb #bi #ce #ai-a_/b #bj-a_/b #ai-a_/b #f-a_/d #e-a_/b #ad-c_/d #ae-c_/d #cf #cb #cf-a_/b #bj #ba #bj #f-a_/d #e-a_/b #ae #af-a_/b ,,mental ,,development ,attention1 facial expression1 irritability and disposition should be considered4 ,six ,months ,child sits unsupported for a few minutes4444 ,balances head4444 ,eye follows a bright object4444 ,looks in direction of an unexpected sound4444 ,child seizes an object and holds it4444 ,twelve ,months ,stands and walks with support4444 ,makes a few sounds1 such as mam-mam1 da-da1 co-oo4444 ,plays with toys4444 ,attempts to use paper and pencil4444 ,shows interest in pictures4444 ,clings to mother4444 ,eighteen ,months ,child walks and runs alone4444 ,says a few words1 such as ,mama1 ,papa1 ,baby4444 ,points to common objects in pictures4444 ,imitates a few simple movements1 such as placing hands on head or clapping hands4444 ,two ,years ,runs4444 ,repeats two or three words4444 ,knows features4444 ,obeys simple commands1 such as ,throw me the ball4444 ,imitates movements4444 ,two and ,one-,half ,years ,talks in short sentences4444 ,knows names of members of the family4444 ,roughly copies a circle4444 ,recognizes self in mirror4444 ,imitates more complex movements4444 ,three ,years ,talks distinctly4444 ,repeats sentences of six simple words4444 ,repeats up to two numerals--meaning repeats first one numeral and then two numerals4444 ,enumerates objects in a complex picture and attempts to describe it4444 ,four ,years ,knows its sex4444 ,names familiar objects1 such as key1 knife1 etc44444 ,repeats three numerals4444 ,compares two sticks 7can select the longer74444 ,distinguishes the longer of two lines4444 ,five ,years ,compares weights and lengths4444 ,copies a square4444 ,counts four pennies4444 ,describes a picture4444 ,breakfast3--7#g to #h o'clock7 ,oatmeal1 hominy or cracked wheat 7cooked three hours71 served with milk1 a little salt but very little sugar4 ,a soft egg1 boiled1 poached1 or coddled4 ,stale bread and butter4 ,one glass of warm milk4 ,at #aj o'clock1 the juice of one orange4 ,dinner3--7#ab o'clock7 ,strained soup1 four ounces4 ,chop1 roast beef1 steak1 chicken1 small quantity of any one4 ,baked potato and cooked rice1 or spaghetti4 ,a selection of green vegetables may be made from asparagus tips1 string beans1 peas1 spinach1 cauliflower1 carrots2 they should be cooked until very soft1 and mashed or put through a sieve4 ,for dessert1 plain rice pudding or bread pudding1 stewed prunes1 baked or stewed apple1 junket1 custard or cornstarch4 ,a glass of milk or water4 ,supper3--7#f o'clock7 ,cereal2 farina1 arrowroot1 cream of wheat1 wheatena 7each cooked two hours71 with salt but no sugar4 ,give two or three tablespoonfuls4 ,drink of milk with stale bread and butter4 ,twice a week1 a little plain ice cream1 or junket1 custard or cornstarch4 ,three meals a day at this time are better than more frequent feedings4 ,the child has a better appetite and much better digestion4 ,it may be found necessary to give delicate children a luncheon at #c o'clock4 ,a glass of milk and a ,graham wafer1 or a cup of broth and a zwieback1 will answer the purpose4 ,children recovering from serious illness will need more frequent nourishment4 ,up to the sixth year the diet may conform to the above schedule1 increasing the individual quantities as circumstances may warrant4 ,,the ,,diet ,,of ,,older ,,children 7,,from ,,six ,,to ,,ten ,,years7 ,after the sixth year the diet will conform to the adult diet1 with certain exceptions4 ,the important exceptions are as follows3 ,all meats are to be excluded except roast beef1 steak1 lamb chops1 roast lamb1 mutton chop2 all meats should be cooked rare and either scraped or finely divided4 ,they should be broiled or roasted1 never fried1 and never given oftener than once daily1 and then only in small quantity4 ,pies1 rich puddings1 pastries of all kinds1 gravies1 sauces1 all highly seasoned dishes2 wine1 beer1 coffee1 tea1 should never be given to children4 ,ham1 bacon1 sausage1 pork1 liver1 kidney1 game1 and all dried and salted meats1 codfish1 mackerel and halibut1 are particularly bad4 ,the following articles are permissible3 ,broiled chicken1 shad1 bass4 ,the platter gravy from a roast is very nourishing if given in small amounts4 ,milk should continue to form an important part of the dietary up to the tenth year4 ,it should be clean and fresh but not too rich4 ,sometimes it is found advisable to dilute the milk with water that has been boiled and cooled4 ,some children will take it if a pinch of salt or bicarbonate of soda is put into it1 and they will digest it easier and better4 ,they should never be allowed to take more than one quart daily and frequently less will do more good4 ,cream is not good for children of this age4 ,eggs are valuable2 they should never be given fried or in the form of omelets1 they are best given boiled1 poached or coddled and only slightly cooked4 ,it is never necessary to give more than one egg at a meal4 ,there are children with whom eggs do not agree2 these children are disposed to biliousness4 ,,vegetables4--,certain vegetables are objectionable at this age3 ,raw celery1 radishes1 raw onions1 cucumbers1 tomatoes1 lettuce1 corn1 lima beans1 cabbage1 egg plant4 ,the following are good3 ,white potatoes 7never fried71 spinach1 peas1 asparagus tips1 string beans1 celery1 young beets1 carrots1 squash1 turnips1 boiled onions and cauliflower4 ,it is important to remember that all vegetables should be thoroughly cooked2 they cannot be cooked too much4 ,after boiling for some time the water should be drained off and fresh water used to complete cooking4 ,vegetables should be fed in small quantities4 ,from the third to the tenth year they form an important and essential part of the diet of all children4 ,after the tenth year they can be eaten as served to adults1 and other vegetables may then be added4 ,as a rule salads of all kinds should be omitted until after the twelfth year4 ,,cereals4--,children should not be allowed to eat too much cereal at one meal1--never more than one small saucerful4 ,cereals should be properly cooked4 ,it is not safe to adhere strictly to the directions on the package of any cereal4 ,as a rule they require much longer cooking4 ,they are best cooked in a double boiler4 ,they may be served with milk1 salt1 and not more than one teaspoonful of sugar4 ,,bread4--,fresh bread is never allowable4 ,graham wafers1 oatmeal crackers1 ,huntley and ,palmer breakfast biscuits1 bran muffins1 rye bread1 corn bread1 stale rolls1 are all suitable to growing children4 ,hot bread1 fresh rolls1 buckwheat or griddle cakes1 all sweet cakes1 are objectionable4 ,,desserts4--,the only permissible desserts for this age are junket1 custards1 plain rice1 or sago2 or bread pudding4 ,the only safe rule to follow so far as sweet things are concerned1 is not to give them at all4 ,this applies to candy1 ice cream1 pies1 pastries1 jam1 syrups1 preserved fruits1 nuts and dried fruits4 ,the parent who indulges a child to a taste1 is guilty of a bad habit1 and it can only lead to trouble4 ,,fruits4--,these should always be fresh and selected with care4 ,fruit is the most important article of diet to a child of this age4 ,up to five years it is safest to use only cooked fruits and fresh fruit juices3 of these the juice from sweet oranges1 grape fruit1 peaches1 strawberries1 and raspberries may be given4 ,stewed or baked apples1 apple sauce1 figs1 prunes1 peaches1 apricots1 pears are excellent because of their effect on the bowels4 ,when the bowels are loose1 and especially in hot weather1 great care must be taken when fruit of any kind is used4 ,the pulp of any fruit should never be used2 cherries1 bananas1 pineapples1 and berries are not to be given to children4 ,milk should never be allowed at the same meal when sour fruit is served4 ,,what ,,mothers ,,should ,,know ,,chapter ,,xxi ,life has taught me that it is the women of a country in whose hands its destiny reposes4 ,no cause that is not great enough to command their devotion and pure enough to deserve their sympathy can ever wholly triumph4 ,,joseph ,h4 ,,choate4 ,,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 ,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 ,vaccination4--,symptoms of ,successful ,vaccination4 ,,what ,,mothers ,,should ,,know ,,about ,,the ,,care ,,of ,,children ,,during ,,illness ,every child has a certain amount of vitality and resistance4 ,when illness comes it should be our duty to maintain the vitality and resistance to the highest degree4 ,we should1 therefore1 irrespective of the nature of the illness1 surround the child with all the conditions that will minister to the preservation of whatever strength and vitality the child has4 ,experience has taught us that there are certain requirements that should be carried out in the general management of sick children4 ,a ,,sick ,,child ,,should ,,be ,,in ,,bed4--,in the first place a sick child should be in bed4 ,there is no exception to this rule4 ,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 sick4 ,a mother should not forget that it is she who must exercise wisdom and decide what is best for her child4 ,the judgment of a sick person is not to be relied upon1 and it would be wrong to submit to the whims and fancies of an ailing child1 if these are known to be medically disadvantageous to its best interests4 ,quiet surroundings are essential in all acute illnesses4 ,the nurse should be congenial to the child4 ,if the patient demands the presence of the mother she should remain1 but she should not try to entertain him or interfere with the nurse4 ,the clothing of the patient should be the ordinary night-dress which is worn in health4 ,in no disease is any special kind1 or quantity of clothing required4 ,the temperature of the room should be #fh deg4 ,f4 ,thermometers are cheap and an exact knowledge of the degree of heat in a sickroom is an essential requisite4 ,nothing drains the vitality during sickness quicker than varying degrees of heat and cold4 ,it uses up nerve force and energy and renders the patient irritable and difficult to manage4 ,the strictest attention should be paid to the ventilation of the sickroom4 ,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 patient4 ,a direct1 continuous communication between the sickroom and out-of-doors is imperative4 ,it is a splendid measure to use two rooms for the patient and to change him twice daily1 and to air thoroughly the unused room4 ,the sickroom itself should be large and in a quiet part of the house4 ,in summer time the windows may be wide open1 in winter months the degree of ventilation can be regulated by the thermometer4 ,many mothers fail to appreciate that drinking water is an important requisite in all ailments of childhood1 should be given freely1 but it should be known to be absolutely pure4 ,the same rule applies to sponging the patient4 ,it must be done every day2 sometimes it is necessary to do it more often1 but if so it will be so directed by the attending physician4 ,,the ,,diet ,,of ,,the ,,sick ,,child4--,prescribing the diet of the sick child is an important undertaking4 ,it should be remembered that during sickness the digestive capacity is reduced2 consequently the food must be lessened in quantity and in strength4 ,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 water1 cooled to the temperature of the body4 ,this dilutes the mother's milk and renders it more easy of digestion4 ,if bottle-fed1 it is accomplished by replacing one-half of the milk with water4 ,in certain diseases milk is totally withdrawn1 but these cases will be noted when discussing the treatment of the various diseases4 ,with older children1 we give milk diluted with water1 or gruels1 soups1 or cereals1 as conditions warrant4 ,needless interference with the patient must not be indulged in4 ,sleep and quiet are essential features of nature's reparative process4 ,it is seldom necessary to disturb a sick child for the giving of food or medicine oftener than every second or third hour4 ,medicine may always be given with food4 ,meddlesome interference1 talkative attendants1 or excessive noise may exhaust a child and may prolong and render dangerous or fatal a condition that would otherwise go on to recovery4 ,one satisfactory movement of the bowel daily is essential to the comfort and progress of a sick person4 ,if this does not take place naturally1 it should be obtained by an enema4 ,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 sick4 ,a ,,child ,,is ,,the ,,most ,,helpless ,,living ,,thing4--,nature endows the young of every species--except those of the human family--with certain instincts1 which1 when developed1 govern and control their lives absolutely4 ,the technical definition of an instinct is an exceedingly complicated word picture4 ,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 is the result of a process of reasoning and an act that is the result of an instinct4 ,if a man finds his way out of his burning home he will stay out as long as there is any danger4 ,the crudest kind of reasoning will teach this lesson4 ,a horse1 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 loose1 will immediately reenter and be burned to death4 ,the horse is the victim of instinct2 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 in4 ,when an ostrich fears danger he buries his head in the sand1 under the impression that if his head is out of sight he is safe from danger4 ,this is his instinctive plan of procedure in the presence of danger1 and it is the plan of every ostrich1 everywhere1 always4 ,a little reasoning would show them how foolish the idea is--but they cannot reason4 ,that is the province of man alone4 ,if the first member of a flock of sheep jumps over a fence to get into the next field1 every member of the flock will follow1 each one jumping the fence1 though there may be an open gate between the two fields a few yards away4 ,instinct dictates the plan to the sheep as they have received instructions from their ancestors always to follow the lead4 ,this is their hereditary legacy and they cannot disobey it4 ,animals are born with instincts which need only circumstances to bring them out4 ,now a baby is not born with instincts of this character1--it has not even the instinct to help itself2 it cannot find the breasts that were made for it2 it is more helpless than the baby cat or dog or worm4 ,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 mother1 until such time as it may be capable of reasoning for itself4 ,motherhood is therefore the supreme privilege of womanhood4 ,it cannot be superseded1 hence the fundamental factor in any system of race culture1 or in any system of infant mortality1 must tend to raise the quality and the intelligence of motherhood as a basic necessity4 ,motherhood at the present time1 though the most important and sacred profession in the world1 is almost exclusively carried on by unskilled labor4 ,the maternal instinct is deeply rooted and universal2 its absence must be regarded as an abnormality1 or as a product of misdirected education4 ,the requisites for the mothers of the future should be absolute physical health and love of children4 ,if nature endowed a baby with instincts there would be no need for reason or education4 ,education cannot teach a cat how to nurse or wash a kitten any better than it does1--its instinct is good enough4 ,the mother of a human baby1 however1 is not born with the instinct which enables her to care for her baby equally as well as the cat cares for her kitten4 ,she must be educated or taught to care for it4 ,she can then care for it better than the cat cares for the kitten1 and she can be taught to bake1 to sew1 to read2 to play on the piano1 which a cat cannot be taught4 ,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 therein4 ,to limit the environment of a child by imposing instincts upon it1 would be to limit its inherent freedom4 ,to be obliged to obey a prescribed instinctive law would rob mankind of his creative or reasoning faculty1 and that would be to lower him to the level of the brute creation4 ,reason is of no use if our acts are already determined for us4 ,there are therefore good reasons why the human baby should be1 at the moment of its birth1 the most helpless living thing2 and as a consequence it is imperative1 if the eugenic ideal is worthy of attainment1 that every baby should have the benefit of trained and efficient care and education4 ,,the ,,delicate ,,child ,there is a certain standard by which we measure the physical and mental development of children4 ,this standard we regard as the evidence of normal development4 ,some children exceed these requirements2 they are bigger and stronger at a given age than the average child at the same age4 ,there are other children who cannot be called sick1 but who are physically and mentally inferior to the average standard1 whom we designate as delicate4 ,these children are not as big1 or as strong1 or as heavy1 as other children of the same age4 ,they are born with a reduced vitality1 or through mismanagement in early infancy they have acquired a subnormal standard of development4 ,children born of parents who are not of standard vitality are predisposed to be delicate4 ,if the parents are of average development1 and the delicacy of the child is acquired by mismanagement1 the proper dietetic and hygienic management will1 as a rule1 promptly result in a satisfactory restoration to normal health4 ,,treatment4--,when a mother awakes to the knowledge that her child is delicate2 when she understands that her child's vitality is not what it should be1 and when she resolves to do something in the interest of her child1 she is on the right road1 and we hope to encourage her in the good intention4 ,we would however tell her that her effort must be thorough1 and that she must be patient and persevering4 ,if she does not falter in well doing she will succeed beyond her expectation1 and the satisfaction she will experience in noting the evidences of returning health and strength in the appearance and conduct of her child1 should be ample recompense for the effort made and the time bestowed4 ,she must begin with a definite knowledge of just what she intends doing2 she must know1 however1 what must be done and she must begin at the beginning and build from a sure foundation4 ,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 child2 this necessitates a thorough examination by a competent physician4 ,if you are assured there is no disease present1 no tuberculosis1 no syphilis1 no malaria1 and that debilitating conditions1 such as adenoids1 sexual abnormalities1 the results of self-abuse1 skin disease1 do not exist1 then certain fixed rules can be laid down1 and definite principles followed in the daily management4 ,,weight1 ,,as ,a ,,standard ,,of ,,development4--,it has been stated elsewhere in this book that one of the safest guides to follow1 as to whether a child is thriving1 is its weight4 ,this can be relied upon as a general rule4 ,a child should therefore be weighed regularly every week4 ,if it is not gaining an average of four ounces weekly it is not thriving up to standard4 ,when the average is below four ounces there is something wrong with the quality or quantity of the food4 ,,how ,,to ,,feed ,,the ,,delicate ,,child4--,if the child is breast-fed and the weight standard1 as evidenced by the weekly averages1 is persistently below normal1 we must find a substitute for the mother's milk4 ,if the child is bottle-fed and it is demonstrated that it is impossible to maintain normal development on cow's milk1 a wet-nurse should be obtained4 ,after the child is weaned1 or put upon a more liberal diet1 milk should continue to be the chief article of diet4 ,from the first to the third year a child should take one quart of milk daily in addition to the other food4 ,there are some children1 however1 who seemingly cannot take milk without getting indigestion2 they should be put on skimmed milk1 to which may be added a small quantity of sugar to make up for the loss of fat4 ,mothers must be certain that too much milk is not given1 or the desire for other necessary food will diminish4 ,after the first year it is a very good plan to give one teaspoonful of scraped beef daily4 ,if this is well borne1 two may be given and later three4 ,it can be given immediately before the regular feeding of cereal and milk4 ,from the twelfth to the sixteenth month eggs may be given3 at first one-half1 and later a whole egg mixed with bread crumbs4 ,various vegetables should also be given cooked in the form of a puree4 ,if at any time the child should refuse the food1 or act as if it had no appetite1 leave the milk out of the diet2 this may then restore the appetite and it will take the other food freely2 the milk can be resumed later4 ,as the child grows older1 the distaste for milk may grow1 or he may be one of those children with whom milk really does not agree2 in either event1 do not hesitate to leave it out of the child's dietary4 ,these children should be encouraged to eat plenty of good butter on their bread and crackers4 ,butter will not only agree with them1 but it will supply any fat deficiency in the general diet4 ,the diet may now consist of milk 7unless it disagrees71 cereals cooked three hours1 raw or rare meat1 poultry1 eggs1 vegetables1 purees1 cooked and raw fruit1 bread1 crackers4 ,,how ,,to ,,bathe ,,the ,,delicate ,,child4--,regular daily baths are particularly of benefit to the delicate child1 despite the prevailing fear that they may catch cold4 ,the salt bath is advised and the time to take it is just before retiring4 ,the room should be warm and the temperature of the water should be #ij deg4 ,f43 it should not last longer than five minutes1 and the water should be cooled down to #gj deg4 ,f41 before the child is removed from the bath4 ,while the cold water is running in1 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 reaction4 ,very delicate children need not have the temperature of the water reduced2 others may stand water of #hj deg4 ,f41 but no lower4 ,in the poorly nourished it is frequently advantageous to rub the body1 after drying1 with olive oil or goose oil4 ,this aids nutrition and because of the massage it aids circulation4 ,in some older children a daily cold spinal douche seems to act particularly well4 ,if the child does not promptly react from the effect of the cold water it is best to discontinue it4 ,,airing ,,the ,,delicate ,,child4--,delicate children should1 above all things1 be assured of the maximum amount of fresh air and sunlight4 ,many mothers entertain the idea that these children are disposed to take cold easily1 if in the open air1--which is not the case4 ,all children need an abundance of fresh air and the delicate need it particularly4 ,the season of the year and the character of the weather will1 of course1 dictate just how much open-air exercise they may take4 ,if the weather is very cold and the air damp1 or if there is a very cold high wind1 it is best to remain indoors2 otherwise the child should remain out for four or five hours4 ,indoor airing is obtained by dressing the child to go out-doors1 putting him in his carriage1 and leaving him before an open window in a room of good size with all the doors closed so as not to create a draught4 ,,habits ,,of ,,the ,,delicate ,,child4--,the amount of sleep necessary for a delicate child is the same as for a normal child of the same age4 ,the room should always be well aired1 night and day1 and should be devoted to the exclusive use of the child4 ,these children should never be allowed to sit on the floor4 ,it is always a difficult matter to avoid this1 but it must be religiously guarded against2 otherwise a cold is the inevitable result4 ,a change of air is sometimes advisable and essential1 especially during the hot1 humid weather of ,july and ,august4 ,much better results will be obtained by sending these children to the mountains than to the seashore4 ,delicate children should always be clothed warmly1 but not too warmly4 ,the feet and legs must always be kept comfortable4 ,moderate exercise1 short of fatigue1 is necessary4 ,a midday nap after the noon meal should be taken every day4 ,the child should be undressed and put to bed for two hours and left there1 whether it sleeps or not4 ,this applies to delicate children of all ages4 ,the education of delicate children should be postponed until the health is restored4 ,they should1 however1 be made to obey and they should be taught good habits4 ,when school work begins it should be made light and easy4 ,they should not go to school before the eighth year1 and then not unless physically fit4 ,they should not play at rough games or with rough companions1 though it is not wise to shield them too much4 ,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 upbuilding4 ,a systematic observance of these suggestions will save many lives and will aid very considerably in producing stronger men and women4 ,infinite patience1 tact and self-sacrifice is necessary1 but the results in every case justify the measures adopted4 ,,indiscriminate ,,feeding3 ,,poor ,,appetite4--,in considering many of the diseases of childhood the term indiscriminate feeding is used4 ,an explanation of just what is meant by this will be of decided advantage4 ,there are two fundamental essentials in the successful feeding of infants and children3 regularity and suitable food4 ,a child whose feeding intervals are not regular and whose food is unsuitable is a victim of indiscriminate feeding4 ,the lack of observance of the regularity rule always leads to loss of appetite and indigestion4 ,loss of appetite is a serious condition in a growing child and may give infinite trouble4 ,indigestion in a growing child is unnecessary1 unfortunate1 and frequently is the one factor that spoils an entire life4 ,it is unnecessary1 because it means and is caused by neglect on the part of the mother2 it is unfortunate1 because it always paves the way for any serious ailment that is epidemic or in the air2 and it is important1 because it very frequently weakens the stomach and renders it unfit for normal digestion for a long period1 if not for life4 ,if for some reason a child's appetite becomes poor and it is not properly managed until the appetite is restored to normal1 indiscriminate feeding is always the result4 ,the reason for the poor appetite may be because the child is kept indoors too long1 or because it is being fed on unsuitable food1 or is living in unsanitary surroundings1 or many other reasons1 sometimes trifling reasons1 may cause it4 ,when a child will not eat at meal time1 the mother feels that it should eat sometime1 so she encourages it to eat between meals1 and because of a mistaken kindness she breaks the law of regularity1--a law that can never be broken without serious results following4 ,a child in this condition becomes a disturber of the peace2 the parents can do nothing with him2 he insists on eating just what he likes and when he likes2 and he chooses1 as a rule1 candy1 cake1 pastries1 ice cream1 tea1 coffee4 ,indigestion follows1 the child loses weight1 is languid and listless and constipated4 ,when finally the physician is called in he finds it necessary to go back to first principles4 ,he lays down the law in a definite1 stern way1 and the mother and the child must obey4 ,most parents know and admit they are doing wrong to give in to a whimsical child1 and if they would only make up their minds to conquer when conquering is easy they would save themselves many heartaches1 many regrets1 and the child much suffering and much possible permanent injury as a consequence4 ,usually one parent is willing to be master but the other lacks the mental equipment to meet the issue1 and argues1 as he or she imagines1 in favor of the child4 ,the parent whose instinct is correct1 whose judgment is true1 whose interpretation of the situation is just1 should not be dissuaded1 or argued away from his or her duty4 ,if it is the first real problem in your domestic experience in which a decided stand must be made1 make it without fear and without hesitation1 and carry it through to the bitter end4 ,results will justify and vindicate you4 ,the general treatment of these children will be found outlined in the following paragraph on ,loss of ,appetite4 ,,loss ,,of ,,appetite4--,if a child complains of not being hungry1 and will not take enough food1 and if this condition continues for some time1 we must regard the matter as being abnormal and find the cause4 ,this is necessary because a child must eat in order to maintain a certain standard of growth and vitality4 ,these children are not sick2 they are active and continue to play as usual and they sleep soundly1 but they have no appetite4 ,one of the most frequent causes of this condition is too frequent feedings4 ,some children are naturally small eaters4 ,they thrive and maintain a satisfactory weight2 their system seems not to demand large quantities or even ordinary quantities of food4 ,parents observe this habit of little eating and begin to coax and bribe the child to eat more at meal time1 and to eat between meals4 ,in this way the child really overeats1 the appetite becomes capricious1 and the stomach rebels4 ,in a very short time the condition of loss of appetite is established as a consequence4 ,another cause is the drinking of too much milk1 and yet another and very common cause is indiscriminate eating of candy1 cakes crackers1 and fruit between meals4 ,children who are fed at the table with adults eat things they should not eat1 and spoil their digestive organs and loss of appetite is the result4 ,the ,scotch custom of compelling children to eat at a separate table is an excellent one4 ,they are not tempted to ask for things they cannot have4 ,lack of fresh air and exercise frequently results in impaired appetite4 ,,treatment4--,the very first thing to do with these children is to stop any habit that may be responsible for the loss of appetite4 ,if the child has been eating between meals1 stop it absolutely4 ,if too much milk has been taken1 stop milk entirely4 ,if the child has not been getting enough fresh air1 or if it has been sleeping in a badly ventilated room1 or if baths have been too infrequent1 rectify the fault4 ,if eating at the family table and fed indiscriminately1 change the programme2 feed him before the family sits down to meals4 ,now regulate the time of feeding to suit the age of the child and adhere to strict regularity4 ,it is a pernicious and absolutely wrong custom to force children to eat1 or to coax them to eat when they do not want to eat4 ,loss of appetite will never be cured by forced feeding1 or by reducing the interval between feedings1 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 up4 ,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 food4 ,pay strict attention to the bowels4 ,be certain the child has a daily satisfactory movement and that he drinks frequently between meals4 ,if the child does not promptly respond to the proper hygienic and dietary treatment as outlined above there are two things that can be done3 #ast3 ,send the child away4 ,a change of scene and climate will sometimes work like a charm in these cases1 and will1 after a reasonable length of time1 establish a permanently good appetite4 #bnd3 ,if this is not possible1 as sometimes it may not be with poor patients1 then we can give the child suitable tonics4 ,,overeating4--,the large majority of individuals eat too much4 ,most of us would enjoy better health1 better spirits1 and greater efficiency if we consumed from one-third to one-half less food than we habitually do4 ,every living organism requires a certain amount of nourishment according to the work performed and to replenish wear and tear2 when food is supplied in excess1 the system cannot utilize it1 but it is compelled to rid itself of the excess in some way4 ,the work involved in this eliminating process is exceedingly detrimental to the various organs and to the individual4 ,to overeat is to overwork1 and to overwork a machine or an animal is not only poor economy but bad judgment4 ,if the digestive apparatus is required to work overtime1 it is a self-evident assumption that the various organs will not digest efficiently the food necessary for ordinary existence4 ,if the necessary nourishment is not adequately digested1 the general health will suffer as a consequence4 ,if the general health is below standard the individual will not be competent to carry on the requirements of a normal1 healthy life4 ,we must1 however1 give some thought to the effect which the excess of food exerts upon the human machine4 ,nature provides and maintains a standard relationship between the capacity of the individual and his needs4 ,a child has a digestive capacity to digest and assimilate a quantity of food sufficient for his growth and proper nourishment2 an adult maintains the same standard according to his requirements4 ,all the other organs are adjusted to harmonize with this scheme4 ,if we overeat1 the immediate result is to disorganize this relationship between the various organs2 hence we have a multitude of effects which manifest themselves in various ways as a direct result of overeating4 ,the combined general effect expresses itself in the form of what is regarded as poor health and a low standard of efficiency4 ,when a larger quantity of food is taken into the stomach than it can properly digest within a reasonable time1 two conditions immediately follow4 ,the stomach itself is dilated and the food is not thoroughly digested4 ,if the habit is persisted in1 indigestion1 and later chronic gastritis ensues4 ,the direct symptoms of these conditions are given in detail in another part of this book4 ,very few individuals1 however1 appreciate the indirect consequences of overeating and of indiscriminate eating on the general health4 ,it is impossible to tabulate in so many words the effect which this habit has on efficiency and temperament4 ,we read and hear a great deal to-day about efficiency4 ,now1 an individual's efficiency is an expression of that individual's health standard or capacity4 ,to be #ajj per cent4 efficient one must enjoy good health4 ,it would be absurd to expect a high standard of efficiency from an individual with a low standard of health4 ,poor health means poor vitality4 ,vitality is the mark of the master4 ,without vitality one can never dominate4 ,all the great achievements of the race have been consummated by those who conserved their vitality4 ,no single factor contributes a larger percentage of inefficients and failures than overeating4 ,the man or woman who1 from habit or experience1 has learned the lesson of right eating and living need not be lacking in efficiency1 nor need they despair of the attainment of success4 ,,symptoms ,,of ,,overeating4--,efficiency depends not only upon one's capacity to perform1 but upon the character of the performance4 ,the spirit must be willing to perform4 ,the overeater is heavy1 phlegmatic1 indifferent1 lacking in energy1 tact and initiative4 ,she is constantly subjecting her system to needless overwork2 she is depressed1 nervous1 imaginative and she is not ambitious4 ,she is a victim of self-poisoning1 of constipation1 indigestion1 headaches1 flatulency1 neuralgia1 vertigo1 and melancholia4 ,an overeater never enjoys good health1 never is efficient1 and cannot possibly be successful4 ,to enjoy good health one should know how to select food and how to combine and proportion it4 ,it has been said that the ,american people are a race of dyspeptics1 and it must be admitted that the assertion is more or less true4 ,there are millions of people who suffer from indigestion in some degree1 and it may justly be said that indigestion has its beginning in overeating1 in some form4 ,it may not be overeating in actual bulk1 but it is overeating some article or articles that do not agree with the individual1 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 to4 ,we are1 therefore1 unwittingly1 victims of our environment4 ,correct eating means simple eating--only a few things at a time4 ,food should be selected according to one's age and occupation1 and according to the season of the year4 ,to eat habitually large quantities and at the same time a large variety is suicide pure and simple4 ,if one dared to make the experiment of cutting down one's diet one-half1 it is absolutely certain the effect would be immediate benefit4 ,the benefit would not only be manifest in the physical betterment1 but the efficiency and general well-being would be greatly enhanced4 ,it is not the kind of food that makes a dyspeptic1 but the quantity4 ,a well person need not consider whether a certain kind of food will or will not agree1 providing she does not eat too freely of that food1 or combine it with other food4 ,the combination of which may in itself form too much of one kind at a time4 ,some people imagine1 for example1 that oatmeal porridge does not agree with them4 ,when the matter is inquired into1 however1 it is found that they habitually eat bread1 eggs1 and other articles1 with coffee at the the same meal with the porridge4 ,from this combination they experience distress and blame the porridge4 ,if these would take a plate of oatmeal porridge with cream and salt1 and some stewed fruit for breakfast they would not experience any trouble1 and this would be an ample meal for the ordinary individual4 ,it is not the porridge1 but the unsuitable combination1 that is at fault4 ,the same may be said of milk4 ,many people state that they cannot take milk and they deprive themselves of one of the very best articles of diet because of this idea4 ,there are very few people in the world who cannot take milk in some way4 ,it is not the milk that is at fault2 it is the combination of it with other less nutritious articles that is the cause of the distress4 ,even candy is responsible for thousands of cases of indigestion4 ,anyone may safely take a reasonable quantity of good candy1 but if it is taken at a wrong time1 or combined with other articles1 it may readily produce indigestion4 ,indiscriminate eating and overeating are prolific causes of rheumatism1 kidney disease1 heart disease1 liver troubles1 obesity1 arteriosclerosis1 and apoplexy4 ,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 indiscriminately4 ,,bran ,,as ,a ,,food4--,in the chapter on constipation there may be found a formula for making bran muffins4 ,these muffins are invaluable to children in health1 and to the victim of indigestion or constipation1 whether child or adult4 ,one muffin with each meal will solve the problem of constipation in growing children without the use of drugs or other aid4 ,they will regulate the bowels of adults in many instances without resorting to drugs4 ,raw fruit in season1 or stewed fruit1 or a baked apple1 with a light boiled egg and one bran muffin1 is an ample and a nourishing breakfast for a child at school4 ,for lunch the same child should have a plate of thoroughly done vegetable soup1 a bran muffin1 and more fruit4 ,after school1 a glass of milk with two or three ,graham wafers may be given4 ,for dinner the child at school may have a mixed meal4 ,this meal should not be later than six-thirty o'clock and the child should retire at eight-thirty at the latest4 ,a bran muffin should be taken with this meal unless the child's bowels are too loose4 ,mothers should insist on their children eating these muffins4 ,if a child eats only what it likes it will not eat what is good for it4 ,if the mother insists in the right way she will win2 if she does not the child will win4 ,if the child wins1 the mother is the wrong kind of mother4 ,i do not know of any other single article of diet that is of such value to growing children as these bran muffins4 ,children who eat them regularly will have less sickness than other children2 they will be strong1 healthy and full of energy4 ,the bran in itself is not responsible for this list of excellent acquirements1 but the regular eating of the bran is4 ,most ailments of children are of gastro-intestinal origin2 bran keeps the entire length of the gastro-intestinal tract sweet and clean2 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 pastry4 ,if white bread or pastry is abstained from the child will not have indigestion1 or constipation1 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 constipated4 ,these muffins should be made of the ordinary unsifted bran4 ,if this is not procurable the sifted bran 7,johnstone's7 may be employed4 ,this bran may be bought in any good grocery4 ,modern milling methods1 modern cookery1 and modern methods of forced farming1 have each contributed their share of rendering food inert and frequently deleterious4 ,the miller has extracted the coarse cellulose from the various flours in the effort to manufacture a product suitable to the super-civilized public demand4 ,this cellulose is absolutely essential to gastric and intestinal digestion1 and if children are deprived of it constipation and indigestion are the natural result4 ,forced farming accomplishes the same effect--the fiber of the vegetable is deficient4 ,bran is rich in mineral salts1 iron1 protein1 and phosphates1 and gives to growing children the ingredients which ordinary food is deficient in4 ,bran prevents intestinal fermentation and children who eat it are free from intestinal gas and putrefaction4 ,it harmonizes chemically with all other foods4 ,children should be made to take it every day as a matter of self-preservation and of duty4 ,,hysterical ,,children4--,hysteria is not a disease of infancy or of young children4 ,it is seen as a rule after the eight year4 ,male as well as female children may be the victims to an equal degree4 ,it is much more frequently seen in the offspring of parents who are themselves nervous1 or alcoholic1 or who suffer from insanity1 or have insanity in the family history4 ,if these children in addition to the hereditary influence suffer from stomach or intestinal disease1 or general poor health and are overworked at school1 they are very apt to become hysterical4 ,they are capricious1 indifferent1 and excitable4 ,their disposition is irritable2 they frequently exhibit fits of great excitability of temper and passion4 ,they cry or weep without cause4 ,they often have hallucinations and while asleep have attacks resembling night terrors4 ,they complain of pains in the joints1 and are frequently treated for disease that does not exist4 ,such condition as hysterical cough1 spasm of the muscles of the face1 mouth1 eyes1 and of the neck exist and are difficult to diagnose from real disease4 ,these children complain of painful sensations and sensitive areas and exaggerate all symptoms unnecessarily4 ,the possibility of curing these patients is good1 providing the treatment is faithfully carried out4 ,it is less favorable when marked hereditary influences are strong4 ,,treatment4--,in all children of distinctly nervous type and especially those of nervous parents1 the first essential duty is to develop their muscular system4 ,try in every way to make healthy animals of them4 ,attention and treatment should not be directed toward the nervous system4 ,if the child is made strong by out-door life1 good plain1 digestible food1 early hours1 regular sleep in thoroughly aired rooms1 regular bathing1 and if the school work is conducted with moderation and judgment1 the nerves and the nervous temperament will participate in the healthy growth which will follow as a result4 ,tea and coffee should be forbidden4 ,exciting books and questionable entertainment as given in picture shows and theaters must not be allowed4 ,if older members of the family1 or parents1 are excitable and nervous the children should be sent away to the country from them4 ,they should be put in charge of a person who will exercise firm control over them4 ,it may be necessary to take these patients away from other children1 and isolate them under proper control until they are able to control themselves4 ,they should be interested in exercise that compels them to work2 they should live and if convenient sleep out of doors2 and they should take iron or cod liver oil1 or any other indicated tonic4 ,if they complain of pain they should receive cold-water douches1 or the cold pack1 or the shower bath2 and they should be put to bed and treated firmly but kindly4 ,attention to the bowels is always essential1 because these children are as a rule the victims of chronic constipation4 ,,what ,a ,,mother ,,should ,,know ,,about ,,cathartics ,,and ,,how ,,to ,,give ,a ,,child ,a ,,dose ,,of ,,castor ,,oil4--,broadly speaking there are three kinds of cathartics4 ,i will1 in a simple way1 explain their action so that a mother may know which one to select under certain circumstances4 ,frequently a mother is told by her physician to keep the bowels of her child open4 ,few mothers know how to keep the bowels open1 and as this is an important matter1 every mother should know the reason why any laxative or cathartic is not always suitable4 ,,castor ,,oil4--,this is one of the oldest and one of the best cathartics we possess for children4 ,it is a mechanical cathartic2 it acts in exactly the same way as a street-cleaning machine4 ,it cleans the street by sweeping or pushing everything before it4 ,,calomel--,this is a chemical cathartic4 ,it acts through the blood4 ,when it is absorbed by the blood its chemical ingredients act on certain nerves as irritants4 ,these nerves excite the liver and bowel to action and an evacuation is the result4 ,,citrate ,,of ,,magnesia4--,this is a saline laxative4 ,it acts by drawing out of the bowel wall enough liquid from the blood to sweep the contents out4 ,it may be likened to the street cleaner who flushes and cleans the street by means of a hose pipe attached to the water hydrant4 ,under what condition should a mother use these remedies8 ,castor oil is ordinarily the best cathartic in childhood2 it is not1 however1 always the best4 ,most ailments of children are of gastro-intestinal origin--they have either overeaten or they have eaten the wrong kind of food4 ,the stomach and bowel are overloaded3 they must be cleaned out4 ,we want a mechanical cathartic1 one that will push everything ahead of it1 so we use castor oil4 ,when a child needs a cleaning out1 use castor oil4 ,by a cleaning out we mean1 when we know he has eaten too much of a questionable variety of food1 as pastries1 cakes1 fruit1 ice cream1 etc41 as children do at parties2 or when he has eaten unripe fruit1 as green apples1 etc42 or when for some reason he is constipated and complains of not feeling well1 use castor oil4 ,if you decide to use castor oil1 use enough4 ,a large dose will act promptly and with less pain and with more certain results than a small dose4 ,it is always safe and it is always best to decide upon castor oil as the proper remedy1 if the child has no fever4 ,if he has a fever he will most likely vomit castor oil when another kind of cathartic would stay on the stomach4 ,castor oil works more effectively1 more thoroughly1 and is less likely to be vomited if given on an empty stomach1 so we give it two hours after eating and we give no food for two hours after it is taken4 ,castor oil is distinctly of advantage in many chronic diseases of the intestines because of its healing properties4 ,in chronic colitis1 for example1 when the child is suffering with malnutrition1 irregular bowel action with an odor1 and mucous or bloody stools1 a combination of castor oil and salol1 in emulsion1 in small doses1--to which a small quantity of opium may be added or withheld according to the frequency of the movements1--with an occasional colon irrigation1 is sometimes invaluable4 ,mothers must remember that castor oil is not good in the treatment of constipation1 because its after effect is to constipate1 consequently we would not use it to keep the bowels open1--it is only of use to clean the bowel out thoroughly when that is indicated4 ,,how ,,to ,,give ,a ,,dose ,,of ,,castor ,,oil--,the best way to give a child castor oil is as follows3 ,place the bottle containing the oil on its side on a piece of ice in the ice box2 chill it thoroughly4 ,take a tablespoon and smear it with butter2 pour the ice cold oil into the spoon2 it will stick together like a piece of chewing gum and it will slide out of the buttered spoon in one lump4 ,in this way it will not spread over the mouth and teeth and throat1 leaving a bad taste1 but will go straight and surely into the stomach4 ,the child cannot swallow some and retain enough in the mouth to sputter it all over itself and only get half a dose2 it will not nauseate it1 because it practically is tasteless if given cold1 and the stomach will tolerate the cold oil much better than when given in the ordinary way4 ,a baby can be given oil in the same way1 but in smaller doses4 ,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 open4 ,if the nose is held closed and the mouth wide open for a few seconds the baby cannot spit the oil out--it must swallow1 and if the oil sticks together as cold oil will1 it gets the whole dose4 ,it usually takes two persons to give a baby a dose of oil--one to open the mouth and give the medicine1 the other to hold the nose and arms4 ,,calomel4--,the general indication for calomel is fever4 ,when a child develops a disease it immediately gets a temperature1 and very frequently the fever is quite high because the slightest ailment gives a child fever4 ,when fever begins1 digestion practically stops1 it is therefore imperative to clean the whole gastro-intestinal canal2 otherwise the undigested material will putrefy and poison the entire system and render the disease more serious than it need be4 ,now we select in such conditions calomel for two reasons3 ,first1 because the presence of fever indicates that infection of the blood is taking place2 this may come either from the intestinal canal itself1 or from the germs of the disease with which the child is suffering4 ,since calomel acts chemically through the blood it is the cathartic indicated4 ,second1 because a cathartic like castor oil does not act through the blood and it would most likely be vomited by a fevered stomach4 ,certain conditions indicate calomel2 biliousness and jaundice1 for example1 because it has a specific action on the liver and if the liver is at fault calomel is the proper remedy4 ,calomel is best given in small divided doses1 #a-aj of a grain every half hour1 for ten doses4 ,it is best given combined with soda2 every drug store carries tablets of calomel and soda for this reason4 ,calomel should never be given in the treatment of constipation1 nor should it be used indiscriminately by mothers1 as much harm may result4 ,it has its specific use as indicated above1 but it should never be used under any other circumstances4 ,,citrate ,,of ,,magnesia4--,this is a mild laxative4 ,after the bowels have been thoroughly opened with castor oil or calomel1 small doses of citrate of magnesia may be given for a few days1 to keep the bowels open4 ,there is no danger or harm in its use if used for this purpose4 ,it must not be used1 however1 in the treatment of constipation of children for the simple reason that you cannot cure constipation by the use of drugs of any kind4 ,laxatives of this type have become a national curse4 ,adults1 especially women1 use them constantly4 ,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 serum1 and produce1 because of the excess of this watery fluid1 large1 and frequently many1 liquid movements4 ,if this practice is continued1 as it often is every day1 the quality of the blood will suffer seriously1 and many individuals are the victims of neuralgic pains1 headaches1 nervousness1 insomnia1 anemia1 and general broken health as a direct consequence of this pernicious habit4 ,mothers will try to remember1 therefore1 that drugs and saline waters have no place in the treatment of constipation in children or themselves4 ,constipation must be treated by diet1 exercise regular living and by the observance of hygienic and sanitary common-sense rules4 ,,vaccination ,,time ,,for ,,vaccination4--,the best time to vaccinate a child is during the first three months if he is healthy4 ,the reason for selecting so early a period is because the constitutional disturbances are much less at this time than in later childhood4 ,it should not be done during active dentition4 ,if the child is delicate if his nutrition is bad it should be deferred until a later time4 ,children suffering from eczema or from any skin disease or those syphilitic should not be vaccinated until it is compulsory1 or until exposed to small-pox4 ,,methods ,,of ,,vaccinating4--,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 countries4 ,the leg or the arm is the usual location selected4 ,in infants the sore can be protected better on the leg2 in children of the run-about age1 the arm is the better location because it can be kept at rest easier4 ,before vaccinating the skin should be rendered surgically clean2 this can be done by washing with soap and water1 drying and then rubbing with alcohol4 ,the wound should be left uncovered for about twenty minutes to dry1 it may then be covered with a bandage1 or with a vaccine shield4 ,the part should not be washed for twenty-four hours4 ,,the ,,symptoms ,,of ,,successful ,,vaccination4--,nothing is noticed until the third or fourth day1 when a red papule appears4 ,in the course of the following day a vesicle appears2 this vesicle enlarges until it reaches its full development on the ninth day4 ,the size of the vesicle is about one-half inch in diameter2 it is surrounded with a reddish inflammatory area for about two inches4 ,the vesicle begins to dry and is shortly a dark crust which remains from one to three weeks and then falls off4 ,it leaves a bluish scar which soon turns white and the part is roughened and honeycombed4 ,during the period when the vaccination is at its height the child suffers from fever and irritability and loss of appetite4 ,if vaccination does not take in an infant it should be done two or three times and if then unsuccessful it should be repeated every year until it takes4 ,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 suitable4 ,there are some children1 however1 who seem to be immune to vaccination4 ,sometimes the symptoms are more severe than those enumerated2 this seems to depend upon the susceptibility of the child4 ,the vesicle may be much larger and the area of inflammation much more dense and angry4 ,the fever may be higher and may last longer2 there may be a general rash and the degree of depression more profound4 ,vesicles may be produced on other parts of the body as a result of scratching4 ,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 wounds1 and that any result coming from such an infection is not due to the vaccine or to the process of vaccination1 but to the infection4 ,many people get unjust ideas about vaccination from just such cases4 ,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 consequence4 ,anyone who doubts the virtue of vaccination is condemning himself2 he is simply ignorant of the accumulation of evidence in favor of it and assumes a position without any possible justification4 ,the mortality of vaccination is stated by ,voigt from statistics to be #ce in #b1bge1jjj cases4 ,in fact1 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 mother4 ,,treatment4--,the mother must understand in what way she may contribute to the successful termination of a case of vaccination4 ,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 water4 ,she should see that the part is allowed to dry thoroughly after vaccination4 ,she should not wash the part for at least twenty-four hours4 ,if a vaccine shield is put on she should not disturb it4 ,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 objectionable4 ,a simple1 clean bandage is all that is necessary4 ,it is very important that the child be kept from scratching the part2 most of the troubles of vaccination come from this habit4 ,it is desirable that the limb should be kept at rest during the stage when the process is at its height4 ,if the vesicle discharges it is necessary that the area should be kept clean and dusted with boracic acid4 ,if the wound becomes infected it must be treated by a physician4 ,the mother must not resort to home remedies in such cases unless she is prepared to take the consequences1 which may be serious4 ,,chapter ,,xxii ,,constipation ,,in ,,infants ,,and ,,children ,it is a greater disgrace to be sick than to be in the penitentiary4 ,when you are arrested it is because you have broken a man-made statute1 but when you are ill1 it is because you have disobeyed one of ,god's laws4 ,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 ,constipation4 ,,constipation4 ,,regularity ,,of ,,bowel ,,function ,the most frequent cause of ill health and inefficiency in the human race is inattention to regulation of the bowel function4 ,good health depends upon many causes of which good blood is an absolutely necessary requisite4 ,good blood depends upon what feeds and sustains it4 ,there are other contributing factors1 such as the proper kind of exercise1 the proper amount and quality of fresh air1 the method of living1 etc41 but these are all food in a sense4 ,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 body4 ,whatever is left1 whatever the body does not want1 is immediately1 or within a reasonable time1 passed out in the form of a movement of the bowels4 ,if any part of the digestive function is deficient1 impaired health1 or mental and physical inefficiency expressed in the form of indigestion1 is the result4 ,if the bowel is at fault1 constipation is the usual consequence4 ,a perfectly healthy living machine must maintain a perfect digestion and regular bowel movements4 ,,the ,,function ,,of ,,the ,,stomach is to mix and churn the food1 and to add certain ingredients to the mixture so that before it is carried into the intestines it is 7as far as it is the stomach's duty to render it7 ready to be absorbed into the system4 ,before it reaches that part of the intestine which absorbs1 it is acted upon again and certain other ingredients are added to it by certain other digestive organs4 ,in time it is in shape to be used and it is sent along on its way4 ,as it passes onward the little sucking glands in the wall of the bowel suck up all the liquid element in the mass of food4 ,the liquid element in the mass is the food itself1 rendered liquid by the stomach and other digestive organs and juices4 ,the remaining solid mass is that part of the food which the body cannot use and does not want4 ,by the time the liquid element is absorbed1 the solid mass 7always kept moving by the bowel wall7 has reached the rectum1 ready to be passed out at once1 or very soon1 provided--and upon this provision depends the success of the entire process1--it has all been done within a certain time4 ,if the stomach takes too long to do its work we have indigestion4 ,if the bowel takes too long to do its work we have constipation4 ,,fermentation4--,now let us consider the matter from another standpoint4 ,if food stays too long in the stomach it begins to ferment4 ,when anything ferments it makes and evolves gas4 ,you1 no doubt1 have noticed many times how the cork pops out of a bottle if its contents are working1 or fermenting4 ,if you watch that bottle you will notice that it is quietly or actively evolving air bubbles4 ,that is gas1--gas manufactured by the process of fermentation4 ,this is exactly the process that goes on in the stomach or bowel of a dyspeptic1 and it is this collection of foul1 poisonous gas that causes the distress and bloated feeling which every dyspeptic suffers from after eating1--if it is this flatulent type of indigestion which is present4 ,,the ,,significance ,,of ,,constipation4--,if the food takes too long to pass through the bowel it causes1 as we have stated1 constipation4 ,what is the real significance of constipation8 ,it means that in passing through the bowel the food has given up all its liquid element 7which is all its nourishing element71 but the bowel has been too slow in passing it along4 ,consequently it is not ready to be expelled while it is yet a harmless semi-solid mass4 ,it stays in the bowel too long--it begins to putrefy1 bacteria attack it1 and it is soon a semi-liquid1 foul1 rotting mass4 ,the sucking glands in the intestinal wall continue to suck--that is their duty4 ,they cannot discriminate between what is good and what is bad--they simply go on absorbing whatever is there to absorb4 ,so there are absorbed into the system liquid and gaseous products which are poison4 ,this process has been called by a number of names2 self-poisoning explains the condition thoroughly4 ,the other names are1 auto-infection1 auto-intoxication1 enteric-infection1 enteric-toxemia1 intestinal indigestion4 ,the condition is a serious one1 because it is absolutely impossible to feel well1 or to enjoy good health1 while it lasts4 ,the feeling of being constantly sick1 yet not sick enough to stop working or to demand a radical cure1 affects a woman's efficiency1 interferes with her capacity to work1 her ability to render the home an abode of contentment1 to be an agreeable companion1 or to adequately take care of her children4 ,the constant absorption of intestinal poisons affects the system itself1--the symptoms are headache1 neuralgia1 loss of appetite1 nervousness1 insomnia1 vertigo1 inability to concentrate1 lassitude1 indigestion4 ,the condition which we name constipation is therefore one of supreme importance4 ,from a medical standpoint1 it is the biggest problem in the whole realm of disease4 ,it is the most significant hygienic function of life1 and it is becoming more and more important1 and more and more a problem4 ,every modern factor upon which physical efficiency seems to depend is an enemy to the systematic regulation of this function4 ,our method of hurried and indiscriminate eating1 our system of strenuous living1 our unsanitary environment1 our business activity1 our method of pursuing pleasure1 take no account of1 and resent the time devoted to cultivating1 as a hygienic necessity1 this toilet requirement4 ,this imperative call of nature is pushed aside by the child at play1 by the housewife for a duty which could wait1 by the merchant for an engagement4 ,it is particularly an ,american disease1 and it is uniquely an ,american woman's affliction4 ,it is a curious commentary on the intelligence of the ,american people1 who are ordinarily alert and analytical1 to realize how few of them really know how serious a matter constipation is4 ,they don't know because they have given the matter absolutely no thought4 ,they have accepted it as a mere matter of fact1 almost of fate4 ,,incomplete ,,constipation4--,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 existence4 ,in this form of constipation there is a daily bowel movement but the movement is not complete4 ,the bowel does not thoroughly empty itself2 it has established this habit because of conditions under which it has had to do its work4 ,if a woman neglects herself1 becomes muscularly inactive1 does not take proper out-door exercise1 grows fat and lazy1 eats irregularly and indiscriminately1--the bowel suffers with the rest of the system4 ,the woman may have a healthy appetite1 may eat the wrong things at the wrong time1 yet the bowel is supposed to go on acting rightly1 but it does not4 ,it1 too1 becomes lazy and acquires bad habits1 and this form of incomplete constipation is the result4 ,these patients look healthy and get little sympathy for any pains they may have4 ,they may even gain in weight2 they get headaches once in a while1 and if they go shopping or visiting they don't feel quite well afterward4 ,they are suffering from the effects of chronic constipation1 though their bowels are apparently regular4 ,they are marching onward toward apoplexy or ,bright's disease of the kidney4 ,,importance ,,of ,a ,,clean ,,bowel4--,every mother1 sooner or later1 observes that a physician always thoroughly cleans out the bowel of a sick child at once1 no matter what the character of the sickness is4 ,he does this for two reasons1--first1 because he knows that the great majority of children's ailments are of gastro-intestinal origin2 second1 if the origin of the disease is not in the stomach or bowels1 experience has taught him that if the bowels are clean at the beginning of a disease1 that disease will run a milder and shorter course than if complicated with a condition of self-poisoning4 ,if a child develops fever the digestive function stops2 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 digestion4 ,if this is not cleaned out at once the self-poisoning process begins4 ,the above is a suggestive admission for a physician to make4 ,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 calomel1 or1 better still1 need never occur4 ,a mother who neglects1 who is guilty of inattention to the conditions of her child's bowel1 fails in one of the most important duties of motherhood4 ,i know as a father and a physician that if a child's bowel acts regularly and thoroughly1 that child is fortified to the highest efficient degree against the multitude of little ailments common to all children4 ,a clean bowel means good blood1 good digestion1 ability to exercise properly1 to sleep soundly and to think clearly4 ,such a child will resist infection and throw off the minor troubles that pave the way for serious sickness4 ,it is a secret worth knowing4 ,a ,,daily ,,movement ,,of ,,the ,,bowel ,,necessary4--,in order to preserve good health one thorough movement of the bowel is necessary daily4 ,a baby may have two or three and enjoy robust health4 ,a larger daily number suggests an abnormal condition of the bowel and an investigation should be made4 ,if a nursing baby's bowels do not move before bedtime it should be given an injection of equal parts of glycerine and hot water1 one-half cupful2 or an enema of soap and water1 or a glycerine suppository4 ,when a child is six months old1 in some sooner1 it should be put on the stool at a certain time every morning4 ,this will aid in the establishment of the habit1 as a child soon understands why it is made to assume this position and acts accordingly4 ,the condition referred to above and which we termed incomplete constipation may affect the nursing infant4 ,a child's bowels may move daily and yet the child will suffer from constipation4 ,if the movements are watched it will be observed that certain children strain when at stool1 and after a time succeed in passing hard1 dry lumps or balls of fecal matter4 ,such a movement is a certain indication that the bowel is not emptying itself satisfactorily and that a constant toxemia or poisoning is going on4 ,very faithful efforts should be made to remedy this condition by the use of articles of diet that are known to be laxative1 otherwise the condition is one that will grow with the child and establish an obstinate chronic constipation with all its miseries and dangers4 ,,constipation ,,in ,,breast-,,fed ,,infants4--,many nursing infants thrive and gain in weight1 yet they are constipated4 ,before you drug your baby be sure the fault is not your own4 ,many mothers are responsible for the constipation with which baby suffers4 ,if the mother is constipated1 so will the child be4 ,cure the constipation of the mother and the baby's bowels will regulate themselves4 ,nursing mothers who are large tea-drinkers have irregular bowels as a rule4 ,a baby whose mother is lazy or indolent1 who does not take a reasonable amount of exercise1 whose diet is faulty and whose hours are bad1 is a sufferer from constipation4 ,the mother's life must be regulated1 her diet and habits corrected1 and the instructions carried out as already recommended4 ,the breast milk should be examined and if any cause for constipation exists in it1 it should be rectified as suggested elsewhere4 ,if it is thought advisable to resort to drugs for the immediate relief of the constipation of infants1 the best ones are the aromatic fluid extract of cascara sagrada2 milk of magnesia with equal parts of the aromatic syrup of rhubarb given in doses of one to three teaspoonfuls daily4 ,irrigations1 enemas1 and suppositories should not be used continuously4 ,the habit is a bad one4 ,the parts become accustomed to their use and fail to act4 ,if the child is passing dry and hard stools it is of advantage to inject two ounces of warm sweet oil at night1 allowing it to remain in the bowel until the following morning4 ,see page #cab4 ,,constipation ,,in ,,bottle-,,fed ,,infants4--,it is much easier to treat the constipation of bottle-fed babies than of those breast-fed1 because the food can be changed to ensure regular bowel movements4 ,the first change to be made in a bottle-fed baby who is habitually constipated is to add more cream to the food4 ,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 cream4 ,if this change partly rectifies the bowel ailment1 add more cream until the bowels are of the proper consistency4 ,milk given constipated babies should be raw1 never boiled1 as boiled milk will always aggravate the trouble4 ,the use of oatmeal water instead of plain water in making the baby's food may cure the bowel trouble4 ,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 constipation4 ,one or two teaspoonfuls of milk of magnesia put into one feeding daily1 or fifteen drops to one tablespoonful of the aromatic fluid extract of cascara sagrada will move the bowels4 ,orange juice1 strained1 two teaspoonfuls twice daily1 is an excellent remedy and should be tried in every case4 ,sweet oil and pure cod liver oil1 in doses of thirty drops to two teaspoonfuls three times daily after feedings1 if the little patient is poorly nourished4 ,if the stools remain hard and dry1 an injection of two ounces of warm sweet oil at bedtime is an excellent method of aiding the bowel4 ,the oil should remain in the bowel all night4 ,this lubricates the parts1 softens the fecal mass and stimulates the gut to perform its own work4 ,see page #cab4 ,,constipation ,,in ,,children ,,over ,,two ,,years ,,of ,,age4--,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 time4 ,there are a few1 however1 whose condition does not seem to improve4 ,these children need attention4 ,we should first insist on regular habits4 ,a child should be told that its bowels must move every morning after breakfast4 ,if this is absolutely insisted upon the child will soon recognize the uselessness of fighting the proposition and submit4 ,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 itself4 ,it has been stated in another part of this book that there are children with whom milk does not agree4 ,experience has taught us that milk1 especially milk that has been boiled1 causes more cases of constipation in growing children than all other causes combined4 ,find out if it is milk that is the cause in any individual case4 ,while these children cannot take whole milk just as it comes from the dairy without suffering in a great many ways1 they can take milk and water1 or milk and oatmeal water1 prepared in the following way1 without becoming constipated4 ,a bottle of fresh milk is allowed to stand in a cool place for five hours1 when the top ten ounces are skimmed off with a ,chapin dipper and mixed with twelve ounces of oatmeal gruel or plain water4 ,this can be used as a drink4 ,parents can select from the following list of articles such combinations as may be suitable to constitute the regular meals of a constipated child3 ,lamb chops4 ,rare steak4 ,rare roast beef4 ,hashed chicken4 ,soft boiled eggs4 ,cracked wheat4 ,hominy4 ,cornmeal4 ,oatmeal1 ,scotch4 ,bran biscuits4 ,oatmeal crackers4 ,graham wafers4 ,stewed or baked apple4 ,apple sauce4 ,plain vanilla ice cream4 ,animal broths1 purees of peas4 ,beans1 and lentils4 ,peas4 ,string beans4 ,spinach4 ,cauliflower4 ,asparagus4 ,stewed tomatoes1 strained4 ,whole wheat bread4 ,zwieback4 ,custard4 ,stewed prunes4 ,junket4 ,cornstarch4 ,malted milk is agreeable and advisable as a drink4 ,orange juice or a scraped raw apple is allowable at this time4 ,constipated children should eat plenty of good butter4 ,olive oil1 two or three teaspoonfuls after each meal1 is excellent4 ,it can be kept up for months to advantage4 ,older children may eat raw and cooked fruits1 figs1 dates1 baked potatoes1 poultry1 and fish4 ,one or two raw apples or a peach or orange may be given daily4 ,a strict observance of the above rules and diet will result in normal movements of the bowel if persisted in for a reasonable time4 ,it may be necessary occasionally to use a suppository or an enema now and again until the habit is established4 ,in children from five to fifteen years of age the use of bran muffins1 with fruit1 etc41 as described above1 will effect a cure of constipation without having to resort to drugs4 ,i have cured many cases of constipation in growing children with these muffins without making any other change in their diet or habits4 ,,recipe ,,for ,,bran ,,muffins ,take one pint of best flour1 one quart unsifted bran1 one teaspoonful bicarbonate of soda 7baking soda71 a pinch of salt4 ,mix these thoroughly together1 then add3 six to eight tablespoonfuls good1 ,new ,orleans molasses1 one pint of milk4 ,mix together very thoroughly4 ,put in muffin rings and bake in oven4 ,about one ounce should be put in each ring as they raise easily4 ,eat with plenty of good butter4 ,they should be given to children before each meal1 when they are hungry1 not after their stomachs are full4 ,put bran in dish first4 ,sift in flour1 soda and salt4 ,mix these thoroughly together1 then add one pint of milk 7two cupfuls7 and six to eight tablespoonfuls of ,new ,orleans molasses4 ,the quantity of molasses depends upon the individual taste4 ,they are good for any child or adult whether constipation exists or not4 ,drugs may be of temporary service in some cases4 ,a pill of cascara sagrada is the best for this purpose4 ,it should not be continued for more than two weeks4 ,castor oil1 calomel1 and other frequently-used cathartics should never be used in simple constipation4 ,,treatment ,,of ,,obstinate ,,constipation ,there are cases that resist treatment of the kind described above4 ,diet and drugs do not succeed in establishing the habit of daily bowel movements4 ,in these cases radical treatment is imperative4 ,the diet should be the same as that described above1 but it will be found advisable to cut out milk altogether4 ,cereals can be taken with sugar and butter instead of milk4 ,the oil injection plan of ,professor ,kerley has given me excellent results4 ,i quote his comments upon and method of giving it3-- ,,oil ,,injections4--,for this purpose a soft-bulb syringe of four ounces' capacity is ordered4 ,over the hard rubber tip is place a small sized adult rectal tube or a ,no4 #ah ,american catheter4 ,the catheter or tube is cut so that but nine inches remain for use4 ,the cut end is forced over the small1 hard rubber tip of the syringe4 ,a fountain syringe is impracticable for this purpose1 as it is soon destroyed by the oil and rendered unfit for use4 ,besides1 sufficient pressure is not produced to force the oil into the gut even with a high elevation of the bag4 ,the child is placed on his back or on his left side4 ,the syringe is filled with oil1 the tube is lubricated1 and passed through the rectum as far as it can go4 ,when it has been passed to the full nine inches1 as may readily be done with a little practice1 the syringe is emptied and the tube withdrawn4 ,the injection should be given after the child has been placed in bed for the night4 ,it is our object to have the oil retained during the night4 ,if a passage of the bowels is produced at the time1 or if the oil leaks out during the night1 a small quantity should be used4 ,in some of my patients ,i have been able to use but one ounce4 ,in very few1 indeed1 does it cause an evacuation at the time4 ,if there is a tendency to leakage a napkin should be worn to avoid soiling the bed-linen4 ,the following morning after breakfast1 the child is placed on the vessel and kept there until a bowel movement results or until fifteen minutes have elapsed4 ,in a great many cases if the constipation has been obstinate for months1 the bowel will be at once evacuated4 ,when this does not occur in fifteen minutes1 a glycerine suppository is inserted1 which invariably produces an evacuation4 ,this use of the suppository1 according to my observation1 can usually be dispensed with in a very few days2 the use of the oil1 however1 may have to be continued for several weeks4 ,when the child has had the oil nightly and an evacuation the next morning without assistance for two weeks1 ,i direct that the oil be omitted for a night and the effect noted4 ,if the usual passage occurs after breakfast1 the oil is given for five nights and then omitted4 ,if the case progresses satisfactorily the use of the oil is gradually omitted1 being given at first every second night1 then every third1 fourth1 or fifth night1 etc4 ,a considerable number of cases have been completely relieved in two months4 ,in the event of no passage following the omission of the oil1 its use is continued for two weeks longer1 when it is again omitted for a night4 ,to illustrate this point the following case is cited4 ,,illustrative ,,case4--,a boy three years of age had never had a bowel evacuation without drugs1 soap enemas1 or suppositories since birth1 and finally these were no longer effective4 ,the mother1 thoroughly frightened1 brought the child to me4 ,eight months of diet and the use of the oil were required before he was entirely well4 ,it is now three months since the local treatment was discontinued and the bowel function remains normal4 ,the diet with the absence of milk must be continued for months after the patient is apparently well1 and he must not be allowed to pass a single morning without an evacuation at the usual time4 ,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 attendant1 and that it may have to be persisted in for weeks1 and unless she is willing to carry it out to the end1 it would better not be undertaken4 ,i assure her1 however1 that with her cooeperation1 which is usually readily given1 the child will make a complete recovery4 ,cases that are slow in responding to treatment1 ,i usually give the additional advantage of abdominal massage from twenty minutes to one-half hour1 before the child is placed at stool4 ,the massage should practiced by one skilled in the work4 ,the above local measures apply particularly to children after the eighteenth month4 ,they may be used earlier1 however1 following out the diet along the lines laid down for bottle-fed children who suffer from constipation4 ,in very young children a smaller amount of oil should be used1 never more than two ounces1 usually one ounce is all that is required4 ,when the oil treatment is under way1 whatever the age of the patient1 laxative drugs should not be given4 ,,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 ,women4 ,it has been stated that constipation is almost universal among the women of ,america4 ,it is a fact that very few ,american women enjoy1 to a reasonable degree1 a permanently satisfactory bowel condition4 ,constipation is an acquired habit and unquestionably negligence is the primary and the chief cause of it4 ,the negligence1 no doubt1 begins at a very early age2 it is at least an established habit before any intelligent1 consecutive effort is made to remedy it4 ,inasmuch as women are the mothers of the race1 and as their part in the scheme of life is the supreme one2 and as constipation has been shown to be a serious1 far-reaching1 significant disease1 a very sincere and persistent crusade should be made to educate women as to its importance4 ,for a less altruistic purpose1 tremendous popular movements have been carried to success4 ,for a less service rendered to the race names have achieved renown4 ,in addition to the symptoms stated in the preceding paper1 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 efficiency4 ,the poison being constantly absorbed1 means general bad health1 bad health to a degree depending upon the degree of constipation which is the cause of the poisoning4 ,it may be simply that the woman does not wholly enjoy good health1 or that she is completely incapacitated because of chronic bad health1 or any degree of indifferent health between these two extremes4 ,if the degree of poison is sufficient to cause habitual poor health1 its effect upon the blood must be bad1 and the effect of the bad blood upon the nervous system and the other vital organs cannot be good4 ,now if this process has been going on for many years1 the condition of the woman1 who is its victim1 as an efficient machine1 compared with the woman in whom this condition never did exist1 must be very different indeed4 ,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 generation4 ,we might go much further and yet be sure of our position1 and maintain that it is this national autotoxemia1 this scourge of womanhood1 that is to a great extent responsible for the characteristic ,american vice of neurasthenia1 and of the domestic infelicity and unhappiness which are so common in the large cities of this country4 ,if we add to the intestinal autotoxemia of constipation1 the tendency to1 or vice of1 indiscriminate eating and drinking--of which the ,american people are particularly guilty--we would be on firmer ground4 ,in fact we would feel that we had pointed out the one underlying cause of most of the domestic irritability prevalent to-day1 which is of serious importance1 and which is1 fortunately1 capable of correction4 ,it is a matter of everlasting and continuous education4 ,,the ,,requirements ,,of ,,good ,,health4--,there are certain fundamental basic requirements which are essential to good health3 fresh air1 good water1 a reasonable amount of physical and mental exercise1 nutritious food1 freedom from unnecessary and unreasonable worry1 frequent bathing1 and a daily movement of the bowels4 ,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 time4 ,the health of so many is being undermined by this one affliction1 that it dominates all other factors that have any bearing upon posterity4 ,a woman may enjoy all the essential conditions necessary to good health1 yet she may be constipated1 and the presence of this condition will undermine1 in her constitution1 all the benefits she derives from her advantageous environments4 ,it will do more2 it will be responsible for the disposition1--the temperament1--of that woman4 ,the natural disposition of that woman may be an amicable one2 if it were allowed to express itself naturally it would be kind1 gentle1 considerate1 affectionate4 ,no woman1 however1 the victim of chronic constipation1 can preserve an equable temperament or an amicable disposition4 ,it is impossible--with her nerves being constantly poisoned--that she can hold the symptoms of that condition in abeyance4 ,she must be irritable and nervous and sick of herself and everything and everybody4 ,the home as a direct result suffers2 its atmosphere is not one of contentment and peace and affection4 ,constipation1 therefore1 blights the home and the influence of one blighted home may have a far-reaching effect on the story of the human race4 ,it is responsible also for that woman's mental attitude outside the home4 ,instead of exerting an optimistic influence1 her whole existence is a message of pessimism and discouragement4 ,multiply these influences and messages to correspond with the prevalence of the disease and we have a condition that is tremendously significant1 a condition that is really a pressing economic issue4 ,a constipated woman is an anti-eugenist--a eugenic atrocity4 ,we have no desire to create a false impression or to build up a foolish fear4 ,are we justified in regarding this as one of the most important1 if not the most important1 disease condition2 the most menacing physical vice1 which the human race has to combat8 ,let us offer the following brief facts in witness of our stand3 ,,the ,,cost ,,of ,,constipation4--,it has been estimated that consumption 7the great white plague7 kills one-tenth of all the human race4 ,cancer kills half as many1 or one in every twenty4 ,constipation1 and the diseases which are caused directly by it1 kills one in every three of all the people on the civilized globe4 ,constipation has been responsible for the expenditure of millions of dollars in advertising in the newspapers alone1--more1 probably1 than has been spent in advertising remedies for all other diseases combined4 ,do you suppose this money was a donation8 ,do you suppose these keen1 alert interpreters of the spirit of the times1 the up-to-date business men1 were not and are not aware that constipation is the universal disease8 ,every drug store1 in every civilized spot on earth1 has its shelves loaded down with constipation remedies2 dinner pills1 liver pills1 cathartic pills1 tablets in all possible coatings and combinations1 mineral waters from a multitude of springs1 aperient drinks by the dozen1 laxative teas and cordials1 cathartic oils and emulsions4 ,if the demand for these articles should cease most of the drug stores would close up4 ,many millions of dollars have been made and are being made by various men and concerns1 who have devised ingenious mechanical agencies which are supposed to cure1 and in curing renew the lost health caused by constipation4 ,we have in mind in this connection1 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 it4 ,in this opening he places an upright nozzle1 and instead of hanging the bag up and allowing the water to run into the bowel1 he has the patient sit on the bag and thereby the water is forced into the bowel4 ,he has written a two-hundred page book on the advantages of this idea1 and his literature contains the names of famous men and women in all walks of life who use his device4 ,the name of one of the famous judges of the ,supreme ,court of the ,united ,states was there2 another was the name of a popular operatic beauty who writes for the daily press little essays on ,how to be beautiful6 and ,how to keep well6 ,he deserves his success4 ,he is an emancipator and has doubtless done a great deal of good4 ,his success demonstrates1 beyond contradiction1 the prevalence of the malady under discussion1 and it must be remembered that he is only one of hundreds who garner from the same ample harvest4 ,if we could estimate in value the economic loss sustained by the race because of the inefficiency of the victims of intestinal intoxication1 due to constipation1 the sum would be colossal4 ,even then it would only represent the direct economic deficiency--it would not express1 nor could any figure adequately represent1 the indirect loss sustained by the race because of the temperamental characteristics1 which are the products of intestinal poisoning1 and which produce domestic tragedies and economic failures4 ,has this array of evidence any meaning1 or does it just happen to be so8 ,we leave it to the reader2 if it stimulates thought1 or pricks a conscience it will have done its duty4 ,,constipation ,,and ,,social ,,exigencies4--,the cause of constipation in women1 whose social station commands every sanitary1 hygienic1 and dietary luxury1 is their method of living1 the food they eat1 and the negligence which is almost obligatory because of social exactions4 ,if constipation did not so frequently accompany good living 7which is the modern name for overeating and drinking7 we would have thousands and thousands of healthy1 robust1 contented women1 fit and willing to assume the onerous duties concomitant with motherhood4 ,all their enthusiasm1 however1 is expended in the effort to keep in the ring1 to overcome the effects of the poison of constipation1 to preserve their youth and freshness1 to undo what neglect has accomplished4 ,it is because of the failure of this simple function that my lady seeks the masseur1 the facial artist1 the society doctor1 the beauty expert1 and the thousand and one agencies1 which an extravagant and profligate age has made necessary to foster the efficiency of its votaries4 ,i am optimistic1 however1 regarding the future4 ,i believe the human race is improving1 despite the disadvantageous surroundings and conditions which hamper honest effort and stultify truth4 ,a higher efficiency is the goal1 and the intention is to obtain this desideratum by fair and by just means4 ,there is an awakening1 an unrest1 a groping for knowledge in almost every field of human endeavor1 and there is none in which the yearning for fact1 for truth1 for instruction1 is stronger and keener1 than in the world-wide movement in the interest of a better motherhood1 and in a more serious study of child life4 ,it is an encouraging sign1 a hopeful promise1 of what the future has in store4 ,,one ,,of ,,the ,,important ,,duties ,,of ,,mothers4--,the immediate lesson to be learnt from the facts just recounted is to instruct mothers in their duty toward their daughters4 ,if each mother would retain the confidence of her daughter sufficient to instruct her in the duties which are important1 how much needless suffering would be saved4 ,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 importance4 ,it is not only necessary to know if they have a movement every day1 it is necessary to know the character of the daily movement2 whether it is hard and dry and necessitates straining1--the evil consequences of which1 in young girls1 is very serious indeed1--or if it is habitually loose and suggestive of what has been described as incomplete constipation4 ,if the mothers of ,america would consecrate themselves to this simple task1 who could tell in mere words the effect it would have on the race yet unborn8 ,there are problems of scientific intent1 and of fancy names1 that engage the attention of philanthropically inclined ladies1 and which are emblazoned on the society columns of the daily press1 of much less importance to the human family than the homely duty we ask mothers to devote themselves to4 ,,constipation ,,and ,,diseases ,,of ,,women4--,constipation is present in a very large majority of the cases of diseases of women4 ,it may be caused by disease of the womb1 or it may cause disease of the womb4 ,there is no question about the bad effect constipation has upon all diseases of this type4 ,in many cases it is absolutely impossible to effect a cure without first curing the accompanying constipation4 ,we seldom appreciate how severe a degree of constipation a growing girl will submit to without seeking relief4 ,some of the worst cases of constipation that have been known1 have been in girls between the ages of sixteen and twenty4 ,the mechanical effects of such a condition can well be imagined4 ,the constant1 severe straining1 necessary to evacuate the bowel1 has1 in very many instances1 produced congestion and displacement of the womb and ovaries4 ,it is not observed at this time1 or if observed it is not understood1 and thus is laid the foundation for years of neurasthenia1 helplessness1 and disease4 ,the more we investigate the ramifications of constipation the more we learn of its seriousness and of its significance4 ,,constipation ,,is ,,always ,,harmful4--,there is no period in life when constipation can be borne with impunity4 ,youth1 with its virility and vitality1 will endure its consequences with an apparent negation1 so far as positive or specific results are concerned1 but it is only an apparent impunity4 ,there is always a certain amount of strength built up1 held in reserve as a heritage of youth1 which will withstand a certain amount of physical license1 but if this reserve is assailed by an unnecessary imposition1 and is successfully undermined1 there will be infinitely less reserve to call upon in the legitimate battle of life4 ,life is too real1 too concentrated1 too strenuous1 and health is too precious to be wilfully wasted in any form of self-abuse4 ,,constipation ,,and ,,pregnancy4--,mothers will appreciate from the foregoing explanation why constipation is eugenically a crime during pregnancy4 ,the evils which result from constipation mechanically1 frequently have serious consequences by interfering with the circulation of the blood to the womb1 by forcing the womb to assume wrong positions1 by straining at stool1 and by preventing the kidneys from functionating properly2 these may render the life of the pregnant woman miserable1 and may be the direct cause of a painful1 prolonged1 difficult labor4 ,the evils which result from constipation because of the absorption of poisons by the bowel are of the gravest importance during pregnancy4 ,these poisons affect the general health2 the victim is tired1 listless1 and apathetic1 and is thereby disinclined to exercise adequately2 the appetite is poor2 there are headaches1 neuralgias1 insomnia1 nervousness1 melancholia1 and general mental and physical inertness4 ,what hope may a pregnant woman entertain of having an easy confinement1 or of bringing a healthy child into the world under these circumstances8 ,who is to blame8 ,sometimes it is necessary to tell the unadorned truth1--the woman is to blame4 ,no woman has a right to assume the responsibilities of maternity who has not had enough respect for herself to discontinue habits which caused this failing1 or who has not had strength of will enough to begin its successful cure4 ,get busy1--do something1--it is never too late1 but do it now4 ,before we take up the treatment of constipation in women1 it is necessary to explain more fully the type of constipation which we referred to as incomplete constipation4 ,there is a condition of the bowel1 in which we find its wall coated with hard fecal matter4 ,the size of the bowel may be dilated as a consequence4 ,this condition may occupy part1 or most1 of the entire length of the large intestine4 ,in the middle of this hard mass there is a small channel through which semi-liquid matter passes4 ,when the bowel moves1 it is this semi-liquid matter that passes out1 and this constitutes the daily movement4 ,we have consequently a condition in which we have a daily movement but not a complete emptying of the bowel4 ,the character of the stools from such a bowel must necessarily be more or less of a semi-liquid consistency1 because the intestine1 being coated with a hard dried out layer of old fecal substance1 is prevented from absorbing the liquid part of the fresh fecal mass passing through it4 ,this condition may exist for a considerable time1 but it will slowly undermine the health and vitality of any person in whom it exists4 ,the symptoms which a patient in this condition complains of are1--a feeling of being tired and languid1 no energy or vim1 headache1 loss of appetite1 loss of flesh1 neuralgic pains1 nausea1 vertigo 7dizziness71 insomnia1 frequent colds1 cold hands and feet1 biliousness1 sallow skin and muddy complexion1 liver spots1 coated tongue and a bad breath1 nervousness1 melancholia1 various abnormal conditions and diseases of the skin1 pimples1 blackheads1 eruptions1 eczema1 piles1 appendicitis1 diseases of the intestinal wall as a result of the constipation1 ,bright's disease of the kidney1 and many other morbid conditions4 ,any physician could name many symptoms1 which were never properly understood but which are now known to be caused by the absorption of poisons resulting from inactivity of the bowels4 ,patients may not necessarily have all of the above symptoms2 they may have a number of them1 or they may have all of them1 and they may have others not mentioned at all4 ,,treatment ,,of ,,constipation ,,in ,,women4--,to effect a movement of the bowels in a patient who is a victim of constipation is not a cure4 ,we can indefinitely cause bowel action by drugs1 etc41 but the condition will remain the same or worse4 ,when habitual constipation exists there is an underlying condition affecting the entire system which indicates that something is radically wrong4 ,it may be necessary to change the whole routine of the patient's life4 ,it will certainly be necessary at the very beginning to inquire into the daily diet1 exercise1 and surroundings4 ,during the past ten years there has been born every few days a new medical ism1 a new religious cult4 ,why8 ,because human nature is an unstable equation4 ,we are never satisfied with the old order of things and there will always be a following wherever there is a leader4 ,these isms and cults do not survive4 ,some seem to thrive1 others die a natural death4 ,there is a law1 as old as the hills1 that you cannot get something for nothing in this world4 ,we learn its bitter truth as the years pass1 and when we get over the day dreams and the sentiment of youth we settle down to real work4 ,if we desire to retain good health1 or regain lost health1 we must do something4 ,no one can hand it to us on a silver plate1 nor can anyone work a miracle in our behalf4 ,we cannot buy health1 we must deserve it4 ,this is the secret of the success of all schemes to cure disease4 ,the human family will not knuckle down and swallow the truth4 ,the man or woman in poor health is looking for ,aladdin's lamp everywhere and always4 ,a new bait1 dressed up in lubricated1 oily words1 promising impossible results1 will be accepted as the simple unadorned truth1 and will be bought and paid for1 in the end forgotten4 ,the royal road1 the easy road1 which they are looking for is impossible4 ,there is no way by which any one of us may continue to break the laws of nature and retain or regain our lost health4 ,miracles are impossible4 ,prayers without deeds are empty mouthings and a waste of time4 ,let us see how this works out in the treatment of constipation4 ,we must find the cause of the constipation4 ,i will name the causes in their order of frequency4 ,,negligence4--,this is unquestionably the primary cause of almost all cases of bowel inactivity4 ,as has been already noted1 the exigencies of modern life are of such a strenuous nature that we do not find the time to devote to this function the degree of systematic attention which it demands in order to preserve a healthy condition of intestinal regularity4 ,the bowel is simply a complex muscle controlled by an elaborate system of nerves of an involuntary type4 ,in order to preserve the highest degree of efficiency of this complicated mechanism1 it must be permitted to obey the laws nature endowed it with and which it must obey4 ,when the fecal mass reaches the rectum the nerve centers1 acting through the spinal cord1 send a message to the rectum something like this3 ,empty yourself of your contents1 we have made all preparations and everything is ready4 ,the rectum obeys to the extent of notifying you that it wants to be relieved2 you feel the desire to evacuate the bowels4 ,if you obey1 all is well1 nature is appeased1 you encourage the systematic regularity necessary to good health4 ,if you do not obey1 you upset the delicate mechanism1 and frequent negligence of this character will result in the complete disarrangement of this complex machinery so that it will fail to warn you that a bowel movement is necessary and constipation is established4 ,we must therefore retrace our steps and re-educate the bowel systematically to empty itself at a certain time every day4 ,this can be done in nearly every case without artificial assistance4 ,it may take time but it is worth a little methodical persistence4 ,the point is1 you must do it2 no ism or esoteric agency can do it for you4 ,mothers will recognize from this explanation the necessity of establishing the habit in children at the earliest possible moment4 ,,lack ,,of ,,exercise4--,what does the word exercise imply8 ,it implies movement1 better circulation of the blood1 better health and tone to every part of the body1 more oxygen1 and a richer1 better quality of blood1 and because of a better quality of blood1 which is the fuel of the body machine1 we have a better1 smoother working machine4 ,every human being requires a certain amount of exercise2 otherwise the machine will not run smoothly4 ,if this exercise is not obtained1 things begin to go wrong4 ,one of the very first signs to indicate that the machine is not running as it ought to run1 is a sluggish condition of the whole digestive apparatus and a certain degree of bowel inactivity 7constipation7 follows4 ,there is no substitute for this need4 ,drugs will not help you1 mechanical devices will not do the work for you1 though they may aid you4 ,you must do the work yourself4 ,if you fail or hesitate to recognize the truth1 if you temporize or procrastinate1 you are only deferring the issue4 ,the argument that you have not the time1 that your work will not permit you1 is no argument at all4 ,you must do it or reap the consequences2 you certainly cannot escape them4 ,the wise woman accepts the situation1 the fool goes to an early grave4 ,,lack ,,of ,,water4--,constipation may be due to a deficiency of water in the system4 ,women who suffer from this type do not drink enough water4 ,the bowel may be willing and able to do its duty1 but is handicapped because a certain amount of liquid is essential to proper digestion and natural bowel activity4 ,at least six glasses of water should be taken by every healthy adult human being in each twenty-four hours4 ,the best time to take this water is as follows3 one glass on arising1 two between breakfast and lunch1 two between lunch and dinner1 and one on retiring4 ,between meals means one hour after a meal and at least one-half hour before the following meal4 ,no liquid should be taken during a meal1 or immediately after1 or before a meal4 ,all water taken may be hot or cold1 according to the fancy of the taker4 ,it is of advantage to squeeze the juice of half a lemon into the water taken on arising if there is any tendency to constipation or if the liver is lazy or torpid4 ,it is also good for the complexion4 ,,lack ,,of ,,bulk ,,in ,,the ,,food ,,taken4--,sometimes the character of the food taken is such that there is no body to it4 ,the process of digestion so completely liquefies it that the bowel has no solid matter to manipulate4 ,to excite the peculiar movements of the intestinal wall there must be substance in the contents4 ,the variety of the daily food must be so arranged as to provide this4 ,a list of these foods is provided elsewhere in this book4 ,certain other foods stimulate intestinal activity1 not because of their bulk1 but because of the chemical elements they contain4 ,all forms of sugar1 the sugars of fruits1 the acids of fruits and vegetables1 are excellent natural laxatives4 ,sour milk and buttermilk1 oils and fats1 are also of distinct value in this respect4 ,on the other hand1 soups1 gruels1 porridges1 and purees are constipating because the digestive process reduces them to liquids and leaves no bulk for the bowel to act upon4 ,new bread1 hot biscuits1 noodles1 and doughy foods are also objectionable1 especially to children4 ,hot baths1 hot drinks1 hot enemas1 and sweating are also constipating because they extract so much liquid from the bowel leaving the contents excessively dry4 ,,abuse ,,of ,,cathartic ,,drugs ,,and ,,aperient ,,waters4--,this is a widespread evil2 it may justly be regarded as a national curse4 ,the victims of this custom do not realize that they are addicted to a habit which must be rightly regarded as equally as bad as the drink habit1 so far as its ultimate effect on the general health and the prospect of longevity is concerned4 ,its popularity is a product of our national vice of indiscriminate eating and drinking4 ,it is more common among the class who live in restaurants1 hotels1 and boarding houses1 who keep late hours1 eat late suppers and who do not exercise enough4 ,these individuals eat too much and live too high4 ,after a time the liver becomes sluggish1 the stomach fails to digest properly1 the bowels lose their tone1 and flatulent indigestion or some other more or less serious condition follows2 to maintain the pace1 to feel and keep fit1 they discover that a glass of some advertised aperient or laxative water before breakfast works wonders1 tides them over for the time being and keeps them in the ring4 ,they compliment themselves and push the specter of age aside4 ,the thought that they were not as young as they once were1 or that they must go slow1 was not a very pleasing suggestion1 so having found a cure by adding another bad habit on top of an existence which is composed of nothing but bad habits1 they start all over again4 ,the suggestion that their trouble is a warning that things are going wrong and that the whole plan of living must be radically and promptly changed does not meet with their approval1 and so the ,department of ,health statistics heap up the records of deaths due to heart disease1 hardening of the arteries1 ,bright's disease of the kidneys and apoplexy4 ,it is not a happy tale1 but the truth is often tragic4 ,when a woman finds that her physical efficiency depends upon the habitual use of cathartic drugs or laxative waters1 she must regard the knowledge with respect1 she must give it serious consideration1 and she must adopt means to so change her method of living1 that nature will be given a chance to work in her interest--not against her4 ,better to find out exactly where the trouble is now1 and go after it than to travel too far along the wrong road4 ,many die from the disease of procrastination4 ,,overeating4--,overeating may be included in this classification because it so overworks the digestive apparatus that it is impossible for it satisfactorily to complete its function4 ,any reader desirous of understanding the full significance of overeating in this connection should carefully read the article on this subject on pages #bhi and #bij4 ,there are1 of course1 a great many other causes for constipation but these are the important ones4 ,when we find the cause of any particular case it will suggest the remedy and we must employ it faithfully if we hope to effect a cure4 ,if it is negligence1 we must correct that fault and compel our daily routine to accommodate itself to a regular observance of this function4 ,if it is lack of exercise1 we must get more exercise1 or if it is lack of bulk in our food1 we must change our method of living and select with more care the foods we eat4 ,if it is lack of water1 we can correct the constipation by adding the proper amount of water at the proper time4 ,a patient who has been a victim of chronic constipation for some time must live a life somewhat after the following general plan3 ,she should increase the vegetables1 fruits1 and fats in her diet and she should drink enough water4 ,it is a good plan to sip slowly one-half pint of hot or cold water morning and evening4 ,daily exercise in the open air is advisable2 exercise of some kind1 even if taken indoors1 is imperative4 ,walking1 riding1 bicycling1 tennis1 golf1 swimming1 are the best forms of exercise for women4 ,indoor gymnastics can be made a satisfactory substitute4 ,after the exercise a hot shower bath and a cold sponge bath or cold plunge or a swim should follow4 ,women in very moderate circumstances may walk briskly a distance of three or four miles1 and on returning can take a warm bath followed by a brisk rub-off with a coarse towel wrung out of cold water1 or they can use a hose with a spray nozzle and allow the cold water to run over them for a few seconds after the warm dip in the bath tub4 ,after the adoption of these measures the bowels may tend to regulate themselves4 ,if so1 this is the proper time to cultivate the habit of regularity1 by selecting a certain time each morning or before retiring for this function4 ,the patient should go to the toilet at the regular time even if the desire is not present4 ,by straining slightly1 and by encouraging the voluntary desire1 the bowel may receive the necessary stimulation and an evacuation may result4 ,if there should seem to be no disposition on the part of the bowel to become accustomed to this procedure1 we must aid it for the time being4 ,a glycerine or soap suppository1 a glass of aperient water1 ,pluto1 ,hunyadi1 ,apenta1 or the imported ,carlsbad salt in warm water1 or the effervescent ,citrate of ,magnesium1 will result in a prompt emptying of the bowel4 ,there are a great many other cathartic drugs and many well-known laxative pills1 etc41 but these are not necessary if a systematic effort is being made to cure the constipation1 because success will come within a reasonable time if the patient will not become unduly discouraged4 ,many victims are deficient in fat2 the bowel needs lubrication2 we therefore recommend a good quality of olive oil1 one tablespoonful after each meal4 ,frequently it is of advantage to inject1 high up in the bowel1 two or three ounces of sweet oil at night1 as is done in children1 and which is fully described in the previous chapter4 ,if the constipation is due to deranged nerves1 in which the reflexes of the intestinal wall seem to share1 we advise massage of the abdomen1 and an occasional hot or cold rectal injection4 ,the proper quantity to use for this purpose is from two to three quarts4 ,the solution to use is the normal salt solution4 ,see page #fbg4 ,in that form of incomplete constipation in which we stated that there was a layer of hard1 impacted feces covering the bowel wall1 a special method of treatment is necessary4 ,in these cases nothing will succeed as satisfactorily as very hot1 high rectal injections4 ,the object of course is to rid the bowel of the old1 hard1 dry mass1 which has collected there1 before we can hope to get the bowel into condition to perform its own work4 ,it is almost incredible that the human bowel can hold so much old dried-out1 nasty stuff as is stored up in these constipated bowels4 ,hot salt water1 as hot as can be tolerated1 two or three quarts at a time1 is the correct way to dislodge this mass4 ,it will not be done at once2 it frequently takes two or three weeks before the bowel is fairly clean4 ,the irrigations should be given every second night until the bowel is clean4 ,the method of giving these washings is fully described on page #cab4 ,while these irrigations are being given the patient should take olive oil by the mouth1 one tablespoonful after each meal4 ,the proper food1 open-air exercise1 sanitary living1 plenty of water1 and regular attention to the bowel movements will in the end cure the affliction4