,,getting ,,ready ,,to ,,be ,a ,,mother ,illustration ,,the ,,macmillan ,,company ,,new ,,york ,,boston ,,chicago ,,dallas ,,atlanta ,,san ,,francisco ,,macmillan ,,co41 ,,limited ,,london ,,bombay ,,calcutta ,,melbourne ,,the ,,macmillan ,,co4 ,,of ,,canada1 ,,ltd4 ,,toronto ,illustration3 ,from the painting by ,gari ,melchers4 ,,the ,,caress ,,the ,,beginning 8,where did ,i come from1 where did you pick me up80 the baby asked its mother4 ,she answered1 half crying1 half laughing1 and clasping the baby to her breast3 8,you were hidden in my heart as its desire1 my darling4 8,you were in the dolls of my childhood's games3 and when with clay ,i made the image of my god every morning1 ,i made and unmade you then4 8,you were enshrined with our household deity1 in his worship ,i worshiped you4 8,in all my hopes and my loves1 in my life1 in the life of my mother you have lived4 8,in the lap of the deathless spirit1 who rules our home1 you have been nursed for ages4 8,when1 in girlhood1 my heart was opening its petals1 you hovered as a fragrance about it4 8,your tender softness bloomed in my youthful limbs like a glow in the sky before sunrise4 8,heaven's first darling1 twin-born with the morning light1 you have floated down the stream of the world's life1 and at last you have stranded on my heart4 8,as ,i gaze on your face mystery overwhelms me2 you who belong to all who have become mine4 8,for fear of losing you ,i hold you tight to my breast4 ,what magic has snared the world's treasure in these slender arms of mine80 ,from 8,the ,crescent ,moon0 7child poems71 by ,rabindranath ,tagore4 ,,getting ,,ready ,,to ,,be ,a ,,mother ,a ,little ,book of ,information and ,advice for the ,young ,woman ,who is ,looking ,forward to ,motherhood ,,by ,,carolyn ,,conant ,,van ,,blarcom1 ,r4,n4 ,,author ,,of 8,,obstetrical ,,nursing10 8,,the ,,midwife ,,in ,,england0 ,formerly ,assistant ,superintendent and ,instructor in ,obstetrical ,nursing and the ,care of ,infants and ,children at the ,johns ,hopkins ,hospital ,training ,school for ,nurses4 ,honorary ,member of the ,midwives' ,institute1 ,england4 ,,with ,,an ,,introduction ,,by ,j4 ,,clifton ,,edgar1 ,m4,d4 ,emeritus ,professor of ,obstetrics and ,clinical ,midwifery in the ,cornell ,university ,medical ,college2 ,consulting ,obstetrician to ,bellevue ,hospital2 ,surgeon to the ,manhattan ,maternity and ,dispensary2 ,consulting ,obstetrician to the ,new ,york ,maternity1 ,jewish ,maternity1 and ,greenwich ,general ,hospitals4 ,,and ,,frederick ,w4 ,,rice1 ,m4,d4 ,associate ,professor of ,obstetrics1 ,new ,york ,university and ,bellevue ,hospital ,medical ,college2 ,attending ,obstetrician to ,bellevue ,hospital2 ,assistant ,surgeon to the ,manhattan ,maternity and ,dispensary2 ,assistant ,surgeon to ,st4 ,bartholomew's ,clinic and ,hospital4 ,,with ,,seventy ,,illustrations ,new ,york ,,the ,,macmillan ,,company #aibb ,all ,rights ,reserved ,,printed ,,in ,,the ,,united ,,states ,,of ,,america ,,copyright1 #aibb1 ,,by ,,the ,,macmillan ,,company4 ,set up and electrotyped4 ,published ,december1 #aibb4 ,,to ,,the ,,baby1 ,,upon ,,whose ,,wellbeing ,,depends ,,the ,,future ,,of ,,the ,,race ,,preface ,the young woman who is looking forward to motherhood is very often torn by sharply conflicting emotions4 ,her eagerness to have a baby and her happy anticipations may be dimmed by fears and misgivings1 by superstitious and erroneous beliefs born of an ignorance that is little less than pathetic4 ,a little information about physiological functions and an explanation of some of the facts of motherhood prove to be very reassuring to the mystified1 uninformed young woman4 ,there is1 too1 the immeasurably important question of the expectant mother's personal hygiene--the general scheme of her living in such a way as to promote her own and her baby's welfare--concerning which the average young woman is almost wholly ignorant4 ,but the busy doctor1 who gives of himself1 impartially1 to a large number of patients1 often finds it difficult to discuss with each one1 in a leisurely1 reassuring way1 the facts that he would like to have her grasp1 the misinformation he would like to dispel and the small but influential details of her daily life that he wishes her to consider4 ,it is just such simple information and such details of personal hygiene that ,i have attempted to set forth in this little book1 with the hope that it may help the expectant mother intelligently and confidently to do her part in making ready for the baby2 and to spend the period of her expectancy in a happy frame of mind1 free from haunting anxieties4 ,and ,i have given some space to a description of the course of the baby's development in order that his mother might have an abiding sense of his reality and his need of her protecting care from the very moment of his origin4 ,in no sense does this book replace the doctor's care1 for it is merely a composite of the advice about simple1 everyday little things which the majority of obstetricians give to the average1 normal woman4 ,i have stressed the fact that the first need of both mother and baby1 from the beginning of pregnancy1 is supervision by a physician and that such advice as these pages offer is of value only as it forms a part of his personal care4 ,i have drawn information from 8,the ,practice of ,obstetrics10 by ,j4 ,clifton ,edgar1 ,m4 ,d42 8,obstetrics10 by ,j4 ,whitridge ,williams1 ,m4 ,d42 8,the ,prospective ,mother10 by ,j4 ,morris ,slemons1 ,m4 ,d42 8,the ,diseases of ,infants and ,children10 by ,j4 ,p4 ,crozer ,griffith1 ,m4 ,d4 and 8,the ,newer ,knowledge of ,nutrition10 by ,e4 ,v4 ,mc,collum1 ,ph4 ,d41 ,sc4 ,d4 ,i am deeply indebted to ,dr4 ,j4 ,clifton ,edgar1 ,dr4 ,frederick ,w4 ,rice and ,dr4 ,john ,w4 ,harris for helpful advice and criticisms and to ,miss ,louise ,a4 ,schofield for editorial assistance4 ,practical suggestions have been generously contributed by other doctors1 and by nurses1 in this country and ,canada1 whose effective work is inspired by their belief that the future welfare of our race depends upon the care given to-day to maternity patients and their babies4 ,,carolyn ,,conant ,,van ,,blarcom4 #adi ,east #djth ,street ,new ,york ,city ,,introduction ,the childbearing function is a wonderfully complex physiological phenomenon4 ,it affects and is influenced by almost every organ and tissue in the human body4 ,the body of the female child from the earliest weeks of its life in its mother's womb1 while receiving nourishment from her body1 through infancy and the years of childhood to maturity is being gradually molded and developed for the special carrying out of this one function--the crowning and most vital act of woman4 ,although the childbearing function is the origin and source of the human race1 existing throughout the ages1 the processes connected with it have only in recent years been clearly understood4 ,our present-day knowledge of the processes connected with childbirth makes it easy to understand how1 in the early ages of the human race1 the function was a normal function1 with little or no danger to mother or child4 ,but with the gradual growth of the race1 with the beginning of the struggle for existence and the appearance and spreading of disease1 all interfering with the natural growth and development of the body1 the function of child bearing ceased to be a normal function1 as designed by its ,maker1 and became one fraught with dangers to both mother and child4 ,nevertheless1 through ignorance of these changes brought on by civilization1 the idea that the function is a normal process1 the risk slight and fatalities infrequent and when occurring1 inevitable1 is the almost universal belief to-day4 ,the dangers to the life of the mother and child in the carrying out of this function are well known to the medical profession1 as well as the fact that for the most part they are preventable4 ,yet in spite of this knowledge1 each year brings forth1 unchanging1 its toll in fatalities and countless numbers of invalid mothers1 with the inevitable destroying factor of the happiness of the home4 ,statistics are available to show that less than half of all pregnancies are normal and that the illness and loss of human life1 from causes associated with childbirth1 are distressingly and needlessly high4 ,failure to get these facts to the public2 failure to teach lay women the dangers to be avoided and the methods of protection1 is one very important reason why there has been no decrease in the high mortality rates4 ,during the past ten years1 maternity hospitals and private and public health bodies1 in various parts of the country1 have obtained wonderful results1 locally1 in reducing infant and maternal mortality1 by giving to large groups of prospective mothers information concerning the common dangers associated with childbirth and how they might best be prevented4 ,if every expectant mother1 no matter what her status or location1 followed the simple1 practical advice which this book offers1 the rate of illness and death among our mothers and babies would be materially lessened4 ,this book1 therefore1 so complete in its information on every subject pertaining to the mother during pregnancy and confinement and of the care of the newborn infant1 should be far reaching in its beneficial results4 ,it is a book containing knowledge which every physician must admit that expectant mothers should have1 and which a large number of expectant mothers are now earnestly seeking for their own protection and that of their newborn4 ,j4 ,,clifton ,,edgar1 ,m4 ,d4 ,,frederick ,w4 ,,rice1 ,m4 ,d4 ,new ,york ,city ,november1 #aibb ,,contents ,,page ,,preface xi ,,introduction1 ,,by ,j4 ,,clifton ,,edgar1 ,m4,d41 ,,and ,,frederick ,w4 ,,rice1 ,m4,d4 xiii ,,chapter ,i ,,getting ,,ready ,,to ,,be ,a ,,mother #a ,,ii ,,signs ,,that ,a ,,baby ,,is ,,coming #aa ,,iii ,,where ,,the ,,baby',s ,,life ,,begins #bj ,,iv ,,how ,,the ,,baby ,,develops ,,before ,,he ,,is ,,born #cd ,v ,,taking ,,care ,,of ,,the ,,baby ,,before ,,he ,,comes #df ,,vi ,,making ,,ready ,,for ,,the ,,baby #hb ,,vii ,,the ,,baby',s ,,arrival #ih ,,viii ,,the ,,baby',s ,,mother #aad ,,ix ,,the ,,mother',s ,,care ,,of ,,herself--,,for ,,the ,,baby',s ,,sake #ach ,x ,,the ,,mother',s ,,care ,,of ,,her ,,baby #adh ,,xi ,,the ,,nutrition ,,of ,,mother ,,and ,,baby #bbf ,,list ,,of ,,illustrations 8,the ,caress0 by ,gari ,melchers ,frontispiece ,chapter ,,iii4 ,,fig4 ,,page #a4 ,diagram of pelvis #ba #b4 ,side view of female generative organs #bc #c4 ,front view of female generative organs #be #d4 ,diagram of human ovum #bf #e4 ,front view of breast #cb ,chapter ,,iv4 #f4 ,diagram showing process of cell division #cf #g4 ,diagram of baby1 cord1 membranes and placenta within the uterus #ch #h4 ,appearance of the baby at different stages of development #dj #i4 ,position of baby in the uterus just before birth #db ,chapter ,v4 #aj4 ,front and side views of maternity corsets #ei #aa4 ,front1 side and back views of home-made abdominal binder and breast bandage1 applied #fj #ab4 ,abdominal binder used in ,fig4 #aa #fa #ac4 ,front and back views of home-made stocking supporters #fb #ad4 ,right-angled position for relief of swollen feet and legs #ga #ae4 ,lying with hips elevated to relieve swelling of vulva #gc ,chapter ,,vi4 #af4 ,leggings for use at the baby's birth #hh #ag4 ,pad made of newspapers1 to protect bed #ij #ah4 ,pattern for baby's petticoat #ib #ai4 ,pattern for baby's dress #ic #bj4 ,outfit of satisfactory baby clothes #id #ba4 ,baby's toilet tray #if ,chapter ,,vii4 #bb4 ,diagram showing cervix in process of being dilated #aja #bc4 ,drawing showing descent of baby during birth #ajd #bd4 ,helping the baby to breathe #aaa ,chapter ,,viii4 #be4 ,supporting heavy breasts with straight binder #aah #bf4 ,supporting heavy breasts by means of three folded towels #aai #bg4 ,indian binder for heavy breasts #abj #bh4 ,protecting nipples with sterile gauze #aba #bi4 ,position of mother and baby while nursing in bed #abc #cj4 ,using shield to protect sore nipples1 while nursing baby #abd #ca4 ,nipple shield used in ,fig4 #cj #abe #cb to #ch1 ,bed exercises inclusive4 #abh to #aca #ci4 ,knee chest position #acb #dj4 ,walking on all fours #acc ,chapter ,x4 #da4 ,baby's weight chart #aea #db4 ,diagram of first teeth #aec #dc4 ,appearance of fresh cord immediately after birth #aed #dd4 ,appearance of cord four days after birth #aee #de4 ,appearance of navel after cord has dropped off #aee #df4 ,appearance of normal1 well healed navel #aef #dg4 ,preparing the baby's milk #afi #dh4 ,position in which to hold baby and bottle for feeding #agb #di4 ,holding baby upright after feeding to prevent colic #agc #ej4 ,putting the baby into his bath #ahe #ea4 ,supporting the baby's head above water while giving bath #ahf #eb4 ,dry1 sterile cord dressing #ahi #ec4 ,flannel band over cord dressing #aij #ed4 ,putting on the straight diaper #aia #ee4 ,the diaper in ,fig4 #ed applied #aib #ef4 ,the ,sutton poncho #aih #eg4 ,method of carrying baby to support back and head #bjj #eh4 ,training the baby to use a chamber #bjb #ei4 ,elbow cuffs to prevent thumb sucking #bjc #fj4 ,immersing baby for bran or mustard bath #bji #fa4 ,putting the baby into a wet pack #baj #fb4 ,the baby in a wet pack #baa #fc4 ,diagrams showing successive steps in giving pack #bab #fd4 ,giving the baby an enema #bag #fe4 ,quilted robe for the premature baby #bbj #ff4 ,bed for premature baby improvised from a clothes basket #bba #fg4 ,the baby in a basket1 ready to travel #bbd ,,getting ,,ready ,,to ,,be ,a ,,mother ,,chapter ,i ,,getting ,,ready ,,to ,,be ,a ,,mother ,how does it seem to you--the coming of a baby8 ,does it seem the most amazing of miracles1 so stirring in its beauty and mystery that you are eager to make ready and prepare for it fitly8 ,or have you1 perhaps1 come to share the general feeling that motherhood is a natural state which one accepts when it comes1 but need not prepare for8 ,this attitude seems to go back to a very old and deeply rooted conviction that1 as women always have had babies and have had them through the working of one of ,nature's laws that has been operating over and over throughout the ages1 they doubtless will continue to have them in the same old way1 and the entire matter may well be left to take care of itself4 ,as to the baby1 when he comes1 one may expect that the ability to care for him will come too4 ,because of this reasoning1 or lack of it1 it has been a fairly general custom for the woman who expected a baby to seek her doctor's aid only when she went into labor1 or shortly beforehand1 and to give no thought to the care of her baby until he was born4 ,all too often the mother has died1 because of this tardy care1 been injured or become an invalid1 while equally sad things have happened to the baby--and needlessly so4 ,but now1 happily1 a great change is taking place in the realm of mothers and babies4 ,we still realize1 of course1 that childbearing is a natural function1 but we know that conditions must be made favorable for the smooth working of this natural law if all is to be well2 that for the sake of both mother and baby it is of urgent importance to give thought and care to the baby during the nine months before he is born4 ,there is little doubt that the most critical period in one's life is the first ten months--the nine months before birth and the first month afterward--and that the care which is given during these months influences one's physical state1 for good or ill1 throughout all the rest of life4 ,in the light of this knowledge1 women are more and more generally seeking and being given 8prenatal care10 which is care before the baby is born1 together with advice and instructions which fit them to assume motherhood safely and successfully4 ,ideal prenatal care would really begin during the expectant mother's own infancy1 for the chances of a normal pregnancy1 labor and lying-in period are greatly increased by good care during the early years of life4 ,but for the time being we shall have to content ourselves with an effort to extend1 as widely as possible1 the care that is now known to be beneficial for expectant mothers from the beginning of pregnancy4 ,this prenatal care is undertaken in much the same spirit in which one makes a garden1 for example4 ,we know1 of course1 that plants which are neglected sometimes grow and blossom satisfactorily1 though one would not think of depending upon them to do so4 ,but we have learned that plants that are given the care and protection that they need are almost certain to flourish and bloom after the manner of their kind4 ,experience teaches1 however1 that this care must be regular and sustained and always given for the twofold purpose of preserving the plants from injury as well as nourishing them4 ,accordingly we put them in good soil1 to begin with1 and then give water1 sunshine or shade1 according to their respective needs1 and we take care to protect them from the destructive effects of harmful insects1 blights1 weeds or anything which may be unfavorable to their healthy progress4 ,we do not close our eyes to the fact that these harmful conditions are possible4 ,instead1 we are anxious to find out all about them--what causes them and how to recognize them--in order that we may prevent or remove them before they do serious damage4 ,many women1 nowadays1 are taking just that kind of attitude toward motherhood4 ,they begin by consulting a doctor as soon as they know that they are pregnant1 because they appreciate the importance of doing so4 ,they study eagerly the questions relating to motherhood2 the structure and workings of those parts of their own bodies which are concerned with the baby's creation2 how he evolves within them2 what he needs during those nine months of development2 what practices1 what conditions are bad for the baby and themselves2 what they can do to avoid or correct these and how they can help to make things go smoothly4 ,the women who face the facts of motherhood in this way generally go through the entire adventure normally and successfully1 as ,nature intended they should4 ,more than this1 those women who place themselves under a doctor's care from the beginning of1 or early in1 pregnancy1 are greatly reassured to find out how much can be done to safeguard them1 and they do not have that fear of the approaching birth which is suffered by so many women who do not know nor understand what is going on4 ,the results of the painstaking work and study which have been carried on to increase the comfort and safety of mothers and babies have made it possible for the doctors to plan something of a routine which they find advisable for their patients to adopt4 ,to begin with1 it is quite plain that the first need of every expectant mother is examination and measurement1 early in pregnancy1 by a good physician4 ,the information thus obtained helps the doctor to foretell the kind of labor that his patient is likely to have1 and by planning for it ahead of time he is often able to save her much harm and suffering4 ,an early examination also enables the doctor to discover and correct any slight trouble which may exist at that time and which might grow worse if not treated1 and to advise his patient about the general care which he wishes her to take of herself throughout pregnancy4 ,in regard to this care1 doctors are generally agreed that the average woman needs to do little more than observe the ordinary rules of personal hygiene1 which as a matter of fact1 should be followed by all of us2 that is1 she should live a simple1 regular life as to diet1 fresh air1 exercise1 rest1 sleep1 diversions1 etc4 ,this all sounds simple enough and as a matter of course1 but it is usually overlooked in spite of being of the most urgent importance to both mother and baby4 ,this advice varies in little things1 here and there1 among different doctors1 but in the main it is about the same the world over1 where thought is being given to the care of expectant mothers4 ,for no matter where they are or what their status1 their needs in general are the same4 ,they need a doctor's supervision and they need to practice the principles of personal hygiene4 ,accordingly1 in addition to making an early examination and giving instructions about the regulation of her daily life1 the doctor usually wants to see his patient and make certain observations every little while during pregnancy1 just to make sure that everything is going as it should and to be in a position to discover the earliest and slightest symptoms of complications4 ,in the old days there were certain complications associated with childbirth which the doctors did not know how to prevent and sometimes could not cure--complications which were bad for both mother and baby4 ,but now they know a great deal about both preventing and curing even the most serious of these complications4 ,they have discovered1 for one thing1 that many conditions which give serious trouble during labor1 or soon afterwards1 actually have their beginnings during pregnancy1 and sometimes very early4 ,quite evidently1 then1 it means a great deal to the expectant mother to have the doctor discover and treat these complications before they have had time to become serious4 ,but he can give early treatment only if he knows about the symptoms of the trouble when they first appear4 ,some of these symptoms may be detected by the expectant mother herself after they have been explained to her1 but some of them can be discovered only by a doctor or a nurse4 ,that is why it is important for the doctor to see his patient at frequent intervals during pregnancy2 about once a month during the first half and every two weeks afterwards4 ,he sees her for much the same reasons that the housewife looks over the contents of her darning basket--not once and for all time1 but regularly1 once a week1 over and over and over4 ,she searches each time not for holes alone1 but for thin places1 too2 an occasional broken thread or the beginning of a 8run10 knowing how much trouble she will save herself1 later on1 by promptly repairing the smallest break or evidence of wear4 ,she knows quite well that there are no more holes because she looks for them1 than there are if she does not1 and that failure to look for them will not keep the holes from being there nor from growing larger4 ,no more does the expectant mother develop a complication because she is examined1 nor does an existing condition cease to exist because she is not examined2 and yet some women still take just that illogical attitude toward examinations and supervision during pregnancy4 ,one factor which keeps some expectant mothers from seeking medical care is the well-meaning but dangerous counsel so freely offered by older women who claim fitness to advise by virtue of having had several children of their own4 ,their lack of success1 as evidenced by miscarriages1 stillbirths1 children dying in early infancy1 as well as injuries and disabilities of their own1 is usually overlooked as they press their superstitions and remedies upon the inexperienced and bewildered younger woman4 ,when disaster follows1 as it so often does1 it is very likely to be ascribed to the will of ,god1 and the mother's needless sacrifice does not even serve as a warning to others who are in line for the same kind of advice4 ,another obstacle to adequate prenatal care is sometimes found in the husband who considers it entirely reasonable to secure expert advice upon the subject of cattle-raising1 let us say1 or the care and running of his automobile or about his investments1 but who has a conviction that it is normal and natural for women to have children without making what he considers a fuss about it4 ,he may cherish1 too1 a suspicion that it is not altogether good for his wife to be thinking too much about her condition4 ,his mother never began bothering until the baby came4 ,on the other hand1 many husbands show the tenderest solicitude for their wives throughout pregnancy and would be only too eager to have them enjoy all the benefits of prenatal care1 if they only knew and understood about it4 ,the expectant mother will be wise1 therefore1 if she undertakes to convince her husband1 if need be1 that her occupation of bearing and rearing children merits quite the same thoughtful attention as his work1 to which he devotes his best powers4 ,how easy and worth while this may be was demonstrated a couple of years ago at a county fair which was attended by a very intelligent farmer and his wife4 ,the farmer was interested in hog-raising and both he and his wife accepted without question the fact that success in this enterprise could be achieved only through serious study and the most painstaking care4 ,but as to childbearing1 if they thought of it at all1 they looked upon it as simply one of those natural functions which always had and doubtless always would take care of itself4 ,when this couple reached the fair the farmer entered one of his fine animals in a prize-winning contest and as there was a baby contest1 too1 the wife entered their little son4 ,in due time the judges inspected the various contestants and it was found that point by point the farmer's hog measured up to all of the standards of perfection for his kind and easily won the first prize4 ,not so with the baby2 point by point he fell below even a moderate average of what a baby should be and was outranked by many of his more robust infant competitors4 ,as various admirers discussed hog-raising with the farmer1 it became quite evident that he had carefully studied the question and had applied to his occupation the most approved methods of which he could learn4 ,but when the doctors and nurses at the baby contest talked with the crestfallen mother about her baby1 who had seemed right enough to her1 they found that she knew little or nothing of the business of being a mother2 that it had never occurred to her nor to her husband that she might profit by care and instruction about herself and her baby both before and after he was born4 ,as might be expected1 she had been unable to nurse him and on the whole he proved to be a pretty poor specimen of a baby1 with a dismal outlook as to health4 ,since the mother was then in an early stage of another pregnancy1 the doctor talked it all over with her and her husband4 ,he convinced them that such thoughtful and painstaking care as they had devoted successfully to hog-raising were equally effective when applied to baby-raising4 ,as a result1 the expectant mother1 with her husband's whole-hearted approval1 placed herself under the care and supervision which she found were available through a prenatal clinic in her vicinity4 ,the happy sequel to that story is that when another fair was held1 a year later1 the farmer entered another one of his hogs and the wife her new baby1 and that this baby held his own with the hog by taking a prize1 too4 ,so sincerely do doctors now believe in the urgency of having all maternity patients under supervision and care during the nine months before the baby comes and the first several weeks afterwards1 that they not only care for those women who come to their offices1 but also give of their knowledge and skill to organizations engaged in prenatal and maternity work4 ,these organizations may be visiting nurse associations1 prenatal clinics1 health centers or dispensaries4 ,as the doctors are assisted by nursing staffs they are able to offer protection1 through these channels1 to a very large number of mothers and babies4 ,among the women who are cared for by such organizations1 or by doctors in their private practice1 there is an enormous reduction in the occurrence of convulsions1 for example1 abortions1 miscarriages1 stillbirths1 infections 7childbed fever71 and prolonged and difficult labors4 ,or1 to put it the other way round1 good care started during early pregnancy and continued throughout labor and the lying-in period gives both mother and baby enormously increased chances to live and enjoy good health4 ,one reason why the baby is so much better off is that good care practically always enables his mother to nurse him1 for1 except in extremely rare cases when there is a definite physical disability1 as tuberculosis for example1 every mother can nurse her baby if she really wants to and if she1 the doctor and nurse bend all their energies to accomplish this happy end4 ,a baby who is not breast-fed is defrauded of a protection which is rightfully his1 and usually because someone has failed to do all in his or her power4 ,organizations which include doctors and nurses who can give skilled care to maternity patients are increasing in scope and number throughout cities1 towns and rural districts in all parts of the country4 ,this makes us hope that before long good care during pregnancy1 childbirth and young motherhood will be available to every woman in the land4 ,but quite as earnestly do we also hope that every woman in the land who is looking forward to motherhood will seek this care4 ,certain it is that the expectant mother who does seek care1 whether from a doctor in his office or through a prenatal clinic1 is approaching her motherhood in the only way that is safe for herself and her baby4 ,she should realize1 however1 that although the doctors can accomplish a great deal through examinations and advice1 they can give the full benefits of their skill only to those women who do their part by following instructions faithfully1 week after week1 throughout nine months4 ,the doctor cannot live his patient's life for her2 he can plan and advise her ever so wisely1 but this counts for very little unless she lives as he directs4 ,the young woman who sees her motherhood as a coveted privilege1 crowded with happy possibilities1 who is willing to bear its inconveniences and take the necessary precautions to insure a satisfactory outcome1 is very likely to go through her experience in good health and buoyant spirits4 ,and in the end she will have not only the ecstasy of possessing a beautiful1 well baby who has every prospect of continuing so1 but as the years pass she will have the satisfaction of knowing that she is a better1 more helpful1 more companionable mother because of being in good health herself4 ,that is the point of good maternity care--future well-being as well as immediate safety for both mother and baby--and it rests with each woman to decide for herself if she is to have such care4 ,,chapter ,,ii ,,signs ,,that ,a ,,baby ,,is ,,coming ,the woman who wants a baby and is in a position to have one is usually eager to know how she can tell when a baby is coming4 ,she wants to know because the baby's coming means so much to her and also in order that she may know when to consult a doctor4 ,i am sorry to have to admit1 at the outset1 that making this important discovery is far from being a simple matter4 ,one would suppose1 after all these ages1 during which countless babies have been born and countless pregnancies have been observed by doctors and others1 that there would be some known way of finding out definitely1 at an early date1 whether or not a baby was coming4 ,but strangely enough1 there is no positive evidence of the baby's existence within his mother's body until eighteen or twenty weeks after his life there has begun4 ,on the other hand1 so many symptoms of pregnancy are known to women1 the world over1 that very often an expectant mother is correct when she suspects at an early date that she is pregnant1 particularly if she has already had a child4 ,but as the well-known symptoms are much like those of various conditions other than pregnancy1 even experienced mothers sometimes believe themselves pregnant when they are not4 ,the reverse is true also1 for we occasionally hear of a woman who fails to recognize the meaning of the changes which she notices in herself1 and is unaware of being pregnant up to the very time of going into labor4 ,and so we find that there are some signs of pregnancy which are only possible1 since they may be caused by some other conditions2 others which may be accepted as probable1 and a few signs which are positive because they are never due to any cause but pregnancy4 ,the possible signs can all be detected by the expectant mother1 herself1 and may be described as follows3 #a4 ,stopping of ,menstruation4 ,this is usually the first symptom noticed4 ,although it is possible for the periods to be stopped by any one of several other causes1 the missing of two successive periods1 after intercourse1 is a strong indication of pregnancy in a healthy woman of the childbearing age1 whose menses have been regular4 #b4 ,changes in the ,breasts4 ,these1 also1 occur early4 ,the breasts usually increase in size and firmness1 and many women complain of throbbing1 tingling or pricking sensations and a feeling of tightness and fullness4 ,the breasts may be so tender that even slight pressure is painful4 ,the nipples become larger and more prominent2 they and the colored circle of skin around them grow darker1 while the veins and the glands that feel like little lumps under the skin become more noticeable4 ,if1 in addition to these symptoms1 it is possible for a woman who has not had children to squeeze from her nipples a pale yellowish fluid1 called colostrum1 she may feel almost certain that she is pregnant4 ,but it must be remembered that these symptoms1 also1 may be due to causes other than pregnancy2 that even milk in the breasts may be present in a woman who has borne children1 for months1 or possibly years1 after the birth of her last baby4 #c4 8,morning sickness10 as the name suggests1 is nausea1 sometimes accompanied by vomiting1 from which many expectant mothers suffer the first thing in the morning4 ,this varies from a little nausea1 when first raising her head1 to repeated attacks of vomiting during the day and even during the night4 ,as a rule1 however1 the discomfort is experienced during the early part of the day only4 ,morning sickness may set in immediately after conception1 but begins about the sixth week1 as a rule1 and lasts until the third or fourth month4 ,it occurs in about half of all pregnancies and is particularly common among women who are pregnant for the first time4 ,on the other hand1 one must not forget that many non-pregnant women suffer from nausea in the morning2 many women go through pregnancy without any such disturbance1 while others are entirely comfortable in the morning but nauseated during the latter part of the day4 #d4 ,frequent ,urination4 ,there is usually a desire to pass urine frequently during the first three or four months of pregnancy1 after which the tendency disappears1 but returns during the later months4 ,the desire may be due in part to nervousness1 but is largely caused by pressure made upon the bladder by the growing baby1 and not by kidney trouble1 as is sometimes believed4 ,for pressure on the outside of the bladder gives much the same sensation as is experienced when the bladder is full of urine4 ,after the baby grows to such a size that he pushes up into the abdomen 7we shall describe this later71 he does not press upon the bladder and therefore ceases to create a desire to urinate until the last month or six weeks before he is born when he sinks back into the pelvis4 #e4 ,increased discoloration of the colored parts of the skin is another early symptom of pregnancy4 ,in addition to the deepened tint of the nipples and the circles around them1 a dark streak appears upon the lower part of the abdomen1 extending upward toward the umbilicus1 or navel4 ,there are also the yellowish1 irregularly shaped blotches which sometimes appear upon the face and neck2 dark circles under the eyes and pinkish or bluish streaks on the abdomen4 #f4 8,quickening0 is the name which is commonly given to the mother's first feeling of the baby's movements4 ,it occurs about the eighteenth or twentieth week1 and is regarded by some doctors as a positive sign of pregnancy and by others as merely a possible sign4 ,the sensation is compared to a very slight quivering1 or tapping1 or to the fluttering of the wings of a bird as it is held in one's hand4 ,beginning very gently1 these movements grow more vigorous1 as time goes on1 until they become very troublesome toward the latter part of pregnancy1 amounting then to sharp kicks and blows4 ,women who have had children can usually distinguish between quickening and the somewhat similar sensation caused by the movement of gas in the intestines2 but a woman pregnant for the first time may be deceived4 ,there are many other possible symptoms of pregnancy1 but their value is very uncertain and as we have seen1 even the ones described above are not entirely dependable4 ,but if you have missed two periods2 if your breasts have grown larger and firmer2 if your nipples are stiffer and more prominent and you can squeeze colostrum from them1 you may be reasonably certain that a baby is coming4 ,the probable signs of pregnancy are more apparent to the doctor than to the expectant mother1 but there are two which you may easily detect3 #a4 ,enlargement of the abdomen1 which is a very important sign1 may be noticed about the third month4 ,at this stage a rounded mass may be felt in the abdomen which steadily increases in size as the weeks and months slip by4 ,rapid enlargement of the abdomen in a woman of childbearing age may be taken as fair1 but not positive1 evidence that she is carrying a baby4 ,however1 complete reliance cannot be placed in this sign1 since it is possible for the abdomen to be enlarged by a tumor1 by dropsy1 or by fat4 #b4 ,painless contractions of the uterus 7or womb1 within which the baby lies7 begin during the early weeks of pregnancy and occur at intervals of five or ten minutes throughout the entire period4 ,the expectant mother may not be conscious of these contractions during the early months1 but later she can detect them by placing her hand upon her abdomen and feeling the uterus1 beneath it1 grow first hard and then soft1 as it contracts and relaxes4 ,but the probable signs of pregnancy1 like the possible symptoms1 may occur in women who are not pregnant1 and accordingly the appearance of any one of them alone1 is not of great significance4 ,the positive signs of pregnancy1 of which there are three1 are not apparent until the eighteenth or twentieth week4 ,they relate to the baby1 but with one exception they cannot be detected by the expectant mother4 ,however1 they are of such moment that you will be interested to know what they are4 #a4 ,hearing and counting the baby's heart beat is unmistakable evidence of the baby's existence4 ,the doctor sometimes hears this by resting his ear upon the mother's abdomen and sometimes by listening through a stethoscope4 #b4 ,ability to feel the outline of the baby's body is also a positive sign of pregnancy1 if the head1 buttocks1 back and extremities are unmistakably made out through the mother's abdominal wall4 #c4 ,feeling the movements of the baby is accepted as a third positive sign of pregnancy4 ,there is some difference of opinion concerning the value of 8quickening10 alone1 as a positive sign1 but if the baby's movements are felt by the doctor1 also1 through the mother's abdominal wall1 or by vaginal examination1 there can be no doubt that a baby is there4 ,feeling these movements some time after the eighteenth or twentieth week1 by placing a hand upon the abdomen1 is the one positive sign which the expectant mother may detect for herself4 ,some ,other ,changes in the ,mother's ,body ,while the ,baby ,grows4 ,in addition to the signs and symptoms which we have just described1 there are a good many other changes which will take place in your own body1 in the course of the baby's development1 and you will want to learn about some of them in order that you may know what to expect4 ,the abdomen4 ,of course1 the steady enlargement of the abdomen and the alteration in its shape1 as pregnancy advances1 is the change that you will be most conscious of4 ,as the abdomen grows larger1 the skin which covers it is stretched more and more tightly with the result that the tissues just under the surface sometimes give way1 or split and form pale pink or bluish streaks4 ,these streaks1 which are called stri1 grow white and glistening after the baby is born1 so that the abdomen of an expectant mother who has had children1 will show silvery streaks from earlier pregnancies and also the bluish ones recently formed4 ,these streaks are of no consequence and ,i mention them simply because you are almost certain to notice them and may wonder what they are4 ,they may appear upon the hips1 thighs and breasts as well as upon the abdomen1 if the skin over these parts is greatly stretched4 ,the umbilicus 7navel7 is deeply indented during about the first three months of pregnancy1 but afterwards the pit steadily grows shallower and by the seventh month1 it is level with the surface of the abdomen4 ,after this time the navel may protrude1 in which state it is described as a 8pouting umbilicus40 ,an increase in the vaginal discharge is another change which you may notice during the latter months of pregnancy4 ,the changes in the skin consist chiefly of the increased discoloration over various parts of the body1 which was mentioned among the possible signs of pregnancy4 ,the degree of this discoloration varies with the complexion of the individual1 as blonds may be tinted but slightly more than usual1 while the discolored areas on a brunette may become almost black4 ,as the skin glands become more active1 there is also an increase in perspiration and sometimes the hair becomes much more luxuriant during pregnancy4 ,changes in the digestive tract are the morning sickness already described1 and constipation4 ,the latter is suffered by at least one half of all pregnant women and is due chiefly to pressure made upon the intestines by the enlarged uterus1 though weakening of the stretched abdominal muscles may be one cause4 ,constipation is most troublesome during the latter part of pregnancy4 ,there may be1 also1 heartburn1 acid stomach and intestinal indigestion giving rise to gas1 diarrhea and cramps4 ,the so-called 8cravings0 of pregnancy are not so common in real life as they are in rumor1 but the expectant mother may show unexpected likes and dislikes for certain dishes1 possibly because of her tendency to be nauseated4 ,her appetite may be very capricious during the early weeks and become almost ravenous later on4 ,the bones and teeth may grow softer during pregnancy1 if the expectant mother does not eat proper food1 and as a result we hear of the old beliefs that each baby costs the mother a tooth and that broken bones heal slowly during pregnancy4 ,both of these occurrences are entirely unnecessary1 and may be prevented by eating suitable food1 as will be explained in the chapter on nutrition4 ,the carriage1 or mode of walking1 is somewhat affected by pregnancy because of the increased size and weight of the abdomen4 ,in an effort1 to hold herself erect1 the expectant mother throws back her head and shoulders and finally assumes a gait that may be described as a waddle1 being particularly noticeable in short women4 ,you hear a good deal about the thyroid gland these days1 so you may as well know that it is very often enlarged during pregnancy and thus may form a swelling on the front part of the neck4 ,if you notice it you might tell your doctor but it need not worry you for it will almost certainly return to its normal size after the baby comes4 ,when to ,expect the ,baby4 ,now that you are familiar with the most apparent changes which will take place in your body during pregnancy1 you are probably on tiptoe to find out as nearly as possible the date upon which to expect the baby4 ,unfortunately we cannot foretell the exact date1 for the very simple reason that we have no way of knowing just when pregnancy begins4 ,quite evidently1 then1 not knowing when it begins we cannot figure out the exact date upon which pregnancy will end in the baby's birth4 ,but we do know that labor usually begins about ten lunar months1 or forty weeks1 or from #bgc to #bhj days1 after the beginning of the last menstrual period4 ,thus the approximate date of the baby's arrival may be estimated by counting forward #bhj days or backward #he days from the first day of the last period4 ,or1 what is perhaps simpler and amounts to the same thing1 one may add seven days to the first day of the last period and count back three months4 ,for example1 if the last period began on ,june #c1 the addition of seven days brings us to ,june #aj1 while counting back three months from this1 indicates ,march #aj as the approximate date upon which the baby may be expected4 ,this is probably as satisfactory as any method of estimation1 but at best it is only approximate1 being accurate in about one case in twenty4 ,however1 it comes within a week of being correct in half the cases2 and is within two weeks of the actual date in eighty per cent4 of all pregnancies4 ,still another method is to count forward twenty or twenty-two weeks from the day upon which you first feel the baby move4 ,this 8quickening10 as we have seen1 usually occurs about the eighteenth or twentieth week1 but is so irregular that it is not wholly reliable4 ,the possibility of figuring out the date of the baby's arrival is made still more uncertain by the fact that there is evidently considerable variation in the length of entirely normal pregnancies4 ,many healthy children are born before ten lunar months have elapsed since the last menstrual period1 while more births occur after than on the expected date4 ,the first pregnancy is usually shorter than later ones1 and women who are well nourished and well cared for usually have longer pregnancies than those who are not4 ,taking it as a whole1 the average woman has unusually good health during pregnancy4 ,she may feel some weariness during the first few months and she may lose a little weight1 but during the latter part of the period her general health is improved and there is an increase of flesh1 not alone in the abdomen1 but over the entire body1 sometimes amounting to twenty-five or thirty pounds4 ,she loses about fifteen pounds of the increased weight when the baby is born1 and still more during the weeks immediately following1 when her body returns to about its original condition4 ,but very often the experience of pregnancy is so beneficial that the improved state of health and nutrition which accompany it become permanent4 ,,chapter ,,iii ,,where ,,the ,,baby',s ,,life ,,begins ,as you plan for the care of your baby during the nine months before he is born1 you will want to know something of the place where his life begins2 where one tiny cell is so miraculously stimulated and nourished that it finally develops into a beautiful little body4 ,not only will you find all of this of absorbing interest1 but a general idea of the structures and workings of those parts of your body where the baby lives and grows will help you better to understand some of the doctor's precautions and to give yourself intelligent care while your body performs its supreme function4 ,to begin with1 there is the pelvis4 ,this is a very irregular1 bottomless1 bony basin1 or curved canal1 within which lie the reproductive or generative organs to be described presently4 ,the pelvis is really composed of four bones which are entirely separate in early life but firmly welded into one rigid structure in adults4 ,i mention this because many women believe that labor pains are caused by a spreading or opening of these bones1 whereas1 as we shall see presently1 the pains are really due to the strong contractions of the muscles of the uterus 7or womb7 in which the baby lies1 which force the baby down through this inflexible ring4 ,you may see in ,fig4 #a how the pelvis is placed in the body1 being interposed between the spinal column1 which it supports1 and the thighs upon which it rests4 ,we can feel two of its prominent points on either side below the waist1 as our hips1 and we rest upon two other projections while in the sitting position4 ,illustration3 ,,fig4 #a4--;,diagram showing the structure of the pelvis and its position in the body1 the inlet being heavily outlined4 ,this bony canal is drawn in1 or narrowed about midway in its length so that it is broader above and below than it is in the middle4 ,you are likely to bear the doctors speak of this narrow part as the inlet4 ,i thought you would be interested to know about this for it is largely in order to discover the size and shape of the inlet that the doctor is so anxious to make certain examinations and measurements4 ,the wide part of the pelvis above the inlet is called the upper1 or false pelvis1 while the smaller cavity below is known as the true pelvis4 ,during the early part of pregnancy the baby lies in the true pelvis1 but as pregnancy advances and he grows larger1 he pushes up through the inlet into the larger pelvis where he remains until he is born4 ,when that time comes he must pass down through the inlet again on his way into the world4 ,if this opening is about the usual size and shape and the baby is of an average size1 he will usually pass through with comparatively little trouble4 ,but if the inlet is smaller than normal or of an unusual shape1 it may be difficult1 or even impossible1 for the head of a normal-sized baby to pass through without the doctor's assistance4 ,you can see how important it is1 therefore1 for the doctor to know beforehand about the size and shape of the pelvic inlet1 since it enables him to plan to help with the birth1 if necessary1 thus saving mother and baby from exhausting themselves in trying to do the impossible4 ,in the old days many mothers and babies were injured1 and sometimes even lost their lives1 because doctors did not know about measuring the pelvis and planning ahead of time for a difficult labor4 ,but now they know how to make things easier and safer4 ,it is worth mentioning here that proper care during infancy and childhood1 with proper food1 fresh air and exercise1 helps to promote normal development of the pelves of little girls1 and this in turn tends to make childbirth normal for these children when they grow up and are ready to have babies of their own4 ,the ,generative or ,reproductive ,organs4 ,the pelvis is an interesting structure but not nearly so interesting as the generative organs which lie within it3 the uterus 7or womb71 tubes and ovaries4 ,these1 with the vagina1 are often called the internal genitalia because they are inside the body4 ,the pelvis practically remains rigid and inactive throughout pregnancy and labor1 but the ovaries and the uterus are constantly active and are concerned with an undertaking which is so utterly amazing that it is far beyond our powers of understanding4 ,we can only look on and wonder4 ,illustration3 ,,fig4 #b4--;,drawing showing the structure and relation of the female generative organs1 as viewed from the side4 7,drawn by ,max ,brdel4 ,used by permission of ,a4 ,j4 ,nystrom and ,co41 ,chicago47 ,the uterus1 or womb1 in which the baby develops1 is a firm little mass of muscle1 which1 in its non-pregnant state1 is much the shape of a slightly flattened pear1 about three inches high1 an inch and a quarter wide at its broadest point1 three quarters of an inch thick1 and weighs about two ounces4 ,we usually speak of the main part of the uterus as the body3 the round top as the fundus and the smaller part of the organ1 below1 as the neck or cervix4 ,this important little organ is placed about the middle of the true pelvis1 with the upper end pointing slightly forward4 7,see ,fig4 #b47 ,it is more or less swung in this position by being attached to ligaments instead of to any fixed part1 the ligaments1 in turn being attached to the sides of the pelvis4 ,this explains why the uterus may move about1 tip forward or backward1 and how1 by a stretching of the ligaments that hold it1 it is able to grow and push upwards as pregnancy advances4 ,within the body of the uterus is a flat cavity which is somewhat triangular in shape1 with an opening at each of the three corners4 ,the two upper openings lead into the tubes1 which will be described in a moment1 while a third opening leads down into the cervix1 the lower end of the cervix1 in turn1 protruding into the vagina4 ,the upper and lower ends of the cervix are drawn in as though with a draw string so that they are scarcely more than small round holes4 ,these are called the internal os and the external os4 ,fig4 #c gives an idea of how the cavity of the uterus and the cervix would look from the front1 with the tubes reaching out from the upper corners of the uterus1 and the cervix opening into the vagina4 ,the uterus is lined with a soft mucous lining something like the lining of one's mouth4 ,bear this in mind1 for this lining represents1 in part1 the soil in which the tiny human seed is planted and through which its roots draw nourishment4 ,the ,fallopian tubes are two little muscular passage ways1 about five inches long1 which extend from the two upper corners of the uterine cavity toward the sides of the pelvis4 ,the tubes are very small where they arise from the uterus1 but gradually grow larger toward their free ends and finally spread out into wide1 funnel-shaped openings that lead directly into the abdominal cavity4 ,the tubes1 also1 are lined with a mucous membrane but of a most surprising kind4 ,its surface is covered with tiny hair-like projections which make it something like a brush with very soft1 moist bristles4 ,these little hairs are in constant motion1 waving and sweeping along in much the same way that a field of wheat waves and sweeps in the wind4 ,remember about this1 too1 for it has something to do with the very beginning of the baby4 ,illustration3 ,,fig4 #c4--;,diagram showing the structure and relation of the female generative organs1 as seen from the front4 ,the ,ovaries4 ,very near and a little below the flaring1 open ends of the tubes are the ovaries1 the sex glands of the female4 ,there is one on each side1 held in place by ligaments and they are about the size and shape of almonds4 ,in the ovaries are embedded the ova1 or eggs1 the female germ cells which are concerned with producing the baby and also with the function of menstruation4 ,illustration3 ,,fig4 #d4--;,diagram of human ovum4 ,just a word about what is meant by 8a cell40 ,it is simply a tiny mass of jelly-like substance1 called protoplasm1 contained in a thin membrane or skin and is so small that it can be seen only through a microscope4 ,in its unmatured state the ovum is a single cell1 about of an inch in diameter4 ,in the protoplasm there is a spot called the nucleus and within this a smaller one called the nucleolus1 or the germinal spot4 ,these are long names and you need not remember them unless you want to1 but glance at ,fig4 #d which shows an ovum and you will see that in its general structure it is much like a hen's egg1 for the latter has a yolk within the white and on the yolk a tiny speck or germinal spot4 ,the formation of each woman's full quota of ova1 fifty thousand or more1 is probably complete at the time of her birth4 ,the vagina is a muscular tube1 or passage way1 leading from the outside of the body to the cervix1 which you will remember is the lower part of the uterus4 ,the vagina slopes upward from its opening and instead of meeting the cervix evenly it meets it almost at right angles and encases it like a sheath for about half an inch4 ,fig4 #b shows how these organs would appear if we were looking at them from the side4 ,the ,bladder4 ,if you will glance again at ,fig4 #b1 you will see that just in front of the vagina there is a tiny passage leading up to a sac which also is in front of the vagina1 and since in this picture it is practically empty1 it lies below the uterus4 ,this sac is the bladder and you can readily understand that as the uterus enlarges during pregnancy1 it presses upon the bladder and this pressure on the outside gives the same sensation as is produced by pressure from the inside when the bladder is filled with urine4 ,that is why the expectant mother has such a constant desire to urinate during the early weeks of pregnancy1 before the uterus pushes up into the abdomen1 and also during the later weeks1 as well as during labor1 when the bladder is being pressed upon by the baby's head4 ,the ,rectum4 ,in the same picture you will see the rectum which lies just behind the uterus and vagina and which terminates in the anus4 ,between the rectum and the vagina is a thick triangular mass of muscle1 called the perineum1 which practically forms a floor to the pelvis1 the bony basin without a bottom4 ,the external genitalia1 sometimes called the vulva1 really have nothing to do with the creation of the baby1 but you will better understand some of the care that is given you if you know a little about them1 too4 ,between the thighs1 where they join the body1 are two thick folds of flesh1 called the labia and between these lie the perineum1 just mentioned1 and the openings from the rectum1 vagina and bladder as shown in ,fig4 #b4 ,now that we have something of an idea of the structure of the organs concerned with the creation of the baby1 we shall want to learn about the usual activities of these interesting little parts1 before the baby begins his life within them4 ,puberty or ,adolescence4 ,you know1 of course1 that girls are incapable of becoming mothers until after what is termed puberty1 or adolescence1 and by these terms we mean the period during which childhood develops into sexual maturity1 and the individual becomes capable of reproduction4 ,the age at which puberty occurs varies with climate1 race and occupation and with different individuals of the same status4 ,but the average for girls1 in temperate climates1 is from the twelfth to the sixteenth year and for boys from the fourteenth to the seventeenth year4 ,girls in southern climates sometimes mature as early as the eighth or ninth year while in colder regions puberty may be delayed until they are eighteen or twenty years old4 ,the occurrence of puberty marks the establishment of ovulation and menstruation1 two functions which are usually performed once a month during the childbearing period4 ,ovulation1 which probably occurs about midway between the menstrual periods1 is simply the name which has been given to the principal function of the ovary and may be defined as the development of the ovum1 or egg1 and its expulsion1 when mature1 from the ovary4 ,as the entire human body has its origin in this tiny ovum1 its career and course of development are of momentous importance to us1 and at the same time furnish a tale of absorbing interest4 ,the ovaries are packed full of these tiny egg-like cells1 which probably lie dormant1 as stated before1 until the girl reaches puberty4 ,then they begin to develop and grow and push their way from the inside of the ovary to the surface where they look more or less like blisters4 ,when an ovum reaches the surface of the ovary1 a thin membrane which contains it1 bursts1 and it is suddenly expelled into the abdominal cavity4 ,you will remember that the ovary is very near the funnel-like end of the tube1 so1 when the little cell is shot out of the ovary1 it finds itself floating around quite close to this wide opening4 ,some of the ova that are projected into the abdominal cavity are doubtless lost1 but others find their way into the near-by mouth of the tube1 and if not fertilized by uniting with a male cell1 which we shall explain presently1 they pass down the tube into the uterus and are finally carried out in the menstrual flow4 ,it is probable that as a rule only one ovum ripens and escapes from the ovary each month from puberty until the menopause or change of life4 ,the interesting thing about all of this is that each time an ovum does mature and is discharged from the ovary1 the lining of the uterus becomes thicker and softer in order to facilitate the attachment of the ovum1 if it is fertilized1 this attachment being necessary if a baby is to develop4 ,this preparation of the uterine lining is often1 and very appropriately1 referred to as 8nest-building40 ,menstruation1 which is the evidence of sexual maturity1 is a monthly hemorrhage from the uterus1 escaping through the vagina1 and it normally recurs regularly throughout the childbearing period1 except during pregnancy and while the young mother nurses her baby4 ,the length of this childbearing period is about thirty years and continues from puberty until the menopause4 ,the frequency of the menstrual periods varies from twenty-one to thirty days but the normal interval between periods is twenty-eight days1 which is the length of what is called the 8menstrual cycle40 ,thus it is usually a lunar month from the beginning of one period to the next one1 making thirteen menstrual periods during each calendar year4 ,the complete course of a menstrual cycle consists of four stages1 which1 it is believed1 occur somewhat as follows3 ,the first1 or constructive stage1 lasts about seven days4 ,it is during this stage that the preparations are made to receive the ovum traveling down the tube4 ,the entire uterus becomes congested with blood and is somewhat enlarged and softened as a result1 while its lining grows red1 thick and velvety4 ,if the ovum remains unfertilized1 which is usually the case1 it does not attach itself to this elaborately prepared lining1 but passes out with the uterine discharges and all of this preparation not only goes for naught but must be undone4 ,the second stage1 therefore1 which lasts about five days1 is the destructive stage and is the period we speak of as menstruation4 ,during this period the extra tissue which has been formed in the uterus is broken down2 it mixes with the blood that oozes from the congested lining and together they pour from the vagina as the menstrual flow4 ,the third or reparative stage1 which follows1 occupies about three days during which time the uterus and its lining return to their normal state4 ,the fourth1 or quiescent stage1 now follows and lasts twelve or fourteen days4 ,this is the time remaining before ,nature1 with unwearying patience1 begins all over again to prepare for the reception and attachment of the next matured ovum1 in ease of its possible fertilization4 ,and so it goes1 month after month and year after year4 ,it is very important for a woman who is suffering from painful menstruation to consult a doctor about correcting the cause1 in the interests of her future childbearing1 if for no other reason1 for this is one step toward preparing a good soil in which to plant the seed from which a baby may grow4 ,for example1 a misplacement of the uterus is a frequent cause of painful menstruation and if it remains uncorrected may make conception impossible2 or if conception perchance does take place1 the malposition of the uterus may1 later1 be the cause of an abortion or miscarriage4 ,inflammation of the lining of the uterus is another cause of menstrual difficulty and if allowed to persist1 may interfere later on with the normal development and nourishment of the baby4 ,the menopause1 also termed the climacteric1 or the change of life1 marks the permanent stopping of menstruation and ability to bear children4 ,this ordinarily occurs between the ages of forty and fifty1 the majority of women ceasing to menstruate during their forty-sixth year4 ,the most favorable age for motherhood to begin is a subject of considerable interest to most women4 ,when it is considered from all standpoints1 social1 ethical1 spiritual as well as physical1 the most favorable age for motherhood to begin seems to be sometime in the early twenties4 ,children have been born to little girls nine years old and to women over sixty1 but the extremes of the reproductive years are not favorable periods for childbearing4 ,now a word about the breasts4 ,they appear to be merely large1 soft masses of fat1 one on each side of the chest1 having no connection with the pelvic organs4 ,but in reality they are very complicated glands and strangely enough1 though no one knows why1 their activities are controlled by the activities of the generative organs down in the pelvis4 ,certain it is that their function is very important to the baby1 for the breasts are the factories in which nourishment is produced to nourish him during the first few months after he is born4 ,illustration3 ,,fig4 #e4--;,front view of breast1 showing areola2 openings from milk ducts and the glands beneath the skin4 ,if we could look inside of the breasts we should see that in structure they are much like several clusters of grapes in which the stems and grapes are hollow4 ,the milk is formed in the tiny sacs corresponding to the grapes1 and pours into the little tubes conforming to the stems2 these empty into a central tube1 opening upon the surface of the nipple from which the baby will extract his nourishment4 ,if you will look at ,fig4 #e you will see in that picture of the front of a breast1 that a part of it apparently has been magnified to show these openings of the milk ducts4 ,there are about fifteen or twenty of them in each nipple4 ,the picture shows also the little glands which appear as small lumps under the skin around the nipple1 both in the dark circle called the areola and in the white skin surrounding it4 ,summing up this chapter briefly1 we find that the pelvis is an irregular1 bony canal or basin1 drawn in about the middle1 thus forming the upper1 or false pelvis and lower or true pelvis1 neither of which has a bottom4 ,the opening between these two basins is called the inlet1 while the lower margin of the true pelvis is called the outlet1 but it is the inlet that is of particular importance during childbirth4 ,in the center of the lower pelvis and swung upon ligaments attached to its sides is the uterus1 whose lower part1 called the cervix1 extends downward into the vagina2 while reaching out from the upper corners of the uterus are the tubes1 and near their open ends1 one on each side1 are the ovaries filled with germ cells called ova4 ,the bladder lies in front of the uterus and vagina and the rectum behind1 while below is the perineum1 forming a floor to the pelvic cavity4 ,every four weeks during the childbearing years an ovum is expelled from one of the ovaries into the abdominal cavity and the uterus regularly prepares to receive it in case of its fertilization1 but if it is not fertilized the ovum is lost and menstruation occurs4 ,we see1 too1 that although the breasts are situated remotely from the pelvic organs they are really very important accessories1 since they provide milk to nourish the baby after his life within the uterus is terminated by his birth4 ,,chapter ,,iv ,,how ,,the ,,baby ,,develops ,,before ,,he ,,is ,,born ,now that we know something of the place where the baby's life begins and how the way is prepared for his growth1 we are ready to follow the interesting course of events that occur from the time the seed1 a tiny egg-like cell1 bursts from an ovary until the beautiful1 fully developed baby comes into the world4 ,you will remember that when the ovum is expelled from an ovary it may float about in the abdominal cavity and be lost or it may enter the near-by mouth of a tube4 ,also that if it enters a tube it is carried downward toward the uterine cavity by the sweeping motion of the hair-like projections on the lining of the tube4 ,this journey of the ovum through the tube is of enormous consequence1 for during its course occur the events which decide whether the ovum shall1 like most of its fellows1 be simply swept along to no end and lost1 or whether by chance it is to receive the mysterious impulse which begins the development of a new human being4 ,the amazing power which enables this cell to reproduce itself1 and to develop with unbelievable complexity is acquired somewhere in the tube1 usually in the upper end1 by meeting and fusing with a spermatozoon1 the germinal cell of the male4 ,the spermatozoa are attracted to the ovum much as bits of metal are drawn to a magnet1 but although the ovum that is destined to be fertilized is surrounded by several spermatozoa1 only one actually enters and fuses with it4 ,this fusion is termed fertilization1 or1 in lay parlance1 conception1 and the instant at which it occurs marks the beginning of pregnancy4 ,the establishment of this fact is of considerable importance1 since it does away with any possible controversy concerning the time at which a new life begins4 ,the origin of the baby is exactly coincident with the fusion of the male and female cells4 ,furthermore1 the sex of the child and any inherited traits and characteristics are also established at this decisive moment4 ,no amount of dieting1 exercise or mental effort on the part of the expectant mother can alter or influence them in the smallest degree1 for the father has made his complete contribution toward the creation of the new being and the mother1 also1 has made hers1 except for nourishment which she provides throughout pregnancy4 ,all told1 probably more than five hundred theories have been advanced to explain what it is that decides of which sex the forthcoming child is going to be4 ,but as the results of applying these theories have scarcely borne out the claims of their advocates1 they are given but scant attention to-day4 ,the present belief regarding the causation of sex is that although there is but one kind of ovum1 there are two kinds of spermatozoa1 one capable of producing a male and the other a female child1 but the sex-determining form of the male cell that fertilizes any one ovum is a matter of the merest chance4 ,statistics show that more male than female babies are born1 the usual proportion being about #aje boys to #ajj girls among those who are carried to 8term0 or the end of pregnancy4 ,among abortions and prematurely born babies there is also a larger number of boys than girls1 but as more boys than girls die in infancy1 the two sexes about even up in the number of those living to adult life4 ,concerning the time of the month when conception is most likely to occur1 there is a wide difference of opinion4 ,some doctors think that the most favorable period is just before or just after menstruation1 while others believe that conception is most likely to take place about midway between the menstrual periods4 ,illustration3 ,,fig4 #f4--;,diagram indicating process of cell division4 ,returning to the ovum which meets a spermatozoon in the course of its journey down the tube1 we find that as soon as a spermatozoon enters an ovum it disappears and is completely absorbed1 and1 as the ovum in turn is instantly possessed of new powers1 through the presence of the male cell1 the result of this union is an entirely new cell4 ,but instead of continuing its existence as a single cell1 the fertilized ovum divides into two cells2 these two into four2 the four into eight and so on until a clustering mass of cells is formed which looks something like a mulberry4 ,if you will look at ,fig4 #f you will see what happens as this cell division progresses and also that in time the cells rearrange themselves in such a way as to leave a space in the center of the mass so that it becomes a little sac with a cluster of cells at one point1 which hangs toward the center1 called the internal cell mass4 ,this will interest you because it is from cells at one point in this little cluster that the baby begins to develop1 together with the cord1 bag of waters and afterbirth1 to be described later4 ,while these changes are taking place1 the entire mass is being carried slowly down the tube toward the uterus by the sweeping motion of the soft little hairs on the lining of the tube4 ,it is steadily growing1 and by the time it reaches the uterus the mass is about the size of the head of a pin4 ,as you will remember1 the lining of the uterus prepares each month to receive the fertilized ovum1 becoming soft and thick4 ,the cell mass floats around for a little while after it reaches the uterine cavity and then resting at some point1 sinks down into the soft lining and is completely buried4 ,from now on the cells which compose the mass rapidly increase in number and very shortly cease to be all of one kind4 ,these different kinds of cells rearrange themselves and grow in such a manner that some of them begin to form the different parts of the baby's body and others develop into two thin membranes that finally enclose the baby in a double sac4 ,he is attached to the inner surface of the sac2 the space which he does not occupy is filled with fluid and the sac itself is attached to the uterine lining at the point where the cell mass happened to stop and bury itself4 ,this sac is what you have heard called the 8bag of waters10 but the doctors refer to it as the membranes4 ,as it enlarges and pushes out into the uterine cavity it still consists of two thin membranes except where it is attached to the uterus1 at which point it grows into a thick1 spongy mass of blood-vessels4 ,these blood-vessels divide and branch out in a tree-like fashion and burrow into the uterine wall4 ,as you will see later1 it is through this mass of branching blood-vessels that the baby virtually eats and breathes and gives off waste materials during the nine months of his life within the uterus4 ,the doctors refer to the mass as the placenta but you have heard it called the 8afterbirth10 because it is expelled after the baby is born4 ,illustration3 ,,fig4 #g4--;,diagram showing the developing baby1 at an early stage1 with cord1 membranes and placenta1 within the uterine cavity4 ,as the baby's development advances the part by which he is connected with the placenta lengthens out into what is called the umbilical cord4 ,there are blood-vessels in this cord through which blood constantly flows back and forth1 carrying nourishment to the baby from his mother and waste matter from his little body to the placenta where it is taken up by her blood4 ,but this exchange of materials takes place through thin membranes and consequently the blood of the mother and baby never mingle4 ,fig4 #g will give you an idea of how the sac of membranes1 with the baby hanging inside1 grows out into the uterine cavity2 how at the point where the membranes are attached to the uterus the blood-vessels have developed into the thick1 spongy placenta and how the baby is connected with it by means of the cord4 ,in ,fig4 #h you may see how the baby changes in appearance as the weeks of pregnancy go by4 ,at the end of the fourth month he really looks quite like the baby that we are so eagerly preparing for4 ,if we follow his development within the uterus month by month1 we find that by the end of the first lunar month1 or fourth week1 the baby's body is about inch long and looks about as is suggested in the third little outline in ,fig4 #h4 ,at the end of the second month1 or eighth week1 his head is fairly well shaped2 bones are beginning to develop1 webbed hands and feet are formed and the little body is about #a inch long4 ,at the end of the third month1 or twelfth week1 his entire body shows marked development and is about #c inches long4 ,his fingers and toes are separated and bear soft nails2 the teeth are forming1 the eyes have lids and the umbilical cord has taken definite form4 ,at the end of the fourth month1 or sixteenth week1 in addition to the development of all parts a fine1 soft hair appears over the body2 there is a black1 tarry substance1 called meconium1 in the baby's intestines and he measures about #f inches in length and weighs perhaps pound4 ,illustration3 ,,fig4 #h4--;,appearance of the baby at different stages1 early in his development4 ,by the end of the fifth month1 or twentieth week1 the baby has grown and developed markedly4 ,he is now covered with skin on which are occasional patches of a greasy1 cheesy substance called vernix caseosa1 and though there is some fat beneath the skin his face looks old and wrinkled4 ,a certain amount of hair has appeared upon the head and the eyelids are opening4 ,it is usually during the fifth month that the expectant mother first feels her baby move1 this sensation being commonly referred to as 8quickening40 ,he is now about #aj inches long and weighs about #i ounces4 ,by the end of the sixth month or twenty-fourth week1 the baby is about #ab inches long and weighs possibly #a pounds4 ,he is thin and wrinkled in appearance and if born at this time will attempt to breathe and move his limbs but will perish in a short time4 ,by the end of the seventh month1 or twenty-eighth week1 he still looks thin and scrawny2 his skin is reddish and is well covered with the cheesy vernix caseosa4 ,if born at this stage1 the baby will move quite vigorously and cry feebly1 but he is not likely to live for any length of time4 ,he is now about #ad inches long and weighs about #b pounds4 ,by the end of the eighth month1 or thirty-second week1 the baby has grown to about #ag inches in length and #d pounds in weight1 but continues to look thin and old and wrinkled4 ,his nails do not extend beyond the ends of his fingers but are firmer in texture2 the soft1 downy hair begins to disappear from his face but the hair on his head is more abundant4 ,if born at this stage1 the baby will have a fair chance to live1 provided he is given painstaking care4 ,this is true in spite of the old belief1 still widely current1 that a seven months' baby is more likely to live than one born at eight months 7meaning calendar months74 ,the fact is that after the twenty-eighth week the probability of the baby's living increases greatly with each added week of life within the uterus4 ,his growth during the latter part of pregnancy is rapid1 for he gains nine tenths of his weight after the fifth month and one half of his weight during the last eight weeks of uterine life4 ,at the end of the ninth month1 or thirty-sixth week1 the increased amount of fat under the baby's skin has given a plumper1 rounder contour to the entire body2 the aged look has passed and his chances for life have greatly increased4 ,he weighs about #e pounds at this stage and is perhaps #ah inches long4 ,the end of the tenth month1 or fortieth week1 usually marks the end of pregnancy4 ,fig4 #i will show you how the baby lies in the uterus just before birth1 curled up into the smallest possible space4 ,illustration3 ,,fig4 #i4--,the usual position of the baby just before he is born4 ,the average normally developed baby has grown to a length of about #bj inches and weighs about #g pounds1 boys usually being about three ounces heavier than girls1 but there may be a variation of weight among entirely normal1 healthy babies from a minimum of #e pounds to as high as #aa pounds or more4 ,newborn babies very seldom weigh more than #ab pounds1 in spite of legends and rumors to the contrary4 ,the size of the baby is affected by the race of his parents2 colored babies1 for example1 averaging a smaller weight than white babies4 ,and1 as might be expected1 the size of the parents is likely to be reflected in their infants1 large parents tending to have large children and vice versa4 ,the number of children which the mother has previously borne is also a factor1 since the first child is usually the smallest1 the size of those following showing an increase with the mother's age up to her twenty-eighth year1 if her pregnancies do not occur at too frequent intervals4 ,twins4 ,sometimes a woman gives birth to more than one baby at the same time4 ,when there are two they are called twins2 triplets when there are three2 quadruplets1 quintuplets and sextuplets respectively1 when there are four1 five and six babies within the uterus at once4 ,six is the largest accredited number on record4 ,it is estimated that twins occur once in ninety pregnancies and triplets once in about seven thousand cases4 ,the tendency seems to be inherited1 as is evidenced by the number of twins and triplets to be found among relatives4 ,twins are often prematurely born and each is likely to be smaller than a baby resulting from a single pregnancy1 but their combined weight is greater than the weight of one normal baby4 ,extra-uterine ,pregnancy4 ,another departure from the normal pregnancy is when the baby develops outside of the uterus4 ,although in the normal course of events the fertilized ovum travels down the tube and becomes attached to the uterine lining1 it is possible for it to stop1 and more or less completely develop at any point along the way4 ,this is called an extra-uterine pregnancy1 since it occurs outside of the uterus4 ,if the baby develops in one of the ovaries1 it is termed an ovarian pregnancy1 and a tubal pregnancy if it develops in a tube1 this being the most frequent variety of extra-uterine pregnancies4 ,only about one out of a hundred such pregnancies continue throughout the allotted period1 and accordingly1 a live baby1 capable of living for any length of time1 seldom results4 ,to sum up a normal pregnancy1 we find that in the course of ten lunar months following the fertilization of an ovum1 the uterus grows from a small1 flattened pelvic organ1 #c inches in length1 to a large muscular sac1 about #ae inches long occupying the abdominal cavity4 ,it increases its weight sixteen times1 that is1 from #b ounces to #b pounds1 while the capacity of the uterine cavity is multiplied five hundred times4 ,within the uterus is a baby weighing about #g pounds2 a placenta weighing perhaps #a pounds and approximately a quart of fluid4 ,the baby is attached to the placenta by means of a jelly-like cord about as thick as one's first finger and #bj inches long2 baby1 placenta1 cord and fluid all being contained in a thin1 but strong sac frequently called the bag of waters1 but by the doctors termed the membranes4 ,the total weight of the uterus and its contents at the end of pregnancy is usually about #ae pounds4 ,throughout the baby's life within the uterus1 the placenta virtually acts as his digestive organs1 lungs1 kidneys and bowels4 ,bear this in mind1 and you will realize why1 in taking care of yourself you are taking care of your baby while his body is being built and getting itself into running order to take up life as a separate being4 ,the full realization that whatever is good for you is good for your baby will make you eager to give yourself the care that is outlined in the next chapter4 ,,chapter ,v ,,taking ,,care ,,of ,,the ,,baby ,,before ,,he ,,comes ,we shall see that taking care of your baby before he is born means taking such care of yourself throughout pregnancy1 that you not only keep your own body in its usual good running order1 but in addition1 so effectively promote the activities of your various organs that you also keep the baby's body going1 his body that is growing all the time4 ,quite reasonably this requires extra work on the part of some of your organs1 particularly those concerned with digestion and the process of throwing off impurities4 ,the latter is of the greatest possible importance for in addition to excreting the usual amount of impurities from your own body you must excrete also those thrown off by your baby4 ,the amount of waste from him is not large but it seems to be of such a character that it harms the mother if it is not steadily excreted4 ,good digestion and satisfactory excretion are dependent upon a number of factors and fortunately most of them are within your own control4 ,your frame of mind is one of the most important factors of all4 ,i know that to suggest the cultivation of a cheerful1 hopeful mental attitude is easier said than done4 ,but after all it really is largely a matter of habit which you can acquire if you set yourself to it1 particularly if you realize that your physical condition will be benefited by your going through pregnancy happily4 ,and remember that whatever is good for you is good for your baby4 ,continue with the work1 amusements and exercise that you are used to and enjoy1 except of course such activities as the doctor may forbid4 ,in general1 try to forget that you are pregnant1 so far as you can do this and still remember to take proper care of yourself4 ,above all1 don't worry4 ,worry will interfere with your sleep and it will also upset your digestion quite as seriously as will wrong food4 ,try not to be too self-centered or too watchful of your symptoms1 but at the same time avoid the dangerous habit of thinking that any unusual condition which develops is due to your being pregnant1 for a sick pregnancy is not normal4 ,it will relieve you of a great deal of anxiety if you report to your doctor everything you do not understand1 for the consciousness that he will know just what to do1 if anything is necessary1 will help to keep you from worrying4 ,it is important1 too1 for you to get rid of the depressing beliefs in connection with pregnancy that have come down to us through the ages4 ,for instance1 do not believe for a moment that anything you do1 think or see can 8mark0 or deform your baby1 for remember that after conception you give him nothing but nourishment4 ,the only communication between you and the baby is through your and his blood1 and blood does not carry mental impressions4 ,accordingly1 no effects of fear1 horror or unpleasant memories which you may have can possibly reach him4 ,it is true that once in a while a woman does see something shocking and later gives birth to a marked or deformed baby4 ,but there is little doubt1 now1 that such an occurrence is merely a coincidence4 ,if you will stop and think for a moment you will realize that most expectant mothers see or hear or think something unpleasant at some time during pregnancy1 and yet most babies are born without mark or blemish4 ,anger1 fright or sudden shock may upset your digestion1 but it does not directly affect your baby4 ,as for that common belief that in 8reaching up0 the mother may slip the cord around the baby's neck--if you will picture for a moment how the baby lies within the uterus you will realize how impossible this is1 for the mother's arms have no connection with him or the cord4 ,so dismiss these doubts and fears from your mind and dwell instead upon the loveliness of what is in store for you1 for1 ,i repeat1 your physical condition will be benefited if you go through pregnancy happily4 ,and remember again that whatever is good for you is good for your baby4 ,so your first step toward caring for the little life already within your charge is to follow the example of ,mrs4 ,wiggs1 who constantly wiped the dust from her rose-colored spectacles4 ,now for the more specific details of your care4 ,of these the question of your diet is of enormous importance4 ,let us consider first what your food accomplishes if it is suitable and conditions are favorable for its use by you and the baby4 ,it should provide nourishment for your various tissues1 as under ordinary conditions2 it should promote the activities of your skin and kidneys1 as well as bowels1 since it is through them that the waste from your own and your baby's body must be excreted1 and your food should be adequate also1 to build and nourish the baby's body without his having to draw materials from your tissues4 ,strange as it may seem1 the baby's physical needs are supplied before yours are met1 and if there are not enough food materials for you both1 your bones1 teeth and muscles will be deprived4 ,furthermore1 taking proper food during pregnancy is an important step toward preparing yourself to nurse your baby1 after he is born1 which is quite as urgent as nourishing him before birth4 ,to accomplish these ends you not only must eat suitable food1 but you must digest and absorb it as well4 ,this requires that you constantly guard against overeating1 constipation and indigestion of any kind4 ,indigestion may be avoided during pregnancy exactly as it is at other times1 by eating proper food1 by cultivating a happy frame of mind2 by having sufficient exercise1 fresh air1 rest and sleep4 ,if you are accustomed to a fairly simple1 well balanced1 mixed diet1 you probably will need to make little or no change1 except to have the evening meal light if it has been a hearty one4 ,it may surprise you to learn that you need not 8eat for two10 in quantity1 as is so commonly believed necessary1 for during pregnancy you make so much better use of food materials than usual that an amount and kind of food that keep you in good condition will be adequate to meet your baby's needs1 too1 until the latter part of pregnancy4 ,on the other hand1 it is very unwise for an expectant mother to cut down her diet1 with the idea of keeping the baby small and thus make labor easy1 except under the direction of her doctor4 ,in general it is the size of the baby's head that makes labor easy or difficult1 and not the amount of fat distributed over his body4 ,and if the mother cuts down the minerals in her diet to make the baby bones soft1 the only result is that her own bones and teeth are softened1 because the baby extracts from them enough lime to supply what the food lacks4 ,three meals a day will usually be enough during at least the first half of pregnancy and they should be taken with clock-like regularity1 eaten slowly and masticated thoroughly4 ,the possible need for slight additional food during the later weeks may be supplied more satisfactorily by lunches of milk1 cocoa or broth and crackers or toast1 between meals and upon retiring1 than by taking larger meals4 ,an expectant mother who has a tendency to nausea early in pregnancy often feels better for taking a small lunch regularly five or six times daily instead of the usual three full meals4 ,it is of the greatest importance that every pregnant woman drink an abundance of fluid to act as a solvent for her food and waste material and promote the activity of her kidneys1 skin and bowels4 ,she needs about three quarts daily1 most of which should be water1 the remainder consisting of milk1 cocoa1 soup and other liquids4 ,alcohol should not be taken except upon the doctor's orders and only moderate amounts of coffee and tea1 unless he gives permission for more4 ,the expectant mother will be wise to avoid fried food1 pastry1 rich desserts1 rich salad dressings and any other food which would ordinarily disagree with her4 ,since the enjoyment of one's meals promotes digestion at all times1 the expectant mother should try to eat the things that she enjoys most and that agree with her4 ,the average pregnant woman who has no symptoms of complications will usually be able to supply her own and her baby's needs and at the same time keep within the bounds of safety if she selects her diet from the foods included in the following groups3 ,animal ,foods4 ,milk and eggs are the most satisfactory1 but for the sake of variety and to tempt her appetite the expectant mother will usually be allowed to take rather sparingly1 and preferably only once a day1 of fish1 the various kinds of shell fish1 beef1 lamb1 chicken or game4 ,pork1 veal and goose should be avoided as a rule1 and particularly by women with whom they ordinarily disagree4 ,soups4 ,thin soups and broths have little food value but because of their appetizing flavor and aroma are an aid to digestion1 and frequently by stimulating a flagging appetite will help the expectant mother to eat and assimilate more than she would without them4 ,but cream soups and pures have a high food value and1 like thin soups and broths1 also supply a definite amount of fluid which she must have4 ,vegetables4 ,the group of vegetables generally designated as 8leafy0 are of even greater importance to the expectant mother than they are to the average person4 ,of these she may safely eat onions1 asparagus1 celery1 string beans1 spinach1 and she should make a point of taking a green salad1 such as lettuce1 cress or romaine1 at least once daily4 ,sweet potatoes1 white potatoes1 rice1 peas1 ,lima beans1 tomatoes1 beets and carrots1 also1 may be eaten with safety1 as a rule1 but cabbage1 cauliflower1 corn1 egg-plant1 ,brussels sprouts1 parsnips1 cucumbers and radishes should be taken with great caution and avoided altogether if they cause gas or any kind of distress4 ,fresh ,fruits4 ,a necessary part of the diet is fresh fruit1 and among those fruits which are both beneficial and usually harmless are apples1 peaches1 apricots1 pears1 oranges1 figs1 cherries1 pineapple1 grapes1 plums1 strawberries1 raspberries1 blackberries and grapefruit4 ,these are more likely to be laxative if eaten alone1 as before breakfast and at bedtime4 ,cooked fruits are also valuable articles of diet1 but are probably less laxative than raw fruit4 ,some of the citrous fruits1 oranges1 grapefruit or lemons1 should be taken daily because they possess a certain indispensable food value which is peculiar to them4 ,cereals4 ,for their nourishing and laxative qualities1 cereals are important and their food value is increased by the milk and cream which are usually taken with them4 ,cooked cereals should invariably be cooked longer than the usual directions suggest4 ,bran1 eaten alone as a cereal or in combination with other grains1 is an excellent laxative4 ,breads4 ,graham1 cornmeal1 whole wheat and bran bread are all good1 in general the expectant mother will be on the safe side if she eats sparingly1 if at all1 of very fresh or hot breads and hot cakes4 ,desserts4 ,desserts are very important for they add to the attractiveness of most people's meals1 and if wisely chosen and properly made1 may supply a good deal of easily digested nourishment4 ,they may include1 in addition to fresh and cooked fruits and preserves1 ice-cream1 a wide variety of custards1 creams and puddings made largely of milk1 eggs and some ingredient to give substance and firmness1 such as gelatin1 cornstarch1 rice1 tapioca1 farina1 arrow-root and similar materials4 ,in general the expectant mother should eat an abundance of fruit and vegetables1 taking at least some uncooked fruit and a green salad1 daily1 and make sure that her food contains a good deal of residue1 such as is provided by fruit and coarse vegetables4 ,this residue increases the bulk of the material in the intestines1 and this helps to overcome the tendency toward constipation4 ,as fat is less easily digested than starchy foods1 and more likely to cause nausea during pregnancy1 it is better to eat no more fat than usual but to supply the additional material which is needed after about the sixth month1 by taking a little more starchy food4 ,however1 a slight increase only is necessary1 and this chiefly during the last three or four weeks4 ,the ,kidneys4 ,it is scarcely possible to say enough about the importance of keeping your kidneys in normal working order during pregnancy1 for through them is excreted much of the waste matter from your baby's body as well as your own4 ,sometimes when these impurities are not thrown off as they should be the expectant mother has convulsions4 ,you will be glad to know how much you yourself can do toward preventing convulsions by drinking plenty of water and by faithfully measuring your urine and taking a specimen to the doctor when he asks you to4 ,as ,i said before1 you should drink at least three quarts of fluid every day4 ,most of this should be water1 the remainder being milk1 cocoa1 soup1 tea1 coffee1 and so on4 ,the doctor will probably want you to measure your urine and take a specimen to him once a month during the first half of pregnancy and every two weeks afterward1 or even every week toward the end4 ,he can tell by examining the urine whether your kidneys are acting as they should and if they are not he may save you serious trouble by putting you to bed for a few days with no nourishment but milk and water4 ,in preparing a specimen you will need a covered corked vessel large enough to hold all the urine passed in twenty-four hours1 and it must be thoroughly washed and scalded4 ,the next step is to pass urine1 suppose we say at eight o'clock in the morning1 and throw it away4 ,all of the urine which you pass after this time until eight o'clock the next morning must be saved in the vessel and kept in a cool place to prevent its decomposing4 ,if you will put a teaspoonful of chloroform or boracic acid powder into the vessel it will tend to preserve the urine and will not injure the specimen4 ,at the end of twenty-four hours the urine should be shaken to mix it thoroughly and about half a pint poured into a bottle that has been washed and scalded4 ,carefully cork and label this with the date1 your name and address and the total amount of urine passed in the twenty-four hours4 ,the vessel for collecting the urine and whatever you use as a measure should be reserved for these purposes only4 ,if you have no tin or glass measure1 a regular-size quart tomato can will prove entirely satisfactory4 ,if you find1 when measuring your urine1 that you pass less than a quart and a half in twenty-four hours1 you may know without being told that this is not enough and that you should drink more water4 ,the ,skin4 ,people are likely to think of the skin as being simply a covering for the body1 whereas1 in reality1 it is a very complicated and active organ which helps to regulate the body temperature and constantly throws off impurities1 just as the kidneys do4 ,this latter function is performed by the sweat glands which open upon the surface of the skin as the 8pores10 and we are told that in all there are some twenty-eight miles of these tiny tube-like structures in the skin4 ,these glands should be1 and usually are1 constantly active2 they pour upon the surface of the body an oily substance which keeps the skin soft2 they also excrete something more than a pint of water daily1 which contains impurities that are harmful if retained in the body4 ,we are not aware of this constant excretion of fluids1 which is termed 8insensible perspiration10 but it continues even in cold weather and must not be stopped if health is to be preserved4 ,if the oil1 dust1 particles of dead skin and the waste material left by dried perspiration are allowed to remain upon the surface of the body they will clog the pores1 or gland openings1 and thus interfere with their action4 ,the removal of this material1 then1 is necessary to maintain health1 and is done automatically in part for the fluid evaporates and much of the solid matter is rubbed off on the clothing4 ,the most important aids to the skin's activity are the drinking of plenty of water1 deep breathing1 exercise and warm baths4 ,regular and thorough bathing serves the double purpose of removing waste matter already on the surface1 and of stimulating the glands to increased activity in giving off still more4 ,many doctors advise a warm1 not hot1 shower or tub bath every day1 with soap used freely over the entire body1 followed by a brisk rub4 ,the best time for this warm1 cleansing bath1 as a rule1 is just before retiring1 as it is soothing and restful1 and tends to induce sleep4 ,very hot baths are fatiguing1 particularly during pregnancy1 and should never be taken except with the doctor's permission2 but cold baths usually may be continued throughout pregnancy if one is accustomed to them and reacts well afterwards4 ,under these conditions the morning cold plunge1 shower or sponge is beneficial1 as it stimulates the circulation and thus promotes the activity of the skin4 ,some doctors forbid tub bathing of any kind after the seventh month1 on the ground that as the expectant mother sits in the tub her vagina is filled with unsterile water and should labor occur shortly afterward an infection1 or fever1 might result4 ,and as she is heavy and somewhat uncertain on her feet1 there is also the danger of her slipping and falling while getting in or out of the tub4 ,other doctors permit tub baths throughout pregnancy1 up until the onset of labor2 while as to hot foot baths1 since there seems to be no reason for or against them at any time during the nine months1 they may be taken or not at will4 ,bathing in a quiet stream or lake is apparently harmless but sea bathing1 if the surf is rough1 is inadvisable because of the beating of the waves upon the abdomen and the general violence of the exercise4 ,the importance of keeping the body evenly warm throughout pregnancy cannot be overemphasized1 for a sudden chilling or wetting may so check action of the skin as to impose more of a burden upon the kidneys than they can meet1 in their effort to throw off the skin's share of the body waste4 ,accordingly1 a single chilling will sometimes be enough to cause convulsions4 ,this may be one reason why convulsions occur more frequently during cold weather or after a sudden drop in the temperature after warm or mild days4 ,the ,bowels4 ,the bowels1 also1 throw off a certain amount of impurities and if they do not move thoroughly at least once a day these impurities may be taken into the system and again the kidneys be given extra work4 ,unhappily a great many pregnant women are constipated1 particularly during the later weeks1 while women who have always had a tendency of this kind may have trouble with their bowels from the very beginning of pregnancy4 ,your bowels should move regularly every day1 and to this end you should attempt to empty them at the same hour each day1 immediately after breakfast being the best time4 ,the importance of regularity in making the attempt cannot be overemphasized1 even though the bowels do not always move4 ,the measures which tend to prevent constipation1 as already pointed out1 are drinking plenty of fluids1 and eating fresh fruit1 coarse vegetables and bulky cereals such as bran2 also taking a glass of hot or cold water just before going to bed and the first thing in the morning4 ,you should not take enemas or cathartics without your doctor's order1 but you may safely increase the amount of fluids which you drink and the bulk of your food1 in order to regulate your bowels4 ,senna and prunes cooked together prove to be helpful in keeping the bowels regular and they are entirely harmless4 ,a simple way of preparing them for this purpose is to pour a quart of boiling water over an ounce of senna leaves and allow them to stand for about two hours4 ,a pound of well washed prunes should soak overnight in this liquor1 after it has been strained1 and then cooked in it until tender4 ,they may be sweetened with two tablespoonfuls of brown sugar1 and the flavor improved by adding a stick of cinnamon or slice of lemon while they are cooking4 ,half a dozen of these prunes1 with some of the syrup1 may be taken at the evening meal to start with1 and increased or decreased in number as necessary4 ,clothes4 ,the chief purpose of clothes under all conditions is to aid in keeping the body warm1 thus helping to preserve an even circulation of the blood and the activity of the sweat glands4 ,as has been pointed out1 this is of especial importance during pregnancy4 ,the expectant mother's clothes should be not only sufficiently warm1 but they should be equally warm over her entire body4 ,they should be light and porous1 and fairly loose1 so as not to interfere with the circulation or other bodily functions4 ,there must be no pressure on chest or abdomen2 no tight garters1 belts1 collars or shoes4 ,the clothes of the mother-to-be1 like every other detail of her care1 must be adapted to her surroundings and mode of living4 ,if her house is well and evenly heated during the cold months1 she may quite safely dress lightly while indoors2 if it is not1 she should wear underwear with high neck1 long sleeves and drawers1 both indoors and out1 except when the weather is warm enough to cause perspiration4 ,at all times1 however1 the warmth of her clothing should be suited to the temperature of the home1 the climate and the state of the weather4 ,remembering that it is important for you to keep up the diversions and amusements that you enjoy1 it is worth while to have your clothes as pretty and becoming as possible1 for you are much more likely to go about and mingle with your friends if you feel that you are becomingly and well dressed4 ,at the same time your clothes should be so made that their weight will hang from the shoulders instead of from the waistband4 ,and that brings us to the question of corsets1 a much discussed garment4 ,women who have not been accustomed to wearing corsets will scarcely feel the need of adopting them during pregnancy except1 perhaps1 during the later weeks when the heavy abdomen needs to be supported for the sake of comfort4 ,this need is felt particularly by women who have had children and whose abdominal walls are somewhat weakened in consequence4 ,if you have been wearing comfortable1 well fitting corsets1 you probably will not feel the need of making a change until the third or fourth month4 ,but by this time the baby will have pushed up out of the lower pelvis into the abdomen and your corsets then1 if you wear any1 must be so constructed that they will not compress nor disguise your figure1 but will provide support and accommodate themselves to an abdomen that is steadily increasing in size and changing in shape4 ,such corsets are made of soft material2 have elastic inserts and have lacings at the sides as well as in the back4 ,they come well down and fit snugly over the hips4 7,see ,fig4 #aj47 ,some women find comfort in attaching shoulder straps to their corsets thus suspending some of the abdominal weight from the shoulders4 ,but as a rule1 the most comfortable arrangement is a short-waisted maternity corset worn with a brassire that supports the breasts and does not compress the nipples4 ,i hope this description will make clear to you why the same style corsets as you ordinarily wear cannot be satisfactory during pregnancy1 no matter how large they are1 and may even prove harmful4 ,illustration3 ,,fig4 #aj4--;,front and side views of a satisfactory maternity corset1 adjusted at the fifth month of pregnancy4 7,by courtesy of ,emma ,e4 ,goodwin1 ,new ,york47 ,illustration3 ,,fig4 #aa4--;,front1 side and back views of home-made binder for supporting a heavy1 pendulous abdomen during later weeks of pregnancy4 ,it is adjusted as the expectant mother lies down1 the ends being crossed in the back and pinned to the lower margin of the front1 thus giving additional support4 ,also breast-binder made of a straight strip of soft cotton material1 #aj or #ab inches wide and #b yards long4 ,this is crossed in front and held with safety-pins1 the ends being carried over the shoulders and pinned to the back of the binder4 ,it should be snug below the breasts but loose over the nipples4 ,the openings over the nipples show how this binder may be used to support the breasts of the nursing mother4 7,from photographs taken at the ,maternity ,centre ,association1 ,new ,york47 ,even a properly fitting maternity corset may become uncomfortable during the last few weeks of pregnancy1 and have to be replaced by an abdominal supporter of linen or rubber4 ,and when this stage is reached1 even the woman who has worn no corsets may find that she is more comfortable if she adopts such a support1 particularly at night4 ,there are many admirable binders on the market1 or such an one as is illustrated in ,figs4 #aa and #ab may easily be made at home as well as comfortable and inexpensive stocking supporters1 made from tapes or strips of muslin1 as in ,fig4 #ac4 ,illustration3 ,,fig4 #ab4--;,abdominal binder used in ,fig4 #aa1 showing darts at top of front to fit it over the abdomen4 ,your shoes1 also1 merit some thought1 for your feet will probably be larger during the latter part of pregnancy1 partly because of the possibility of their being somewhat swollen and partly because the increased weight of your body tends to spread them4 ,this added weight also increases the strain put upon the arch and as a result1 flat-foot is fairly common among expectant mothers who have not taken pains to have their arches well supported4 ,your shoes would better be an inch longer than those you ordinarily wear2 they should have broad1 common sense heels and fit snugly over the instep1 in spite of being full large4 ,if your shoes are not comfortable you will find yourself tiring easily and for this reason will tend to take less exercise than you should4 ,another reason for the need of proper shoes is that as pregnancy advances the expectant mother becomes rather unsteady on her feet1 and broad1 firm heels help to make her feel more secure4 ,the heels need not be flat at first1 if you have been accustomed to wearing high ones1 for the sudden lowering of the heels may injure your arches1 but as the weeks wear on you would better adopt moderately low heels4 ,high ,french heels should be avoided because they not only increase the difficulty and discomfort of walking but cause backache1 as well1 by forcing a position that adds to the pressure on the lower part of the abdomen4 ,they increase the risk of turning the ankles1 too1 and of tripping and falling1 which is a very serious accident for the expectant mother4 ,illustration3 ,,fig4 #ac4--;,front and back view of home-made stocking supporters made of webbing or #a-;inch strips of muslin and a pair of child's side garters4 ,the straps are sewed together in the back1 but pinned in front to permit adjustment as the abdomen enlarges4 7,by courtesy of the ,maternity ,centre ,association1 ,new ,york47 ,fresh ,air4 ,if you realize by this time how important it is to keep your digestion in good order and promote the activity of all your excretory organs1 you probably suspect how important fresh air and exercise are to you and your expected baby1 because of their effect upon your entire well-being4 ,the average individual uses up in a minute's time the oxygen contained in four bushels of air1 and since the pregnant woman takes in through her lungs the oxygen for both herself and her baby1 she must have a sufficient quantity of air to supply at least this amount4 ,accordingly1 you should make a point of spending at least two hours of each day in the open air4 ,if the weather is so stormy or severe as to make it undesirable for you to go out from under cover1 because of the danger of getting wet or chilled1 you can wrap up well and take your airing on a protected porch or in a room with all the windows wide open4 ,but this is only a part of it1 for the air in your house or rooms must be kept fresh all day by being constantly changed2 this requires a steady inpouring of fresh air and outpouring of stale air4 ,a very good way to accomplish this is to have one or more windows open slightly1 top and bottom1 all the time4 ,but there must be no sudden changes of temperature1 nor drafts1 for fear of chilling your skin4 ,at night you should sleep in a room with the windows open1 taking care to be well protected by light1 warm coverings4 ,exercise4 ,each detail of the expectant mother's daily routine seems to be more important than the last4 ,and so when we come to the question of regular out-of-door exercise we are almost persuaded to believe that whatever else may be neglected1 this is indispensable1 since it promotes digestion1 stimulates the activity of the skin and lungs1 steadies the nerves1 quiets the mind and promotes sleep4 ,and more than that1 walking1 which is probably the most satisfactory form of exercise for her to take1 also strengthens some of the muscles that are used during labor4 ,but exercise is downright injurious if continued to the point of fatigue1 no matter how little has been taken4 ,each woman must be a law unto herself in this matter1 therefore1 and must be impressed with the importance of stopping before she is tired4 ,it may be a good plan for you to start by walking only a short distance at a time1 increasing this gradually until you are able to walk possibly as much as an hour in the morning and an hour in the afternoon without fatigue4 ,all violent exercise and sports are of course to be avoided1 particularly swimming1 horseback riding and tennis4 ,while motoring and carriage driving are pleasant diversions1 they cannot be classed as exercise4 ,they should be taken only in comfortable vehicles and over smooth roads1 so that there will be no jarring nor jolting1 and the expectant mother should not do the driving herself4 ,a certain amount of exercise1 in the shape of light housework1 may be taken indoors4 ,this is distinctly beneficial if not continued to the point of fatigue1 both because of the exercise which it provides1 and also the diversion and interest1 for these promote mental and physical health4 ,but this indoor exercise must not interfere with1 nor to any degree replace the daily exercise which you take out of doors2 nor must it include heavy work1 such as washing1 sweeping1 heavy lifting1 running a sewing machine by foot or much running up and down stairs4 ,however1 the amount and kind of work which the expectant mother may comfortably and safely do1 are so related to what she has been accustomed to1 that it is not possible to do more than describe what has proved of benefit for the average woman4 ,there are women to whom massage and gymnastics are helpful during pregnancy when for some reason the out-of-door activities are not possible or advisable4 ,this might be true of an expectant mother with heart trouble1 for example1 or of one who is being kept in bed to prevent an abortion and accordingly is a matter which is closely directed by the doctor4 ,traveling4 ,in general1 traveling is less dangerous for the expectant mother of to-day than formerly because it causes less strain1 discomfort and fatigue than in the old days4 ,but the question cannot be settled once for all women nor for all stages of pregnancy4 ,each woman's general condition must be considered2 her tendency to nausea2 the length of the journey and the ease with which it may be made2 also1 whether or not she has ever had or been threatened with an abortion4 ,as a rule1 it is considered wise to avoid traveling during the first sixteen and the last four weeks of pregnancy1 and at the time of the month when menstruation would ordinarily occur4 ,certainly a journey should not be undertaken at any time during pregnancy without a doctor's permission4 ,rest and ,sleep4 ,when we studied the changes that take place during pregnancy we found that as the abdomen increased in size and weight the expectant mother was required to make a constant1 though unconscious effort to stand upright4 ,this is probably one reason for the fatigue which she so often feels without apparent cause1 and why1 upon exertion1 she tires more easily than usual4 ,accordingly1 you may find it necessary to rest frequently during the day in order to avoid the ill effects of fatigue4 ,it is a good plan to work and exercise in short periods rather than long1 always lying down when tired1 and for an hour or two after the noon meal4 ,you should be careful not to be over active or to overexert yourself at the time when menstruation would occur if you were not pregnant1 for fear of bringing on an abortion4 ,this precaution is particularly important during the first four months1 the period when abortions occur most frequently4 ,since eight hours' sleep is usually considered necessary to keep the average person in good condition1 you can scarcely expect to get along satisfactorily with less4 ,in fact1 this is so important to your general well-being that you should make a serious effort to secure it4 ,fresh air during the day and open windows at night2 prudent eating2 a comfortable bed furnished with warm but light bedding2 warm baths2 a hot water bag to the feet and a hot drink upon retiring are all conducive to sleep4 ,but in addition to these1 and perhaps of even more importance1 are cheerfulness and a tranquil1 untroubled state of mind4 ,breasts4 ,breast feeding is the most urgent single need of the baby1 for whose coming we are making preparations1 and practically every mother1 excepting those with definite physical disability1 can supply this need of her baby's if she gives herself proper care both before and after his birth4 ,you will be glad to know in this connection that everything that promotes your general health helps to prepare you to nurse your baby1 but there is need also for care of the breasts and nipples themselves1 to make the nursing satisfactory1 and to prevent sore nipples and possibly even breast abscesses4 ,briefly1 this local care consists of supporting heavy breasts1 but avoiding pressure2 bringing out flat or retracted nipples and toughening the skin which covers them4 ,after they become heavy and uncomfortable the breasts may be supported by brassires1 which are snug below the breasts1 loose over the breasts themselves and suspended from shoulder straps2 or by some such binder as is shown in ,fig4 #aa1 which answers the same purpose4 ,if your nipples are flat or retracted1 you should begin about the fifth month to make them more prominent in order that when the baby nurses he may be able to grasp them easily4 ,there are several ways of accomplishing this1 all of them in the nature of massage1 but whatever is done must be done regularly and persistently4 ,one simple and effective method is to grasp the nipple between the thumb and forefinger1 draw it out1 hold it for a moment1 then release it and allow it to retract4 ,this should be done over and over1 two or three times daily4 ,or the unstoppered opening of a warm bottle may be placed over a flat nipple and held in place until the nipple is drawn up into the neck of the bottle as it cools and a partial vacuum is formed4 ,the toughening of the nipples should be begun eight weeks before the baby is expected4 ,there are two general methods which seem to give about equally satisfactory results4 ,one is to soften the skin1 and the other is to harden it4 ,in either case the nipples should first be scrubbed gently with a soft brush or cloth1 warm water and soap1 for about five minutes night and morning4 ,after the scrubbing they should be rubbed with lanolin1 cocoa butter or vaselin and covered with a piece of clean soft cloth or gauze1 to protect the clothing4 ,or1 they may be bathed with a wash consisting of equal parts of a saturated solution of boracic acid and #ie per cent alcohol4 ,you will probably have to have a druggist prepare this for you because of the alcohol4 ,but no matter which course is followed the care must be regular to be effective4 ,you will find that matters will be simplified if you will assemble in one place and keep in readiness the soap1 brush and lotion or ointment which you use each time1 using them for no other purpose4 ,care of the ,teeth4 ,it is very important for the expectant mother to give her teeth scrupulous care from the beginning of pregnancy1 for in addition to the ordinary wear and tear with which we all have to cope1 her tendency to have an acid stomach makes her mouth acid and this is bad for her teeth4 ,accordingly1 in addition to using dental floss and brushing your teeth after each meal1 you should use an alkaline mouth wash several times daily1 particularly after vomiting and before retiring1 for much damage may be done by the acid secretions in the mouth if they are allowed to bathe the teeth during the long night stretches4 ,common baking soda 7a teaspoonful to a tumbler of water71 lime water or milk of magnesia all make excellent mouth washes4 ,it is important1 also1 that you consult a dentist as soon as you know that you are pregnant and have any necessary repairs done promptly1 for delay may be serious4 ,,common ,,discomforts ,,during ,,pregnancy ,you may have a number of minor ills and temporary disturbances during pregnancy which are not serious but capable of making you very uncomfortable1 and which you may sometimes relieve yourself4 ,but should they be severe or persistent1 you should consult your doctor at once4 ,the most common of these minor discomforts may be grouped as digestive disturbances and 8pressure symptoms40 ,chief among the digestive disturbances are 8morning sickness10 8heartburn10 8distress0 and flatulence or 8gas40 8,morning sickness0 is probably the commonest discomfort of pregnancy as it occurs in about half of all cases4 ,because of the expectant mother's tendency to nausea during the early months1 it may be brought on by slight causes which would not produce nausea under ordinary conditions4 ,while it is true that grief1 anxiety1 fright1 shock1 incessant worry1 fits of temper or brooding may induce nausea when the diet is entirely satisfactory1 nausea and even vomiting may be caused in the expectant mother just as they may in any one else by indiscretions in diet1 rapid or overeating4 ,on the other hand1 simple1 light food taken in small quantities1 five or six times daily1 eaten slowly and masticated thoroughly2 the cultivation of a happy frame of mind2 exercise and fresh air all tend to prevent this very uncomfortable condition4 ,prevention is of great importance1 as the habit of vomiting is acquired easily but broken up with difficulty4 ,when 8morning sickness0 occurs1 however1 the sufferer is often relieved by eating two or three hard1 unsweetened crackers or crisp toast1 immediately upon awaking and then lying still for half or three quarters of an hour4 ,she should then dress slowly1 sitting down as much as possible while doing so1 and eat her regular breakfast4 ,lying flat1 without a pillow for a little while after meals1 or whenever having the slightest feeling of sickness1 will frequently prevent1 and also relieve nausea4 ,sometimes comfort is derived from the use of either hot or cold applications over the stomach4 ,some expectant mothers find that they can prevent nausea by having hot coffee1 or even a full breakfast before arising4 ,but the habit of having breakfast in bed should not be cultivated lightly1 for in spite of yourself it is likely to make you feel like an invalid1 the thing you should carefully avoid4 ,so don't do it unless your doctor orders it4 8,heartburn10 so called1 which is suffered by so many expectant mothers1 has nothing to do with the heart4 ,it is due entirely to too much acid in the stomach and is usually felt as a burning sensation1 which starts in the stomach and rises into the throat4 ,it may be prevented1 as a rule1 by taking a tablespoonful of olive oil or a cupful of cream or rich milk fifteen or twenty minutes before meals and avoiding fat and fried food at the meals themselves4 ,or1 it may be enough simply to avoid eating fats and fatty foods4 ,since the painful1 burning sensation is directly due to too much acid in the stomach1 it usually may be relieved by taking a tablespoonful of lime water2 a teaspoonful of sodium bicarbonate in water2 a small piece of magnesium carbonate2 or a drink of any alkaline water that one fancies4 8,distress40 ,another common discomfort of pregnancy is called 8distress0 by the sufferers themselves1 and occurs after eating4 ,it may be neither heartburn nor pain1 but resemble both and make the expectant mother very miserable4 ,it is usually suffered by women who eat rapidly1 do not chew their food thoroughly or who eat more at one time than the stomach can hold comfortably4 ,this is one more reason for taking small amounts of food at a time1 eating slowly and masticating thoroughly4 ,flatulence1 or 8gas10 may or may not be associated with heartburn1 but is fairly common among expectant mothers1 and is rather uncomfortable4 ,a daily bowel movement is of prime importance in preventing and relieving flatulence and at the same time foods which form gases should be carefully omitted from the diet4 ,the chief offenders are parsnips1 beans1 corn1 fried foods1 sweets of all kinds1 pastry and very sweet desserts4 ,yeast cakes and artificially fermented milk sometimes help to prevent flatulence4 ,pressure ,symptoms4 ,under the general heading of pressure symptoms are several forms of discomfort resulting from pressure of the enlarged uterus 7containing the baby7 on the blood-vessels which return from the lower part of the body1 thus interfering with the flow of blood back to the heart4 ,the commonest pressure symptoms are swollen feet1 varicose veins1 hemorrhoids 7piles71 cramps in the legs and shortness of breath4 ,they may appear at any time during the last half of pregnancy and they grow worse as the weeks wear on4 ,illustration3 ,,fig4 #ad4--,right-angled position to relieve swelling or varicose veins of the feet and legs4 7,by courtesy of the ,maternity ,centre ,association47 ,swelling of the feet is very common1 and when very slight may not be serious or particularly uncomfortable4 ,the swelling may be confined to the back of the ankle1 which grows white and shining1 or it may extend all the way up the legs to the thighs4 ,sitting down1 with the feet resting on a chair1 or lying down with the feet elevated on a pillow will give a certain amount of relief4 ,if the swelling and discomfort are extreme1 the expectant mother may have to go to bed until they subside1 but very often she will be relieved by elevating her feet or assuming the right-angled position shown in ,fig4 #ad1 for even a little while1 several times a day4 ,but while employing these harmless measures to make yourself comfortable1 you must remember that the swelling of your feet and ankles is one of the symptoms that your doctor wants to know about4 ,for this reason you should promptly report to him even the slightest swelling and begin to measure and save your urine for examination4 ,varicose veins are not peculiar to pregnancy but they are among the pressure symptoms which frequently appear during the later months1 particularly among women who have borne children4 ,the enlargement of the veins is not usually serious but it may cause a good deal of discomfort4 ,while varicose veins may occur in the vulva1 they are usually confined to the legs1 and both legs are about equally affected4 ,sometimes1 however1 the veins in the right leg are more distended than those in the left1 or the right side alone may be affected4 ,considerable relief may be obtained by keeping off the feet1 particularly by elevating them1 and also by the use of elastic bandages4 ,when an expectant mother finds it difficult or nearly impossible to sit or lie down for any length of time1 she may secure great relief in a few moments by lying flat on the bed with her legs extended straight into the air1 at right angles to her body1 resting against the wall or head board1 as shown in ,fig4 #ad4 ,this right-angled position for five minutes1 three or four times a day1 will accomplish wonders in reducing varicose veins4 ,a spiral elastic bandage1 also1 will give comfort and help to prevent the veins from growing larger1 if applied freshly after each time that the leg is elevated4 ,the most satisfactory bandages1 from the standpoint of expense1 comfort and cleanliness1 are of stockinette or of flannel cut on the bias1 measuring three or four inches wide and eight or nine yards long4 ,if made of flannel1 the selvages should be whipped together smoothly so that there is neither ridge nor pucker at the seam4 ,the bandage should be wrapped around the leg with firm1 even pressure1 starting with a few turns over the foot to secure it1 and leaving the heel uncovered1 carried up the leg to a point above the highest swollen vessels4 ,as a rule the bandage may be left off at night4 ,there are satisfactory elastic stockings on the market1 but they are fairly expensive1 often cannot be washed and seem to offer no practical advantage over the bandages4 ,swollen veins in the vulva may be relieved by lying flat and elevating the hips1 or by lying on the side with the hips elevated on a pillow for a few moments several times a day1 as shown in ,fig4 #ae4 ,illustration3 ,,fig4 #ae4--,lying on the side with hips elevated to relieve swelling or varicose veins of the vulva4 7,by courtesy of the ,maternity ,centre ,association47 ,hemorrhoids1 or 8piles10 are virtually varicose veins which protrude from the rectum1 but1 unlike those in the legs1 are extremely painful4 ,as it is the straining in constipation that causes these enlarged veins to protrude from the rectum1 this is one more reason for preventing constipation1 for a pregnant woman whose bowels move freely every day rarely has hemorrhoids4 ,if hemorrhoids appear1 and give pain1 the first step is to soften the fingers with vaselin and gently push the hemorrhoids back into the rectum4 ,you can do this quite easily for yourself4 ,you should notify your doctor if you have hemorrhoids1 but while waiting to see him1 if you are very uncomfortable you will be almost certain to find relief in lying down with your hips elevated on one or two pillows2 applying an ice bag to the rectum1 or ice-cold cloths or cloths wrung from equal parts of water and witch hazel4 ,sometimes the hemorrhoids are worse during the first few days after the baby is born but as a rule they disappear when the ultimate cause is removed1 which in this case is pressure made by the baby4 ,cramps in the legs1 numbness or tingling may be caused by pressure of the large1 heavy uterus upon nerves supplying the lower extremities4 ,lying down1 applying heat and rubbing the painful parts will usually relieve the discomfort4 ,shortness of breath is sometimes very troublesome toward the end of pregnancy1 and as may be easily understood1 is due to the upward1 and not downward pressure of the uterus4 ,for this reason the discomfort is made worse by lying down and relieved by one's sitting up or being well propped up on pillows or a back rest4 ,vaginal ,discharge4 ,although the normal vaginal discharge is increased during the later months of pregnancy you should tell your doctor if your discharge is very free4 ,you should not take douches to remove it1 unless your doctor orders them1 for the normal discharge gives you a certain amount of protection against infection4 ,if it is irritating or causes itching or burning you may obtain relief by avoiding the use of soap and by bathing the uncomfortable parts with water1 containing a teaspoonful of sodium bicarbonate to a pint1 or with olive oil4 ,itching of the skin is a fairly common discomfort1 and is possibly a result of irritating material being excreted by the skin glands and deposited upon the surface of the body4 ,the local irritation usually may be relieved1 if not very severe1 by bathing the uncomfortable areas with the solution of sodium bicarbonate as above1 or a lotion consisting of a pint of lime water1 half an ounce of glycerin and thirty drops of carbolic acid4 ,it is a good plan1 also1 to drink more water1 in order to promote the activity of the skin1 kidneys and bowels1 and thus dilute the material that may be responsible for the itching and increase its elimination through all channels4 ,some women complain of discomfort caused by the stretching of the skin over the enlarged abdomen4 ,there is a very old belief that rubbing the skin with oil will relieve this sensation and also prevent the appearance of the purplish streaks described in a previous chapter4 ,there seems to be little foundation for this belief1 but if a woman fancies that she is safer and more comfortable after oiling her abdomen1 there is certainly no reason why she should not do so4 ,,helping ,,to ,,prevent ,,complications ,i have described to you the details of personal hygiene which your doctor is likely to want you to adopt during your months of expectancy1 and some of the simple things that you may do to relieve minor discomforts when they arise1 for having these things in black and white may make the whole matter a little easier for you4 ,but there is still more that you can do to help the doctor help you4 ,you can tell him about any discomfort or any new condition that appears1 and follow his advice instead of talking it over with your family or friends4 ,this will make it possible for him to prevent serious complications by treating them in the very beginning4 ,you have probably learned1 in one way or another1 that the complications associated with childbirth that are most serious are infections 7childbed fever71 convulsions1 abortions or miscarriages and severe bleeding1 but perhaps you have not heard that you1 yourself1 can help greatly in the prevention of all of these conditions1 in your own case1 and chiefly by little more than exercising good common sense4 ,your part in preventing childbed fever1 if your baby is to be born at home1 lies in having in readiness a clean room1 sterile sheets1 towels1 gauze pads1 etc41 as will be described in the next chapter4 ,concerning the other complications we shall say a word here4 ,convulsions4 ,you can do a great deal toward preventing the condition that causes convulsions by following the advice about your personal care that we have just gone over and by making it possible for the doctor to treat early symptoms promptly4 ,in fact1 after looking over the records of many thousands of mothers who have had prenatal care1 it seems almost safe to say that the expectant mother who follows such a course will not have convulsions4 ,one of the commonest of the early symptoms is headache1 sometimes persistent and very severe4 ,others which you can detect are blurred vision1 spots before the eyes1 dizziness1 vomiting which is more persistent or severe than could be called 8morning sickness10 puffiness under the eyes or elsewhere about the face or hands1 swelling of the feet and ankles and severe pain in the stomach4 ,it might be that if you had even one of these symptoms your doctor would think it worth while to put you to bed and give you nothing but milk1 or only water1 for a day or two1 not because you were sick1 but to keep you from being so1 on the same principle that you darn a thin place in a stocking to keep a hole from coming4 ,in any event1 tell your doctor about the symptoms and let him decide what is to be done1 for therein lies your safety4 ,miscarriages4 ,the question of abortions1 miscarriages and premature births is one of enormous importance1 and one about which there is a good deal of misunderstanding4 ,as to the meaning of the terms1 many women are puzzled to know the difference between them4 ,doctors are not likely to use the word miscarriage1 but will describe as an abortion a termination of pregnancy which occurs before the end of the seventh month and as premature labors those occurring from that time until the expected date of confinement4 ,in the minds of lay people1 however1 the term abortion is often associated with criminal practice1 miscarriage being a term loosely applied to all births occurring before the seventh month1 while the premature baby is the one born after the seventh month of pregnancy but before the expected date of confinement4 ,of all of these accidents1 abortions are the most frequent1 though in the nature of things it is impossible to say how often they occur4 ,they sometimes happen so early in pregnancy that the expectant mother is unaware of the accident2 or if she does know of it she may make the mistake of taking no notice of it or regard it of so little consequence that she does not consult a doctor4 ,but such information as is available suggests that at least one out of every five pregnancies ends in abortion1 the tragedy of this being that it is very largely a preventable disaster4 ,since the ovum is insecurely attached to the uterine lining until the sixteenth or eighteenth week1 an abortion is more likely to occur during this time than later1 while of this period1 the second and third months seem to be the most perilous4 ,abortions are less likely to happen during first pregnancies than succeeding ones and their frequency seems to increase with the number of pregnancies4 ,they occur more often among women over thirty-five years than in younger ones1 and in all cases are most likely to take place at the time when menstruation would fall due were the woman not pregnant4 ,the prevention of abortions is of such obvious importance and there is so much that you can do to this end1 that we shall take up the question somewhat at length4 ,preventive treatment really begins very early4 ,in the discussion about menstruation we referred to the importance of finding out the cause of painful periods1 in the interest of good obstetrics1 since inflammation of the uterine lining or a misplaced uterus might be responsible for the pain and if neglected might cause an abortion later on4 ,the correction of such troubles1 no matter when they are discovered1 is an early step toward preventing abortions4 ,but after pregnancy has actually begun1 there are certain preventive measures which have proved to be very effective4 ,a woman who is pregnant for the first time1 and who1 therefore1 does not know whether she is likely to have an abortion or not1 should avoid such risks as fatigue1 sweeping1 lifting or moving heavy objects1 running a sewing machine by foot1 running1 jumping1 dancing1 traveling or any action which might jar or jolt her during the first sixteen or eighteen weeks4 ,an expectant mother who has had an abortion will have to take even greater precautions1 as she is in more danger than is a woman who has not had this experience4 ,it is of prime importance1 to begin with1 that she have the cause of her previous abortion discovered1 and if possible corrected4 ,and since the accident is most likely to be repeated at about the same time1 or a little earlier1 in each succeeding pregnancy it is a wise precaution for the expectant mother to remain quietly in bed for at least a week before and after the time when an abortion may be feared4 ,complete rest and relaxation are such effective preventive measures that patients with a tendency to have abortions who have been willing to stay in bed during most of their pregnancy have sometimes been rewarded by going through the entire period and in the end giving birth to a normal1 fully developed baby4 ,as out-of-door exercise is clearly impossible in such cases1 it is important that the patient keep her room very well ventilated all of the time1 and possibly1 under the doctor's direction1 have massage or bed exercises4 ,the marital relation is usually considered inadvisable in all cases after the eighth month of pregnancy1 and among women who have had abortions or miscarriages it is best omitted throughout the entire period4 ,this is particularly true of women over thirty-five who are pregnant for the first time4 ,to sum it up in a word1 your part in preventing an abortion or miscarriage after pregnancy has begun1 consists largely of avoiding fatigue2 resting when tired2 avoiding physical shocks such as blows upon the abdomen1 jolts or falls particularly during the first sixteen or eighteen weeks and at the time when menstruation would ordinarily occur if you were not pregnant1 and avoiding overwork during the later weeks of pregnancy4 ,the common symptoms of abortions or miscarriages are bleeding1 often accompanied by recurring pain1 beginning in the small of the back and finally felt as cramps in the lower part of the abdomen4 ,since menstruation is suspended during pregnancy you should always regard bleeding or a bloody discharge as a symptom of a possible miscarriage1 whether you have pain or not4 ,upon its appearance you should send for the doctor1 go to bed at once and keep absolutely quiet4 ,should you be so unfortunate as to have a miscarriage1 in spite of all your precautions1 bear in mind that you will need to stay in bed quite as long afterwards and have the same care as though you had given birth to a fully developed baby4 ,it is because so many women fail to appreciate this that abortions and premature births are often followed by ill health and invalidism4 ,under proper care1 an abortion or premature labor is not1 of itself1 any more serious for a woman than a normal delivery4 ,bleeding from the vagina1 or a sudden increase in the size of the abdomen with perspiration and a sudden feeling of faintness1 may be the beginning of severe bleeding1 or hemorrhage1 from any one of a number of causes1 and in such a case the expectant mother should notify her doctor1 go to bed at once and keep quiet until he arrives4 ,summing up the whole question of preventing complications1 we find that the following symptoms may be forerunners of serious trouble and therefore should be watched for and reported to the doctor as soon as they are noticed3 #a4 ,persistent or severe vomiting4 #b4 ,persistent or severe headache4 #c4 ,dizziness4 #d4 ,blurred vision or the appearance of black spots before the eyes4 #e4 ,puffiness under the eyes1 or elsewhere about the face4 #f4 ,swelling of the feet1 ankles or hands4 #g4 ,sharp pains1 particularly in the stomach4 #h4 ,prolonged failure to feel the baby's movements after they have once been felt4 #i4 ,bleeding1 or a bloody discharge4 #aj4 ,pain in the small of the back followed by cramp-like pains in the abdomen1 before the expected date of confinement4 #aa4 ,unwarranted mental depression1 anxiety or apprehension4 ,these are generally accepted as the danger signs of pregnancy1 any one of which1 alone or in combination with one or more of the others1 is of importance4 ,in addition to these it really is important that you talk to your doctor or your nurse freely if you are feeling worried or depressed about anything at all4 ,sometimes one feels blue without knowing why1 and if you should feel so during your pregnancy you should not keep it to yourself but talk it over with your doctor or your nurse4 ,when all is said and done1 what we want for each expectant mother is little more than that she shall live a normal1 regular1 wholesome life2 that she shall be able1 and what is of equal importance1 be willing to weave into her everyday life the principles of personal care which every one should adopt2 that she shall watch and be watched for symptoms of complications throughout the entire period of pregnancy1 in order that they may be detected early1 speedily treated and serious troubles thereby prevented4 ,the adoption of such simple precautions will pave the highroad to health and happiness for yourself and your baby4 ,,chapter ,,vi ,,making ,,ready ,,for ,,the ,,baby ,in making ready for the actual arrival of the baby there are several factors to consider1 chief among them being the doctor2 the nurse2 the place where the baby is to be born2 the room he is to occupy and an equipment which will facilitate the care of yourself and the baby1 at the time of his birth and afterwards4 ,of course you have long since placed yourself under a doctor's care1 so that is settled4 ,if you are in the care of a privately engaged physician1 he will1 in all probability tell you his wishes in regard to your engaging a nurse4 ,she should be satisfactory to both you and the doctor from the standpoint of training and professional fitness as well as her personality4 ,the selection of the nurse1 therefore1 should be made in coperation with your doctor4 ,it is wise to engage her during the early part of your pregnancy both to insure your securing the one that you and the doctor want especially1 and to have that much of the preparation off your mind4 ,it is usually a good plan to engage the nurse to hold herself in readiness to respond to your call at any time after two weeks before the expected date of your confinement4 ,quite reasonably1 if she is obliged to give up or refuse an engagement in order to hold herself available for you1 from a given date1 she will do so at your expense4 ,try to arrange to have the nurse stay with you for six weeks after the baby is born1 even though this involves considerable financial sacrifice on your part4 ,of course if you can afford to keep her still longer1 so much the better4 ,all of this is in case you are in the care of a privately engaged physician and are to have a special nurse4 ,if you are being cared for during pregnancy by doctors and nurses connected with a dispensary1 health center or prenatal clinic1 they will advise with you about your nursing care at the time of confinement and afterwards4 ,the next question to consider is whether the baby is to be born at your home or in a hospital4 ,the doctor who is advising you will have his wishes on this subject1 too1 and as they are entirely in your interest1 you will1 of course1 do as he advises4 ,you will be likely to find that for the birth of the first baby he will want you to go to a hospital1 if there is a good one available2 also if you have had any symptoms of complications during this pregnancy or difficulty with previous labors4 ,if you are going to a hospital you or your doctor will make the necessary arrangements about your room1 well in advance of the date upon which you expect to go1 in order to feel sure that a room will be ready for you4 ,it sometimes happens1 that for a variety of reasons it is nearly or quite impossible for the expectant mother to go to a hospital1 or that her doctor is entirely willing that she shall be confined at home4 ,if it is decided that you are to remain at home1 it will be possible1 with a little planning and effort on your part1 to imitate very nearly in your own home the advantages which are offered by a hospital4 ,you will remember that in the last chapter ,i mentioned childbed fever as being one of the serious complications1 associated with childbirth1 that could be prevented by careful work4 ,in the old days1 when the importance of cleanliness was not appreciated1 this fever was very common in maternity hospitals1 but nowadays it seldom occurs in well conducted institutions because the doctors and nurses know how to do clean work and also because they have clean things to work with4 ,so if you are to be attended at home by a good doctor and a good nurse you may make the conditions of your confinement practically ideal by providing a clean room and such an outfit of sterile sheets1 towels1 dressings and certain other articles as would be available for their use in a hospital4 ,suppose we settle the question of the rooms first4 ,it is a very important one but need not be the bugbear that some people think it is4 ,in all probability you will have no choice as to a room for yourself and will have to use the one you ordinarily occupy4 ,should you have a choice1 however1 it will be well to select one that is cool and shady1 if the baby is coming during the summer1 but one that is bright and sunny for occupancy during most of the year4 ,it should be conveniently near a bathroom1 if possible2 have an adjoining room for the nurse and one near by for the baby4 ,the ideal to work toward is3 ,a room with a washable floor with small1 light rugs2 freshly laundered curtains at the windows but no heavy draperies2 a single brass or iron bedstead1 about thirty inches high1 with a firm mattress1 and so placed as to be accessible from both sides and with the foot in a good light1 either by day or night2 a bedside table and two others 7folding card tables are a great convenience72 a bureau2 a washstand1 unless there is a bathroom on the same floor2 one or two comfortable chairs1 two or three straight chairs and a couch or chaise longue1 all of which should be of wood or wicker or covered with freshly laundered chintzes4 ,between such a room as this and the one that must be used there may be a wide difference1 but it will be worth while to approach this standard as nearly as possible4 ,it is not necessary to make the room bare2 in fact1 it should be as cheerful and pretty as is compatible with cleanliness4 ,there is no objection to pictures on the walls1 but the room should be free from useless1 small articles which are likely to be dust catchers1 give the nurse unnecessary work and occupy space needed for other things4 ,the room should be given a thorough house-cleaning about two weeks before the baby is expected4 ,if there is a carpet on the floor that cannot be taken up conveniently1 it might be well to have in readiness a large canvas or rubber or an abundance of newspapers to protect the floor near the bed4 ,if the bed is low1 the attentions of the doctor and nurse will be made much easier if you have ready four solid blocks of wood1 of the same size1 upon which to elevate the bed1 after the casters have been removed4 ,the blocks should be of such a size as to bring the height of the bed up to thirty inches4 ,and it is important1 too1 to have a large board1 or table leaves1 at hand1 to slip under the mattress to make it firm1 particularly if the bed is soft or sinks in the middle4 ,the chief requisites for the baby's room are that it may be well ventilated and easily cleaned4 ,the floor should be of hard wood1 or covered with linoleum1 in order that it may be wiped up with a damp cloth every day1 and the walls should be freshly papered1 or1 better still1 painted4 ,as bright light and glare are bad for the baby the walls would better be of a soft shade1 such as grayish green or blue1 than white1 and there should be dark shades at the windows1 in order that the room may be darkened at will4 ,the furnishings may consist of a brass or enameled crib1 with a hair mattress2 a chest of drawers2 a low straight chair and low rocker1 both without arms1 and a low table for the baby's toilet articles4 ,an ordinary kitchen table1 enameled and with the legs sawed off1 serves admirably4 ,all of the furniture should have smooth1 washable surfaces1 such as hard wood or enamel1 and the walls should be free from pictures1 for the baby's room will have to be kept scrupulously clean and free from dust4 ,so much for the rooms4 ,when it comes to the question of providing the outfit to be used in your personal care1 the matter of nightgowns and the like will be determined by your tastes and your means1 rather than by specific needs4 ,but six or eight nightgowns1 a warm bed jacket if the weather is cool1 a dressing-gown and a pair of slippers1 will probably be enough to keep you fresh and comfortable1 so far as these things are concerned1 whether you are in a hospital or at home4 ,but the preparation of necessary dressings and other articles for a home confinement is a different matter and you should learn the wishes of your doctor concerning them4 ,if his instructions are not specific1 you may find that the following lists will be helpful guides in assembling an equipment which will prove adequate to meet the ordinary requirements of a home confinement4 ,most of the articles listed1 or satisfactory substitutes1 are to be found in the average household1 but they should be gotten together in one place so as to be ready at a moment's notice4 ,for the ,confinement and ,your ,own ,care3 ,plenty of sheets1 pillow cases and towels4 #d sanitary belts4 #a piece rubber sheeting or oil cloth1 #a #a yards4 #a piece rubber sheeting or oilcloth1 #b #a yards4 ,two or three dozen safety-pins4 ,hot water bag with flannel cover4 #a two-quart fountain syringe4 #a douche pan4 #a bed-pan4 #b covered slop jars or covered pails4 #c basins1 about #af1 #ad and #ab inches in diameter4 #b stiff nail brushes1 nail scissors and file or orange stick4 #c agate or enamel pitchers1 holding at least #a quart each4 ,medicine glass4 ,medicine dropper4 #b bent glass drinking tubes4 #ajj bichlorid tablets4 #d ounces chloroform4 #d ounces boric acid powder4 #d ounces green soap4 #a pint grain alcohol4 ,small jar of vaselin to be sterilized4 ,lard1 olive oil1 vaselin or albolene to oil the baby4 ,roll of adhesive plaster1 #a inch wide4 ,one package of absorbent cotton4 ,one clinical thermometer4 ,in addition to these1 a certain supply of sterile dressings will be needed4 ,complete outfits of such dressings1 sterilized and ready for use1 may be obtained from any one of a number of firms1 of which your doctor will know2 or they may be prepared by the nurse1 or you yourself may prepare and sterilize the following3 ,one dozen towels4 ,three sheets4 ,five or six dozen sanitary pads1 about #aj inches long and #d inches wide1 made of gauze and cotton batting with a top layer of absorbent cotton4 ,two to four bed pads1 about #cj inches square and #d inches thick1 made of gauze and cotton waste or cotton batting with a top layer of absorbent cotton2 or of newspapers covered with muslin4 ,one pair of leggings made of canton- or outing-flannel1 either loose fitting hose reaching to the thighs or a yard square folded diagonally and stitched on one side4 ,see ,fig4 #af4 ,five or six dozen gauze sponges1 made by folding pieces of gauze #ah inches square into small pads with all raw edges inside4 ,two or three dozen gauze squares1 #d inches square4 ,four or five dozen cotton pledgets1 or wads of absorbent cotton about the size of an egg with the edges drawn together between thumb and finger and twisted into a spiral4 ,six pieces of bobbin or narrow tape1 #i inches long1 to tie the baby's cord4 ,illustration3 ,,fig4 #af4--,two types of easily made leggings1 suitable for use at the baby's birth4 ,to make these supplies you will need about four pounds of absorbent cotton1 #f or #h packages of cotton batting1 and possibly #dj yards of gauze in addition to cotton flannel for the hose4 ,in preparing the dressings for sterilization1 you may divide them into packages as follows3 ,the sheets in one package2 #f towels in a package2 #f sanitary pads in a package2 #b delivery pads in a package2 the gauze squares in two packages2 the leggings in one package2 the bobbin in one package4 ,the sponges and pledgets should be put up in bags or small pillow cases1 #b or #c dozen in a bag4 ,wrap each package in heavy muslin1 either new or old1 using pieces large enough to well protect the contents from contamination by dust or handling1 tie them securely with string and sterilize as follows3 ,fill a wash boiler about a quarter full of water and fashion a hammock by securely tying a towel or strip of muslin to the handles at each end and allowing it to hang so that the bottom of the hammock is about halfway down in the boiler4 ,as the weight of the dressings makes the hammock sag low in the middle it is a wise precaution to place a rack or support of some kind in the bottom of the boiler1 to hold the dressings well above the bubbling water1 at the point where they hang lowest4 ,pile the dressings into the hammock1 cover the boiler tightly and keep the water boiling vigorously for an hour2 dry the packages in the sun1 or by placing them in the oven for a few moments1 taking care that they are not loosened or opened1 and at the end of twenty-four hours repeat the steaming and drying process1 wrap the packages in a clean sheet and put them in a drawer or covered box where they may remain undisturbed until needed4 ,the nail brushes1 douche pan and fountain syringe may be wrapped in muslin and sterilized in the same way1 or the nurse may boil them when the time comes to use them4 ,bed pads made of newspapers offer excellent protection and are1 of course1 less expensive than those made of cotton4 ,they consist of six or eight thicknesses of newspaper opened out to the full size of the page and covered with a piece of freshly laundered muslin which is folded over the edges and basted in place or held with safety-pins1 as shown in ,fig4 #ag4 ,these pads may be made virtually sterile by ironing them on the muslin side with a very hot iron1 folding the ironed surface inside without touching it1 ironing the outside after it is folded and wrapping the pads in a clean sheet or muslin1 also recently ironed1 and putting them away with the other dressings1 in a place protected from dust4 ,illustration3 ,,fig4 #ag4--,reverse side of pad made of newspapers and old muslin to protect bed during a home confinement4 ,if muslin is held in place with safety-pins it may be removed easily1 washed and used for another pad4 7,by courtesy of the ,maternity ,centre ,association47 ,baby ,clothes4 ,in planning the baby clothes1 there are a few general principles to bear in mind that are of considerable importance to the baby's welfare4 ,his health actually may be injured by having his clothes too warm or not warm enough1 and also if they are tight enough to bind or constrict any part of his body or so ample as to form bunches and wrinkles which will make him uncomfortable and restless4 ,to be entirely satisfactory his clothes should be simple in design and so made as to slip on easily1 fit loosely and at the same time smoothly2 the materials should be soft1 light and porous4 ,complete outfits of baby clothes may be bought outright1 but few expectant mothers are willing to forego the sheer ecstasy of fashioning the little garments themselves1 while they dream dreams of the baby who is to wear them4 ,the following list of garments will meet the baby's needs1 and those which you may make are really very simple3 ,two to four dozen diapers1 about #ah inches square4 ,three flannel bands #f inches wide and #bg inches long1 unhemmed4 ,three knitted bands with shoulder straps4 ,three shirts1 infants'1 size #b1 of cotton and wool1 silk and wool but not all wool4 ,four wool and cotton flannel petticoats4 ,four wool and cotton flannel nightgowns4 ,six thin white cotton slips1 or dresses4 ,flannel wrapper or a yard square of flannel for extra wrap in cool room4 ,cloak and cap or other wrap for out door use in cool weather4 ,let us take these up in turn4 ,the diapers may be of any soft1 absorbent1 loosely woven material1 such as cheesecloth1 stockinette1 bird's-eye1 cotton flannel or thin ,turkish toweling1 single or double thickness1 according to the weight of the material used1 and about #ah inches square when hemmed4 ,the first bands are of cotton and wool flannel1 torn-straight across the width of the material in #f-;inch strips and left unhemmed4 ,after the cord separates1 this band is usually replaced by a knitted band with shoulder straps4 ,the shirts should have high necks and long sleeves1 come well down over the hips and open all the way down the front4 ,they should be of cotton and wool or silk and wool but not all wool as this is too warm4 ,during very warm weather the shirts should be of thin cotton or silk4 ,it is better to start with size #b as the smaller size will soon be outgrown4 ,illustration3 ,,fig4 #ah4--,pattern for baby's petticoat 7shown in ,c4 ,fig4 #bj7 requiring yard of material one yard wide4 ,the cotton dress 7,a7 and flannel nightgown 7,b7 in ,fig4 #bj1 may be made from this pattern with the addition of straight sleeves4 ,the petticoat is a very important item in the baby's wardrobe1 for1 helping as it does to keep his body evenly warm1 it is worn constantly except during very warm weather4 ,it should be a straight little slip1 about #bg inches long1 hanging from the shoulders1 made entirely of flannel1 without the broad cotton waistband that has tortured so many babies in days gone by4 ,the chief purpose of the dresses or slips is to keep the petticoats clean and add to the daintiness of the baby's attire and they are made1 therefore1 of very thin1 soft cotton or linen material4 ,they are made from the same pattern as the petticoats1 except that they have sleeves and these may be set in or cut out in one piece with the rest of the garment like kimono sleeves1 as in ,fig4 #ai4 ,illustration3 ,,fig4 #ai--,pattern for kimono-style dress or nightgown1 shown in ,e1 ,fig4 #bj1 and requiring #a yards of material #bg inches wide4 ,the nightgowns are made like the slips1 but of the same part wool flannel as that used for the petticoats4 ,the petticoats1 slips and nightgowns should all open down the back and may be fastened with either tapes or buttons and buttonholes4 ,these fastenings present about equal advantages but there is perhaps a slight preference for buttons as babies sometimes tangle their fingers in tapes or get them in their mouths4 ,illustration3 ,,fig4 #bj4--;,an outfit of satisfactory baby clothes3 ,a4 ,thin cotton dress1 open down the back4 ,b4 ,flannel nightgown with set-in-sleeves4 ,c4 8,gertrude0 petticoat1 open down the back4 ,d4 ,shirt1 opened all the way down the front4 ,e4 ,flannel nightgown with kimono sleeves4 ,f4 ,knitted band with shoulder straps4 ,g4 ,flannel square with tapes run through casings to form hood of one corner4 ,h4 ,bag1 with hood1 suitable for premature baby or for outdoor sleeping4 ,a satisfactory little wrap to use at first may be made from a yard square of soft1 warm material with a hood formed of one corner by running tapes through casings4 ,patterns for these baby clothes may be obtained from two or three of the large pattern concerns1 or you may cut them out1 yourself1 by using ,figs4 #ah and #ai as guides1 while ,fig4 #bj shows how the various little garments look when finished4 ,the question of socks for the new baby is one upon which doctors hold different opinions1 some believing that the warmth provided by the petticoat is sufficient2 others1 that there is an advantage in the extra protection afforded by socks1 so you would better learn the wishes of your own doctor in this connection4 ,additional ,articles ,which ,are ,needed or ,useful in the ,care of the ,baby3 ,bath tub1 tin1 enamel1 agate or rubber4 ,drying frames for shirts and stockings4 ,rubber bath apron4 ,flannel1 or ,turkish toweling bath apron4 ,low chair without arms4 ,low table4 ,screen to protect baby during bath4 ,rack upon which to hang clothes to warm during bath4 ,scales1 with beam and basket or scoop1 not the spring variety4 ,hot water bag and cover4 ,crib1 basket or box1 to be used as bed4 ,folded felt pad1 blanket or hair pillow for mattress4 ,rubber or oilcloth to cover mattress4 #f crib sheets4 #a thermometer4 #b crib blankets4 ,soft towels and wash cloths4 ,an old blanket to be used for bath blanket4 #c or #d dozen safety-pins1 assorted sizes4 ,castile soap4 ,boric acid powder4 ,olive oil or albolene4 ,absorbent cotton pledgets1 preferably sterile4 ,enamel pail and cover4 ,illustration3 ,,fig4 #ba4--;,baby's toilet tray equipped with jelly glasses1 bottles1 celluloid hair receiver for cotton1 and a soap dish1 as follows3 #a4 ,safety-pins sticking in cake of soap4 #b4 ,jar for sterile nipples4 #c4 ,jar of sterile water4 #d4 ,jar of boracic acid solution4 #e4 ,nursing bottle4 #f4 ,sterile water to drink4 #g4 ,nursing bottle for water4 #h4 ,small tooth pick swabs4 #i4 ,liquid petrolatum4 #aj4 ,gauze mouth swabs4 #aa4 ,absorbent cotton4 #ab4 ,soap4 7,by courtesy of the ,maternity ,centre ,association47 ,the giving of the baby's daily bath1 after he comes1 will be greatly simplified if you will assemble beforehand and keep in readiness on a tray or small table1 all of the things which are to be used each time4 ,dainty little outfits for this purpose may be bought1 or you may arrange an entirely satisfactory one from jars and bottles to be found in the house1 as suggested in ,fig4 #ba4 ,the above lists of dressings and articles to be used in the care of both mother and baby can be considerably modified1 according to one's tastes and means1 and still be satisfactory4 ,they merely represent a fair average of what has been found adequate to meet the usual needs of the mother and baby at home4 ,it will be a good plan for you to have in readiness1 by about the end of the seventh calendar month1 all of the dressings and other articles to be used during the confinement4 ,this is in case you should have a premature labor1 for which the same dressings are needed as in a normal delivery4 ,the baby's clothes1 however1 will be in time if they are ready by the end of the eighth month4 ,a baby born before this time would probably be so frail that he would be wrapped in cotton at first1 instead of being dressed in the clothes ordinarily prepared for a fully developed baby4 ,if you will make such preparations for the baby's arrival as ,i have suggested1 you will be doing a great deal toward securing his safety and well-being1 as well as your own4 ,,chapter ,,vii ,,the ,,baby',s ,,arrival ,during the past nine months you have had the happiness of guarding the little life within you and of making soft1 warm garments to have in readiness for the baby when he comes4 ,you have prepared your room and his2 folded up the packages of gauze and cotton and prepared all sorts of other things to be pressed into service upon the baby's arrival1 and through it all you have dreamed and planned and built the loveliest of castles in ,spain4 ,and now1 at last1 the baby is coming6 ,it almost takes your breath away to realize it after all those months of waiting and dreaming1 and though it scarcely seems possible1 the waiting is almost over4 ,this same waiting grows very hard toward the end for you are tense with expectation and suspense4 ,the hours and days seem endlessly long1 as they pass without giving the looked-for signs that the baby has started4 ,you find it very hard not to grow discouraged and impatient1 he seems so long in coming4 ,your physical discomfort is aggravated by the greater pressure made by the baby during this period1 and you cannot get away from it day or night4 ,the desire to urinate is almost constant2 your back aches2 your feet feel heavy and swollen and the baby disturbs your nights by his increasingly vigorous kicking4 ,but this does not last long1 so try to minimize the fatiguing effects of it all by resting and sleeping as much as possible during the day4 ,the time does slip by and the baby really does come and you don't want to be tired before the big event4 ,the miracle of the baby's origin at the moment of conception2 of his growth and the development of the intricate parts of his little body1 is equaled only by the miracle of his birth--his separating from your protecting body and coming into the world as a new human being when the time comes that he is able to exist separately and independently4 ,since very early in pregnancy1 you will remember1 your uterus has been growing alternately hard and soft as the muscles have contracted and relaxed4 ,but these contractions have been as painless1 and so far as we know1 as fruitless as the contractions of a boy's biceps as he clenches his fist and produces a hard lump on his arm4 ,but when the baby is ready to take up his life among the rest of us human beings1 the contractions of your uterine muscles are altered in such a manner that you gradually become conscious of them and they become so purposeful that they are able slowly but steadily to force the baby down through that narrow part of the pelvis called the inlet1 through the cervix1 and finally out into the world4 ,since1 at the proper time you will be able to help these altered muscular contractions to accomplish their high purpose1 you will want to watch their progress1 with your mind's eye1 as far as possible4 ,recall1 for a moment1 the fact that the baby is contained in a sac of fluid in the cavity of the uterus1 above the cervix2 that the cervix1 below1 is a canal drawn in tightly at the upper end1 or internal os1 and also at the lower end1 or external os4 ,quite evidently after the baby's head has been squeezed through the pelvic inlet by pressure of the uterine contractions1 the cervix must open widely in order that he may pass through it1 too4 ,and so ,nature gradually stretches this narrow canal by using the lowermost part of the bag of waters as a water-wedge and forcing it down into the internal os1 a little farther with each pain4 ,the opening grows wider and wider as the bag of waters is pressed farther and farther down into the cervical canal1 which also widens slowly1 and finally the external os1 too1 is stretched wide open by the water-wedge4 ,fig4 #bb shows how the cervix looks with the bag of waters pressed against the upper opening and how the entire canal is gradually dilated by this wedge1 as it is pressed downward4 ,as you doubtless know1 the process of your baby's emergence into the world and separation from your body is termed labor4 ,the onset of labor is usually marked by the expectant mother becoming conscious of the uterine contractions through dragging pains which are felt first in the small of the back and then in the lower part of the abdomen and thighs4 ,in the beginning the pains are feeble and infrequent1 but they gradually grow more severe and more frequent4 ,sometimes the first sign of labor is a gush of fluid1 caused by the rupture of the membranes1 or the appearance of blood1 but these are not typical4 ,intestinal colic is sometimes mistaken for labor pains by women who are pregnant for the first time1 but when the cramps come regularly and the uterus is felt1 through the abdominal wall1 to grow hard as the pain increases1 and soft as it subsides1 there can be no doubt that they are labor pains4 ,this is the time1 usually1 when you will go to the hospital1 if your baby is to be born there1 or when you will notify your doctor that you think you are in labor4 ,if you are to remain at home the doctor may want you to send for the nurse at once1 in which case he depends upon her to communicate with him4 ,or he may prefer that you notify him and let him send the nurse4 ,either arrangement is simple and easy to carry out1 but you must be sure that you understand just what the doctor wants you to do when you think labor has started4 ,it is not a bad plan to write down his instructions about this1 with the telephone number and street address of the one to be summoned1 so that you will know exactly how to proceed when the time comes4 ,illustration3 ,,fig4 #bb4--;,diagrams showing how the cervix is dilated as the bag of waters is forced downward by the uterine contractions4 ,the entire duration of labor may vary from a few moments to several days1 but the average length of the first labor is about eighteen hours and of subsequent births about twelve hours4 ,the process is usually described as being divided into the first1 second and third stages of labor1 approximately as follows3 ,first stage ,second stage ,third stage ,total ,first labor #af hours #a hours #ae minutes #ah hours ,later labors #aa hours #de minutes #ae minutes #ab hours ,the first stage begins with the onset of labor and lasts until the cervical canal is completely dilated2 the second stage begins when the cervix is dilated and lasts until the baby is born2 the third stage begins with the birth of the baby and lasts until the afterbirth is expelled4 ,first ,stage4 ,the pains are mild at first and occur at intervals of from fifteen to thirty minutes1 but they gradually increase in frequency and intensity until by the end of fourteen to sixteen hours1 they are very severe1 and recur every three or four minutes1 each pain lasting about one minute4 ,the pains begin in the back1 then pass slowly forward to the abdomen and down into the thighs4 ,the average woman is entirely comfortable between pains and until they become very frequent she will usually prefer to be up and about1 but if she is on her feet when a contraction begins she will usually seek relief by leaning forward on something secure1 as the foot of the bed or a table1 or by sitting down until the pain subsides4 ,as time passes1 there is an increasing1 sometimes persistent desire to empty the bowels and bladder because of pressure upon these two organs by the baby's head as it is forced slowly downward4 ,there may be vomiting1 also when the cervix becomes nearly1 or quite dilated4 ,in the course of the stretching process1 the cervix sustains many tiny tears from which blood oozes and tinges the vaginal discharge4 ,this bloodstained discharge is often called the 8show0 and usually appears toward the end of the first stage4 ,when the cervix is fully dilated1 the membranes1 or bag of waters1 usually rupture1 and there is a sudden gush of fluid1 but the rupture of the membranes does not necessarily mark the end of the first stage4 ,sometimes1 though not often1 they break before labor begins1 thus producing what is known as a 8dry0 labor4 ,they may rupture before the cervix is fully dilated or they may not rupture at all until the doctor punctures them to facilitate the baby's birth4 ,if the nurse is delayed in reaching you1 there is a good deal that you can do and have done1 during this first stage of labor1 in the way of preparing for the baby's arrival1 this preparation relating in general to yourself and to the room including placement of the sterile dressings4 ,as to yourself1 try first to picture what takes place during the fifteen or sixteen hours of the first stage4 ,the baby's head has usually passed through the pelvic inlet and not much happens1 now1 beyond the widening of the cervical canal1 as the bag of waters is forced down by the squeezing of the uterus each time that it contracts4 7,see ,fig4 #bc47 ,as the contractions grow stronger and more frequent you may have a desire to help matters by 8bearing down10 or straining1 but this is very unwise for nothing that you can do will hasten the dilation of the cervix4 ,the bearing down will tire you and then you will not be able to make as much helpful effort during the second stage as you would in a fresh and rested condition4 ,for this reason1 if your pains begin at night1 don't get up1 but stay in bed and try to get as much sleep as possible4 ,if they begin during the day1 keep up and about during most of the time1 but lie down often enough and long enough to prevent your getting tired4 ,but above all don't bear down during the first stage4 ,illustration3 ,,fig4 #bc4--;,drawing showing the baby's descent at the time of birth4 ,the head is passing through the inlet and pressure by the bag of waters has started to dilate the cervix4 7,drawn by ,max ,brdel4 ,used by permission of ,a4 ,j4 ,nystrom and ,co41 ,chicago47 ,take a warm soapsuds enema2 a thorough1 warm1 sponge or shower bath1 scrubbing the inner surface of the thighs and lower abdomen thoroughly1 but do not bathe between the labia4 ,put on a freshly laundered nightgown1 stockings1 dressing-gown and slippers and braid your hair1 preferably in two braids4 ,drink all of the water you want and about every three or four hours take some form of liquid nourishment such as milk1 cocoa1 strained soup or broth1 with toast or crackers4 ,such nourishment will help to keep you from getting tired and will do no harm1 but it may not be altogether wise to take anything more solid without your doctor's permission4 ,it is not uncommon for one to feel nauseated toward the end of the first stage and this tendency may be aggravated by taking solid food4 ,one thing to remember is the very great importance of your poise and favorable mental attitude4 ,so much of proved value has been done1 and still is being done1 to safeguard you and your baby1 that you have every reason to feel calm and secure1 and it is of very practical importance that you cultivate this attitude4 ,the woman who allows herself to become excited1 nervous and apprehensive has much harder time than the one who asserts her self-mastery and preserves a tranquil state of mind4 ,this is so definitely the case that for the sake of your own comfort ,i cannot urge you too strongly to remember it and to exclude disturbing or exciting influences as far as possible4 ,one of the most troublesome of these is excitable but well-meaning and officious friends or relatives4 ,accordingly1 if your nurse is not at hand try to have some one cool-headed woman with you and insist upon excluding those who would be upsetting or likely to offer advice and suggestions4 ,in getting yourself ready1 then1 it is advisable to take a bath and an enema2 put on clean clothing2 not to stay in bed entirely throughout the first stage1 but on the other hand to try to keep mind and body fresh and rested by lying down when you begin to feel tired1 taking light nourishment regularly1 not bearing down during pains and denying yourself to visitors who might be excitable4 ,this is all simple enough and you will not find it difficult to carry it out4 ,and1 happily1 the preparations relating to the room are equally simple and uncomplicated4 ,either you or the friend who is with you1 may make the bed--you if you feel like it1 she1 if you are tired4 ,the mattress is covered with the larger of the two pieces of rubber sheeting that you have in readiness and over this is placed the lower sheet1 stretched very smooth and tight and tucked well under the mattress at head1 foot and sides4 ,if the sheet is not very large1 it may be made secure by being pinned with safety-pins to the under side of the mattress4 ,the smaller rubber is then placed across the middle third of the bed and over this a muslin sheet1 folded once through the middle1 tucked well under the sides of the mattress4 ,next1 the upper sheet1 a light blanket and a thin counterpane1 all left open at the foot1 and a pillow4 ,the packages of sterile dressings1 douche pan1 fountain syringe1 pitchers and basins may be placed on the tables1 and the washstand equipped for the doctor's hands with soap1 sterile nail-brush1 nail scissors and file4 ,a large kettle or pail of water should be boiled1 covered and put aside to cool and a large receptacle such as a wash-boiler1 half or two thirds full of water put on to boil when the pains begin to come about every five minutes4 ,the baby's bathtub should be near at hand for sometimes babies do not breathe quite satisfactorily at first and are helped to do so by being held in a tub of warm water4 ,there should be1 also1 a box1 basket or crib1 in readiness to receive the baby1 furnished with a clean blanket and hot water bottle with a flannel cover4 ,these are the preparations which may be made during the first stage--that period when the cervix is being slowly but steadily dilated by the bag of waters as it is forced downward by the uterine contractions4 ,you feel these as pains beginning in the back1 and finally in the lower abdomen and thighs1 gradually growing stronger and more frequent4 ,second ,stage4 ,the first stage is ended1 and the second stage begins1 when the cervix is wide enough for the baby to pass through4 ,from this time on you should stay in bed and if neither the doctor nor the nurse has arrived1 your cool-headed friend must stand by and not leave you alone4 ,the bag of waters usually1 though not always1 breaks at this time1 and there is a rush of fluid4 ,but the character of the pains changes even though the membranes do not rupture4 ,they come about every two minutes1 now1 from the beginning of one pain to the one following1 each pain lasting about a minute4 ,they are stronger and more forcible and you begin to have an uncontrollable desire to strain or bear down4 ,if the doctor or nurse is with you1 they will tell you how to use your pains to advantage1 but if they are not there you would better avoid bearing down since you want to retard the baby's birth1 if possible1 until one or the other arrives4 ,in such a case1 you may delay matters by opening your mouth and breathing deeply during pains and by lying on your side4 ,we all know that in spite of the most careful planning1 babies are sometimes born before the arrival of doctor or nurse and that the mother and her cool-headed friend1 who is standing by1 meet the emergency together4 ,fortunately1 births occurring under such circumstances are not the ones that are likely to be associated with trouble for either mother or baby1 so there is little or no cause for concern4 ,most doctors feel that the wisest course for the cool-headed friend to follow at such a time is to do nothing at all4 ,so if the baby arrives in advance of the doctor1 why1 he is here1 and that is about all there is to it6 ,the moment you have been longing for1 for nine long months1 has come2 your anxiety and waiting are all over1 and with much less trouble than you expected4 ,third ,stage4 ,after the baby is born1 your pains will subside for a few moments and then the uterus will begin again to contract and gradually detach the placenta from its inner surface1 forcing it out just as the baby was expelled4 ,in the meantime the baby is lying on the foot of the bed with the cord connecting him with the placenta which is still within your uterus4 ,under no circumstances should anyone pull on the cord to aid in the expulsion of the placenta4 ,it will come away1 naturally1 in due time4 ,when the placenta is finally expelled1 the third and last stage of labor is over4 ,in case you and your cool-headed friend feel that something should be done1 perhaps ,i would better assure you once more that when a baby is born so quickly and easily that he arrives before the doctor1 you have cause for relief only--not anxiety4 ,practically the only unfavorable conditions which may arise are hemorrhage in your case and failure to breathe satisfactorily1 on the part of the baby1 and you and your cool-headed friend may as well understand how simply these possibilities may be met4 ,although1 as everyone knows1 there is normally a certain amount of blood lost at the time of confinement1 varying from one half to one pint1 this is accepted as a matter of course4 ,a serious hemorrhage very rarely occurs because of one of ,nature's ingenious provisions4 ,the tiny muscle fibers that make up the uterine wall run in every direction1 criss-cross1 up and down and around1 forming a veritable tangle4 ,after the placenta comes away1 all of these little fibers contract1 or grow shorter1 and the result is that the muscles squeeze down upon the blood-vessels so tightly that they are closed and blood cannot escape4 ,accordingly1 as long as the uterine muscles are contracted there can be no hemorrhage4 ,the fortunate thing about this is that you can find out if they are contracted1 and if they are not1 you1 yourself can stimulate them to do so4 ,if you will press your fingers down deep into your abdomen1 near the navel1 you will feel the uterus as a hard round mass1 which is often likened to a baseball4 ,if it continues to feel hard and round there cannot be any serious amount of bleeding1 but if it becomes soft1 the tiny muscle fibers are relaxing their grip on the vessels and bleeding may possibly occur4 ,quite naturally the thing to do1 then1 is to stimulate the muscles to contract and this is done by kneading the uterus through the abdominal wall4 ,you will feel it grow hard under your hand and then you will know that everything is all right4 ,your friend may want to bathe you and put on a pad but it would be better to leave this for the doctor or nurse for this reason3 ,childbed fever is the result of introducing infective material into the vagina4 ,remember that4 ,if no germs gain entrance1 there will be no childbed fever4 ,when your baby came quickly and there was a rush of water1 your vagina was well washed out4 ,if you and your friend keep fingers and everything else away from the vaginal outlet and the area immediately surrounding it1 it will remain clean and you need not worry about the possibility of infection4 ,perhaps ,i have given more space to all of this than seems warrantable1 but ,i want you to know just what is going on so that you will not be worried4 ,and also1 in order that you will not make trouble for yourself by trying to do something when all that you really need do is to lie still1 as comfortably as possible1 keep your hand on the uterus and knead it enough to keep it hard4 ,if your friend can slip out the wet sheet and put a dry one in its place1 without your having to turn over1 you will be just that much more comfortable1 but the doctor will attend to everything else when he comes4 ,next the baby4 ,presumably he is lying there on the foot of the bed1 all safe and sound1 trying to get used to the new order of things4 ,he is probably making his presence known by crying lustily and though the day may come when that sound will not be altogether pleasant1 it is nothing short of music to you now1 for you have been waiting a long time to hear it4 ,the baby has come from a very warm place and has suddenly undergone the most abrupt change in his entire mode of living that he will ever experience1 so the transition should be made as easy for him as possible4 ,there are two things which he must do immediately1 that your body has been doing for him4 ,he must breathe through his lungs and he must keep his body warm4 ,if he has cried loudly1 your faithful cool-headed friend may just wrap a little blanket about him1 letting him lie as he is until the doctor comes1 taking care that his face is not covered for he needs plenty of air4 ,if the room is chilly she might place a flannel covered bag of warm water beside him outside the blanket4 ,if the baby has not really cried lustily1 as we know that even the youngest baby can1 he should be made to cry1 as that is the way he gets his breathing apparatus to running as it should4 ,your friend may take one of the clean little gauze squares that you prepared1 and wrapping it around her little finger reach well back into the baby's mouth and remove any mucus that may be lodged there and interfere with his breathing4 ,she will do this more easily and thoroughly if she will pick the baby up by the feet1 with one finger between his slippery little ankles so that her grip will be firm1 and wipe out his mouth as he hangs head down4 ,illustration3 ,,fig4 #bd4--;,helping the new baby to breathe by holding him head downward and sharply spanking him4 ,note that the nurse has one finger between the baby's ankles to prevent his slipping from her hand4 ,the main thing to remember is that the lining of that new little mouth is as delicate as a rose leaf and if it is wiped with other than the gentlest stroke the surface may be injured and give trouble later on4 ,while he is hanging1 head down1 your friend may rub his back or stroke it with her free hand and in all probability you will then hear the baby use his lungs to your heart's content4 ,but if he still does not cry well he may be sharply spanked two or three times as shown in ,fig4 #bd4 ,in this picture the cord has been cut and the baby is removed from the bed1 but that is not necessary for it is very common to hold the baby up1 wipe out his mouth1 stroke his back or spank him1 before the cord is cut4 ,you need not be at all disturbed if your baby needs these little forms of encouragement1 at first1 for remember that all of a sudden he is given some very complicated and taxing work to do and it is only reasonable that he should have all possible help as he undertakes it4 ,remember1 too1 in looking forward to this event1 that the probability that you or your friend will have to think of any of these things is very remote for the doctor and nurse are almost certain to be with you1 and you will be able to give yourself over entirely to being very happy that at last your baby has come4 ,,the ,,miracle#a ,by ,,elizabeth ,,newport ,,hepburn ,the wind blows down the street1 ,a shutter bangs somewhere1 ,while twilight falls as softly as ,a woman's flowing hair4 ,within a quiet room1 ,adventurers at rest1 ,a mother holds her new-born son1 ,safe1 now1 upon her breast6 ,for out of ,night and ,pain1 ,the womb of mystery1 ,is sprung this miracle of ,life ,that she can touch and see4 ,no seer's prophetic dream1 ,no star in all the skies ,burns with a luster half so bright ,as happy mother eyes4 ,no questor for the ,grail1 ,no searcher for the ,truth1 ,counts more than those who bear and rear ,and love and nurture ,youth6 ,within her curving arm1 ,all safe and warm he lies1 ,the heir of all that ,man has won ,down countless centuries6 ,footnote #a3 ,written expressly for 8,obstetrical ,nursing0 by ,carolyn ,conant ,van ,blarcom4 ,,chapter ,,viii ,,the ,,baby',s ,,mother ,for the first week or two after the baby comes1 you will be in bed1 of course2 your doctor will come in often and you will doubtless be cared for by a nurse devoted exclusively to you1 or by a visiting nurse aided by members of your family4 ,you will find that it is money well spent to keep the nurse1 or someone else1 to care for and help you1 for six or eight weeks after the baby's birth1 or longer if possible4 ,adequate care after childbirth accomplishes two important ends4 ,it practically always averts such immediate complications as hemorrhage and infection and it prevents more or less chronic invalidism4 ,infection is prevented by the scrupulously clean care which is given to your breasts and perineum1 while hemorrhage is avoided by keeping you quiet and closely watching the condition of the uterus4 ,later invalidism is prevented by the many precautions which enter into your general care4 ,these relate to your position in bed1 diet1 fresh air1 rest1 exercise1 bathing1 attention to your bowels2 observance of symptoms and conserving all of your forces while increasing your strength4 ,all of these details are important1 for during the five or six weeks after confinement certain changes take place in your body which return it very nearly to its pre-pregnant state1 and lack of watchful care while these changes are in progress may retard them and result in your being more or less permanently wretched4 ,make every effort1 therefore1 to secure the care that you need during this transitional period of five or six weeks called the puerperium4 ,you will doubtless feel a little tired and nervous at first1 for you have been through something of an ordeal1 but when one considers the great things that your body has accomplished1 your recovery and return to a normal condition will be surprisingly rapid4 ,during the first few days you are likely to have little or no appetite but be very thirsty2 be constipated2 perspire freely and have an increased amount of urine1 which you may have difficulty in passing2 but these conditions are only temporary4 ,in the beginning you will probably be nursed just about as anyone would be after a slight operation1 with the addition of special attention to your breasts and perineum to prevent infection1 and the toning up of abdominal muscles4 ,in order to prevent bleeding and hasten your recovery you will be kept very quiet for a day or two1 perhaps flat on your back2 you may not be allowed to have any visitors and your diet1 at first consisting of liquids1 will finally be made up of light1 easily digestible but nourishing food4 ,about the sixth or eighth day you will probably begin to sit up in bed and about the ninth or tenth day you may be allowed to sit up in a chair for a little while4 ,some young mothers are able to sit up for an hour the first time1 without fatigue1 while others can sit up for only a few moments1 morning and afternoon1 on the first day1 gradually lengthening the period each time that they get up4 ,you will probably be able to sit up an hour or so longer on each successive day and walk a few steps on the third or fourth day after getting up4 ,these first few days of being up and trying to walk are often tiring1 and a little discouraging in consequence1 but of course you will gain steadily1 even though it be slowly1 do a little more each day and gradually feel more and more like your old self4 ,the mother who has stitches1 because of the perineum having been torn at the time of the baby's birth1 does not usually sit up in bed until the ninth or tenth day1 when the stitches are removed1 sitting up in a chair for an hour1 two or three days later4 ,in connection with tears it may be well for you to know that in spite of the most skillful and careful efforts to prevent them1 tears of some degree usually occur when the first baby is born and in about half of the confinements that follow4 ,but as most tears are very slight and are immediately repaired they have little or no effect upon one's comfort or general health4 ,it is ordinarily considered a safe precaution to avoid going up and down stairs until the baby is about four weeks old and not wholly to resume normal activities within six or eight weeks after his birth4 ,a pinkish or red discharge or backache1 after the mother gets up are regarded as indications that she is not quite ready to do much standing or walking and that she still needs a good deal of rest4 ,the whole question of the time for sitting up1 of getting up and of walking about varies so with different individuals1 as you see1 that it is not possible to describe a definite routine1 for some women recover slowly and would be injured by getting up and about at a period which would be entirely safe and normal for the majority4 ,the doctor has to decide what is best in each case4 ,while you are being actually nursed as a bed patient1 especial attention is given to the bathing of the perineum1 as has been stated2 the care of the breasts and restoring tone to your abdominal muscles1 so we may well have a word of explanation about each of these details4 ,the ,perineum4 ,the nurse will bathe the area between your thighs very carefully1 at regular intervals1 using pledgets soaked in some kind of antiseptic solution1 and put on a fresh one of the sterile pads that you made and sterilized some weeks back4 ,this attention is partly to promote your comfort and partly to remove any infective material that may be present1 thus preventing fever4 ,after the care that you have had up to this time1 it will scarcely be possible for you to have childbed fever if all infective material is kept away from the vaginal outlet4 ,i speak of this in order that you may realize how important it is for you to avoid touching these parts with your fingers1 upon which there are almost certain to be germs4 ,there is little doubt that women sometimes seriously infect themselves after the doctor and nurse have taken the most scrupulous care to protect them from this very complication4 ,your breasts will be given painstaking care in order that the baby may nurse satisfactorily and to prevent both sore nipples and breast abscesses4 ,if you cared for your breasts during the latter part of pregnancy as was advised in ,chapter ,v and will continue to observe ordinary precautions while the baby is nursing1 it is not at all likely that you will have any trouble with your breasts4 ,the main features of the care of your breasts1 now1 are keeping the nipples clean and supporting the breasts themselves if they grow heavy enough to be uncomfortable4 ,this latter condition is not uncommon about the third or fourth day after the baby is born1 when the colostrum is replaced by what one might call almost a rush of milk4 ,the breasts may then become hard1 swollen and uncomfortable and sometimes a sensitive lump or 8cake0 may be felt4 ,the usual course1 nowadays is simply to support those swollen breasts and to apply ice bags or hot compresses to the painful areas4 ,there are innumerable bandages and methods for supporting heavy breasts1 any one of which is satisfactory so long as it meets the two chief requirements3 to lift the breasts1 suspending their weight from the shoulders1 and1 while fitting snugly below1 to avoid making pressure at any point1 particularly over the nipples4 ,one may take a towel for example1 or a straight strip of muslin1 fasten it around the chest1 pin in darts below the breasts with safety-pins1 and provide support by means of shoulder straps1 attached with safety-pins to the front and back of the binder4 ,fig4 #be shows such a binder being used to hold ice bags in place1 for which also it is satisfactory and very easily devised4 ,illustration3 ,,fig4 #be4--,straight binder for supporting heavy breasts1 or holding ice caps in place on breasts that are painful4 ,darts are pinned in below the breasts and the binder is held up by shoulder straps1 pinned on front and back4 ,illustration3 ,,fig4 #bf4--,supporting heavy breasts by means of three folded towels2 one fastened about the waist1 one over each shoulder1 crossing front and back4 ,three folded towels or folded bands of muslin will provide a comfortable support if applied in the sling-like manner indicated in ,fig4 #bf2 the ,indian binder shown in ,fig4 #bg1 made of cheesecloth or any soft material is cool1 light and very comfortable1 and in addition to these improvised binders there are several entirely satisfactory brassires1 opening down the front1 to be bought in the shops4 ,happily the discomfort from swollen breasts lasts only a day or two1 for in some mysterious way ,nature makes an adjustment between the amount of milk produced by the mother and that withdrawn by the baby4 ,so as he comes to nurse regularly and satisfactorily1 the excessive supply of milk disappears1 and with it the discomfort4 ,illustration3 ,,fig4 #bg4--;,indian binder for supporting heavy breasts1 used at ,the ,montreal ,maternity ,hospital4 ,the tapering ends tie in a knot in front4 ,the care of the nipples practically resolves itself into keeping them clean in order to avoid infection4 ,notice that ,i say keeping them clean1 for merely bathing them1 no matter how regularly1 is not enough4 ,the nurse will probably bathe your nipples with boracic acid solution and sterile cotton pledgets before and after each time that the baby nurses1 and keep them covered1 during the intervals1 with sterile gauze or cotton4 ,illustration3 ,,fig4 #bh4--,sterile gauze held in place over nipples by means of tapes and adhesive strips4 ,here again you may undo all of the nurse's careful precautions against infection1 which might cause an abscess1 if you touch your nipples with your fingers or anything else that is not sterile1 except the baby's mouth4 ,the gauze squares or sponges or the cotton pledgets that you sterilized will serve excellently to protect your nipples between nursings4 ,these may be held in place by a binder or by tapes tied through the ends of narrow strips of adhesive plaster1 four being applied to each breast as shown in ,fig4 #bh4 ,strips of adhesive plaster about five inches long are folded back at one end so that two adhesive surfaces stick together for about an inch4 ,through a hole cut in this folded end a narrow tape or bobbin is tied1 and the strips are applied to the breast1 beginning at the margin of the darkened area and extending outward4 ,the free ends of the tapes are tied over pads of gauze or cotton between nursings1 and untied to expose the nipple at nursing time4 ,lead shields are sometimes used to protect the nipples1 being held in place by means of a binder4 ,these shields should be scoured and boiled daily4 ,method of ,nursing4 ,one important reason for all of this scrupulous care is that it favors the baby's nursing satisfactorily and without interruption1 so now you will want to know about the actual details of nursing him4 ,the baby is usually put to the breast for the first time1 between eight and twelve hours after he is born4 ,this gives the mother an opportunity to rest1 and the baby too profits by being quiet and undisturbed during this interval4 ,his need for food is not great as yet1 nor is there much if any nourishment available for him4 ,there is no hard and fast rule for the mother's position in bed1 while nursing her baby1 beyond the fact that both she and the infant should be in a relation that makes the nursing easy4 ,one very natural and satisfactory method is for her to turn slightly to one side1 and hold the baby in the curve of her arm so that he may easily grasp the nipple on that side4 ,if you take this position you should hold your breast from the baby's face with your free hand by placing the thumb above and the fingers below the nipple1 thus leaving his nose uncovered to permit free breathing1 as shown in ,fig4 #bi4 ,you and the baby should lie in such positions that both will be comfortable and relaxed and the baby will be able to take into his mouth1 not only the nipple but much of the dark circle as well1 so as to compress the base of the nipple with his jaws and extract the milk by suction4 ,the comfort of this position is sometimes increased by laying the baby on a small pillow placed close to the mother's side1 thus raising his body to the level of his head as it rests upon her arm4 ,you and the nurse may have to resort to a number of expedients in persuading the baby to begin to nurse1 for he does not always take the breast eagerly at first4 ,he must be kept awake1 first and foremost1 and sometimes suckling will be encouraged by patting or stroking his cheek or chin or lightly spanking his buttocks4 ,if his head is drawn away from the breast a little1 as he holds the nipple in his mouth1 he will sometimes take a firmer hold and begin to nurse4 ,moistening the nipple by expressing a few drops of colostrum or with sweetened water may whet the baby's appetite and thus prompt him to nurse4 ,illustration3 ,,fig4 #bi4--;,a comfortable position for mother and baby1 while nursing in bed4 ,you must be prepared to find the early attempts to nurse your baby far from satisfactory1 but if you persevere in making attempts regularly1 you will almost certainly succeed4 ,during the first two or three days the baby obtains only colostrum while nursing1 but the regular suckling is extremely important1 not alone for the sake of getting him into the habit of nursing but because his suckling is the best and surest means of stimulating your breasts to produce milk4 ,and1 as we shall see in a moment1 the irritation of the nipples in this manner so definitely promotes desirable changes in the uterus that these go on more rapidly in women who nurse their babies than in those who do not4 ,illustration3 ,,fig4 #cj4--,protecting cracked or sore nipples by having the baby nurse through a shield4 ,if your nipples are not sufficiently prominent for the baby to grasp them1 or if they become sore1 you may have to use a shield for a while as shown in ,figs4 #cj and #ca1 but the shield should be discarded as soon as possible for it is the baby's suckling that produces the desired effects4 ,if a shield is used1 it should be washed and boiled after each nursing and kept in a sterile jar or solution of boracic acid1 between times4 ,the length of the nursing periods1 and the intervals between them1 are decided upon by the doctor according to the needs and condition of each baby3 his weight1 vigor1 the rapidity with which he nurses1 the character of his stools and his general condition4 ,the length of the nursing periods themselves1 is usually from ten to twenty minutes1 the intervals between them being measured from the beginning of one feeding to the beginning of the next1 and are fairly uniform for babies of the same age and weight4 ,illustration3 ,,fig4 #ca4--,nipple shield used in ,fig4 #cj4 ,the average baby nurses about every six hours during the first two days1 or four times in twenty-four hours4 ,after this1 according to one schedule1 he will nurse every three hours during the day for about three months and at #aj p4m4 and #b a4m41 or seven times in twenty-four hours4 ,from the third to the sixth month he nurses every three hours during the day and at ten o'clock at night1 or six times in twenty-four hours1 and from that time until he is weaned he nurses at four-hour intervals during the day and at ten o'clock at night1 or five times daily4 ,such a feeding schedule may be arranged in a table as follows3 ,day ,night ,first and second days #f #ab #f #ab ,first three months #f #i #ab #c #faj #b a4m4 ,third to sixth month #f #i #ab #c #faj ,after the sixth month #f #aj #b #f #aj ,it is becoming more and more common to omit night feedings after ten o 'clock with the average baby who is in good condition even during the first three months4 ,when this practice is adopted the baby seems not only to do as well as he normally should1 but to profit by the long digestive rest during the night4 ,certainly the mother is benefited by the unbroken sleep thus made possible4 ,as a rule the baby nurses from one side1 only1 at each nursing1 emptying the breasts alternately1 but if there is not enough milk in one breast for a complete feeding both breasts may be used at one nursing4 ,neither you nor the baby should go to sleep while he is at the breast1 but he should pause every four or five minutes to keep him from feeding too rapidly4 ,after you sit up you will find it a good plan to occupy a low1 comfortable chair while nursing the baby4 ,lean slightly forward and raise the knee upon which the baby rests by placing your foot on a stool2 support his head in the curve of your arm and hold your breast from his face though slightly above it1 just as you did while nursing him in bed4 ,nurse him in a quiet room where you will not be disturbed and where neither your breasts nor the baby will be exposed to drafts or the possibility of being chilled4 ,some mothers like to lie down while nursing the baby1 for in addition to finding the position comfortable they are glad to have these regular1 though short periods of rest4 ,abdominal ,binders and ,bed-,exercises4 ,most women are interested in this question as it concerns the restoration or preservation of the 8figure40 ,the application of a snug binder for the first day or two after the baby comes1 is a fairly common practice1 for many women are very uncomfortable as a result of the sudden release of tension on their abdominal walls1 a discomfort which a binder relieves4 ,and during the first few days after the mother gets up and walks about she is sometimes given great comfort by a binder that is put on and snugly adjusted about her hips and the lower part of her abdomen1 as she lies on her back4 ,in addition to this1 some doctors like to have the young mother wear a snug binder throughout her entire stay in bed1 while others instruct their patients to take bed exercises4 ,if the binder is your portion1 you have nothing to do but wear it1 for some one else must put it on you4 ,but if bed exercises are in order1 the following descriptions and pictures of the exercises taken by young mothers at the ,long ,island ,college ,hospital may be helpful4 ,the day upon which the exercises are started1 the rate at which they are increased and the length of time during which they are continued1 are1 of course1 entirely regulated by the doctor according to the strength and needs of each patient1 for they are never continued to the point of fatigue4 ,quite evidently1 then1 there can be no definite directions for these exercises2 one can give only a description of the positions and movements that are frequently used and the order in which they are adopted4 ,the average mother who is recovering normally begins the chin-to-chest exercise from twelve to twenty-four hours after the baby's birth4 ,she lies flat on her back and raises her head until the chin rests upon her chest4 7,see ,fig4 #cb47 ,by resting her hand upon the abdomen she feels for herself that the abdominal muscles contract as she lifts her head and accordingly realizes that she is actually exercising them4 ,the movement is usually repeated twenty-five times1 morning and evening1 every day and continued as long as the patient is in bed4 ,illustration3 ,,fig4 #cb4 ,,figs4 #cb to #ch inclusive are bed exercises the young mother4 ,for description see text4 7,from photographs taken at the ,long ,island ,college ,hospital47 ,illustration3 ,,fig4 #cc4 ,the familiar deep-breathing exercise comes next and is ordinarily started on the third or fourth day4 ,the mother lies flat1 with her arms at her sides1 then extends them straight out from the shoulders 7,fig4 #cc71 raises them above her head1 as in ,fig4 #cd1 and returns them to their original position4 ,she repeats this exercise ten times morning and evening as long as she is in bed4 ,illustration3 ,,fig4 #cd4 ,illustration3 ,,fig4 #ce4 ,the one-leg flexion exercises are not taken by mothers who have stitches1 but in other cases they are usually started about the fifth day4 ,one thigh is flexed sharply on the abdomen and the foot brought down to the buttocks as in ,fig4 #ce4 ,the leg is then straightened out and lowered to the bed4 ,this is repeated ten times1 with each leg1 morning and evening1 for two or three days4 ,illustration3 ,,fig4 #cf4 ,the next exercise sometimes replaces the one-leg-flexion and sometimes it is taken up in addition to it1 being started after the former has been done for a day or two1 according to the strength of the mother4 ,both thighs are brought up on the abdomen in this one1 as in ,fig4 #cf1 but when the legs are straightened the feet are lowered not quite to the bed1 as in ,fig4 #cg1 before being raised again4 ,this is repeated ten times morning and evening4 ,illustration3 ,,fig4 #cg4 ,then comes the exercise for which the leg-flexions prepare the mother and which are sometimes discontinued when this one is adopted4 ,it is started1 as a rule1 about the seventh day1 or two or three days before the mother gets up4 ,both legs are slowly raised to a position at right angles to the body1 as in ,fig4 #ch1 and slowly lowered but not far enough for the heels to touch the bed 7see ,fig4 #cg71 and the movement repeated4 ,as this exercise requires a good deal of effort it is taken up very gradually1 somewhat as follows3 ,the legs are raised once in the morning and twice in the evening of the first day2 second day1 three times in the morning and four times in the evening2 third day1 five times in the morning and six times in the evening and so on1 if the mother is not fatigued1 until the exercise is repeated ten times or more each morning and evening for several months4 ,illustration3 ,,fig4 #ch4 ,the knee chest position shown in ,fig4 #ci is intended to prevent a misplacement of the uterus1 from which so many women suffer after childbirth4 ,it is usually started about the seventh day and the patient begins by being assisted to that position and keeping it for a moment or two1 gradually lengthening the time to about five minutes each morning and evening2 this is often continued for two months or more4 ,walking on all fours is violent exercise and is taken up very gradually4 ,some women are able to attempt it on the first day out of bed1 if they have been taking the other exercises regularly1 but as a rule it is not started until the second1 third or fourth day after getting up4 ,the clothes are free from all constrictions1 pajamas being very satisfactory2 the knees are held stiff and straight with the feet widely separated1 to allow a rush of air into the vagina1 and the entire palmar surface of the hands rests flat on the floor4 7,see ,fig4 #dj47 ,the patient starts by taking only a few steps each morning and evening1 gradually lengthening the walk to five minutes twice daily and continuing it for about two months4 ,it is believed that as the young mother walks in this position the uterus and rectum rub against each other1 producing something the same result as would be obtained if it were possible to massage them1 the effect of this being to promote involution1 which will be explained later1 and lessen the tendency toward constipation and uterine misplacement4 ,illustration3 ,,fig4 #ci4--,knee chest position4 ,the general purpose of these exercises1 as a whole1 then1 is to strengthen the abdominal muscles1 thus helping to prevent a large1 pendulous abdomen2 to increase the convalescing mother's general strength and tone just as exercise benefits the average person2 to promote involution 7,see page #acd72 to prevent misplacement of the uterus and in a measure to relieve constipation4 ,in order that the exercises may accomplish these much-to-be-desired ends1 the doctors who advise them feel that it is important for them to be taken with moderation and judgment2 started slowly2 increased gradually and constantly adjusted to the strength of the individual mother4 ,illustration3 ,,fig4 #dj4--,walking on all fours4 ,otherwise they may do more harm than good4 ,concerning the changes that take place in your body during the puerperium1 the ones that will interest you particularly are3 7#a7 the shrinkage in the size of your uterus and its gradual descent into the pelvis where it was before the baby began his life within it2 7#b7 the production of milk by your breasts2 7#c7 a loss of body weight4 ,the ,uterus4 ,immediately after delivery the uterus weighs about #b pounds2 is from #g to #h inches high2 about #e inches across and #d inches thick4 ,the top of the uterus1 or fundus1 may be felt just below the navel and the inner surface where the placenta was attached1 is raw and bleeding4 ,at the end of six or eight weeks the organ has descended into the pelvic cavity and resumed approximately its original position and size and its former weight of #b ounces4 ,this return of the uterus to practically its pre-pregnant state is called involution and in the interest of your immediate recovery and future health it is important that this shall progress normally4 ,there is evidently a close relation between the functions of the breasts and of the uterus and accordingly involution is likely to progress more satisfactorily in women who nurse their babies than in those who do not4 ,the so-called 8after-pains10 also1 are affected by nursing1 being more severe1 as a rule1 when the baby is at the breast than at other times4 ,these pains are caused by alternate contractions and relaxations of the uterine muscles and are more common in women who have had other children than after the first baby4 ,these pains usually subside after the first twenty-four hours1 though they may persist for three or four days4 ,in connection with the changes that take place in the uterus1 the discharge called lochia should be mentioned4 ,this is quite profuse and bloody at first but if the uterus involutes normally the discharge gradually decreases in amount and fades in color1 until by the end of the puerperium it has entirely disappeared4 ,the ,production of ,milk4 ,during the first two or three days after the baby is born1 the breasts secrete a small amount of yellowish fluid called colostrum1 which differs somewhat from the milk that comes later4 ,about the third day the meager amount of colostrum is replaced by milk and as this increases rapidly in amount1 the breasts usually become tense and swollen and sometimes painful2 but this discomfort generally subsides in a day or two4 ,the production of milk is definitely stimulated by the baby's suckling and will not continue for more than a few days without this stimulation1 a fact to be remembered if1 for any reason1 it is desirable to dry up the breasts4 ,the end earnestly to be desired is for the breasts to produce a quantity and quality of milk which will adequately nourish the baby during the first eight or ten months of his life1 and with proper care and effort this ideal can nearly always be realized4 ,but if the mother becomes pregnant while nursing her baby--and this sometimes occurs as early as a few weeks after childbirth--the quality of her milk is likely to suffer4 ,the return of menstruation1 however1 does not necessarily affect the milk unfavorably1 as is so generally believed4 ,it is true that in the ideal course of events1 the mother does not menstruate while nursing her baby1 that is1 for eight or ten months1 but it is probable that about one-third of all nursing mothers begin to menstruate about two months after confinement and half of those who do not nurse their babies begin to menstruate in six weeks4 ,a nursing mother may menstruate once and then not again for several months or a year2 or she may menstruate regularly and still nurse her baby satisfactorily4 ,menstruation is more likely to return early after the birth of the first baby than after those born subsequently4 ,mothers sometimes wonder whether this early discharge is menstrual or lochial1 and though they1 themselves1 cannot possibly distinguish between them1 a physician can easily decide by examination1 and in the interest of the mother's future health it is important that this uncertainty be cleared up4 ,the loss of weight is one of the striking changes which take place during the puerperium1 varying in different women from a total loss of from twelve to fifteen pounds4 ,fat women lose more than thin women and those who nurse their babies lose more than those who do not4 ,this loss may be somewhat controlled1 however1 by suitable diet and under most conditions the mother returns to not less than her pre-pregnant weight by the end of the sixth or eighth week4 ,you will recall that there was a general gain in weight1 over the entire body1 during pregnancy1 in addition to the increased weight of the uterus4 ,if all goes well1 your doctor may not call to see you regularly after the first couple of weeks1 but he will probably want to make a thorough examination1 sometime about five or six weeks after the baby's birth4 ,as this examination is a very influential factor in securing your future health you should be sure to have it made4 ,a slight abnormality1 if detected at this time1 may usually be corrected with little difficulty1 but if allowed to persist may result in chronic invalidism1 or necessitate an operation4 ,in case the uterus is not properly involuted1 for example1 or the perineum is found to be flabby1 a little more rest in bed is indicated2 while a uterine misplacement1 which seems to occur in about a third of all cases1 usually may be corrected by the adjustment of a pessary4 ,quite evidently1 then1 it rests with the young mother to coperate with the doctor in guarding against future ill health1 or even operations1 by having this final examination made and following whatever course he prescribes1 as a result of his inspection4 ,most of the discussion in this chapter relates to the care that is given to you by others1 in preparing you to take up life anew1 perhaps unaided1 and assume the care of your baby4 ,as we shall see in the next chapter1 the care of your baby1 for the next few months1 is closely associated with the care which you take of yourself and the regulation of your daily life4 ,,chapter ,,ix ,,the ,,mother',s ,,care ,,of ,,herself--,,for ,,the ,,baby',s ,,sake ,now that you actually have your baby in your arms1 soft and warm and lovely1 you find yourself looking into those wide1 wondering eyes of his and wanting nothing so much as to give him your protection4 ,if he could talk1 as he looks back at you1 ,i fancy your baby would tell you how much your care of him1 during the months before he was born1 has meant1 and then he would beg you to stand by1 very closely1 for a few months more1 until he is a little more used to being a separate person living outside your body4 8,you have given me a wonderful start10 he seems to tell you1 8and now ,i want to go on and develop the best possible mind and body4 ,i shall be able to do this if you will help me1 for what you can give me now is of more importance than what all the rest of the people in the world can give4 ,you can give me through your milk exactly the materials that ,nature intends me to use to develop and build this partly finished body of mine1 and to protect it from disease4 ,just tide me over this most difficult period of my life1 and ,i'll be a credit to us both1 not only as a baby but as a growing child and later as a robust man or woman1 helping to do my share of the world's work4 ,i'll have fine straight limbs to bear me on my way1 a good brain to help me take a creditable place among people who count1 and steady nerves ,i'll have1 that will always be dependable4 ,i'll put into reality the dreams that you and ,i are dreaming1 and when ,i do1 ,i'll look back to these early weeks and months and realize that ,i could not have done it but for you40 ,and so you look into the eyes of this baby of yours and pledge yourself to stand by and do for him all that lies in your power1 realizing already that the keeping of that pledge is going to bring you1 along with its demands1 an endless and satisfying happiness2 a consciousness that you are doing something indispensable to your baby's welfare that no one else in the world can do4 ,you know1 now1 that your baby's greatest single need for the next few months is satisfactory nursing at your breast1 but you will be able to give him this only if your diet and general mode of living are favorable to the production of good milk4 ,quite evidently1 then1 your big service to your baby1 for a while1 is largely a matter of caring for yourself4 ,it seldom happens that the mother who has had good prenatal care1 followed by good care during and after labor1 is unable to nurse her baby if she orders her own life in the way that is known to be necessary to promote and maintain the production of breast milk4 ,the first essential is her real desire to nurse her baby1 next1 her appreciation of the continuous care of herself that is necessary to this end1 and third her whole-hearted willingness to take such care1 for her baby's sake4 ,it is safe to say that if the doctor and the nurse and the baby's mother all want him to nurse at the breast1 and all do everything in their power to make this possible1 they will almost invariably succeed4 ,this assertion can scarcely be made too positively and we should never lose sight of the fact that if the baby is not breast-fed he is being defrauded1 and in the vast majority of cases1 because of insufficient effort on the part of those who are caring for him4 ,practically the only conditions which doctors in general now recognize as sufficient reason for the mother's not nursing her baby are retracted nipples1 tuberculosis1 convulsions1 severe heart or kidney trouble1 certain acute infectious diseases such as typhoid fever1 and the state of pregnancy4 ,when none of these conditions exist1 a favorable frame of mind and a state of good nutrition are the two indispensable factors in establishing breast feeding and maintaining the production of a satisfactory quantity and quality of breast milk4 ,these factors in turn are both affected by the mother's general mode of living4 ,women with happy1 cheerful dispositions usually nurse their babies satisfactorily1 while those who worry and fret are likely to have an insufficient supply of milk or milk of a poor quality4 ,in addition to this sustained influence exerted by the nursing mother's state of mind it is well to remember that the quality of milk that has been entirely satisfactory may be seriously injured1 for the time being1 by a fit of temper1 fright1 grief1 anxiety or any marked emotional disturbance4 ,actual poisons seem to be created as a result of these emotions and they may affect the baby so unfavorably as to make it necessary to give him artificial food1 temporarily1 and empty the breasts by pumping or stripping before he begins to nurse again4 ,i realize that it is not easy entirely to reorganize your life and assume new and exacting duties1 while recovering from an experience resembling an illness in some of its effects1 and still remain calm1 undiscouraged and perpetually cheerful4 ,but each tiny victory that you accomplish in your attempt to achieve this end will bring such satisfaction that you will not count the cost4 ,and the incomparable1 always deepening happiness of watching your very own baby grow lovelier and sturdier1 day by day1 because of the things that you1 and no one else1 are doing1 will make you deny1 even to yourself1 that anything you do is hard4 ,particularly will this be true if you repeatedly remind yourself that the satisfactorily breast-fed baby is much more likely to live through the difficult first year than is the bottle-fed baby1 and also is much less susceptible to disease and infection4 ,we shall consider1 for a moment1 the more important details of the routine care that you should give yourself1 for the baby's sake1 and then we shall be ready for the pleasantest task of all--the actual care of the baby himself4 ,in general you should try to live just a normal1 tranquil1 unhurried kind of life that is unfailingly regular in its daily routine4 ,diet4 ,as was the case during pregnancy1 the question of your diet is an important one4 ,throughout the entire nursing period your food should be such that it will nourish you and also aid in producing milk of a character that will meet the baby's needs1 the needs of a growing1 developing body4 ,the best producer of such milk is a diet consisting largely of milk1 eggs1 8leafy0 vegetables and fresh fruit1 all taken with an appetite made keen by constant fresh air4 ,bear this in mind and it will keep you from putting your faith in so-called milk-producing foods and nostrums4 ,your meals may well be made up from the groups of foods that are suitable for the expectant mother1 as given in ,chapter ,v4 ,at this time1 as during pregnancy1 you should avoid all food that may produce any form of indigestion1 but for the baby's sake now1 as well as your own4 ,while it is not generally believed by doctors of to-day1 that there are many1 if any1 articles of diet which may in themselves injure the mother's milk1 it is generally accepted that if her digestion is upset this may be1 and usually is1 bad for her milk and therefore bad for the baby4 ,certain drugs are excreted through the milk and may affect the baby just as they would if administered to him directly1 as for example alcohol and opium1 from which morphine1 heroin1 codein1 laudanum and paregoric are derived4 ,although the old belief no longer holds sway1 that certain substances from such highly flavored vegetables as onions1 cabbages1 turnips and garlic were excreted through the milk and upset the baby1 it is definitely known that certain substances in certain foods are excreted through the milk to the baby's great advantage4 ,it is necessary to the baby's well-being1 therefore1 that the nursing mother's diet shall include1 regularly1 those articles of food which contain these substances4 ,these foods are milk1 egg-yolk1 glandular organs such as sweetbreads1 kidneys and liver2 the green salads such as lettuce1 romaine1 endive1 and cress and the citrous fruits which are oranges1 lemons1 grapefruit and limes4 ,these are called 8protective foods0 because they protect the body against certain diseases which will be described in the chapter on ,nutrition4 ,it is possible for a baby who nurses at the breast of a woman whose diet is poor in protective foods1 to be so incompletely nourished as to be on the border line of one of these diseases1 or even to develop the disease itself4 ,it becomes apparent1 therefore1 that although you did not have to 8eat for two0 before the baby came1 you have to do so now in certain very important respects4 ,for this reason it may be advisable for you to increase the nourishment provided by your three regular meals by taking a glass of milk1 cocoa1 or some beverage made of milk1 during the morning and afternoon and before retiring4 ,the morning and afternoon lunches would better be taken about an hour and a half after breakfast and luncheon1 respectively1 in order not to spoil your appetite for the meals which follow4 ,it is of considerable importance that you take your meals with clock-like regularity and enjoy them1 as enjoyment promotes digestion2 but at the same time you should guard against overeating for fear of causing indigestion1 as this1 you know1 is almost sure to upset the baby4 ,rich and highly seasoned foods1 in fact any articles of food or drink which might upset you1 should be avoided for the same reason4 ,drink water freely but do not take alcohol nor strong tea or coffee without your doctor's permission4 ,summing up the matter of your diet1 we find that you should have light1 nourishing1 easily digestible food1 consisting chiefly of cereals1 creamed dishes1 creamed soups1 eggs1 meat in moderation1 salads and the fresh fruits and vegetables that ordinarily agree with you4 ,many doctors advise at least a quart of milk daily1 in addition to that which is used in preparing the meals and an abundance of water to drink4 ,bowels4 ,your bowels should move freely and regularly every day1 but you should not take cathartics1 or even enemata without your doctor's order4 ,you probably will be able to establish the habit of a daily movement by taking exercise1 eating bulky fruit and vegetables1 drinking an abundance of water and regularly attempting to empty your bowels at the same time every day1 preferably immediately after breakfast4 ,rest and ,exercise4 ,you will not be likely to thrive1 nor will the baby1 unless you have adequate rest and sleep and take daily at least a moderate amount of exercise in the open air4 ,you need eight hours sleep1 out of twenty-four1 in a room with the windows open1 and as fatigue is bad for your milk it may be a good plan for you to lie down for a while every afternoon4 ,your exercise will1 of course1 have to be adjusted to your tastes1 habits1 circumstances and physical endurance1 for it must always be stopped before you are tired4 ,walking is often the best form of exercise that the nursing mother can take and though as a rule she may engage in any mild sports that she enjoys1 violent exercise is inadvisable because of the exhaustion that may follow4 ,recreation4 ,part of the value of exercise lies in the pleasure and diversion which it offers1 for as we have seen1 a happy1 contented frame of mind is practically indispensable to the production of good milk4 ,in addition to some regular and enjoyable exercise1 therefore1 you need a certain amount of recreation and change of thought and environment4 ,if life is monotonous and colorless1 the average woman is almost sure to become irritable and depressed2 to lose her poise and perspective2 to worry and fret1 and then1 no matter what she eats nor how much she sleeps1 her digestion will suffer1 her milk will be affected and the baby will pay4 ,this1 of course1 goes back to the question of the young mother's mental state and the condition of her nerves as determining factors in her ability to nurse the baby successfully4 ,just here it is important to say a word of caution about this very question of your attitude of mind1 particularly as it relates to your care of yourself4 ,it may be that one of the most difficult tasks you will have will be that of getting out of the habit of accepting the position that borders on being an invalid--of being a protected person who is thought about1 cared for and considered at every turn4 ,this has been your position for several months and the most natural result of it all is a tendency to cling1 perhaps ever so little and even unconsciously1 to this very pleasant state4 ,it is not possible for anyone to reduce so broad and intangible a subject to a few definite words of advice4 ,but think it over for yourself and try to strike that happiest of happy mediums that lies somewhere between the equally harmful courses of coddling yourself and of overdoing4 ,a good many doctors think that for the sake of giving the nursing mother an opportunity to go out1 mingle with her friends1 take in some music or a play1 it is often a good plan to replace one breast feeding1 sometime in the course of each day1 with a bottle feeding4 ,the freedom which this long interval between two nursings gives the mother for diversion and amusement1 will often affect her general condition so favorably that the quality of her milk is definitely better than it otherwise would be and the baby is benefited as a result4 ,this single supplementary feeding cannot be regarded lightly1 however1 for it must be prepared with the same cleanliness and accuracy as an entirely artificial diet1 which will be described in the next chapter4 ,weaning4 ,one advantage in giving the baby a supplementary bottle once a day1 is that it paves the way for weaning1 when the time comes to make this change4 ,under ordinary conditions1 the mother begins to wean her baby about the eighth or tenth month4 ,having started by replacing one breast feeding1 daily1 with a bottle feeding1 she gradually increases the number of bottles given daily until the breast feedings are discontinued by the time the baby is eleven or twelve months old4 ,there are exceptions to this general rule1 of course1 and under any conditions the weaning should always be directed by a doctor1 for the baby may suffer seriously unless the change in food is skillfully made4 ,if the mother's milk is satisfactory and the baby is doing well1 it is often considered wise not to discontinue the breast feeding entirely1 during the hot summer months even though the weaning falls due at this time4 ,it was formerly deemed advisable to wean the baby for any one of several reasons1 but at present the only indications for this step which seem to be generally accepted by the medical profession1 are3 pulmonary tuberculosis1 acute infectious diseases in the mother and pregnancy4 ,menstruation was long regarded as incompatible with satisfactory nursing1 but it is now known that if the mother is taking proper care of herself and is in generally good condition1 the impoverishing effect of menstruation upon the milk is usually for the duration of the periods only4 ,it may be necessary to supplement the breast feeding with suitably modified cows' milk during menstruation1 but the baby should be put to the breast regularly1 just the same1 for if the stimulation of the baby's suckling is discontinued1 the temporary reduction in the amount of the milk secreted will probably become permanent4 ,the state of pregnancy1 however1 is different1 for though some women nurse a baby satisfactorily for some months after becoming pregnant1 it is not considered advisable to subject any woman to the combined strain of pregnancy and nursing4 ,moreover1 the mother's milk is usually so impoverished during pregnancy that the nursing baby suffers in consequence4 ,drying up the breasts used to be a great bugbear4 ,lotions1 ointments and binders were employed and often a breast pump as well4 ,various drugs were given by mouth and the mother was more or less rigidly dieted4 ,it is true that some of these measures are still employed and are followed by a disappearance of the milk4 ,but at the same time1 the breasts dry up quite as satisfactorily when none of these things are done1 provided the baby does not nurse4 ,it is not known what starts the secretion of milk in the mother's breasts1 but certain it is that absence of the baby's suckling stops it4 ,if it is left to you to dry up your breasts1 your safest course will be to do nothing beyond applying a supporting bandage1 if your breasts are heavy enough to be uncomfortable1 and keeping your nipples scrupulously clean4 ,you may rely absolutely upon the fact that the baby's suckling is the most important stimulation in promoting the activity of the breasts and if this stimulation is not given1 or is removed1 the secretion of milk will invariably subside in the course of a few days4 ,this is true whether the reason for drying up the breasts is that the baby is stillborn or has died1 or a live baby's nursing is discontinued4 ,it is true that the breasts may be swollen and very uncomfortable for a day or two1 and in addition to a supporting bandage the doctor may order sedatives1 but the discomfort subsides as the milk disappears4 ,quite naturally you will not drink an extra amount of milk if you are drying up your breasts1 but it probably will not be necessary to place any other restrictions upon your diet4 ,in thinking over the nursing period as a whole1 we find that after all it is a fairly simple matter so to order one's life as to promote and maintain a satisfactory supply of milk4 ,the milk thus produced is the ideal baby food and there is no entirely adequate substitute4 ,never forget that4 ,it gives the baby enormously increased chances of living past babyhood and protects him from many diseases4 ,quite evidently breast feeding is every baby's birthright and his mother is the only one who can deprive him of it4 ,,chapter ,x ,,the ,,mother',s ,,care ,,of ,,her ,,baby 8,the mother is the natural guardian of her child2 no other influence can compare with hers in its value in safeguarding infant life40--,sir ,arthur ,newsholme4 ,before undertaking the care of the new baby1 suppose we stop for a moment1 and consider just what he represents2 what he has been through2 what struggles and dangers are ahead of him2 what are the weaknesses of his equipment to meet these perils and what must be the character of your service to him if you are to do quite all in your power to help him safely over this hazardous period of early infancy4 ,at the time of birth1 the baby makes the most complete and abrupt change in his surroundings and condition that he will make during his entire lifetime4 ,for nine months he has existed under ideal conditions2 he has been safeguarded from injury2 kept at the temperature which was best for him1 and above all1 has been furnished with exactly the proper amount and character of nourishment necessary for his growth and development4 ,suddenly he emerges from this completely protecting environment into a more or less hostile world1 where he must assume the task of living1 with a frail little body that in many respects is only imperfectly developed4 ,and yet the baby must not only continue the bodily functions and activities that were begun during his intra-uterine life1 but must develop certain functions which were imperfect and even establish others which were performed for him4 ,you will recall that while within the uterus1 the baby received his nourishment and oxygen and gave up waste material through the placenta4 ,accordingly1 his organs of digestion1 respiration and excretion are imperfectly developed at birth and are capable of functioning only within very narrow limits at first4 ,his respirations are usually established immediately after birth1 when he cries vigorously1 for his lungs are thereby filled with air4 ,the other functions are established more gradually and the care of the baby must be such that the immature1 unused organs will have their development promoted through activity and yet not be overtaxed4 ,the ,baby's ,condition at ,birth4 ,the newborn baby boy weighs from seven and a quarter to seven and a half pounds and is about twenty inches long1 girl babies being perhaps a little smaller4 ,his body is well rounded and his flesh firm4 ,the skin is a deep pink1 or even red1 and is covered with the cheesy substance called vernix caseosa1 which is likely to be thickly deposited over the back and in folds of the skin and creases1 as in the thighs and under the arms4 ,some babies still have1 when born1 the fine downy hair on parts or all of the body1 that they had before birth4 ,the head and abdomen are relatively large1 the chest narrow and the limbs short4 ,the legs are so markedly bowed that the soles of the baby's feet may nearly or quite face each other1 but they finally assume a normal position4 ,the bones are still soft and the entire body is1 therefore1 very flexible4 ,some of the bones which unite later in life and make the adult skeleton firm and rigid1 are separate at birth4 ,most newborn babies have faded blue eyes1 the permanent color appearing gradually1 but the amount and color of the hair varies greatly1 some babies being bald1 while others have abundant hair from the beginning4 ,the shape of the baby's head is often badly distorted at birth1 being so long from chin to crown that the mother is deeply concerned4 ,but you may rest quite assured that even though badly misshapen1 your baby's head in the course of a few days will assume the lovely1 rounded contour so characteristic of babyhood4 ,the temporary deformity of the head is caused by a molding and overlapping of the bones of the skull as it is forced through the narrow part of the pelvis1 the inlet1 that we learned about in ,chapter ,,iii4 ,about the middle of the top of the head you will be able to feel a soft1 diamond shaped spot and farther back another soft spot1 smaller than the one in front and somewhat triangular in its outline4 ,these soft places are openings between the bones of the skull and are called the anterior and posterior fontanelles4 ,they always may be felt on the new baby's head4 ,growth and ,development4 ,the physical progress which is made during the first year by average1 normal babies who are satisfactorily nourished and cared for is fairly uniform and the average rate of this progress is somewhat as follows3 ,weight4 ,there is a loss in weight of #f to #aj ounces during the first week of life1 after which the baby usually gains from #d to #h ounces each week1 during the first five months4 ,from this time the gain is only about half as rapid1 or at the rate of #b to #d ounces weekly4 ,at six months1 therefore1 the average baby weighs from #ae to #af pounds1 or double the normal birth weight of #g pounds1 and at twelve months he weighs from #bj to #bb pounds1 or three times the average birth weight4 ,fig4 #da gives an idea of how the baby's weight drops during the first week and the rate of the normal weekly gain afterwards1 during the first year4 ,illustration3 ,,fig4 #da4--;,baby's weight chart showing the usual loss during the first week and subsequent gain during the first year of life4 ,the weight is perhaps the most valuable single index to the baby's condition that we have1 but at the same time it must be remembered that a baby whose food contains an excess of sugar or starch may be of normal weight1 or over1 but be incompletely nourished and very susceptible to infection1 while other babies who are small and gain slowly are sometimes very well and vigorous4 ,moreover1 quite commonly there are periods in the lives of entirely normal babies during which there is little or no gain in weight4 ,this may occur during the period from the seventh to the tenth month1 for example1 or in very warm weather4 ,but the doctor is likely to want to watch the baby's weight1 for when studied in conjunction with other conditions it gives a certain amount of information about the baby's general state and progress4 ,height4 ,the height of the average baby at birth is about #bj inches1 though boys may measure a little more and girls a little less2 at six months it is about #be inches and #bh or #bi inches at the end of a year4 ,head and ,chest4 ,the circumferences of the head and chest are about the same at birth1 the chest being possibly a little the smaller of the two4 ,both measure about #ac inches1 gradually increasing to about #af inches in six months and to #ah inches by the end of the first year4 ,fontanelles4 ,the posterior fontanelle1 the one at the crown of the head1 usually closes in six or eight weeks but the larger1 anterior fontanelle is not entirely closed until the baby is about eighteen or twenty months old4 ,teeth4 ,although it occasionally happens that a baby has one or two teeth at birth1 the average infant has none until the sixth or seventh month1 when the two lower1 central incisors appear4 ,after a pause of a few weeks the two upper1 central incisors come through1 followed by the two lateral incisors in the upper jaw4 ,at the end of the first year1 therefore1 the average baby has six teeth1 or eight if the lower lateral incisors have appeared by the first birthday1 as they sometimes do4 ,this is the usual course of dentition1 during the first year1 as shown in ,fig4 #db1 but there are wide variations among entirely well and normal babies1 the first tooth sometimes not appearing before the tenth1 eleventh or even twelfth month4 ,as a rule1 however1 an entire lack of teeth by the time the baby is a year old is regarded as an evidence of faulty nutrition4 ,illustration3 ,,fig4 #db4--;,diagram showing first1 or 8milk10 teeth and the ages at which they usually appear4 ,the baby who is properly fed and cared for1 cuts his teeth with little or no trouble1 in spite of the widely current but seriously mistaken belief that a teething baby is a sick baby4 ,we have no way of estimating the number of babies who die1 needlessly1 as a result of this dangerous conviction1 for if the baby is sick while teething1 the trouble is all too often accepted as a normal occurrence and is not given the attention it needs until too late4 ,frail1 delicate babies may have convulsions each time that a tooth is cut and if a baby is having digestive trouble1 this is likely to grow worse while he is teething4 ,but cutting teeth is a normal process and the healthy1 properly fed baby suffers little or no inconvenience while it is in progress4 ,stools and ,urine4 ,during the first two or three days the stools are of dark green1 tarry material called meconium4 ,in the course of two or three days they begin to grow lighter and shortly the normal stools appear1 these being bright yellow in color1 of a smooth1 pasty consistency and having a characteristic odor4 ,during the first month or six weeks the baby's bowels may move three or four times daily1 but after this they usually move but once or twice in the course of twenty-four hours4 ,as the nourishment is increased1 the stools grow somewhat darker and firmer and finally become formed4 ,illustration3 ,,fig4 #dc4--;,appearance of cord immediately after birth4 ,the newborn baby's bladder usually contains urine and this may be passed immediately after birth or not until several hours later4 ,after the first urination the bladder may be emptied five or six times a day or oftener4 ,the ,cord4 ,within a few days after birth the stump of the umbilical cord that is attached to the baby's navel1 begins to shrivel and turn black and a red line appears where the cord joins the abdomen4 ,by the eighth or tenth day1 as a rule1 the cord has shrunken to a dry1 black string1 when it drops off and leaves an ulcer or small red area which heals entirely in the course of a few days4 ,figs4 #dc1 #dd1 #de and #df show these progressive changes4 ,illustration3 ,,fig4 #dd4--;,appearance of cord four days after birth4 ,illustration3 ,,fig4 #de4--;,appearance of navel immediately after cord has dropped off4 ,skin4 ,the soft1 downy hair that may be remaining on the surface of the body usually disappears by the end of the first week and there is often a scaling of the skin which lasts for two or three weeks1 while a delicate pink tint replaces the deeper color of the skin in the course of ten days or two weeks4 ,the baby does not perspire until after the first month1 ordinarily1 when a very slight perspiration begins1 gradually increasing until by the time the baby is a few months old he is perspiring freely4 ,illustration3 ,,fig4 #df4--;,appearance of a normal1 well healed navel4 ,tears4 ,there are no tears at birth and opinions differ as to whether they appear in the course of two or three weeks or three or four months4 ,the absence of tears is one reason for bathing the baby's eyes so carefully during the early days and weeks1 for if dust or other foreign material gets into the eyes it is not washed out by tears as it is after their flow is established4 ,general ,behavior4 ,during the first few weeks the average baby sleeps most of the time2 that is1 from #ai to #ba hours daily4 ,he gradually sleeps less1 as the special senses develop and will sometimes lie quietly for an hour or more with his eyes open1 sleeping only #af or #ah hours1 daily1 at six months and #ad to #af hours at the end of a year4 ,the baby begins to make noises and 8coo0 at about two months and to utter various vowel sounds when about six months old4 ,by the end of a year these indefinite noises and sounds become distinct words4 ,at about the fourth month he grasps at objects and smiles1 and very soon even laughs4 ,he holds up his head at about the third or fourth month2 sits up and also begins to creep at six or seven months1 while sometime between the ninth and twelfth months he will stand while holding on to something secure and begin to walk with assistance4 ,these degrees of development at different ages are not to be taken as the only measure of normal progress1 for some well babies mature more rapidly and many others more slowly than at the rate which is found to be average4 ,in addition to these fairly specific evidences of the baby's condition and progress1 such as weight1 height1 strength and muscular development1 there are other and less definite indications of his well-being which should be taken into account4 ,the baby who is well and is being properly fed in all respects1 will have good color2 his flesh will be firm2 he will take his nourishment with a certain amount of eagerness and seem satisfied afterwards4 ,he will sleep for two or three hours after each feeding2 will sleep quietly at night and while awake1 unless he is wet or uncomfortable for some other good reason1 he will seem contented1 good-natured and happy4 ,you have seen how the average1 well baby grows and develops1 provided he is given proper care4 ,i want you now to have just a glimpse of the other side of the question1 so that you may realize what happens to the unfortunate little citizens who are not given such care4 ,this glimpse will make you realize more than ever1 how worth while are all of the precautions that you take for your baby4 ,it is estimated that out of every #ajjj babies born alive1 in this country1 #dj die during the first month of life1 and that more than as many again1 or about #he all told1 perish before reaching the first birthday4 ,so hazardous is this period of early infancy1 in the ,united ,states1 that our annual loss of baby life is between seven and eight times as great as was the yearly loss of our young men in the war1 for upwards of #bjj1jjj babies less than a year old die each year4 ,that the first month is more dangerous than any which follow is shown by the fact that about #ajj1jjj of these baby deaths occur during the first four weeks of life4 ,the tragedy of these figures is made darker by the fact that at least half of the babies who are lost die from preventable causes4 ,in other words1 they die from lack of proper care4 ,that is the point of this for you4 ,these babies die1 not by an act of ,providence1 but from lack of care--not the difficult1 complicated care needed by sick babies but just the everyday care which any mother may give--the care that keeps well babies well4 ,that is what you are going to do--keep your well baby well4 ,and you are going to be surprised to find how easy it is1 after all1 to say nothing of the pleasure of it1 for the thing very nearly sums itself up into feeding your baby as the doctor orders and keeping him clean in every particular4 ,bear these two factors in mind for errors in feeding and lack of cleanliness are the underlying causes of the vast majority of baby ills4 ,you will often feel a little like ,alice in ,wonderland1 who found1 one time1 that she had to keep running very fast to stay where she was1 for you will not be able to relax in a single detail of your baby's care if you are to keep him well4 ,with him1 as with you1 or anyone else1 the satisfactory use of even ideal food is largely dependent upon the general condition and mode of living1 and we find accordingly1 that the question of keeping the baby well finally resolves itself into the following common sense requirements3 #a4 ,proper food4 #b4 ,fresh air4 #c4 ,regularity in the daily routine care4 #d4 ,cleanliness of food1 clothing and surroundings4 #e4 ,preservation of an even body temperature4 #f4 ,adequate rest and sleep4 #g4 ,periodic consultations with your doctor4 ,carve these principles into the tablets of your brain and you cannot fail to give your baby the kind of care that is literally life-saving4 ,i am going to describe the tiny1 intimate details of this care1 for ,i think this will help you1 in the beginning at least1 but if you will keep these fundamentals in mind and use good common sense you really need not read another word about baby care1 for they give it all in a nutshell4 ,let me warn you emphatically against making the very serious mistake of acting upon the advice of friends or relatives1 no matter how many children they have had4 ,these counselors are just as dangerous for babies as they are for expectant mothers1 so beware of them6 8,is it not preposterous10 says ,herbert ,spencer1 8that the fate of a new generation should be left to the chance of unreasoning custom1 impulse1 fancy1 joined with the suggestions of ignorant nurses and the prejudiced counsel of grandmothers8 ,to tens of thousands that are killed1 add hundreds of thousands that survive with feeble constitutions1 and millions that grow up with constitutions not so strong as they should be1 and you have some idea of the curse inflicted on their offspring by parents ignorant of the laws of life40 ,it is a very wise precaution to have your doctor see the baby every week or ten days during the first three months and once a month during the remainder of the year4 ,not because he is fragile or ill4 ,not at all4 ,you consult your doctor in order to be sure that you are keeping your baby well4 ,did you ever hear of the ,chinese custom of paying the doctor as long as one is well1 but not paying for attention during illness8 ,it isn't so very heathenish--that idea of paying for the skillful care that will prevent illness4 ,in addition to taking the general precaution of seeing your doctor periodically1 about the baby1 be sure to consult him about anything that you do not understand or about any new condition that arises4 ,you will find any number of persons who are ready and eager to advise you1 but your doctor is the only one whose advice it is safe for you to follow4 ,the ,daily ,schedule4 ,the importance of regularity in the daily routine of the baby's care cannot be stressed too often nor too insistently4 ,no matter how well he is nursed in other respects1 nor how skillfully the doctor directs his care1 the baby cannot be expected to progress satisfactorily if his life is not absolutely regular4 ,begin by arranging a daily program for the feedings1 fresh air1 bath1 sleep and exercise and then allow nothing to interfere with your carrying it out4 ,the hours for the nursings1 which vary with different doctors1 will constitute the greater part of this daily schedule4 ,for a baby on four hour feedings1 for example1 some such program as the following may be arranged1 while for a baby on a three hour schedule a slightly different program may be arranged4 #f a4m4 ,feeding4 #h a4m4 ,orange juice 7when ordered74 #i a4m4 ,bath4 #aj a4m4 ,feeding4 #aj3cj to #b p4m4 ,out of doors4 #b p4m4 ,feeding4 #b3cj to #d p4m4 ,out of doors4 #d p4m4 ,orange juice 7when ordered74 #d to #e3cj p4m4 ,indoor airing and exercises 7when ordered74 #e3cj p4m4 ,preparation for the night4 #f p4m4 ,feeding4 #aj p4m4 ,feeding4 #b a4m4 ,feeding 7when ordered74 ,,your ,,baby',s ,,food ,proper feeding is probably the most decisive single factor in the routine care of the baby4 ,in order that the food shall be satisfactory1 it must be not only suitable in composition for the individual baby1 but it must be clean1 fresh and at the right temperature2 given in suitable amounts and at suitable intervals2 it must be given properly--not too fast nor too slowly and it must be given under favorable conditions4 ,moreover1 as has been stated1 the baby1 himself1 must be kept in a general condition which will promote the digestion and assimilation of the food that is given to him4 ,fresh air1 suitable clothing1 an even body temperature1 gentle handling1 proper bathing1 regular sleep1 freedom from excitement1 fatigue1 and irritation all promote the baby's ability to use his food to advantage4 ,reverse conditions all work against it4 ,accordingly1 the actual value of the baby's food to him will be largely dependent upon the care that you give him4 ,there are three methods of nourishing the baby3 by breast feeding1 by artificial feeding and by a combination of the two1 termed mixed or supplementary feeding4 ,breast ,feeding4 ,from all standpoints1 maternal nursing1 under normal conditions1 is the most satisfactory method of nourishing a baby4 ,if the breast milk is suitable it meets all of the baby's requirements and the proportion and character of its constituents are exactly suited to his digestive powers4 ,in order for maternal nursing to be entirely satisfactory1 the condition of both mother and baby must be favorable4 ,the preparation and care of the mother have been described3 her general condition and state of nutrition2 the care and condition of her nipples1 flat or retracted nipples being brought out if possible1 and if not1 the nursing facilitated by the use of a shield4 ,as to the baby1 if his diaper is wet or soiled1 it should be changed before he is put to the breast1 partly to make him comfortable and partly to avoid disturbing him for this after his feeding2 and his mouth is gently swabbed with boric-soaked cotton1 if your doctor so orders4#b ,footnote #b3 ,boracic acid solution is made by adding one teaspoonful of the crystals to one cup 7half-pint7 of boiling water4 ,although nursing is an instinct1 the baby may have to learn how to nurse or to acquire the habit1 this being one reason for putting him to the breast during those first two or three days when he obtains little or no actual food1 as was explained in ,chapter ,,ix4 ,as he expresses the milk by squeezing and suction made possible only when the nipple is well back in his mouth1 he must take into his mouth practically the entire colored area which surrounds the nipple4 ,to do this he lies in the curve of his mother's arm as she turns slightly to one side1 and holds her breast away from his nostrils in order that he may breathe freely4 ,sometimes1 even when other conditions are favorable1 the baby is unable to nurse because of some physical disability4 ,he may be too feeble1 may have a cleft palate or find suckling painful because of an injury to the mucous membrane which occurred when his mouth was wiped out just after birth4 ,the manner in which the baby nurses1 therefore1 may be significant and should be described to the doctor if there is any difficulty4 ,when the baby has finished nursing he should be taken up very gently1 held upright against the shoulder for a moment or two1 to help him bring up gas if he has any1 and then placed in his crib and left to sleep4 ,if he is nursing satisfactorily1 he will be sleepy and contented afterwards and will sleep for two or three hours2 he will seem generally good-humored and comfortable while awake2 he will have good color2 gain weight steadily and have two or three normal bowel movements daily4 ,the normal stool in breast-fed babies is bright yellow1 smooth and has no evidences of undigested food4 ,if the baby is not being adequately nourished1 he will present exactly the opposite picture1 in some or all of these respects4 ,he will be unwilling to stop nursing after the normal length of time and will give evidence of being not satisfied when taken from the breast4 ,he may be listless and fretful and sleep badly4 ,he will not gain weight as he should and he may vomit or have colic after nursing4 ,to ascertain whether or not such a baby is getting enough milk it is customary to weigh him1 without undressing him1 before and after each nursing4 ,each fluid ounce of milk will increase his weight one ounce4 ,if the baby is not obtaining a normal amount of milk at each nursing1 he is often given enough modified milk after each meal to supply the shortage1 but at the same time an effort is made to increase the supply of breast milk by improving the mother's personal hygiene1 as described in ,chapter ,,ix4 ,the amount which the baby needs at each feeding varies1 not only according to his weight and age1 but also according to his vigor and activity and therefore must be estimated for each baby4 ,a very general estimate of the amount taken by the average1 well baby at each feeding1 is about as follows3 ,first week #a to #b ounces ,second and third week #b to #d ounces ,fourth to ninth week #c to #d ounces ,tenth week to fifth month #c to #e ounces ,fifth to seventh month #d to #f ounces ,seventh to twelfth month #f to #i ounces ,artificial ,feeding4 ,there is no entirely adequate substitute for satisfactory maternal nursing1 and any other food that is given to the young baby is at best a makeshift4 ,considering the baby's delicacy1 therefore1 and his urgent needs1 no pains should be spared to make any artificial food that is given to him1 as satisfactory as possible4 ,and no matter what it costs1 he should have only the freshest1 cleanest and purest milk that can be bought4 ,in preparing and giving artificial food it must be borne in mind that normal breast milk has the following characteristics3 #a4 ,it is exactly right in quantity1 quality and proportion4 #b4 ,it is fresh1 clean and sweet4 #c4 ,it is free from bacteria4 #d4 ,it tends to protect the baby from infection4 #e4 ,it definitely protects him from certain nutritional diseases4 ,cows' milk1 suitably modified1 is apparently the best available substitute for mother's milk1 but it must first meet certain requirements and then be handled with scrupulous cleanliness and care1 if it is to be satisfactory4 ,the requirements are that the milk shall be3 #a4 ,whole milk4 ,it must not be altered by the removal of cream nor the addition of such preservatives as salicylic acid1 formaldehyde or boracic acid4 #b4 ,its composition must not vary greatly from day to day4 #c4 ,it must be clean and free from disease germs2 other organisms should not be present in excessive numbers4 #d4 ,it must be fresh2 less than #bd hours old when it is delivered4 ,all of this means that the milk must come from a herd of healthy1 tuberculin-tested cows4 ,the milk from a single cow may vary markedly from day to day but that from several cows is nearly constant4 ,the stables and the cows must be kept clean1 the udders carefully washed before each milking2 the milkers themselves must wear freshly washed clothing1 scrub their hands thoroughly and milk into sterile receptacles2 the milk must be immediately covered and cooled to a temperature of #de ,f4 or #ej ,f4 and kept there4 ,milk produced under such conditions is usually described as 8certified milk0 and is often prescribed as infant food without being pasteurized or sterilized4 ,but if there is any doubt about the source of the milk and the method of its handling1 it should be strained into a clean receptacle through filter paper or a thick layer of absorbent cotton and subsequently boiled or pasteurized4 ,whether certified or not1 the milk should invariably be placed in the refrigerator1 or some other place which has a temperature of #ej ,f41 as soon as it is received1 and it must be kept cool and clean4 ,keeping milk cool means keeping it at a temperature of #ej ,f4 ,keeping it clean implies cleanliness not alone of the milk itself but of your hands and the utensils that you use as well as the destruction of disease germs by pasteurization or sterilization4 ,among the germs which are likely to be present in infected milk are those that cause diarrhea1 sore throats1 typhoid fever1 diphtheria and scarlet fever4 ,when the doctor makes out the formula for the baby's milk1 he will adjust the proportions of the different ingredients to the baby's immediate needs and digestive powers4 ,but his careful estimations will be set at naught unless you are absolutely accurate in preparing and giving the milk4 ,your invariable responsibility in connection with the baby's milk1 therefore1 is to keep it cool and clean and be accurate4 ,you will appreciate the necessity for modifying cows' milk before giving it to your baby if you will note the differences between mother's milk and cows' milk as indicated by the following table and consider1 too1 why ,nature has made these differences3 ,mother's ,milk ,cows' ,milk ,fats #c4e to #d4 per cent #c4e to #d4 per cent ,sugar #f4e to #g4e per cent #d4e to #d4ge per cent ,proteins #a4 to #a4e per cent #c4e to #d4 per cent ,salts 4#b per cent 4#g to 4#ge per cent ,water #hg4 to #hh4 per cent #hg4 per cent ,the various tissues of the body and the bony skeleton are built by the proteins and salt4 ,accordingly ,nature supplies these in greater abundance to the baby calf1 who grows so fast as to double his birth weight in about forty-seven days1 than to the baby boy who scarcely doubles his birth weight within #ahj days4 ,the calf begins life with a physical need for the large amount of proteins and salts which are present in cows' milk and with digestive organs that can cope with them1 but the baby needs less1 can digest less and1 therefore1 should be given less4 ,there are of course1 other and finer differences between the two milks and an attempt is sometimes make to meet these4 ,for example1 mother's milk is slightly alkaline and cows' milk slightly acid and the curd of cows' milk is larger1 tougher and harder to digest than that formed by mother's milk4 ,some doctors add lime water to cows' milk1 before giving it to the baby1 to make it alkaline and have the curd made softer1 finer and more digestible by boiling4 ,articles ,needed in ,preparing the ,baby's ,food4 ,a complete equipment for preparing and giving the baby's milk should be assembled1 kept in a clean place1 separate from utensils in general use1 and never put to any other service4 ,a satisfactory outfit for this purpose comprises the following articles3 ,one dozen graduated nursing bottles4 ,one dozen nipples4 ,clean1 new corks or a package of sterile1 non-absorbent cotton for stoppers4 ,bottle brush4 ,covered kettle1 capacity one gallon1 for boiling bottles and possibly pasteurizing milk4 ,pasteurizer or wire bottle rack4 ,small kettle1 about one quart size4 ,graduated pint or quart measuring glass4 ,pitcher1 two-quart size4 ,long-handled spoon for mixing4 ,funnel4 ,measuring spoons--table and tea sizes4 ,double boiler4 ,thermometer which will register at least #bab ,f4 ,cream dipper 7if ordered74 ,two small covered jars for sterile and used nipples4 ,sugar 7lactose1 maltose or cane sugar according to orders74 ,lime water 7if ordered74 ,utensils of enamel or aluminum ware are probably the most satisfactory ones to use as they are easily kept clean1 while bottles with wide mouths and curved bottoms and inner surfaces can be thoroughly washed more easily than those with small necks and sharp corners4 ,nipples that can be turned inside out to be washed should be selected as it is almost impossible to clean thoroughly those with tubes or narrow necks4 ,new bottles will be rendered less breakable if placed in cold water1 which is gradually heated1 allowed to boil for half an hour and cooled before the bottles are removed4 ,the bottles should be rinsed with cold water after each feeding and then carefully washed and scrubbed with the bottle brush in hot soapsuds or borax water1 containing two tablespoonfuls to the pint4 ,they may be kept full of water while not in use or rinsed with hot water and stood upside down until they are all boiled on the following morning1 preparatory to being filled with the freshly prepared milk4 ,the baby's bottles should never be washed in dishwater nor dried on a towel4 ,the nipples should be rinsed in cold water1 turned inside out and scrubbed with a brush1 in hot soapsuds or borax water2 rinsed and placed in a jar ready to be boiled with the bottles4 ,preparing the ,milk4 ,the full quantity of milk which the baby will take in the course of twenty-four hours is prepared at one time and the prescribed amount for each feeding poured into as many separate bottles as there will be feedings4 ,you should begin by assembling on a table everything that you will use in preparing the milk formula1 as the nurse has in ,fig4 #dg4 ,boil for five minutes all of the articles that will come in contact with the milk1 including the full number of bottles and nipples and the jars in which the nipples are kept2 remove them with the long-handled spoon without touching the edges or inner surfaces1 dropping the nipples into one of the sterile jars4 ,wash the mouth of the milk bottle before removing the cap and pour the amount which the formula calls for into the sterile pitcher4 ,to this is added the sterile water in which the sugar has been dissolved in the measuring glass and then the potato or barley water1 the lime water or soda solution as ordered4 ,this mixture is thoroughly stirred and the amount for one feeding at a time1 measured in the measuring glass and poured into the specified number of bottles1 which are then stoppered4 ,illustration3 ,,fig4 #dg4--,preparing the baby's milk4 7,from a photograph taken at ,johns ,hopkins ,hospital47 ,if certified milk is used for the milk mixture it is often given to the baby without being pasteurized1 in which case the bottles are placed in the refrigerator as soon as they are filled and stoppered4 ,very frequently1 however1 the milk is sterilized or pasteurized4 ,you will feel surer of keeping the mouths of the bottles clean if you cover them with squares of gauze or muslin before they are sterilized1 holding the caps in place with tapes or rubber bands4 ,pasteurization as applied to infant feeding consists of heating the milk to #adj-afe ,f4 and keeping it at that temperature for #bj to #cj minutes4 ,there are many excellent pasteurizers for home use on the market1 but entirely satisfactory results may be obtained by improvising one from the wire bottle rack seen in ,fig4 #dg1 and the large kettle already provided4 ,one method is to place the rack1 containing the bottles1 in the kettle which is filled with cold water to a level a little above the top of the milk in the bottles1 and allow the water to come to the boiling point4 ,the kettle is removed from the fire1 covered tightly and the bottles allowed to stand in the hot water for twenty minutes4 ,cold water is then run into the kettle to cool the milk gradually and avoid breaking the bottles1 after which they are placed in the refrigerator1 well or spring-house and kept at a temperature of #ej ,f4 until they are taken out1 one at a time1 for feedings4 ,if a wire rack is not available the bottles may be stood on a saucer or a thick pad of folded newspapers in the bottom of the kettle4 ,pasteurization does not destroy all germs that may be in the milk1 but it kills the more important ones and apparently impairs the nutritive and protective properties of the milk less than boiling4 ,however1 pasteurized milk must be kept cold and must be used within twenty-four hours1 for the aging of milk is quite as undesirable as souring4 ,scalding is another method of destroying germs in milk4 ,the milk is placed in an open vessel and the temperature raised to about #ahj ,f41 or until bubbles appear around the edge and the milk steams in the center1 after which it is cooled and kept at a temperature of #ej ,f4 ,many doctors prefer to have the baby's milk boiled1 since boiling insures absolute sterilization and also renders the curd more digestible4 ,other changes are produced by boiling1 however1 which make it important to add orange juice and cod-liver oil to the baby's diet at an early date1 as will be explained in the next chapter4 ,milk may be boiled directly over the flame for a time varying from three to forty-five minutes1 or it may be placed in a double boiler1 the water in the lower receptacle being cold1 and allowed to remain until the water has boiled from six to forty-five minutes4 ,when milk is boiled or scalded1 the other ingredients are added beforehand1 as a rule1 after which it is measured and poured into the bottles4 ,or the milk mixture may be poured into the bottles as for pasteurization and the bottles kept in the actively boiling water for any desired length of time4 ,all of these points1 however1 are definitely specified by the doctor4 ,giving the ,baby ,his ,bottle4 ,at feeding time1 the bottle should be taken from the refrigerator1 the stopper removed and a sterile nipple taken up by the margin and put on the bottle without touching the mouthpiece4 ,the milk is brought to a temperature of about #ajj ,f4 by standing the bottle in a deep cup or kettle of warm water and placing it on the fire4 ,the temperature of the milk may be tested by dropping a few drops on the inner side of the wrist or forearm where it should feel warm but not hot4 ,this dropping will also indicate if the hole in the nipple is of the proper size to allow the milk to drop rapidly in clean drops but not to pour4 ,if the hole is too small1 the drops will be small and infrequent and the baby will be obliged to work too hard to obtain it2 while if the hole is too large the baby will feed too rapidly and may have colic as a result4 ,if the hole is too large the nipple will have to be discarded2 if too small or if there is no hole1 one of the proper size may be made by piercing the nipple with a heated darning needle or small steel knitting needle4 ,illustration3 ,,fig4 #dh4--,proper position in which to hold baby and bottle during feeding4 ,illustration3 ,,fig4 #di4--;,holding the baby upright immediately after feeding1 and gently patting his back to help him bring up air in order to prevent colic4 ,the baby's diaper should be changed if it is soiled or wet before he is given the bottle and he should be held comfortably on your arm1 in a reclining position1 while you hold the bottle with your free hand as shown by the nurse in ,fig4 #dh4 ,the bottle should be inclined sufficiently to keep the neck full of milk2 otherwise the baby may draw in air as he nurses4 ,he should be kept awake while feeding but he should be allowed to pause every three or four minutes in order not to take his milk too rapidly4 ,not less than ten nor more than twenty minutes is devoted to a feeding1 as a rule1 and if the baby refuses a part of his milk1 it should be thrown away2 never warmed over for another time4 ,after being fed1 the baby should be held upright against your shoulder for a moment or two1 as in ,fig4 #di1 and ever so gently patted on the back to help bring up any air which he may have swallowed4 ,he should on no account be rocked nor played with after taking the bottle1 but should be placed gently in his crib1 warm and dry and left alone to sleep4 ,turning him or moving him about even to the extent of changing his diaper at this time may cause vomiting4 ,the evidences of satisfactory and unsatisfactory feeding in the bottle-fed baby are about the same as in the baby who is fed at the breast1 except that the gain in weight on artificial food may be a little slower and less steady than on maternal nursing2 the stools have a characteristic sour odor2 are a little lighter in color and may contain white lumps of undigested fat2 are usually dryer than in breast feeding and may be formed1 in even a very young baby4 ,many doctors feel that all babies1 whether breast-fed or on the bottle1 require a certain amount of cool boiled water to drink between feedings4 ,a small amount is given at first and gradually increased according to the doctor's instructions1 and it may be given from a bottle1 a medicine dropper or poured slowly from the tip of a teaspoon4 ,i feel sure that you have realized1 long before this1 that the entire question of planning the baby's food is such an important and complicated matter that it cannot with safety to the baby be undertaken by any one but your doctor4 ,unexpected situations do arise1 however1 when the doctor is not within immediate reach and the mother has to plan the baby's food1 temporarily1 to the best of her ability4 ,should you find yourself in such an emergency1 you will find help in the milk formulas contained in a pamphlet issued by the ,american ,medical ,association1 remembering that they are intended for the average1 normal baby and are not necessarily suitable for all babies4 ,a large1 vigorous baby may need more food and a small1 frail baby have to take less than the amounts specified in the following directions3#c ,footnote #c3 ,from 8,save ,the ,babies0 by ,dr4 ,l4 ,emmet ,holt and ,dr4 ,h4 ,k4 ,l4 ,shaw4 ,copied by courtesy of ,the ,american ,medical ,association4 8,the simplest plan is to use whole milk 7from a shaken bottle7 which is to be diluted according to the child's age and digestion4 8,beginning on the third day1 the average baby should be given #c ounces of milk daily1 diluted with seven ounces of water4 ,to this should be added one tablespoonful of lime water and #b level teaspoonfuls of sugar4 ,this should be given in #g feedings4 8,at one week1 the average child requires #e ounces of milk daily1 which should be diluted with #aj ounces of water4 ,to this should be added #a even tablespoonfuls of sugar and one ounce of lime water4 ,this should be given in #g feedings4 8,the milk should be increased by ounce about every #d days4 8,the water should be increased by ounce about every #h days4 8,at #c months the average child requires #af ounces of milk daily1 which should be diluted with #af ounces of water4 ,to this should be added #c tablespoonfuls of sugar and #b ounces of lime water4 ,this should be given in #f feedings4 8,the milk should be increased by ounce about every #f days4 8,the water should be reduced by ounce about every #b weeks4 8,at #f months the average child requires #bd ounces of milk daily1 which should be diluted with #ab ounces of water4 ,to this should be added #b ounces of lime water and #c even tablespoonfuls of sugar4 ,this should be given in #e feedings4 8,the amount of milk should be increased by ounce every week4 8,the milk should be increased only if the child is hungry and digesting his food well4 ,it should not be increased unless he is hungry1 nor if he is suffering from indigestion even though he seems hungry4 8,at #i months1 the average child requires #cj ounces of milk daily1 which should be diluted with #aj ounces of water4 ,to this should be added #b even tablespoonfuls of sugar and #b ounces of lime water4 ,this should be given in #e feedings4 8,the sugar added may be milk sugar or1 if this cannot be obtained1 cane 7granulated7 sugar or maltose 7malt sugar74 8,at first plain water should be used to dilute the milk4 8,at #c months1 sometimes earlier1 weak barley water may be used in the place of plain water2 it is made with level tablespoonful of barley flour to #af ounces of water and cooked #bj minutes4 8,at #f months the barley flour may be increased to #a even tablespoonfuls1 cooked in the #ab ounces of water4 8,at #i months1 the barley flour may be increased to #c level tablespoonfuls1 cooked in the #aj ounces of water4 8,a very large baby may require a little more milk than that allowed in these formulas4 ,a small delicate baby will require less than the milk allowed in the formulas40 ,these formulas may be tabulated as shown on p4 #agg4 ,mixed ,feeding4 ,under some conditions the breast-fed baby is given also a certain amount of modified milk1 and this combination of natural and artificial feeding is termed mixed or supplementary feeding4 ,a deficiency in the breast milk1 ascertained by weighing the baby before and after each nursing1 may be supplied by following each nursing with a bottle feeding2 or for some reason1 one or two breast feedings1 in the course of the day are sometimes replaced by entire bottle feedings4 ,in any case the milk mixture to be used as supplementary feeding is prepared with exactly the same painstaking care as is the milk for entire artificial feeding4 ,if supplementary food is given because of an inadequate supply of breast milk1 it is of great importance that the baby be put to the breast regularly1 no matter how little food he obtains1 for his suckling is the best possible means of stimulating the breasts to secrete more milk1 and of equal importance is the fact that they will tend to dry up if the baby nurses less than about five times in twenty-four hours4 ,moreover1 even a little breast milk is valuable to him and he should have the benefit of all there is to be had4 ,age ,milk ,water ,barley ,lime ,sugar ,no4 ,hours ,water ,water of feed- ings ,day ,night #c-g days #c ozs4#g ozs4 ozs4#b tea- #g #f-i-ab-c-faj-b spoons #b;d week #e #aj #a #a table- #g #f-i-ab-c-faj-b spoons #c;d #f #aj #a #a #g #f-i-ab-c-faj-b #a month#g #aa #a #b #g #f-i-ab-c-faj-b #b #aa #ac #a #b #g #f-i-ab-c-faj-b #c #af #af ozs4#b #c #g #f-i-ab-c-faj-b #d #ai #ae #b #c #f #f-i-ab-c-faj #e #ba #ad #b #c #f #f-i-ab-c-faj #f #bd #ab #b #c #e #f-aj-b-f #aj #g #bf #ab #b #c #e #f-aj-b-f #aj #h #bh #aa #b #b #e #f-aj-b-f #aj #i #cj #aj #b #b #e #f-aj-b-f #aj ,an entire bottle feeding is sometimes given to a baby who is nursing satisfactorily at the breast1 in order to give his mother an opportunity to take longer outings than are possible between the regular nursings4 ,and sometimes it is to the mother's advantage1 and therefore to the baby's1 to give him a bottle during the night and thus allow her to sleep undisturbed4 ,,commercial ,,baby ,,foods ,since the baby's nourishment is prescribed by the doctor1 you have no reason to concern yourself with the various proprietary baby foods and canned and powdered milks that are so persuasively advertised to young mothers4 ,and ,i earnestly hope that by the time you finish this little book1 no one will be able to make you believe that any of these foods is likely to be satisfactory if used as a sole article of diet throughout the bottle-feeding period4 ,unquestionably there are many times and circumstances when the temporary or supplementary use of a prepared infant food or canned or powdered milk is advantageous4 ,in some cases of intestinal disturbance a proprietary food may be a great boon1 or while the mother is traveling and is unable to have freshly prepared milk formulas supplied to her along the way4 ,these foods may be valuable1 also1 during the summer1 while one stays at a hotel or boarding house where the freshness1 cleanliness or purity of the milk are uncertain1 or during a sudden shortage of fresh milk1 as may occur during a strike or severe storm when transportation is interrupted4 ,but you should not use a prepared infant food for any length of time without your doctor's order4 ,if you are confronted with the necessity of choosing a prepared food1 for temporary use1 you may be guided by considering the general objects and principles of baby feeding and the character of the various foods at your disposal4 ,the proprietary foods may be divided into two general groups3 one kind contains milk powder and is usually added to water1 while the other consists largely of sugar and starch and is added to fresh milk before being given to the baby4 ,canned milk is of two kinds2 evaporated1 which is unsweetened1 and condensed1 which is sweetened4 ,evaporated milk is whole milk from which part of the water has been removed1 the milk then being canned and sterilized4 ,the addition of water to evaporated milk restores it to the composition of whole milk in many respects1 but it is still milk that has been heated4 ,condensed milk is evaporated milk to which cane sugar has been added to aid in its preservation4 ,since bacteria do not grow well in highly sweetened foods1 it is not necessary to bring sweetened condensed milk to as high a temperature as the unsweetened product1 to prevent subsequent bacterial decomposition4 ,the high percentage of sugar in condensed milk quite obviously renders it unsuitable for continuous use as the sole article in a baby's dietary4 ,milk powders or dried milks are prepared by rapidly evaporating the water from whole milk1 skimmed milk or partly skimmed milk1 leaving the solid constituents in the form of a light1 white powder4 ,milk powder readily dissolves in water1 forming a 8reconstructed milk0 which closely resembles the fresh milk from which it was prepared4 ,but it must not be forgotten that reconstructed milk has been heated4 ,many doctors consider whole milk powder the most satisfactory form of preserved milk which is available for baby food4 ,should it be used1 however1 the importance of keeping it tightly covered and in a cold place must be recognized1 for the presence of fat renders it likely to become rancid if not kept cold4 ,,articles ,,of ,,food ,,which ,,are ,,sometimes ,,included ,,in ,,the ,,baby',s ,,dietary ,barley water1 sometimes used to dilute whole milk1 is made by mixing the barley flour to a smooth paste in cold water1 adding boiling water and boiling for twenty minutes or cooking in a double boiler for an hour1 straining and adding enough water to replace the amount lost in cooking4 ,the proportions for different ages are as follows3 ,three months1 level tablespoonful barley flour to #af oz4 water4 ,six months1 #a level tablespoonfuls barley flour to #ab oz4 water4 ,nine months1 #c level tablespoonfuls barley flour to #aj oz4 water4 ,potato ,water4 ,one tablespoonful of thoroughly boiled potato is mashed into one pint of the water in which the potato was boiled and carefully strained4 ,spinach4 ,spinach is carefully washed1 steamed for half an hour and mashed through a fine sieve4 ,it is sometimes started at the sixth month2 one teaspoonful daily1 gradually increased to one or two tablespoonfuls daily4 ,orange ,juice4 ,the orange should be dipped in boiling water and wiped on a clean towel before being cut and squeezed1 to avoid possible infection of juice4 ,it is usually given to babies1 sometimes as young as one month old1 who take heated milk4 ,it is carefully strained and started gradually by giving one teaspoonful in water once or twice daily between feedings and increasing to or #a ounce by the sixth month and #a to #b ounces by the end of the first year4 ,infusion of ,orange ,peel4 ,this is sometimes used instead of orange juice1 and is made by boiling one ounce of finely grated orange peel in two ounces of water1 adding a little sugar to counteract the bitter taste and adding enough sterile water to bring it up to two ounces4 ,tomato ,juice4 ,canned tomato strained through a fine sieve1 is sometimes given to a baby a few weeks old1 starting with one teaspoonful and gradually increasing to four to six ounces daily4 ,whey4 ,one quart of whole milk heated to #ih ,f4 or #ajj ,f4 and one half ounce of liquid rennet or one junket tablet stirred into it and allowed to stand half an hour or until firm and solid1 is poured into a cheesecloth bag and allowed to drain for about an hour without being squeezed4 ,protein ,milk4 ,the curd from one quart of milk1 which remains after the whey is drained1 as directed above1 is mashed through cheesecloth in a fine wire sieve1 with a potato-masher or bowl of a spoon and the curd washed through with one pint of water4 ,a pint of buttermilk is added and the mixture boiled while being stirred constantly4 ,this is sometimes given in diarrhea4 ,beef ,juice4 ,one pound of thick round steak1 slightly broiled1 is cut into small pieces and the juice expressed with a meat press or a lemon squeezer1 the amount varying from #b to #c ounces4 ,it may be diluted with an equal amount of warm water1 or slightly warmed by being placed in a cup standing in hot water1 and salted to taste4 ,broths4 ,one pound of lean meat1 all fat and gristle removed1 is allowed to one pint of water4 ,the meat is cut finely and put on in cold water1 heated slowly and allowed to simmer for three or four hours1 when water is added to replace what was lost in cooking4 ,it is strained1 the fat removed and slightly salted4 ,oatmeal ,water4 ,two level tablespoonfuls of oatmeal in a pint of boiling water is cooked in a double boiler for two hours1 strained and enough boiling water to replace the amount lost in cooking4 ,,bathing ,,and ,,dressing ,,your ,,baby ,by the time you assume your baby's care he will probably be having his daily bath in a tub4 ,it may be given under a spray1 however1 or the doctor may prefer to have him sponged4 ,the sponge bath may be given in your lap or on a table covered with a pad1 either method being satisfactory if the baby is kept warm and comfortable4 ,but one inclines to the idea of having the baby bathed in the lap for he seems happier there2 more comfortable and less frightened and we cannot be sure that these factors are unimportant to even a tiny baby4 ,the best time for the daily bath1 during the first three or four months1 is about an hour before the second feeding in the morning4 ,after this age the full bath is sometimes given before the six o'clock feeding1 in the evening1 for a bath at this hour is soothing and restful and often helps toward giving the baby a good night4 ,preparation for the bath should be made with its possible effects1 both good and bad1 in mind1 for the baby may be helped or harmed according to the skill with which he is bathed4 ,he must not be chilled during his bath1 and fatigue and irritation must be avoided by giving it quickly and with the least possible handling and turning4 ,these ends may be served by conveniently arranging all of the articles which will be needed1 on a low table at the right hand side of your chair1 before the baby is undressed4 ,there should be a pitcher of hot and one of cold water2 a bath thermometer2 two soft washcloths2 soft towels2 bath blankets2 ,castile1 or some other mild soap2 boracic acid solution2 sterile cotton pledgets2 large and small safety-pins1 or large ones and a needle and thread if the band is to be sewed on2 unscented talcum powder2 sterile albolene or olive oil2 soft hair brush and a complete outfit of clothing4 ,the little garments should be arranged in the order in which they will be put on1 the petticoat slipped inside the dress1 and in cold weather1 all hung before the fire or heater1 to warm4 ,the temperature of the room should be about #gb ,f4 and if it is possible to bathe the baby before an open fire or a heater1 so much the better4 ,in any case he must be protected from drafts and a sheet hung over the backs of two straight chairs will serve very well as a screen if no other is available4 ,the tub or basin should be about three-quarters full of water at #ajj ,f4 for the new baby2 about #ie ,f4 after the third month and gradually lowered to #he ,f4 or #ij ,f4 for the baby a year old4 ,the temperature of the water should not be guessed at1 but tested with a thermometer1 though in an emergency you may safely use water that feels comfortably warm to your elbow4 ,lay a folded towel in the bottom of the tub1 before beginning1 as babies are often frightened by coming in contact with the hard surface4 ,it is a good plan to wear a waterproof apron1 covered with one of flannel over which is laid a soft towel1 until the bath is finished4 ,the towel is then slipped out1 leaving the dry1 flannel apron to wrap about the baby4 ,wash your hands thoroughly with hot water and soap1 before beginning2 sit squarely1 with your knees together1 on a chair without arms2 take the baby in your lap and undress him under a blanket4 ,in order that the bath may be given deftly and quickly it is well to bathe the different parts in the same order every day1 for practice makes perfect4 ,it is usually a routine to weigh the baby every morning1 during the first two or three weeks and once or twice a week afterwards1 though premature babies and those who are frail are sometimes weighed at longer intervals because of the inadvisability of disturbing them so often4 ,the baby is undressed for his bath1 wrapped in a blanket1 and laid in the scoop or basket of a beam scale and a note made of the entire weight1 for if he is placed in the scales without protection he is likely to be chilled and frightened4 ,the weight of the blanket is ascertained separately and deducted from the total thus giving the baby's exact weight4 ,the eyes should be bathed first1 with pledgets of sterile cotton dipped in warm boracic acid solution1 each pledget being used but once4 ,to prevent the solution from running from one eye into the other1 the baby's head is turned slightly to one side and the lower eye wiped gently from the nose outward4 ,the lids may then be separated by placing one thumb below the brow and lifting it slightly1 and the eye flushed with a gentle stream by squeezing a freshly soaked pledget just above it4 ,the head is turned to the other side and the eye on that side bathed in like manner4 ,the mouth is swabbed out very gently with boric-soaked cotton wrapped about the tip of the little finger1 care being taken not to injure the delicate mucous lining4 ,the nostrils are cleaned with little spirals of cotton dipped in mineral oil or olive oil4 ,the face is then washed with warm water1 no soap1 and patted dry4 ,the scalp1 neck and ears are washed with soap and water and thoroughly dried by patting and by wiping gently in the creases4 ,the body should then be soaped with your hand1 only one part being uncovered at a time in order to avoid chilling4 ,to place the baby in the tub1 slip your left hand under his head in such a way that it will rest upon your wrist as your fingers spread out to support his shoulders4 ,your thumb naturally curves over and holds the upper part of the baby's arm without pulling or straining it4 ,grasp his ankles with the right hand and lower the little body into the water1 feet first1 as shown in ,fig4 #ej4 ,this gradual lowering of the baby into the water is worth while1 for he is likely to be frightened if he is plunged in suddenly4 ,if the baby's arm and shoulder are firmly held and supported by your left hand1 it is an easy matter to steady his entire body and keep his head out of the water while giving the bath with your right hand1 as in ,fig4 #ea4 ,illustration3 ,,fig4 #ej4--,method of holding baby and lowering him into his bath4 ,illustration3 ,,fig4 #ea4--,method of comfortably supporting the baby's head above the water while giving his bath4 ,the new baby is not usually kept in the tub for more than two or three minutes1 but when he is three or four months old he may stay in for five minutes and still longer as he grows older4 ,hot water should never be poured into the tub after the baby has been placed in his bath but cold water is often added1 for a three or four months old baby1 or the warm bath followed by a quick sponge with cold water4 ,the little body is quickly patted dry1 afterwards1 and rubbed briskly with the palm of the hand2 the legs and arms stroked toward the body2 the back from the neck downward and the chest and abdomen with a circular motion4 ,babies who react well to cold baths are benefited by them1 but those who do not1 may be harmed4 ,such 8toughening0 methods1 to be beneficial1 therefore1 must be adjusted very carefully to the individual baby and should be employed only in accordance with the doctor's directions4 ,the genitals should be bathed and dried with care2 inspected daily and any unusual appearance reported to the doctor4 ,it is not uncommon for girl babies to have a slight bloody discharge from the vagina4 ,although this is unimportant and soon disappears1 your doctor should be told of any discharge1 however slight4 ,the doctor often wishes to have the foreskin of boy babies retracted every morning at the time of the bath1 by gently rubbing it back with gauze or cotton1 taking pains that it is pulled forward to the original position after the part underneath has been thoroughly bathed with boracic acid solution4 ,if retraction is impossible after several daily attempts1 the baby is not infrequently circumcised4 ,the care of the baby's teeth is a part of the bath and should begin when the first tooth appears4 ,it should be wiped front and back with a piece of gauze or cotton dipped in boracic acid or soda solution or some other weak alkaline wash1 to neutralize the acid secretions of the mouth as these favor decay4 ,after the baby has five or six teeth1 the use of a very soft brush with tooth paste is often advised1 the teeth being brushed with a circular motion or from the gums toward their edges4 ,the teeth should be wiped1 or brushed1 morning and evening and after feedings4 ,the reason for such close care of the temporary teeth is that they serve as a mold or brace to hold the jaws in proper shape for the permanent teeth which appear later4 ,if the 8milk0 or first teeth decay or crumble away before the jaws are developed to the point when the permanent teeth appear1 these second teeth are likely to be crowded1 crooked and uneven4 ,after all of these details have been attended to and the entire body1 including creases and folds1 has been patted quite dry1 it may be dusted with an unscented talcum powder1 but this powdering must not be resorted to as an aid in drying the skin4 ,in order to prevent chafing1 the buttocks and thighs should be wiped clean with oil1 or bathed with warm water1 no soap1 patted dry and powdered or oiled each time that the diaper is changed4 ,the cord has dropped off1 in all probability1 by the time you begin to bathe your baby1 and the navel so well healed that you need do nothing to it1 but you may be interested to know what painstaking care the nurse has given to this important detail of the baby's toilet4 ,the form and method of cord dressings vary somewhat with different doctors but in practically all cases the dressings are sterile1 to prevent infection1 and porous in order that air may gain access to the cord and promote the drying process4 ,the dressing itself may consist of dry1 sterile gauze or gauze wet with alcohol wrapped about the cord1 as shown in ,fig4 #eb2 or it may consist of squares of sterile gauze or muslin with holes in the centers to fit around the cord1 and dusted with some such powder as boric acid1 bismuth or salicylic acid and starch4 ,the dressed cord is laid flat on the abdomen and directed upward to prevent its being wet with urine2 a gauze sponge is placed over the dressing and the flannel binder applied1 being sewed on or held in place with safety-pins1 as shown in ,fig4 #ec4 ,illustration3 ,,fig4 #eb4--;,cord dressed with dry sterile gauze4 7,from photograph taken at ,johns ,hopkins ,hospital47 ,illustration3 ,,fig4 #ec4--,straight flannel binder applied over cord dressing4 ,the band is put on firmly and with even pressure1 but not tightly4 ,it is a mistake to think that a tight band strengthens the baby's abdominal muscles1 for it has quite the opposite tendency and in addition may give pain and even cause vomiting4 ,the band is removed every morning at the time of the bath1 or whenever it is soiled1 but the cord dressing is not usually taken off unless it is soiled4 ,when the cord finally drops off1 the straight flannel binder is replaced by a knitted band with shoulder straps4 ,this is usually worn for three or four months1 particularly in cold weather1 to provide a little extra warmth over the abdomen4 ,thin1 delicate babies sometimes need this band for a year or more4 ,illustration3 ,,fig4 #ed4--,putting on the diaper which has been folded straight through the middle4 ,after the band has been applied1 the warmed shirt is put on and then the diaper4 ,there are two methods of putting on the diaper4 ,one is to fold the square diagonally and bring the diagonal fold around the baby's waist4 ,one of the lower corners is drawn up between the thighs1 the two corners from the sides brought over this1 straight across the waistline and not carried down between the thighs4 ,the fourth corner is brought up over these and all are pinned securely with a safety-pin1 while two other safety-pins hold the margins of the diaper together above the knees4 ,the other method is to fold the diaper straight through the center1 forming a rectangle twice as long as it is wide2 to lay the baby on it lengthwise1 draw the lower half up between his thighs as shown in ,fig4 #ed1 and pin it on each side at the waistline and above the knees4 7,see ,fig4 #ee47 ,in either case the diaper must be put on smoothly and care taken to avoid forming a thick pad between the thighs as this will tend to curve the bones of legs1 which1 as you know1 are still soft4 ,squares of soft1 absorbent material1 which may be burned1 when soiled1 placed inside the diapers will greatly facilitate the laundry work4 ,illustration3 ,,fig4 #ee4--;,how the diaper in ,fig4 #ed looks after it has been put on4 ,the baby's diaper should be changed whenever it is wet or soiled1 for in addition to making him restless and fretful for the time being1 the skin about the thighs and buttocks will grow red and chafed if he is allowed to wear wet diapers4 ,wet diapers should not be dried and used again but washed with mild soap1 boiled and whenever possible1 dried in the open air and sunshine4 ,all of this makes it apparent that the regular use of waterproof protectors is to be condemned since a baby so protected may wear a wet diaper for some time before it is discovered4 ,under special circumstances such as a drive1 a short journey or visit the diaper may be covered by waterproof drawers but their habitual use will make the baby unhappy and uncomfortable and may even result in a serious condition of the skin4 ,coming back to dressing the baby1 after his bath1 we find that after the band1 shirt and diaper have been adjusted the petticoat and dress are put on with the fewest possible motions and the baby's hair brushed upward from his neck and back from the forehead4 ,he should be wrapped in a small blanket1 fed and laid quietly in his crib to sleep4 ,if his hands and feet are cold a hot water bottle at #abe ,f4 with a flannel cover1 may be placed beside him4 ,when the baby is made ready for the night he may have a sponge bath or simply have his face and hands sponged with warm water1 according to the wishes of the doctor4 ,the clothing which the baby has worn during the day should be entirely replaced4 ,the day and night clothing may be worn more than once1 if clean and if aired between times1 but it is better not to have the baby wear the same set of clothes for twenty-four hours at a stretch4 ,in cold weather a tape is often run through the hem of the stockinette or flannel nightgown in order that it may be drawn up1 bag fashion1 to keep the baby's feet warm4 ,during very warm weather the baby sleeps in a thin cotton slip4 ,,your ,,baby',s ,,clothes ,your baby's clothes were made long since1 of course1 but a word about their use is worth while as they may be very influential in promoting the baby's well-being4 ,in order that his body may be kept at an even temperature the warmth of his clothing must always be adjusted to the needs of the moment4 ,the general tendency is to dress the baby too warmly and the usual result is that he perspires2 is listless1 pale1 and fretful2 sleeps badly2 is susceptible to colds and other infections and has poor recuperative powers4 ,his digestion is likely to be deranged and he may have prickly heat4 ,on the other hand1 if the baby is not dressed warmly enough his hands and feet will be cold and his lips blue2 he will cry from discomfort and the general result may be lowered vitality and disturbed digestion4 ,if the baby's clothes are not comfortable1 if they pull and drag or have tight bands1 he will be fretful and restless1 with disturbed sleep and upset digestion in consequence4 ,the little wardrobe will be entirely adequate1 under ordinary conditions1 if it consists of shirts1 bands1 diapers1 flannel petticoats1 dresses1 nightgowns1 flannel wrappers and sacques4 ,as the petticoats and dresses are cut twenty-seven inches long1 many doctors feel that they offer enough protection for the feet of the average baby to make stockings unnecessary until he is from four to six months old4 ,the skirts are then shortened to ankle length and stockings added to the baby's attire4 ,other doctors think it wiser to put knitted socks or part wool stockings on the new baby1 particularly if he is born during cold weather4 ,when the baby begins to creep1 he should wear soft soled shoes1 part wool stockings in cold weather and thin cotton or silk ones during the summer1 and firm but flexible soled shoes as soon as he tries to stand alone or to walk4 ,during the first month or two the baby scarcely needs special clothing for outdoor wear as he may be wrapped in one of the flannel squares with a casing run in one corner to form a hood1 or he may be placed on a square diagonally and the upper corner folded about his head and held under the chin with a safety-pin4 ,the corners on the sides are folded about his shoulders1 the lower one brought up over his feet and limbs and the additional blankets tucked in over all4 ,but as the baby grows older and moves about in his carriage1 he will need a cap and cloak or wrap with hood attached4 ,in cold weather the cap should be knitted or wool lined and the cloak of soft woolen material or wool lined4 ,in moderate weather the cap may be of one thickness of cotton or silk1 or very light flannel1 while on very warm days he will need no head covering at all4 ,to sum up3 ,the baby's clothes should be simple in design1 hang from the shoulders1 fit smoothly but loosely and have no constricting bands2 they should be of soft1 light1 porous material2 their warmth always adjusted to the immediate temperature so that the baby will be protected from being either chilled or overheated4 ,and his clothing must always be clean and dry4 ,,airing ,,your ,,baby ,an abundance of fresh air is one of the baby's greatest needs as it increases his resistance to disease and his recuperative powers1 improves his appetite and aids digestion4 ,in general1 the more the baby is in the open air and the more fresh air he has while in the house1 the better4 ,the two factors which must be considered in supplying the baby with fresh air are the condition and vigor of the baby himself and the immediate temperature and state of the weather4 ,his age and the season of the year can be only partial guides because of the difference between individual babies of the same age and the variations in temperature1 winds and moisture during any one season4 ,the air of the room which the baby occupies should be changing constantly in order that it may always be fresh1 but the temperature should be equable and the baby protected from drafts4 ,as the tendency here1 as with the baby's clothes1 is toward overheating1 you will do well to remember that the young baby who lies covered up in his crib1 may usually be kept in a colder room than is advisable for an older one who is creeping or walking about4 ,during cold weather the baby's bed should not be directly in front of an open window and he should be protected from direct currents of cold air by a sheet hung over the head and side of his crib4 ,two or three times daily1 while the baby is out of the room1 the windows should be opened wide to air the room thoroughly1 one of these airings being just before the baby is put to bed for the night4 ,the doctor's usual instructions concerning the temperature of the nursery are to keep it from #fh ,f4 to #gj ,f4 during the day and about #fe ,f4 at night1 during the first three months and lower it gradually to #fd ,f4 during the day and about #ee ,f4 at night as the baby grows older4 ,it is customary to begin to open the nursery window at night when the baby is three or four months old1 if he is well and the temperature is above freezing4 ,in planning to take the baby out of doors it is wiser1 as a rule1 to begin with the indoor airing when he is about a month old1 except1 of course1 during the moderate or mild months of the year1 when he is taken out at once4 ,if the weather is cold1 the baby may be protected with extra wraps and carried in the arms1 into a room in which the windows are open and kept there for fifteen or twenty minutes4 ,this indoor airing is increased by being gradually lengthened to two or three hours and by having the windows opened wider and wider4 ,by the time he is two or three months old he is taken out of doors on clear1 bright days1 the best time being between ten and three o'clock1 when the sun is high4 ,if he is carried in the nurse's arms at first the warmth of her body serves as a protection and helps to accustom him to the out-of-door life1 when he spends a good deal of his time out of doors in his carriage4 ,on windy1 stormy days or when there is melting snow on the ground1 the baby may be given his airing on a protected porch or in a room with the windows open4 ,he is not usually taken out if the temperature is below freezing until the third or fourth month4 ,after this time the average baby is taken out when the temperature is not lower than #bj ,f4 ,when the baby is dressed in his extra wraps he must be taken out of doors or the windows opened immediately1 for otherwise he will become overheated and be in danger of chilling when taken into the colder air4 ,warm hands and feet1 a good color and the baby's tendency to sleep most of the time while out of doors are evidences of his being adequately clothed for his airing1 while the reverse is true if he is not warm enough4 ,a robust baby who has been gradually accustomed to being out of doors during the day will usually be much benefited by sleeping out at night4 ,but he must be protected from winds and his clothing so arranged that he cannot be chilled4 ,knitted or flannel sleeping garments or sleeping bags 7,see ,fig4 #bj7 are valuable and in addition1 the blankets which cover the baby should be securely pinned to the mattress with safety-pins and tucked well under it at the sides and foot4 ,the baby should wear a warm cap and the bed should be warmed before he is put into it4 ,or better still1 he may be dressed for the night1 put to bed in a warm room and the crib then moved out on the sleeping-porch4 ,an excellent device for protecting the baby's arms and chest1 and keeping him generally well covered1 is the poncho 7,fig4 #ef7 devised by ,dr4 ,lucy ,porter ,sutton of ,bellevue ,hospital4 ,the poncho is a rectangle made of flannel1 outing flannel or an old blanket and cut large enough to tuck well under the head and sides of the mattress and extend below the baby's feet4 ,the baby's head slips through an opening1 which is almost a right-angled slit1 equally distant from the sides of the poncho and about #bj inches from the top4 ,the slit is firmly bound and provided with tapes to tie it together after the baby is put in4 ,the poncho should be put on loosely enough to permit the baby to move about at will beneath it4 ,after it is adjusted the bed is made up as usual with additional blankets4 ,illustration3 ,,fig4 #ef4--,the 8,sutton ,poncho0 which keeps even a restless baby well covered4 ,the insert shows how to make the slit for his head to pass through4 ,the regular bedding is turned back in this picture4 7,from a photograph taken at ,bellevue ,hospital47 ,under all conditions the baby's airings must be increased gradually1 both as regards lowering the temperature and lengthening the time1 and always adjusted to the vigor and reaction of the individual baby4 ,he must be warm1 but not too warm2 he must be protected from wind and dust1 and his eyes shielded from glare and from flickering light1 such as may be caused by a tree in a light breeze4 ,,exercising ,,your ,,baby ,although the baby should not be handled unnecessarily nor tossed about and played with by friends and relatives1 it is important that his muscular development be promoted by regular and carefully planned exercise4 ,it is usually considered best for the baby to lie quiet and undisturbed in his crib most of the time during the first three or four weeks4 ,dr4 ,griffith begins the baby's exercise about that time by having the nurse or mother take him in her arms on a pillow and carry him about for a few moments several times daily4 ,after a week or two of this form of exercise the baby is carried in the arms without a pillow but with his head and back carefully supported as the nurse is doing in ,fig4 #eg4 ,the position of the baby's body is changed by his being carried about in this way and the movement of the nurse or mother as she walks1 causes a certain amount of motion of the baby's muscles which constitutes a gentle exercise4 ,the baby should be carried first on one arm and then on the other in order that both sides of his body may be equally exercised4 ,this semi-passive form of exercise by means of being carried about is regarded by many doctors as almost indispensable to the baby's welfare4 ,there is a possibility that lack of this form of 8mothering0 is one reason why babies in institutions sometimes fail to progress as they should4 ,certainly1 it is inadvisable for the baby to be allowed to lie for very long in one position4 ,by the third or fourth month the baby sits up in his mother's arms1 as she carries him about1 and he may be placed on the outside of his crib coverings for a little while every day1 to kick and struggle at will4 ,his skirts should be rolled up under his arms1 or removed entirely1 to leave his legs quite free1 care being taken that the room is warm and that he has on stockings4 ,illustration3 ,,fig4 #eg4--,method of carrying baby to support his head and back4 ,by about the sixth month he will usually begin to make an effort to creep1 if turned over on his stomach and helped a little1 and he may be propped up in the sitting position1 in his crib1 for a few moments every day4 ,as he gives evidence of having enough energy to creep farther than the limits of his crib permit1 he may be put into a creeping pen1 or upon the floor under certain conditions4 ,it must be remembered that the floor is likely to be cold1 drafty and dusty4 ,you should assure yourself1 therefore1 that the floor is warm and that all drafts are cut off1 and then spread a clean sheet or quilt on the floor before the baby is put down to creep4 ,when the sheet is taken up1 be sure that it is folded with the upper surface inside in order that when it is again put down the baby will play on that side and not on the side that has been next the floor4 ,a creeping pen or cariole or some such provision is often more satisfactory than the floor1 consisting as it does of a railed-in platform raised about six or eight inches from the floor4 ,the suggestions for exercise1 like those for the baby's airing1 must be very general since it should always be adjusted to the powers of the individual baby and directed by the doctor4 ,,training ,,your ,,baby ,bowels4 ,it is possible to train even a very young baby to have regular1 daily bowel movements2 and this training should be started when the baby is about a month old4 ,at the same hour each day he may be laid on a padded table1 or taken in your lap1 a small basin being placed against or under the buttocks and a soap stick introduced an inch or two into the rectum and moved gently in and out4 ,this slight irritation will usually result in the baby's emptying his bowels almost immediately4 ,another method is to hold the baby in a comfortable1 reclining position1 on a small chamber in your lap1 as in ,fig4 #eh or with his back supported against your chest1 and the desire to empty his bowels stimulated by using the soap stick as described4 7,a soap stick is simply a piece of soap about three inches long whittled down to about the size and shape of a lead pencil with a blunt point47 ,illustration3 ,,fig4 #eh4--;,a comfortable position for the baby who is being trained to use a chamber4 ,it is of considerable importance that the position and method which are adopted1 be employed at exactly the same time each day in order to establish a habit4 ,if this is done and the baby is being properly fed1 it will usually be found that before he is many months old1 his bowels will move freely and regularly without the stimulation of the soap stick and only when he is resting on the small chamber or basin that he is accustomed to using4 ,this establishment of a regular bowel movement not only simplifies the laundry work and the care of the baby but is of great moment to his health4 ,illustration3 ,,fig4 #ei4--,stiff cuffs on the baby's elbows keep him from sucking his thumbs4 ,thumb ,sucking4 ,it is scarcely necessary nowadays to tell a mother that her baby must not be allowed to suck on an empty bottle or a pacifier nor be permitted to suck his thumb4 ,these habits are very dirty and help to spread disease4 ,the baby may swallow air while practicing them1 with colic as a result1 and he may so deform the shape of his upper jaw that later in life1 the upper and lower teeth will not meet as they should for satisfactory mastication2 his front teeth may protrude in a disfiguring manner2 and by narrowing and elongating the roof of his mouth1 the structure of the air passages may be altered1 with respiratory troubles and adenoids as a probable consequence4 ,thumb sucking may be prevented by the simple procedure of putting stiff cuffs on the baby's elbows1 such as are shown in ,fig4 #ei1 and which make it impossible for him to reach his mouth with his thumb4 ,these cuffs are easily made by covering pieces of cardboard with muslin and attaching tapes with which to tie them on the baby's arms4 ,another method is to put the baby's hands into celluloid or aluminum mitts made for this purpose1 or little bags made of stiff1 heavy material1 which in turn are tied to his wrists2 or his sleeves may be drawn down over his hands and sewed or pinned with safety-pins4 ,it should be borne in mind that a baby sometimes sucks his thumb because he is hungry or thirsty and will give up the practice when his food is increased or when he is regularly given water to drink4 ,ear pulling is not uncommon among young babies and1 if allowed to continue1 a long1 misshapen ear may result4 ,this may be prevented by using a thin close fitting cap which ties under the chin1 or by using the same kind of elbow splints as for thumb sucking4 ,crying4 ,it is very easy to allow the baby to develop the crying habit but very difficult to break it up4 ,the first step toward prevention is general good care1 for a baby who is properly fed and exercised1 kept dry and warm1 but not too warm1 and whose clothes are comfortable1 will usually cry very little if wisely handled in other respects4 ,but a baby may cry because he is hungry1 thirsty1 wet1 cold1 overheated1 sick or in pain or simply because he wants to be taken up and entertained and has learned that the way to realize his wish is to cry4 ,by examining the baby's condition and observing his habits1 it is usually possible to discover the cause of his crying4 ,very often a drink of fairly warm water will quiet him1 particularly at night4 ,but unless he seems to have colic and stops crying because of the relief due to the upright position in your arms1 you should hesitate to take the crying baby up and carry him about and hold him when it is discovered that this attention stops his crying4 ,persistent crying should be reported to your doctor as it may be of some significance4 ,,keeping ,,your ,,baby ,,well ,,in ,,summer ,notice that ,i say keeping him well4 ,there was a time when we looked upon the scourge1 variously known as 8summer complaint10 8summer diarrhea0 and 8cholera infantum0 as a seasonal visitation that was to be accepted with resignation4 ,but happily those dark days are past1 for though the condition itself is a complicated one1 the one big factor in its causation was dirty milk--milk that was infected or spoiled or both--given to a baby whose forces were lowered by the heat4 ,it is perfectly clear1 then1 isn't it1 that a baby is no more likely to be ill during the summer than at any other time1 if he is given proper care1 the kind of care that we have been going over in detail8 ,each of these details is important but just bear in mind that during warm weather it is particularly urgent to3 #a4 ,feed the baby properly4 #b4 ,keep him clean4 #c4 ,keep him cool4 #d4 ,keep him quiet4 ,the end and aim of these precautions is to prevent disturbance of the baby's digestion4 ,as babies suffer from the heat more than adults do and are often excessively irritated and exhausted on warm days1 these results of the heat are sometimes enough to upset his digestion unless he is safeguarded with greatest care4 ,it is much the same as with grown people1 who often find that their digestions are upset solely by their being tired or excited4 ,the baby should have maternal nursing if possible1 during the summer1 for breast-fed babies fall victim to summer complaint much less frequently than de bottle babies4 ,quite evidently1 then1 you should regulate your own life with even more care than usual--for the baby's sake4 ,he should be fed with absolute regularity1 and as a rule1 no matter what the nature of his food1 it should be reduced one quarter to one third in amount when the days are very hot1 and he should have an increased amount of cool1 boiled water to drink4 ,his weight may increase only slightly1 or even stand still for a short time1 as a result of his decreased food1 but you need not worry about this if he keeps well1 for the important thing is to avoid digestive disturbances4 ,it is just the same as with grown people who are advised to eat less and lighter food than usual1 while the weather is very warm1 in order to keep well4 ,cleanliness1 as at other times1 applies to the baby's food1 clothing and surroundings4 ,many doctors think it safer to have all milk boiled during the summer1 and of course expect scrupulous cleanliness in its preparation and administration4 ,the baby's soiled napkins should be placed immediately in a covered receptacle containing water1 or a disinfecting solution and not left for even a moment where they may be reached by flies4 ,they should be washed1 boiled and dried in the open air and sunshine as promptly as possible4 ,the baby should be protected from flies and mosquitoes by screens in the windows and netting over his crib and carriage1 both because these insects make him restless and irritable and because flies1 particularly1 are carriers of filth and disease--the kind of disease that kills so many babies during the summer4 ,accordingly1 you should regard dies with deadly fear4 ,the baby should be kept away from dusty places and from cats and dogs4 ,and since he will put his fingers into his mouth1 in spite of you1 it is a wise precaution to wash his hands several times a day4 ,the baby should be in the country1 in the mountains or at the seashore1 if possible during the warmest part of the summer at least1 but if he is in town there is much that you can do to keep him cool and comfortable4 ,his clothing at this season must be adjusted to his condition and the temperature of the moment just as it is in cold weather4 ,a thin shirt1 band1 diaper and cotton slip will usually be enough for out-of-door wear1 while in the house he may often dispense with the slip1 and sometimes with everything but his diaper4 ,it is usually best to take the baby out of doors early in the morning and late in the afternoon1 but to keep him indoors during the warmest part of the day1 when it is likely to be cooler inside than out1 particularly if the blinds are closed4 ,during excessively hot days1 the baby will usually be more comfortable if he has two or three cool sponge baths1 in addition to the soap and water bath1 one of the sponges being given just before he is put to bed for the night4 ,he should sleep on a firm mattress1 preferably curled hair but never feathers1 and in the coolest1 best ventilated room available4 ,he must not be played with1 held on hot laps nor subjected to the entertainment and attention which well-meaning but misguided mothers and friends are so eager to lavish on a hot1 fretful baby4 ,prickly ,heat4 ,very often during warm weather a fine rash1 known as 8prickly heat0 or heat rash1 appears on the back of the baby's neck and spreads over his head1 neck1 chest and shoulders4 ,as this rash is due to too warm clothing or to the hot weather or to both1 less clothing and frequent baths will often give relief4 ,if the baby is very uncomfortable he may he greatly soothed by being immersed1 for two to four minutes in baths1 at the temperature he is accustomed to1 containing soda1 bran or starch in the following proportions3 ,soda ,bath4 ,two tablespoonfuls of baking soda to one gallon of water4 ,bran ,bath4 ,a cheesecloth bag about six inches square1 partly filled with bran1 is soaked and squeezed in the bath until the water is milky4 ,starch ,bath4 ,about a cupful of cooked laundry starch to one gallon of water4 ,the baby should be placed in the tub as for his daily bath and his entire body submerged1 as shown in ,fig4 #fj1 care being taken that his ears are above the surface of the water4 ,no soap should be used while the baby has prickly heat and after the bath he should be patted thoroughly dry and powdered with some such soothing powder as the following3 ,powdered starch one ounce ,oxid of zinc one ounce ,boracic acid powder #fj grains ,illustration3 ,,fig4 #fj4--,method of holding the baby in the tub to keep all but his head covered1 in giving a bran1 starch1 soda or mustard bath4 ,diarrhea4 ,if your baby has an increase in the number of his movements1 or if they become watery in character1 something is wrong4 ,it may be only a mild disturbance or it may be the beginning of an attack of summer diarrhea1 and as at first you cannot possibly tell which it is1 you must not take it lightly4 ,notify your doctor at once1 but if you are remotely situated or he is delayed in communicating with you1 there are certain helpful things that you can do for the baby while waiting for the doctor4 ,the first is to give an enema of half a pint of water1 at #aaj ,f41 containing teaspoonful of salt4 7,see ,fig4 #fd1 page #bag1 for method of giving enema47 ,if the baby seems to have only a slight diarrhea it may be enough to reduce his food one half1 whether he is breast-fed or bottle-fed1 and to give him an abundance of cool boiled water to drink4 ,if he is bottle-fed it is a wise precaution to make up his formula with skimmed milk and leave out the sugar4 ,illustration3 ,,fig4 #fa4--,putting the baby into a wet pack4 ,if the baby has frequent loose movements2 seems feverish2 vomits and cries as though he had pain1 stop all food and give nothing by mouth but water1 until the doctor comes4 ,if you care for your baby1 yourself1 through an attack of summer complaint you will find that the doctor's instructions are directed toward keeping the baby cool1 clean and quiet1 while he1 himself1 gives very careful attention to the question of feeding4 ,it is clear1 then1 that the baby should be lightly clad and kept quiet and undisturbed1 in a cool shady place1 out of doors as much as possible4 ,during the warmest part of the day1 however1 he will often he better off in the house1 in a room with the shutters closed4 ,but while keeping the baby cool1 you must bear in mind the harm that may be done by chilling him or exposing him to a cold draft or wind4 ,the doctor may want him to have several baths daily1 possibly tub baths1 at a temperature of #ajj ,f41 or cool sponge baths4 ,packs1 also1 are given1 for they not only cool the baby but quiet him as well1 if he is restless4 ,these packs may be cool 7#hj ,f472 tepid 7#ajj ,f47 or hot 7#aje to #ajh ,f47 according to the baby's needs4 ,illustration3 ,,fig4 #fb4--,the baby in a wet pack with a hot water bag at his feet and cold compress on his head4 ,it is a simple matter to give a pack and you will enjoy doing it for you will actually see that your baby will grow quieter and more comfortable as you give it4 ,cover the bed with a rubber and sheet and bring to the bedside a basin containing a sheet wrung from water of the specified temperature2 a basin containing ice and compresses for the baby's head and a flannel covered hot water bottle at #abe ,f41 for his feet4 ,the baby is laid on the upper half of the folded wet sheet1 and an upper corner wrapped about each arm1 as in ,fig4 #fa1 and the sides folded around his legs4 ,the lower half is brought up between his feet and used to cover his entire body1 being tucked around his shoulders4 ,the hot water bottle is placed at his feet and an ice compress on his head1 as in ,fig4 #fb4 ,if the sheets are wrung from warm or hot water1 the baby is covered with a blanket after he is put into the pack4 ,illustration3 ,,fig4 #fc4--;,diagrams shoving the successive steps in putting the baby in a pack4 ,should your baby have summer complaint1 remember that even a mild attack predisposes to another and you will have to be even more watchful and painstaking than ever1 in your care of him4 ,he will have to return to his customary diet very slowly1 or he may not be able to take his usual amount of nourishment at all until the weather turns cool4 ,even though he gains no weight it is important to avoid taxing his digestion since it is already being threatened by the heat4 ,,keeping ,,your ,,baby ,,well ,,in ,,winter ,there are certain evils that beset the baby's way during the winter just as there are seasonal pitfalls in summer1 but the truth is that if you care for yourself and him according to the suggestions that have been set down in the foregoing pages1 you are doing practically everything necessary to make his way safe and comfortable4 ,a baby who has proper food1 plenty of fresh air1 is kept clean and whose daily life is regular1 is not likely to be ill during the winter or any other time4 ,the chief baby ills that come with the blustery weather are colds and the troubles that are likely to follow in their wake1 such as bronchitis and pneumonia4 ,colds are infectious1 you know1 so keep the baby away from sneezy people and out of crowds and dusty places4 ,if he should take cold in spite of you1 send for the doctor at once4 ,it may amount to nothing and clear up in a day or two1 but if you let it run on1 the dreaded bronchitis or pneumonia may result4 ,,relieving ,,colic1 ,,constipation ,,and ,,convulsions ,i have tried to impress upon you1 at every step1 that it is very unwise for you to delay in sending for the doctor when your baby seems ill1 or to attempt to treat him according to your own ideas or those of your neighbors4 ,but if the baby should begin to scream with colic or have a spasm1 you would want to know what to do at the moment1 and in case of constipation there are a few simple nursing procedures that you may employ to the baby's advantage4 ,colic is always due to indigestion1 whether the baby is breast-fed or bottle-fed1 because of the food itself being wrong in some respect or because it is not properly given4 ,the milk may contain too much of the material that forms the curd1 or so much starch and sugar that fermentation takes place1 the pain itself usually being due to undigested food or gas in the intestines4 ,this condition may also result from the baby's being fed too rapidly or too frequently1 or from his swallowing air while sucking on a pacifier or an empty bottle4 ,colic may be caused1 too1 by chilling the baby as this is likely to disturb his digestion4 ,most babies have colic at some time during the first year1 usually before the fifth month4 ,the attacks may occur several times a day1 after feeding1 or they may not come on until the late afternoon or evening when the baby is tired4 ,colic is so common that most people are familiar with the symptoms3 violent crying and a flushed drawn face2 cold hands and feet2 tightly clenched fists and a hard1 swollen abdomen4 ,as the pain is cramp-like1 the baby stops crying every little while1 and then suddenly begins again1 drawing up his legs1 doubling up his body and then straightening out with a jerk4 ,for immediate relief1 you may give the baby a tablespoonful of hot water in which half a soda mint tablet has been dissolved1 and an enema of half a pint of water1 at #aaj ,f41 containing one half teaspoonful of salt1 given through a small rubber tube introduced about six inches4 ,this empties the lower bowel and enables the baby to expel a good deal of the gas that is troubling him so4 ,rub his abdomen with a little oil and apply a compress of several thicknesses of flannel1 wrung from hot water1 covering this with a larger piece of dry flannel1 and change it every three or four minutes for a while4 ,place a flannel covered hot water bottle 7at #abe ,f47 at his feet1 cover him warmly1 darken the room and he will almost certainly go to sleep4 ,it is often a good plan to substitute barley water for one or two feedings1 after an attack of colic1 in order to give the disturbed digestive tract a rest4 ,quite naturally1 you must tell your doctor if your baby has colic for the cause may lie in the character of his food4 ,but it may lie in some error on your part4 ,go over all the details of your share of the baby's care and see if you can discover anything to correct4 ,with breast-fed babies1 prevention is often accomplished by the mother's nursing her baby more slowly1 lengthening the intervals between nursings and by improving her own hygiene1 particularly by relieving constipation and increasing her recreation and out-of-door exercise4 ,nursing mothers who lead sedentary lives and eat rich food very often have colicky babies as do those who are nervous1 irritable and inclined to worry4 ,if the baby is bottle-fed he may be taking his food too fast because of an over-large hole in the nipple2 he may not pause often enough during his meal or he may take in air as he nurses because the bottle is not properly held1 as shown in ,fig4 #dh4 ,in any event do not stop until you get at the cause of the trouble for though the colic itself may not necessarily be serious1 a continuation of the cause may result in a run down condition or even in malnutrition4 ,don't forget the importance of holding the baby upright over your shoulder after each feeding1 to help him bring up gas1 and of placing him immediately in his crib to be left quiet and undisturbed4 ,and ask your doctor about drinking water4 ,very often the tendency toward colic is lessened by increasing the amount of cool boiled water given between meals4 ,constipation is very common among babies and may be manifest by the stools being too small1 too dry or too infrequent4 ,it is more difficult to cope with than colic1 though it1 too1 may have its origin solely in unsuitable food4 ,in some cases1 however1 the constipation is due to absence of habit in emptying the bowels regularly2 to weakness of the intestinal muscles2 to long-continued undernourishment or to some such disease as rickets4 ,it becomes apparent that the prevention of this troublesome condition is accomplished largely by giving suitable food2 constant fresh air2 regularity in the daily routine and training the baby to empty his bowels at the same time every day4 ,when constipation is due to insufficient fat in the food1 cod-liver oil is sometimes given1 #ae to #cj drops three or four times a day2 or a teaspoonful of olive oil two or three times a day4 ,maltose1 malt soup1 malted milk1 milk of magnesia1 mineral oil1 oatmeal water and orange juice are all found among the remedies for constipation2 while soap sticks1 suppositories and enemas of oil or soapsuds sometimes have to be resorted to4 ,in giving an enema to relieve constipation1 the baby should be protected from chilling1 laid on a pillow and the bed-pan so placed that he will be comfortable and not inclined to move1 and from half a cup to a cup of soapsuds1 at #aje ,f41 given with a small hard-rubber nozzle1 as in ,fig4 #fd4 ,when warm olive oil is given at night 7#b to #d tablespoonfuls slowly through a small rubber tube introduced about six inches71 it is very often retained until morning when the baby empties his bowels freely with little or no assistance4 ,abdominal massage will often relieve constipation by strengthening the intestinal muscles1 this in turn tending to make the bowels move4 ,the abdomen should be rubbed with a firm but not hard1 circular stroke1 beginning in the right groin and working up to the margin of the ribs1 across to the left side and down to the groin4 ,this massage is often given for about ten minutes every day1 preferably at night1 but never just after feeding4 ,illustration3 ,,fig4 #fd4--;,giving the baby an enema4 ,he is well protected1 to prevent chilling1 and lies comfortably on a pillow which reaches to the bed-pan1 the latter being covered with a diaper where he rests upon it4 ,constipation is sometimes entirely cured by nothing more than a suitable dietary2 an abundance of drinking water2 an out-of-door life2 massage1 and above all1 the unceasing effort to establish a regular habit4 ,these are all things which you1 yourself1 may do for the baby4 ,the longer constipation persists1 the harder it is to cure1 so do all in your power to prevent it and if it develops1 try to end it at once4 ,convulsions are a symptom of several disorders of infancy and they may occur unexpectedly4 ,although at the moment1 they are more distressing than serious1 you should notify your doctor at once4 ,if he cannot come promptly you may end the seizure by employing measures that will quiet and relax the struggling baby4 ,the room should be darkened1 kept absolutely quiet and the baby handled with the utmost gentleness4 ,as a rule the most satisfactory course is to immerse the baby in water at #ajj ,f4 and keep him there for five or ten minutes1 supporting his head above the level of the water as shown in ,fig4 #fj4 7,see p4 #bji47 ,have some member of the household place cloths1 wrung from cold or iced water1 on the baby's head and change them frequently4 ,when removed from the bath1 the baby should be wrapped in a blanket1 kept very quiet and the cold applications to his head continued4 ,if the baby often has convulsions the doctor may instruct you to give him either a mustard bath or pack whenever he has an attack4 ,for a bath1 one ounce1 or six level tablespoonfuls of dry mustard is added to one gallon of water at #aje ,f4 and the baby kept in it for about ten minutes1 or until the skin is well reddened4 ,he is then wrapped in a warm blanket and surrounded by hot water bottles1 with cold compresses applied to his head4 ,the mustard pack is given in the manner shown in ,figs4 #fa and #fb1 with a sheet wrung from mustard water which is possibly a little warmer and stronger than that for the bath1 care being taken that the sheet is not cooled before it is wrapped about the baby4 ,he is usually left in the pack for about ten minutes or until his skin is reddened1 and then wrapped in warm blankets1 with cold compresses to his head4 ,,the ,,premature ,,baby ,all of the precautions and gentleness which are necessary in the care of the normal baby1 born at term1 must be greatly increased in caring for the baby who is born prematurely4 ,the premature baby is not only small1 but in general is imperfectly developed1 having slenderer powers than the full term baby1 and at the same time much greater needs4 ,his respiratory and digestive organs are less ready to act than those of the normal baby2 his muscles and nerves are feeble2 his heat-producing machinery is unstable and yet he loses an excessive amount of body heat4 ,accordingly1 the baby who has been deprived of those valuable last weeks of growth and development within the uterus1 is small and limp2 lies quietly most of the time2 moves very feebly1 if at all1 and needs special care4 ,to help him in maintaining a normal body temperature it is usually necessary for him to be oiled with warm olive oil and entirely wrapped in cotton batting or flannel or enveloped in a quilted garment1 with hood attached1 made of cheesecloth or flannel and cotton batting1 such as is shown in ,fig4 #fe4 ,diapers are often omitted in caring for very feeble babies1 a pad of cotton1 instead1 being slipped under the buttocks1 as this may be changed with less disturbance to the baby than a diaper4 ,a satisfactory bed may be devised from a basket or box with the bottom well padded with several inches of cotton1 a small pillow or a soft blanket folded to the proper size1 covered with rubber or oiled muslin and a cotton sheet4 ,the sides of the basket may be lined with heavy quilted material1 to shut out drafts and help to preserve an even temperature of the air immediately around the baby1 or such a basket as is shown in ,fig4 #ff may be used4 ,a flannel covered hot water bag at #aaj ,f4 may be placed beside the baby1 or two1 three or four glass bottles1 each holding about a pint1 containing water at #ajj ,f4 and securely stoppered1 may be hung in the corners of the basket4 ,a thermometer1 also1 should hang in the basket and the temperature kept between #hj ,f4 and #ij ,f4 ,the temperature varies less if the bottles are filled in rotation than if all are reheated at the same time4 ,illustration3 ,,fig4 #fe4--,quilted robe1 with hood1 for the premature baby4 ,it may be made of flannel or cheesecloth with cotton batting for the padding4 ,the amount of heat needed around the baby is decided by taking his temperature 7by rectum7 at regular intervals2 supplying more heat if the temperature is low and less if it is at or above normal4 ,some doctors have the temperature taken every four hours2 others twice daily4 ,as the baby grows able to maintain a temperature of #ih ,f4 to #ajj ,f41 unassisted1 the surrounding heat is gradually reduced and finally removed1 and flannel clothing replaces the quilted robe4 ,illustration3 ,,fig4 #ff4--;,an improvised bed for the premature baby1 consisting of a closely woven clothes basket with padded bottom and four flannel covered bottles of hot water1 attached to the sides4 ,the necessary thermometer and special feeder are shown in the basket4 7,by courtesy of ,dr4 ,alan ,brown1 ,hospital for ,sick ,children1 ,toronto47 ,the basket in which the baby lies should be placed in a darkened1 well ventilated room and should be carefully screened from drafts4 ,as the baby needs moist air there should be a large1 open vessel of water in the room4 ,since the premature baby's lungs are not fully expanded1 respirations are likely to be shallow and irregular1 thus failing to supply the amount of oxygen which he needs4 ,and as crying always causes deep breathing1 it is a common practice to make the baby cry at regular intervals during the day4 ,in feeding the premature baby1 breast milk is the most desirable food4 ,in fact1 many doctors feel that his life virtually depends upon it4 ,if the baby is too feeble to nurse1 the milk may be expressed from the mother's breast1 being immediately covered and placed in the refrigerator unless used at once4 ,breast milk is sometimes used whole and sometimes diluted with sterile water and is often given from a medicine dropper or through a special feeder4 ,such a feeder consists of a glass tube with a small nipple on one end and a rubber bulb on the other1 by means of which the milk may be gently expressed into the baby's mouth4 7,see ,fig4 #ff47 ,the premature baby's bath is of considerable importance4 ,it almost always consists of sponging him with warm olive oil as he lies in his bed and with the least possible exposure and turning4 ,it is given every day or every second or third day1 according to his condition4 ,the eyes are wiped with boric pledgets and the nostrils with spirals of cotton dipped in oil4 ,the buttocks are wiped with an oil sponge each time the diaper is changed4 ,it must be borne in mind constantly that the premature baby is particularly susceptible to infection4 ,he should be safeguarded by having everything that comes in contact with him scrupulously clean2 being protected from drafts1 chilling and dust1 and allowing no one with a trace of a cold to come near him4 ,the person who cares for him should wear a freshly laundered gown and protect her nose and mouth with a gauze mask while attending him4 ,,traveling ,,with ,,your ,,baby ,babies should not travel2 that is obvious4 ,but if a journey is unavoidable1 the attendant difficulties and disadvantages may be greatly lessened by making certain preparations4 ,if the baby is bottle-fed1 the preparations will depend upon the length of the journey and whether or not it will be possible to have freshly prepared feedings1 for each twenty-four hours1 put on the train from laboratories along the way4 ,if this is not possible and the journey is not to take more than twenty-four hours1 the entire quantity of food1 ice-cold1 may be carried in a thermos bottle4 ,the requisite number of sterile nursing bottles may be taken or one bottle which is boiled before each feeding4 ,or the milk may be prepared as usual and the bottles packed in a portable refrigerator4 ,such a refrigerator may be bought or one may be improvised4 ,the bottles are placed in a covered pail and packed solidly in crushed ice2 this is placed in a second pail or a box with a diameter which is at least two inches larger than the inner pail and the space between the two packed firmly with sawdust4 ,several thicknesses of newspapers should be pressed down over the top and a tight cover fitted to the outer receptacle4 ,the sterile nipples may be taken in a sterile jar and a deep cup or kettle will be needed in which to warm the bottle before each feeding4 ,it is usually possible to obtain water on the train which is hot enough for this1 or cans of solid alcohol1 a stand and a metal tray may be added to the traveling outfit4 ,if fresh formul cannot be delivered to the train1 daily1 and the journey is to last more than twenty-four hours1 one of the proprietary foods or a powdered milk will often prove to be a satisfactory solution to the problem of feeding the baby while traveling4 ,the course to be followed1 however1 should be selected by your doctor4 ,illustration3 ,,fig4 #fg4--;,if traveling is unavoidable the baby will be comfortable and undisturbed in a basket converted into a bed4 7,by courtesy of the ,maternity ,centre ,association47 ,the baby will usually travel more comfortably and sleep better if he is carried in a basket4 ,a large market basket with a handle or a small clothes basket will serve4 ,it may be lined with a sheet or a blanket2 have a small hair pillow or folded blanket in the bottom and be made up like a crib4 7,fig4 #fg47 ,if this basket stands on the car seat during the day1 and on the foot of your berth at night1 the baby will be cleaner1 quieter and less exposed to drafts than if carried in the arms4 ,as we look back over these pages of somewhat detailed description of the baby's care it is borne in upon us that the nursing of this unfailingly delightful and engaging little person has special adjustments and adaptations for different seasons and circumstances4 ,but that on the whole the care of all babies1 the year round1 resolves itself into the observation of a few general principles1 namely3 proper feeding2 fresh air1 rest and quiet2 regularity in the daily routine2 cleanliness of food1 clothing and surroundings2 preservation of an even body temperature2 consultation with the doctor at regular intervals and also whenever the baby seems ever so little ill4 ,if you are guided constantly by these general principles and apply them conscientiously1 you may revel in the satisfying consciousness that you are keeping your pledge to your baby by giving him the best possible start on his life's journey4 ,,chapter ,,xi ,,the ,,nutrition ,,of ,,mother ,,and ,,baby ,perhaps you are wondering1 just a little1 why ,i devote even a short chapter to the subject of nutrition when ,i have already given you suggestions about dietaries for yourself and your baby4 ,i am doing so because this question of nutrition is one of such enormous importance in relation to the baby's future well-being that ,i want to give it special emphasis4 ,it is probably safe to say that the two most influential factors in creating and maintaining a satisfactory state of health are suitable nutrition and the prevention of infection4 ,although we shall concern ourselves solely with nutrition1 in this chapter1 it may be stated in passing that a state of good nutrition goes far toward protecting one from infection4 ,it will help to make the entire matter clearer to explain in the beginning that a state of good nutrition is not necessarily evidenced by one's being tall nor by being fat4 ,but it is evidenced by normal size and development2 sound teeth and bones2 hair and skin of normal color and texture2 blood of the normal composition2 stable nerves2 vigor both mental and physical2 normally functioning organs2 resistance to disease1 and above all that indescribable condition which is summed up as a state of general well-being4 ,that this degree of nutritional stability is not as prevalent in this country as might be desired is disclosed by reports upon findings of the examining boards for army service1 over a period of three years1 and physical examinations of various groups of school children throughout the country4 ,it was found in the first case1 that about sixteen per cent4 of the apparently normal young men who were inspected for military service1 were undernourished in some degree1 and according to ,dr4 ,thomas ,w4 ,wood1 ,professor of ,physical ,education1 ,columbia ,university1 8,five million children in the ,united ,states are suffering from malnutrition40 ,this army of undernourished children1 which represents about one third of the children of the country1 is on the broad highway to ill health1 invalidism of various kinds and degrees1 instability and inefficiency4 ,they are certainly not developing into the clear-eyed1 alert1 buoyant individuals that go to make up good citizenry4 ,the tragic aspect of this state of undernourishment is that though a great deal can be done to nourish and build up the malnourished child or adult1 a certain amount of damage that results from inadequate nourishment during the early1 formative weeks and months cannot be entirely repaired later on in life4 ,as the baby grows and develops1 certain substances are needed at the various stages of his progress1 and if these are not supplied at these stages1 there will always be some degree of inadequacy in the adult make up4 ,it is much like the futility1 when building a house1 of using bricks without straw for the foundation instead of firm1 durable rock1 and then trying to make the structure substantial and secure later on by using good materials when building the upper stories4 ,the solid foundation and substantial beams and girders for men and women are put in during infancy and early childhood in the shape of good material that forms good nerves1 muscles1 bones1 teeth and general physical stability4 ,it is practically impossible to make up to the older child or adult for damage caused by failure to supply sufficient nourishment to the growing1 developing1 infant body4 8,the moving finger writes2 and1 having writ1 ,moves on2 nor all thy piety nor wit ,shall lure it back to cancel half a line1 ,nor all thy tears wash out a word of it40 ,we see all about us1 the results of this form of neglect of babies1 in the bow-legged1 knock-kneed1 undersized1 misshapen1 chicken-breasted adults and in those who are nervous and below par in endurance2 are susceptible to colds and other infections and may be summed up as being 8not strong40 ,the reasons for much of the undernourishment among people in this country to-day are to be found in certain widespread misconceptions of long standing as to what constitutes a state of good nutrition or malnutrition and the value and purposes of different foodstuffs4 ,for malnutrition does not necessarily describe a simple condition due to an insufficient amount of food1 but to any one of several complex conditions due to a lack in the food of one or more essential substances4 ,one may eat a large amount of food and even have a well-padded body and yet be seriously in need of certain food factors--in other words1 be incompletely nourished in some particular4 ,that was possibly the first misconception--the belief that one simply needed enough food1 and accordingly was well nourished if three large meals were eaten daily1 irrespective of the composition of those meals4 ,a step forward was taken when housewives and people generally accepted the fact that quantity alone was not enough to consider in providing food1 but that the dietary should consist of balanced amounts of the five food materials3 fats1 carbohydrates1 proteins1 minerals and water1 in order to build and maintain the body in a state of health4 ,but this1 too1 was found to be an error1 in so far as it was only a part of the truth1 for it was next ascertained that even provision for a suitable balance of the five food groups was not enough to nourish us1 but that we must consider the heat-and-energy-producing properties of these component parts1 as measured by the caloric unit1 and that we must daily take in the requisite number of calories if we would keep our engines going4 ,it is now known that even this is not enough1 for we may eat food in ample quantities1 consisting of the properly balanced fats1 proteins1 carbohydrates1 minerals and water1 and it may daily yield the required number of calories1 and still we may suffer from seriously faulty nutrition4 ,we find an explanation for this fact in the comparatively recent recognition of three substances1 as yet not clearly understood1 which are contained in a certain few articles of food1 each one of which is essential to growth and normal health and well-being1 though not necessarily concerned in the production of heat or energy4 ,various terms have been applied to these mysterious1 but necessary substances1 such as vitamines1 accessory food substances1 as applied to all1 or fat-soluble ,a1 water-soluble ,b and water-soluble ,c to designate them separately4 ,a surprisingly small amount of each of these substances is sufficient to meet the needs of an individual1 but no one of these1 even in this small amount1 can be safely dispensed with1 for if the diet is deficient1 or lacking in one or more of them some form of nutritional disturbance will result4 ,it may be severe enough to be diagnosed as a disease1 or it may be only enough to keep the individual below a normal state of health4 ,when the disturbance is profound enough to produce a definite1 recognizable condition1 it is designated as a deficiency disease1 of which there are three3 scurvy1 beri-beri and xerophthalmia4 ,with these are sometimes included rickets and pellagra4 ,the exact cause of the two latter disorders is not definitely known but both are associated with faulty nutrition4 ,poor hygienic conditions may enter into the causation of rickets1 and infection may be a factor in the occurrence of pellagra1 but neither disease appears in people who are suitably fed while both diseases may be produced by faulty diet and both may be cured with suitable food4 ,but probably of graver importance to the public welfare than the well defined nutritional disturbances1 themselves1 is the fact that between a state of good health and the level upon which a disease is recognizable is a long scale1 along which is ranged an uncounted army of under-par1 half-sick people4 ,these are the ones who are tired1 nervous1 susceptible to infections1 with feeble recuperative powers1 and in general are more or less ineffective in the business of life4 ,it is this borderline state1 or as ,dr4 ,goldberger terms it1 8the twilight zone10 which cannot quite be called disease but is not health1 that is serious to the masses1 for diagnosed disease is given treatment1 but nervousness1 lack of energy and endurance1 weakness and inefficiency are not treated2 as a rule they are merely tolerated4 ,the sufferers fail to reach their highest possible development and they fail to be of highest value to society4 ,this is the condition which can be so largely prevented by giving the baby a good nutritional foundation4 ,this must be started during his prenatal existence1 carried through the nursing period and then continued throughout the rest of his life4 ,it will mean much to the coming generation if the expectant and nursing mothers at large are able so to compose their diets that they will provide not only the requisite fats1 proteins1 carbohydrates1 minerals and water and yield the necessary calories1 but will contain1 also1 all three protective substances3 fat-soluble ,a1 water-soluble ,b and water-soluble ,c4 ,it can be demonstrated that when these food factors are not present in the mother's diet1 they will not appear in her milk1 and accordingly will not be supplied to her baby4 ,that is the crux of the whole question4 ,if your diet is faulty1 your milk will be faulty in the same respect and your baby1 being incompletely nourished1 will start life with tissues that are lacking in those substances that are needed to make them sound and to promote health4 ,that is what we have in mind when we say that the mother's milk must be satisfactory not alone in quantity but in quality as well1 if the baby is to be well nourished4 ,in order to make quite clear how damaging are the results of diets which are deficient or lacking in protective substances we shall have a word about rickets and scurvy1 the two diseases due to faulty diet1 that are so serious for babies4 ,rickets is a nutritional disturbance1 common among babies who are fed solely or continuously on heated milk1 either boiled or canned1 and on proprietary food and sweetened condensed milk4 ,rickets may develop1 also1 among nursing babies whose mothers are on faulty diets4 ,the chief characteristics of the disease are arrested growth and softening of the bones1 with dwarfism and deformities as a result4 ,it is essentially a disease of infancy1 occurring as a rule1 between the fourth and eighteenth months but some of its unfavorable effects1 such as bone deformities and poor resistance to disease1 may persist throughout life4 ,although babies rarely die of rickets alone1 it is one of the most serious of all health problems since it predisposes to such diseases as bronchitis1 pneumonia1 tuberculosis1 measles and whooping cough and in general greatly weakens the powers of resistance and recuperation4 ,the common1 early symptoms of rickets are irritability2 restlessness1 particularly at night2 a tendency to have convulsions from very slight causes2 digestive disturbances and profuse perspiration about the head4 ,the baby may be fat1 but is likely to be flabby and have a characteristically white1 8pasty0 color4 ,the fontanelles are large and late in closing2 the abdomen is large and the chest narrow2 teething is usually delayed and the teeth may be soft1 when they do come in1 and decay early4 ,but the most conspicuous effect of rickets is upon the bones which are soft1 easily bent and broken and often misshapen4 ,their growth is likely to be retarded and the ends of the long bones may be enlarged1 causing swollen wrists and ankles and the little lumps on the chest1 so commonly called a 8rickety rosary40 ,the bones in the arms and legs may become curved as the baby lies or sits in his crib1 making him either bow-legged or knock-kneed4 ,since the soft bones are easily bent their deformity is increased by the baby's walking or by the bunch which may be formed between the thighs by a large1 improperly applied diaper4 ,the spinal column may be curved1 or too weak to permit the baby to sit straight or stand alone4 ,the entire chest wall is often deformed1 producing the familiar 8chicken-breast0 and so decreasing the size of the chest that the baby's breathing space is cut down4 ,this is one reason why pneumonia is so serious with a baby who has1 or has had rickets4 ,the forehead is prominent and the whole head looks square and larger than normal1 while the pelvic deformities in girl babies often give rise to very serious obstetrical complications later in life4 ,all of this1 with the misery which it entails1 is due to faulty nutrition4 ,the sovereign remedies in rickets are cod-liver oil and sunshine1 in addition to general good care4 ,but the treatment is a long1 slow process1 taking from three to fifteen months1 and it is doubtful if the damage which the disease works can ever be repaired4 ,rickets is more common during the cold months of the year1 winter and spring1 than during the milder summer and autumn seasons4 ,a possible explanation for this lies in the higher value of the cows' food during the warm months when green things form the diets of animals4 ,since it is now recognized that milk is not a constant product1 but that its properties vary with the food of the animals that produce it1 cows' milk would be favorably influenced by their being put to pasture4 ,similar evidence of such an influence is seen in the fact that although rickets is not seen among breast-fed babies whose mothers are on satisfactory diets1 it may and does occur in breast-fed babies who are nourished by mothers who are1 themselves1 on dietaries which are poor in milk and fresh fruit and vegetables4 ,it is quite plain that a baby who is fed and cared for in accordance with the suggestions offered in the preceding chapters is not likely to develop rickets4 ,infantile scurvy is seen among babies who are fed solely on milk that has been heated1 boiled1 pasteurized or canned1 since the vitamine1 in milk1 that prevents scurvy is practically destroyed by heating or aging4 ,that is one reason why it is dangerous to give stale milk to babies and why you should not use canned milk on your own responsibility4 ,if the doctor orders it for your baby1 he will know what to give in addition to the milk to keep the baby from having scurvy4 ,the disease develops slowly1 the first symptoms appearing between the seventh and tenth months4 ,tenderness or pain in the legs is perhaps the most common symptom and may be detected first by the baby's crying when his diaper is changed or his stockings put on4 ,and a baby who has been cheerful1 playful and active will prefer to lie quietly and will cry whenever he is touched4 ,he grows pale1 listless and weak and fails to gain in weight or length4 ,his large joints are likely to be swollen and tender2 his swollen gums may bleed2 his urine be diminished in amount and contain blood4 ,but it is entirely possible for a baby to be in serious need of the vitamine that prevents scurvy and still not present these well defined symptoms of the disease4 ,in such a case there may be stationary weight1 fretfulness1 a muddy complexion and perhaps tenderness of the bones4 ,scurvy1 of itself1 does not often cause death among babies1 but it is serious1 nevertheless1 for it makes the babies very susceptible to infection1 particularly nasal diphtheria and 8grip40 ,the disease may be either prevented or cured by giving orange juice1 potato water1 spinach or tomato juice to a baby whose diet consists of milk that has been heated and is therefore lacking in the vitamine that prevents scurvy4 ,although scurvy is seldom seen in breast-fed babies it is believed that an infant who is nursing at the breast of a woman whose diet is lacking or deficient in fresh milk1 oranges and leafy vegetables will suffer a certain degree of starvation and thus be sickly and susceptible to infection without actually having scurvy4 ,the significance to you1 of this complicated and enormously important question of nutrition may be summed up as follows3 #a4 ,there are five recognized diseases resulting from faulty nutrition1 which may be either prevented or cured by a diet which contains the protective substances1 called vitamines1 which are now regarded as essential to normal growth1 development and well-being4 #b4 ,these essential substances are not necessarily provided in adequate amounts by a diet that is satisfactory in bulk or in its balance of fats1 carbohydrates1 proteins1 salts and water or that yields the requisite number of calories4 ,the familiar diet of meat1 potatoes1 peas1 beans1 bread1 pie and coffee is so far from providing complete nourishment that those who are limited to it are in a state of partial starvation4 #c4 ,although the breast tissues are capable of converting into milk certain substances which they extract from the blood1 they cannot create the protective substances which we have been considering4 ,they can merely excrete these substances if they are contained in the mother's diet4 ,the absence1 or shortage of these food essentials in the mother's diet1 and therefore in her milk1 may result in rickets or other malnourished conditions in the baby1 or in a degree of faulty nutrition which is not marked enough to be diagnosed1 but enough to keep him frail2 enough to give him the poor start that is so likely to put him1 ultimately1 in the class of those adults who are more or less unfit1 though not actually ill4 #d4 ,the great protective foods are milk and leafy vegetables and any diet which is poor in these is incapable of nourishing satisfactorily4 ,by milk we mean fresh milk1 first and foremost and also cream1 butter1 buttermilk1 cream soups and sauces1 custards1 ice-cream and all dishes and beverages made of milk4 ,by leafy vegetables we mean lettuce1 romaine1 endive1 cress1 celery1 cabbage1 spinach1 onions1 string beans1 asparagus1 cauliflower1 ,brussels sprouts1 artichokes1 beet greens1 dandelions1 turnip tops and the like4 ,other foods which are rich in protective substances are fresh fruit1 egg-yolks and glandular organs1 as liver and sweetbreads4 ,nearly all of the common foods are deficient in some respect1 but as the shortcomings of the various groups are different1 we can arrange entirely satisfactory diets by combining foods which supplement each other's deficiencies4 ,this explains to us why the meat-potato-peas-beans-bread-and-pie type of meals fail to supply adequate nourishment4 ,these foods belong in the same general group and are deficient in about the same kind of food factors1 thus tending to duplicate1 rather than supplement each other4 ,if such a fare is enriched by the addition of the protective foods1 milk and leafy vegetables1 we have a well rounded diet in which the deficiencies of one group of foods are supplied by the properties of the other groups4 ,in fact1 it is only by such a supplementing combination that an entirely satisfactory diet can be secured4 ,it is generally agreed that the two big problems of babyhood are proper nutrition and the prevention of infection1 but nutrition is perhaps the greater problem1 since any form or degree of malnutrition lessens the baby's powers to resist and to recover from infection4 ,whether breast-fed or bottle-fed1 therefore1 it is imperative that the baby be nourished in the complete sense of being given all of the food materials which are essential to normal growth1 development and protection against disease4 ,if your baby is artificially fed on milk that has been heated you will understand why the doctor adds such protectives as cod-liver oil and orange juice1 since the protective properties of milk are impaired by heating4 ,if he is breast-fed1 you will be able to supply to your baby the requisite nourishment and protective substances only if you yourself are adequately nourished and in good condition4 ,that is the point of this discussion2 the fact that you must be on a satisfactory diet or you cannot satisfactorily nurse your baby4 ,satisfactory nursing means to give to your baby1 from the beginning1 through your milk1 the materials necessary to build well and securely that temple1 in the form of his body1 which he will occupy throughout life2 a structure so substantially built1 from the foundation up through each successive stage1 that it will be able to withstand the attacks of disease and weather the inevitable storm and stress of life1 for perhaps even more than the allotted three score years and ten4 8,the race marches forward on the feet of little children40 ---------------------------------------- -------------------------------- ,,transcriber',s ,,notes #a4 ,silently corrected obvious typographical errors and variations in spelling4 #b4 ,retained archaic1 non-standard1 and uncertain spellings as printed4 #c4 ,re-indexed footnotes using numbers4 #d4 ,enclosed italics font in underscores4